NHC Healthcare Rossville

Inspectors wroteBased on interview, record review, and policy review, the facility failed to identify and report abuse including an injury of unknown source, and misappropriation of property for four of 29 sampled residents (R) (R245, R74, R6, and R70). The facility's nursing staff reported incidents of abuse directly to the facility's Director of Nursing (DON) and the facility's Director of Social Services (DSS); however, neither identified the incidents as abuse nor reported the abuse to the State Survey Agency (SSA). Additionally, a resident reported to the DSS that she was missing money; however, the DSS did not identify the resident's missing money as an incident of possible misappropriation and report the possible misappropriation to the SSA. These systemic failures had the potential to affect all residents and future residents of the facility. [...]

Inspectors wroteBased on interview and record review, the facility failed to investigate incidents of abuse, misappropriation, and injury of unknown source for five of 29 sampled residents (R) (R245, R74, R6, and R70, and R56). Additionally, the facility failed to prevent further abuse and possible abuse to all residents of the facility by failing to investigate. The facility's nursing staff reported incidents of abuse directly to the facility's Director of Nursing (DON) and the facility's Director of Social Services (DSS); however, neither investigated the incidents of abuse, misappropriation, or the injury of unknown source. These systemic failures had the potential to affect all residents and future residents of the facility. [...]

Inspectors wroteBased on interviews, record review, and review of the facility's Director of Nursing's (DONs) and the Director of Social Services (DSS) Job Descriptions, the facility failed to be administered in a manner that enabled effective use of its resources to attain and maintain the highest practicable physical, mental, and psychosocial well-being of each resident. This failure had the likelihood of affecting all residents of the facility. The facility's administration failed to maintain standard levels of care and services for its residents when Immediate Jeopardies were identified at F600-J, F609-L, and F610-L. 1. The facility's administration failed to ensure residents remained free from abuse when the facility's nursing staff identified and reported incidents of resident-to-resident abuse to the DON and the DSS. Neither the DON nor the DSS identified the incidents as abuse. [...]

Inspectors wroteBased interview, record review, and review of the facility's policy, the facility failed to ensure four of 29 sampled residents (R) (R245, R74, R6, and R70) were free from abuse. The facility's administration was aware of incidents where either abuse occurred or incidents of possible abuse; however, the facility did not act to protect the residents from abuse. The facility's failure had affected and/or had the likelihood to affect residents of the facility including any future admissions to the facility. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused or had the likelihood to cause, serious injury, harm, impairment, or death to residents. The facility's Administrator, Director of Nursing, and the Senior [NAME] President were informed of the Immediate Jeopardy (IJ) on [DATE] at 5:47 pm. [...]

Inspectors wroteBased on record review, interview, and policy review, the facility failed to transfer a resident with the correct transfer lift and with the assistance of two staff during routine care for one of five residents (R) (R29) reviewed for falls. This failure resulted in harm when R29 fell and required sutures to the top of the skull. The findings constituted past noncompliance, as the facility implemented a plan of correction.

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to ensure to ensure urinary catheter bags were properly positioned in a manner to prevent potential urinary tract infections due to contamination for three of five residents (Residents (R)8, R9, and R87) reviewed for urinary catheters and urinary tract infections out of a total sample of 29 residents.

Inspectors wroteBased interview, record review, and review of the facility's policy, the facility failed to ensure residents were free from misappropriation for one of 30 sampled residents (Resident (R) 56). R56 reported to the Director of Social Services (DSS) that she was missing money; however, the DSS failed to ensure the resident was protected from further misappropriation.

Inspectors wroteBased on observation, interviews, record review, and policy review, the facility failed to ensure that respiratory equipment was cleaned, stored, and/or administered per facility policy for two of 29 sampled residents (R) (R25 and R23). Staff failed to clean and air-dry nebulizer equipment between uses, failed to assess R25 prior to and after the nebulizer treatment, and failed to ensure R25's nebulizer machine was clean.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure pharmacy services thoroughly reviewed the resident medication regimens to identify irregularities related to the use of trazodone, an antidepressant and sedative, for one of six residents (R) (R70) reviewed for unnecessary medication.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure that one of six residents (R) (R70) reviewed for unnecessary medication use received antipsychotic medication at the appropriate time of day.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policies titled, Safety & Sanitation Best Practice Guidelines, Dry Storage and Safety and Sanitation Best Practice Guidelines (subject) Refrigerator and Freezer Storage, the facility failed to maintain sanitary conditions in the dietary kitchen. This deficient practice had the potential to adversely affect 89 of 91 residents that received meal trays from the kitchen.

Inspectors wroteBased on observations, resident and staff interviews, and record review, the facility failed to maintain effective pest control in the kitchen with the potential to affect all 89 of 91 residents receiving oral feedings.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policy titled, NHC Respiratory Manual, the facility failed to maintain bilevel positive airway pressure (BiPAP) equipment in a sanitary manner for two of four sampled residents (R) (R#59 and R#21). The deficient practice had the potential to affect R#59 and R#21 who were receiving positive airway pressure (PAP) therapy.

Inspectors wroteBased on observations, staff interviews, record review, and review of the policy titled, Specific Medication Administering Procedures, the facility failed to ensure the medication error rate was less than 5%. There were four errors with 27 opportunities for one of seven residents (R) (R#40) for a medication error rate of 14.81%.

Inspectors wroteBased on observations, interviews, and review of the facility's policies titled, Medication Storage in the Facility and Specific Medication Administration Procedures, the facility failed to ensure that medications were properly labeled on two of two medication carts (North Hall cart and South Hall cart). Specifically, an intravenous (IV) medication bag did not contain a label with the name of the medication, the date and time of the infusion, or the nurse's name or initials and an opened box of ophthalmic (eye) drops were without an open date or a discard date labeled on the box or container.