Jacksonville Health and Rehabilitation, LLC

Inspectors wroteBased on observation, interview, the facility's Dishwashing Machine Temperature Log, the 2022 United States (U.S.) Food and Drug Administration (FDA) Food Code, and the facility's policies for Food Receipt and Storage, Dish Machine Sanitization, Food Preparation Guidelines, and Tray Assembly; the facility failed to ensure food safety by the following: • storing food less than six inches from the floor in the Walk-in Cooler, • having soiled and dusty vent covers over the refrigeration fans in the Walk-in Cooler, • not effectively monitoring and documenting the dishwashing machine's sanitizing final rinse temperature, and • not maintaining the temperature of a pan of Pureed Turkey Sandwiches below 41 degrees Fahrenheit (F). This had the potential to affect all residents receiving meals in the facility, 151 of 151 residents.

Inspectors wroteBased on observations, interviews, and a facility policy titled Preventative Maintenance Strategy the facility failed to provide necessary maintenance services to maintain good repair of equipment and a home like environment. This deficient practice was observed on four of four days of the survey and had the potential to affect residents residing on the 100 hall, one of three halls in the facility.

Inspectors wroteBased on observation, interview, the facility's Diet Guide Sheet for Spring 2023/Week 2/Tuesday/Day 10, and the facility's policy for Cycle Menus; the facility failed to provide a six-ounce portion of Pureed Turkey Sandwich for 8 of 8 pureed meals observed. The facility further failed to provide a full six-ounce portion of Pureed Cream of Broccoli Soup for 5 of 8 pureed meals observed. This had the potential to affect 8 of 20 residents receiving pureed meals during a Supper trayline observation on 09/26/2023.

Inspectors wroteBased on interview and the facility's Tray Service Schedule, the facility had scheduled an excess of 14 hours between the service of the Supper meal and the service of the Breakfast meal. This affected three of three resident units and had the potential to affect all residents receiving meals in the facility, 151 of 151 residents.

Inspectors wroteBased on observation, interviews, a review of the 2017 Food Code, the facility policy titled, Dish Machine Sanitization, the facility's Dish Machine Temperature Log, and the manufacturer's Dish Temp (irreversible thermometer) Calibration Certificate, the facility failed to ensure the dishmachine effectively sanitized dishes following the breakfast meal on 09/17/19. The final rinse water (sanitization) temperatures failed to rise to the minimum recommended temperature of 180 degrees Fahrenheit (F) during 10 of 10 cycles observed. This had the potential to affect 149 residents for whom meals were prepared and served at the time of this survey.

Inspectors wroteBased on observations, interviews, medical record reviews and review of a facility policy titled, Hand Hygiene, the facility failed to ensure: 1. a Certified Nursing Assistant (CNA) washed her hands after removing her gloves and before applying clean gloves during and after incontinence care for Resident Identifier (RI) #67 and 2. a CNA changed her gloves and washed her hands after providing incontinence care for RI #139 and before touching the resident's clean brief, bed covers, resident clothing and bed control. These deficient practices affected RI #139 and #67, two of three sampled residents observed for incontinence care. Findings Include: A review of a facility policy titled, Hand Hygiene, with an effective date of September 1, 2017, documented: . III. Hand Hygiene . the primary means of preventing the transmission of infection. [...]

Inspectors wroteBased on observation, interview, record review and a facility policy titled, Person Centered Care Plans the facility failed to implement Resident Indentifer (RI) # 94's nutritional care plan for receiving supplements. This affected one of nine residents whose care plans were reviewed for nutritional concerns during the survey. Findings Include: A review of a policy titled, Person Centered Care Plans with an effective date of 8/15/18, documented: .Person centered plans of care are developed by the interdisciplinary team, to coordinate and communicate care approaches and goals of the resident/guest, consistent with the resident/guest(s) rights . RI #94 was readmitted to the facility on [DATE], with diagnoses to include Parkinson's Disease. A review of RI # 94's Physician Orders dated September 2019, documented the following: .8/30/19 .ensure 1 can with each meal . [...]

