Fair Haven

Inspectors wroteBased on observation, interviews and facility policies tilted Garbage & Refuse and Insect and Rodent Control the facility failed to ensure the dumpster/area outside the kitchen was free of debris and pests. This had the potential to effect residents in the main Long Term Care building one of three buildings. Findings Include: A review of a policy titled Garbage & Refuse with a revised date of 12/28/2012 documented the following: .To prevent the spread of bacteria .Garbage and refuse containers should be free from cracks or leaks and covered when not in use. Procedure: 1) Garbage should be disposed of in refuse containers which have . lids. 2) When the refuse container is full, plastic liners should be tied securely before transferring the garbage to the dumpster. [...]

Inspectors wroteBased on record review, interviews and a facility policy titled Comprehensive Care Planning-Person Centered the facility failed to ensure a Person Centered Care Plan was developed for the use of anticoagulant (AC) medication for Resident Identifier (RI) # 97. This affected 1 of 2 residents sampled for AC medication Findings Include: Review of a policy titled Comprehensive Care Planning-Person Centered with an approved date of 1/15/2018 documented: .A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. RI # 97 was admitted to the facility on [DATE] with diagnoses to include arteriosclerotic heart disease. A review of RI # 97's physician orders documented: [...]

Inspectors wroteBased on observation, interviews, record review, and a review of Potter and [NAME], Fundamentals of Nursing, the facility failed to ensure: A licensed staff washed her hands and changed gloves after cleaning the wound and before applying the new dressing to the wound for Resident Identifier (RI) #132. This affected RI #132, one of one opportunities of wound care observation. RI #132 was admitted to the facility on [DATE] with a Diagnosis of Unspecified Dementia with Behavioral Disturbance. RI #132 Physicians Orders dated 5/4/21 revealed: . Clean and dry, apply skin prep to peri-wound per facility protocol. Apply Medihoney calcium alginate sheet to wound bed. Cover with bordered adhesive foam dressing and change QOD and PRN on sacrum wound . Findings Include: A review of Potter and [NAME] Fundamentals of Nursing, ninth edition, chapter 48, page 1225 revealed . Implementation 1. [...]

Inspectors wroteBased on record review, interview and review of a facility policy titled Abuse and Crime Investigation and Reporting, the facility failed to report an allegation of abuse involving Resident Identifier (RI) # 188 within two hours of staff being made aware of the incident. This affected one of four Facility Reported Incidents reviewed during the survey. Findings Include: A review of a facility policy titled Abuse and Crime Investigation and Reporting, dated 11/28/17, documented the following: . Reporting 1. All ALLEGED violations involving abuse .will be reported .to .a. The State Agency responsible for surveying/licensing the facility .2. SUSPECTED abuse .will be reported within two hours . On 8/22/19 at 12:03 PM, the State Agency received an initial report from the facility regarding an incident involving RI #188. [...]

Inspectors wroteBased on interview, medical record review and review of a facility policy titled, Discharge Summary and Plan, the facility failed to ensure a discharge summary was completed for Resident Identifier (RI) #242, a resident who discharged from the facility on 10/31/19. This affected one of three residents sampled for discharge. Finding Include: A review of a policy titled Discharge Summary and Plan, with a revised date of December 2016, revealed: .When a resident's discharge is anticipated, a discharge summary .will be developed to assist the resident to adjust to his/her new living environment .The discharge summary will include a recapitulation of the resident's stay at the facility and a final summary of the resident's status at the time of the discharge . RI #242 was admitted to the facility on [DATE] and discharged to another facility on 10/31/19. [...]

Inspectors wroteBased on observations, interviews, medical record review, and review of the facility policy titled, Fingernails/Toenails, Care of' the facility failed to ensure a brown substance was not under Resident Identifier (RI) #120's finger nails. This was observed on 01/29/20 and 01/30/20, two of three days of the survey. This deficient practice affected RI #120, one of six residents sampled for Activities of Daily Living (ADL) care. Findings Include: A facility policy titled, Fingernails/Toenails, Care of, revised February 2018, revealed, .The purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections. . General Guidelines 1. Nail care includes daily cleaning and regular trimming. . Steps in the Procedure . 4. Allow the . hand .to soak in . warm soapy water for approximately five (5) minutes . 10. [...]

