Greenville Health Care Center

Inspectors wroteBased on interview and record review, the facility failed to keep one resident (Resident #1) free from sexual abuse when another resident (Resident #2) intentionally grabbed and squeezed Resident #1's breast twice. The incident upset Resident #1 and the interventions put into place to prevent the incident from happening again caused Resident #1 to feel punished. The facility census was 58. Review of the facility's policy titled, Abuse and Neglect, dated 06/10/24, showed:Abuse is the willful infliction of injury, reasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, which can include staff to resident abuse and certain resident to resident altercations;Sexual abuse is non-consensual contact of any type with a resident. Sexual abuse includes, but is not limited to, the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement Enhanced Barrier Precautions (EBP) during urinary catheter (a flexible tube placed in the body to drain and collect urine) care for two residents (Residents #2 and #56) out of two sampled residents. The facility failed to put interventions in place to ensure the facility's Legionella (a type of bacteria that can cause serious lung infection) testing was completed in a timely manner. The facility census was 57. Review of the facility's policy titled, Enhanced Barrier Precautions, last reviewed 05/18/24, showed: - EBP of gown and gloves must be used for high-contact resident care activities for residents with any of the following: infection or colonization with a Centers for Medicare and Medicaid (CDC)-targeted multidrug-resistant organism (MDRO) when contact precautions do not otherwise apply; [...]

Inspectors wroteBased on interview and record review, the facility failed to follow physician's orders for one resident (Resident #20) out of 15 sampled residents and one resident (Resident #25) outside the sample. The facility's census was 57. Review of the facility's policy titled, Transcription of Orders/Following Physician's Orders, last reviewed May 2024, showed: -The purpose of this policy is to outline procedures in accurately transcribing physician's orders and to ensure that all physicians' orders are followed. To ensure a process is in place to monitor nurses in accurately transcribing and following physician's orders; - Upon receiving a physician's order via telephone, fax, written order, verbal order, transcribed order or other, it will be documented in residents' electronic medical records in orders section; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide protective oversight when facility staff left the medication carts unattended and unlocked on three separate occasions. This had the potential to affect all residents in the facility. The facility census was 57. Review of the facility's policy titled, Medication Storage Policy, last reviewed May 2024, showed: - It is the policy of this facility to ensure all medications housed on our premises will be stored in the medication rooms according to the manufacturer's recommendations and sufficient to ensure proper sanitation, temperature, light, ventilation, moisture control, segregation, and security; - All drugs and biologicals will be stored in locked compartments (i.e. medication carts, cabinets, drawers, refrigerators, medication rooms) under proper temperature controls; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide documentation of ongoing assessments, monitoring, and communication between the facility and the dialysis (a process for removing waste and excess water from the blood) center for one resident (Resident #51) out of one sampled resident. The facility census was 57. Review of the facility's policy titled, Dialysis, revised 03/18/22, showed: - Ensure that residents who require dialysis and such services as ordered by the physician; - The facility will ensure that residents who require dialysis receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure staff reconciled narcotics (a process that allows one staff to reconcile the exact narcotic inventory on hand with another staff) at each shift change for three out of three sampled medication carts. This practice had the potential to affect all residents. The facility census was 57. Review of the facility's policy titled, Controlled Substance Administration and Accountability Policy, last reviewed 05/14/24, showed: - The charge nurse or other designee conducts a daily visual audit of the required documentation of controlled substances. Spot checks are performed to verify; - Inventory verification: for areas without automated dispensing systems, two licensed nurses account for all controlled substances and access keys at the end of each shift. 1. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to ensure that as needed (PRN) orders for antipsychotic (medications that treat psychotic disorders) medications were limited to 14 days for one resident (Resident #46) of five sampled residents. The facility census was 57. Review of the facility's policy titled, Use of Psychotropic (medications that affect the mind, emotions, and behavior) Medication Policy, dated 06/26/24, showed: - PRN orders for all psychotropic medications shall be used only when the medication is necessary to treat a diagnosed specific condition that is documented in the clinical record and for a limited duration (14 days); [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a medication error rate of less than five percent (%). There were 38 opportunities with five errors made, resulting in an error rate of 13.15% for two residents (Residents #20 and #25) out of four sampled residents. The facility's census was 57. Review of the facility's policy titled, Administration of Insulin Policy, last reviewed May 2024, showed: - It is the policy of this facility to provide timely administration of insulin in order to meet the needs of each resident and to prevent adverse effects on a resident's condition; - All insulin will be administered in accordance with physician's orders; - Insulin administration will be coordinated with mealtimes and bedtime snacks unless otherwise specified in the physician order; - Monitor blood sugar as ordered by the physician. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that two residents (Residents #20 and #25) out of two sampled residents were free from significant medication errors when staff did not check blood sugars prior to administering insulin (a medication that regulates blood sugar levels). The facility's census was 57. Review of the facility's policy titled, Administration of Insulin Policy, last reviewed May 2024, showed: - It is the policy of this facility to provide timely administration of insulin in order to meet the needs of each resident and to prevent adverse effects on a resident's condition; - All insulin will be administered in accordance with physician's orders; - Insulin administration will be coordinated with mealtimes and bedtime snacks unless otherwise specified in the physician order; - Monitor blood sugar as ordered by the physician. