Majestic Gardens at Memphis Rehab & Snc

Inspectors wroteBased on facility policy review, record review, observations, and interviews, the facility failed to ensure residents were free from physical restraints for 1 of 1 (Resident #14) sampled residents reviewed for physical restraints.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to ensure staff reported an allegation of staff to resident abuse to the appropriate agencies in a timely manner for 2 of 3 (Resident #65 and #107) sampled residents for allegations of abuse.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to ensure Activities of Daily Living (ADL) assistance was provided related to showering and personal hygiene care for 4 of 5 (Resident #2, #3, #89 and #148) sampled residents reviewed for ADLs.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to ensure staff were dispensing and accurately administering medications and treatments per Physician's Orders for 4 of 32 (Residents #3 #41, #51, and #148) residents reviewed.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to store medication in accordance with facility policy when medication was found unsecured at the beside for 4 of 32 (Resident #11, # 72, #122, and #148) residents.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were maintained when 1 of 4 nurses (Licensed Practical Nurse (LPN) A) failed to disinfect reusable resident equipment for 1 of 5 (Resident #151) residents observed during medication administration.

Inspectors wroteBased on policy review, medical record review, observation and interview, the facility failed to provide care and services when 1 of 3 (Resident #18) discharged sample residents reviewed did not receive a personal refund within 30 days of discharge.

Inspectors wroteBased on policy review, Director of Maintenance job description, facility investigation, manufacturer's manual recommendations, medical record review, observation, and interview, the facility failed to ensure the environment was free from accident hazards when dangerously elevated hot water temperatures were measured and when the facility failed to provide a safe environment and adequate supervision to prevent falls and injury for 2 of 5 (Resident #14 and #86) sampled residents reviewed for accidents. [...]

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 21 of 32 sampled residents (Resident #1, #3, #14, #21, #26, #31, #33, #41, #47, #55, #65, #66, #70, #71, #75, #87, #88, #102, #106, #112, and #115) reviewed for Advanced Directives.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to provide effective housekeeping and maintenance services to ensure a sanitary, orderly, and comfortable environment as evidenced by the odor of urine in Resident's rooms, the 200 and 300 hallways, dirty privacy curtains, standing water in resident's bathroom sinks and in basins, and a loose handrail observed in the 100 Hall.

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 staff using bare hands to prepare food, unlabeled, undated food items, and dirty equipment. The facility had a census of 131 with 124 of those residents receiving a tray from the Kitchen.

Inspectors wroteBased on observation, and interview, the facility failed to maintain equipment in safe operating condition for 4 of 4 (Hall 100 shower room stall #2, Hall 200 shower room stall #2, Hall 300 shower room stall #2 and Hall 400 shower room stall #2) shower rooms and for 1 of 2 elevators (200 hall elevator) reviewed for safe operating equipment.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to treat all residents with dignity and respect when 3 of 19 staff members (Certified Nursing Assistant (CNA) - CNA S, and CNA T), and Licensed Practical Nurse (LPN) LPN U) failed to knock and announce themselves before entering a resident's room during dining

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to notify the Ombudsman of emergency transfers for 1 of 1 (Resident #66) sampled residents reviewed for hospitalization.

Inspectors wroteBased on medical record review and interview the facility failed to accurately assess residents for Brief Interview for Mental Status (BIMS) scores, falls, discharge disposition, and diagnoses for 5 of 32 sampled residents (Resident #41, #47, #66, #86 and #128) reviewed for accuracy of assessments.

Inspectors wroteBased on policy review, medical record review, review of Skin Check sheets, and interview the facility failed to ensure Activities of Daily Living (ADL) assistance related to bathing was provided for 2 of 3 sampled residents (Resident #1 and #80) reviewed for ADL care.

Inspectors wroteBased on policy review, medical record review, observation and interview the facility failed to provide care and services for an indwelling catheter (a tube in the bladder that drains urine) for 1 of 1 (Resident #44) sampled resident reviewed for indwelling catheters.

Inspectors wroteBased on medical record review, observation, and interview the facility failed to ensure medication was stored securely when medications were left unattended in resident rooms for 1 of 61 sampled (Resident #31) and when 2 of 7 medication carts (Back up medication cart and the 100 hall medication cart) were left unlocked, unattended and out of staff's line of sight.

Inspectors wroteBased on facility policy, facility document review, medical record review, and interview revealed the facility failed to maintain an accurate and complete medical record for 1 of 32 (Resident #66) sampled residents reviewed. Resident #66 ' s medical record contained an inaccurate Neurological check (an evaluation of brain and nervous system function).

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 a dirty ice machine and milk cooler, rusted tables and shelves, loose food particles in the freezer, dusty storage shelves, boxes stored on the floor, open and undated items in the cooler, pots and pans with carbon build-up and a greasy brown substance, and dirty floors and doors. The facility had a census of 139 residents with 125 of those residents receiving a tray from the kitchen.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure 4 of 10 (Licensed Practical Nurse (LPN) #2, #3, #8, and Registered Nurse (RN) #1) nurses administered medications with a medication error rate of less than 5 percent (%). A total of 4 errors were observed out of 36 opportunities, resulting in an error rate of 11.11%.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure medications and chemicals were not stored in the same compartment, medications were dated when opened, not expired, and medications were secured and attended for 9 of 14 (Patriot and Tulip Split Hall Medication Cart, Sunflower Hall Medication Cart, Tulip Medication Room, [NAME] Hall Medication Cart, [NAME] Medication Room, [NAME] Hall Medication Cart, [NAME] Medication Room, Sunflower Medication Room, and Tulip Hall Medication Cart) medication storage areas.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to complete a quarterly Minimum Data Set (MDS) for 1 of 35 (Resident #128) sampled residents reviewed.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to develop a comprehensive care plan for 1 of 31 (Resident #126) sampled residents reviewed.

Inspectors wroteBased on observation and interview, the facility failed to ensure the environment was free of accident hazards when unsecured chemicals were observed in 1 of 4 (100 Hall) shower rooms.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to provide appropriate care and services for 1 of 1 (Resident #130) residents reviewed for dialysis.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure weights were accurately obtained and recorded for 1of 4 (Resident #10) sampled residents reviewed for nutritional risk.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were followed when 1 of 1 (Resident #126) residents reviewed in transmission based precautions did not have isolation signage on the resident's door and 1 of 1 (Licensed Practical Nurse (LPN) #8) nurses failed to perform proper hand hygiene during Percutaneous Endoscopic Gastrostomy (PEG) tube care.