Reserve at Appling of Journey LLC, the

Inspectors wroteBased on observations, staff interviews, and review of the facility's policy titled Ice Machines and Portable Ice Carts, the facility failed to ensure the dietary ice machine was free from buildup. This deficient practice had the potential to place the 76 residents receiving nutrition or hydration from the kitchen at risk of foodborne illness.

Inspectors wroteBased on observation, staff interviews, record review, and review of the facility's policies titled Hand Hygiene and Enhanced Barrier Precautions (EBP), the facility failed to ensure nursing staff performed hand hygiene and used personal protective equipment (PPE) while administering medications via gastrostomy tube (G-Tube [a tube surgically inserted through the abdominal wall into the stomach to provide nutrition and medication]), while suctioning the tracheostomy (a surgically created hole in the trachea to provide an airway and facilitate breathing), and during perineal care for one of 18 residents (R) (R23) on EBP. The deficient practice had the potential to place R23 at increased risk of unmet needs and medical complications and to increase the spread of infection due to cross-contamination for the 80 residents residing in the facility.

Inspectors wroteBased on observation, staff interviews, record review, and review of the facility policies titled Medication Storage and Medication Administration Policy, the facility failed to ensure that medications, biologicals, and supplies were stored following manufacturers' recommendations, or those of the suppliers, in one of four medication carts and two of two medication rooms. This deficient practice has the potential to place residents at risk of receiving medications or biologicals with altered effectiveness.

Inspectors wroteBased on observation, staff and resident interviews, and record review, the facility failed to ensure one of 52 sampled residents (R) (R34) was treated with dignity during dining. This deficient practice had the potential to place R34 at risk of a diminished quality of life or feeling intimidated when staff fed her while standing over her.

Inspectors wroteBased on observations and staff and resident interviews, the facility failed to maintain a safe, functional, and sanitary environment by not repairing roof leaks in one of two shower rooms (Shower Room A) and the facility's dining room. This deficient practice had the potential to place the 80 residents residing in the facility at risk of living in an unsafe and unsanitary environment.

Inspectors wroteBased on observation, staff interviews, record review, and review of the facility's policy titled Comprehensive Care Plans, the facility failed to implement care plan interventions for one of 18 residents (R) (R23) requiring Enhanced Barrier Precautions (EBP). This deficient practice had the potential to place R23 at risk of unmet care needs and a diminished quality of life.

Inspectors wroteBased on record review, staff interviews, and review of the facility's policy titled Resident Rights Regarding Treatment and Advance Directives, the facility failed to ensure the comprehensive person-centered care plan was updated for one of 52 sampled residents (R) (R82).

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility's policy titled Nail Care, the facility failed to provide nail care for three of 52 sampled residents (R) (R66, R50, and R81). This deficient practice had the potential to place R66, R50, and R81 at risk of unmet needs and a diminished quality of life.

Inspectors wroteBased on observations, staff interviews, and record review, the facility failed to deliver oxygen (O2) per physician order for one of eight residents (R) (R74) receiving O2 therapy. The deficient practices had the potential to place R74 at risk of respiratory complications.

Inspectors wroteBased on record review, staff interviews, and review of the policy titled Advanced Beneficiary Notices, the facility failed to provide a Notice of Medicare Noncoverage (NOMNC) Centers for Medicare and Medicaid Services (CMS) form 10123 and Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) CMS form 10055 for three of three residents (R) (R340, R341, R342) who were reviewed after being discharged from Medicare Part A Services.

Inspectors wroteBased on record review, staff interviews, and review of the Payroll Based Journal (PBJ) [NAME] Report for the first quarter (Q1) of Fiscal Year 2024, the facility failed to accurately report direct care staffing data to the Centers for Medicare and Medicaid (CMS). The facility census was 89 residents.

Inspectors wroteBased on observations, record review, interviews, and review of the policy titled Call Lights: Accessibility and Timely Response, the facility failed to ensure two residents (R) (R15 and R20) had their call light placed within their reach when they were in bed, creating the potential for their needs to not be addressed timely. Findings Include: Review of the policy titled Call Lights: Accessibility and Timely Response dated 12/1/2022 indicated the policy is to assure the facility is adequately equipped with a call light at each resident's bedside, toilet, and bathing to allow residents to call for assistance. Policy Explanation and Compliance Guidelines: Number 5. Staff will ensure the call light is within reach of the resident and secured, as needed. Number 6. The call system will be accessible to residents while in their bed or other sleeping accommodation within the resident's room. [...]

