Macon Health Care Center

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident (Resident #1), in a review of three sampled residents, did not leave the facility without staff knowledge. Further review showed the facility had not addressed the resident's history of exit seeking and had not ensured effective interventions were put in place that all staff were aware of both before and after the resident's elopement. The census was 51. Review of the facility policy, Elopement Prevention and Response Policy, dated 04/07/25, showed the following: -The facility is committed to ensuring resident safety through vigilant prevention, monitoring and timely intervention related to elopement and exit-seeking behaviors. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and prepare food in accordance with professional standards for food service safety. Staff failed to discard food that was expired or showed visible signs of deterioration and failed to label and date food items. Staff failed to shield lights located in food storage areas. The facility failed to ensure sanitary practices when staff failed to ensure tableware was protected from moisture, debris, and other contaminants and failed to ensure surfaces, such as ceiling vents and ice machines, were clean to prevent potential contamination. Staff failed to ensure hygienic practices when preparing and serving food and beverages to residents and employ proper hand hygiene, hair restraint usage, and surface sanitization practices. The facility census was 34. [...]

Inspectors wroteBased on observation, interview, and record review ,the facility failed to develop a policy to address Legionella Control that included specific control parameters based on Center for Disease Control (CDC) and American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) standards and failed to complete a facility assessment to identify potential sources of Legionella growth (started but not completed). The facility's water management team had not had a meeting, and the facility's water flow map was not completed and did not implement the facility's Legionnaire Disease (severe pneumonia like infection caused by contaminated water) policy that instructed staff how to monitor residents for Legionnaire's disease. [...]

Inspectors wroteBased on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS), a federally mandated assessment completed by staff, according to the Resident Assessment Instrument (RAI) manual for two sampled residents (Resident #22 and #185) in a review of 13 sampled residents and one additional resident (Resident #32). The facility census was 34. Review of the Resident Assessment Instrument Manual, dated October 2019, showed the following: -Code question N0410B, Antianxiety: Record the number of days an anxiolytic medication was received by the resident at any time during the 7-day look-back period (or since admission/entry or reentry if less than 7 days). -Code question N0410D, Hypnotic: [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a baseline care plan consistent with the resident's specific conditions, needs and risks to provide effective person centered care that met professional standards of quality care within 48 hours of admission to the facility for one resident (Resident #185), in a review of 13 sampled residents and two closed record residents (Resident #32 and #35). The facility census was 34. Review of the facility's undated policy for Baseline Care Plans showed the following: -Baseline care plans will be completed on all residents upon admission within 48 hours of admission; -All problems, goals, and interventions will be reviewed and replaced by a comprehensive care plan within 21 days of admission. [...]

