Magnolia Ridge

Inspectors wroteBased on interviews, record review, and the Administrator's and Director of Nursing's Job Description the administration failed to provide oversight and guidance to the facility's staff to ensure policies and procedures were developed and implemented to ensure: staff knew what behaviors and abuse should be reported and communicated; residents with Mental Illness were determined to be appropriate for the facility and received the appropriate treatment and medications as ordered; staff communicated resident's needs pre-admission to ensure medications were administered as expected following a transition of care from hospital to the facility; and management staff identified medications that had not been administered. [...]

Inspectors wroteBased on interviews, record reviews, and the job description for Center Sr. Executive Director the Governing Body failed to provide oversight to ensure residents were free from abuse, neglect, and significant medications errors. Further the Governing Body failed to ensure the facility staff responsible for administering medications and parenteral fluids via PICC were trained on the standards of practice. The Governing Body further failed to ensure facility staff were trained on proper resident care for residents with a PICC. It was determined the facility's noncompliance with one or more requirements of participation has caused, or was likely to cause, serious injury, harm, impairment, or death to residents. The Immediate Jeopardy (IJ) was cited in reference to 483.70 Administration. [...]

Inspectors wroteBased on interviews, medical record review, and review of a facility policy titled, Genesis Physician Services, the facility's Medical Director (MD) failed to ensure the appropriateness and quality of Resident Identifier (RI) #9's medical care. On 04/07/2025 a change of condition was noted in RI #9's medical record related to bleeding from a surgical incision. The CRNP (Certified Registered Nurse Practitioner) was notified, and orders were obtained to hold RI #9's Apixaban (Eliquis) 5 milligrams (mgs), ordered twice daily, for three days. RI #9's Eliquis was held on 04/07/2025 at 8 PM until 04/10/2025 at 8PM.On 04/09/2025 the MD (Medical Director) made an acute care visit for RI #9. The MD's note indicated that he was not aware of ongoing concerns regarding bleeding from RI #9's surgical incision and RI #9's current lab results. [...]

Inspectors wroteBased on interviews and record reviews the facility failed to ensure Resident Identifier (RI) #119, RI #76, and RI #9 were free of a significant medication errors. Specifically, the facility failed to ensure: 1) RI #119's monthly paliperidone (Invega) injection was administered on 01/24/2025 and 02/24/2025. RI #119 had a history of cursing and yelling in the facility and on 03/18/2025 RI #119 threatened to kill people in the facility. RI #119 was sent to the hospital for evaluation. On 04/01/2025 RI #119 hit RI #53 in the face twice with a closed fist. 2) Further the facility failed to ensure RI #76's morning medications including Imdur (Isosorbide Dinitrate), Lacosamide, Keppra, Amlodipine, and Losartan were administered on 05/06/2025 when RI #76 requested that Licensed Practice Nurse (LPN) #42 administer the medications after he/she ate breakfast. [...]

Inspectors wroteBased on interviews, record review, and review of a facility policy titled, Change in Condition: Notification of, the facility failed to ensure the physician was when a significant change was identified on 04/07/2025 when Resident Identifier (RI) #9 was noted to have continued bleeding from a surgical incision ten days after being admitted and 13 days after the surgical procedure. The facility further failed to ensure the physician was notified on 04/09/2025 Resident Identifier (RI) #9's hemoglobin was 7.7 g/dL (grams per deciliter). On 04/07/2025 a change of condition was noted in RI #9's medical record related to bleeding from his/her surgical incision. The Certified Registered Nurse Practitioner (CRNP) was notified, and orders were obtained to hold RI #9's Eliquis for three days and obtain Complete Blood Count (CBC) on 04/08/2025. [...]

Inspectors wroteBased on interviews, resident record reviews, review of a facility policy titled Abuse Prohibition, review of Facility Reported Incidents (FRI) received by the State Agency, and review of the facility investigative file, the facility failed to ensure residents were free from abuse perpetrated by other residents and failed to ensure Resident Identifier (RI) #9 was free from neglect. Specifically the facility failed to ensure:1) Resident Identifier (RI) #53 was free from verbal and physical abuse perpetrated by RI #119 on 04/01/2025 when RI #119 hit RI #53 in the face twice with a closed fist, as witnessed by several staff members. RI #53 had a red mark on his/her face. Staff said, someone hit in that manner would feel hurt and confused. During the investigation, it was revealed that RI #119 was admitted to the facility with diagnoses to include Schizoaffective Disorder. [...]

