Magnolia Healthcare and Rehabilitation Center

Inspectors wroteBased on facility policy review, medical record review, observation and interview the facility failed to ensure the environment was free from accident hazards when sharps were found unattended and unsecured in the shared room of 2 of 82 (Residents #30 and #65) sampled residents observed. 1. Review of the facility's policy titled, Regulated [Biohazard] Medical Waste, dated 6/11/2025, revealed .It is the policy of this facility to ensure that regulated medical waste is managed, handled, stored, and transported as per Federal, State, and local guidance and regulations. Examples of regulated medical waste include.sharp items. Contaminated sharps will be placed in appropriate sharps containers located at the point of use. 2. [...]

Inspectors wroteBased on facility policy review, medical record review, and interview, the facility failed to ensure staff obtained daily weights for 1 of 6 (Resident #16) sampled residents reviewed for nutrition.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to ensure medication was properly stored in 1 of 2 (South Short Hall) medication rooms and in 2 of 82 (Resident #8 and #24) sampled residents' rooms.

Inspectors wroteBased on facility policy review, observation, and interview, the facility failed to ensure food was stored and prepared under sanitary conditions when unlabeled, undated, and expired food items were found stored, an empty soap dispenser was observed at the hand washing station, the inside of the microwave was splattered with dried food particles, the deep fryer had brown oil with food particles floating in it, there was a black build up on the floor, there was dried food particles on a metal pan, a layer of dust on a shelf of the drying rack, and the warming oven had a build up inside the doors. The facility had a census of 82 and 79 of the residents were served from the Kitchen.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to maintain the prevention and spread of infection during wound care, catheter care, and with Enhanced Barrier Precautions for 2 of 4 (Resident #16 and #24) sampled residents reviewed.

Inspectors wroteBased on the Centers for Disease Control and Prevention (CDC) guidelines, policy review, review of Employee Screening logs, employee time sheets and agency invoices, observation, and interview, the facility failed to ensure practices to maintain the spread of infection were maintained when 14 of 67 staff members (Licensed Practical Nurse (LPN) #1, Agency LPN #1, #2, #3, and #4, Certified Nursing Assistant (CNA) #1, #2, and #3, Agency CNA #1, #2, #4, #5 and #6, and Dietary Aide #1) failed to complete screening for the prevention and detection of COVID-19 prior to working on 3 of 3 days (5/28/2022, 5/29/2022 and 6/4/2022) reviewed and when 3 of 4 nurses (Registered Nurse (RN) #1, Agency LPN #5, and #6) failed to perform hand hygiene for 4 of 5 sampled residents (Resident #7, #34, #35, and #375) observed during medication administration. [...]

Inspectors wroteBased on policy review, review of the interdisciplinary Care Plan meeting sign in sheets, medical record review, and interview, the facility failed to ensure residents were involved in developing the Care Plan and making decisions about his or her care and failed to include direct care staff in the Interdisciplinary Care Planning for 3 of 3 sampled residents (Residents #20, #35, and #65) reviewed for Care Plan meetings.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to provide information regarding a resident's right to formulate an Advanced Directive for 16 of 27 sampled residents (Resident #7, #8, #13, #15, #19, #20, #21, #26, #28, #32, #35, #37, #47, #53, #56, and #65) reviewed for Advanced Directives.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to accurately assess the nutritional status and to follow the facility's policy for monitoring weights for 6 of 6 sampled residents (Resident #19, #28, #42, #57, #375, #376) reviewed for nutrition.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to ensure 6 of 16 sampled residents (Resident #13, #28, #42, #52, #56, and #376) had alternative food and menu choices.

Inspectors wroteBased on medical record review and interview, the facility failed to develop a Baseline Care Plan within 48 hours of admission that included the initial goals and needs for 3 of 19 sampled residents (Resident #42, #57 and #75) reviewed.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure medications were administered as ordered for 2 of 2 sampled residents (Resident #47 and #65) reviewed.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure Care Plan interventions were followed to prevent falls for 1 of 1 sampled resident (Resident #20) reviewed for falls.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure food was stored, prepared, and served under sanitary conditions as evidenced by the absence of hand washing supplies, improper handwashing, undated, unlabeled, and expired food items, carbon build up on pans and the stove, lack of hair restraints, dirty oven doors, dirty kitchen floor, improper storage of an ice scoop, black build up on the seal of the milk cooler, a dirty drip pan, a dirty deep fat fryer, potatoes contaminated with an alcohol preparation (prep) pad package, improper cleaning of a thermometer, unsealed food items, incomplete dishmachine temperature logs, improper storage of glasses, and improper handling of tongs. The facility had a census of 73 residents with 72 of those residents receiving a tray from the kitchen.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to ensure the patient representative was involved in developing the care plan and making decisions and failed to revise the care plan for 2 of 20 (Resident #7 and #26) sampled residents reviewed.

Inspectors wroteBased on the chemical safety chart, observation and interview, the facility failed to ensure the environment was free of accident hazards as evidenced by an aerosol can and an unsecured razor in 1 of 51 (room [ROOM NUMBER]) resident rooms.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure medications were stored properly and safely in 1 of 6 (South Long Hall Medication Cart 1) medication storage areas.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to ensure measures to prevent the potential spread of infection were followed by 1 of 1 (Licensed Practical Nurse (LPN) #1)nurses observed during wound care observations.