Moundville Health and Rehabilitation, LLC

Inspectors wroteBased on observations, interviews and a review of the facility's policies titled, Leftover Food Storage and Use, Calibrating and Sanitizing Thermometers and, Food Storage Temperature Logs, the facility failed to ensure: 1) reheated food (chicken fingers) on the tray line reached 165 degrees F (Fahrenheit); 2) a dietary worker properly calibrated the thermometer at the tray line and; 3) a temperature log was placed on the resident's supplement refrigerator on Unit One. This had the potential to affect 56 of 56 residents who receive meals from the kitchen. Findings Include: 1) A review of a facility policy titled, Leftover Food Storage and Use with an effective date of 8/15/2009, revealed: .PURPOSE: To assure that food borne illnesses are avoided. PROCESS: .e. Reheat foods to 165 degrees for at least 15 seconds . [...]

Inspectors wroteBased on record review, an interview and a review of a facility policy titled, Resident Assessment Instrument (RAI), the facility failed to ensure Resident Identifier (RI) #29's Foley catheter was coded on the 1/25/19 Quarterly Minimum Data Set (MDS). This affected RI #29, one of three residents sampled with a Foley catheter. Findings Include: A review of a facility policy titled, Resident Assessment Instrument (RAI), with an effective date of October 29, 2015, revealed: .STANDARD: .the facility conducts initially and periodically a comprehensive, accurate and standardized assessment of each resident's functional capacity, using the RAI specified by the state . RI #29 was re-admitted to the facility on [DATE] with a diagnosis of Retention of Urine. [...]

Inspectors wroteBased on observation, interviews, medical record review and a review of facility policies titled, Medication Administration Procedures Oral Medication and Medication Procedures Enteral Tube (given through a tube into the stomach) Administration, the facility failed to ensure licensed staff did not pour liquid medication back in the medication bottle after pouring out too much. The facility also failed to ensure a licensed staff member checked tube placement prior to administering the evening medications on 4/2/19. This affected Resident Identifier (RI) #25 one of one residents observed for medications by enteral tube. Findings Include: A review of a facility policy titled, Medication Administration Procedures Oral Medication with a date of 3/11 revealed: .Procedures .2. If medication is a liquid .Any over-pour should be disposed of according to the facility policy. [...]

Inspectors wroteBased on observation, interview, medical record review and review of facility policies titled, Contact Precautions and Wound Care Procedure for Major Wounds, the facility failed to ensure licensed staff did not clean a wound, then with the same gloves, apply the medication and outer covering. This affected Resident Identifier (RI) #32, one of one resident sampled for pressure ulcers. Findings Include: A review of a facility policy titled, Contact Precautions, with an effective date of September 1, 2017, revealed: .PURPOSE : . II. Gloves and hand hygiene .B. Gloves should be changed after having contact with infective material (e.g., fecal material and wound drainage). A review of a facility policy titled, Wound Care Procedure for Major Wounds, with an effective date of December 1, 2009, revealed: .PURPOSE : To provide guidelines for clean technique during wound care .II. Procedure .N. [...]

Inspectors wroteBased on observation, medical record review and interview, the facility failed to ensure licensed staff did not take a small water pitcher from the medication cart into Resident Identifier (RI) #25's room, place it on an unclean bedside table, then return the water pitcher to the medication cart without being cleaned. This was observed on 4/2/19, and affected one of one residents observed for medications by gastrostomy tube. Findings Include: RI #25 was readmitted to the facility on [DATE] with a diagnosis of Encounter for attention to gastrostomy. A review of RI #25's April 2019 Physician Orders revealed: .VITAMIN C 250 MG (milligram) TABLET GIVE TWO TABLETS BY PEG (gastrostomy) TWICE DAILY, METOCLOPRAMIDE 5 MG/5 ML (millimeters) SYRUP GIVE 5 ML PER GTUBE (gastrostomy tube) TWO TIMES A DAY . [...]