Inspectors wroteBased on observation, interview, medical record review and a facility policy titled, Therapeutic Supplements, the facility failed to ensure Resident Identifier (RI) # 94, a resident at risk for weight loss, received an ordered supplement. This affected RI #94, one of nine residents who were sampled for weight loss concerns and who was observed during two meal observations. Findings Include: A review of a policy titled, Therapeutic Supplements with an effective date of 8/10/18, documented: .Resident/Guest(s) may require supplementation of their meal plan in order to attain or maintain acceptable parameters of nutrition .The need for therapeutic supplements should be determined based upon the resident/guest assessment, conducted by the Dietary Manager and the Registered Dietitian . RI # 94 was readmitted to the facility on [DATE], with diagnoses to include Parkinson's Disease. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure Resident Identifier (RI) #196 received all ordered medication from the pharmacy on 5/18/18. This deficient practice was cited as a result of the investigation of complaint # AL00035746 and affected one of one resident. Findings Include: RI #196 was admitted to the facility on [DATE]. Diagnoses included Chronic Obstructive Pulmonary Disease, Adult Failure to Thrive, Anxiety Disorder and Shortness of Breath. On 9/5/18 RI #196's record was reviewed. RI #196's Physician Orders included Lorazepam 2.5 milligrams (anxiety) and Ranexa ER 500 milligrams (heart disease of native coronary artery). The Medication Administration Records (MAR) for 5/18/18 through 5/20/18 were reviewed. The review revealed RI #196 was not given the Lorazepam and Ranexa medications on 5/18/18, as ordered. [...]

Inspectors wroteBased on observation, interview and review of facility policy, Standard Precautions, the facility failed to ensure: 1. A Certified Nursing Assistant (CNA) did not deliver trays to residents on the rehab unit without washing or sanitizing her hands between residents. This was observed on 9/4/18 and affected one of three units, and 2. A Licensed Practical Nurse (LPN) did not remove gloves from her uniform pocket to administer the Albuterol breathing treatment and did not place the vial of the medication in her name tag pouch while preparing Resident Identifier (RI) #92 and the nebulizer machine. This was observed on 9/5/18 and affected one of five nurses observed for medication pass. Findings Include: A review of a facility policy titled, Standard Precautions, with an effective date of 11/16 16 revealed, Purpose: [...]

Inspectors wroteBased on observation and interview, facility failed to ensure nurse staff posting was posted on two of three days of the survey. This had the potential to affected 141 of 141 residents. Findings Include On 9/04/18 at 5:30 PM, the Nurse Staff Posting was observed not posted for the evening shift. The day shift was the only posted shift on the sheet. On 9/06/18 at 7:26 AM, the Nurse Staff Posting was observed. Staffing was posted from 9/5/18, no staffing posted for the 9/6/18 day shift. On 9/06/18 at 7:30 AM, Nurse Staff Posting was posted. On 9/06/18 at 3:43 PM, an interview was conducted with Employee Identifier (EI) #1, Director of Nursing. EI #1 was informed of the 9/4 evening staffing not observed posted by the surveyors upon entering the facility on 5:30 PM. EI #1 was asked why the staff posting was not posted by that time. EI #1 replied, she did not know why. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure two of three dumpster doors were closed, plastic bags were not hanging from two of the dumpster's and gloves and a milk carton were not laying on the ground outside of the dumpster's. The facility further failed to ensure the dumpster's were well maintained and did not have a broken door. This was observed on 9/4/18 and had the potential to affect 141 of 141 residents. Findings Include: On 9/04/18 at 5:15 PM, the surveyor observed three dumpster's. Two of the three dumpster's had doors that were not closed. Plastic bags were also observed hanging out of these two dumpster's, latex gloves were lying on the ground outside of the one dumpster, with the open door and a milk carton was lying on the ground. [...]