Hickory Manor

Inspectors wroteBased on interview and record review, the facility failed to issue a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) and Notice of Medicare Non-Coverage (NOMNC) to the resident and/or the resident's representative in writing at least two calendar days before discharge from skilled services. This notice informs the beneficiary about potential non-coverage and the option to continue services with the beneficiary accepting the financial liability for those services. This practice affected one resident (Resident #31) out of two sampled residents. The facility census was 39. [...]

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 39. Review of the facility's policy titled, Homelike Environment, revised February 2021, showed:- Residents are provided with a safe, clean, comfortable and homelike environment;- The facility maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting;- These characteristics include a clean, sanitary and orderly environment. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly assess the use of a bed and chair alarm (devices that contain sensors that trigger an alarm when they detect a change in pressure) to determine if utilized as restraints (a device that limits a person's movement), failed to identify a medical symptom that supported the use of the alarms, and failed to document the least restrictive use for the alarms for one resident (Resident #5) out of one sampled resident. The facility census was 39. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure pre-employment screenings were completed for abuse, neglect or misappropriation of property by verifying employees through the Nurse Aide Registry and Employee Disqualification List (EDL) for six employees (Employees #2, #3, #5, #6 , #7, and #9) of 10 sampled employees, placing all of the residents at risk for potential abuse or neglect. The facility's census was 39. Review of the facility's policy titled, Fiscal Services Manual, dated February 2022, showed:- Check Nurse Aide (CNA) Registry for all new hires. Complete this because some employees may have a federal indicator (a permanent ban from employment in nursing homes) on the Nurse Aide Registry that does not show up when they apply for other positions. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a significant change Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff) assessment within 14 days of admission to hospice services for one resident (Resident #27) out of one sampled resident. The facility census was 39. Review of the facility's policy titled, Resident Assessments, dated October 2023, showed:- Omnibus Budget Reconciliation Act of 1987 (OBRA - a federal legislation reforming nursing home care) required assessments are federally mandated, and therefore, must be performed for all residents of Medicare and/or Medicaid certified nursing homes. OBRA assessments include: a. admission assessment; b. Quarterly assessment; c. Annual assessment; d. [...]

Inspectors wroteBased on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff) for one resident (Resident #7) out of 12 sampled residents. The facility census was 39. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement care plans with specific interventions to meet individual needs for two residents (Residents #2 and #3) out of 12 sampled residents. The facility census was 39. Review of the facility's policy titled, Care Plans, Comprehensive Person-Centered, revised March 2022, showed:- The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident;- The comprehensive, person-centered care plan: includes measurable objectives and timeframes, describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to update and revise care plans with specific interventions tailored to meet individual needs for one resident (Resident #7) out of 12 sampled residents. The facility census was 39. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure nursing staff followed professional standards of practice for medication administration for one resident (Resident #11) out of 12 sampled residents reviewed for medication administration. The facility failed to follow facility policy and accepted standards of nursing practice during transdermal pain patch (medicated adhesive patch applied to the skin to deliver a specific dose of medication) administration. The facility census was 39. Review of the facility policy titled, Transdermal Drug Delivery System Patch Application, revised July 2024, showed:- Remove the old patch from the body;- Wear gloves when handling patches;- Rotate patch application sites to prevent irritation;- Dispose of patches appropriately. 1. Review of Resident #11's medical record showed:- admitted on [DATE];- Diagnosis of chronic pain. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a safe environment during smoking by not providing adequate supervision while smoking and failed to complete smoking assessments at least quarterly for one resident (Resident #7) out of four residents. The facility census was 39. Review of the facility's policy titled, Facility Smoking Policy and Procedure, undated, showed:- Purpose: To set guidelines and safety standards for residents who smoke;- Policy: A smoking assessment will be completed on admission for each resident who smokes to determine if they are capable of safely smoking unsupervised. The facility will also perform the same assessment, quarterly or as needed for change of condition to ensure those residents who smoke unsupervised are able to do so safely;- The facility will provide a staff member to supervise during scheduled smoking times. [...]