Inspectors wroteBased on interviews, resident record reviews, review of a facility policy titled, Abuse Prohibition, review of Facility Reported Incidents (FRI) received by the State Agency (SA) and review of the facility investigative file, the facility failed to ensure nurses and staff reported verbal abuse to the abuse coordinator and the SA and took actions to prevent escalating resident on resident abuse in the facility. During the investigation of the FRI alleging physical abuse occurred on 04/01/2025 when Resident Identifier (RI) #119 hit RI #53 in the face, staff told surveyors they did not always document or report RI #119's behavior of yelling and cursing, which was a daily behavior since admission on [DATE], even when it was directed at other residents. Because RI #119's verbally abusive behaviors continued, and escalated, on 03/18/2025 RI #119 threatened to kill people in the facility. [...]

Inspectors wroteBased on interviews, resident record review, review of a facility policy titled Abuse Prohibition, during and after the facility investigation, the facility failed to ensure thorough investigations were conducted and appropriate corrective actions were taken or interventions were developed to ensure residents in the facility were protected from residents with unmanaged, escalating abusive behaviors and to prevent further abuse. Resident Identifier (RI) #119 had verbally abusive behaviors which escalated on 03/18/2025 when RI #119 threatened to kill people in the facility. The incident was not identified as potential abuse, was not reported as an allegation of abuse, and was not investigated in a manner to prevent further abuse. On 04/01/2025 RI #119 hit RI #53 in the face twice with a closed fist. [...]

Inspectors wroteBased on interviews, resident record review, and review of a facility policy titled Pre-admission Screening for Mental Disorder and or Intellectual Disability Patients, the facility failed to ensure the Preadmission Screening and Resident Review (PASRR) screening process was completed for Resident Identifier (RI) #119 for a Level I or Level II determination to be made about the level of services RI #119 required for Mental Disorder or Mental Illness (MI) before admission to the facility. RI #19 was admitted to the facility on [DATE] and had a diagnosis of Schizoaffective Disorder which is a Mental Illness. On 03/18/2025 RI #119 threatened to kill people in the facility. On 04/01/2025 RI #119 hit another resident, RI #53, in the face twice with a fist. A Level I determination was not made for RI #119 until 05/08/2025 during the survey. [...]

Inspectors wroteBased on interviews, resident record review, and review of a facility policy titled, Medication Administration General Guidelines, and review of ALABAMA BOARD OF NURSING ADMINISTRATIVE CODE CHAPTER 610-X-6 STANDARDS OF NURSING PRACTICE the facility failed to ensure licensed staff implemented physician orders and followed standards of practice when they documented administration of Resident Identifier (RI) #9's intravenous (IV) medications. Specifically, on 05/14/2025 the facility submitted a plan to remove the immediacy of jeopardy that included . On 5/14/25, the DON [Director of Nursing (Former DON #2)] and/or designee reviewed Medication Administration Records for the last 60 days and no additional concerns were identified. [...]

Inspectors wroteBased on interviews, record review, and review of facility policies titled, Vascular Access Devises and Infusion Therapy Procedures- Maintaining Patency of Peripheral and Central Vascular Access Devices and Administration of IV Fluids and Medication - SETTING UP A PRIMARY INFUSION (HYDRATION OR MEDICATION, and the ALABAMA BOARD OF NURSING ADMINISTRATIVE CODE CHAPTER 610-X-6 STANDARDS OF NURSING PRACTICE the facility failed to ensure Resident Identifier (RI) #9's intravenous antibiotics (IV) were administered in accordance with professional standards of practice. 1) The facility failed to ensure a process was implemented to ensure RI #9's IV antibiotics were ordered and administered upon RI #9's re-admission on [DATE]. Seven doses of Piperacillin-Tazobactam (Zosyn) were not administered on 05/03/2025, 05/04/2025, and 05/05/2025. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a Registered Nurse (RN) was consistently scheduled to administer Resident Identifier (RI) #9's 12:00 AM dose of intravenous (IV) antibiotic, Piperacillin-Tazobactam (Zosyn). Six doses of RI #9's Zosyn scheduled to be administered at 12: AM were either not documented as administered or documented days later by RN #25 who was not clocked in at the time the documented doses were scheduled. It was determined the facility's noncompliance with one or more requirements of participation has caused, or was likely to cause, serious injury, harm, impairment, or death to residents. The Immediate Jeopardy (IJ) was cited in reference to 483.35 Nursing Services at F725- Sufficient Nursing Staff. [...]

