Marietta Center for Nursing and Healing

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policies titled, Transmission-Based (Isolation) Precautions and Hand Hygiene, the facility failed to follow infection control protocols and precautions measures for one of eleven residents (R) (R2) with wounds. The deficient practice had the potential to spread microorganisms and infections.

Inspectors wroteBased on observations, staff interviews, and review of the facility policies titled Food Receiving and Storage and Refrigeration and Freezers, the facility failed to ensure opened food items in the dry storage area and walk-in refrigerator were labeled and dated, and failed to remove a dented can from the food storage rack to prevent usage. The deficient practices had the potential to place 117 residents who received an oral diet from the kitchen at risk of contracting a foodborne illness.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy titled Disposal of Garbage and Refuse, the facility failed to ensure two of two dumpster's side doors were closed and failed to ensure the ground surrounding the dumpsters was free from trash debris. The deficient practice had the potential to promote the harboring of pests, insects, and other organisms and create the potential for disease transmission by pests and rodents. The facility census was 124 residents.

Inspectors wroteBased on observations, staff interviews, and record review, the facility failed to maintain safe water temperatures to ensure residents were free from potential accident hazards, as evidenced by water temperatures exceeding 120 degrees Fahrenheit (F) in one of five shower rooms (South Hall Shower Room). The deficient practice had the potential to place residents who use the shower at increased risk of burns.

Inspectors wroteBased on observations, staff interviews, record review, and review of facility policies titled Personal Protective Equipment and Transmission-Based (Isolation) Precautions, the facility failed to protect residents from infection by not wearing personal protective equipment (PPE), when providing care to one of two residents (R) (R328) on Contact Precautions. The deficient practice had the potential to cause the spread of infections to other residents, staff, and visitors.

Inspectors wroteBased on observations, staff interviews, and review of the facility's policy titled, Use By Dating Guidelines, the facility failed to ensure food items were properly stored, labeled, and dated, and expired food items were disposed of in a timely manner. In addition, the facility failed to ensure the kitchen areas (tile and ceiling) were maintained in a sanitary condition free from debris, grease, and dirt build-up. The deficient practice had the potential to affect 123 residents receiving an oral diet.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure that the dumpster area was maintained in sanitary condition as it relates to dumpster lids being secured tightly and fitted at all times The deficient practice had the potential to promote the harboring of pests, insects, and other organisms that could affect all residents in the facility.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policies titled, Resident Self-Administration of Medications and Medication Administration, the facility failed to ensure five of 41 sampled residents (R) (R22, R39, R90, R81, and R1) reviewed for self-administration of medications did not have medications stored at the bedside. This deficient practice had the potential to allow residents to administer the medications in an unsafe manner.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policy titled, Oxygen (O2) Administration, the facility failed to change and date O2 tubing weekly for three of 41 sampled residents (R) (R36, R84, R54), to clean O2 and CPAP (continuous positive airway pressure device) filters for two of 41 sampled residents (R36 and R61), and to have orders for CPAP use for one of 41 sampled residents (R50).

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policies titled, Hand Hygiene, PPE Source Control, Standard Precautions Infection Control, and Infection Prevention and Control Program, the facility failed to utilize personal protective equipment (PPE) properly in an isolation room for one of one resident (R) (R95) on transmission based precautions and failed to perform hand hygiene between residents when delivering resident meals to resident rooms for seven of eight residents on the East-C hall. The deficient practice had the potential to spread infection to other residents and staff. The facility census was 127 residents.

Inspectors wroteBased on observations, record review, and review of the facility policy titled, Activities of Daily Living (ADL), the facility failed to give a dependent resident the appropriate assistance with eating meals and to ensure meals in their room in a timely manner for one of 41 sampled residents (R) (R25). The deficient practice had the potiential to cause weight loss for R25.

Inspectors wroteBased on record review, staff interview, and review of the facility policy titled, Comprehensive Care Plans, the facility failed to follow a care plan for one of 41 sampled residents (R) (R42) related to wound care. The deficient practice had the potential to cause R42 to not receive treatment and/or care according to their needs.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policies titled, Wound Treatment Management and Charting and Documentation, the facility failed to provided treatment and care in accordance with professional standards for two of 41 sampled residents (R) (R42 and R81) related to failure to document wound care was performed as ordered by the physician. The deficient practice had the potential to cause further decline and possible infection of wounds.

