Perry County Nursing Center

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to ensure an indwelling catheter was managed in a manner to prevent possible complications when nursing staff failed to assess and respond timely to a resident's complaint of catheter-related discomfort for one (1) of (1) residents reviewed for urinary catheters. Resident #1.

Inspectors wroteBased on interview, record review, and facility policy and assessment review, the facility failed to designate a licensed nurse to serve as the charge nurse for each tour of duty for two (2) of three (3) shifts reviewed (3:00 PM-11:00 PM and 11:00 PM-7:00 AM), which had the potential to affect all 57 residents residing in the facility.

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to ensure a resident's right to the provision of care in a respectful and dignified manner when staff provided incontinent care for one (1) of nine (9) sampled residents without ensuring privacy. (Resident #1).

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to ensure medications were administered in accordance with professional standards of quality and accepted standards of practice by not referencing the Medication Administration Record (MAR) during medication preparation and administration for one (1) of three (3) residents observed for medication administration (Residents #8).

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to ensure that a resident who was unable to perform activities of daily living (ADLs) received personal hygiene and incontinence care in a safe and dignified manner, consistent with accepted standards of practice, for one (1) of nine (9) sampled residents (Resident #1).

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to ensure respiratory medications were administered in accordance with manufacturer's instructions by not instructing a resident to rinse the mouth following administration of an inhaled corticosteroid for one (1) of three (3) medication administrations reviewed, Resident #4.

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to ensure the residents' right to a safe, clean, comfortable, and homelike environment by not maintaining appropriate and comfortable water temperatures in resident rooms on three (3) of three (3) resident halls, affecting all 57 residents residing in the facility.

Inspectors wroteBased on observations, interviews, record reviews, and facility policy review, the facility failed to honor a resident's rights to make choices regarding daily routines by not assisting a cognitively impaired resident outdoors for scheduled smoking breaks (Resident #25) and regarding bathing times (Resident Council Attendees: Res #33, #2, #51, #5, #10, #41, #31, #16, #11, and #20) for 11 of 57 residents residing in the facility.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to honor a resident's food preferences and provide a menu alternative for one (1) of sixteen (16) sampled residents. Resident #30. Findings Included: A review of the facility's policy, Dignity and Respect, dated 7/2022 revealed, A facility must treat each resident with dignity and respect and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life recognizing each resident's individuality . 4 . Residents' individual preferences regarding such things as menus . will be elicited and respected by the facility, and efforts will be made to accommodate these wishes . [...]

Inspectors wroteBased on interview and facility policy review the facility's Quality Assurance and Performance Improvement (QAPI) Committee failed to ensure the program was sustained during transitions in leadership and failed to maintain implemented procedures and monitor the interventions the committee put into place in March 2021. This was for one (1) recited deficiency originally cited in March 2021 on an annual recertification survey. The deficiency was in the area of activities. The facility's continued failure during two federal surveys shows a pattern of the facility's inability to sustain an effective QAPI Committee. Findings Include: [...]

Inspectors wroteBased on observation, interviews, record review, and the facility policy review, the facility failed to implement activity care plan approaches for three (3) of 13 sampled residents. Resident #23, Resident #27, Resident #32.

Inspectors wroteBased on observations, staff and resident interviews, record review, and the facility policy review, the facility failed to provide structured activities for three (3) of 13 sampled residents. Resident #23, Resident #27, and Resident #32 Findings Include: Review of the facility's, Activity Programs & Activity Program Scheduling, revised 11/17, revealed, The facility will provide for an ongoing program of age-appropriate activities designed to meet, in accordance with the comprehensive assessment, the interest and the physical, mental, and psychosocial needs of each resident .Activity Programs & Activity Programs Scheduling .Activity Programs - Scheduling .Activity programs will be conducted as scheduled. An alternate will be provided upon cancellation of a scheduled program. Procedures .1. [...]

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to provide respiratory care consistent with professional standards of practice as evidenced by nebulizer mask and oxygen tubing for a resident (Resident #40) did not have a designated storage bag for two (2) of four (4) observations.

Inspectors wroteBased on observation, interviews, record review and facility policy review, the facility failed to honor the resident's rights by not allowing them to smoke for three (3) of five (5) residents reviewed for smoking for Resident #15, Resident #24, and Resident #25.

Inspectors wroteBased on observation, interviews, record review and facility policy review the facility failed to provide an ongoing activities program for five (5) of (14) sampled residents, Resident #28, Resident #32, Resident #15, Resident #24, and Resident #25. The facility's, Activity Programs and Activity Program Scheduling policy, revised 11/17, revealed the facility has a policy in place to provide an ongoing program of activities. Purpose: To assure that the activities program occurs within the context of each resident's comprehensive assessment and care plan, and is reflective of each resident's individual needs and interests. Resident #28 Record Review of the Face Sheet revealed Resident #28 was admitted on [DATE]. She has diagnoses to include Anxiety Disorder and Major Depressive Disorder. [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to follow Standard Infection Control Precautions related to removing gloves and performing hand hygiene prior to applying a dressing to a wound to prevent the possible spread of infection for two (2) of three (3) wound care observations. [Resident #14 and Resident #24] Findings Include: The facility's, Standard Precautions, revised June 2014, General Infection Prevention and Control Nursing Policies revealed it is the policy of this facility that all nursing activities will be performed in a manner to minimize the potential for infection in residents, staff, and visitors. [...]