Prattville Health and Rehabilitation, LLC

Inspectors wroteBased on observations, interviews, and review of the facility's policy for Cycle Menus, the facility's Week 4 Week-At-A-Glance menu for June 5-11, 2022, the facility's Diet Guide Sheet for Day 24 (Week 4 - Tuesday), the facility's Diet Guide Sheet for Day 25 (Week 4 - Wednesday), and the facility's posted conversion information for portion control Dishers, the facility failed to ensure the menu was followed when: 1.) pears were not served at dinner on Tuesday, 6/7/2022, 2.) the specified 1/2 cup (4-ounce) serving of pudding for lunch on Wednesday, 6/8/2022, was being portioned with a #10 disher (3.25 ounces), and 3.) the Chicken and Dumpling alternate for dinner on Wednesday, 6/8/2022, had a 4-ounce (oz.) spoodle for trayline service, although the menu specified a 6 oz. portion was to be served. [...]

Inspectors wroteBased on observations, interviews, and review of the 2017 Food Code of the United States (U.S.) Public Health Service and the U.S. Food and Drug Administration (FDA), the facility's June 2022 refrigeration temperature logs for Unit 1, Unit 2, and the Dementia Unit, and the facility's policies for Dish Machine Sanitization, the policy for Foods from Families and Friends, and the policy titled, Nursing Pantry Foods, the facility failed to ensure 1.) the dishwashing machine consistently reached the minimum sanitizing temperature of 180 degrees Fahrenheit (F) on Wednesday, 6/8/2022, and Thursday, 6/9/2022; 2.) the air dryer used for drying clean dishes did not have a dirty filter on Tuesday, 6/7/2022, and Wednesday, 6/8/2022; 3.) the veneer of the door in the dishroom was not peeling away from the door surface in large pointed sections on Tuesday, 6/7/2022; [...]

Inspectors wroteBased on observations, interviews, and review of the facility's policy for Garbage and Refuse, and the 2017 Food Code of the United States (U.S.) Public Health Service and the U.S. Food and Drug Administration (FDA), the facility failed to ensure the oil/grease waste receptacle and the four by eight foot area around it did not have a buildup of oil/grease during June 7-9, 2022. This had the potential to affect all the residents in the facility, 138 of 138 residents. Findings Include: The facility's policy for Garbage and Refuse, dated 2/1/2002, included the following: . Purpose: To prevent the spread of bacteria that may cause food borne illnesses. Standard: Garbage and refuse containers should be free from cracks or leaks . The 2017 Food Code of the U.S. Public Health Service and the FDA included the following: . 5-501.13 Receptacles. (A) . [...]

Inspectors wroteBased on observation, interviews and review of a facility policy titled, Feeding the Impaired Resident, the facility failed to ensure Resident Identifier (RI) #25 was treated by staff in a manner to maintain dignity when Employee Identifier (EI) #11 Nursing Assistant (NA) stood up to feed RI #25, who was in bed during the breakfast meal on 6/8/2022. This affected one of 28 sampled residents. Findings Include: The facility policy titled Feeding the Impaired Resident with an effective date of 10/1/2010 documented: . Residents should eat in the location of their preference, and should be provided with a pleasant dining environment, regardless of the location. RI #25 was admitted to the facility on [DATE]. 6/8/2022 at 8:19 AM EI #11 NA was observed to enter RI #25's room and set up the breakfast meal tray for RI #25 who was in bed. [...]

Inspectors wroteBased on record review, interviews and review of facility policy Pressure Ulcers, the facility failed to ensure weekly wound assessments were accurately completed for Resident Identifier (RI) #114's sacral wound that was documented as a stage three on 5/2/2022. This had the potential to affect RI #114, one of six residents reviewed for pressure ulcers. Findings Include: A review of a facility policy titled Pressure Ulcers with an effective date of October 1, 2010 revealed . Stage III (three) . Full thickness tissue loss. Subcutaneous fat may be visible . Slough may be present . May include undermining and tunneling. Documentation . c) The status of ulcers should be recorded on the Wound Flow Record weekly. RI #114 was admitted to the facility on [DATE] and readmitted on [DATE]. [...]

Inspectors wroteBased on observations, interviews, resident record review and review of a facility policy titled Hand Hygiene the facility failed to ensure Employee Identifier (EI) #10, Certified Nursing Assistant (CNA), washed and sanitized her hands after delivering and setting up Resident Identifier (RI) #25's meal tray prior to delivering and setting up RI #94's meal tray. This had the potential to affect RI #94, one of 61 total residents on unit one who received meal trays.

Inspectors wroteBased on observation, interviews, a review of facility policies including Sanitation Principles, Use of Gloves and Hairnets, Food Reheating, Calibrating and Sanitizing Thermometers and Foods from Families and Friends, as well as the 2017 FOOD CODE regulations, the facility failed to ensure: 1) Food preparation equipment and dishes were maintained in a clean condition; 2) Dietary staff covered hair while handling food and working in food distribution areas; 3) Foods served from the 11/06/19 supper tray line were re-heated to recommended temperatures prior to service, and the thermometer used to check each item was sanitized prior to use; 4) Nursing staff handled ready-to-eat (RTE) food for Resident Identifier (RI) #16 during the 11/06/19 lunch meal without directly contacting the item with bare hands and 5) Resident food was dated and labeled in one of three nursing pantry refrigerators. [...]

