Pruitthealth- Estill

Inspectors wroteBased on interviews, record reviews, and policy review, the facility failed to ensure residents and/or their resident representative (RR) received written information regarding the right to accept or refuse medical and surgical treatments for one of two residents (Resident (R) 8) out of 23 sampled residents. This failure had the potential for the residents' wishes not to be followed if they were unable to speak for themselves.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to prevent a potential accident hazard by failing to maintain hot water temperatures below 120 degrees Fahrenheit (F) to prevent potential scalding for one of three sampled residents, (Resident (R) 87).

Inspectors wroteBased upon observations and interviews, the facility failed to post the daily staffing report in a prominent place accessible to all residents and visitors. This failure had the potential for residents, family, friends, or other visitors to not know the ratio of nursing staff to residents, causing uncertainty of the ability and availability of the staff for residents' needs.

Inspectors wroteBased on review of the facility policy, observations and interviews, the facility failed to ensure that food was properly stored and labeled in 2 of 2 unit nourishment rooms.

Inspectors wroteBased on manufacturer's recommendations, observations and interviews, the facility failed to ensure an excessive amount of lint was removed from 2 of 2 clothes dryers, which has the potential to cause a fire.

Inspectors wroteBased on record reviews and interviews the facility failed to implement and/or develop a comprehensive plan of care for Resident (R)33, R44 and R41 for 3 of 6 residents reviewed for care plans.

Inspectors wroteBased on observations, interviews, record reviews and reviews of facility policy and procedure the facility failed to ensure prompt and thorough incontinent care was provided for two Residents (R)6 and R62. Furthermore, the facility failed to ensure R33 received baths for 3 of 5 residents reviewed for Activities of Daily Living (ADLs). Findings Include: Review of facility procedure guide titled Elimination and Toileting: Incontinence Prevention revealed, manage incontinence according to the client's care plan not for staff convenience. Furthermore Providing Peri-Care states urine and feces are very irritating to the skin and mucous membrane and will cause irritation and breakdown if not thoroughly and promptly removed. Review of the undated facility policy titled, Documentation: [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure Resident (R)54 with decisional capacity to make his own health care decisions was afforded the right to formulate an advance directive for 1 of 1 residents reviewed for Advance Directives.

Inspectors wroteBased on review of facility policy, record review, and interviews, the facility failed to ensure Resident (R)54 and her representative received notice of transfer or discharge in writing and in a language they could understand, and the reason for transfer, for 1 of 5 residents reviewed for hospitalization.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure a quarterly, Minimum Data Set (MDS) assessment for Resident (R)54 was coded correctly for dialysis for 1 of 1 residents reviewed for Dialysis.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure that Resident (R)41 had an accurate level-1 Preadmission Screening and Resident Review (PASARR) assessment for 1 of 3 residents reviewed for PASARR.

Inspectors wroteBased on record reviews, observations, interviews and review of the medical literature in Facts and Comparisons, Epocrates and Drugs.com, the facility failed to ensure Resident (R)67 did not have multiple drug therapies that could cause central nervous system depression for 1 of 6 residents reviewed for unnecessary medications.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure Resident (R)44 was afforded the opportunity to participate in activities of choice and further failed to ensure R44 was invited to out of room activities related to his preferences and interest for 1 of 4 reviewed for activities.

Inspectors wroteBased on record reviews, observations, interviews and medical literature in Facts and Comparisons, Epocrates and Drugs.com, the facility failed to coordinate psychiatric care for Resident (R)67 with LifeSource, Inc. for 1 of 6 residents reviewed for unnecessary medications.

Inspectors wroteBased on review of the facility policy, observations and interviews, the facility failed to follow a procedure during wound care for Resident (R)21 to prevent infection and to promote wound healing for 1 of 4 residents reviewed with pressure ulcers.

Inspectors wroteBased on review of facility policy, observations, interviews and record review, the facility failed to ensure Resident (R)26 was free from potential entrapment of bedrails for 1 of 1 residents reviewed for bedrails.

Inspectors wroteBased on review of facility policy, record reviews, observations, and interviews, facility failed to ensure that the enteral feeds for Resident (R)6 were running at the correct rate, was properly labeled, and properly connected for 1 of 1 resident reviewed for tube feeding. Findings Include: Review of the facility procedure guide titled Enteral tube feeding, duodenal and jejunal dated 11/18/20 in the Preparation of Equipment section states, Make sure the enteral formula is labeled clearly with patient identification information, the type of formula, the method of administration, the date and time of preparation, and the name of the person preparing the formula (If appropriate). Verify the enteral formula label with the practitioner's order. [...]

Inspectors wroteBased on review of facility policy, observations, interviews and record review, the facility failed to ensure Resident (R)26 had proper evaluations for the use of bedrails for 1 of 1 residents reviewed for bedrails.

Inspectors wroteBased on review of facility policy, observations and interviews, the facility failed to ensure sufficient nursing staff to meet the residents needs for multiple days.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that pharmacist drug regimen review recommendations for Resident (R)67 were acted on in a timely manner for 1 of 6 residents reviewed for unnecessary medications.

Inspectors wroteBased on record reviews, observations, interviews and medical literature in Facts and Comparisons, Epocrates and Drugs.com the facility failed to ensure that Resident (R)67 was free of unnecessary medications for 1 of 6 residents reviewed for unnecessary medications.

Inspectors wroteBased on record reviews, observations, interviews and medical literature in Facts and Comparisons, Epocrates and Drugs.com the facility failed to ensure that Resident (R)67 was free of unnecessary psychotherapeutic medications for 1 of 6 residents reviewed for unnecessary medications.

Inspectors wroteBased on observations, interviews, and review of facility policy, the facility failed to properly store medications and biologicals in 1 of 2 treatment carts. Findings Include: Review of facility policy titled Medication Storage in the Healthcare Centers last reviewed on [DATE] states, Medications and biologicals are stored safely, securely, and properly following manufacturer's recommendations or those of the supplier. Procedures 12. Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedures for medication destruction, and recorded from the pharmacy, if a current order exists. [...]

Inspectors wroteBased on review of facility policy, observation, and interview the facility failed to ensure Personal Protective Equipment (PPE) was used during the sorting of soiled linen into the washers.

Inspectors wroteBased on review of the facility policy, record reviews and interview, the facility failed to ensure Resident (R)41 received education for the Pneumococcal Vaccination prior to receiving it and giving consent prior to receiving the Influenza Vaccination. The facility further failed to ensure R23 received education for the Influenza Vaccination prior to receiving it. The facility additionally failed to offer R67 the Pneumococcal Vaccine and failed to ensure R55 received education prior to receiving the Pneumococcal Vaccine for 3 of 5 residents reviewed for the Influenza and Pneumococcal Vaccinations.