Florence Nursing and Rehabilitation Ctr, LLC

Inspectors wroteBased on observations, interview, review of a facility policy titled, Labeling and Dating Foods (Date Marking), Cleaning Instructions: Ice Machine and Equipment, Cleaning Instructions: Slicer, and review of the 2017 U.S. (United States) Public Health Service Food Code, the facility failed to ensure: 1. outdated food was not stored in the walk-in cooler; 2. the ice machine was clean and free of a build-up of black substance; and 3. the meat slicer was clean and free from food particles between uses. These failures had the potential to affect 135 of 135 residents who received meals from the kitchen. Findings Include: 1)The facility policy titled, Labeling and Dating Foods (Date Marking), dated 2016, . Prepared food or opened food items should be discarded when: The food item is leftover for more than 3 days . [...]

Inspectors wroteBased on observation, interviews, medical review, and a facility document titled Hand Hygiene in Healthcare Settings, the facility failed to ensure: 1. a Licensed Practical Nurse (LPN), Employee Identifier (EI) #1, washed or sanitized her hands after she gave Resident Identifier (RI) #87's oral medication, and prior to administering (RI) #87's eye drop medication, and 2. a Registered Nurse (RN), EI #2, did not wash or sanitize her hands after she removed her gloves from giving RI #110's oral medications, and prior to opening RI #110's door, and placing RI #110's inhalation medications in the medication cart drawer. This affected two of six residents observed during medication pass and two of six nurses observed during medication pass. Findings Include: A review of a facility document titled Hand Hygiene in Healthcare Settings, with last reviewed date of 4/29/2019, revealed . [...]

Inspectors wroteBased on observations, interviews, and review of a facility policy titled, Labeling and Dating Foods, the facility failed to ensure: 1. no outdated hot dog buns were on open shelving in the facility kitchen; 2. no outdated lettuce and sweet and sour sauce were stored in kitchen walk-in cooler and 3. no outdated bacon bits were stored in a facility unit nourishment room refrigerator. These failures had the potential to affect 127 of 127 residents receiving meals from dietary and one of one unit refrigerator observed with outdated bacon bits. Findings Include: 1. The facility's policy titled, Labeling and Dating Food,' 2016 Edition documented: . Procedure . 4. Prepared food or opened food items should be discarded when: . the food item is leftover for more than 3 days . the food item is older than the expiration date. [...]

Inspectors wroteBased on interview, medical record review and review of a facility policy titled, COMPREHENSIVE PERSON CENTERED CARE PLANS, the facility failed to ensure: 1. Resident Identifier (RI) #112's baseline care plans addressed smoking and 2. RI #186's baseline care plans addressed the use of a foley catheter and antipsychotic medications. This affected RI #112 and RI #186, two of 25 sampled residents. Findings Include: A review of a facility policy titled, COMPREHENSIVE PERSON CENTERED CARE PLANS, with a history date of 3/18, documented: POLICY: Each resident will have a person centered plan of care to identify problems, needs, strengths, preferences, and goals that will identify how the interdisciplinary team will provide care. Baseline Care Plan - initial plan of care to be used upon admission . PROCEDURE: .3. A Baseline Care Plan is to be developed within 48 hours. [...]

Inspectors wroteBased on interview and medical record review, the facility failed to obtain physician orders for the use of Resident Identifier (RI) #186's foley catheter and foley catheter care after admission to the facility on [DATE]. This affected RI #186, one of three residents sampled with catheters. Findings Include: RI #186 was admitted to the facility on [DATE] with the following diagnoses: Aftercare Following Joint Replacement Surgery, Presence of Right Artificial Hip Joint, History of Falling, Paroxysmal Atrial Fibrillation, Unspecified Chronic Ischemic Heart Disease, Unspecified Heart Failure, Other Specified Hypothyroidism, Unspecified Dementia Without Behavioral Disturbance and Unspecified Hyperlipidemia. A review of RI #186's medical record revealed no orders for a foley catheter or cath care until 10/23/18, seven days after admission to the facility. [...]

