Gallatin Nursing and Rehab

Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to sufficiently monitor residents for behaviors that might cause a reaction in other residents, such as cursing or physically slapping another resident, for 2 of 42 sampled residents, (Resident (R)118 and R78).

Inspectors wroteBased on observation, interview, and review of facility policy, the facility failed to demonstrate acceptable infection control procedures to help prevent and control the spread of disease and infection for one of three residents (Resident (R) 80) observed during medication administration.

Inspectors wrote4. Review of Resident #53's clinical record revealed the facility admitted the resident on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease with Acute Exacerbation, Dementia with Behavioral Disturbance, Major Depressive Disorder, and Restlessness and Agitation. Review of Resident #53's CCP, revealed a focus of psychotropic drug use with an initiation date of [DATE]. The goal stated the resident would be/remain free of psychotropic drug related complications. The interventions included: administer psychotropic medications as ordered by physician; monitor for side effects and effectiveness; monitor/document/report as needed any adverse reactions of psychotropic medications; Psych to see as needed; consult with pharmacy and Physician to consider dosage reduction when clinically appropriate at least quarterly; [...]

Inspectors wroteThe facility failed to ensure each resident's psychotropic drug regimen was managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial well being. There was no documented evidence of adequate monitoring for efficacy and adverse consequences for psychotropic medications. In addition, there was no documented evidence non-pharmacological interventions were used prior to administering a PRN (as needed) psychotropic medication. These failures affected six (6) of (21) twenty-one sampled residents (Resident #3, #7, #18, #53, #57, and #69). Review of the facility's Behavior/Intervention Monthly Flow Sheets revealed target behaviors, interventions, outcome and medication side effects of each psychotropic medication were to be monitored. [...]

Inspectors wroteBased on interview, record review, and review of the facility's policy, it was determined the facility failed to ensure residents were free from abuse for two (2) of twenty-one (21) sampled residents (Residents #46 and Resident #200) Staff interviews and review of the facility Investigation, revealed Resident #46 alleged Resident #200 hit him/her five (5) times in the arm on 05/19/18, due to an argument over the bathroom.

Inspectors wroteBased on interview, record review, and review of facility Policies, it was determined the facility failed to develop and implement written policies related to reporting and investigating allegations of abuse. This affected four (4) of of twenty one (21) sampled residents (Resident #41, #46, #49 and #200). There was no documented evidence the facility implemented their written abuse policies related to completing a thorough investigation related to an allegation on 05/19/18, of a physical altercation between Resident #46 and Resident #200. In addition, there was no documented evidence this allegation of abuse was reported to State Agencies within two (2) hours as per regulation. [...]

Inspectors wroteBased on interview, and record review, it was determined the facility failed to ensure all alleged violations involving abuse or neglect, were reported immediately, but no later than two (2) hours after the allegation is made, if the events that cause the allegation involve abuse to the Administrator of the facility and to State Agencies for four (4) of of twenty one (21) sampled Residents (Resident #41, #46, #49 and #200). Staff interviews and review of the facility Investigation, revealed Resident #46 alleged Resident #200 hit him/her five (5) times in the arm on 05/19/18, due to an argument over the bathroom; however, there was no documented evidence the facility notified State Agencies within two (2) hours of the allegation. [...]

Inspectors wrote2. Review of Resident #49's clinical record revealed the facility admitted the resident on 10/03/18 with diagnoses including Cerebral Infarction, Dysphagia, Dementia in other Diseases Classified Elsewhere with Behavioral Disturbances, and Depressive Disorder. Review of the Significant Change MDS Assessment, dated 02/17/19, revealed under Section E for Behaviors, the resident exhibited physical behavioral symptoms directed towards others one (1) to three (3) days, during the seven (7) day look back period. Review of Resident #49's Comprehensive Care Plan, initiated 02/21/19, revealed a focus of cognitive loss due to severely impaired cognition and exhibited poor safety awareness and poor decisional capacity. The goal revealed the resident would maintain cognitive ability. [...]

Inspectors wroteBased on interview, record review, and review of the Centers for Medicare and Medicaid Services, Resident Assessment Instrument (RAI) Manual 3.0, it was determined the facility failed to submit the Minimum Data Set (MDS) Assessments to the Centers for Medicare and Medicaid Services (CMS) within the required timeframe for one (1) of twenty-one (21) sampled residents (Residents #41). Resident #41 was re-admitted to the facility on on 04/15/19; however, his/her Entry MDS Assessment was not submitted until 05/12/19.

Inspectors wroteBased on observation, interview, record review, review of facility policy, and review of the Centers for Medicare and Medicaid Services, Resident Assessment Instrument (RAI) Manual 3.0, it was determined the facility failed to assure the accuracy and completion of Section E related to Behaviors on the Minimum Data Set (MDS) Assessment, for two (2) of twenty-one (21) sampled residents (Resident #41 and #69). Resident #41's Annual Minimum Data Set (MDS) Assessment, dated 05/31/19, revealed the resident exhibited no behaviors; however, review of the Nurse's Notes dated 05/29/19 and 05/30/19, and the Monthly Flow Record dated 05/24/19 through 05/31/19, revealed the resident was demanding, and impatient and exhibiting explosive and attention seeking behaviors. [...]

Inspectors wroteBased on observation, interview, record review and review of facility policies, it was determined the facility failed to revise the Comprehensive Care Plan for three (3) of twenty-one (21) sampled residents (Resident #46, #57 and #200). Record review revealed Resident #57 was observed to be shaving his/her head with a razor on 07/09/19 and sustained several nicks to the scalp. However, there was no documented evidence the Comprehensive Care Plan was revised in order to prevent recurrence. In addition, review of the Incident/Condition Report, dated 07/16/19, revealed Resident #57 was found with small nicks noted on the left posterior scalp, and was noted to have two (2) disposable razors and small scissors in the drawer by the sink in the resident's room. However, again there was no documented evidence the Comprehensive Care Plan was revised to prevent recurrence. [...]

Inspectors wroteBased on observation, interview, record review and review of the facility's Policy, it was determined the facility failed to provide an environment that was free from accident hazards and failed to provide supervision to each resident to prevent avoidable accidents including implementing interventions to reduce hazard(s) and risk(s), monitoring for effectiveness and modifying interventions when necessary for one (1) of twenty-one (21) sampled residents, (Resident #57). Observation on 07/16/19 at 11:33 PM, revealed the State Agency Representative entered the hallway and noticed Resident #57 walking down the hall to the dining room with blood running down the back of his/her scalp and on to his/her shirt. The facility investigation determined the resident had two (2) disposable razors in his/her room and had received the cuts to his/her scalp from shaving his/her head unsupervised.