Inspectors wroteBased on interviews, resident record reviews, and review of a facility policy titled Behaviors: Management of Symptoms, the facility failed to ensure a behavior management process was implemented. Specifically, the facility failed to ensure staff understood what steps to take when resident behaviors were observed or reported, and staff took action to address behaviors and implement interventions and supervision instructions to protect residents in the facility from abuse and prevent escalation of RI #119's behaviors. RI #119 had a history of unmanaged behaviors in the facility including on 03/18/2025 when RI #119 threatened to kill people in the facility. RI #119 was evaluated at the hospital and returned to the facility on the same day without any new orders except a newly ordered medication. [...]

Inspectors wroteBased on interviews, record review, and Review of Mosby's 2017 Nursing Drug Reference Book, the facility failed to ensure Resident Identifier (RI) 9's Apixaban (Eliquis) was not resumed on 04/10/2025 at 8:00 PM when RI #9 had an actively bleeding surgical incision and abnormal laboratory (lab) blood values. On 04/07/2025, a change of condition was noted in RI #9's medical record related to bleeding from a surgical incision. Certified Registered Nurse Practitioner (CRNP) #75 was notified, and orders were obtained to hold RI #9's Eliquis for three days. RI #9's Eliquis was held on 04/07/2025 at 8 PM until 04/10/2025 at 8 PM.On 04/09/2025 at 10:41 AM, the lab reported the Complete Blood Count (CBC) results that included hemoglobin of 7.7 g/dL (grams per deciliter), hematocrit of 25.9% (percent) and Red Blood Count (RBC) of 2.6 10 6/uL (microliters). [...]

Inspectors wroteBased on interviews, record review, and review of a facility policy titled, Center Quality Assurance Performance Improvement (QAPI) Process, the facility's QAPI committee failed to identify that appropriate corrective actions had not been taken and no interventions were developed to ensure RI #53 was protected from RI #119 after RI #119 hit RI #53 in the face twice with a closed fist on 04/01/2025. RI #119 continued to have access to RI #53 until 05/08/2025 after a staff intervened to separate the residents when RI #119 was observed yelling, cussing, and behaving aggressively toward RI #53. RI #119 was placed on 1 to 1 supervision, resident RI #119 room assignment was changed to an alternate unit and room on the [NAME] Wing. [...]

Inspectors wroteBased on interviews, resident record reviews, review of a facility policy titled Abuse Prohibition, review of Facility Reported Incidents (FRIs) received by the State Agency, and review of the facility's investigative files, the facility failed to protect the residents' right to be free from physical, mental, and verbal abuse perpetrated by staff and residents. On 07/25/2023 around 9:15 AM Resident Identifier (RI) #60 was mentally abused by Certified Nursing Assistant (CNA) #41 and RI #287 was physically abused by RI #60 while outside at the smoking area with other residents and staff present to witness the abuse. RI #60, a resident with a history of behaviors toward staff, called CNA #41 names and CNA #41 responded by throwing a metal ashtray weighing over one pound at RI #60. The ashtray thrown by CNA #41 missed RI #60 and hit the wall behind the resident. [...]

