Montgomery County Nursing Home

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined that the facility did not ensure Enhanced Barrier Precautions (EBP) were implemented and that staff wore proper personal protective equipment (PPE) when care was provided for 1 (Resident #61) of 3 residents reviewed for wound care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dishcloths and scouring pads were stored in a safe, sanitary manner, and the staff failed to ensure proper hand hygiene when handling food, and food was placed down in an unsanitary manner to prevent cross contamination. These failed practices had the potential to affect all 67 residents that eat from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to protect 1 (Resident #53) sampled resident ' s privacy by leaving the Medication Administration Record [MAR] book open and unattended on the medication cart across from the nurses station. This failed practice had the potential to affect 4 sampled residents that ambulate and self-propel in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure fingernails were kept clean to promote good personal hygiene and grooming for 1 (Resident #47) of 6 sampled residents who were dependent on staff for nail care on 100 Hall.

Inspectors wroteBased on observations, interview, and record review, the facility failed to ensure the resident environment was as free of potential accident hazards as possible, as evidenced by failure to ensure medication carts containing medications were locked to prevent access to the medications, and the possible risk for misappropriation of medications. This failed practice had the potential to affect 4 (Residents #1, #34, #53, #58) sampled residents of 23 residents who were independent for ambulation or self-propelled in wheelchairs.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure food items stored in the refrigerator and dry storage areas were sealed, covered and dated; leftover food items were maintained to promote food quality and or prevent potential food borne illness for residents who received meal trays from 1 of 1 kitchen; expired food items were promptly removed from stock; staff washed their hands between dirty and clean tasks and before handling clean dishes or food items; 1 of 2 ice scoop holders was maintained in a clean and sanitary condition. These failed practices had the potential to affect 68 residents (total Census 68) who received meals from 1 of 1 kitchen as documented on a list provided by the Dietary Supervisor on 02/08/23 at 2:58 PM.

Inspectors wroteBased on interview, and record review, the facility failed to be in compliance with all applicable Federal, State, and local laws, regulations, and codes by failing to ensure the admission Packets were completed with original signatures for 7 (Residents #9, #19, #27, #34, #40, #46 and #60) of 7 sampled residents. This failed practice had the potential to affect all 68 residents who resided in the facility as documented on the Resident Census provided by the Administrator on 02/06/23.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure residents in the same Dining Room and at the same table were served concurrently to promote dignity and respect for 1 (Residents #29) of 4 (Residents #2, #29, #39 and #46) sampled residents who ate meals in the Unit Dining Room and were dependent for eating. These failed practices had the potential to affect 4 residents who were dependent for eating and had the potential to affect all 21 residents who resided in the Unit on the 400 Hall as documented on lists provided by the Assistant Director of Nursing (ADON) on 02/10/23.

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents who had a resident Trust Fund account with the facility received monthly applicable interest deposited into the account of each entitled resident for 3 (Residents #1, #2 and #34) of 3 sampled residents whose Trust Fund accounts were reviewed. This failed practice had the potential to affect 20 residents who had resident Trust Fund accounts managed by the facility as documented on the Trust Fund Report dated 02/06/23 provided by the Bookkeeper on 02/08/23 at 9:21 AM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure generally accepted proper bookkeeping techniques were followed to accurately reconcile individual resident Trust Funds for 3 (Residents #23, #26 and #70) of 13 (Resident #1, #2, #3, #8, #10, #23, #26, #29, #34, #35, #45, #55, and #70) sampled residents who had Trust Funds managed by the facility. This failed practice had the potential to affect 20 residents who had their personal Trust Funds managed by the facility as documented by the Trust Fund Report dated 02/06/23 provided by the Bookkeeper on 02/08/23 at 9:21 AM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents who received Medicaid benefits were notified when the amount in their Trust Fund account was within $200.00 of the maximum Medicaid recipient cash assets for 2 (Residents #1 and #29) of 13 (Residents #1, #2, #3, #8, #10, #23, #26, #29, #34, #35, #45, #55 and #70) sampled residents who had Medicaid coverage and had Trust Funds managed by the facility as documented on the Trust Fund Report dated 02/06/23 provided by the Bookkeeper on 02/08/23 at 9:21 AM.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure meals were prepared and served in accordance with the planned, written menu, to meet the nutritional needs of the residents for 2 of 2 meals observed. This failed practice had the potential to affect 11 residents who received pureed diet and 4 residents who received a liquified pureed diet (total census: 68), according to the Diet List provided by the Dietary Supervisor on 02/08/23.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure food was prepared by methods that maintained the flavor and appearance; hot foods were served hot and cold foods were served cold to maintain palatability and to encourage adequate nutritional intake for 2 of 2 meals observed on the 400 Hall Unit. This failed practice had the potential to affect 21 residents who received their meals in the Unit Dining Room according to a list provided by the Dietary Supervisor on 02/08/23 at 2:16 PM.

Inspectors wroteBased on observation, and interview, the facility failed to ensure pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meals observed. The failed practice had the potential to affect 11 residents who received pureed diets and 4 residents who received liquified pureed diets as documented on a List provided by the Dietary Supervisor on 02/08/23 at 2:16 PM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure monitoring and auditing were conducted on a regular basis by the Compliance Officer in the areas of resident trusts and admissions to prevent and detect potential criminal, civil, and administrative violations.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure BiPAP [Bilevel Positive Airway Pressure] mask was properly stored in a bag when not in use to prevent potential possible cross contamination that could result in a respiratory infection for 1 (Resident #42) of 1 sampled resident who had a physician's order for a BiPAP.