Gulf Coast Health and Rehabilitation, LLC

Inspectors wroteBased on observations, interviews, a review of facility policies: Food Preparation Guidelines, Use of Gloves and Hairnets, Cleaning of Miscellaneous Equipment and Utensils and the 2017 Food Code regulations, the facility failed to ensure staff: 1) thawed frozen meat using recognized sanitary measures; 2) utilized hair restraints while handling clean utensils and food; and 3) air dried and stored clean dome lids and bases on drying racks free of an accumulation of rust. This had the potential to affect all 87 residents for whom meals were prepared and served at the time of this survey. 1) THAWING OF FROZEN MEATS The facility policy, Food Preparation Guidelines dated 08/10/18, specifies: .food should be prepared by methods that conserve nutritive value, flavor and appearance. The process by which staff are directed to thaw frozen foods is as follows: .d. [...]

Inspectors wroteBased on observations, interviews, record review and review of a facility policy titled, INFECTION PREVENTION & (and) CONTROL MANUAL, the facility failed to ensure the treatment nurse, Employer Identifier (EI) #10, removed her gloves, sanitized her hands, and applied new gloves after cleaning Resident Identifier (RI) #17's right heel and sacrum pressure ulcers, and before applying the treatments and clean dressings to the pressure ulcers when providing wound care for RI #17 on 01/09/20. This deficient practice affected RI #17, one of one sampled resident observed for wound care. Findings Include: Review of a facility policy titled, INFECTION PREVENTION & (and) CONTROL MANUAL, dated 09/01/17, revealed the following: . Policy title: Hand Hygiene . PURPOSE: [...]

Inspectors wroteBased on interviews, record review and review of a facility policy titled, MEDICATION ADMINISTRATION STANDARDS PSYCHOACTIVE DRUG PROTOCOL, the facility failed to ensure Resident Identifier (RI) #85 had a medical diagnosis to warrant the use of the antipsychotic medication, Seroquel. This deficient practice affected RI #85, one of six residents sampled for the unnecessary use of medications. Findings Include: Review of an undated facility policy titled, MEDICATION ADMINISTRATION STANDARDS PSYCHOACTIVE DRUG PROTOCOL, revealed the following: Statement of Policy: The facility acknowledges the resident's right to be free from psychopharmacological drugs administered for purposes of discipline or convenience and not required to treat the resident's medical symptoms . Unnecessary drugs, as defined by federal regulations, are any drugs when used: . Without adequate indication for its use . [...]

Inspectors wroteBased on observations, interviews, record review and review of a policy titled, Tray Tickets, the facility failed to ensure Resident Identifier (RI) #62 received a tossed salad at the lunch and supper meals per their preference. This deficient practice affected one of two residents requesting tossed salad with lunch and dinner meals. Findings Include: A review of a facility policy titled, Tray Tickets, with an effective date of 08/10/18, revealed: .PURPOSE: Tray tickets should be used to assist dietary staff to serve the resident/guest(s) meal according to food preference profiles .PROCESS: . b. When individual meal patterns are ordered for a resident/guest, outside the normal facility diets or meal patterns, specific information on that meal pattern should be communicated on the tray ticket . [...]

Inspectors wroteBased on observations and interviews, the facility failed to ensure: 1) CNAs (Certified Nursing Assistants) did not hold residents' water pitchers against their uniforms when transporting the water pitchers in the hallways; and 2) Employee Identifier (EI) #14, a Licensed Practical Nurse (LPN) did not use a glove from her uniform pocket to open a carton of juice for a resident during the morning medication pass on 01/09/19. These deficient practices were observed on two of the three days during the survey and affected one of the two medication carts observed during medication pass on 01/09/20. Findings Include: 1) On 01/07/20 at 3:05 p.m., the surveyor observed a CNA walking in the hallway carrying four residents' water pitchers resting against her uniform top. The water pitchers/cups were supported with her arms embracing each water pitcher. [...]

