Signature Healthcare of McCreary County Rehab and

Inspectors wroteBased on observation, interview, record review and facility policy, the facility failed to ensure its staff implemented and provided care in accordance with the resident's written care plan interventions for 1 of 26 sampled residents (Resident (R47). R47 sustained a tibial (bone in the lower leg) fracture.

Inspectors wroteBased on observation, interview, record review and facility policy review, the facility failed to ensure its staff provided adequate supervision and assistance to prevent injury for 1 of 26 sampled residents (Resident (R47), which resulted in the resident sustaining a fracture.

Inspectors wroteBased on interview, record review, and review of the facility's policy, it was determined the facility failed to immediately notify the physician when there was a change in resident condition and/or a need to alter treatment for five (5) of eighteen (18) sampled residents (Resident #250, Resident #7, Resident #19, Resident #12, and Resident #42). The facility utilized a protocol for Hypoglycemia (low blood glucose) that required staff to notify the resident's physician for blood glucose levels (blood sugar) less than 70. On 08/06/2020, Resident #250's fingerstick blood glucose level was 66 (ADA recommendation range for someone with diabetes: 80-130 mg/dl) at 5:09 PM and was 59 at 8:15 PM. However, the resident's physician was not notified of the resident's low blood glucose level. On 08/07/2020 at 12:26 PM, the resident's blood glucose level was 56. [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined that the facility failed to implement the care plan for six (6) of eighteen sampled residents (Resident #7, #12, #19, #42, #29 and #250) and failed to develop a person-centered care plan for one (1) residents (Resident #31) out of eighteen (18) sampled residents related to activity preferences. Resident #7, #12, #19, #42, and #250 had care plans related to their diagnosis of Diabetes Mellitus with interventions to complete blood glucose monitoring and/or to monitor for signs/symptoms of Hypoglycemia. However, the facility failed to implement the care plans for these residents related to obtaining blood glucose monitoring and monitoring/notifying the physician of low blood glucose levels. [...]

Inspectors wroteBased on observation, interview, record review, and review of the facility's policy, it was determined the facility failed to ensure residents received care and treatment in accordance with accepted standards of practice to treat and prevent adverse events related to hypoglycemia (low blood sugar) for five (5) of eighteen (18) sampled residents (Resident #250, Resident #7, Resident #19, Resident #12, and Resident #42). Review of the facility's Hypoglycemia Management Algorithm, developed by the American Diabetes Association, revealed if a resident's blood sugar was less than or equal to 70 milligrams per deciliter (mg/dl), staff were required to notify the resident's physician, recheck the resident's blood sugar in 15 minutes, then take other necessary actions based on the resident's blood sugar result. [...]

Inspectors wroteBased on interview, record review, and review of the facility's policy, it was determined the facility failed to ensure licensed nursing staff had the knowledge and competency to provide care for residents that require blood glucose monitoring and the implementation of the facility's Hypoglycemia Management Algorithm, for five (5) of eighteen (18) sampled residents (Resident #250, Resident #7, Resident #19, Resident #12, and Resident #42). Record review and interviews revealed, on 08/06/2020, Resident #250's fingerstick blood glucose level was 66 (ADA recommendation range for someone with diabetes: 80-130 mg/dl) at 5:09 PM and was 59 at 8:15 PM. On 08/07/2020 at 5:09 PM, the resident had a blood glucose level of 46. Approximately, four (4) hours hours later at 9:19 PM, the resident's blood glucose level was 37. Resident #250 requested to be sent to the hospital, on 08/07/2020 at 9:30 PM. [...]

Inspectors wroteBased on observation, interview, record review, and a review of the facility freezer policy, it was determined the facility failed to store food under sanitary conditions. Observations of the facility walk-in freezer revealed water had leaked from the condenser unit causing ice buildup on containers of frozen strawberries and ice cream cups stored directly under the condenser unit in the freezer.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to revise the care plan for one (2) of eighteen (18) sampled residents (Resident #37 and Resident #38). Resident #37 was assessed to be at risk for pressure ulcers and had a physician's order to utilize heal protectors at all times; however, review of the care plan for Resident #37, revealed the care plan did not include interventions to address the use of the heal protectors. Interviews with staff revealed Resident #38 threw cups/pitchers of fluids on the floor and staff did not leave cups/pitchers at the resident's bedside. However, review of the resident's care plan revealed the facility did not revise the care plan to address the behavior, nor did it address how staff were required to ensure the resident met hydration needs.

Inspectors wroteBased on observation, interview, record review, and facility policy review it was determined the facility failed to ensure activities were provided based on residents choices and preferences for one (1) of eighteen (18) sampled residents (Resident #31). Resident #31's admission assessment noted that it was very important to the resident to go outside for fresh air when the weather was nice; however, observations and interviews revealed that the resident was not given the opportunity to spend time outside.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to implement ordered devices to assist in maintaining skin integrity, and to assist in preventing the development of pressure ulcers for one (1) of eighteen (18) sampled residents (Resident #37). Resident #37 had a physician's order dated 02/13/2020, for heel protectors to be used at all times. Observations of Resident #37, on 09/30/2020 and 10/01/2020, revealed the heel protectors were not being used as ordered.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure fluid intake was monitored related to sufficient fluid intake to maintain hydration and health for two (2) of eighteen (18) sampled residents (Resident #29 and Resident #38). Resident #29 and Resident #38 were assessed to be at risk for hydration concerns; however, the facility failed to monitor to ensure residents were meeting their fluid needs. The Findings Include: Review of the facility policy titled, Hydration, last reviewed 06/27/2018 revealed Residents will receive sufficient amounts of fluid to maintain proper hydration. Further review of the policy revealed, Water is made available at mealtime, at bedside, on hydration cart (unless contraindicated). The policy did not indicate how the facility would ensure fluid intake was monitored. 1. [...]

Inspectors wroteBased on observation, interview, record review, review of facility policy and CDC guidelines, it was determined the facility failed to prevent the possible spread of COVID-19. Staff were observed in two (2) resident rooms (Resident #20 and #29) without donning appropriate Personal Protective Equipment (PPE).