Inspectors wroteBased on interview and record review, the facility failed to identify, assess, and provide supportive interventions for one resident (Resident #7) with a diagnosis of post-traumatic stress disorder (PTSD - a mental health condition triggered by a terrifying event - either experiencing it or witnessing it; symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event) out of one sampled resident. The facility census was 39. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary behavioral health services and implement effective behavioral interventions for one resident (Resident #7) out of one sampled resident reviewed for behavioral health needs. The facility failed to assess, monitor, care plan, and intervene for ongoing verbally aggressive, disruptive, and maladaptive behaviors that affected other residents and staff. The facility census was 39. Review of the facility policy titled, Behavioral Assessment, Intervention, and Monitoring, revised February 2025, showed the facility would identify behavioral symptoms, evaluate the severity and safety risks of behaviors, develop individualized interventions, monitor the effectiveness of interventions, and document changes in resident behavior. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow enhanced barrier precautions (EBP - precautions for use during high-contact resident care activities for residents infected with a multidrug-resistant organism (MDRO - microorganisms that are resistant to one or more classes of antimicrobial agents) or any resident who has a chronic wound and/or indwelling medical device) for two residents (Residents #6 and #9). The facility also failed to perform hand hygiene and change gloves during wound care for one resident (Resident #6) out of four sampled residents and during medication administration for one resident (Resident #11) out of 12 sampled residents. The facility census was 39. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program to control the fly population in the facility. This deficient practice had the potential to affect all residents. The facility census was 39. Review of the facility's policy titled, Pest Control, dated May 2008, showed:- Our facility shall maintain an effective pest control program;- This facility maintains an on-going pest control program to ensure the building is kept free of insects and rodents. Review of the facility's pest control invoice, dated 04/23/26, showed:- Services did not target flies;- An exit door didn't close/seal properly and required installation of weather stripping. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide showers for one resident (Resident #1) out of four sampled residents. The facility's census was 39 Review of facility's policy titled, Bath, Shower/Tub dated 2001, showed: - The purpose of this procedure is to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. Resident will have bath/shower per their request; - Documentation: the date, time the shower/tub bath was performed; name and title of who performed shower/tub bath; all assessment data (skin assessment) obtained during shower/tub bath; If resident refused the shower/tub bath and reasons; Notify supervisor if the resident refuses the shower/tub bath with reasons. Review of Resident #1's medical record showed: - An admission date of 02/04/25; [...]

Inspectors wroteBased on interview and record review, the facility failed to follow their policy and procedure to complete Criminal Background Checks (CBC) for four of the ten sampled staff prior to hire and to check the Nurses Aide (NA) Registry for all new staff before the employment date to ensure they did not have a Federal Indicator (a marker given by the federal government to individuals who have committed abuse/neglect) for seven of the ten sampled staff. The facility census was 37. Review of the facility's policy titled, Abuse Prevention, dated September 2021, showed: - Background checks will be done at the time of hire in accordance with the facility background check policy. Staff will not be hired who have been found guilty, or plead nolo contendere (a plea of no contest) of abuse, neglect, mistreatment of residents, or misappropriation of resident property by a court of law. [...]

