McRae Manor Nursing Home

Inspectors wroteBased on observation and staff interviews, the facility failed to ensure that food was properly labeled and dated and stored under sanitary conditions to prevent foodborne illness. The deficient practice has the potential to affect 79 of 86 residents receiving food from the kitchen.

Inspectors wroteBased on observation and policy titled Home Trash Management Policy and Procedure the facility failed to ensure trash and garbage refuse was maintained in a sanitary manner for three of three dumpsters observed. The deficient practice created the potential for harboring pests and insects. Findings Include:A record review of policy titled [NAME] Manor Home Trash Management Policy and Procedure revealed [NAME] Manor trash policies require staff to separate general waste from regulated medical waste (e.g., sharps, pharmaceuticals materials) and handle each stream according to specific regulations. General trash is disposed of like typical refuse, while regulated waste needs special containers, storage, and professional pickup services to prevent injury and environmental contamination. The specific rules for pickup frequency and handling vary by state and local regulations. [...]

Inspectors wroteBased on observations, staff interviews, and the facility policies titled Environmental Quality Policy and Procedure and Homelike Environment, the facility failed to ensure the residents' living area was safe, clean, comfortable, and homelike in 16 rooms (Rooms 104, 105, 107, 108, 109, 111, 112, 113, 208, 210, 211, 218, 226, 227, 229 and 303) on three of three halls (100 Hall, 200 Hall and 300 Hall) observed. Specifically, residents' rooms contained dirty air filters in self-contained heating and air system individual wall units (PTAC), cracked outlet cover, bed hand control wires exposed and window handle missing. This failure had the potential to affect patient comfort and safety.

Inspectors wroteBased on observations, record review and staff interviews, and policy titled, Care Planning, the facility failed to develop and/or implement the care plan for two of seven residents (R) (R12 and R9) reviewed for care planning. This deficient practice has the potential to place R12 at risk of dehydration and clinical decline and R9 from reaching the highest practicable level of functioning.

Inspectors wroteBased on observation, staff interview, record review and facility policy titled, Enteral Nutrition, the facility failed to follow physician orders regarding water flush for one of seven residents (R) (R12) that received enteral feedings via gastrostomy tube (G-tube) [tube inserted into the stomach for supplemental feeding]. This deficient practice had the potential to place R12 at increased risk for complications and adverse clinical outcomes. Findings Include:Review of the facility policy titled Enteral Nutrition, revised on 11/2018 documented: 11. The nurse confirms that orders for enteral nutrition are complete. Complete orders include g. instructions for flushing (solution, volume, frequency, timing, and 24-hour volume). [...]

Inspectors wroteBased on observations, staff interviews, and facility policy titled, Medication Storage in the Facility and Administering Medications, the facility failed to ensure one of three medication storage rooms did not have expired medications and one of one wound care cart was locked and secured when unattended by the nurse. In addition, three of five medication carts had expired medication, medication not stored or labeled correctly, and medications left on the cart for a discharged resident. The deficient practice had the potential to allow unauthorized staff, residents, and visitors access to medications, and place residents at risk of receiving expired medications. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to attempt appropriate alternatives, assess for risk of entrapment, review the risks versus benefits, and obtain informed consent prior to installing side rails for residents' beds for four of five Residents (R) (R60, R1, R14, and R66) reviewed for side rail/bedrail usage. Substandard Quality of Care was identified related to bedrails.

Inspectors wroteBased on observations, staff interviews and review of Job Description and Performance Standards - Maintenance Supervisor, the facility failed to provide a safe/clean/comfortable/homelike environment for one hallway (200 hall) of three hallways. Specifically, there was a handrail with loose posts and one handrail with broken brackets.

Inspectors wroteBased on observation, interview, and review of policy titled Production, Storage and Dispensing of Ice, the facility failed to maintain the cleanliness of one of two ice machines, ensure proper storage of ice scoops for two of two ice machines, and failed to discard expired food items. These deficient practices had the potential to affect 74 out of 76 residents who received an oral diet.

Inspectors wroteBased on observations, staff interviews, record reviews, and a review of the facility policy titled Dignity Policy, the facility failed to ensure dignity for two of 25 sampled residents (R) (R62, R29). Specifically, staff were observed standing while feeding R62 and there was no privacy bag used to cover the catheter drainage bag for R29.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled Administration Medication Policy and Procedures, the facility failed to ensure one of 23 sampled residents, (R) R23, did not have unsecured medications stored at the bedside. This deficient practice had the potential to allow unauthorized access of medications to other residents and visitors in the facility.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility's policy titled Activities of Daily Living the facility failed to ensure one resident, (R) R44, of 23 residents sampled were given showers as scheduled. This failure had the potential to cause R44 to be unclean and create an environment that could increase the potential for actual infections and cause the residents to feel self-conscious of appearance.

Inspectors wroteBased on observations, resident interviews, staff interviews, and the facility policies titled Accidents and Incidents-Investigating and Reporting, Oxygen Delivery Policy, and Chemical Safety and Storage, the facility failed to ensure two of 23 sampled residents (R) ( R49 and R65) were free from accident hazards. Specifically, the facility failed to ensure R49 was free from exposure to free standing oxygen and R65 was free from exposure to harmful chemicals.

Inspectors wroteBased on observations, staff interviews, record review, and the facility policy titled Urinary Catheter, Maintenance of Indwelling Policy and Procedure , the facility failed to have a Physician order for one resident, (R) R62, of six residents with catheters. In addition, the indwelling urinary catheter order was omitted on the Medication Administration Record (MAR) to ensure monitoring instructions, and appropriate treatment services for the catheter. This deficient practice had the potential to put residents at risk for complications related to their urinary health with the possibility of urinary tract infections.

Inspectors wroteBased on record review and staff interview and review of the policy titled Medication Monitoring and Management, the facility failed to ensure a stop date for the use of a PRN (as needed) antipsychotic medication (quetiapine) was not over 14 days for one of five residents, (R) R65, reviewed for unnecessary medications.

Inspectors wroteBased on observations, interviews, record review, and review of the facility policy titled Maintenance of Indwelling Urinary Catheters, the facility failed to properly perform infection control practices to prevent the possible spread of infections by allowing an indwelling urinary catheter bag to drag on the floor for one of six residents, (R) (R7), with catheters.

Inspectors wroteBased on observations and staff interviews the facility failed to ensure a clean, comfortable, and homelike environment in three resident's bathrooms (shared bathrooms 208/210, 209/211, and 213/215), one resident room (room [ROOM NUMBER]), and in the 200-hall shower room on one of three halls.

Inspectors wroteBased on observations, record review, staff interviews and review of the facility policy titled Medication Monitoring and Management the facility failed to ensure that psychotropic medications including an antipsychotic was not ordered as needed (PRN) for more than 14 days unless clinically indicated for one (1) of five (5) residents ((R) R#30) reviewed for unnecessary medications.