Inspectors wroteBased on interviews, resident record reviews, review of a facility policy titled Abuse Prohibition, review of Facility Reported Incidents (FRIs) received by the State Agency, and review of the facility's investigative files, the facility failed to ensure allegations of abuse were reported immediately by staff to a supervisor or the Administrator so action could be taken to investigate abuse and protect residents. Specifically, on 07/25/2023, a Certified Nursing Assistant (CNA) #39 failed to immediately report that she witnessed CNA #41 throw a metal ashtray weighing over one pound at RI #60. Further, CNA #40 failed to report the allegation of abuse immediately on 07/25/2023 around 10:00 PM when CNA #41 made a telephone call to tell CNA #40 she had thrown an ashtray at RI #60. CNA #40 failed to report what CNA #41 told her until the next day on 07/26/2023. [...]

Inspectors wroteBased on interviews, medical record review, and review of facility policies titled, OPS111 Elopement of Patient, and OPS100 Accidents/Incidents, facility failed to ensure Resident Identifier (RI) #48 was supervised in a manner that staff knew of his/her whereabouts and that he/she did not leave the facility without staff knowledge. The facility failed to have a system to ensure residents were unable to exit the facility without staff's knowledge and without supervision. The facility further failed to ensure the Physical Therapy Assistant (PTA) did not leave RI #48 in an unsafe area without taking measures to ensure the resident's safety when he observed RI #48 off the facility property on 02/01/2025. On 02/01/2025 around 8:40 AM, the PTA observed RI #48 in his/her wheelchair near the road, across the street from the facility. [...]

Inspectors wroteBased on interviews, resident record review, and review of a facility policy titled Behavioral Health Care Services, the facility failed to ensure staff utilized and implemented behavior management care plan approaches to manage Resident Identifier (RI) #60's verbal behaviors, outbursts, and cursing. Specifically, on 07/25/2023 RI #60 was outside in the smoking area with other residents (RI #287 and RI #488) and staff Certified Nursing Assistant (CNA #39 and CNA #41). RI #60 was cursing and calling staff names. CNA #41 failed to respond to RI #60 calmly and gently, and instead, CNA #41 picked up an ashtray and threw it at RI #60. The ashtray did not hit RI #60 but caused RI #60's behavior to escalate. RI #60 picked up the ashtray and threw it back at CNA #41. The ashtray did not hit the CNA, but the ashtray did hit another resident, RI #287 on the head and caused injury. [...]

Inspectors wroteBased on observation, interview, the facility's policies for Menus and Portion Control, the facility's Fall/Winter Menu for Week 3, and the Portion Control Chart posted in the facility's kitchen; the facility failed to ensure the correct food portions were served to residents for Mandarin Orange Sections at Supper on 03/02/2025 and for Puree [NAME] Stew without Corn, Puree Bread, Puree Tomato Soup, Mashed Potatoes, Tossed Salad, and Shredded Lettuce Salad served at Lunch on 03/04/2025. This had the potential to affect 132 of 132 residents receiving meals from the facility's kitchen.

Inspectors wroteBased on observation, interview, the facility's policies for Food Storage: Cold Foods and Meal Distribution, the facility's Labeling and Dating Inservice, and the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code; the facility failed to prevent possible cross-contamination by allowing meat to thaw on a shelf 3.5 inches from the floor, incompletely covered meal plates to be delivered on an open cart to residents throughout the facility on 03/02/2025 for Supper, and a damaged Handwashing Sink with a draining issue and no cold water to be used by staff. The facility further failed to ensure Use By dates were used for sandwiches prepared for residents' snacks. This had the potential to affect 132 of 132 residents receiving meals from the facility's kitchen.

Inspectors wroteBased on observation, interview, and the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code; the facility failed to ensure: 1.) the air filters for two of two Ice Machines were cleaned as recommended by the manufacturer; 2.) an in-use Handwashing Sink in the kitchen was repaired; 3.) a new fuse was obtained for the Dishwashing Machine; 4.) a Plate Lowerator (one of one), which would help keep food warm for the residents, was repaired. This had the potential to affect 132 of 132 residents receiving meals from the facility's kitchen. Findings Include: The U.S. FDA 2022 Food Code included the following: . 4-501.11 Good Repair and Proper Adjustment. (A) EQUIPMENT shall be maintained in a state of repair . [...]