Inspectors wroteBased on observation, interview, and review of a facility policy titled Storage of Medications, the facility failed to ensure that a stock bottle of expired Vitamin C (Citrus) 500 MG (milligram) was not left on a medication cart. This deficient practice was observed one of six medication carts selected for review. Findings Include: A facility policy titled Storage of Medications, revised [DATE], stated . The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals . On [DATE] at 9:52 AM, the surveyor conducted a medication cart review of the medication cart on the 6200 hall (2nd floor) of Building K, the Rehabilitation Building, with Employee Identifier (EI) #2, a Licensed Practical Nurse (LPN). There was a stock bottle of Vitamin C 500 milligrams with an expiration date of 08/19, observed on the medication cart. [...]

Inspectors wroteThe facility failed to ensure a licensed nurse washed her hands or used hand sanitizer after taking Resident Identifier (RI) #148's blood pressure, prior to putting on gloves to administer RI #148's oral medications. Further, the licensed nurse did not wash her hands or use hand sanitizer between administering RI #148's oral medication and administering RI #148's inhalation medication. This affected one of nine residents observed during medication administration pass and one of four nurses during medication administration pass. Findings Include: A review of a facility policy titled Handwashing/Hand Hygiene, with a revised date of August 2015, revealed This facility considers hand hygiene the primary means to prevent the spread of infections . 7. Use an alcohol-based hand . or alternatively, soap . water for the following situations . c. Before preparing or handling medications . l. [...]

Inspectors wroteBased on observations, interviews, facility records, a facility document titled, Reporting Communicable Disease, a facility policy titled Reportable Diseases and guidance from the Alabama Department of Public Health Infectious Diseases and Outbreaks Division, the facility failed to ensure: 1) an outbreak of a Norovirus on Unit L1 was reported to the appropriate governmental agencies within the required specific time frame. Resident Identifiers (RI) #4, #9, and #74 were tested and confirmed positive but were not reported timely. This deficient practice affected three residents on unit L1, but had the potential to affect all 22 residents residing on the unit. 2) The facility further failed to ensure a licensed staff did not take RI # 114's medication and place it on the bedside table without a barrier and return them back to the medication cart; [...]

Inspectors wroteBased on record review, interview and a facility policy titled, Resident Assessment Instrument, the facility failed to ensure an anticoagulation medication for Resident Identifier (RI) #23 did not continued to be coded on the 11/30/18 Minimal Data Set (MDS), when the medication was discontinued on 10/4/18. This affected one of 40 residents for MDS review. Findings Include: A review of a facility policy titled, Resident Assessment Instrument revised September 2010, revealed: . Policy Interpretation and Implementation . 7. All persons who have completed any portion of the MDS Resident Assessment Form . attesting to the accuracy of such information. RI #23 was admitted to the facility on [DATE] with diagnosis of Chronic Atrial Fibrillation. A review of a Physician's Orders for RI #23 dated 7/18/18 revealed: . 7/18/18 Admit Medications: .Apixaban (Eliquis) 2.5 mg (milligrams) . [...]

Inspectors wroteBased on observation, interviews, medical record review, and a review of Fundamentals of Nursing Ninth Edition, the facility failed to ensure the medication nurse did not leave medications on RI #140's bedside table while she went into the bathroom to wash her hands. While Employee Identifier (EI) #5 was in the bathroom, the resident administered nasal spray to self. This deficient practice affected 1 of four nurses observed during medication pass. Findings Include: A review of the Fundamentals of Nursing Ninth Edition [NAME]/Perry text page 657 Chapter 32- Medication Administration revealed: . l. Do not leave medications unattended. Nurse is responsible for safekeeping of drugs. RI #140 was admitted to the facility on [DATE]. On 3/6/19 at 8:11 AM, EI #5 was observed for medication administration. Among the medications prepared by EI #5 was (Fluicasone) Flonase Nasal Spray. [...]