J G Alexander Nursing Center

Inspectors wroteBased on interview, record review, and resident rights and responsibilities guide review, the facility failed to ensure residents' rights to be informed of and have ready access to the most recent State survey results for all 57 residents residing in the facility during three (3) of three (3) days of survey.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to implement Enhanced Barrier Precautions (EBP) during care for one (1) of two (2) residents reviewed for perineal and catheter care. Resident #7.

Inspectors wroteBased on observation, interview, and record review, the facility failed to notify the physician of a significant change in condition, as evidenced by the facility did not notify the physician of a resident's 33-pound weight loss of 17 percent (%) of total body weight, persistent drowsiness affecting oral intake, and the failure to implement dietary recommendations which delayed necessary medical interventions and contributed to continued weight loss for one (1) of sixteen (16) sampled residents (Resident #45) Cross Reference F692 and F758

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure that a resident did not experience a significant weight loss of over 10% in six months, as evidenced by Resident #45 was observed to be lethargic and was unable to intake appropriate nutrition to sustain weight. Resident #45 did not have Registered Dietitian (RD) interventions implemented when ordered and did not have medications reviewed for one (1) of sixteen (16) sampled residents (Resident #45) Cross Reference F580 and F758

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to ensure that a resident received a Gradual Dose Reduction (GDR) as required for psychotropic medications. Specifically, the resident was prescribed Rexulti and Trileptal for behavioral health needs in April 2024 but had not undergone a GDR for over ten (10) months. Resident #45 exhibited excessive drowsiness, missing multiple meals, and significant weight loss exceeding 10 percent (%) over six (6) months for one (1) of sixteen (16) sampled residents (Resident #45) Cross Reference F580 and F692

Inspectors wroteBased on observations, interviews, and facility policy review, the facility failed to label and date food stored in the refrigerator and freezer and failed to dispose of expired food for one (1) of four (4) days of kitchen observations.

Inspectors wroteBased on observations, interviews, record reviews, and the facility policy review, the facility failed to honor residents' rights and dignity by not honoring requests for a second bed rail as an enabler and by posting signs at the head of the bed related to resident care for three (3) of 16 sampled residents: Resident #5, Resident #39, and Resident #54.

Inspectors wroteBased on observations, interviews, record review and facility policy review the facility failed to maintain a record log of bed rail maintenance for two (2) of 16 sampled residents (Resident #5 and Resident #54). Findings Include: A record review of the facility's policy, Side Rail Policy, dated 06/25/18, revealed, It is the policy of this facility to attempt to use appropriate alternatives prior to installing a side or bed rail. If a side or bed rail is used, the facility will ensure correct installation, use, and maintenance of bed rails . Follow the manufacturer's recommendations and specifications for installing and maintaining rails . A record review of the Zenith Series manual revealed . Recommended Maintenance . Regular maintenance of the Long Term Bed is necessary to ensure continuing proper and safe operations . Inspect all fasteners for wear or looseness every six (6) months . [...]

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to ensure a resident received received necessary behavioral health services to address psychiatric needs and psychotropic medication management. Specifically, the resident was prescribed Rexulti and Trileptal for behavioral health needs in April 2024 but had not been reassessed by a psychiatric provider for ten (10) months which resulted in Resident #45 exhibiting excessive drowsiness, missing multiple meals, and experiencing a significant weight loss of over (10) percent (%) in six months for one (1) of (16) sampled residents. (Resident #45)

Inspectors wroteBased on record review, staff interview, and facility policy review, the facility's Quality Assurance and Performance Improvement (QAPI) committee failed to sustain corrective actions to prevent recurrence of a previously cited deficiency. Specifically, the facility was cited for failing to label and date food stored in the refrigerator and freezer during an annual recertification survey on 8/3/23 and was cited again for the same deficiency during the current survey, demonstrating that QAPI failed to sustain ongoing monitoring and oversight to prevent recurrence for one (1) of nine (9) deficiencies cited. F812 Findings Include: Record Review of the facility's policy Quality Assessment and Performance Improvement (QAPI) Program revised September 2022, revealed, .The facility will .5. [...]

Inspectors wroteBased on observations, interviews, and facility policy review the facility failed to post daily nursing staffing information in a clean and readable format in a prominent place readily accessible to residents and visitors. The postings also failed to include the facility name, date, census, and the total number and actual hours worked per shift for two (2) of four (4) survey days.

Inspectors wroteBased on observation, staff interviews, and facility policy review the facility failed to ensure items in the kitchen refrigerator/freezer were dated and labeled and food items were discarded by the expiration date for one (1) of three (3) dietary observations. Findings Include: Review of the facility's policy, Storing: Food and Equipment, undated, revealed, Policy:Team members must store food in a manner that ensures quality, freshness and safeguards against foodborne illness .Procedure Label .Ensure all food items are labeled . Label information. Each label must contain the following information: Product name .Use-by date. Date the product was prepared or opened . Observation and interview on 7/31/23 at 11:10 AM, during a brief initial tour of the kitchen with the Food Service Director (FSD) revealed the following: 1. Observation of Kitchen refrigerator #1: [...]

Inspectors wroteBased on observations, resident interview, staff interview, record review and facility policy review the facility failed to develop and/or implement the comprehensive care plan related to side effects and behavior monitoring for psychotropic medications and the use of an anticoagulant medication for four (4) of (20) residents care plans reviewed. Resident #19, Resident #33, Resident #35, and Resident #160 Findings Include: Record review of the facility's policy, Develop/Implement Comprehensive Care Plan, undated, revealed, The facility will develop and implement a comprehensive person-centered care plan for each resident .that includes measurable objectives and timeframes to meet the resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment . [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure residents were free from unnecessary medications by failing to monitor resident behaviors and side effects for psychotropic and anticoagulant medication for three (3) of (11) residents reviewed for medications. Resident #33, Resident #35, and Resident #160 Findings Include: A review of the facility's policy, Use of Psychotropic Drugs, (undated), revealed, Policy: Residents are not to be given psychotropic drugs unless the medication is necessary to treat a specific condition, as diagnosed in the clinical record, and the medication is beneficial to the resident, as demonstrated by monitoring and documentation of the resident's response to the medications .Policy Explanation and Compliance Guidelines .9. [...]

Inspectors wroteBased on observation, staff interview, and facility policy review, the facility failed to ensure a medication was securely stored for one (1) of 17 sampled residents. Resident # 10.

Inspectors wroteBased on observation, staff and resident representative interview, record review and facility policy review, the facility failed to ensure a mechanical soft, chopped meat diet was provided for one (1) of five (5) residents observed for dining. Resident #19 Findings Include: Review of the facility's policy, Dental Soft Diet (Mechanical), undated, revealed, . Principle:To use regular foods of a consistency which may be easily chewed and swallowed .Food Groups .Meat, Fish, Fowl .Foods Excluded .Any whole meat . On 7/31/23 at 1:00 PM, during an observation and interview, Resident #19 was sitting up in bed with her lunch meal in front of her on an overbed table. She had a whole chicken patty on a bun on her meal tray and her husband stated that he comes to the facility and assists with feeding her lunch. [...]