Inspectors wroteBased on interviews, record review, review of facility policies titled, Medication Administration Controlled Substances and Abuse Prohibition, review of the facility's investigative file and review of information from the Alabama Department of Public Health's (ADPH) Online Reporting System, the facility failed to ensure Resident Identifiers (RI) #'s 15, 21, 40, 76, 79, 103, 108, and 113 were free from misappropriation of property when the resident's controlled substances were unable to be accounted for after Registered Nurse (RN) #33 removed the resident's controlled substances from the medication cart on 11/13/2024 on the 7 PM to 7 AM shift. This deficient practice affected RI #'s 15, 21, 40, 76, 79, 103, 108, and 113 eight of 11 residents reviewed for misappropriation of property, and affected two of two medications carts on the Rehab Hall. [...]

Inspectors wroteBased on interviews, record review, review of facility policies titled Medication Administration General Guidelines and Medication Administration Controlled Substances and review of the facility's investigative file, the facility failed to ensure Resident Identifier (RI) #'s 15, 21, 40, 76, 79, 103, 108 and 113 received their on the 7 PM to 7 AM shift on 11/13/2024 as ordered by the physician. This deficient practice affected eight of 11 residents residing on the Rehab unit reviewed for not receiving their medications as ordered by the physician. Findings Include: Cross-Reference F 602. Review of a facility policy titled, Medication Administration General Guidelines, dated 2007 and 01/2025, revealed the following: . GENERAL GUIDELINES . PROCEDURES . Medication Administration: 1. Medications are administered in accordance with written orders of the Prescriber . 4. [...]

Inspectors wroteBased on medical record review, interviews, and review of a facility policy titled, Change in Condition: Notification of, the facility failed to notify Resident Identifier (RI) #237's family/responsible party when RI #237's Ativan 1 mg (milligram) was decreased to 0.5 mg on 12/12/2024. This affected RI #237 one of one sampled resident reviewed for notification of change. This deficiency was cited as a result of the investigation of complaint/report number AL00042921. Finding Include: Review of a policy titled Change in Condition: Notification of, with an effective date of 11/28/2016, documented: . POLICY A Center must immediately inform the patient, . and notify, consistent with their authority, the patient's representative, where there is: . [...]

Inspectors wroteBased on interviews, observation, medical record review, and facility's policies titled, Safeguarding and Storage of Health Information Records and Medication Administration, the facility failed to ensure the Electronic Medication Administration Record (eMAR) screen was closed and did not reveal personal information concerning Resident Identifier (RI) #127. This was observed on 03/03/2025 during the evening medication pass and affected RI #127, one of 134 residents residing in the facility. Findings Include: A review of a facility policy titled, Safeguarding and Storage of Health Information Records, with a revision date of 05/01/2022 revealed the followings: . [...]

Inspectors wroteBased on observations, interview, and the facility's document titled, YOUR RIGHT . AS A NURSING HOME RESIDENT, the facility failed to maintain a safe, comfortable, and homelike environment as evidence by: 1) Exit door at end of 100 hall was scraped, dirty with an unknown black substance. The door was in view of residents on the hall. 2) Resident Identfier's (RI) #15, RI #92, and RI #340 bathrooms' ceiling tiles were missing. This deficient practice affected the residents on the 100 hall and RI #15, RI #92, and RI #340 bathrooms. This was cited as a result of the investigation of complaint/report number AL00042921. Findings Include: A review of a facility's document titled, YOUR RIGHT . AS A NURSING HOME RESIDENT, with no effective date revealed the following: . Federal law require us .to provide . a safe, clean, comfortable and homelike environment . [...]

Inspectors wroteBased on observation, interviews, a review of the facility's investigative file, and a review of a facility's policy titled, Grievance/Concern, the facility failed to ensure a Grievance/Concern filed on 05/15/2024 by Resident Identifier (RI) #117 and RI #117's Resident Representative (RR) was resolved when CNA #44 went back into RI #117's room to provide care on 05/31/2024 after being instructed not to enter RI #117's room. This deficient practice affected one of 29 sampled residents.

