McDowell Healthcare Center

Inspectors wroteBased on record review, policy review, observation, and interview, the facility failed to provide a sanitary environment to help prevent the development and prevention of communicable disease and infection by not providing hand hygiene to multiple residents in the first floor dining room before lunch. This was a random opportunity for discovery in the long-term care survey process and had the potential to affect more than an isolated number of residents. Resident identifiers: #81, #24, #41, #82, and #12. Facility Census: 91. In a policy titled Standard Precautions given to State Agency by DON, hand hygiene is defined as cleaning hands by using handwashing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis. [...]

Inspectors wroteBased on record review and staff interview the facility failed to implement comprehensive care plan for one (1) of 19 residents. Resident identifier: #7. Facility census: 91. Record review revealed physician orders and the resident's care plan directed staff to: Perform a fingerstick blood glucose test. If the blood glucose is less than 60 mg/dl or greater than 400 mg/dl (milligram per deciliter), notify the provider. [...]

Inspectors wroteBased on resident interview, observation, and staff interview, the facility failed to ensure one (1) of two (2) residents received the assistance needed with activities of daily living. Resident #88 did not receive the assistance needed to maintain personal grooming according to his preferences. Resident identifier: #88. Facility census: 91.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure menus were updated when changes were being made to food items. This had the potential to affect more than an isolated number of residents. Facility census: .

Inspectors wroteBased on medical record review and staff interview the facility failed to update the [NAME] Virginia Department of Health and Human Resources Pre-admission Screening and Resident Review (PASRR) with new qualifying diagnoses for five (5) out of 30 residents reviewed during the long term survey process. Residents identifiers: #26, #49, #14, #17, #45. Facility Census: 93.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure the correct diagnoses on the Pre-admission Screening and Resident Review (PASRR) and, if necessary, submit a new one, at the time of admission. This was true for five (5) of thirty (30) residents reviewed for PASRRs during the survey process. Resident identifiers: #53, #33, #7, #17, #29. Facility census: 93.

Inspectors wroteThis will be cited as past noncompliance because the facility identified what had happened and took immediate steps to correct the failure to ensure it does not recur. All components of the plan of correction were completed prior to this survey beginning. On 08/07/24 at 9:05 AM record review shows the facility reported incident concerning wound dressings that were not changed according to the Physicians order. Resident #45 has an order to change the dressing to the coccyx daily. On 07/21/24 when Registered Nurse (RN) #73 went to change Resident #45's wound dressing she found the old dressing to be dated 07/18/24 and the initials of Licensed Practical Nurse (LPN) #180. The documentation in Point Click Care reflected the dressing was changed on 07/20/24 when in fact it had not been changed since 07/18/24 reflecting it had not been changed for three (3) days. [...]

Inspectors wroteBased on record review and staff interview the facility failed to properly investigate and make prompt efforts to resovle a grievance from Resident #19. This was true for 1 (one) of 1 (one) resident's reviewed for the Long Term Care Survey Process. Resident identifier: #19. Facility census: 93.

Inspectors wroteBased on medical record review and staff interview, the facility failed to update the care plan for a new diagnosis. This was true for three (3) out of 30 residents reviewed during the long-term care process. Resident identifiers: #17, # 26 and #29. Facility census: 93.

Inspectors wroteBased on observation, record review, and resident and staff interview, the facility failed to ensure resident environment, over which it had control, was as free of accident hazards as possible, by failing to complete a smoking assessment, upon admission, for smokeless tobacco use for Resident #25. This was true for one (1) of eight (8) residents reviewed for accident hazards during the survey process. Resident identifier: #25. Facility census: 93.

Inspectors wroteBased on record review and staff interview, the facility failed to monitor Resident #30, #29, and #82 for side effects of antidepressant, antianxiety, and antipsychotic medications as ordered. This was true for three (3) out of five (5) residents monitored for unnecessary medications during the survey process. Resident identifiers: #30, #29, #82. Facility census: 93.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure medical records for each resident were accurately documented for two (2) of five (5) records reviewed. The facility failed to obtain correct signatures on Physician orders for scope of treatment (POST) form. Resident identifiers: #36 and #17. Facility census:

Inspectors wroteBased on facility records review and staff interview the facility failed to ensure to have all the required signatures and attendees and signatures for their Quality Assurance Performance Improvement (QAPI) meetings. This was discovered during the long term care survey process and had the ability to affect more than a limited number of residents. Identifiers: Meetings dated- 02/23/23, 06/30/23, 08/10/23, 08/02/24. Facility Census: 93. a) 02/23/23 During a record review on 08/07/24 at approximately 2:00 PM of the QAPI meeting attendance it was identified that the Director of Nursing (DON) who was also the Person In Charge (PIC) for the facility. The DON/PIC at this time did not sign in attendance for this meeting. It is further identified, the QAPI information was reviewed with the Medical Director verbally. [...]