Inspectors wroteBased on observation, interview and review of a facility policy titled, Nurse Staff Posting Protocol, the facility failed to ensure the nurse staff posting form was in an area visible for residents and visitors. This was observed on three of three days of the survey and had the potential to affect all residents in the facility. Findings Include: A review of a facility policy titled, Nurse Staff Posting Protocol with an effective date of 12/27/05, revealed: The Administrator will select a prominent location to post the nursing direct care staffing form that is readily accessible to visitors and residents On 4/2/19 at 10:00 AM, the surveyor attempted to locate the nurse staff posting form. The surveyor was unable to locate the nurse staff posting form. On 4/2/19 at 3:00 PM, the surveyor continued to be unable to locate the nurse staff posting form. [...]

Inspectors wroteBased on observation, interview, medical record review and review of a facility policy titled, Person Centered Care Plans, the facility failed to ensure a care plan was developed for RI (Resident Identifier) #13's skin lesion to the right forearm. This affected one of seventeen sampled residents whose care plans were reviewed. Findings Include: A review of a facility policy titled, Person Centered Care Plans, with an effective date of November 28, 2016 revealed: .STANDARD: .the facility develops a comprehensive person centered plan of care for each resident .that includes measurable objectives and timetables to meet a resident/guest's medical, nursing and mental/psychosocial needs . RI #13 was admitted to the facility on [DATE], with a diagnosis to include Basal Cell Carcinoma Skin/Unsp(unspecified) Upper Limb. [...]

Inspectors wroteBased on observation, interview, medical record review, and a review of [NAME] AND PERRY'S FUNDAMENTALS OF NURSING and the facility' policy titled, Urinary Catheter Care the facility failed to ensure a Certified Nursing Assistant (CNA): 1. wiped to clean the length of the exposed catheter and 2. the catheter was secured to Resident Identifier (RI) #20's adhesive stabilization device. This affected one of one resident observed for catheter care. Findings Include: A review of [NAME] AND PERRY'S FUNDAMENTALS OF NURSING, NINTH EDITION, UNIT VII, page 1122, revealed: . BOX 46-10 Preventing Catheter-Associated Urinary Tract Infection (CAUTI) . Secure indwelling catheters to prevent movement and pulling on the catheter. Perform routine perineal hygiene daily and after soiling using antiseptic wipes. Be sure to a wipe to clean the length of the exposed catheter. [...]

Inspectors wroteBased on observation, interview, and review of a facility policy titled, Medication Storage, the facility failed to ensure three vials of a controlled drug, (Lorazepan) Ativan were stored in a locked box, inside the of the refrigerator of the medication room. This deficient practice was observed in one of two medication rooms. Findings Include: A review of a facility policy titled, Medication Storage, with a date of 3/11, documented the following: Policy Medications and biologicals are stored safely, securely and properly, . Procedures .7. Controlled medications are stored separately from other medication in a locked drawer or compartment designated for that purpose On 3/21/18 at 5:39 p.m., the surveyor was accompanied by EI (Employee Identifier) #6, a Registered Nurse (RN), to observed the medication room. EI #6 opened the refrigerator lock with a key. [...]

Inspectors wroteBased on observations, interviews, medical record reviews, a review of [NAME] AND PERRY'S FUNDAMENTALS OF NURSING, and a review of the facility's policy titled, Hand Hygiene, the facility failed to ensure: 1. a licensed nurse did not use the gloves she had in her uniform pocket while administering medications to Resident Identifier (RI) #39, 2. a licensed nurse did not lay RI #160's inhaler on the bathroom sink while washing her hands during medication administration, and 3. a Certified Nursing Assistant (CNA ) washed her hands after cleaning stool from RI #20's buttocks and before applying clean gloves during catheter care. This affected two of six residents observed during medication pass administration and one of one resident observed for catheter care. Findings Include: A review of [NAME] AND PERRY'S FUNDAMENTALS OF NURSING, NINTH EDITION, CHAPTER 29, page 445, revealed: . [...]