Life Care Center of Hendersonville

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure Registered Nurse (RN) coverage was provided for at least 8 consecutive hours per day for 5 of 6 days reviewed (Dates 02/01/25, 02/02/25, 02/09/25, 03/01/25, and 03/02/25).

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to discard expired milk in 1 of 1 walk-in cooler; label and date a food item in 1 of 1 walk-in freezer; label and date open food items and store food off the floor in 1 of 1 dry storage room; maintain a clean and sanitary ice machine for 1 of 2 ice machines; and maintain a clean and sanitary refrigerator in 1 of 2 nourishment rooms (500/600 hall nourishment refrigerator).

Inspectors wroteBased on observations, record review, and interviews with the Registered Dietitian (RD) and staff, the facility failed to follow the physician's diet order to provide double portions (Resident #10) and nutritional supplements (Resident #54) for 2 of 4 residents reviewed for nutrition (Resident #10 and Resident #54).

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to follow their infection control policy and procedure to implement Enhanced Barrier Precautions (EBP) for a resident with a diabetic foot ulcer (Resident #10) and failed to wear a protective gown during tracheostomy care (a surgical opening in the neck), and a dressing change for an endoscopic gastrostomy (feeding tube) for a resident on EBP (Resident #3). Additionally, the facility failed to follow their hand hygiene policy and procedure to remove gloves and perform hand hygiene when a soiled dressing was changed from around a feeding tube (Resident #3). The deficient practice occurred for 1 of 3 staff members observed for infection control practices (Treatment Nurse).

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure daily nurse staffing sheets accurately reflected the nursing staff who worked for 4 of 6 days reviewed (02/01/25, 02/02/25, 02/09/25, and 03/02/25).

Inspectors wroteBased on staff and Physician Assistant (PA) interviews and record review, the facility failed to notify the Physician or Physician Assistant (PA) about a newly identified pressure ulcer for 1 of 4 residents reviewed (Resident #3).

Inspectors wroteBased on record review, and staff and Physician Assistant (PA) interviews, the facility failed to complete weekly skin assessments and comprehensive assessments including measurements of newly identified pressure ulcer and failed to obtain treatment orders which resulted in no treatment being completed for five days for 1 of 4 residents reviewed for pressure ulcers (Resident #3).

Inspectors wroteBased on observation, staff interviews and record reviews, the facility failed to remove an opened eye medication from the medication cart as specified by manufacturer's guidelines and failed to discard expired antiseptic wound care solutions from another medication cart in accordance with the manufacturer's expiration date for 2 of 5 medication carts observed during medication storage checks (200 halls and 600 halls).

Inspectors wroteBased on record review and staff interviews, the facility failed to complete a comprehensive Minimum Data Set (MDS) assessment within 14 days of the Assessment Reference Date (abbreviated as ARD and referring to the last day of the assessment period) for 1 of 6 sampled residents (Resident #6).

Inspectors wroteBased on record review and staff interviews, the facility failed to complete quarterly Minimum Data Set (MDS) assessments within 14 days of the Assessment Reference Date (abbreviated as ARD and referring to the last day of the observation period) for 3 of 6 sampled residents (Residents #2, #3, and #5).

Inspectors wroteBased on record review and staff interviews, the facility failed to complete a discharge-return anticipated Minimum Data Set (MDS) within 14 days of the discharge date and an entry tracking record within 14 days of the admission date for 1 of 6 sampled residents (Resident #5).

Inspectors wroteBased on observation, record review and Responsible Party, Physician Assistant, resident and staff interviews, the facility failed to include a resident's transfer status in the comprehensive care plan for staff to safely transfer a resident from the wheelchair to bed resulting in the resident falling to the floor (Resident #44) and failed to transfer a dependent resident from the bed to the wheelchair using a mechanical lift and two-person assistance as indicated on the care plan (Resident #8) for 2 of 3 residents reviewed for accidents and mobility. On the evening of 05/17/24, Nurse Aide #1 attempted to independently transfer Resident #44 to the bed resulting in Resident #44 falling to the floor onto her left side. Upon initial nurse assessment, Resident #44 complained of no pain and had a small topical abrasion to the left elbow with no other obvious injuries identified. [...]

Inspectors wroteBased on observations and staff interviews the facility failed to maintain a clean fan in the food preparation area of 1 of 1 kitchen; maintain clean walls and a clean ceiling in 1 of 1 walk-in cooler; label and date open food items, discard expired food, and discard food with signs of spoilage in 1 of 1 walk-in cooler; date milkshakes to identify their use-by date in 1of 1 walk-in cooler; date an opened food item in 1 of 1 walk-in freezer; discard expired food items in 1 of 1 kitchen; and ensure food and beverage items were labeled and dated and date milkshakes to identify their use-by date in 2 of 2 nourishment rooms (activity room refrigerator and 500/600 hall). These practices had the potential to affect food served to the residents.

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code Minimum Data Set (MDS) assessments in the areas of falls, functional limitation in range of motion, anticoagulant (blood thinner) use, weight loss, colostomy status, and bowel incontinence for 5 of 18 sampled residents (Residents #44, #17, #2, #7, and #13).