Inspectors wroteBased on interview and medical record review, the facility failed to ensure Resident Identifier (RI) #186's medical record contained an appropriate medical diagnosis to justify the continued use of a foley catheter after admission to the facility on [DATE]. The facility further failed to ensure catheter care was provided for RI #186 on 10/16, 10/17, 10/18, 10/19, 10/20 and 10/22/18. This affected RI #186, one of three residents sampled with catheters. Findings Include: RI #186 was admitted to the facility on [DATE] with the following diagnoses: Aftercare Following Joint Replacement Surgery and Presence of Right Artificial Hip Joint. A review of RI #186's medical record revealed no diagnosis to justify the continued use of a foley catheter. Further review of the medical record revealed, no documentation of catheter care being provided on 10/16, 10/17, 10/18, 10/19, 10/20 and 10/22/18. [...]

Inspectors wroteBased on observations, record review of The 2013 Food Code, Food & Nutritional Services' policy/procedure manual and staff interviews, the facility failed to assure: 1. holding temperature of hot foods were maintained at 135 degrees or above when served from the trayline, 2. the tea urn spigot was cleaned every 24 hours and 3. utensils (flatware) were cleaned and air dried to prevent cross-contamination and food-borne illness. The above practices posed the potential for food contamination and compromised food safety. This had the potential to affect all 141 residents on the diet list who received food from dining services.

Inspectors wroteBased on observation and interviews, the facility failed to ensure RI (Resident Identifier) #109's pillowcase was free of a brown colored substance. This was observed on 01/24/2018. This affected one of 28 sampled residents whose bed linens were observed. Findings Include: RI #109 was admitted to the facility on [DATE], with a diagnosis of Hypertension. On 01/24/2018, during a Resident Council meeting, RI #109 stated his/her bed was never made and his/her pillowcase had dried blood on it for two weeks. On 01/24/2018 at 4:08 p.m., the surveyor went to RI #109's room and with permission observed a brown substance on the pillowcase. On 01/24/2018 at 4:15 p.m., RN (Registered Nurse) Unit manager, EI (Employee Identifier) #4 observed RI #109's pillowcase. EI #4 was asked did RI #109's bed linens and pillowcase look clean. EI #4 said RI #109's pillowcase did not look clean. [...]

Inspectors wroteBased on a review of a facility policy titled, Smoking Policy, and a facility document titled, SMOKING SAFETY EVALUATION, record reviews and interviews, the facility failed to complete a smoking evaluation on RI (Resident Identifier) #95, a resident identified as a smoker. This affected one of two sampled residents identified as smokers. Findings Include: RI #95 was admitted to the facility on [DATE] with diagnoses to include Specified Surgical Aftercare, Type 2 Diabetes and Hypertension. A review of RI #95's admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 12/02/2017, revealed the resident had a BIMS (Brief Interview for Mental Status) score of 15, which indicated RI #95 was cognitively intact. Further review of RI #95's MDS revealed the resident was assessed as a current tobacco user. [...]

Inspectors wroteBased on observations, interviews and review of facility policies titled, HAND WASHING, NASAL INHALATION ADMINISTRATION PROCEDURES and STANDARD PRECAUTIONS and review of POTTER AND [NAME], FUNDAMENTALS OF NURSING, NINTH EDITION, the facility failed to ensure a licensed nurse: 1. changed gloves and washed her hands after administration of nasal spray and before administration of an inhaler to Resident Identifier (RI) #72, 2. cleaned RI #72's nasal spray container after contact with resident's nares and 3. washed her hands after cleaning RI #72's nebulizer reservoir and removing her gloves and before obtaining RI #72's vital signs. The facility further failed to ensure a Certified Nursing Assistant: 1. did not place clean gloves on an unclean counter for use during incontinence care and catheter care for RI #93, 2. [...]