Putnam County Care Center

Inspectors wroteBased on observation, interview and record review, the facility failed to provide safe transfers for one resident (Resident #7), in a review of eleven sampled residents. Resident #7 was unable to use his/her left arm due to a stroke. Staff failed to protect the resident's left arm during transfers which caused repeated skin tears and bruising to his/her left arm that required wound care treatment within the facility. The facility census was 57. [...]

Inspectors wroteBased on interview and record review, the facility failed to notify one of eleven sampled resident's (Resident #4's), physician when the resident returned from a hospital stay with a urinary catheter (a sterile tube inserted into the bladder to drain the bladder of urine) and failed to notify the physician and obtain orders for discontinuation of the urinary catheter. Staff also failed to notify the physician the resident had not urinated for two days following removal of the urinary catheter and failed to notify the physician before inserting a straight catheter (inserted a temporary urinary catheter and removal and then removing for the purpose of draining the bladder and determine the residual urine quantity). [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain one of 11 sampled residents' (Resident #4's) private health information when the Administrator shared the resident's change in code status (CPR -cardiopulmonary resuscitation (CPR), vs DNR- do not resuscitate), with members of the public who were not privileged to that information. The facility census was 57. Review of the facility policy, Resident Rights, dated February 2021, showed the following:-Federal and state laws guarantee certain basic rights to all residents of the facility including the resident's right to a dignified existence, privacy and confidentiality;-The unauthorized release, access or disclosure of resident information is prohibited. All release, access or disclosure of resident information must be in accordance with current laws governing privacy of information issues. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide care according to professional standards of practice for one resident (Resident #4) in a review of eleven sampled residents when staff failed to obtain physician orders for removal of the resident's urinary catheter (a sterile tube inserted into the bladder to drain the bladder of urine) that was in place on re-admission from an outside hospital and failed to obtain orders for straight catheterization when the resident was unable to urinate for two days. The facility census was 57. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff utilized appropriate infection control technique when providing care for two residents, (Resident #1 and #2) who had indwelling urinary catheters, in a review of five sampled residents, to prevent infection. The facility census was 52. Review of the facility policy, Catheter Care, Urinary,, last revised 8/2022, showed the following: -Purpose of this procedure is to prevent urinary catheter-associated complications, including urinary tract infections; -Wash and dry hands thoroughly; -Use a clean washcloth with warm water and soap or bathing wipe to cleanse and rinse the catheter from insertion site to approximately four inches outward. Review of the facility policy, Handwashing/Hand Hygiene, last revised 10/2023, showed the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide oversight and prevent injury for one resident (Resident #1), who was dependent on staff for transfers and bed mobility and had a history of falls from bed on 8/25/24 and 10/1/24, in a review of 12 sampled residents. On 10/7/24, staff failed to ensure interventions to prevent falls from the bed were in place when staff left the resident's bedside while in the resident's room. The resident rolled out of bed and hit his/her head. The resident sustained an intraventricular hemorrhage (bleeding inside the brain) and left hip fracture, which resulted in his/her death. The facility census was 56. The administrator was notified of the Immediate Jeopardy (IJ) on 10/16/24 at 5:10 P.M., which began on 10/7/24. The IJ was removed on 10/7/24 as confirmed by surveyor onsite verification. [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain a surety bond (an amount equal to at least one and one half times the average monthly balance of the residents' personal funds) sufficient to ensure protection of all personal funds the facility held for 15 residents in the resident fund account. The facility census was 55. Review of the facility undated policy, Surety Bond, showed the following: -The facility has a current surety bond to assure the security of all residents' personal funds deposited with the facility; -A surety bond is an agreement between the facility, the insurance company, and the resident or the State acting on behalf of the resident, wherein the facility and the insurance company agree to compensate the resident for any loss of residents' funds that the facility holds, accounts for, safeguards, and manages; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure personal privacy for multiple residents when one resident (Resident #51), who had diagnoses of dementia and identified as a wanderer, wandered in and out of other residents' rooms. The facility census was 55. Review of the facility policy, Dignity, revised February 2021, showed the following: -Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem; -Residents' private space and property are respected at all times; -Staff promote, maintain, and protect resident privacy. Review of the facility policy, Resident Rights, revised February 2021, showed Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to privacy. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop a person-centered comprehensive care plan specific to the resident, for three residents (Resident #22, #31 and #47), in a review of 20 sampled residents. The facility census was 55. Review of the facility's policy, Care Plans, Comprehensive Person-Centered, revised March 2022 showed the following: -A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident; -The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident; [...]

