Signature Healthcare of Bowling Green

Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to ensure confidentiality of medical records for one (Resident (R) 83) of 11 residents sampled during medication pass. Facility staff failed to ensure that R83's medical information was secured when unattended, so as to prevent unauthorized access to the record.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to maintain an infection prevention and control program to help prevent the development and transmission of communicable diseases and infections for two (R68 and R83) of eight residents reviewed for infection control. Staff failed to use personal protective equipment (PPE) for R68, who was on contact precautions. In addition, staff failed to perform hand hygiene when indicated, including before and after resident contact/care for R83.

Inspectors wroteBased on interview, and record review, the facility failed to ensure three of three residents (R) reviewed out of a sample size of 42 for Skilled Nursing Facility (SNF) Beneficiary Protection Notification, (R381, R71, and R95) whose Medicare therapy services were terminated, received an estimated cost for services if they chose to pay for the services themselves. This had the potential for residents not to be able to make an informed decision as to whether to continue therapy services.

Inspectors wroteBased on interview and record review, the facility failed to ensure two residents of 42 sampled residents' (R) Resident Assessment Instruments ([NAME]) accurately reflected the resident's hospice designation for R88 and ability to communicate for R58. This failure could result in the residents' needs, strengths, and areas of decline not being addressed appropriately for R 88 and R58.

Inspectors wroteBased on observation, interview and review of facility policy it was determined the facility failed to Store, prepare, distribute and serve food in accordance with professional standards for food service safety. Observations of the kitchen on 02/19/19 and 02/20/19, revealed during lunch tray-line, [NAME] #1 inserted the thermometer into the foods past the stem to the handle, which was not sanitized, was the handle was coming in contact with the foods. In addition, dishes were stored improperly. Review of the Census and Condition, dated 02/19/19, revealed one-hundred twenty-five (125) of one-hundred twenty-nine residents received their meals from the kitchen.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, it was determined the facility failed to ensure they developed and/or implemented a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment, for six (6) of thirty-three (33) sampled residents (Residents #30, #76, #79, #83, #110 and #374). The facility failed to implement care plans for Residents #30, #76, #79, #83, and #374 related to ADL assistance and failed to develop person centered interventions for falls related to Resident #110's severely impaired cognition.

Inspectors wroteBased on interview, record review and review of facility policy, it was determined the facility failed to ensure five (5) of thirty-three sampled residents who were unable to carry out activities of daily living received the necessary services to maintain personal and oral hygiene (Residents #38, #76, #83, #86, and #427). The facility failed to provide oral hygiene to Resident #427, failed to ensure two (2) staff provided bathing for Resident #76, and failed to provide bathing every three (3) times a week for Residents #38, #83 and #86.

Inspectors wroteBased on interview, record review, and review of the facility policy, it was determined the facility failed to ensure each resident was treated with respect and dignity and ensure care was provided in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality, for two (2) of thirty-three (33) sampled residents (Residents #38 and #67).

Inspectors wroteBased on interview, record review, and review of the facility's policy, it was determined the facility failed to ensure that each resident who experiences a significant change in status is comprehensively assessed using the CMS-specified Resident Assessment Instrument (RAI) process, for two (2) of thirty-three (33) sampled residents (Residents #86 and #87).

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure the Comprehensive Care Plans were reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments and changes in conditions for three (3) of thirty-three (33) sampled residents (Residents #37, #44, and #110). Resident #37 sustained a fall on 09/12/18 and Resident #44 sustained falls on 08/19/18 and 02/07/19, however, the comprehensive care plans were not updated to reflect new interventions after the therapy department determined physical therapy was not indicated. In addition, Resident #110 sustained falls on 12/31/18, 01/03/19, 01/07/19 and 02/08/19; however, the comprehensive care plans was not updated to reflect new interventions.

Inspectors wroteBased on observation, interview and review of facility policy, it was determined the facility failed to ensure each resident receives adequate supervision and assistance devices to prevent accidents for two (2) of thirty-three sampled residents (Residents #37 and #44). Residents #37 and #44 had falls for which interventions were implemented to consult Physical Therapy (PT)/Occupational Therapy (OT). When therapy evaluated the residents, it was determined the falls were not related to the residents' decline and therapy was not indicated. However, another intervention was not implemented to prevent future falls.

Inspectors wroteBased on interview, record review and review of facility policy, it was determined the facility failed to ensure that a resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain for two (2) of thirty-three (33) sampled residents (Residents #86 and #110). The facility failed to assess Resident #110 and Resident #86 for possible interventions to improve the resident's noted decline in bowel and bladder continence. The Findings Include: Review of the Facility Policy titled Bowel and Bladder Management, dated 04/27/16, revised 7/19/18 revealed the Facility will evaluate, monitor and track resident's bowel and bladder patterns and will identify the need for early intervention. [...]

Inspectors wroteBased on interview, record review and review of facility policy, it was determined the facility failed to maintain medical records on each resident that are accurately documented for one (1) of thirty-three (33) sampled residents (Resident #65).