Inspectors wroteBased on interview and record review, the facility failed to implement an accurate baseline care plan (the minimum healthcare information necessary to properly care for a resident) upon admission with specific interventions for one resident (Resident #191) out of one sampled resident. The facility census was 37. Review of the facility's policy titled, Care Plans - Baseline, revised March 2022, showed: - A baseline plan of care is developed for each resident within 48 hours of admission to meet the resident's immediate health and safety needs; - The baseline care plan includes instructions needed to provide effective, person-centered care of the resident that meet professional standards of quality care; - The resident and/or representative are provided a written summary of the baseline care plan that includes, but not limited to: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement a care plan with specific interventions to meet individual needs for four residents (Residents #4, #5, #12, and #38) out of 12 sampled residents. The facility census was 37. Review of the facility's policy titled, Care Plans - Comprehensive, revised September 2010, showed: - An individualized comprehensive care plan that includes measurable timetables to meet the resident's medical, nursing, mental, and psychological needs is developed for each resident; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician's orders for oxygen (O2) for two residents (Residents #3 and #14) out of three sampled residents and wound care for one resident (Resident #5) out of three sampled residents. The facility's census was 37. Review of the facility's policy titled, Oxygen Administration, dated October 2010, showed: - The purpose of the procedure is to provide guidelines for safe oxygen administration; - Verify that there is a physician's order for this procedure; - Review the the physician's orders or facility's protocol for oxygen administration; - Review the resident's care plan to assess for any special needs of the resident; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a physician's order for a house supplement recommendation by the registered dietician (RD) and failed to ensure the RD completed a nutritional assessment due to significant weight loss for four residents (Residents #4, #24, #34 and #38) out of four sampled residents. The facility census was 37. Review of the facility's policy titled, Monthly Dietary Consultant Report, undated, showed: - A report of RD activities shall be made in writing or completed electronically and provided to the facility in hard copy or electronic format at the close of each consultation; - The monthly consultant report is to: [...]

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 two out of two sampled medication carts. This practice had the potential to affect all residents. The facility census was 37. Review of the facility's policy, titled, Controlled Substances, revised November 2022, showed: - Controlled substance inventory is monitored and reconciled to identify loss or potential diversion in a manner that minimizes the time between loss/diversion and detection/follow-up; - Nursing staff count controlled medication inventory at the end of each shift, using these records to reconcile the inventory count; [...]

Inspectors wroteBased on interview and record review, the facility failed to monitor the drug regimen for unnecessary medications by not ensuring the as needed (PRN) psychotropic (medications that affect a persons mental state) medication orders were limited to 14 days unless specific duration and clinical rationale were provided for one resident (Resident #18) out of five sampled residents and one resident (Resident #19) outside the sample. The facility failed to ensure a gradual dose reductions (GDR) was attempted for four residents (Residents #7, #14, #18 and #24) out of five sampled residents. The facility failed to ensure an appropriate diagnosis for the use of a psychotropic medication for one resident (Resident #24) out of five sampled residents. The facility census was 37. Review of the facility's policy titled, Tapering Medications and Gradual Drug Dose Reduction, revised July 2022, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement Enhance Barrier Precautions (EBP) during wound care for two residents (Resident #5 and #191) out of three sampled residents and one resident (Resident #12) outside the sample. The facility census was 37. Review of the facility's policy titled, Enhanced Barrier Precautions, reviewed March 2024, showed: - Enhanced barrier precautions are utilized to reduce the transmission of multi-drug resistant organisms (MDROs) to residents; - EBPs employ targeted gown and glove use in addition to standard precautions during high contact resident care activities when contact precautions do not otherwise apply; - Examples of high-contact resident care activities requiring the use of gown and gloves for EBPs include: a. dressing; b. bathing/showering; c. transferring; d. providing hygiene; e. changing linens; f. [...]

Inspectors wroteBased on interview and record review the facility failed to develop and implement comprehensive care plans in seven days after completion of the comprehensive assessment and no more than 21 days after admission to properly care for two residents (Residents #1 and #2) out of five sampled residents. The facility census was 36. Review of the facility policy, Care Plans; Comprehensive Person Centered, dated March 2022, showed: - A comprehensive person-centered care plan that includes measurable objectives and timetable to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident; - The comprehensive person centered care plan is developed within seven days after completion of the required Minimum Data Set (MDS) (a federally mandated assessment instrument completed by facility staff), and no more than 21 days after admission; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician's orders for four residents (Resident #1, #2, #3, and #5) out of five sampled residents. The facility census was 39. The facility did not provide a policy. 1. Review of Resident #1's medical record showed: - An admission date of 11/16/23; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the dumpster was maintained to keep pests out and/or to keep the garbage contained in the dumpster. This failure had the potential to affect all residents. The facility census was 35. Review of the facility's policy titled, Food-Related Garbage and Refuse Disposal, revised October 2017, showed the outside dumpsters provided by the garbage pickup services will be kept closed and free of surrounding litter. 1. Observations on 01/08/24 at 11:00 A.M., 01/09/24 at 10:45 A.M., 01/10/24 at 2:00 P.M., and 1:53 P.M., and 01/11/24 at 9:03 A.M., of the outside trash dumpster located near the kitchen entrance showed one 6-yard (yd.) dumpster partially filled with the one plastic lid completely opened. [...]

