Nelson County Health System Care Center

Inspectors wroteBased on observation, record review, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 5 of 7 sampled residents (Resident #1, #3 #5, #6, and #16) and one supplemental resident (Resident #20) observed during cares. Failure to practice infection control standards related to transmission based precautions (TBP), enhanced barrier precautions (EBP), and hand hygiene, has the potential to spread infection throughout the facility.

Inspectors wroteBased on observation, record review, review of manufacturer's instructions, review of facility policy, and staff interview, the facility failed to provide necessary care and services for 1 of 1 supplemental resident (Resident #10) observed during administration of rapid-acting insulin. Failure to administer rapid-acting insulin according to the physician's order may result in a hypoglycemic (low blood sugar) reaction.

Inspectors wroteBased on record review, review of the facility reported incident (FRI) investigations, review of facility policy, and resident interview, the facility failed to ensure residents remain free from abuse for 2 of 2 sampled residents (Resident #2 and #4) who were subjected to physical abuse by Resident #1. Failure to protect residents from physical abuse may result in injury, fear, anxiety, mental anguish, and emotional distress.

Inspectors wroteBased on record review, review of the facility reported incident (FRI) investigations, review of facility policy, and resident interviews, the facility failed to investigate alleged violations of abuse for 2 of 2 sampled residents (Resident #2 and #4). Failure to investigate Resident #1's incidents of abusive behavior, ensure the protection of other residents during the investigation, implement corrective actions, and evaluate the effectiveness of the actions, placed all residents at risk for mistreatment, verbal abuse, and/or experiencing anxiety/fear.

Inspectors wroteBased on record review, review of the facility reported incident (FRI) and investigation, review of facility policy, and staff interview, the facility failed to ensure residents remained free from abuse for 1 of 1 sampled resident (Resident #1) who displayed physical behaviors towards other residents. Failure to provide necessary services to protect residents from abuse resulted in physical abuse. This citation is considered past non-compliance based on review of the corrective actions the facility implemented immediately following the incident.

Inspectors wroteBased on observation, record review, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 1 of 2 sampled residents (Resident #9) observed with an indwelling catheter. Failure to practice infection control standards related to enhanced barrier precautions (EBP), urinary catheters, and hand hygiene has the potential to spread infection throughout the facility.

Inspectors wroteBased on observation, record review, review of the facility reported incident, review of facility policy, and staff interviews the facility failed to ensure residents remained free from abuse from 1 of 1 sampled resident (Resident #1) who displayed verbal and physical behaviors towards residents. Failure to provide necessary services to protect residents from abuse resulted in physical and psychosocial harm.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure 1 of 1 closed record (Resident #1) remained free from a chemical restraint (morphine sulfate-an opioid pain medication). Failure to attempt non-pharmacological interventions and/or utilize the least restrictive alternative medication does not allow the resident to attain and/or maintain his/her highest level of practicable well-being.

Inspectors wroteBased on review of the Electronic Staffing Data Submission Payroll-Based Journal (PBJ) Long-Term Care Facility Policy Manual and staff interview the facility failed to submit direct care staffing information based on payroll data to the Electronic Staffing Data Submission PBJ for 2 of 4 reporting periods. Failure to submit direct care staffing information may result in inaccurate representation of the level of staff in the facility which can impact the quality of care delivered.

Inspectors wroteBased on observation, record review, and resident and staff interview, the facility failed to review and revise the comprehensive care plan to reflect the resident's current status for 3 of 14 sampled residents (Resident #13, #25, and #32). Failure to revise the care plan for Residents #13 and #32 limited the staff's ability to communicate care needs and ensure continuity of care for each resident and failure to update Resident #25's transfer status placed the resident at risk for injury.

Inspectors wroteBased on observation, record review, and resident and staff interview, the facility failed to provide care and services for 1 of 1 sampled residents (Resident #25) reviewed for edema (fluid retention) and 1 of 2 sampled residents (Resident #26) observed wearing a splint. Failure to apply compression stockings as ordered may result in worsening edema and failure to obtain an order for use of a splint may result in worsening pain.

Inspectors wroteBased on observation, record review, review of professional reference, facility policy, and staff interviews, the facility failed to provide supervision and assistive devices necessary to prevent accidents for 2 of 14 sampled residents (Residents #13 and #19). Failure to provide supervision of certified nurse aides (CNAs) by a licensed nurse regarding resident transfer modes and failure to utilize safe/proper technique during transfers may result in unnecessary pain, falls and/or injury for residents.

Inspectors wroteBased on observation, record review, review of a professional reference, and staff interview, the facility failed to provide appropriate toileting for 2 of 12 sampled residents (Resident #8 and #13) who required staff assistance with toileting. Failure to provide toileting may result in a loss of dignity and placed residents at risk for skin breakdown, poor grooming/hygiene, decreased self-esteem, urinary tract infections, and risk for fall and/or injuries.

Inspectors wroteBased on observation, review of facility policy, and staff interview, the facility failed to ensure safe and secure storage of medications in 1 of 1 medication carts. Failure to store all medications securely may result in unauthorized access to medications.

Inspectors wroteBased on observation, facility policy review, and staff interview, the facility failed to ensure staff followed standard infection control practices for 2 of 10 sampled residents (Resident #6 and #16) and 1 supplemental resident (Resident#1). Failure to follow infection control practices related to hand hygiene and glove use has the potential for transmission of communicable diseases and infections to residents and staff.