Pruitthealth - Lanier

Inspectors wroteBased on observations, staff interviews, and review of the facility's policies titled, Pot/Pan Washing and Sanitation and Ice Machines (Handling/Scoops), the facility failed to prevent wet-nesting in stored steam pans to avoid the potential for bacterial growth and the facility failed to ensure that the ice machine was properly cleaned to prevent bacteria growth. The facility census was 97 and 92 residents received an oral diet.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure reasonable accommodation of need related to keeping the call light within reach while in bed to call for staff assistance for two out of 45 sampled residents (R) (R31 and R37).

Inspectors wroteBased on record review and staff interview, the facility failed to ensure that the Minimum Data Set (MDS) assessment was transmitted within 14 days of completion to the Centers for Medicare and Medicaid Services (CMS) Quality Improvement Evaluation System (QIES) Assessment Submission and Processing (ASAP) system for one of 45 sampled residents (R) (R25).

Inspectors wroteBased on staff interviews, records review, and review of the facility's policy titled, MDS Assessment Accuracy, the facility failed to ensure an accurate Minimum Data Set (MDS) assessment was completed for one of 45 sampled residents (R) (R52). Specifically, the facility failed to accurately code the use of a wander/elopement alarm for R32. This failure placed the resident at risk for medical complications and unmet needs.

Inspectors wroteBased on observations, record review, resident and staff interviews, the facility failed to provide Activities of Daily Living (ADL's) for one of 45 sampled residents (R) (R5). Specifically, the facility failed to provide nail care for R5. This failure had the potential to affect the resident's comfort, body image and increase the risk for infections.

Inspectors wroteBased on observations, record review, resident and staff interviews, the facility failed to follow physician orders for one of 45 sampled residents (R) (R7) related to (r/t) behavior monitoring. This deficient practice had the potential to cause undetected changes in the resident's mental status and/or behavior.

Inspectors wroteBased on observations, staff interviews, record review and review of facility's policy Test Water Temperatures, the facility failed to keep residents free of accident hazards as evidenced by water temperatures above 110 degrees Fahrenheit ( degrees F) in 16 out of 48 resident rooms (102, 104, 103, 105, 106, 108, 110, 112, 114, 116, 201, 203, 210, 212, 213, and 215). The deficient practices 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 How to Purée Foods, the facility failed to ensure that dietary staff followed recipes for preparing puree food items to avoid compromising the nutritive value and flavor for eight of 88 residents receiving a pureed diet.

Inspectors wroteBased on observation and staff interviews, the facility failed to replace a missing privacy curtain and to ensure full visual privacy for one of 48 rooms (room [ROOM NUMBER]). The facility census was 88 residents.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy titled, Infection Control - Housekeeping Services, the facility failed to maintain a clean and homelike environment for residents in 12 of 49 resident rooms (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], and room [ROOM NUMBER]). This deficient practice had the potential to place residents at risk for living in an unsanitary and unsafe living environment and a potential for diminished quality of life.

Inspectors wroteBased on observations, interviews, record reviews, and review of facility policy titled, Medication Administration: Enteral Tubes, the facility failed to ensure that care and services were provided according to accepted standards of practice for two of seven residents (R) (R6 and R9) reviewed for medication administration. Specifically, the facility failed to administer R6 medications in a timely manner; and failed to follow procedure for enteral medication administration for R9.

Inspectors wroteBased on observations, staff interviews, record review, and review of facility policy titled Enhanced Barrier Precaution (EBP), the facility failed to follow infection control practices during direct contact care for one of 11 residents (R) (R9) on Enhanced Barrier Precautions (EBP) during incontinent care and the administration of medications through a gastrostomy tube (G-tube) (a tube surgically inserted through the skin into the stomach to deliver nutrition, hydration, and medication). These failures had the potential to expose residents to infections due to cross-contamination.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure that ten hollow plastic handrails were maintained for safe use on two of the three halls (200 Hall and 300 Hall). The deficient practice had the potential to affect residents and visitors utilizing rails for assistance with ambulation.

Inspectors wroteBased on observations, interviews, record review, and review of the policies titled Self-Administration of Medications by Patients/Residents and Medication Administration: General Guidelines, the facility failed to assess one of 39 residents (R) (R#16) for the ability to self-administer medications prior to leaving medications at the bedside. Specifically, the facility failed to ensure R#16 was assessed to self-administer TUMS and antifungal ointment that were stored at residents' bedside.

Inspectors wroteBased on observations, interviews, record review, and review of the facility document titled Your Rights as a Patient, the facility failed to ensure that one of 39 residents (R#55) was provided showers according to his preferences.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled, Restorative Nursing Program, the facility failed to ensure brace/splint was applied for one of 11 residents (R) #29. Specifically, the facility failed to ensure R#29 splint was applied to residents left hand as ordered by the physician.

Inspectors wroteBased on observations, record review, staff interview, and review of the facility policy titled, Respiratory Equipment Changeouts, the facility failed ensure that the oxygen (02) tubing was changed according to the physician's order for one of 11 Residents (R) (R#215). The deficient practice had the potential to affect R#215 respiratory status by increasing the potential of a respiratory infection.

Inspectors wroteBased on observation, interviews, and review of the facility policies titled, Storage of Pharmaceuticals, Enteral Products and Supplies and Medication Administration: General Guidelines, the facility failed to ensure that one of three medication carts (200 Hall cart) was locked and secured when the cart was out of view of the nurse. Specifically, the facility failed to ensure the medication cart on the 200 was locked and medications secured when not in use.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy titled, Cleaning Schedules the facility failed to ensure that the main kitchen was kept clean and sanitary. Specifically, the facility failed to ensure routine cleaning of the hood vent and the kitchen floor were conducted consistently in the main kitchen.