Franklin-Simpson Nursing and Rehabilitation Center

Inspectors wroteBased on observation, interview, record review and facility policy review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality, for four (4) of 20 sampled Residents (R) (R11, R28, R32, R67) who were unable to freely go outside and one Resident (R32) who had a wander guard in place with no attempts to elope from facility.

Inspectors wroteBased on observations, interviews, record review, and facility policy, it was determined the facility failed to ensure the care plan was followed related to the dietary needs of two (2) of eighteen (18) sampled residents. (Resident #66 and Resident #40) Observation during lunch meal pass on 05/18/2021, Resident #40 and #66 did not have fortified mashed potatoes. Review of care plan interventions for both Resident #40 and #60 interventions directed staff to provide diet as ordered. Additionally, Resident #66 meal ticket required (2) two cartons of milk that were observed to not be on the tray of Resident #66 during meal service.

Inspectors wroteBased on observation, interview, and Code of Federal Regulations (CFR) 483.45(g) review, it was determined the facility failed to ensure drugs used in the facility were labeled in accordance with currently accepted professional principles for one (1) of the facility's two (2) medication rooms. On [DATE], observation of the medication room on the 200 Hall revealed a Levemir (insulin) pen and Bromfed (antihistamine, cough suppressant, decongestant) liquid were opened. However, the drugs were not dated when opened. Interview with the Administrator revealed the facility did not have a policy for storage and labeling of drugs and biologicals.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, it was determined the facility failed to provide a well-balanced diet to meet the dietary needs of for two (2) of eighteen (18) sampled residents, Resident # 66 and #40 During lunch meal pass on 05/18/2021, Resident #40 and #66 did not have fortified mashed potatoes per the Meal Ticket, physician order, or care plan. Additionally, Resident #66's Meal Ticket required (2) two cartons of milk to be provided, however, they were not on Resident #66's tray.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, it was determined the facility failed to ensure each resident was free from abuse, neglect and corporal punishment of any type by anyone for one (1) of twenty-five (25) sampled residents (Resident #67). Interviews with Resident #67 on 02/12/19 revealed during the night shift on 02/11/19, he/she asked a staff member to put a pillow behind his/her head and the staff member threw the pillow at him/her, hitting him/her in the face. Resident #67 stated the staff threatened the resident that he/she would remain in the facility longer for asking for help. Resident #67 stated this treatment caused him/her to be fearful and sad. [...]

Inspectors wroteBased on interview, record review and review of facility policy, it was determined the facility failed to prevent further potential abuse, or mistreatment while an investigation was is in progress by failing to suspend the alleged perpetrator for one (1) of twenty-five (25) sampled residents (Resident #67). On 02/12/19, Resident #67 alleged he/she was abused by staff on the night shift on 02/11/19, but Resident #67 was unable to identify the staff by their name. On 02/14/19, Resident #67 stated the staff came into his/her room on the evening of 02/13/19 and he/she identified the staff as State Registered Nurse Aide (SRNA) #3. On the morning of 02/14/19, Resident #67 and Surveyors reported this information to the Administrator; however, the Administrator failed to suspend or remove SRNA #3 from care while the allegation was investigated

Inspectors wroteBased on observation, interview and review of facility policy, it was determined the facility failed to ensure food was Stored, prepared, distributed and served in accordance with professional standards for food service safety. Kitchen observations on 02/12/19, revealed open, unsealed foods being stored in the freezer, dirty kitchen equipment and staff sanitation concerns. Review of Census and Condition dated 02/12/19 revealed eighty-two (82) of eighty-six (86) resident receive there meals from the kitchen.

Inspectors wroteBased on interview, record review, and review of the facility policy, it was determined the facility failed to ensure each resident care plan was reviewed and revised by the interdisciplinary team ongoing with any changes pertinent to the residents' care needs, for five (5) residents (Residents #20, #21, #32, #36, and #71), in the selected sampled of twenty-five (25). Resident #32 had a history of Urinary Tract Infections (UTIs) and had an indwelling urinary catheter. He/she was hospitalized on [DATE] with diagnoses of UTI and Sepsis. However, the comprehensive care plan did not reflect a history of UTIs or Sepsis. Resident #20 had an appointment for cataract surgery on 02/19/18. However, the resident refused to go to the appointment stating I'm not having surgery. The comprehensive care plan was not updated to reflect the resident's preferences related to cataract surgery. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility policy, it was determined the facility failed to treat one (1) of twenty-five (25) sampled residents with respect and dignity and care for the resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing the resident's individuality (Resident #36). Resident #36 was resistive to care when staff identified the resident had food on his/her shirt and face after eating his/her meal; however, staff failed to provide a second attempt to clean the resident's face and change shirt for over and hour later and failed to follow facility protocol of having another staff attempt to clean the resident.

Inspectors wroteBased on observation, interview, record review and facility Resident Rights review, it was determined the facility failed to ensure one (1) of twenty-five (25) sampled residents, the right to have reasonable access to visit his/her son at the facility (Resident #48).

Inspectors wroteBased on observation, interview, record review, review of facility policy, and housekeeping inservice training, it was determined that the facility failed to ensure the resident environment was sanitary for one (1) of twenty-five (25) sampled residents (Resident #17). Observation of Resident #17's bathroom on 02/12/19 and on 02/13/19, revealed the commode had dried, crusted fecal matter smeared all over the commode seat and commode bowl in the same areas for the two (2) consecutive days.

Inspectors wroteBased on interview, record review and review of facility policy, it was determined the facility failed to ensure each resident had a person-centered comprehensive care plan that was developed and/or implemented to meet the residents' preferences and goals, and address the resident's medical, physical, mental and psychosocial needs for one (1) of twenty-five (25) sampled residents (Resident #20). Resident #20 was prescribed Plavix 75 milligrams (mg) (anti-platelet) and Aspirin 325 mg daily. However, there was no documented evidence a care plan was initiated to monitor resident for complications of the medications. In addition, the resident had an uncontrolled nosebleed and was sent to the emergency room on [DATE]; however, the care plan was not revised due to an uncontrolled nose bleed, not reflected on the comprehensive care plan.

Inspectors wroteBased on interview, record review, and review of facility 24 hour Report, it was determined the facility failed to ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities, the facility must, if necessary, assist the residents In making appointments, and by arranging for transportation to and from the office of a practitioner specializing in the treatment of vision or hearing impairment or the office of a professional specializing in the provision of vision or hearing assistive devices for one (1) of twenty-five sampled residents (Resident #20). Resident #20 was seen by an ophthalmologist on 01/22/18 and recommendations were made for the resident to be evaluated by a cataract surgeon. An appointment was scheduled for 02/19/18, however, the resident was a no show, as the resident refused to go to the appointment. [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure a resident, with or without an indwelling catheter, receives the appropriate care and services to prevent urinary tract infections to the extent possible for one (1) of twenty-five sampled residents (Resident #32). Three (3) observations revealed improper positioning of Resident #32's urinary catheter tubing and drainage bag placement.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to apply oxygen (O2) therapy according to the Physician's Order for one (1) of twenty-five (25) sampled residents (Resident #7). Observation on 02/12/19 revealed staff failed to ensure Resident #7 received O2 at three (3) liters per minute (LPM) per the Physician's Order.