Monroe Manor Health & Rehabilitation Center

Inspectors wroteBased on interview, record review, review of the facility's Director of Nursing's (DON) Job Description, and review of the facility's Administrator's Job Description, the facility failed to be administered in a manner that ensured residents attained and maintained their highest practicable physical, mental, and psychosocial well-being. The facility's Administrator and DON failed to identify and/or act on identified failures related to abuse and implementation of their abuse policy. These deficient practices affected four of 29 sampled residents (Resident (R) 44, R86, R21, and R90) reviewed for abuse. R86 was a cognitively intact resident who set relationship boundaries with R41; however, R41 crossed the boundaries and R86 sustained verbal sexual abuse. The facility was aware of and enabled R41 to touch the cognitively impaired residents inappropriately. [...]

Inspectors wroteBased on observation, interview, record review, and review of the facility's abuse policies, the facility failed to ensure residents were free from abuse perpetrated by other residents. Specifically:(1) The facility failed to ensure Resident (R)86 was free from verbal abuse perpetrated when R41 put both his/her hands on both of his/her face cheeks and stated to him/her, I want to f*** you so bad.(2) The facility failed to assess R87, a cognitively impaired resident, for his/her capacity to consent before developing a care plan for resident's desire to engage in sexual expression.(3) The facility failed to ensure R44 was free from sexual abuse following an assessment of his/her capacity to consent to sexual contact using a facility assessment questionnaire that indicated R44 did not have the capacity to consent. [...]

Inspectors wroteBased on interview, record review, review of the facility's policy, and review of the Code of Alabama the facility failed to implement the facility's abuse policies to ensure residents were free from all forms of abuse and failed to ensure their policy was developed to meet the minimum federal regulatory requirements related to sexual abuse, including residents' capacity to consent to sexual activity for two of 29 sampled residents, Resident (R) 44 and R87. Specifically, the facility failed to ensure R87, a cognitively impaired resident, was assessed for their capacity to consent before developing a care plan related to his/her desire to engage in sexual expression. [...]

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure the attending physician was immediately notified of a significant change in condition (low blood glucose levels) for one of one resident (Resident (R) 12) reviewed for notification of changes. R12 experienced repeated blood glucose levels ranging from 32 mg/dL (milligrams/ deciliter) to 44 mg/dL across multiple shifts without physician notification. This deficient practice resulted in a delay in medical evaluation and treatment.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure Notice of Medicare Non-Coverage (NOMNC) notification was provided and that the responsible party was notified for two of three residents (Residents (R) 21 and R36) reviewed for beneficiary notification out of a total sample of 29 residents. This had the potential to affect all residents being discharged from services.

Inspectors wroteBased on interview, record review, and review of the facility's policy, the facility failed to: 1.) identify and intervene for a change in the resident's condition and ensure the resident received prompt assessment and emergency care for one of one resident (Resident (R) 88) reviewed for changes in condition out of 29 sampled residents. Licensed Practical Nurse (LPN) 9 failed to listen to R88's airway when the resident presented with signs and symptoms of aspiration. This failure caused a potential delay in R88's treatment. R88 was admitted to the hospital for aspiration pneumonia; and 2.) ensure residents were appropriately screened and had documentation to support the use of wander guards for one of two residents (Resident (R) 41) reviewed for wander guards out of a total sample of 29. [...]

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure there was a current physician's order for a resident to receive dialysis treatment for one of one resident (Resident (R) 3) reviewed for dialysis out of a total sample of 29. This had the potential to affect the continuity of care for residents who received dialysis treatment.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure residents received alternative measures prior to the installation of side rails; documented discussion related to risk versus benefits; and signed informed consent prior to bed rail use for two of three residents (Resident (R) 3 and R6) reviewed for side rails out of 29 sampled residents. The lack of alternate side rail measures and proper assessment/consent could lead to potential restraint or side rail entrapment.

Inspectors wroteBased on interview, record review, and review of the facility's Social Service Director's (SSD's) job description, the facility failed to ensure three of 29 sampled residents (Resident (R) 44, R86, and R87) received medically related social services related to assessment for residents' capacity to consent to sexual contact with others and follow-up services for psychosocial support after a resident's companionship ended. These failures by the facility's SSD enabled the cognitively impaired residents (R44 and R87) to be exploited by a cognitively intact resident (R41), and when R86's companionship ended with R41, the SSD did not offer services to R86 to rule out any inappropriate sexual conduct R86 may have received from R41. (Cross Reference F600)

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure nursing staff did not administer glimepiride (an oral hypoglycemic medication used to lower blood glucose levels) with documented low blood glucose levels ranging from 32 mg/dL (milligrams/ deciliter) to 44 mg/dL and poor oral intake for one of one resident (Resident (R) 12) reviewed for unnecessary drugs of 29 sample residents. This deficient practice placed R12 at risk for, and resulted in, worsening hypoglycemia requiring hospitalization.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure staff implemented appropriate personal protective equipment (PPE) in accordance with Enhanced Barrier Precautions (EBP) during high-contact care activities (medication administration via gastrostomy tube [G-tube]), for one of one resident (Resident (R) 4) reviewed for EBP of 29 sample residents. This deficient practice had the potential to increase the risk of transmission of infectious organisms between residents and staff, and within the facility, which housed a vulnerable population of 68 residents.

Inspectors wroteBased on interview, record review, and review of the facility's policy, the facility failed to ensure the resident's guardian gave consent prior to the resident being administered the COVID-19 vaccination for one of one resident (Resident (R) 44) reviewed for COVID-19 vaccinations out of a total sample of 29. The facility obtained consent for the vaccination from R44; however, the resident had a guardian. This had the potential to cause R44 physical harm as the resident was unable to understand the risks or benefits of the vaccination.

Inspectors wroteBased on observation, interviews, record review and review of facility policies ADMINISTRATIVE PROCEDURE SUBJECT: Infection Prevention and Control Program and ADMINISTRATIVE POLICY SUBJECT: Isolation Precautions , the facility failed to ensure that a Certified Nursing Assistant (CNA): 1. wore gloves and gown while providing caring for Resident Identifier (RI) #232 (a resident on contact precautions); 2. washed her hands before leaving the room of RI #232 after obtaining vital signs and 3. sanitized the vital sign machine used to obtain vital signs on RI #232. These observations were made on 12/03/19 and involved one of two residents sampled for isolation precautions. Findings Include: A review of a facility policy titled ADMINISTRATIVE PROCEDURE SUBJECT: Infection Prevention and Control Program with a revised date of 09/12/2009 revealed . PROCESS: . 2. [...]

Inspectors wroteBased on observations, interviews, and a facility training sheet, titled GLUCOSE MONITORING EQUIPMENT CARE AND USE SKILLS CHECK OFF LIST, the facility failed to ensure a licensed professional nurse disinfected a blood glucose meter between residents. This affected one of five glucose checks during a glucometer use observed during a medication pass.

Inspectors wroteBased on observation, interviews and a review of the policy: Food From Outside Sources, the facility failed to ensure food brought in by family, visitors or volunteers for resident use was consistently labeled with resident's name, room number, date of receipt and date of discard. This had the potential to affect 44 residents (of a total of 76) serviced by one of two nursing units.

Inspectors wroteBased on observation, interviews, and a facility policy titled, Glucose Monitoring Equipment - Care and Quality Control Testing , the facility failed to ensure a employee properly cleaned and disinfected the glucometer after use. This had the potential to effect 1 of 5 resident's observed during glucose checking.