Pruitthealth - Blue Ridge

Inspectors wroteBased on observations, staff interviews, record review and review of the facility's document titled, Water Management Plan, the facility failed to ensure residents were free of accident hazards as evidenced by water temperatures above 110 degrees Fahrenheit (F) in seven out of 49 shared resident bathrooms (Room A-12, C-10, C-12, D-2, D-3, D-5, D-6) . The deficient practice had the potential to cause injury to residents residing in these rooms.

Inspectors wroteBased on observations, staff interviews, record review and review of the facility's policy titled Cleaning Schedule Policy, Dietary Partner Hygiene and Dress Code, and Handwashing: Dietary Services, the facility failed to ensure food was stored, prepared, distributed, and served in accordance with professional standards for food service safety. This deficiency had the potential to affect 64 of 67 residents who ate meals from the facility's kitchen.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility's policy titled Patient/Resident Voting, the facility failed to support three out of 37 sampled Residents (R) (R#54, R#55, and R#56) with their rights to vote. In addition, the facility failed to promote dignity by using disposable cutlery at meals for four out of 37 sampled Residents (R) (R#28, R#49, R#41, and R#55) observed during dining.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policy titled Patient/Resident Council, the facility failed to complete an investigation, response, and resolution to the residents' concerns that attended the Resident Council Meetings. The facility census was 67 residents.

Inspectors wroteBased on observations, staff and resident interviews, record review and review of the facility's policy titled How to Purée Foods, the facility failed to ensure they served food that was prepared by methods that conserved the nutritive value, flavor, and appearance, and that the foods served from the facility's kitchen was palatable and attractive. This deficiency affected three out of 37 sampled Residents (R) (R#62, R#49, and R#17) but had the potential to affect all 37 residents on a regular consistency diet and all 10 residents with orders for puréed diets.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled, Care Plans, the facility failed to develop a comprehensive care plan that addressed activity preferences and accurately reflect the level of assistance required with transfers for one out of 37 sampled Residents (R) (R#17) reviewed for care plans.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled Care Plans, the facility failed to ensure that resident care plans were revised to include appropriate interventions for two out of 37 sampled Residents (R) (R#10 and R #17) reviewed for care plans.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility's policy titled Medication Administration: General Guidelines, the facility failed to ensure that care and services were provided according to accepted standards of clinical practice. The facility failed to document medication administration of an as-needed (PRN) pain medication in a timely manner for one out of 37 sampled Residents (R) (R#8) reviewed for medication administration.

Inspectors wroteBased on observations, staff and resident interviews, record review, review of the facility's policy titled Resident Rights, the facility failed to provide incontinence care for a resident who requested it. Specifically, the facility failed to provide incontinence care during mealtime for one out of 37 sampled Residents (R) (R#17) reviewed for activities of daily living. Findings Include: A review of the facility's policy titled Resident Rights, dated 12/1/2023, Under the section titled RESPECT AND DIGNITY revealed, You have the right to be treated with respect and dignity, including, c. The right to reside and receive services in the center with reasonable accommodation of your needs and preferences except when to do so would endanger your health and safety or that of other patients. [...]

Inspectors wroteBased on staff interviews, record review, and review of the facility's document titled Position Description, the facility failed to ensure they employed a qualified Activity Director (AD) for the facility. This deficient practice had the potential to affect all the residents residing in the facility. The facility census was 67 residents.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled Occurrences, the facility failed to develop, implement, and document appropriate interventions to prevent further falls for one out of 37 sampled Residents (R) (R#10) reviewed for accidents.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility's policy titled Infection Prevention - Hand Hygiene, and Medication Administration: General Guidelines, the facility failed to follow standard precautions during the administration of medications. In addition, the facility failed to ensure that staff demonstrated proper use of gloves and hand hygiene during medication administration for one out of 37 sampled Residents (R) (R#8) reviewed for medication administration.

Inspectors wroteBased on observations, staff interviews, and review of policies titled, Foodborne Illness, Labeling, Dating, and Storage, Patients/Residents' Personal Food, Nourishments, and Dishwashing, the facility failed to ensure opened food items in the walk-in cooler and dry storage area were labeled and dated; failed to discard food items by expiration date; failed to ensure staff and resident food items were not stored together in same refrigerators; failed to maintain temperature logs on nursing unit refrigerators. In addition, the facility failed to ensure high temperature dish machine was maintained in working order. This deficient practice had the potential to affect 59 residents who received an oral diet.

Inspectors wroteBased on observation, interviews, and review of the policy titled Infection Control-Linen and Laundry, the facility failed to ensure that essential equipment in the laundry was in working order to properly sanitize facility linens, as evidenced by a non-functioning boiler. The facility was currently in COVID-19 outbreak status and had no hot water for laundry. The census was 69 residents.

Inspectors wroteBased on observations, resident and staff interviews, the facility failed to ensure staff provided privacy for two of two residents (R) (R#22 and R#47) during medication administration. The sample size was 32.

Inspectors wroteBased on record review, staff interviews, and review of the policy titled Advance Directives: Georgia, the facility failed to ensure that the health record including physician orders, accurately reflected the code status for one resident (R) (R#47) of 31 sampled residents.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure the confidentiality of resident electronic medical records during medication administration for two residents (R) (R#14 and R#53) on one of four nursing units. The sample size was 31.

Inspectors wroteBased on record review and interviews, the facility failed to coordinate with the appropriate State designated authority, one resident (R) (R#8) who was admitted to the facility with a diagnosis of bipolar disorder and depression, for a Level II Preadmission Screening and Resident Review (PASRR) evaluation, to ensure resident received care and services in the most integrated setting appropriate to his needs. The sample size was 31residents. Findings Include: Review of the clinical record revealed R#8 was admitted to the facility on [DATE] with diagnosis of but not limited to bipolar disorder and unspecified depressive disorder. Review of the admission Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview Mental Status (BIMS) was coded as 15, indicating no cognitive impairment. Section A. [...]

Inspectors wroteBased onobservation, record review, interviews, and review of the policy titled Care Plans, the facility failed to develop a comprehensive person-centered care plan with measurable goals and interventions for one resident (R) (R#16) who required assistance with eating. The sample size was 32.

Inspectors wroteBased on observation, record review, interviews, and review of policy titled Restorative Nursing Program, the facility failed to identify the need and assist one resident (R) (R#16) with meals. The sample size was 32.

Inspectors wroteBased on observations, record review, staff interview, and review of the policy titled Restorative Nursing Program, the facility failed to provide palm protectors to prevent further contractures for one resident (R) (R#17). The sample size was 32 residents.

Inspectors wroteBased on observations, interview, and review of facility policy titled Medication Administration Guidelines, the facility failed to ensure two of three licensed nursing staff performed hand hygiene during observation of medication administration. The census was 59.