Inspectors wroteBased on observations, interviews, resident record review, and review of the Centers for Medicare & Medicaid Services (CMS) Long-Term Care Resident Assessment Instrument 3.0 Manual, the facility failed to ensure Minimum Data Set (MDS) assessments were coded accurately. 1.) Resident Identifier (RI) #69's quarterly Minimum Data Set assessment dated [DATE] was coded to reflected RI #69 was receiving tracheostomy care, invasive mechanical ventilator and non-invasive mechanical ventilator, when RI #69 was not receiving those special services. 2.) RI #60's annual MDS assessment dated [DATE] section A1500 was not coded accurately to reflect RI #60's Preadmission Screening and Resident Review (PASRR) Level II and Serious Mental Illness. These deficient practices had the potential to affect RI #69 and RI #60 two of 29 sampled residents whose MDS assessments were reviewed.

Inspectors wroteBased on interview, medical record review, and review of the Preadmission Screening and Resident Review (PASRR), the facility failed to submit a new Level I for Resident Identifier (RI) #339 when a new diagnosis of Post Trauma Stress Disorder (PTSD) was given on 08/30/2024. This deficient practice affected RI #339, one of 29 residents PASRR reviewed.

Inspectors wroteBased on observation, interview, record review, and review of the facility's policy titled, PROCEDURE - RESPIRATORY EQUIPMENT/SUPPLY CLEANING/DISINFECTING the facility failed to ensure Resident Identifier (RI) #94's Oxygen (02) concentrator water bottle was not empty during the administration of oxygen. This affected one of one sampled resident identified with humidified oxygen. Findings Include: A review of the facility's policy titled, PROCEDURE - RESPIRATORY EQUIPMENT/SUPPLY CLEANING/DISINFECTING with a revised date of 07/15/21, revealed the following: . 5. Schedule for Supply Changes: . Item . Oxygen Humidifiers . Frequency . Every 7 days . PRN . For soiling . RI #94 was readmitted to the facility on [DATE], with diagnoses including: Chronic Respiratory Failure with Hypoxemia, Chronic Obstructive Pulmonary Disease and Chronic Respiratory Failure. [...]

Inspectors wroteBased on observations, interviews, and review of facility policies titled, Personal Clothing Handling, the facility failed to ensure staff provided care to residents and handled supplies and linen in a manner to prevent the possibility for cross-contamination of residents and their environment. This deficient practice had the potential to affect 134 of 134 residents observed for infection control.

Inspectors wroteBased on record review, interview, and Payroll Based Journal (PBJ) Report, the facility failed to report accurate staffing data from July 01, 2024 until September 30, 2024, to Centers for Medicare & Medicaid Services (CMS). This affected one quarter of data reviewed during the survey.

Inspectors wroteBased on observation, staff interviews, a review of the policy titled Food: Preparation, and a review of the Food and Drug Administration (FDA) 2017 Food Code Section 3-302.15 Washing Fruits and Vegetables paragraph 4, the facility failed to ensure that holding temperature for lettuce was at or below 41 degrees Fahrenheit when served from the trayline. The above practice had the potential to affect 41 of 41 residents who received salad with lunch on 12/4/19.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident Identifier (RI) #135's Significant Change Minimum Data Set (MDS) Assessment was completed, in a timely manner, after RI #135 was admitted to hospice. This affected one of three closed charts reviewed.

Inspectors wroteBased on observation, interviews, medical record review and a facility policy titled, Medication Administration: Oral, the facility failed to ensure EI( Employee Identifier) #2, a RN (Registered Nurse) administered RI (Resident Identifier's) #73 pain medication as prescribed and not leave it in a medicine cup on resident's bed side table on 12/4/19. This deficient practice affected RI #73, one of two residents sampled for pain. Findings Include: A review of a facility's policy titled, Medication Administration: Oral, with a revision date of 11/01/19 documented: . 3. Administer medication.3.3. Give patient medication and water, . 3.4 Stay with patient until the drug has been swallowed. RI #73 was admitted to the facility on [DATE] with a diagnosis of Gastrointestinal Hemorrhage, Unspecified. [...]

Inspectors wroteBased on observations, interviews, and a facility policy titled, NSG259 Range of Motion and Mobility, the facility failed to ensure Resident Identifier (RI) #18 had a splint or a handroll for a contracture to the right hand. This had the potential to affect one of six residents sampled for range of motion.

