Merry Wood Lodge

Inspectors wroteBased on interviews, resident record review, review of the facility investigative files, review of Facility Reported Incidents (FRI), and review of a facility policy titled Abuse Prohibition, the facility failed to protect the rights of Resident Identifier (RI) #22 and RI #21, to be free from verbal and physical abuse perpetrated by RI #101. Specifically, the facility failed to provide adequate supervision and interventions per facility policy to prevent occurrences of abuse perpetrated by RI #101. RI #101 was admitted to the facility in July of 2024 with Dementia and Behaviors and was care planned for exhibiting physical behaviors. On 10/04/2024 RI #101 hit RI #22 in the chest while in the dining area for the lunch meal. Witnesses stated, RI #22 put his/her hands up in self-defense while being hit and someone in that situation would feel very upset and scared. [...]

Inspectors wroteBased on interviews, record review, review of the facility's investigative file, review of the facility's abuse policy titled Abuse Prohibition, and review of the job responsibilities of the Administrator (ADM), the ADM failed to ensure the Abuse Policy was implemented, failed to investigate abuse thoroughly, failed to identify abuse, and take appropriate action for prevention of abuse. On 07/01/2023, Certified Nursing Assistant (CNA #14) reported that she grabbed Resident Identifier (RI) #398's wrists to keep RI #398 from hitting her to Licensed Practical Nurse (LPN) #17. The incident was not reported to the Administrator (ADM) and no protective measures were implemented until 07/06/2023. On 07/06/2023 red and purple discolorations were noted on RI #398 's bilateral arms and wrists. [...]

Inspectors wroteBased on interviews, record review, review of facility policies titled Abuse Prohibition and Center Quality Assurance Performance Improvement Process, the facility failed to ensure the Quality Assurance and Performance Improvement (QAPI) committee reviewed and analyzed an allegation of abuse in a manner to analyze causes and implement preventative actions. The committee failed to identify physical abuse against Resident Identifier (RI) #398 and failed to identify concerns with identification, reporting, investigation, and protection for an allegation of physical abuse reported to the State Agency (SA) on 07/06/2023. It was determined the facility's non compliance with one or more requirements of participation had caused, or was likely to cause, serious injury, harm, impairment, or death to residents. [...]

Inspectors wroteBased on interviews, residents' record review, 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 residents right to be from abuse perpetrated by staff of the facility. On 07/01/2023 Resident Identifier (RI) #398 was physically abused by Certified Nursing Assistant (CNA) #14. This deficiency was cited as the result of the investigation of complaint /report #AL00044697. The facility further failed to ensure RI #48 was free from abuse perpetrated by CNA #10. On 03/10/2024 RI #48 was physically abused by CNA #10. The facility further failed to substantiate the allegations as abuse. These deficient practices affected RI #48 and RI #398, two of four sampled residents reviewed for employee to resident abuse. [...]

Inspectors wroteBased on interviews, record review, review of the facility's investigative file and review of the facility's abuse policy titled Abuse Prohibition, the facility failed to ensure the abuse policy was implemented following an incident of staff to resident physical abuse. The facility failed to ensure the incident was identified by licensed staff as abuse and protective measures were immediately implemented to prevent further potential abuse. The facility further failed to ensure the incident was reported to the Administrator (ADM) within two hours and thoroughly investigated to identify that abuse occurred and to ensure appropriate actions were taken to prevent further potential abuse. On 07/01/2023, Certified Nursing Assistant (CNA #14) reported to Licensed Practical Nurse (LPN) #17 that she grabbed Resident Identifier (RI) #398's wrists to keep RI #398 from hitting her. [...]

Inspectors wroteBased on interviews, record reviews, review of the facility's abuse policy titled, Abuse Prohibition, review of Facility Reported Incidents (FRIs) received by the Alabama State Survey Agency, and review of the facility's investigative files, the facility failed to ensure an allegation of staff to resident physical abuse was thoroughly investigated to identify that abuse occurred, determine if bruising was a result of the abuse, and take appropriate action to prevent further potential abuse. On 07/01/2023, Certified Nursing Assistant (CNA #14) reported to Licensed Practical Nurse (LPN) #17 that she grabbed Resident Identifier (RI) #398's wrists to keep RI #398 from hitting her. The incident was not reported to the Administrator (ADM) and no protective measures were implemented until 07/06/2023. On 07/06/2023 red and purple discolorations were noted on RI #398 's bilateral arms and wrists. [...]

Inspectors wroteBased on observations, interviews, the 2022 United States (U.S.) Food and Drug Administration (FDA) Food Code, and a facility's policy titled Environment, the facility failed to ensure the kitchen floor was maintained in a clean and sanitary manner. This had the potential to affect all residents who received meals from the facility's kitchen. Findings Include: A review of 2022 United States (U.S.) Food and Drug Administration (FDA) Food Code, documented: (A) PHYSICAL FACILITIES shall be cleaned as often as necessary to keep them clean . A review of policy titled Environment Revised 9/2017 documented: .The Dining Services Director will ensure that the kitchen is maintained in a clean and sanitary manner, including floors, walls, ceilings, lighting, and ventilation . On 08/20/2024 at 10:16 AM, the Surveyor along with the Dietary Manager conducted an initial inspection of the kitchen. [...]

