Emanuel County Nursing Home

Inspectors wroteBased on observations, staff interview, record review, and review of the facility policies titled, Labeling, Dating, Storage and Dietary Staff Dress Code/Personal Hygiene, the facility failed to ensure food items were discarded and properly labeled and dated. In addition, the facility failed to ensure dietary staff's hair was completely contained in a hair net. This deficiency practice had the potential for food-borne illness for all residents receiving food items from the kitchen.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility's policy titled, Medications-Administration and Preparation, the facility failed to ensure two of 24 sampled residents (R) (R25 and R30) did not have unauthorized and unsecured medications at the bedside. This deficient practice had the potential to cause adverse effects for R25 and R30 and allowed unsecured medications to be accessible to other residents and visitors.

Inspectors wroteBased on observations, staff interviews, and review of the policy titled, Resident's Federal and State Rights, the facility failed to protect the privacy and confidentiality of two of 24 sampled residents (R) (R14 and R16) personal and medical records. This failure placed R14 and R16 at risk for unauthorized disclosure of sensitive information.

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled, Pre-admission Screening and Resident Review (PASRR) Policy Level I and Level II, the facility failed to ensure one of two residents (R) (R6) reviewed with a serious mental disorder was referred for a Level II PASARR assessment on admission or within 30 days of a new diagnosis. This deficient practice had the potential to affect the appropriate level of care and services provided for R6.

Inspectors wroteBased on observations, record review, staff interviews, and review of the facility's policy titled, Resident Nursing Care Plans, the facility failed to follow the care plan related to providing oxygen as ordered for one of 24 sampled residents (R) (R43) reviewed for oxygen administration. The deficient practice had the potential to place the resident at risk for medical complications, unmet needs and a diminished quality of life.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policy titled, Respiratory Devices Nebulizer Treatments, the facility failed to follow the physician's order for the administration of oxygen (O2) for one Resident (R) (R43) and failed to prevent the spread of infections by not cleaning the O2 concentrators for three of 12 residents (R36, R40, and R43) receiving O2 therapy. The deficient practice had the potential to place the residents at risk for medical complications, unmet needs, and a diminished quality of life.

Inspectors wroteBased on observation, staff interviews, record review, review of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHREA) and Centers for Disease Control and Prevention (CDC) guidelines, and review of the facility document titled, Water Management Program for [NAME] County Nursing Home, the facility failed to have an adequate water management program. The facility's water management program was incomplete and was not consistent with the current ASHRAE Guideline, which specifically called for design and maintenance procedures for the potential exposure of Legionnaires' disease (a serious pneumonia infection) within a healthcare facility. This failure created the potential for the facility residents to be infected by Legionella.

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled, Reference 8: Behavior Monitoring Procedure, the facility failed to ensure that three of five residents (R) (R17, R21, and R40) sampled for unnecessary medications were monitored for behaviors, side effects and efficacy of antipsychotic medications. This failure to monitor for adverse effects and efficacy had the potential to place R17, R21, and R40 at risk of medical complications and unmet needs. Findings Include: Review of the facility's undated policy titled, Reference 8: Behavior Monitoring Procedure, revealed 1. Each MAR (Medication Administration Record) will have three major lines (one for each shift), with four subdividing minor lines within each major line. 2. Inside the frequency column of each minor line will have directions. a. Line 1-will indicate the shift. [...]

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policies titled, titled, Medications - Administration and Preparation and Policy and Procedure for Expired Drugs, the facility failed to ensure one of six residents (R) (R7) observed during medication pass medications were not expired. This deficient practice increased R7's risk of infection and exacerbation of R7's compromised respiratory status related to chronic obstructive pulmonary disease.

Inspectors wroteBased on staff interview, record review, review of the facility policy titled Immunizations, and review of the Centers for Disease Control and Prevention (CDC) guidelines, the facility failed to offer one of five residents (R) (R28) reviewed for flu and pneumonia vaccinations and/or their representatives the opportunity for the residents to be vaccinated in accordance with nationally recognized standards of 44 sample residents. In addition, the facility failed to update their immunization to reflect current CDC recommendations. These deficient practices had the potential to place R28 at risk of contracting pneumonia and other residents at risk of not being offered immunizations based on current CDC guidelines.

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to ensure that opened food items were labeled and dated in two walk-in refrigerators, the walk-in freezer, and the dry storage area. The facility census was 46, with 44 residents receiving an oral diet.

Inspectors wroteBased on staff interviews, record review, and review of policy titled Bed Holds During Hospital Stays and Therapeutic Leaves, the facility failed to provide written documentation of bed hold to resident/family upon discharge to hospital for one of eight residents (R# 2) who was transferred to the hospital. Policy on Bed Holds During Hospital Stays and Therapeutic Leaves last revised 1/20/23: 1. Hospital stays: Medicaid will provide payment to hold the Resident's bed for a period of seven days while the Resident is hospitalized . List of transfers December 2022 through March 2023 indicated eight residents had been transferred during the identified time period. Electronic record review for R#2 revealed hospital leaves on 12/22/22 and 3/14/23. [...]