Inspectors wroteBased on interview, and record review, the facility failed to document a complete and accurate Minimum Data Set (MDS, a federally mandated assessment to be completed by the facility) for two residents (Resident #3, and #18) out of 12 sampled residents. The facility's census was 35. Review of the facility's Resident Assessment policy, revised March, 2022, showed: - The resident assessment coordinator is responsible for ensuring that the interdisciplinary team conducts timely and appropriate resident assessments and reviews; - A comprehensive assessment includes a completion of the MDS. 1. Review of Resident #3's medical record showed: - An admission date on 07/17/23; [...]

Inspectors wroteBased on interview, and record review, the facility failed to implement care plans with specific interventions tailored to meet individual needs for three residents (Resident #2, #9, and #28) out of 12 sampled residents. The facility census was 35. Review of the facility's policy titled, Care Plan, revised 03/2022, showed: - A comprehensive, person centered care plan includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs and is developed and implemented for each resident; - Builds on the resident's strength; - Reflects currently recognized standards of practice for problem areas and conditions. 1. Review of Resident #2's medical record showed: - admitted on [DATE]; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a physician's order and failed to complete a resident assessment and safety evaluation for the use of a trapeze (a device designed to assist residents in changing positions) for one resident (Resident #27) out of one sampled resident. The facility census was 35. The facility did not provide a policy regarding trapeze use. 1. Review of Resident #27's Physician's Order Sheet (POS), dated January 2024, showed: - admission date of 08/31/22; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician's orders for two residents (Resident #18 and #27) out of 12 sampled residents. The facility census was 35. The facility did not provide a policy related to following physician's orders. 1. Review of Resident #18's Physician Order Sheet (POS), dated January 2024, showed: - Diagnoses of benign prostatic hyperplasia (BPH) (enlargement of the prostate causing difficulty in urination), hearing loss, and obstructive uropathy (disorder of the urinary tract that occurs due to obstructed urinary flow); - An order to change the Foley catheter (a tube inserted into the bladder to drain urine) size 16 french with 10 milliliter (ml) balloon monthly (on the 19th) and as needed for obstructive uropathy, dated 09/23/22; - An order to change hearing aid batteries every Friday, dated 03/24/23. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess residents for the use of bed rails prior to installation and use nor did they obtain informed consent from the resident or if applicable, the resident representative for two residents (Resident #18 and #27) out of 12 sampled residents. The facility's census was 35. Review of the facility's policy titled, Bed Safety and Bed Rails, revised August 2022, showed: - The resident's sleeping environment is evaluated by the interdisciplinary team; - Bed frames, mattresses, and bed rails are checked for compatibility and size; - Bed dimensions are appropriate for resident's size; - The use of bed rails or side rails is prohibited unless the criteria for the use if bed rails have been met, including attempts to use alternatives, interdisciplinary evaluation, resident assessment, and informed consent.; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to post the nurse staffing data with all the required components in a clear and readable format in a prominent place readily accessible to residents and visitors on a daily basis. The facility's census was 35. The facility did not provide a nurse staffing policy. Observations of the facility showed: - On 01/08/24 at 11:45 A.M., and 2:30 P.M., no documentation of the nurse staffing posted; - On 01/09/24 at 9:10 A.M., and 1:05 P.M., no documentation of the nurse staffing posted; - On 01/10/24 at 10:30 A.M., no documentation of the nurse staffing posted. During an interview on 01/10/24 at 10:30 A.M., Registered Nurse (RN) A said the nurse staffing sheets were completed and placed into the hanging folder on the door across from the nurse's station. The nurse staffing sheets were not visible to the residents or visitors. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the pharmacy consultant identified an appropriate diagnosis for the use of an antipsychotic (a medication used to treat psychosis or the loss of connection to reality) medication during the pharmacist's monthly Medication Regimen Review (MRR) for three residents (Resident #2, #9, and #18) out of three sampled residents. The facility's census was 35. Review of the facility's policy titled, Antipsychotic Medication Use, revised July 2022, showed: - Residents will only receive antipsychotic medications when necessary to treat a specific condition for which they are indicated and effective; - The attending physician and other staff will gather and document information to clarify a resident's behavior, mood, function, medical condition, specific symptoms, and risks to the resident and others; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the appropriate diagnosis for the use of an antipsychotic (a medication used to treat psychosis or the loss of connection to reality) medication for three residents (Resident #2, #9, and #18) out of three sampled residents and failed to limit the use of an as needed (PRN) psychotropic (a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system) medication to 14 days or to document the rationale for extending the order for three residents (Resident #2, #14, #25) out of 12 sampled residents during the pharmacist's monthly Medication Regimen Review (MRR). The facility's census was 35. Review of the facility's policy titled, Antipsychotic Medication Use, revised July 2022, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide information and education to the resident or the resident's representative of the pneumococcal (any infection caused by bacteria called Streptococcus pneumoniae, or pneumococcus) and influenza (a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs) vaccines, and offer the pneumococcal and influenza vaccines to four residents (Resident #2, #3, #18, and #22) out of five sampled residents. The facility census was 35. Review of the Centers for Disease Control and Prevention (CDC) Pneumococcal Vaccine Timing for Adults, revised on 09/22/23, showed the CDC recommends pneumococcal vaccination for adults [AGE] years old and older and adults 19 through [AGE] years old with certain underlying medical or risk conditions. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure COVID-19 resident vaccinations were offered, administered, or refused by the resident and/or the resident representative for four residents (Residents #2, #3, #18, and #22) out of five sampled residents. The facility census was 35. Review of the facility policy titled, COVID-19 Vaccination of Residents, revised June 2022, showed: - Residents eligible to receive the COVID-19 vaccine are strongly encouraged to do so; - Resident or representative has the right to accept, refuse, and change his/her decision about taking the COVID-19 vaccine; - Resident is provided with education regarding the benefits, risks, and potential side effects associated with the each vaccine and booster; - Residents are screened for contraindications to the vaccine; - Residents must sign a consent to vaccinate form prior to receiving the vaccine; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the required annual competencies of dementia care (care of a resident with an impaired ability to remember, think, or make decisions) or the abuse and neglect training and 12 hours of training for two Certified Nurse Aides (CNA) (CNA B and CNA C) out of two sampled CNAs, which had the potential to affect all residents. The facility's census was 35. The facility failed to provide a policy regarding the required annual nurse aide training. 1. Review of CNA B's in-service record showed: - A hire date of 03/30/20; - No documentation of the annual dementia care training provided for March 2022 through March 2023; - No documentation of 12 hours of training provided for March 2022 through March 2023. 2. Review of CNA C's in-service record showed: - A hire date of 12/12/22; [...]

Inspectors wroteBased on interview and record review, the facility failed to notify one resident's (Resident #1) responsible party after the resident fell and sustained injuries on two separate occasions, one of which resulted in the resident going to the emergency room for evaluation. The facility census was 32. Review of the facility policy titled, Change in Resident's Condition or Status, revised on February 2021, showed the following: -The facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition; -Unless otherwise instructed by the resident, a nurse will notify the resident's representative when: The resident is involved in an accident or incident that results in an injury including injuries of an unknown source; [...]