Miller's Merry Manor

Inspectors wroteBased on record review and interview, the facility failed to ensure each residents' dignity and rights were maintained related to not responding to complaints of excessive television volume in a timely manner for 3 of 4 resident council members and one random resident that resided on the 100 unit. (Residents 6, 30, 41 and 45)

Inspectors wroteBased on record review and interview, the facility failed to invite and hold care planning conferences for residents and/or their family members for 2 of 16 residents whose care plans were reviewed. (Residents 34 and 6)

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure bruises were assessed and monitored for 1 of 3 residents reviewed for non-pressure related skin conditions. (Resident 34)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure fall precautions were in place for a resident with a history of falls for 1 of 2 residents reviewed for accidents. (Resident 2)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure proper medication storage related to eye drops not labeled with directions for use and the physician's name, insulin pens used past their expiration date, and Tuberculin multi-use vials not labeled when opened, for 1 of 8 residents observed during medication administration, 2 of 2 medication carts, and 1 of 1 medication room observed. (Resident 39, the ICF and Rosewood medication carts, and the main medication room)

Inspectors wroteBased on observation and interview, the facility failed to ensure infection control practices were in place and implemented related to not wearing personal protective equipment (PPE) in enhanced barrier precaution rooms, and failing to disinfect multi-use equipment during random infection control observations. (Residents 57 and 39)

Inspectors wroteBased on record review and interview, the facility failed to ensure CNAs had a current and valid certificate to work in the facility for 1 of 15 CNA records reviewed. (CNA 1)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a resident received proper assistance to prevent accidents, related to a CNA (CNA 1) transferring a dependent resident from a chair to the bed without following the plan of care, causing an injury to the left lower leg, which required an emergency room (ER) visit and 19 sutures to the injury, for 1 of 3 residents reviewed for mechanical lift usage. (Resident E)

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident received the necessary care and services related to an antibiotic medication not administered as ordered by the Physician for 1 of 3 residents reviewed for urinary tract infections. (Resident E)

Inspectors wroteBased on observation, record review, and interview, the facility failed to keep the kitchen clean and in good repair related to food not labeled and dated for 1 of 1 kitchen. (The Main Kitchen) This had the potential to affect all residents receiving food from the kitchen.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure infection control practices were in place and implemented related to staff failing to perform hand hygiene after glove removal and prior to donning personal protective equipment (PPE) for 1 of 8 residents observed during medication administration, enhanced barrier precautions (EBP) not followed, and glove use in the hallway during random infection control observations. (Residents 1, 51, and 13)

Inspectors wroteBased on observation and interview, the facility failed to provide a sanitary, comfortable environment for staff, residents, and the public related to the strong odor of urine on 1 of 3 halls. (The 100 hall/ICF) This had the potential to affect all residents residing on the ICF wing.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the resident's responsible party was promptly notified after the development of a venous stasis foot ulcer (a wound caused by abnormal or damaged veins) for 1 of 1 resident reviewed for notification of change. (Resident 51)

Inspectors wroteBased on record review and interview, the facility failed to file a grievance form for multiple complaints regarding pain, care, dignity, and room location that were reported by the resident to the Administrator for 1 of 1 resident reviewed for grievances. (Resident 32)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure activities of daily living (ADLs) were completed for dependent residents related to not providing showers twice a week for 3 of 4 residents reviewed for ADLs (Residents 24, 40, and 8), and not providing oral care for 2 of 2 residents with a feeding tube reviewed for ADLs. (Residents 24 and 40)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure signs and symptoms of constipation were addressed for 1 of 1 resident reviewed for constipation, residents were transported and arrived to physician visits on time and heels were floated for non-pressure ulcers for 2 of 6 residents reviewed for non-pressure skin conditions, and insulin was administered as ordered for 1 of 5 residents reviewed for unnecessary medications. (Residents 7, 32, and 51)

Inspectors wroteBased on observation, record review, and interview, the facility failed to assist a resident with eating, monitor nutritional intake for meals, obtain readmission and post dialysis weights, and provide breakfast before dialysis for residents with a history of significant weight loss for 2 of 2 residents reviewed for nutrition. (Residents 19 and 32)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure oxygen was at the correct flow rate for 1 of 1 resident reviewed for oxygen. (Resident 36)

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure a resident's pain was managed and monitored for 1 of 1 resident reviewed for pain. (Resident 32)

Inspectors wroteBased on record review and interview, the facility failed to ensure each resident's medication regimen was managed and monitored related to not monitoring the resident's blood pressure for medications with blood pressure parameters for 2 of 5 residents reviewed for unnecessary medications. (Residents 21 and 29)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a medication error rate of less than 5% for 2 of 8 residents observed during medication pass. Three errors were observed during 25 opportunities for errors during medication administration. This resulted in a medication error rate of 12%. (Residents 6 and 1)

Inspectors wroteBased on record review and interview, the facility failed to ensure clinical records were complete and accurately documented related to meal consumption for 1 of 1 resident reviewed for ADL (activities of daily living) decline. (Resident 42)

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a dependent resident received assistance with activities of daily living (ADL's) related to nail care for 1 of 4 residents reviewed for ADL's. (Resident 199)

Inspectors wroteBased on record review and interview, the facility failed to ensure the residents' clinical records were complete and accurately documented, related to clarification orders for apical pulse monitoring and lack of documentation of a non-pressure area that had healed with treatment orders still in place, for 1 of 2 residents reviewed for accidents and 1 of 2 residents reviewed for non-pressure related skin conditions. (Residents 11 and 28)