Inspectors wroteBased on record review, observations, and interviews with staff the facility failed to date two open and in use bottles of medicated eye drops being stored at room temperature on 1 of 4 medication carts (Hall 400 med cart) and failed to date three in use multi-dose vials of tuberculin purified protein derivative (a diagnostic antigen used in testing for tuberculosis) and failed to remove expired medications and influenza vaccines from 2 of 2 medication room refrigerators (medication room for halls 200, 300, 400, 500, and 600) reviewed for medication storage and labeling. Findings revealed: a. Review of manufacturer's package insert for latanoprost eye drops read in part, store unopened bottle(s) under refrigeration at 36 to 46°F. Once it was opened for use, it may be stored at room temperature for 6 weeks. [...]

Inspectors wroteBased on observation of the meal service tray line, record review, and Registered Dietician and dietary staff interviews the facility failed to provide all food items as specified by the planned menu for residents receiving a pureed (foods that have a smooth consistency and don't have to be chewed) diet. This practice had the potential to affect 6 of 6 residents receiving a pureed diet.

Inspectors wroteThe facility failed to ensure the physician's order for an advanced directive matched the medical orders for scope of treatment (MOST) form signed by the resident's family for 1 of 18 residents (Resident #270) reviewed for advanced directives.

Inspectors wroteBased on record review, observations, and interviews with staff, the facility failed to provide oral hygiene assistance for a dependent resident with visibly dirty dentures and teeth for 1 of 11 residents reviewed for activities of daily living (Resident #64).

Inspectors wroteBased on observations, record review, Registered Dietitian, Physician Assistant, and staff interviews, the facility failed to follow a physicians order to administer the correct amount of a high protein, fiber fortified nutritional supplement as recommended by the Registered Dietitian for 1 of 2 residents reviewed for tube feeding (Resident #15).

Inspectors wroteBased on record review, observations, and staff and resident interviews the facility failed to honor food preferences for 1 of 3 residents reviewed for food preferences (Resident #9).

Inspectors wroteBased on observations and resident and staff interviews, the facility failed to offer and provide nighttime snacks for 3 of 4 sampled residents (Residents #2, #9 and #44).

Inspectors wroteBased on observations and interviews with staff, the facility failed to dispose of trash and keep the area surrounding the dumpster free of debris for 1 of 2 dumpsters reviewed.

Inspectors wroteBased on record review and staff interviews, the facility failed to follow their COVID-19 testing policy and the nationally recognized standard to test residents and staff immediately, but not earlier than 24 hours after the exposure, for 4 of 4 residents (Resident #12, Resident #56, Resident #59, Resident #60) and 5 of 5 staff members who tested positive for COVID-19 (Nurse Aide #2, Nurse Aide #6, Nurse Aide #7, Nurse #3, and Receptionist #1) and were identified through contract tracing as having close contact.

Inspectors wroteBased on record review and staff, Consultant Pharmacist, and Medical Director interviews, the facility failed to follow-up on the monthly pharmacist consultation reports for 2 of 5 residents reviewed for unnecessary medications (Residents #32 and #27).

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to ensure foods were dated after opened and failed to ensure thickened liquids were discarded prior to the use by date after being opened. These failures occurred in 1 of 1 walk-in refrigerator and 1 of 2 nourishment room refrigerators (500/600 Hall).

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to implement their policy for Personal Protective Equipment (PPE) when 2 of 2 staff members (Health Information Manager and Nurse Aide #7) failed to don N95 masks and goggles or faceshield before entering and change facemasks upon exiting 2 of 2 resident rooms who were positive for COVID-19.

Inspectors wroteBased on observations, record review, and resident and staff interviews the facility failed to assess the ability of a resident to self-administer medications for 1 of 1 resident reviewed for self-administration of medication (Resident #27).

Inspectors wroteBased on observations, record review, and interviews with staff, the facility failed to ensure the comprehensive care plan was updated in the area for the use of palm guards for 1 of 1 resident reviewed for limited range of motion (Resident #15).

Inspectors wroteBased on observations, record review, and interviews with Family Members, residents, and staff the facility failed to provide oral hygiene assistance for 2 of 8 dependent residents reviewed for activities of daily living (Resident #20 and #41).

Inspectors wroteBased on record review, observations, and interviews with the Medical Director and staff the facility failed to monitor the water flush settings on the feeding pump to ensure those were consistent with the physician's order as transcribed on the Medication Administration Record to flush 23 milliliters every hour for 1 of 1 resident reviewed for tube feeding (Resident #15).

Inspectors wroteBased on observations and staff interviews, the facility: 1) failed to ensure personal care equipment was labeled and covered and a bathroom was clean that had a strong odor of urine for 3 of 22 resident bathrooms (Rooms 501, 510 and 305) and 2) failed to maintain a homelike environment in 1 of 12 resident rooms observed to have debris and stains on the floor (room [ROOM NUMBER]). This deficient practice affected 2 of 5 resident halls (300 and 500 Halls).

Inspectors wroteBased on record review and staff interviews the facility failed to complete a recapitulation of stay for 3 of 4 closed records reviewed for discharge (Resident #264, Resident #63, and Resident #61).