Maggie Valley Health and Rehabilitation Center

Inspectors wroteBased on record review and resident, staff and Regional Business Office Manager interviews, the facility failed to provide residents with access to their personal trust accounts for more than two months for 2 of 2 residents reviewed for management of personal funds (Resident #74 and #12). This practice had the potential to affect 66 residents who maintained trust accounts at the facility.

Inspectors wroteBased on record review and staff interviews, the facility failed to submit a request for a Level II Preadmission Screening and Resident Review (PASRR) evaluation after a new serious mental illness disorder was identified for residents previously determined to have a Level I PASRR status for 2 of 4 residents reviewed for PASRR (Residents #8 and #88).

Inspectors wroteBased on record review and staff interviews, the facility failed to submit a request for a Level II Preadmission Screening and Resident Review (PASRR) evaluation for a resident who was admitted to the facility with a serious mental health disorder for 1 of 4 residents reviewed for PASRR (Resident #27).

Inspectors wroteBased on observations, record reviews, and staff interviews, the facility failed to implement their infection control policies and procedures when Nursing Assistants (NA) #1, NA #2, and NA #3 did not wear required personal protective equipment (PPE) before entering Resident #79's room who was on special droplet contact precautions. This deficient practice was observed for 3 of 6 staff observed for infection control practices (NA #1, NA #2, and NA #3).

Inspectors wroteBased on observations, record review, and interviews with resident, staff, and law enforcement agent, the facility failed to protect a resident's right to be free from abuse when a family member (Family Member #2) pinched and twisted Resident #2's upper right shoulder during a visit. A staff member that intervened at the time of the incident asked Resident #2 if she was okay and Resident #2 started crying and appeared distressed. Resident #2 reported the incident resulted in pain, bruises, and soreness in her right shoulder and right forearm areas. In addition, the facility failed to protect a resident's right to be free from abuse when a family member (Family Member #1) grabbed and pinched Resident #1's right arm during a visit. [...]

Inspectors wroteBased on record review and interviews with staff, the facility failed to ensure staff implemented their abuse policy and procedure in the area of reporting when the facility failed to report an abuse allegation to the State Agency within the specified timeframes and failed to notify the Adult Protection Services (APS). This affected 1 of 3 residents reviewed for abuse (Resident #1).

Inspectors wroteBased on observations, record review, and staff, Nurse Practitioner (NP), and Health Department (HD) Nurse interviews, the facility failed to operationalize updated infection control policy and procedures in accordance with current Centers for Disease Control and Prevention (CDC) guidance. A) The facility failed to implement broad-based approach COVID-19 testing for staff and residents on 12/26/24 when a staff member and residents on two different resident halls tested positive for COVID-19. Broad-based COVID-19 testing per the (CDC) guidance was not implemented until 1/8/24 after surveyor intervention. Before broad-based testing was implemented on 1/8/24, a total of 8 staff members and 17 residents tested positive for COVID-19. Results of the broad-based testing from 1/8/24 and 1/9/24 yielded one (1) staff member and 4 additional residents positive for COVID-19. [...]

Inspectors wroteBased on observations and staff interviews, the facility failed to date medications available for use, store an unopened eye drop bottle in the refrigerator until opened for use, and discard expired medications from 3 of 4 medication carts (400 hall medication cart, 500 hall medication cart, and 200 medication cart).

Inspectors wroteBased on record review, observation, and staff interviews, the facility failed to provide privacy during tube feeding administration for 1 of 1 resident (Resident #80) reviewed for tube feeding. A reasonable person would expect privacy when being provided tube feedings.

Inspectors wroteBased on record review, observations and staff and Consultant Pharmacist interviews, the facility failed to maintain a medication error rate of less than 5% as evidenced by a medication omission and failure to follow a physician order to have the resident their rinse mouth after being given a steroid inhaler (2 medication errors out of 26 opportunities), resulting in a medication error rate of 7.69% for 1 of 3 residents (Residents #19) observed during medication pass.

Inspectors wroteBased on observations and staff interviews, the facility failed to remove an expired nutritional supplement and expired ready-to-eat personal resident food from 2 of 2 nourishment rooms (North and South hall). The deficient practice had the potential to affect residents residing in the facility.

Inspectors wroteBased on record review and staff interview the facility failed to accurately code the Minimum Data Set (MDS) assessment for behaviors (Resident #3), anticoagulant use (Resident #12 and #8) and developmental disability (Resident #72) for 4 of 23 residents whose MDS assessments were reviewed.

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to maintain a medication storage refrigerator within the recommended temperature range for 1 of 2 medication storage refrigerators reviewed (South Medication Storage Room).

Inspectors wroteBased on observations and staff interviews, the facility failed to properly contain refuse and keep the dumpster area free from trash and debris for 3 of 3 dumpsters.

Inspectors wroteBased on staff interview and record review the facility failed to refer residents with a newly identified serious mental health diagnosis for a level II Pre-admission Screening Resident Review (PASRR) for 2 of 6 residents reviewed for PASSR (Resident #49 and Resident #56).

Inspectors wroteBased on observations and staff interviews, the facility failed to post daily staffing census for 1 of 4 days during the recertification and complaint investigation survey.

Inspectors wroteBased on record review, resident interview, Ombudsman interview and staff interview, the facility failed to provide written notice of discharge for residents who were transferred to the hospital to the resident or the resident's representative and the ombudsman for 2 of 3 residents reviewed for hospitalization (Resident #65 and Resident #1).