Inspectors wroteBased on observation, record review, resident and staff interview, and review of the facility's policy titled, Electrical Safety for Residents, the facility failed to ensure the environment was free from potential accident hazards by ensuring one of 41 sampled residents (R) (R111) was not exposed to a heating device. The deficient practice had the potential to cause skin damage not limited to but including burns specifically due to the use of an electrical blanket.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled, Use of Psychotropic Medication, the facility failed to indicate a 14 day stop date for psychotropic medication for one of 41 sampled residents (R) (R35) and failed to ensure one of 41 sampled residents (R22) was evaluated for use of as needed (PRN) psychiatric medications beyond 14 days.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that three of 43 sampled residents (R) (R30, R24, and R4) were treated with dignity related to providing Activities of Daily Living (ADL) care. Psychosocial harm was identified for R30 related to her becoming tearful and expressing feelings of humiliation when she was ignored, and staff refused the resident incontinence care.

Inspectors wroteBased on record review, and staff interview, the facility failed to ensure that one of five residents (R) (R16) reviewed for misappropriation was free from misappropriation of their personal property. Psychosocial harm was identified when R16 revealed facility staff took her keys and went to her house without her permission causing her fear of retaliation if reported.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that five of 43 sampled residents (R) (R30, R24, R4, R25, and R31) were provided Activities of Daily Living (ADL) care. Psychosocial harm was identified for R30 related to her becoming tearful and expressing feelings of humiliation when she was ignored, and staff refused the resident incontinence care.

Inspectors wroteBased on resident and staff interviews, record review, and review of the facility policy and the Grievances Logs from June 2023 to September 2023 the facility failed to take appropriate corrective action and failed to document and to make follow up resolutions for five of nine residents (R) (R21, R40, R41, R42, and R45) grievances reviewed per the facilities grievance policy titled, Resident and Family Grievances.

Inspectors wroteBased on interviews, record review, the facility failed to ensure that all alleged violations involving misappropriation of resident property were reported immediately to the administrator of the facility and to other agencies for one of five residents (R) (R16) reviewed for misappropriation of resident property.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide showers as scheduled and Activities of Daily Living (ADL) care according to the Plan of Care for seven residents (R) (R#44, R#50, R#84, R#57, R#209, R#90 and R#78) of 27 sampled residents.

Inspectors wroteBased on observation, interview, record review, review of Resident Council Minutes, and policy review, the facility failed to have sufficient nursing staff to provide seven residents (R) (R#44, R#50, R#84, R#57, R#209, R#90 and R#78) and two supplemental residents (R#210 and R#211) with bed baths or showers as scheduled, failed to provide one of one resident (R#212) medications and Accu check timely, failed to provide sufficient nursing staff to ensure one of one resident (R#44)'s treatments and dressings were changed as ordered by the physician and failed to provide sufficient nursing staff to answer residents' call lights and provide the care the residents' requested for R#360, R#44, R#93,R#60, R#78, and R#6.

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to ensure advanced directives included a signature by the resident or her health care Power of Attorney (POA) for one of one resident (R) (R#64) out of a total sample of 27 residents reviewed for advance directives.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to conduct a thorough investigation for one resident (R) (R#361) of two residents reviewed for abuse. R#361 alleged staff to resident abuse; however, the facility failed to obtain statements from staff who may have had knowledge of the incident.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to provide written notification to the resident, the resident representative and/or state ombudsman of facility-initiated transfers/discharges to the hospital for two residents (R) (R#60 and R#80) of two sampled residents who were transferred to the hospital. The failure to notify resulted in the ombudsman not having the opportunity to review the appropriateness of these transfers.

Inspectors wroteBased on record reviews, interviews, and facility policy review, the facility failed to develop a care plan for one of two residents (R)(R#48) reviewed for receiving hospice services.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure one of 27 sampled residents (R) (R#43) participated in the care plan meeting.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure medications and dressings were changed in accordance with physician's orders for one of five residents (R) (R#44) reviewed for wounds of a total sample of 27 residents. R#44's topical antibiotic ointment and wound dressings were not consistently changed on the weekends; R#44's left knee surgical site became infected during her stay in the facility.

Inspectors wroteBased on record review and interview, the facility failed to provide follow-up Psychiatric services for one of one resident (R) (R#84) reviewed for depression in the sample of 27. The failure to provide follow-up behavior health services, specifically Psychiatric services, had the potential to affect the resident psychosocial wellbeing.

Inspectors wroteBased on record review and interview, the facility failed to provide one of three residents (R) (R#84) reviewed for rehabilitation services, physician ordered Speech Therapy (ST) once the resident tested positive for COVID and was transferred to the COVID unit. This deficient practice has the potential to affect the resident's ability to swallow foods and liquids.