Inspectors wroteBased on observations, interviews, record review and a review of facility policies titled, Critical Control Points-Safe Food Handling Guide and Cleaning of Miscellaneous Equipment and Utensils the facility failed to ensure: 1. plates were not stacked wet in the plate warmer; 2. okra in the freezer was labeled; 3. vents over the stove were free of a grease and dust like substance; and 4. staff did not touch or handle RI #60's food with ungloved hands. This had the potential to affect 90 of 90 residents who received meals from the kitchen. Findings Include: 1. A review of a facility policy titled, Cleaning of Miscellaneous Equipment and Utensils with an effective date of August 23, 2017 revealed: .Dishes .Place dishes in dish rack; avoid overloading and nesting .allow dishes to air dry . On 11/07/2018 at 11:28 a.m., the surveyor observed EI (Employee Identifier)#5, the [NAME] plating food. [...]

Inspectors wroteBased on observations, interview and a review of a facility policy titled, Garbage and Refuse, the facility failed to ensure dumpster lids were closed tightly, boxes and paper towels were not around the dumpster, and food debris was not on the front side of the dumpster. This had the potential to attract pests and affect all 93 residents residing at the facility. Findings Include: A review of a facility policy titled, Garbage and Refuse with an effective date of February 1, 2002 revealed: .PURPOSE: To prevent the spread of bacteria that may cause food borne illnesses. STANDARD: Garbage and refuse containers should be free from cracks or leaks and covered when not in use. PROCESS: .e. Refuse container and dumpsters kept outside the facility should have tightly fitting lids and should be kept covered when not being loaded. f.garbage should not accumulate or be left outside the dumpster. [...]

Inspectors wroteBased on observation, interview, record review and a review of the facility's policy titled, Privacy Upon Entering Resident's Room, the facility failed to ensure staff knocked and received permission prior to entering RI (Resident Identifier) #60's room. This affected one of 23 sampled residents observed for privacy issues. Findings Include: A review of a facility policy titled, Privacy Upon Entering Resident's Room with an effective date of 11/6/14, revealed: .PROCESS: 1. Prior to entering Resident's room, knock and ask permission to enter . RI #60 was admitted to the facility on [DATE] with a diagnosis of Gastrointestinal Hemorrhage. A review of RI #60's most recent Quarterly MDS (Minimum Data Set) revealed he/she had a BIMS of 15, which indicated he/she was cognitively intact. [...]

Inspectors wroteBased on observation, record review, interview and review of facility policies titled, Nebulizer and Hand Hygiene, the facility failed to ensure: 1. a nebulizer was contained in a plastic bag when not in use and 2. staff washed their hands after removing unclean gloves and before applying clean gloves and touching other items. This affected RI (Resident Identifier) #10, RI #25 and RI #31, three of seven residents observed during medication administration. Findings Include: 1. A review of a facility policy titled, Hand Hygiene with an effective date of 9/01/17, revealed: .Hand Hygiene .The following is a list of some situations that require hand hygiene .After removing gloves .Consistent use by staff of proper hygienic practices and techniques is critical to preventing the spread of infections . RI #25 was re-admitted to the facility on [DATE] with a diagnosis of Paraplegia. [...]

Inspectors wroteBased on record reviews, an interview, and review of a policy titled, Disposal of Medications Non-Controlled Medication Destruction, the facility failed to ensure medications were disposed of with the required number of signatures. This deficient practice was found for the month of November 2017, one out of months of Drug Destruction Records reviewed. Findings Include: A review of the Facility's Policy and Procedure titled Disposal of Medications Non-Controlled Medication Destruction with a date of 03/11 revealed: Policy Discontinued medications, expired medications, and medications left in the facility after a resident has expired or has been permanently discharged (,) are destroyed or disposed of per federal/state regulations. Procedures . 3. [...]

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure Resident Identifier (RI) #135's nebulizer mask was not stored in the top of RI #135's dresser drawer. This deficient practice affected RI #135, one of one sampled resident observed with a nebulizer set-up. Findings Include: RI #135 was admitted to the facility on [DATE], with diagnoses to include Pneumonia and Chronic Obstructive Pulmonary Disease. RI #135's January 2017 Physician Orders documented: . IPRAT(Ipratropium)-ALBUT (Albuterol) 0.5-3(2.5) MG (Milligram)/3 ML (Milliliter) ONE VIAL VIA (by way of) NEBULIZER EVERY FOUR HOURS FOR COPD (Chronic Obstructive Pulmonary Disease) . On 01/03/18 at 11:37 a.m., RI #135's nebulizer mask was observed stored uncovered, in the top of the dresser drawer in RI #135's room. On 01/03/18 at 5:35 p.m., RI #135's nebulizer mask remained in the top of the dresser drawer. [...]