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a safe, clean and comfortable homelike environment. This deficient practice had the potential to affect all residents in the facility. The facility census was 51. Review of the facility's policy titled, Work Order Policy, dated, 12/21/2022 showed: - To provide an orderly means of communication between the facilities maintenance department and the facilities residents, visitors and staff to report and track needed maintenance work; - Work order forms should be submitted for any issues that an employee observes which need the attention of the Facility Maintenance; - Work order forms are located at front receptionist desk or nurses station; - All employees may submit a work order form by either calling the receptionist/nurse station or by stopping by either desk to fill out a work order form; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain infection control practices for eight sampled residents (Residents #11, #24, #34, #36, #38, #48, #50, and #56) out of 14 sampled residents and two residents outside of the sample (Residents #13 and #33) when facility staff failed to clean/disinfect the glucometer (a device used to measure and display the amount of sugar in a person's blood) between each resident use, and failed to perform hand hygiene in between each resident during blood glucose monitoring and medication administration. The facility's census was 53. Record review of the facility's Handwashing policy, revised 12/10/21, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to obtain a physician's order for a code status (the type of treatment a person would or would not receive if their heart or breathing were to stop) for two residents (Resident #42 and #49) out of 14 sampled residents. The facility census was 53. Record review of the facility's Advance Directive (a written statement of a person's wishes regarding medical treatment) policy, dated [DATE], showed: - Individuals with the right to make decisions concerning their care, including the right to accept or refuse medical or surgical treatment, and the right to formulate advance directives as permitted under state statutory and case law; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop, implement and follow an individualized comprehensive care plan with specific interventions for three residents (Resident #24, #38, and #56) out of 14 sampled residents. The facility's census was 53. Record review of the facility's Comprehensive Care Plans and Baseline Care Plans policy, revised 1/19/22, showed: - The Comprehensive Care Plan must be completed within 14 days of admission; - Daily nursing meetings will occur Monday through Friday with a review of the resident's medical, functional, and psychosocial problems. From this meeting, information will be individualized to the resident's plan of care. On Monday morning, the resident's status will be reviewed from the weekend to ensure all areas that need to be assessed for care plan needs will be addressed; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were transferred with safe transfer techniques for two residents (Residents #38, and #56) out of three sampled residents. The facility census was 53. Record review of the facility's Resident Transfer With a Gait Belt policy, dated 4/9/21, showed: - Apply the gait belt around the waist over clothing with the buckle in front; - Be sure the belt sits snug with just enough room to get your fingers under it; - Place hands underneath the gait belt and instruct the resident to stand on the count of three; - Assist the resident to a standing position. 1. Record review of Resident #38's medical record showed: - Resident admitted on [DATE]; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff maintained proper positioning and placement of catheter tubing and drainage bags on residents with an indwelling urinary catheter (a tube inserted into the urinary bladder to drain the bladder) and a suprapubic catheter (a hollow flexible tube inserted into the bladder through a cut in the abdomen to drain urine) for three residents (Resident #26, #38, and #45) out of 14 sampled residents. The facility census was 53. Record review of the facility's Catheter Care policy and procedure, revised on 2/26/21, showed: - The facility will ensure any resident with a urinary catheter will be maintained to prevent infection; - Staff will make urine flows out of the the catheter into the drainage bag; - Staff to keep the urinary drainage bag below the level of the bladder to prevent back flow of the urine; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an error rate of less than five percent (%) when medications were administered. There were 34 opportunities with three errors made, for an error rate of 8.82%. Out of ten residents observed, this affected one sampled resident (Resident #56) and two residents outside the sample (Resident #29 and #33). The facility census was 53. Record review of the facility's Medication Administration and Monitoring policy, revised 9/17/21, showed: - Medications to be given per doctors' orders. All medications will be recorded on the Medication Administration Record (MAR) and signed immediately after the medications administered to the resident. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to label and store medications in a safe and effective manner. This had the potential to affect all residents. The facility census was 53. Record review of the facility's Monthly Inspections - Medications policy, dated 7/5/22, showed: - The charge nurse on night shift will complete a monthly review of all medication carts, treatment carts, and medication rooms on the last Saturday of every month; - The medication carts, treatment carts, and medication rooms will be reviewed for refrigerator temperature checks, medication expiration dates on the medication/treatment carts, and dated when opened items within the proper timeframe after opened in the medication rooms; - The charge nurse will correct any concerns identified by the audit; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the dish machine was free of debris and calcium buildup. The facility census was 53. Record review of the facility's Dietary Equipment Operations, Infection Control and Sanitation policy, revised 1/19/22, showed: - The dietary staff shall maintain the sanitation of the Dietary Department through compliance with written, comprehensive cleaning schedules developed for the facility by the Dietary Manager; - Operating instructions will be made available and cleaning procedures developed for all Dietary Department equipment; - Clean dish machine interior and exterior with de-liming solution weekly. Observations on 8/28/22 at 10:41 A.M., 8/29/22 at 10:08 A.M., and 8/30/22 at 12:02 P.M., of the kitchen showed: - Debris and calcium buildup visible on top of the dish machine. [...]