Pruitthealth- Walterboro

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure kitchen staff thoroughly cleaned and air-dried pots, pans, and food service equipment prior to storage. In addition, dishware was found to be chipped and was being used during meal service. This failure increased the potential risk of foodborne illness and had the potential to affect 119 of the 123 residents receiving dietary services. Four residents received nutrition through tube feeding.

Inspectors wroteBased on review of facility policy, observations, and interviews, the facility failed to ensure foods stored in the main walk in refrigerator and freezer were labeled, dated and not expired. Additionally, the bin in the kitchen contained flour with the scoop in the flour. This failure could potentially affect 114 residents who consume foods from the kitchen.

Inspectors wroteBased on review of the facility policy, record review, and interview, the facility failed to invite Resident (R) 65 to the initial comprehensive care plan meeting for 1 of 4 residents reviewed for resident rights, to participate in planning care.

Inspectors wroteBased on review of the facility policy, interview, and record review, the facility failed to ensure incontinence care was provided for 1 of 2 residents (R)61, requiring incontinence care.

Inspectors wroteBased on observations, interviews, record review and facility policy, the facility failed to ensure there was an order for changing respiratory supplies for Resident (R)109 for 1 of 1 residents reviewed for respiratory care.

Inspectors wroteBased on review of the facility policy, record reviews, and interviews, the facility failed to ensure that a snack was sent to dialysis for 1 of 1 residents (R)107, reviewed for dialysis.

Inspectors wroteBased on observations, record review, interviews and facility policy, the facility failed to ensure medications were properly stored for Resident (R)82 for 1 of 9 residents reviewed for accident hazards.

Inspectors wroteBased on interview and record review, the facility failed to appropriately notify Resident (R)1's Resident Representative or Physician after a change in condition for 1 of 3 reviewed for notification of changes.

Inspectors wroteBased on observations, record reviews, interviews and review of the manufacturer's package insert, the facility failed to ensure that Resident (R)1 was free of unnecessary psychotropic medications for 1 of 6 residents reviewed for unnecessary medications.

Inspectors wroteBased on interviews, record review, and review of facility policy, the facility failed to provide and document sufficient preparation and orientation to a resident to ensure safe and orderly discharge from the facility for one of three residents reviewed for discharge. Specifically, Resident (R)267, nor his representative was adequately prepared or counseled per facility policy and discharged unsafely. During interviews and document review conducted during a Recertification/Complaint survey on 03/27/23 through 03/30/23, it was identified that R267, was involuntary discharged to a locked private residence unaccompanied, after being sent to a scheduled physician's appointment. R267 is blind, a bilateral below the knee amputee, and is wheelchair bound. [...]

Inspectors wroteBased on interviews, record review and facility job description, the facility failed to employ a qualified dietitian or clinically qualified nutritional professional on a full time, part time or consultant basis. This affected the need for nutritional assessment for 112 of 119 census residents (7 residents received nutrition via tube feeding). Specifically, a Dietary Manager (DM) was not employed by the facility thereby putting the residents' nutritional status at risk.

Inspectors wroteBased on observations, interview, record review, and policy review, the facility failed to ensure that the kitchen was maintained in a sanitary manner for 112 of 119 census residents (7 residents received nutrition via tube feeding). Specifically, food items in the refrigerator, freezer and dry storage were not labeled or dated correctly and food items were found to have passed their use by dates and/or were found uncovered which put the residents in the facility at risk for foodborne illness.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to follow infection control procedures to ensure the proper storage of nebulizer masks for two Residents (R)41 and R97 of two residents reviewed for nebulizer treatment. Additionally, the facility failed to handle linens to prevent the spread of infection for R90 and R468. Findings Include: Review of an undated facility policy titled, Procedure: Small-Volume Nebulizer [SVN], indicated, Disassemble and rinse the SVN and mouthpiece, shaking out excess moisture. Store the setup in the bag at the bedside. Review of a facility policy titled, Infection Control - Linen and Laundry, reviewed 04/02/20, revealed, Soiled laundry will be bagged at the location of use . Soiled laundry will not be placed on the floor or on furniture . 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to determine if self-administration of nebulizer treatments was safe and clinically appropriate for two (Residents (R)97 and R41) of 35 sampled residents. This failure placed the residents at risk for inappropriate and unsafe medication use.

Inspectors wroteBased on interviews, record reviews, and review of the facility's policy, the facility failed to ensure two (Residents (R)37 and R48) of four residents reviewed for abuse were free from physical abuse, when R37 and R48 had a physical altercation that resulted in a minor injury for both residents. This deficient practice placed R37 and R48 at potential risk for further physical abuse.

Inspectors wroteBased on interview, record review and policy review, staff failed to investigate an allegation of abuse for two of four residents (R)37 and R48 reviewed for abuse out of a total sample of 35 residents. R37 wandered into R48's room he yelled at her to get out and she struck him, he then pulled her hair, and the residents were separated.

Inspectors wroteBased on interviews, record review, and review of facility policy, the facility failed to notify the ombudsman for one (Resident (R) 267) of two residents reviewed for discharge. Specifically, the Ombudsman was never contacted, and informed of R267's discharge plan.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that one Resident(R)48, of 35 residents observed for activities of daily living, was offered/provided assistance with removal of facial hair as scheduled.

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to ensure that one Resident (R)27, of three residents reviewed for range of motion, received consistent range of motion services to prevent reduction in range of motion. Specifically, R27 was not consistently provided with a splint and passive range of motion (PROM) ordered as part of a restorative nursing program.

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to ensure one Resident(R)60 of two residents sampled for catheter care, received catheter care to prevent urinary tract infections. Specifically, R60's indwelling urinary catheter tubing was not secured appropriately and maintained to prevent it from lying on the floor. This failure increased R60's risk of contracting a urinary tract infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care in accordance with professional standards. The facility failed to ensure one of four sampled residents (Resident (R) 27) received the correct oxygen (O2) flow rate per physician's orders. Additionally, the facility further failed to ensure the O2 was not administered to a resident without a physician's order for one of four residents (R41) reviewed for respiratory care. Findings Include: 1. Review of R41's undated Resident Face Sheet revealed the resident was admitted to the facility on [DATE] with diagnosis including acute and chronic respiratory failure, and chronic obstructive pulmonary disease. [...]