Signature Healthcare of Chapel Hill

Inspectors wroteBased on observations and staff interviews the facility failed to (1) remove expired medication and date open medication for 1 of 2 medication storage refrigerators reviewed (Blue Hall), and (2) failed to date open medications for 1 of 2 medication carts reviewed (Red Hall).

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure the furniture and floors were maintained in a clean state, free from drainage from an enteral feeding (Resident #76) and the insulated outer covering of the bed control wires was intact (Resident #31) for 2 of 6 rooms on 1 of 2 halls observed for a safe, clean and homelike environment.

Inspectors wroteBased on observation and staff interviews, the facility failed to remove expired fortified nutritional supplements stored for use in 1 of 2 nourishment rooms (Nourishment Kitchenette at Blue side). These practices had the potential to affect 2 of 2 residents who received tube feeding.

Inspectors wroteBased on record review and interviews with residents and staff, the facility failed to maintain an accurate Medication Administration Record (MAR) when insulin that was administered by licensed nursing staff was signed off on the MAR as administered by Medication Aide (MA) #2. This deficient practice affected 3 of 27 sampled residents whose medical records were reviewed (Resident #11, Resident #43, and Resident #80).

Inspectors wroteBased on record review, residents and staff interviews, the facility failed to follow the current Centers for Disease Control (CDC) recommendations for coronavirus disease 2019 (COVID-19) vaccination for 5 of 5 residents reviewed for COVID-19 vaccination (Resident #53, Resident #4, Resident #43, Resident #6, and Resident #46).

Inspectors wroteBased on record review, and interviews with the resident, Responsible Party (RP), and staff, the facility failed to facilitate the inclusion of a cognitively intact resident and her RP in the care planning process for 1 of 1 resident reviewed for the care planning process (Resident #71).

Inspectors wroteBased on observations, record review, interviews with resident and staff, the facility failed to assess if a cognitively impaired resident could self-administer eye drops kept at the bedside for 1 of 1 resident reviewed for self-administration (Resident #6).

Inspectors wroteBased on record review, resident interview and staff interviews, the facility failed to allow a resident the right to manage personal funds for 1 of 3 sampled residents reviewed for personal funds. (Resident #40)

Inspectors wroteBased on record review, law enforcement interview and staff interviews, the facility failed to report an allegation of abuse to law enforcement and adult protective services (Resident #242) and failed to report an allegation of misappropriation of resident property to adult protective services (Resident #66). In addition, the facility policy failed to include procedures for reporting allegations of abuse/misappropriation of resident property to adult protective services. This was for 2 of 3 residents reviewed abuse/misappropriation of resident property.

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to arrange podiatry services and/or provide toenail care for 1of 1 resident reviewed for foot care (Resident #70). Findings Included: Resident #70 was admitted to the facility on [DATE]. His diagnoses included left hemiplegia (weakness on one side) and hemiparesis (paralysis on one side) following a stroke. Review of the facility's skin alert form indicated [redacted]'s nails were trimmed on 12/5/23, 12/19/23 and 12/29/23. A review of Resident #70's quarterly Minimum Data Set, dated [DATE] revealed he was cognitively intact and had an impairment on one side of his body. He was assessed as requiring supervision or touch assistance for showers. He was independent in performing personal hygiene and in putting on and taking off his footwear. [...]

Inspectors wroteBased on staff interview, and record review, the facility's Quality Assurance and Performance Improvement (QAPI) committee failed to maintain implemented effective procedures and monitor the interventions that the committee put into place following a recertification and complaint investigation survey on 04/11/24, the complaint investigation survey on 11/3/23 and the complaint investigation survey on 6/23/22. This was for one deficiency in the area of Resident Self-Administer Medication (554) recited on the current recertification and complaint investigation survey on 4/11/24. The continued failure of the facility during three federal surveys of record showed a pattern of the facility's inability to sustain an effective QAPI program.

Inspectors wroteBased on test tray observation, record reviews and interviews with residents and staff the facility failed to serve food that was palatable and at temperatures acceptable to 2 of 2 residents review for food palatability. (Resident #2 and #18) This practice had the potential to affect other residents.

Inspectors wroteBased on record review, observation, resident and staff interviews, the facility failed to assess the ability of residents to self-administer medication for 2 of 2 sampled residents observed with medications at the bedside (Resident #11 and Resident #17).

Inspectors wroteBased on record review, resident and staff interviews, the facility failed to honor resident requests for two showers per week for 2 of 2 sampled residents reviewed for self-determination (Resident #11 and Resident #8)

Inspectors wroteBased on record review, staff, and Behavioral Health Nurse Practitioner's interview, the facility failed to inform the resident's Responsible Party when there were changes in the resident's medications for 1 of 3 sampled residents reviewed for notification of changes (Resident #1).

Inspectors wroteBased on record review, observation, resident and staff interviews, the facility failed to ensure that residents did not possess smoking material for 2 of 2 sampled residents observed for accidents (Residents #11 and Resident #10).

Inspectors wroteBased on record review, staff interviews and home healthcare agencies interview the facility failed to follow through with the referrals to the home healthcare agency as ordered by the physician, failed to verify their services when discharged from the facility. This was for 2 of 3 sampled residents (Resident #133 and Resident #79) reviewed for discharge.

Inspectors wroteBased on record review and staff interviews, the facility failed to develop a person-centered care plan with measurable goals and objectives for one of three residents reviewed for activities. (Resident #9)

Inspectors wroteBased on observations, staff interviews and record review, the facility failed to provide an ongoing activity program that met the individual interests and needs to enhance the quality of life for 1 of 2 sampled cognitively impaired residents reviewed for activities. (Resident #9).

Inspectors wroteBased on record review and staff interview, the facility failed to administer a pneumococcal (pneumonia) vaccine as consented for 2 of 5 residents (Resident #12 and Resident #59) and failed to obtain a consent for 1 of 5 residents (Resident #11) reviewed for immunizations.