Inspectors wroteBased on observations, interviews, and review of the facility policy titled Preventive Maintenance Program, the facility failed to ensure that it was maintained in a safe, clean, and comfortable home-like environment in seven resident rooms on three of three halls (A10, B6, B7, B8, B13, C17, and C18) including dirty floors and walls, dirty privacy curtains, and scuffed walls, chipped paint, and peeling wallpaper. The census was 89.

Inspectors wroteBased on record review, staff interviews, and review of the facility document titled, Instructions for Completing the Medication Administration Clinical Skills Checklist, the facility failed to ensure that care and services were provided according to accepted standards of practice. Specifically, the facility failed to complete Medication Administration Clinical Skills Checklist for 11 of 12 certified Medication Aides employed at the facility.

Inspectors wroteBased on record review, interviews, and review of policy titled Pneumococcal Vaccine, the facility failed to provide education, offer, or administer pneumonia vaccinations for three of five residents (R) (R29, R71, R68) reviewed for pneumonia vaccinations.

Inspectors wroteBased on observations, record review, resident and staff interviews, and review of the policy titled Promoting/Maintaining Resident Dignity, the facility failed to ensure residents rights were not violated, and dignity was maintained for two residents (R) (R53 and R71). Specifically, the facility posted notification in front lobby prohibiting visitation for R53 and failed to maintain the privacy and dignity during the provision of incontinent care for R71. The sample size was 46.

Inspectors wroteBased on record review, interviews, and review of the policy titled Care Planning-Resident Participation, the facility failed to conduct care plan meetings and ensure that residents and/or their families were invited to participate in care planning for one of 46 sampled residents (R) R5.

Inspectors wroteBased on record review, staff interviews, and review of the policy titled Resident Assessment-Coordination with PASRR Programs, the facility failed to ensure that two residents (R) (R29 and R85) were assessed for Level II Pre-admission Screening/Resident Review (PASRR) and coordinate services, if warranted. The sample size was 46.

Inspectors wroteBased on record review, interviews, and review of the policy titled Comprehensive Care Plans the facility failed to revise the care plan to reflect current code status for one resident (R) R5. The sample size was 46.

Inspectors wroteBased on record review, interviews, and review of policy titled COVID-19 Prevention, Response, and Reporting, the facility failed to ensure documentation was available regarding the education, offering, and administering the COVID-19 vaccine for one of five sampled residents (R) (R) R29.

Inspectors wroteBased on record review, staff interviews, and review of the facility's policy titled, Transfer or Discharge Notice, the facility failed to provide written notification of a transfer to the hospital and failed to send a copy of the discharge notice to a representative of the Office of the State Long-Term Care Ombudsman for one resident, (R) R#33, of three residents reviewed for hospitalization.

Inspectors wroteBased on record review, staff interviews, and review of the facility policy titled, Transfer or Discharge Notice, the facility failed to provide written notification of the facility's bed-hold policy upon discharge to the hospital for one resident, (R) R#33, of three residents reviewed for hospitalization. This failure had the potential to contribute to possible denial of re-admission following a hospitalization for residents discharged emergently to the hospital.

Inspectors wroteBased on record review, observations, staff interviews, and policy review, the facility failed to ensure one resident (R) R#33 of three sampled residents, received wound treatment in accordance with professional standards of practice, physician orders, and the comprehensive person-centered care plan.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure residents remained free of accidents and hazards for one resident , (R) R#26, of 20 sampled residents. R#26 was not assessed for the use of a Broda Chair and sustained multiple falls from the chair. This failure had the potential to cause R#26 harm.

Inspectors wroteBased on record review, staff interview, and review of the facility's Surety Bond Policy, the facility failed to maintain a surety bond sufficient to cover the current total funds in the resident trust account. The deficient practice had the potential to affect 68 residents with trust fund accounts managed by the facility.