Erwin Health Care Center

Inspectors wroteBased on medical record review, observations, and interviews the facility failed to ensure 1 resident (Resident #322) of 9 residents were treated with dignity during the lunch meal service when residents at the same table were not served the meal at the same time.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to implement a person-centered care plan related to vision impairment for 1 resident (Resident #68) of 19 residents reviewed for care plans.

Inspectors wroteBased on facility policy review, observations, and interviews, the facility failed to ensure garbage and refuse were properly contained in 1 of 2 dumpsters (dumpster A) and failed to ensure the outside dumpster area was maintained in a sanitary and orderly condition.

Inspectors wroteBased on facility policy review, observation, and interview, the facility failed to offer hand hygiene assistance prior to meals for 2 residents (Residents #53 and #25) of 9 residents observed in the secure unit dining room.

Inspectors wroteBased on facility policy review, review of facility documentation, medical record review, observation, and interview, the facility failed to recognize and use the least restrictive interventions or restraint device for the least amount of time and failed to attempt a reduction to a least restrictive device or eliminate the restraint devices during the 30-day assessments. The facility's failure to recognize and use the least restrictive interventions or restraint device for the least amount of time and failure to attempt a reduction to a least restrictive device or eliminate the restraint devices during the 30-day assessments resulted in 4 residents of 29 residents (Residents #9, #13, #18, and #21) being placed in restraints that were not the least restrictive for an extended amount of time.

Inspectors wroteBased on facility policy review, review of facility documentation, medical record review, observation, and interview, the facility failed to recognize and use the least restrictive interventions or restraint device for the least amount of time and failed to attempt a reduction to a least restrictive device or eliminate the restraint devices during the 30-day assessments. The facility's failure to recognize and use the least restrictive interventions or restraint device for the least amount of time and failure to attempt a reduction to a least restrictive device or eliminate the restraint devices during the 30-day assessments resulted in 4 of 29 sampled residents (Resident #9, #13, #18, and #21) being placed in restraints that were not the least restrictive for an extended amount of time.

Inspectors wroteBased on review of facility policy, observation, and interview, the facility failed to maintain a clean environment in the dietary department with the potential to affect 81 of 81 residents in the facility.

Inspectors wroteBased on review of facility policy, review of Quality Assurance Performance Improvement (QAPI) Plan of Correction, medical record review, review of facility documentation, and interview, the facility failed to ensure the Quality Improvement Committee identified issues and implemented corrective action plans with monitoring to ensure care plans were continuously updated and current to meet the resident's needs and to ensure equipment in the kitchen was sanitary for use to prepare resident meals. The facility's failure had the potential to effect 81 of 81 residents in the facility.

Inspectors wroteBased on review of The Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, medical record review, and interview, the facility failed to complete a significant change assessment for 1 resident (Resident #17) of 18 residents reviewed for assessments.

Inspectors wroteBased on facility policy review, medical record review, review of facility documents, observation, and interviews, the facility failed to provide a comprehensive care plan to address a potential environmental hazard and failed to address the injury sustained from the environmental hazard for 1 resident (#80) of 18 residents reviewed. The facility's failure resulted in harm for Resident #80 who had entrapment of his left arm that resulted in soft tissue injuries.

Inspectors wroteBased on facility policy review, medical record review, and interview, the facility failed to update a comprehensive care plan to reflect changes in care needs due to a decrease in Activities of Daily Living (ADL) function for 1 resident (#17) of 18 residents reviewed for care plans.

Inspectors wroteBased on facility policy review, medical record review, review of facility documents, observation, and interviews, the facility failed to provide an environment free from potential accident hazards, failed to investigate an incident that led to injury, and failed to implement interventions to prevent further avoidable accidents for 1 resident (#80) of 7 residents reviewed for accidents.

Inspectors wroteBased on facility policy review, observation, and interview, the facility failed to ensure dishes, and food service equipment were clean and sanitary in 1 of 1 kitchen, affecting 102 of 103 residents.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview the facility failed to maintain infection control practices during dining observation in 2 of 3 dining rooms and 1 of 4 halls observed, failed to follow contact isolation precautions for 1 resident (#63) of 1 resident observed for contact isolation, and failed to maintain infection control practices during 1 of 3 medication administration observations.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to asses for use of a physical restraint and obtain a Physician's Order for a physical restraint prior to use for 1 resident (#45) of 4 residents reviewed for restraints of 22 sampled residents.

Inspectors wroteBased on medical record review and interview, the facility failed to complete a quarterly Minimum Data Set (MDS) assessment timely for 1 Resident (#83) of 22 sampled residents.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to accurately complete a quarterly Minimum Data Set (MDS) assessment for the use of a physical restraint for 1 resident (#45) of 22 residents reviewed for comprehensive and quarterly assessments of 22 sampled residents.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to develop and implement a Comprehensive Care Plan for the use of a physical restraint for 1 resident (#45) of 4 residents reviewed for restraint care plans of 22 sampled residents.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to revise the care plan in a timely manner for a nothing by mouth (NPO) Physician's Order regarding enteral feeding (artificial nutrition through a tube inserted into the abdomen) for 1 resident (#87) of 1 resident reviewed for NPO status and enteral feedings of 22 sampled residents.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to administer an enteral feeding (artificial nutrition provided by tube inserted into the abdomen) at the correct rate as ordered by the Physician for 1 resident (#87) of 1 resident reviewed for enteral feedings of 22 sampled residents.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to administer oxygen as ordered by the Physician for 1 resident (#87) of 4 resident's reviewed for oxygen therapy of 22 sampled residents.

Inspectors wroteBased on medical record review and interview, the facility failed to follow Pharmacy recommendations for 1 resident (#2) of 5 residents reviewed for unnecessary medications of a total of 22 sampled residents.