NHC Healthcare, Anniston

Inspectors wroteBased on interviews, record review, review of a facility policy titled Patient Protection and Response Policy for Allegations/Incidents of Abuse, Neglect, Misappropriation of Property and Exploitation, review of Facility Reported Incidents (FRIs) received by the State Agency, and review of the facility's investigative files, the facility failed to protect the rights of residents to be free from abuse perpetrated by other residents of the facility. Specifically, on 05/22/2023 Resident Identifier (RI) #237 was physically abused by RI #239 when facility staff witnessed RI #239 grab RI #237's wrists and pull RI #237 from a recliner onto the floor and punch RI #237 multiple times. The facility failed to prevent this from occurring as staff members were aware RI #239 was annoyed with RI #237 yelling and RI #239 had already told RI #237 to shut up, earlier in the night. [...]

Inspectors wroteBased on interviews, resident record reviews, review of the facility policy titled BEHAVIORAL HEALTH SERVICES, the facility failed to provide immediate and necessary behavioral interventions and supervision to prevent Resident Identifier (RI) #290, a resident exhibiting physically aggressive behaviors, from physically abusing RI #288. On 08/15/2023 RI #290 displayed physically aggressive behaviors toward the facility staff, ramming them with his/her walker and swinging at them with a dispenser for hand sanitizer. RI #290 was then allowed to walk into a day room area with other residents and staff who were preparing for lunch. RI #290 hit RI #288 in the face and chest. This affected RI #288 one of five residents reviewed for behaviors.

Inspectors wroteBased on interviews, resident record review, review of a Facility Reported Incident (FRI) received by the State Agency, the facility's investigative file, and review of a facility policy titled PATIENT'S RIGHTS, the facility failed to ensure Resident Identifier (RI) #237's rights were honored on 05/22/2023 when RI #237 told facility staff he/she had been attacked and wanted to notify the police. Facility staff witnessed RI #239 grab RI #237's wrists, pull RI #237 out of a recliner onto the floor, and RI #239 threw punches at RI #237. The police were not notified of RI #237's request. This deficient practice affected one of 26 residents sampled and was cited as a result of the investigation of complaint/report number AL00044297.

Inspectors wroteBased on resident record review, interviews, review of a facility policy titled Patient Protection and Response Policy for Allegations/Incidents of Abuse, Neglect, Misappropriation of Property and Exploitation, and review of the facility investigative files, the facility failed to report reasonable suspicion of a crime against residents who were physically abused to Local Law Enforcement for Resident Identifier (RI) #237 and RI #288. Specifically, on 05/22/2023 facility staff witnessed Resident Identifier (RI) #237 being pulled from a recliner by the wrists onto the floor and punched by RI #239. RI #237 was assessed with redness and bruising to the right wrist after the incident and RI #237 told staff who witnessed the physical abuse occur, he/she had been attacked and wanted the police. [...]

Inspectors wroteBased on interviews, resident record review, review of facility polices titled, Patient Protection and Response Policy for Allegations/Incidents of Abuse, Neglect, Misappropriation of Property and Exploitation and INCIDENT AND ACCIDENT PROCESS, and review of the facility investigative files, the facility failed to thoroughly investigate incidents of resident-on-resident physical abuse for appropriate action to be taken to prevent further occurrences. On 05/22/2023 facility staff witnessed Resident Identifier (RI) #239 grab RI #237's wrists, pull RI #237 from a recliner onto the floor, and punch RI #237 multiple times. The facility failed to prevent this from occurring after RI #239 was annoyed with RI #237 yelling out and RI #239 had told RI #237 to shut up earlier in the night. RI #237 was assessed with redness and bruising to the right wrist. [...]

Inspectors wroteBased on interviews, review of Resident Identifier (RI) #237's medical record, review of a facility policy titled NEUROLOGICAL CHECKS, and an Online Incident Report (FRI), the facility failed to ensure Registered Nurse (RN) #4 documented assessment details in RI #237's medical record after a resident-on-resident incident on 05/22/2023. This had the potential to affect RI #237, one of 26 sampled residents and was cited as a result of the investigation of complaint/report number AL00044297.

Inspectors wroteBased on observation, interviews, and a review of the facility policy titled, Handling Linen, the facility failed to ensure that a staff member changed gloves and washed hands between rooms while collecting dirty laundry. This deficient practice had the potential to affect 2 out of 3 residents who had soiled laundry removed from their rooms by a staff member.

Inspectors wroteBased on observation, interview, the 2017 Food Code, and the facility's policy titled, Refrigerator and Freezer Storage, the facility failed to ensure ice cream and frozen nutritional treats were maintained solidly frozen during storage and failed to prevent the potential for contamination from backflow of contaminated sewage by allowing a food preparation sink's drain pipe to extend into the floor drain, This had the potential to affect all residents receiving meals from the kitchen, 135 of 136 residents. Findings Include: I. Frozen Food The 2017 Food Code recommendations of the United States (U.S.) Public Health Service and the U.S. Food and Drug Administration included: . 3-501.11 Frozen Food. Stored frozen FOODS shall be maintained frozen. The Code of Federal Regulations, Title 21, Volume 2, revised April 1, 2018, included: . [...]

Inspectors wroteBased on observation, interview, record review, and a facility policy titled, Nail Care, Cleaning and Trimming, the facility failed to ensure Resident Identifier (RI) # 92's toenails were not long, thick and curved, on two of four days of the survey. This effected 1 of 52 residents observed for (ADL'S) Activities of Daily Living care. RI #92 was admitted to the facility on [DATE]. Diagnoses included muscle wasting and atrophy. A review of RI #92's Quarterly Minimum Data Set (MDS) assessment, with a reference date of 08/22/2018, reflected the resident had a Brief Interview of Mental Status of 12/15, indicating moderate cognition impairment. The MDS also reflected the resident required extensive assistance of one person for personal hygiene care. A review of RI #92's Assessment Record form, with dates of 8/6, 8/13, and 8/20, was documented with a N (No) for thick mycotic nails. [...]

Inspectors wroteBased on observation, interview, medical record review and a review of the facility's policy titled, MEDICATION ADMINISTRATION-GENERAL GUIDELINES, the facility failed to ensure a licensed staff did not a leave a medication cart unlocked, unattended and out of staff view. This affected one of four nurses and one of four medication carts observed during medication administration. Findings Include: A review of the facility's policy titled, . Medication Administration-General Guidelines, effective date: 6/2016, included . B. Administration . 15) During administration of medications, the medication cart is kept closed and locked when out of sight of the medication nurse . On 09/19/18 at 8:22 AM, Employee Identifier (EI) #5, Licensed Practical Nurse (LPN) was observed during a medication pass. After EI # 5 completed her pass she returned to the med cart and reconciled all med passed. [...]