Inspectors wroteBased on observation and staff interview the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety. This was a random opportunity for discovery and had the potential to affect more than a limited number of residents that currently reside at the facility. Facility census 90.

Inspectors wroteBased on staff interviews and observation the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public. This was a random opportunity for discovery and has the potential to affect more than a limited number of residents who recurrently reside at the facility. Facility census 90.

Inspectors wroteBased on observation and staff interview the facility failed to ensure a dignified dining experience. This was a random opportunity for discovery and had the potential to affect a limited number of residents who currently reside in the facility. Resident identifier: #57. Facility census 90.

Inspectors wroteBased on observation and staff interview the facility failed to ensure all residents were provided a dignified existence. The failed to provide a privacy cover on the Foley catheter collection bag. This was a random opportunity for discovery and was true for Resident #64. Resident identifiers: Resident # 64. Facility census 91.

Inspectors wroteBased on observation and staff interview the facility failed to provide a safe, clean, comfortable and homelike environment by not providing a clean, and safe ventilation wall unit for Resident #23. This was a random opportunity for discovery. Resident identifier #23 Facility Census: 91 Findings Included: a) Resident #23 On 8/22/22 at 11:44 AM during the initial interview process of the survey it was observed that the ventilation wall unit under the window was rusty and the front of the unit was loose and hanging off on the right hand corner. The Director of Nursing observed this ventilation wall unit on 08/23/22 at 10:12 am and agreed the unit was rusted and in poor repair. .

Inspectors wroteBased on medical record review and staff interviews the facility failed to timely submit a correct discharge tracking Minimum Data Sets (MDS) for : Resident # 89. The MDS was inaccurate in the area of discharge status. This was true for one (1) of one (1) sampled residents reviewed during the Long Term Care Survey Process. Resident identifiers: #89. Facility census: 91.

Inspectors wroteBased on record review and staff interview the facility failed to develop a care plan that included non-pharmacological interventions for a resident who was receiving a PRN (as needed) medication for pain. This was true for one (1) out of 19 sampled residents reviewed. Resident identifiers: Resident #77. Facility census 91.

Inspectors wroteBased on record review and staff interview the facility failed to revise the care plan for Resident #84's dialysis information. In addition the facility failed to revise Resident #66's care plan when an antifungal medication was discontinued. This was true for two (2) of 19 sampled residents. Resident identifier: #84 and #66. Facility Census:

Inspectors wroteBased on observation and staff interview the facility failed to provide urinary catheter care in accordance with the current professional standards of care. This was a random opportunity for discovery. Resident identifiers: #64. Facility census 91.

Inspectors wroteBased on record review and staff interview the facility failed to ensure the attending physician provided a rationale for a pharmacy recommendation they declined. This failed practice was true for one (1) out of five (5) sampled residents for unnecessary medications. Resident identifiers: Resident #77. Facility census 91.

Inspectors wroteBased on observation and staff interview the facility failed to store food in a safe manner. There was opened foods stored in the kitchen walk in freezer that were not labeled as to when the foods were opened and when they expired. The failed practice had the potential to affect a limited number of residents currently receiving nutrition from the facility's kitchen. Facility Census: 91 Findings Included: a) Kitchen During the initial walk through tour of the kitchen on 8/22/22 at 11:50 AM with the Dietary Services Supervisor #20 it was found that there was a bag of opened breaded fish sticks and a bag of breaded chicken that was not dated with an open date, nor a use by date. This was confirmed with the Dietary Services Supervisor #20 on 8/22/22 at 11:50 AM. [...]

Inspectors wroteBased on record review and staff interview the facility failed to ensure the dialysis order for Resident #84 was correct and failed to properly complete a smoking assessment for Resident #13. Resident identifiers: #84 and #13. Facility Census: