Montgomery Children's Specialty Center

Inspectors wroteBased on observation, interview, the facility's policy for Dispose of Garbage and Refuse, and the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code; the facility failed to ensure the side door of the dumpster was closed on 5/22/2023 at 6:45 PM to prevent the potential for rodents being attracted to and possibly entering the facility. This had the potential to affect 45 of 45 residents in the facility.

Inspectors wroteBased on observation, interview, review of the facility's policy for Menus, the facility's menu and diet guides for Week 1, Tuesday (Day 3) for Lunch on 5/23/2023, the residents' Diet Cards (sub-heading: Category Information) for Lunch on 5/23/2023, and the residents' Tray Tickets for Lunch on 5/23/2023; the facility failed to ensure food was portioned as specified by the approved menu for lunch on 5/23/2023. The facility also failed to ensure nutritional adequacy and appropriate modification of texture by not consulting with the Registered Dietitian before making substitutions to the menu for lunch on 5/23/2023. This had the potential to affect 7 of 17 residents receiving meals from the kitchen at the facility.

Inspectors wroteBased on observation, interview, the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code, the facility's policies for Food: Preparation and Equipment, and the facility's inservice information for Time and Temperature Control and Recording Inservice; the facility failed to prevent possible cross-contamination from a soiled manual can opener and a food preparation sink drain without an air gap on 5/23/2023. The facility further failed to ensure the food thermometer was properly checked and calibrated to check food temperatures accurately on 5/23/2023. This had the potential to affect 17 residents receiving meals from the kitchen and 17 of 45 residents in the facility.

Inspectors wroteBased on resident record review, interviews, and review of the Centers for Medicare & Medicaid Services Long Term Care Facility Resident Assessment Instrument Manual, the facility failed to ensure Resident Identifier (RI) #7's quarterly Minimum Data Set (MDS) dated [DATE] and RI #29's quarterly MDS dated [DATE] were coded accurately to reflect current diagnosis. This affected two of 12 residents for whom MDS assessments were reviewed.

Inspectors wroteBased on observation, interview and review of a facility policy titled, CLEAN (ASEPTIC) TREATMENT TECHNIQUE, the facility failed to ensure Employee Identifier (EI) #1, Registered Nurse (RN), Assistant Director of Nursing (ADN), Infection Control Nurse, did not place a clear plastic wound measuring tool that was lying on the resident's overbed table without a barrier, against the resident's skin to measure the resident's wound. This affected RI #6, one of two residents sampled with pressure ulcers in the facility. Findings Include: A facility policy titled, CLEAN (ASEPTIC) TREATMENT TECHNIQUE, with a revised date of 4/2018, stated: .II. Set up a clean field . e. Place a pad on the table, a water resistant pad or a clean towel on the table. f. Put all needed supplies (dressings, topical medications, cleansing solutions, etc.) on the clean field . [...]

Inspectors wroteBased on observation, medical record review and interview, the facility failed to ensure a licensed staff member did not pick up a paper towel from the floor then touch the clean feeding syringe while returning it to the clean plastic bag. This deficient practice affected Resident Identifier (RI) #16, one of the four residents observed during medication administration.

Inspectors wroteBased on record reviews, interviews and a review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF, the facility failed to ensure a staff member did not verbally abuse Resident Identifier (RI) #39 on 8/28/18, during the provision of care. This affected RI #39, one of one sampled resident reviewed for abuse. Findings Include: A review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF with a revised date of 8/13, revealed the following: Abuse means the willful infliction of injury, . intimidation, . with resulting . mental anguish . Verbal Abuse is defined as the use of oral . language that willfully includes disparaging and derogatory terms to residents . or within the hearing distance . RI #39 was admitted to the facility on [DATE], with diagnoses including Other Obesity Due to Excess Calories, Muscular Dystrophy, Heart Failure and Scoliosis. [...]

Inspectors wroteBased on record reviews, interviews and a review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF, the facility failed to ensure Employee Identifier (EI) #3, Certified Nursing Assistant (CNA), followed the reporting component of the abuse policy in order to report an allegation of abuse immediately to the facility Administrator, EI #1 and/or the Director of Nursing (DON) on 8/28/18. This affected Resident Identifier (RI) #39, one of one sampled resident reviewed for abuse. Findings Include: A review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF with a revised date of 8/13, revealed the following: .Reporting/Response: The facility employee . who becomes aware of abuse . shall immediately report the matter to the facility Administrator and/or the Director of Nursing . Abuse means the willful infliction of injury, . intimidation, . [...]

Inspectors wroteBased on record reviews, interviews and a review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF, the facility failed to ensure an allegation of abuse was reported to the Administrator or the State Agency within a two hour time frame. This affected Resident Identifier (RI) #39, one of one sampled resident reviewed for abuse. Findings Include: A review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF with a revised date of 8/13, revealed the following: .Reporting/Response The facility employee . who becomes aware of abuse . shall immediately report the matter to the facility Administrator and/or the Director of Nursing. An employee .may directly make a report to the state agency . [...]

Inspectors wroteBased on observation, interview, record review and a review of a facility policy titled, Using the Care Plan, the facility failed to develop and implement a baseline care plan for Resident Identifier (RI) #202 for the use of a divided plate and straw. This affected one of 14 residents observed during meals. Findings Include: A review of the facility's policy titled, Using the Care Plan with a revised date of August 2006, revealed the following: Policy Statement The care plan shall be used in developing the resident's daily care routines . RI #202 was admitted to the facility on [DATE], with diagnoses including Generalized Idiopathic Epilepsy and Epileptic Syndromes, Not Intractable with Status Epilepticus, and Dependence on Wheelchair. A review of RI #202's NURSING ADMISSION/readmission DATA COLLECTION form dated 10/11/18 revealed: .Eating Needs Focus: [...]

Inspectors wroteBased on observations, interviews, record review and a review of the facility's policy titled, Assistive Devices, the facility failed to ensure Resident Identifier (RI) #202 received a divided plate and a straw for the supper meal on 10/16/18. This affected one of 14 residents observed during meals. Findings Include: A review of the facility's policy titled, Assistive Devices with a revised date of 09/17, revealed the following: Policy Statement Assistive devices/utensils will be provided as identified in the individualized plan of care to maintain or improve a resident's/patient/s ability to eat or drink independently. RI #202 was admitted to the facility on [DATE], with diagnoses including Generalized Idiopathic Epilepsy and Epileptic Syndromes, Not Intractable with Status Epilepticus, and Dependence on Wheelchair. [...]

Inspectors wroteBased on observation, interview and a review of [NAME] and Perry's FUNDAMENTALS OF NURSING, the facility failed to ensure a licensed staff member washed her hands after removing unclean gloves and before applying clean gloves. This affected one of five nurses and RI (Resident Identifier) #49, one of six residents observed during medication administration. Findings Include: A review of [NAME] and Perry's FUNDAMENTALS OF NURSING Ninth Edition, Copyright 2017, page 458 revealed: .Hand Hygiene .3. If hands are not visibly soiled .use an alcohol based, waterless antiseptic agent for routinely decontaminating hands in the following clinical situations: Before, after, and between direct patient contact . After removing gloves . RI #49 was admitted to the facility on [DATE] with diagnoses of Depression and Diabetes. [...]