Inspectors wroteBased on observation, interview, review of a facility policy titled, Environmental Services Policies and Procedures and review of the 2017 U.S. (United States) Public Health Service Food Code, the facility failed to ensure the grounds around the dumpster's were free of a burn pile with an accumulation of discarded cardboard boxes piled on top of the burn pile. This had the potential to attract rodents and pests and affect all 98 residents living in the facility. Findings Include: A review of the the 2017 U.S. (United States) Public Health Service Food Code revealed: . 5-501.110 Storing Refuse, Recyclables, and Returnable's. REFUSE, . shall be stored in receptacles or waste handling units so that they are inaccessible to insects and rodents . 5-501.115 Maintaining Refuse Areas and Enclosures. A storage area and enclosure for REFUSE, . shall be maintained free of unnecessary items . [...]

Inspectors wroteBased on interviews and review of the Payroll Based Journal (PBJ) Staffing Data Report, the facility failed to report accurate staffing data to the Centers for Medicare & (and) Medicaid Services (CMS). This affected the second quarter of the PBJ Staffing Data Report for 2024 (January 1, 2024 - March 31, 2024).

Inspectors wroteBased on observations, interviews and a review of a facility policy titled, Food Storage: Cold Foods, the facility failed to ensure: 1. outdated food was not stored in the walk-in cooler, and 2. food items were labeled with a received date or use by date prior to storage in the walk-in cooler/reach-in freezer. These failures had the potential to affect 89 residents receiving meals from the kitchen out of 92 total residents residing in the facility. Findings Include: The facility policy titled, Food Storage: Cold Foods, with a revised date of 4/2018, included . Procedures . 5. All foods will be stored . labeled and date, and arranged . to prevent cross contamination . On 02/29/20 at 01:18 p.m., the surveyor observed food items in the walk-in cooler. [...]

Inspectors wroteBased on interview, record review and review of a facility policy titled Change in Condition: Notification of the facility failed to contact Resident Identifier (RI) # 24's resident representative when his/her diet was changed to pureed in August 2019. This affected 1 of 20 sampled residents. Findings Include: A review of policy titled Change in Condition: Notification of, with an effective date of 11/28/16, documented: .A Center must immediately inform the patient's Health Care Decision Maker (HCDM) where there is: .A need to alter treatment significantly (that is, a need to discontinue or change an existing form of treatment due to adverse consequences, or to commence a new form of treatment . RI # 24 was admitted to the facility on [DATE] with diagnoses to include Vascular Dementia without Behavioral Disturbance. [...]

Inspectors wroteBased on record review, interviews, review of the consultant pharmacist's February 2020 Medication Regimen Review reports, and review of policies titled 9.1 Medication Regimen Review and 3.8 Psychotropic Medication Use, the facility failed to ensure the consultant pharmacist identified concerns during the February 2020 medication review with Resident Identifier (RI) #24's Seroquel, an antipsychotic medication, that was ordered on 1/27/20 without adequate justification for use. This affected RI #24, one of six sampled residents reviewed for unnecessary medications.

Inspectors wroteBased on record review, interviews, and review of the facility's policy titled Psychotropic Medication Use, the facility failed to ensure Resident Identifier (RI) #24 was not given Seroquel, an antipsychotic medication, without a diagnosis or medical justification to warrant its use. This affected RI #24, one of six sampled residents reviewed for unnecessary medications.

Inspectors wroteBased on record review, interview and review of a facility policy titled Medication: Administration: General, the facility failed to ensure nursing staff documented administration of Resident Identifier (RI) #24's Norco on 01/28/20 and 01/30/20 on the Medication Administration Record (MAR). This affected 1 of 20 sampled residents whose MARs were reviewed. Findings Include: A review of a facility policy titled Medication: Administration: General, revised 11/1/19, documented: .11. Document: 11.1 Administration of medication on Medication Administration Record (MAR) . RI # 24 was admitted to the facility on [DATE] with a diagnosis of Vascular Dementia without Behavioral Disturbance. RI #24's Physician's Orders included an order for Norco to be given every six hours as needed for pain, with a start date of 1/27/20. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure Nurse Staffing information was posted on Saturday, 2/29/20, when the survey team entered the building. This was observed on 2/29/20 and had the potential to affect all 92 residents residing in the facility, as well as family and visitors in the facility.

Inspectors wroteBased on observations, record review, interviews, and review of the Material Safety Data Sheet (MSDS) for a bottle of shampoo, the facilty failed to ensure: 1) Resident Identifier (RI) #46 was not observed repeatedly plugging and unplugging an electrical cord within reach of his/her bed; and 2) RI #21, a cognitively impaired resident, did not have access to a bottle of shampoo, that posed the risk for eye irritation and was identified as potentially harmful if swallowed. On 12/13/18, RI #21 was observed applying the shampoo to another resident's hair (RI #54) during an activity being held in the secure/dementia unit. These failures affected one of 22 sampled residents with electrical outlets in their rooms, and had the potential to affect all 33 residents residing on the secure unit.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure Resident Identifier (RI) #46's electrical outlets were blocked as specified on his/her care plan. This affected one of 22 residents for whom care plans were reviewed.