Inspectors wroteBased on interview and record review, the facility failed to update interventions in the resident's care plan to reflect current care needs for four residents (Resident #26, #38, #44, #48), in a review of 20 sampled residents. The facility census was 55. Review of the facility's policy titled, Care Plans, Comprehensive Person-Centered, revised March 2022 showed the following: -A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident; -The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide supervision for one resident (Resident #51), in a review of 20 sampled residents. Resident #51 had dementia and wandered into other resident rooms causing two other residents (Resident #36 and Resident #37), to be upset and fearful, while another resident (Resident #35) expressed wanting to harm Resident #51 because of his/her behavior. The facility also failed to provide supervision when the resident was wandering by an unlocked and unattended treatment cart and attempting to gain access to the medication room. The census was 55. Review of the facility policy, Wandering and Elopement, last revised 03/2019 showed the following: -The facility will identify residents who are at risk of unsafe wandering and strive to prevent them from harm while maintaining the least restrictive environment for residents; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure eight nurse aides (NA) (NA B, NA D, NA N, NA R, NA S, NA T, NA U and NA V) completed a nurse aide training program within four months of their employment in the facility. The facility census was 55. Review of the facility policy titled Nurse Aide Qualifications and Training Requirements revised August 2022 showed the following: -Nurse aides must undergo a state-approved training program; -The facility will not employ any individual as a nurse aide for more than four months full-time, temporary, per diem, or otherwise unless: -That individual is competent to provide designated nursing care and nursing related services; -That individual has completed a training program and competency evaluation program, or a competency evaluation program approved by the state; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to offer a bedtime snack to all residents. The facility census was 55. Review of the facility policy titled Serving Snacks (Between Meals and Bedtime) revised September 2010 showed the following: -The purpose of this procedure is to provide the resident with adequate nutrition; -Review the resident's care plan and provide for any special needs of the resident. 1. During a group interview on 09/09/2024 a 2:10 P.M., 20 out of 20 residents said the following: -Bedtime snacks were not offered; -Staff do not come around to offer snacks in the evenings or at bedtime; -Sometimes there were snacks available at the nurse's station on a cart. Observation on 9/12/24 at 2:45 P.M. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper infection control practices were utilized for respiratory care supplies for two residents (Resident #9 and Resident # 19) out of 20 sampled residents when staff did not store nasal cannula oxygen tubing in a bag per policy instruction, when not in use and when the tubing had been on the floor and then later placed in the resident's nares. The facility failed to adhere to proper hand washing techniques and proper use of personal protective equipment while providing care for five resident's (Residents #38, #48, #47, #39 and #34) and failed to ensure a urinary drainage system did not touch the floor for one resident (Resident #37). The facility failed to ensure all procedures were implemented to address prevention, development, and transmission of Tuberculosis (TB) as directed by facility policy. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff followed infection control practices to prevent urinary tract infections for one resident (Resident #47), who had urinary catheter, in a review of 20 sampled residents. The facility identified six residents with urinary catheters. The facility census was 55. Review of the facility policy, Urinary Catheter Care, last revised 8/2022, showed the following: -The purpose of this procedure is to prevent urinary catheter-associated complications, including urinary tract infections. -Be sure the catheter tubing and drainage bag are kept off the floor. 1. Review of Resident #47's urine culture report, dated 5/18/24, showed the following: -Greater than 100,000 colony forming unit (CFU) /milliliter (ml) of pseudomonas aeruginosa (bacteria); -50,000-100,000 CFU/ml of proteus mirabilis (bacterium). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store medication in a locked compartment while left unattended and failed to return or destroy outdated medications. The facility census was 55. Review of the facility policy, Medication Labeling and Storage, revised February 2023, showed the following: -The facility stores all medications and biologicals in locked compartments under proper temperature, humidity, and light controls. Only authorized personnel have access to keys; -The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner; -If the facility has discontinued, outdated, or deteriorated medications or biologicals, the dispensing pharmacy is contacted for instructions regarding returning or destroying these items; [...]

Inspectors wroteBased on interview and record, review the facility failed to ensure one resident (Resident #4), in a review of nine sampled residents, who staff identified required an indwelling urinary catheter (a sterile tube inserted into the urethra to drain urine from the body related to urinary retention and enlarged prostate (gland around the urethra), and history of urinary tract infection, received treatment and care in accordance with professional standards of practice to meet the resident's physical, mental and psychosocial needs. Staff failed to notify the physician and assess and document the resident's urinary status following an episode of urinary retention that required changing the indwelling urinary catheter (removing and inserting a new urinary catheter) with tea colored urine and foul urine odor noted. [...]

