Pruitthealth - Toccoa

Inspectors wroteBased on observations, record review, and resident and staff interviews, the facility failed to ensure call lights were within reach for one of 31 sample residents (Residents (R) 58) reviewed for accommodation of needs and preferences. Specifically, the facility failed to ensure residents had access to their call lights to best assist the residents in maintaining and/or achieving their independent functioning, dignity, and well-being to the extent possible.

Inspectors wroteBased on staff interview, document review, and facility policy review, the facility failed to report the results of the investigation of sexual abuse to the State Survey Agency (SSA) within five working days of the incident for one of one resident (Resident (R) 68) reviewed for abuse out of a total sample of 31 residents. Specifically, R71 removed her clothes and incontinence brief and climbed into R68's bed.

Inspectors wroteBased on interviews, record review, document review and review of the facility's policy, the facility failed to complete a thorough investigation of an allegation of sexual abuse for two of 31 sampled residents (Resident (R) 68 and R71). The facility's failure to complete a thorough investigation placed residents at risk of being unprotected from abuse.

Inspectors wroteBased on observations, staff interviews, and review of the facility's policy titled How to Puree Foods, the facility failed to follow the recipes to ensure puree foods were prepared by methods to conserve nutritive value, flavor, and appearance. This deficiency had the potential to affect all twelve residents that received a puree diet. The facility census was 102 residents.

Inspectors wroteBased on observations, staff interviews and review of the facility's policy titled Patients/Residents' Personal Food, the facility failed to maintain sanitary resident nourishment refrigerators in the unit pantries, failed to store food items properly in the resident nourishment refrigerators and failed to dispose of expired food items in a timely manner in the resident nourishment pantries for two of three units (Blue Unit and Memory Care Unit). The facility had a census of 102 residents.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policies titled Infection Prevention-Hand Hygiene, and Medication Administration: General Guidelines, the facility failed to perform proper infection control processes as evidenced by two of six staff (Licensed Practical Nurse (LPN) JJ and LPN KK) observed not performing proper hand hygiene during meal tray pass, one of four staff (Certified Medication Aide/Certified Nursing Assistant (CMA/CNA) DD observed for medication administration who failed to properly prepare insulin for one Resident (R) (R73), and two of four staff (CMA/CNA EE and CMA/CNA DD) that failed to properly handle medications during medication administration for two residents (R87 and R73). The facility census was 102 residents, and the sample size was 46 residents.

Inspectors wroteBased on observations, resident and staff interviews, the facility failed to ensure a safe/clean/comfortable/homelike environment in one of 14 resident rooms (room [ROOM NUMBER]) on the Magnolia Hall. Specifically, a metal plate was observed on the bathroom door in room [ROOM NUMBER] to have a hole with sharp, jagged edges. The deficient practice had the potential to cause injury to residents and staff.

Inspectors wroteBased on observations, record review, staff interview, and review of the facility's policy titled, Care Plan, the facility failed to follow the care plan for one of 46 sampled residents (R) (R37) related to providing assistance with showers and baths. Findings Include: Review of the facility's policy titled Care Plan dated 7/27/2023 revealed under admission Comprehensive Plan of Care, Number 3. The comprehensive person-centered care plan is developed to include measurable goals and timeframes to meet a patient/resident's medical, nursing and psychosocial needs, the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial needs that are identified in the comprehensive assessment. [...]

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility's policy titled, Documentation: Charting Activities of Daily Living (ADLs) the facility failed to ensure that one of 46 sampled residents (R) (R37) had the necessary assistance with ADLs.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's titled Medication Storage in Healthcare Centers and Medication Administration: General Guidelines, the facility failed ensure the medication cart was locked when unattended for one out of five medication carts and failed to obtain orders from a physician to allow one out of 46 sampled Residents (R) (R55) the ability to self-administer medications prior to leaving medications at the bedside.

Inspectors wroteBased on observations, resident and staff interviews, and record review, the facility failed to ensure that the call light communication system was functioning adequately to allow the resident to call for assistance in one room (room [ROOM NUMBER]A) on one of five halls. The sample size was 46 residents.

Inspectors wroteBased on record review and staff interview, the facility failed to provide the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week. There were no Registered Nurses in the facility for at least eight consecutive hours on 12/18/22 and 1/21/23. The facility census was 98.

Inspectors wroteBased on observations, interviews, and review of the policies titled Medication Storage in the Healthcare Centers and Controlled Substances for Healthcare Centers, the facility failed to ensure that two of six medication carts and one of two treatment carts on one of two units (unit one) were locked and secured when unattended and out of the view of the nurse. In addition, facility failed to ensure that narcotics were counted and documented at the beginning and end of each shift on one of six medication carts (Unit one). The census was 98.