Inspectors wroteBased on interview, and a review of the facility's financial records titled, Resident Statement Landscape and Resident Fund Management Service, the facility failed to ensure Resident Identifier (RI) #103 was provided his/her thirty dollars from the trust fund account when requested. This affected one of 73 residents with money in their trust fund. Findings Include: A review of the facility's financial records revealed: The document tiltled, Resident Fund Management Sevice, dated 6/26/19 and signed by RI #103's sponsor and Employee Identifier (EI) #2, a Financial Specialist Assistant, authorized the facility to handle the residents' funds with a $30 monthly allowance. A review of the document titled, Resident Statement Landscape revealed a balance of $994.00 in RI #103's Trust Fund Account. RI #103 was admitted to the facility on [DATE] and re-admitted to the facility on [DATE]. [...]

Inspectors wroteBased on record review and interviews the facility failed to ensure Resident Identifier (RI) #17's care plan meetings were held quarterly. This had the potential to affect RI #17, one of 28 sampled residents.

Inspectors wroteBased on record review, interviews and a facility policy titled, Bowel and Bladder Program, the facility failed to ensure Resident Identifier (RI) #17 had a bowel and bladder review after a change in physical ability. This affected RI #17, one of two residents sampled for bowel and bladder concerns.

Inspectors wroteBased on a review of the facility policy titled Psychoactive Drug Monitoring, the pharmacist's recommendation for the consideration of antipsychotic dose reduction, and and an interview with the Certified Registered Nurse Practitioner (CRNP), the facility failed to provide justification for the continued use of an antipsychotic medication (Abilify) for Resident Identifier (RI) #23. This affected one of 5 sampled residents reviewed for the potential use of unnecessary medications.

Inspectors wroteBased on interviews, record review and a facility policy titled, Medication Administration-General Guidelines, the facility failed to ensure a Licensed Practice Nurse (LPN) documented Resident Identifier (RI) #64's administration of eye drops on 11/04/19 and 11/05/19. This deficient practice affected one of 28 residents reviewed for documentation on the Medication Administration Record. Findings Include: A review of a facility's policy titled, Medication Administration - General Guidelines, with a date of 03/11, included the following: .Procedures . 22. After administration, . document administration on the Medication Administration Record (MAR) . RI# 64 was admitted to the facility on [DATE]. RI #64 had diagnoses to include Unspecified Glaucoma. [...]

Inspectors wroteBased on interview, and document review of Employee Identifier (EI), #16's certification, the facility failed to ensure the Activity Program was directed by a qualified licensed or registered professional from [DATE] (date of hire) through the current survey. This deficient practice had the potential to affect 137 of 137 residents in the facility. Findings Include: A review of the Activity Director, Employee Identifier (EI) #16's certification document titled, National Certification Council for Activity Professionals (NCCAP), revealed the certification had expired [DATE]. The certification also indicated renewal was required bi-annually. On [DATE] at 1:31 p.m., the surveyor asked EI #16 how long she had been the Activity Director with the facility. EI #16 stated that she previously worked 2007-2014 but was re-hired at the facility two weeks prior, on [DATE]. [...]

Inspectors wroteBased on observations, interview and a review of the facility policy titled, Sanitation Principles, the facility failed to ensure the side door of one dumpster was closed. Facility staff also failed to ensure the interior garbage was securely contained in each bag prior to disposal to prevent the potential attraction of flies, ants and possible rodents. This affected two of two dumpster's on two of three days of the survey.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident Identifier (RI) #10's Quarterly Minimum Data Set (MDS) with an assessment reference date of 4/18/18 reflected the presence of an unhealed Stage 3 pressure ulcer. This affected one of 29 sampled residents for whom MDS assessments were reviewed.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to ensure Resident Identifier (RI) #52's care plan was implemented for daily skin checks. The facility further failed to ensure RI #118's care plan was implemented for pressure ulcer treatment. This deficient practice affected RI #52 and RI #118, two of 12 sampled residents reviewed for pressure ulcers.

Inspectors wroteBased on observation, interview, medical record review and review of the facility's policy titled Section: Documentation and Medical Records Policy Title: Charting and Documentation Guidelines, the facility failed to ensure Employee Identifier (EI) #8, a Licensed Practical Nurse (LPN) did not document completion of wound care on the Treatment Administration Record (TAR) before the treatment was administered. On 10/10/18, EI #8 signed that she completed RI #118's wound care treatment; however, she had not done it. This deficient practice affected RI #118, one of 12 sampled residents reviewed for pressure ulcers.

Inspectors wroteBased on record review, interviews, and review of a facility policy titled Section: Physician Services Policy Title: admission Physician's Orders, the facility failed to ensure treatment orders were obtained for RI #118, a resident admitted to the facility with a Stage 2 pressure ulcer. The facility further failed to ensure RI #118's treatment orders were administered as ordered by the physician. This deficient practice affected RI #118, one 12 sampled residents reviewed for pressure ulcers.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure Resident Identifier (RI) #50 was not left unattended by facility staff at an offsite physician's office after transport to a previously cancelled appointment. Further, the facility failed to ensure Nystatin powder was not left on RI #50's bedside table on 10/12/2018. This affected one of three sampled residents sampled for transport to outside appointments, and one on one sampled resident's observed with medication at the bedside.