Inspectors wroteBased on interview and record review, facility staff failed to maintain professional standards of practice when staff failed to notify the physician of a change in condition in a timely manner. On 12/15/23 at approximately 1:00 A.M. one resident (Resident #2) exhibited mental status changes and direct care staff reported to the charge nurse that the resident was acting high or under the influence of drugs. The resident had a history of drug abuse. The resident tested positive for tetrahydrocannabinol (also known as THC or the substance that's primarily responsible for the affects of marijuana on a person's mental state) and methamphetamine (a synthetic stimulant that is addictive and can cause considerable health adversities that can sometimes result in death) on 12/15/23. The facility census was 52. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure expired medications were removed from the medication cart for hallway 1 and 2. The facility failed to discard medication for one additional resident (Resident #25), according to the pharmacy label. The facility failed to label insulin pens when opened for one resident (Resident #5), in a review of 13 sampled residents and one additional resident (Resident #9). The facility failed to label two antidiabetic medication pens when opened for one resident (Resident #4) and two additional residents (Residents #11 and #20). The facility census was 46. Review of the facility's policy for Administering Medications, revised April 2019, showed the expiration/beyond use date on the medication label is checked prior to administering. When opening a multi dose container, the date opened is recorded on the container; [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain an air gap between the floor and the drain to one of two ice machines in the facility to prevent possible backflow from the drain back into the ice machine. The facility also failed to refrigerate opened containers of food as specified by the manufacturer, and failed to label and date opened food and beverage items located in a resident-accessible unit refrigerator to prevent staff and residents from using out-dated food items that have the potential to cause food-borne illness. The facility census was 46. 1. Review of the Food and Drug Administration Food Code, dated 2013, showed an air gap between the water supply inlet and the flood level rim of the plumbing fixture or equipment shall be at least twice the diameter of the water supply inlet and may not be less than one inch. Observation on 03/27/23 at 11:17 A.M. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide restorative therapy services for one resident (Resident #13), in a review of 13 sampled residents, and for one additional resident (Resident #15), who had limited range of motion (ROM), which resulted in a reduction of their physical ability to perform activities of daily living. The facility census was 46. Review of the facility policy, Rehabilitative Nursing Care, revised August 2007, showed the following: -Rehabilitative nursing care is provided for each resident admitted ; -Policy Interpretation and Implementation: -1. General rehabilitative nursing care is that which does not require the use of a Qualified Professional Therapist to render such care; -2. Nursing personnel are trained in rehabilitative nursing care. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement oxygen interventions according to facility policy by failure to ensure that humidification and oxygen tubing were changed per facility policy and physician's orders for one resident (Resident #8), in a review of 13 sampled residents, and for two additional residents (Residents #10 and #20). The facility census was 46. Review of the facility's policy and procedure for respiratory therapy prevention of infection, last revised in November 2010, showed the following: -The purpose of the procedure was to guide prevention of infection associated with respiratory therapy tasks and equipment; -Check water level of any pre-filled humidification (used to reduce sensations of dryness in the upper airways) reservoir every 48 hours; -Change pre-filled humidifier when the water level becomes low; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide a written notice of transfer to three residents (Residents #13, and #26, and #447) and/or their representatives, in a review of 13 sampled resident when they were transferred to the hospital. The facility census was 46. During an interview on 3/30/23 at 3:55 P.M., the Administrator said that she could not find a transfer/discharge policy for the facility. 1. Review of Resident #13's face sheet showed his/her family member was his/her responsible party. Review of the resident's progress notes, dated 2/17/23 at 3:04 P.M., showed the resident received an order for direct admit to the hospital. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide a written notice of bed hold with required information to the resident and/or resident representative when the facility initiated a transfer to the hospital for three residents (Residents #13, 26, and 447), in a review of 13 sampled residents. The facility census was 46. During an interview on 3/30/23 at 3:55 P.M., the Administrator said that she could not find a bed hold policy for the facility. 1. Review of Resident #13's face sheet showed his/her family member was his/her responsible party. Review of the resident's progress notes, dated 2/17/23 at 3:04 P.M., showed the resident received an order for direct admit to the hospital. [...]