Inspectors wroteBased on observations, interviews, record review, facility documentation, and policy review, the facility failed to maintain an effective Infection Control Program (ICP) to prevent the spread of infections by not ensuring staff donned required Personal Protective Equipment (PPE) prior to entering COVID-19 positive room for one resident (R) (R#19) and failed to ensure staff washed/sanitized their hands during the provision of wound care for one resident (R) (R#144). In addition, the facility failed to properly store continuous positive airway pressure (CPAP) mask for R#344. The sample size was 38.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure that it was maintained in a clean, comfortable, and homelike environment in 12 of 15 resident rooms (238/239, 240/241, 242/243, 244/245, 260/261, and 262/263) on one of five halls (Blue Hall) including clogged sinks, dust buildup on bathroom vents, light fixtures with debris in globes, air conditoner units with dust/grime buildup and dirty filters. The facility census was 98.

Inspectors wroteBased on observations, record review, interviews, and review of the policy titled Prevention of Patient Abuse, Neglect, Exploitation, Mistreatment, and Misappropriation of Property, the facility failed to ensure one resident (R) R#19 was protected from neglect, by failing to answer a call light, when multiple staff members walked past her room over 50-minute timespan. The sample size is 37.

Inspectors wroteBased on record review, interviews, review of facility documentation, and policy review, the facility failed to report within the required timeframe (24 hours for incidents that do not result in serious bodily injury) to the State Survey Agency (SSA) an incident of resident-to-resident abuse, in which resident (R) R#74 hit R#59 with a pool noodle. The incident was documented to have happened on 10/19/2022, but was not reported to the SSA until 12/9/2022. The sample size was 37.

Inspectors wroteBased on observations, record review, staff interviews, and review of facility policy titled Dialysis Care Pre and Post Dialysis and SNF [Skilled Nursing Facility] Outpatient Dialysis Agreement, the facility failed to ensure that pre and post dialysis assessments were conducted for one of two residents (R) R#37, receiving dialysis services. In addition, the facility failed to maintain ongoing communication between the facility and the dialysis center for R#37. Findings Include: Review of the policy titled Dialysis Care Pre and Post Dialysis, revised 8/22/2022, revealed procedure I. Pre-Dialysis number 2. Take and record resident blood pressure and pulse and observe shunt access prior to resident transport to dialysis. II. Post-Dialysis number 2. Upon return from dialysis, take and record resident blood pressure, pulse, and observations of the dressing at the access site. [...]

Inspectors wroteBased on record review, Registered Dietician (RD), and staff interview, the facility failed to ensure that the staff designated as Director of food and nutrition services was a certified dietary or food service manager or had a similar food service management certification or degree.

Inspectors wroteBased on observation, record review, and staff interview the facility failed to ensure proper sanitization/cleaning of monitors for testing of blood glucose during 9 observations of 6 resident's (R) (R#36, R#136, R#18, R#117, R#139, and R#58) on 3 of 6 halls out of a total of 36 residents who receive glucose testing. One out of two nurses observed reforming finger sticks failed to clean the blood glucose monitoring equipment. Review of the Healthcare Professional Operator's Manual for the G3 Blood Glucose Monitoring System revealed on page 11 that the G3 Meter should be cleaned and disinfected between each patient. The meter is validated to withstand a cleaning and disinfection cycle of ten times per day for an average period of three years. Clorox Healthcare Bleach Germicidal and Disinfectant Wipes have been approved for cleaning and disinfecting the G3 Meter. Step 1. [...]

Inspectors wroteBased on record review and staff interview, the facility failed to obtain a concurring physician's signature on a DNR (Do Not Resuscitate) order form for two residents (R)(R#72 and R#118). A total of 41 residents' advance directives information was reviewed.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to implement the care plan related to nail care prn (as needed) for one totally-dependent resident (R) (R#52). The sample size was 68 residents.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to perform nail care for one totally-dependent resident (R) (R#52), who had bilateral hand contractures. The sample size was 68 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow the physician ' s orders to discontinue a divided plate for one of one resident (R) (R#62), who was reviewed for adaptation devices for eating.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to ensure that a urinary catheter was secured to the leg to prevent urethral traction for one resident (R) (R#52). A total of three residents were reviewed for urinary catheter use.

Inspectors wroteBased on record review and staff interviews, the facility failed to communicate with the dialysis center for one resident (R) R #76. According to the facilities Resident Census and Conditions of Residents (CMS Form 672) there are two dialysis residents. The census is 147.