Inspectors wroteBased on interview and record review, the facility failed to update interventions in the resident's care plan to reflect current care needs for two residents (Resident #2 and #14) in a sample of 22 residents. The facility census was 34. Review of the facility's undated policy for Care Plans showed the following: -Our facility's Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs is developed for each resident; -Care Plan interventions are designed after careful consideration of the relationship between the resident's problem areas and their causes. When possible, interventions address the underlying sources of the problem areas, rather than addressing only symptoms or triggers; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure facility staff provided one resident (Resident #2), the necessary care and services to maintain good personal hygiene and prevent body odor. Additionally, the facility failed to provide and one resident (Resident #14), in a sample of 13 residents, the necessary feeding assistance to ensure adequate consumption of meals. The facility census was 34. Review of the facility's undated policy, Peri care, showed the following: -Perineal care is provided to clean the perineum and provide comfort; -Wash and Rinse areas well, starting with the inner most area and moving to the outer most area. Wash legs if urine came into contact with any portion of them. Review of the facility's policy, Patient Care Policies, revised 02/2023, showed the following: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff transported residents in wheelchairs utilizing the foot rests for two residents (Resident #2 and #185), and failed to ensure a proper gait belt transfer for one resident (Resident #14), in a sample of 22 residents. The census was 34. Review of the facility's Wheelchair Transportation and Leg Rests Policy, dated 12/07/22, showed the following: -The primary objective of this policy is to ensure the safe and efficient transportation of residents in wheelchairs within the skilled nursing home premises; -Leg rests are provided to enhance resident comfort and provide proper support for their legs and feet and they should be adjusted to the resident's height and comfort level; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure nursing staff performed acceptable infection control practices to prevent contamination of respiratory equipment according to facility policy, when staff failed to protect the mask of a continuous positive airway pressure (CPAP) (machine that uses a hose connected to a mask or nosepiece to deliver constant and steady air pressure to help you breathe while you sleep) device when not in use, and left the CPAP machine and mask on the floor for one resident (Resident #19) in a review of two residents with respiratory devices. The facility failed to change and document oxygen tubing and ensure proper infection control was utilized according to facility policy for three residents (Resident #2, #11 and #19) and one additional resident (Resident #10) in a sample of 13 residents. The facility census was 34. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure physician's orders for as needed (PRN) psychotropic medications were limited to 14 days for three residents (Resident #2, #12 and #30), in a review of 13 sampled residents, and one additional sampled resident (Resident #10) unless otherwise indicated by the physician. The facility failed to identify use of psychotropic medications without an indication for use for one sampled resident (Resident #185), when one of his/her medications, quetiapine (an antipsychotic medication), was contraindicated for use in resident's with dementia. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure insulin pens were labeled when opened for two residents (Resident #28 and #31 ), in a review of 13 sampled residents and one additional resident (Resident #16 ). The facility census was 34. Review of the undated, facility Insulin Policy, showed it did not provide direction to staff regarding the labeling of insulin pens when opened. Review of the manufacturer's information for Humalog insulin suggests after opening a vial or pen of Humalog, throw away an opened vial or pen after 28 days of use, even if there is insulin left in the vial. 1. Review of Resident #16's [DATE] physician's orders (POS), showed an order for Humalog (fast acting insulin) KwikPen 100 units/milliliter (ml), give 12 units subcutaneously (SQ) four times a day. [...]

Inspectors wroteBased on interview and record review, the facility failed to follow an antibiotic stewardship program as part of their infection prevention and control program that included antibiotic use protocols and a system to monitor antibiotic use. The facility census was 34. Review of the facility's policy, Antibiotic Stewardship, showed the following: -The facility is committed to encouraging appropriate use of antibiotics; -Record all antibiotics used in the facility on a patient by patient basis. (dose, duration, indication); -Report the culture reports, antibiotic use to treat the infection, and outcome of treatment; -Obtain antibiogram for the region from the reference laboratory and provide it at the nurse's stations and provide a copy to each provider; -Use Interact tools (SBAR) to communicate resident change in condition to the provider; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide pneumococcal (lung inflammation caused by bacterial or viral infection) vaccine for two residents (Resident #2, and #235), in a review of five sampled residents, or provide education for refusal of vaccine for one resident (Resident #30). The facility census was 34. Review of the facility's policy, Pneumococcal Vaccine, updated January 2023 showed the following: -The best way to prevent pneumococcal disease is by getting vaccinated; -Two pneumococcal vaccines are recommended for adults: -Pneumococcal conjugate vaccine (PCV15, PCV20); -Pneumococcal polysaccharide vaccine (PPSV23); [...]

