Piedmont Gardens Health Facility

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure food are prepared under sanitary conditions when:-Ice machine had brownish material build up on the water bin and tubing on the inside area of the machine where water was present.- Kitchen [NAME] (CK) did not cover beard with hair restraint.- Kitchen floor and tiles with cracked areas and brownish buildups.- Kitchen vents with dusty blackish materials- Food shelves and trays with debris.- Two hot boxes (Food warmer) with food debris.- Broom with dustpan were stored in the dry food storage room.- Kitchen wall had cracked and chipped paint and blackish discoloration.- Equipment's air-gaps drainage pipe-basin areas had yellowish brown buildup.- Chemical and cleaning agents were stored in open area next to clean pots and pans.- Floor sink area next to clean pots and pans had yellowish black buildup. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure two of 21 sampled residents (Residents 18 and 90) were served food in a dignified manner and one of 21 sampled residents (Resident 90) was groomed in a dignified manner when: 1. Resident 90 waited 16 minutes, and Resident 18 waited 27 minutes after other residents at their table were served food, to get their food. 2. Resident 90 was not offered facial hair grooming. This failure resulted in Resident 90 feeling upset and had the potential to cause Residents 18 and 90 to feel insignificant, embarrassed and undignified. During a review of Resident 90's Brief Interview for Mental Status (BIMS, is a scoring system used to determine the resident's cognitive status regarding attention, orientation, and ability to register and recall information. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the safe and secure storage of medications when:A damaged/crushed plastic, orange colored medication bottle containing crushed pills, for Resident 32, was kept in the medication cart. An expired bottle with Calcium 600 milligrams (mg) tablets was kept in the medication cart. The central supply/over the counter (OTC) medication storage room doors (entry door and inside door) were left unlocked and unattended. These failures resulted in unsafe medication storage practices, had the the potential for medication errors and unauthorized access to OTC medications and supplies.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow infection prevention and control practices when Certified Nursing Assistant (CNA) 3 and CNA 4 did not wear a Personal Protective Equipment (PPE, specialized gear-such as gloves, masks, gowns, face shields, and respirators-used to protect healthcare workers and patients from infectious agents) gown, while providing activities of daily living (ADL) to one of 21 sampled residents (Resident 48). This failure has the potential for cross contamination and compromise the health and safety of the residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of five sampled residents (Resident 77) was prescribed Azithromycin (an antibiotic used to treat various bacterial infections) for cough and shortness of breath with an appropriate indication for use. This failure had the potential for Resident 77 to receive unnecessary medications and to suffer adverse side effects.

Inspectors wroteBased on observation, interview and record review, the facility staff did not have comprehensive care plan for bed alarms and chair alarm as fall prevention for 3 out of 8 sampled residents(Resident 36, 55 and 44.) The failure to not care plan interventions for bed alarm use under fall risk for Resident 36, 55 and 44 has the potential to not provide direct or limited staff supervision for resisdents and also to not accurately monitor, provide care, and reassess the effectiveness of the bed alarms.

Inspectors wroteBased on observation ,interview record review, facility staff including Certified Nursing Assistant (CNA), Licensed Nurses (LNs), and Maintenance Staff did not perform hand hygiene while providing care to one of five sampled residents (Resident 42) when : 1. CNA 3 did not perform hand hygiene before and after putting in hearing aides in Resident 42 's ears and before donning gloves for incontinence care. 2. LNs did not sanitize/disinfect glucometer and flat surfaces to keep medication tray during medication administration. This failure placed all residents at risk for spread of in infection. 1.

Inspectors wroteBased on observation, interview and record review facility did not promptly investigate and act upon complaints of one of one sampled resident's (Resident 11) missing personal belongings (sweatpants). This failure resulted in the Resident 11 feeling angry.

Inspectors wroteBased on interview and record review, for one of five (Resident 259) sampled residents reviewed for unnecessary medications, the facility failed to provide treatment and care in accordance with professional standards of practice and the comprehensive care plan when the physician was not notified as ordered when Resident 259's blood sugar level exceeded 400 milligrams per deciliter (mg/dL). This failure increased the risk for Resident 259 of developing complications related to severely elevated blood glucose levels, like diabetic ketoacidosis (life-threatening complication of diabetes when the build-up of acids in the body occurs when the blood sugar is too high for too long) or coma.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to follow proper sanitation and food storage practices when: - The High temperature dishwasher was not within the required temperature range - Kitchen floor tiles had brownish residual discoloration, - Two food steamers had brownish food debris on the bottom shelf and around the steamer areas - Bowl of lettuce, bowl of tomatoes in refrigerator were not labeled or dated - Two opened milk cartons in the walk in refrigerator were not label or dated - Bowl of sliced ham in the refrigerator had use by date 11/10/22 -Two food mixers had brownish discoloration and debris around the edges - Plate covers were faded and discolored - Three compartment sink air gap drain area had yellow residue - Ice machine cover had debris and crumbs - Ice machine air-gap drain area with yellowish residual - [NAME] trays with thick blackish [...]

Inspectors wroteBased on observation, interview, and record review, for one of two sampled residents (Resident 2), the facility failed to provide devices to ensure Resident 2's activities of daily living (ADL) did not diminish when Resident 2 was not provided with an assistive device to stay upright during meals. This failure resulted in Resident 2's inability to feed self independently and had the potential to result in decreased oral intake.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the Consultant Pharmacist's (CP) monthly Medication Regimen Review (MRR) reported a medication irregularity for two (Residents 18 and 27) sampled residents. For Resident 18, CP did not address the duration for the administration of Macrobid (antibiotic medication) for the prevention of Urinary Tract Infection (UTI). For Resident 27, the duration of Keflex (antibiotic) for UTI was not identiied for more than one year. These deficient practices had the potential for residents to receive unnecessary drugs and future antibiotic resistant infections due to prolong use

Inspectors wroteBased on interview and record review, the facility failed to ensure appropriate use of antibiotic (medication for infection) for one of five residents reviewed (Resident 27) when they did not monitor appropriate use and improved outcomes. This failure had the potential for Resident 27 to take unnecessary antibiotics which could lead to antibiotic resistance.