Inspectors wroteBased on observation, interviews, and review of a policy titled, Nebulizer: Small Volume, the facility failed to ensure that a licensed nurse cleansed and dried a nebulizer mask prior to storing. This affected Resident Identifier (RI) #5, one of one residents observed for nebulizer administration.

Inspectors wroteBased on observations, interviews and review of facility policies titled, Dry Storage and Refrigerator/Frozen Storage, the facility failed to ensure: 1. dented cans were stored separately from other stock; 2. outdated food was not stored in the refrigerator; and 3. a steamer pan was not placed on the rack wet. These failures had the potential to affect 124 of 124 residents who received meals from the kitchen. Findings Include: 1. The facility policy titled, Dry Storage with a revised date of 12/01/15, included, Products stored in dry storage are maintained in a safe and sanitary manner. Process . 1. Food Storage: . 2.4 Dented cans that are deemed unusable are separated from stock and clearly marked for return. On 10/15/18 at 4:09 PM, an observation was made in the dry storage room. [...]

Inspectors wroteBased on resident record review, interview, and a facility policies titled Transcription of Orders and Oxygen: Concentrator, the facility failed to ensure: 1.) A Physician's order for oxygen (O2) was transcribed to Resident Identifier (RI) #188's medical record; 2.) RI # 127 had an order for the use of a foley catheter and 3.) RI # 97 had an order for O2. This had the potential to affect 3 of 27 sampled residents who physician orders were reviewed. This citation was written as a result of the investigation of Complaint/Report #AL00035897 Findings Include: A review of a facility policy titled, . Transcription of Orders, revision date 10/01/12, documented the following: . Purpose To communicate all practitioner orders to caregivers regarding patient's care and treatment. 1. RI #188 was admitted to the facility on [DATE]. [...]

Inspectors wroteBased on observation, record review, interview and review of a policy titled, Catheter : Indwelling Urinary - Care of , the facility failed to ensure soap and water were used by staff when performing catheter care for Resident Identifier (RI) # 127. This affected 1 of 1 resident observed for catheter care. Findings Include: The facility's policy titled, Catheter: Indwelling Urinary - Care of , revised date 01/02/14, included, . 9. Cleanse the proximal third of the catheter with soap and water, . RI # 127 was admitted to the facility on [DATE] with diagnoses to include benign prostatic hyperplasia with lower urinary tract symptoms and urinary tract infection. On 10/16/18 at 5:21 PM, an observation was made of RI #127's foley catheter care by Employee Identifier (EI) #7 CNA, along with the assistance of CNA EI #14. [...]

Inspectors wroteBased on observaton, interview and review of a facility policy titled, . Storage and Expiration Dating of Medications, . , the facility failed to ensure there were no expired medication on 1 of 6 medication carts and in 2 of 3 medication rooms observed. Findings Include: Review of a facility policy titled, Storage and Expiration Dating of Medications, ., revised date 10/31/18, included, . 4. Facility should ensure that medications and biologicals that : (1) have an expired date on the label; . are stored separate from other medications until destroyed or returned to the pharmacy or supplier. 10/16/18 at 11:10 AM, in the 300 Hall medication room, an observation was made of Peg - 3350 and Electrolytes 4000 an expiration date of 07/2018. On 10/16/18 at 11:37 AM, an observation was made of one of six medication carts. [...]

Inspectors wroteBased on observations, record reviews, interviews and a facility policy titled, Nebulizer: Small Volume, the facility failed to ensure Resident Identifier (RI) # 63's hand held nebulizer was bagged when not in use and RI #s 119, 113 and 97's nebulizer mask and tubing were bagged when not in use. This affected 4 residents observed on 1 of 3 halls in the facility. Findings Include: The facility policy titled, Nebulizer: Small Volume, with a revised date of 11/28/17, included, . 19. Upon completion of the treatment, . 20. Rinse . 20.1 Place in treatment bag labeled with patient name and date. 1. RI #119 was admitted to the facility on [DATE] with diagnoses to include Atherosclerotic Heart Disease of Native Coronary Artery, Cardiomyopathy and Unspecified Asthma. [...]