Redbay Nursing and Rehab Center

Inspectors wroteBased on observations, interviews, and review of a facility policy titled Storage and Destruction of Medications, the facility failed to ensure the crash cart did not contain expired intravenous fluids and an expired prefilled syringe of normal saline. This was observed on one of five days of the survey, and had the potential to affect any resident who may have required treatment from the facility's crash cart.

Inspectors wroteBased on record review, document review, and interviews, the facility failed to provide a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) after Resident Identifier (RI) #301, RI #39, and #21 were discharged from Medicare Part A services. Further, the facility failed to provide documentation of receipt of the Notice of Medicare Non-Coverage (NOMNC) by RI #301, RI #39, and RI #21 and/or their responsible parties. This affected three of three residents sampled for beneficiary protection notification review.

Inspectors wroteBased on observations and interviews, the facility failed to provide a clean, homelike, and orderly environment for Resident Identifier (RI) #48 and RI #29. Specifically, the facility failed to ensure: 1. Maintenance services were provided to address a non-latching door for room [ROOM NUMBER], and a difficult-to-latch door for RI #48. 2. RI #29's room was not used for storage for medical supplies not belonging to RI #29. This deficient practice affected RI #48 and RI #29, two of six residents reviewed during environmental observations.

Inspectors wroteBased on record review, observations, and interviews, the facility failed to ensure nursing staff contacted the physician to obtain clarification orders to determine the most appropriate route of administration for Resident Identifier (RI) #8's Atropine eye drops, ordered to treat excess respiratory secretions. This deficient practice affected RI #8, one of one sampled resident reviewed for tracheotomy care and orders.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure Resident Identifier (RI) #33 was provided showers as scheduled. This affected one of two sampled residents reviewed for Activities of Daily Living (ADLs).

Inspectors wroteBased on observation, record review, and interviews the facility failed to ensure Resident Identifier (RI) #29's PICC (Peripherally Inserted Central Catheter) line dressing was changed in accordance with professional standards of practice. This deficient practice had the potential to affect RI #29, one of one sampled resident reviewed for IV care.

Inspectors wroteBased on observations, interviews, record review, and review of a facility policy titled Hand Hygiene, the facility failed to ensure: 1. Nursing staff washed their hands and changed gloves while providing tracheostomy (trach) care and suctioning for Resident Identifier (RI) #8; and 2. Staff performed appropriate hand hygiene during wound care for RI #29. These deficient practices affected RI #8, one of one sampled residents reviewed for tracheostomy care, and RI #29, one of three sampled residents reviewed for wound care.

Inspectors wroteBased on observations, interview and review of facility policy titled, Refrigerator/Freezer Storage, the facility failed to ensure: 1. outdated food was not stored in the stand-up refrigerator/walk-in freezer; and 2. prepared food items were labeled with a use by date prior to storage in the walk-in freezer. These failures had the potential to affect 71 of 73 residents who received meals from the kitchen. Findings Include: The facility policy titled, Refrigerator/Freezer Storage with a last revised date of 11/08, included, Label all refrigerated food .by its use by date .Outdated food is to be discarded . On 08/26/19 at 4:01 p.m., the surveyor observed food items in the stand-up refrigerator. There was one plastic container of Puree Swedish Meatballs with an open date of 08/22/19 and use by date 08/25/19. On 08/26/19 at 4:18 p.m., the surveyor observed food items in the walk-in freezer. [...]

Inspectors wroteBased on observation, interview, record review, and a facility document titled RESIDENTS-These are YOUR Rights, the facility failed to ensure Resident Identifier (RI) #32's catheter bag was covered with a privacy cover during the Resident Council Meeting on 8/27/2019 with 9 other residents in the room. This affected RI #32 one of two residents sampled with a catheter bag. Findings Include: A review of a facility document, RESIDENTS-These are YOUR Rights, with no date, revealed .Federal law requires us to treat YOU with dignity, privacy, . RI #32 was readmitted to the facility on [DATE]. A review of RI #32's physician order dated 2/22/19 revealed Foley Catheter 18 fr (french) with 30 ml (millimeter) bulb for urinary retention. [...]

Inspectors wroteBased on observation, interviews, medical records, and a facility policy titled Handwashing, the facility failed to ensure a Licensed Practical Nurse washed her hands: 1. after giving Resident Identifier (RI) #63's oral medications, and prior to putting on gloves to give RI #63's eye drop medication, and 2. after administering RI #63's eye drop medication, removing her gloves, and prior to leaving RI #63's room, before opening the drawer of the medication cart. This affected one of three residents during medication pass and one of three licensed nurses observed during the mediation pass. Findings Include: A review of a facility policy titled Handwashing, with no date, revealed Purpose To provide guidelines to employees for proper and appropriate handwashing techniques that will aid in the prevention of the transmission of infections . When to Wash Hands . 4. [...]

Inspectors wroteBased on interview, review of the facility's online reports to the State Agency, and review of the facility policy titled, Resident Abuse, the facility failed to ensure allegations of physical abuse were reported to the state agency within two hours. This affected 1 of 5 reports of abuse reviewed and involved 3 residents: Resident Identifier (RI) #25, #44 and #49. Findings Include: Review of undated policy tilted Resident Abuse documented: .VIII .8. If reportable .the facility will report the alleged event immediately not to exceed 2 hours if the events that cause the allegation involve abuse or result in serious bodily injury . 1) Review of the facility's online report to the state agency revealed the facility became aware of an allegation of physical abuse concerning RI #25 on 7/11/18 at 10:00 a.m The allegation of physical abuse was not reported to the State Agency until 7/11/18 at 2: [...]

Inspectors wroteBased on interview, medical record review and a facility policy tilted Comprehensive Care Plans, the facility failed to ensure a care plan for oxygen use was developed for Resident Identifier (RI) #62. This affected RI # 62, 1 of eighteen residents, whose care plans were reviewed. Findings Include: A review of a policy titled Comprehensive Care Plans with a revised date of November 2017 documented: .Purpose: To assure each resident has a Comprehensive Care Plan that is current, person-centered, and consistent with the medical regimen .8. The resident care plans are kept in the medical record .Residents who are readmitted to the facility .will have their previous Care Plan reviewed and revised as needed . RI # 62 was readmitted to the facility on [DATE] with diagnoses to include shortness of breath (SOB). A review of a Physician's Order Form for RI # 62 documented: [...]

Inspectors wroteBased on observation, interview, medical record review, and review of facility policies titled, Small Volume Nebulizer, Hand Washing and Oral Medications, the facility failed to ensure: 1. a Licensed Practical Nurse (LPN) rinsed with water and dried the mouthpiece and cup of the nebulizer after administration of Resident Identifier (RI) #6's nebulizer treatment, and 2. a LPN washed her hands, per facility policy, after having direct contact with RI #71, after removing gloves and after completion of medication administration to RI #71. The LPN further handled medications with her bare hands during the medication administration to RI #71. These deficient practices affected RI #6, one of one resident observed during a nebulizer treatment, and RI #71, one of three residents observed during medication administration, involved two of three nurses observed for medication administration. [...]