Inspectors wroteBased on interview and record review, facility staff failed to implement interventions to promote healing for one resident (Resident #32), of two sampled closed records, at risk for pressure ulcer development after the resident returned to the facility from an acute hospital stay with pressure ulcers. Staff also failed to complete timely skin assessments as directed to monitor for improvement or decline of the pressure ulcers for two residents (Resident #32 and #35) and complete accurate documentation regarding Resident #35's skin. The facility census was 34. Based on interview and record review facility staff failed to complete timely skin assessments as directed to monitor for improvement or decline of pressure ulcers for two closed record residents (Resident #32 and #35) and complete accurate documentation regarding one resident's (Resident #35) skin. The facility census was 35. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure interventions added by the Registered Dietitian (RD) were acted upon for one resident (Resident #22) in a sample of 13 residents, who had a 10.63 percent (%) weight loss the month prior. The facility census was 34. Review of the facility's Protocols related to Nutrition Interventions, dated February 2023, showed the following: -The Nutrition Intervention Program (NIP) as set forth by the NHC Clinical Resource/Best Practice Guidelines for Dietary Services is available to allow residents the highest practicable level of nutritional care through aggressive intervention. NIP Fortified Foods, oral nutrition supplements, house supplement and house protein supplement are four types of nutritional interventions; -NIP Fortified Foods: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow professional standards of practice for 14 residents (Residents #2, #7, #14, #17, #21, #26, #27, #29, #34, #39, #44, #45, #248, and #297), in a review of 16 sampled residents and five additional residents. The facility failed to obtain weights upon readmission per facility protocol for Resident #27 who presented with a significant weight loss; failed to obtain physician orders for oxygen and failed to confirm gastrostomy tube (a tube inserted through the belly that brings nutrition directly to the stomach) placement prior to administering his/her feeding for Resident #44; failed to follow the facility's protocol following a fall for Resident #39; failed to follow up on physician recommendations to discuss a reduction in psychotropic medication use with Resident #2; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff washed their hands after each direct resident contact and when indicated by professional standards of practice during personal care for four residents (Residents #14, #21, #26, and #297), in a review of 16 sampled residents. The facility certified census was 48. 1. Review of the facility's undated policy Infection Control Guidelines for all Nursing Procedures showed the following: -Standard precautions will be used in the care of all residents in all situations regardless of suspected or confirmed presence of infectious diseases. Standard precautions apply to blood, body fluids, secretions and excretions, regardless of whether or not they contain visible blood, no-intact skin, and/or mucous membranes. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure care plans for two residents (Residents #39 and #297), in a review of 16 sampled residents, included interventions and approaches to address the residents' care needs. The certified facility census was 48. 1. Review of facility's undated policy, Care Plans, showed the following: -Assessments of residents are ongoing and care plans are revised as information about the resident and the resident's condition change; -The care planning/interdisciplinary team is responsible for the review and updating of care plans. 2. Record review of Resident #297's admission skin assessment, dated 11/7/19 at 6:11 P.M., showed the following: -The resident was not at risk for developing pressure ulcers; -An open/red area on left buttock 2 centimeters (cm) by 2 cm; -Rash on right and left buttock and groin area; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide necessary services to maintain personal and oral hygiene for two residents (Residents #14 and #21), who were unable to carry out their own activities of daily living (ADLs), in a review of 16 sampled residents. The facility certified census was 48. 1. Review of the facility's policy on mouth care, revised October 2010, showed the purpose of the procedure was to keep the resident's lips and oral tissues moist, to cleanse and freshen the resident's mouth, and to prevent infections of the mouth. 2. Review of the Nurse Assistant in a Long-Term Care Facility manual, revised 2001, showed the following: -Oral hygiene: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to notify the physician and obtain a treatment to treat a Stage II pressure ulcer (partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed, without slough) identified on admission for one resident (Resident #249), in a review of 16 sampled residents. The facility failed to document the details of the pressure ulcer (type, stage, measurements, etc) according to facility policy, and to provide documentation of daily monitoring. An open area was also identified on 11/20/19. Nursing staff did not assess the resident's skin until 11/21/19. Staff identified the area as a pressure ulcer and applied treatment without obtaining a physician order. The facility identified one resident (Resident #249) with pressure ulcers. The facility certified census was 48. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to maintain urinary catheter (small tubular structure that drains urine from the bladder to the outside of the body) bags and tubing off the floor and below the level of the bladder for two residents (Residents #21 and #35), with indwelling urinary catheters, in a review of 16 sampled residents. The facility identified three residents with urinary catheters. The facility certified census was 48. 1. Review of the facility's policy on catheter care, undated, showed the following: -Maintain indwelling catheters as ordered and prevent catheter associated urinary tract infections; -The urinary drainage bag must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and drainage bag from flowing back into the urinary bladder; [...]