Parkway Health and Rehabilitation Center

Inspectors wroteBased on personnel file review, facility document review and interview, Administration failed to ensure that nursing services were provided by qualified personnel when the facility hired an imposter nurse (Imposter Nurse A) to function as a Registered Nurse (RN) using another RN's (RN C) Tennessee license.

Inspectors wroteBased on facility policy review, medical record review, quarterly statement review, and interview, the facility failed to notify residents and/or representatives of account balances over the eligibility limit for 5 of 56 (Residents #11, #57, #65, #94, and #113) sampled residents reviewed for personal funds.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to follow physician orders when staff administered medications outside of ordered parameters and failed to report blood glucose levels for 1 of 5 (Resident #4) sampled residents reviewed for unnecessary medications.

Inspectors wroteBased on policy review, facility documentation review, observation, and interview, the facility failed to ensure proper infection control practices were followed when 2 of 14 staff members (Certified Nursing Assistant (CNA) A and CNA E) touched food and flatware with their bare hands and failed to properly perform hand hygiene for 4 residents (Residents #9, #93, #94, and #103) reviewed for dining, and when the Infection Preventionist (IP) failed to track and monitor organisms being treated in the facility, which could potentially affect 114 out of 114 residents.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to provide and maintain a safe, functional, and sanitary environment for 2 of 60 (Resident #6, #44, #60, and #121) shared occupied bathrooms, when a toilet was clogged with feces and when the biohazard red bag (bag used for disposal of potentially infectious or hazardous materials) was overflowing with trash and Personal Protective Equipment (PPE), and when 1 of 60 (Resident #60 and #121) occupied resident rooms had floors dirty with trash and marks, the over bed tables had a spill of dried shiny substance, and the resident's bed would not adjust positions.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure a safe and sanitary environment in the kitchen and failed to clean the East Hall ice machine.

Inspectors wroteBased on policy review, medical record review, and interview the facility failed to ensure staff reported an allegation of resident-to-resident abuse to the facility Administrator in a timely manner for 1 of 4 (Resident #37) sampled residents for allegations of abuse.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to ensure Activities of Daily Living (ADL) assistance was provided related to showering for 2 of 2 (Resident #82 and #320) sampled residents reviewed for ADLs.

Inspectors wroteBased on medical record review and interview the facility failed to administer the prescribed medication for 1 of 5 (Resident #90) sampled residents reviewed for unnecessary medications.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to ensure residents' right to be free from neglect for 1 of 9 (Resident #10) sampled residents reviewed for allegations of abuse. Resident #10 was severely cognitively impaired, bedridden and totally dependent on staff for all needs. On 4/5/2024 staff noted Resident #10's left arm swollen with nonpitting edema. On 4/8/2024 the practitioner was notified and orders obtained for x-rays. On 4/9/2024 an x-ray revealed a comminuted (A broken bone that has shattered into 3 or more pieces. This type of fracture is usually caused by a serious trauma) humeral fracture to the left arm of unknown source. The facility's failure to provide timely services to address Resident #10's left arm swelling resulted in Actual Harm.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to thoroughly investigate an injury of unknown source/origin for 1 of 9 (Resident #10) residents reviewed for abuse. The facility failed to thoroughly investigate an injury of unknown origin when Resident #10, a severely cognitively impaired, bedridden resident sustained a comminuted (A broken bone that has shattered into 3 or more pieces. This type of fracture is usually caused by a serious trauma) humeral fracture. This resulted in Actual Harm for Resident #10.

Inspectors wroteBased on policy review, medical record review, facility investigation, and interview, the facility failed to ensure a safe environment, adequate supervision/monitoring related to falls, illegal substance use, and elopement for 5 of 9 (Residents #44, #85, #89, #102, and #119) sampled residents reviewed for a safe environment. On 5/27/2024 Resident #44 had a fall, and the facility failed to monitor the resident post fall. On 5/31/2024, 4 days after the fall, Resident #44 complained of rib cage pain and an x-ray revealed a fractured rib, the facility failed to monitor the resident. The Nurse Practitioner was unaware of the resident's fall and fractured rib until 6/3/2024, the resident complained of chest pain on breathing. The facility's failures resulted in Actual Harm for Resident #44.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure a resident's missing property was replaced timely after the Social Worker reported they would replace the missing item for 1 of 32 residents (Resident #38) sampled residents.

Inspectors wroteBased on medical record review and interview, the facility failed to ensure assessments were accurately completed to reflect the resident's status related to Hospice services for 1 of 1 (Resident #61) residents reviewed or hospice.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to obtain weights in accordance with the facility's policy for 1 of 2 sampled resident (Resident #31) reviewed for nutrition.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to provide care and services for residents with enteral feedings when staff failed to check residual as ordered, failed to follow physician orders for water flushes, and failed to administer medications with gravity through a percutaneous endoscopic gastrostomy (PEG) tube (plastic tube inserted into the stomach to administer medications, supplements and liquid food) syringe for 2 of 2 (Resident #8 and #10) residents reviewed for enteral feedings, and failed to ensure the enteral feedings and the flush solutions were properly labeled for 1 of 3 sampled residents (Resident #90) reviewed PEG tube feedings.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure assistance was provided with grooming and dressing for a Resident with a scheduled physician's appointment in order to ensure the Resident was ready and available when transportation services arrived to take the Resident to the physician's appointment for 1 of 1 resident (Resident #67) sampled residents who missed a scheduled physician's appointment.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure medications were administered in a safe and sanitary manner during Percutaneous Endoscopic Gastrostomy (PEG) - a plastic tube inserted into the stomach for the administration of medications and feedings) administration for 2 of 2 (Resident #8 and #10) sampled residents observed during medication administration, and the facility failed to ensure hazardous, and infectious waste was properly stored for the prevention of infectious diseases in 2 of 2 soiled linen rooms (West End Hall Soiled Linen Room and East End Hall Soiled Linen Room).

Inspectors wroteBased on policy review, observation, and interview, the facility failed to provide a functioning call light for 1 of 114 (Resident #108) sampled residents which had the potential to result in unmet care needs.