Fayette Medical Center Long Term Care Unit

Inspectors wroteBased on observation, interview, and review of a facility policy titled, Hand Washing Guidelines- Food Service Employees, the facility failed to ensure Employee Identifier (EI) # 4, a Kitchen Assistant, washed hands and changed gloves after leaving the work area, touching a contaminated item, then returning to the meal service line. This deficiency had the potential to affect all residents receiving meals from the kitchen.

Inspectors wroteBased on observation, interviews, medical record review, and a review of the facility's policy titled, Resident Dignity, the facility failed to ensure Resident Identifier (RI) #53 was provided privacy during the a Percutaneous Endoscopic Gastrostomy (PEG) Tube medication administration by a licensed nurse. This affected RI #53, one of one resident observed during PEG Tube medication administration, and by one of four licensed nurses observed during medication administration. Findings Include: A review of a facility policy titled, Resident Dignity, with a revised date of 11/16/2009, revealed, .Guidelines .,12. Maintain resident privacy . RI #53 was admitted to the facility on [DATE] with diagnoses to include Dysphagia following Cerebral Infarction, Cognitive Communication Deficit, Aphasia following Cerebral Infarction, Gastrostomy Status, and Dry Eye Syndrome of Bilateral Lacrimal Glands. [...]

Inspectors wroteBased on observation, interviews, and review of a facility policy titled, Hand Hygiene, the facility failed to ensure a licensed nurse washed her hands after she picked up alcohol swabs and paper off the floor, prior to putting on gloves to administer an eye drop medication to Resident Identifier (RI) #53. This affected one of four licensed nurses observed during medication administration pass and RI #53, one of four residents observed during medication administration pass. Findings Include: A review of a policy titled, Hand Hygiene, with a revised date of 12/2009 revealed, Decontaminate hands - To reduce bacterial counts on hands by performing antiseptic hand rub or antiseptic handwash . 4. Decontaminate hands before having direct patient contact . 9. Decontaminate hands after contact with inanimate objects . [...]

Inspectors wroteBased on observations, a review of the 2017 Food Code, a review of the Quat Sanitizer Technical Data Sheet, well as interviews with facility staff, the facility failed to ensure: 1. staff air dried the Robot Coupe mixer prior to storing; 2. staff cleaned the tea urn spigot every 24 hours; 3. staff took corrective action when the temperature in the dishwashing machine exceeded 194 degrees Fahrenheit; (temps higher than 194 result in ineffective sanitizing) 4. during manual dishwashing, the staff monitored the water temperature in the final rinse sink to ensure accuracy of the test strip when determining chemical concentration. This had the potential to affect all 111 residents who received meals from dining service.

Inspectors wroteBased on observation, interview, medical record review, and a review of [NAME] and [NAME]'s FUNDAMENTALS OF NURSING, the facility failed to ensure physician orders for RI #100 were followed for a divided plate and no straws with meals were followed. Findings Include: A review of [NAME] and [NAME] FUNDAMENTALS OF NURSING Eight Edition, Chapter 23, page 305, revealed the following: Health Care Providers' Orders . Nurses follow health care providers' orders . RI #100 was readmitted to the facility on [DATE] with diagnoses including Gastro-Esophageal Reflux Disease Without Esophagitis and Hemiplegia Following Cerebral Infarc Affected Right Dominant Side. A review of RI #100 Care Area Triggers (CAT) dated 02/19/18 revealed the following: .Cognitive Loss/Dementia . BIMs (Brief Interview for Mental Status score) is 8 (indicating cognition was moderately impaired . [...]

Inspectors wroteBased on observation of incontinent care, review of a facility policy titled, Perineal Care and staff interviews the facility failed to ensure certified staff cleaned Resident Identifier (RI) #30's buttock area from front to back. This affected one of one incontinent care observations made during the survey. Findings Include: A review of a facility's policy titled, Perineal Care with a revised date of 11/2017, documented the following: . Standard Perineal care is provided to clean the perineum and provide comfort. Procedure for a . Resident . 5. Help the resident turn onto . side. Wash, . the anal area, moving upward toward the back. RI #30 was readmitted to the facility on [DATE] with diagnoses to include: Diarrhea and Chronic Kidney Disease, Stage 3. [...]

Inspectors wroteBased on observation, interviews, medical record review, and a review of the facility's policy titled, ENTERAL NUTRITION GUIDELINES, the facility failed to ensure licensed staff waited in between gentle pushes to unclog Resident Identifier (RI) #265's Gastrostomy Tube (GT). This affected one of one resident observed with a GT during medication administration. Findings Include: A review of the facility's policy titled, ENTERAL NUTRITION GUIDELINES without a date, revealed the following : . L. If a tube becomes clogged, instill 10 mL (milliliter) of warm water as close to the clog as possible for 1 (one) minute, and then using a back and forth motion with a 30-50 mL syringe plunger to help dislodge the clog. If the tube does not clear, clamp the tube for 5-15 minutes. Fill the syringe with 10mL of warm water and try again . [...]

Inspectors wroteBased on observations, interview, medical record reviews, and a review of the facility's policy titled, Oral Medication - Administration, the facility failed to ensure Licensed staff did not leave Resident Identifier (RI) #264's and RI #265's medications unattended and out of visual sight. This affected two of two residents observed during medication administration. Findings Include: A review of the facility's policy titled, Oral Medication -- Administration without a date, revealed the following: . Special Points: . G. Never leave medication on top of cart unless cart is in view of staff . 1. RI #264 was readmitted to the facility on [DATE] with diagnoses including Type II Diabetes, Cerebrovascular Disease and Anxiety Disorder. [...]

Inspectors wroteBased on observation, interviews, medical record review, the facility failed to ensure Resident Identifier (RI) #100 was provided a divided plate with meals. This affected one of 24 residents whose meals were observed. Findings Include: 1. RI #100 was readmitted to the facility on [DATE] with diagnoses including Gastro-Esophageal Reflux Disease Without Esophagitis and Hemiplegia Following Cerebral Infarct Affected Right Dominant Side. A review of RI #100 Care Area Triggers (CAT) dated 02/19/18 revealed the following: .Cognitive Loss/Dementia . BIMS (Brief Interview for Mental Status score) is 8 (indicating cognition was moderately impaired . ADL (Activities of Daily Living) Function/Rehabilitation Pot (Potential) . left (him/her) with right sided weakness . A review of RI #100's April 2018 Physician's Orders revealed the following: Order Date . 4/02/18 . Start Date 4/02/18 . Orders . [...]

Inspectors wroteBased on observations, interviews, medical record reviews and a review of the facility's policy titled, Hand Hygiene, the failed to ensure: 1. Licensed staff did not place her fingers inside three medication cups; pour 30 cc (cubic centimeters) of water into the medication cup and then administer the water via RI #265's Gastrostomy Tube (GT); and 2. A CNA(Certified Nursing Assistant) did not store a soiled bedpan in RI #30's bathroom. This was observed 4/12/18 and had the potential to affect RI#30, a resident requiring assistance with toileting. These deficient practices affected 2 of 2 sampled residents. Findings Include: A review of the facility's policy titled, Hand Hygiene without a date, revealed the following: Purpose: to reduce the risk of transmission of pathogenic microorganisms to patients, . Definition: [...]