Signature Healthcare of Monteagle Rehab & Wellness

Inspectors wroteBased on review of the facility's assessment, facility's nursing staff schedules, daily nursing staff posting sheets, time clock punches, and interviews, the facility failed to provide the services of a Registered Nurse (RN) for the minimum requirement of 8 consecutive hours a day 7 days per week for 10 days from 4/1/2025 - 6/30/2025 and 13 days from 8/14/2025 - 9/17/2025 of 123 days reviewed.

Inspectors wroteBased on facility policy review, medical record review, resident trust accounts review, and interview, the facility failed to notify the resident representatives when the amount in the residents' trust account exceeded the eligibility limit for 4 residents (Residents #28, #29, #214, and #43) of 46 residents reviewed for resident trust accounts.

Inspectors wroteBased on facility policy review, observation and interview, the facility failed to maintain a clean, comfortable, homelike environment for 4 residents (Resident #8, Resident #22, Resident #46, and Resident #69) of 68 residents observed.

Inspectors wroteBased on review of the Centers for Medicare and Medicaid (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, medical record review, and interview, the facility failed to complete Minimum Data Set (MDS) assessments timely for 2 residents (Residents #79 and #7) of 4 residents reviewed for timely MDS assessment completion.

Inspectors wroteBased on review of the Centers for Medicare and Medicaid (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, medical record review, and interview, the facility failed to transmit a Minimum Data Set (MDS) assessment timely for 2 residents (Residents #8 and #74) of 4 residents reviewed for MDS assessments transmission.

Inspectors wroteBased on facility policy review, Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual review, medical record review, and interview, the facility failed to ensure a MDS assessment was accurate for 1 resident (Resident #67) of 17 residents reviewed for MDS assessments.

Inspectors wroteBased on facility policy review, medical record review, and interview, the facility failed to revise the comprehensive care plan for 2 resident (Residents #79 and #67) of 17 residents reviewed for care plans.

Inspectors wroteBased on facility policy review, record review, and interview, the facility failed to ensure wound care treatments were administered per physician's orders for 1 resident (Resident #1) of 2 residents reviewed with wound care treatment ordered. Review of the facility policy titled, Physician Orders, dated 1/31/2025, revealed .It is the standard of this facility that physician orders are followed .Licensed Nurses are expected to follow physician's orders .Review of the medical record revealed Resident #1 was admitted to the facility on [DATE] with diagnoses including Diabetes and Pressure Ulcer of Sacral Region, Stage 4. [...]

Inspectors wroteBased on facility policy review, observation, and interview, the facility failed to ensure garbage and refuse were properly contained in 1 of 4 dumpsters (dumpsters #1) and the outside dumpster area was not maintained in a sanitary condition.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility staff failed to perform appropriate hand hygiene when serving residents' meal trays for 4 residents (Residents #67, #23, #68, and #32) on 1 of 4 units observed for meal tray distribution, and failed to ensure appropriate Personal Protective Equipment (PPE) was donned for 1 resident (Resident #38) of 3 residents observed for Enhanced Barrier Precautions (EBP), and failed to ensure appropriate PPE was donned for 1 resident (Resident #1) of 1 resident observed for Transmission Based Precautions (TBP).

Inspectors wroteBased on facility policy review, medical record review, facility investigation review, and interviews, the facility failed to protect the residents' right to be free from physical abuse by another resident for 2 residents (Resident #6 and Resident #74) of 26 residents reviewed for abuse. The facility's failure to prevent resident to resident altercations resulted in actual harm for Resident #6. On 6/27/2024, Resident #283 struck Resident #6 with a water pitcher causing a laceration and bruising to the left eye on 12/15/2023 and Resident #74 when Resident #31 struck resident #74 with a walker causing a small cut to Resident #74's right earlobe and a skin tear to the resident's left hand, which resulted in actual HARM to Residents #6 and #74.

Inspectors wroteBased on facility policy review, observation and interviews, the facility failed to post accurate daily staffing information for 7 days of 1 of 1 days observed for staff posting.

Inspectors wroteBased on facility policy review, observations, and interviews the facility failed to maintain kitchen equipment in a sanitary condition and failed to discard expired food which had the potential to affect 71 of 71 residents.

Inspectors wroteBased on medical record review, observations, and interviews, the facility failed to ensure the call light was within reach and to provide an adaptive call device to meet the need of 1 resident (Resident #41) of 71 residents reviewed for call light accessibility.

Inspectors wroteBased on facility policy review, medical record review, observations, and interviews, the facility failed to provide a clean and homelike environment in 3 of 4 shower rooms and 2 residents' rooms (Residents #3 and #74) of 71 residents reviewed for a homelike environment.

Inspectors wroteBased on facility policy review, medical record review, and interview, the facility failed to develop a comprehensive person-centered care plan related to Post Traumatic Stress Disorder (PTSD) for 2 residents (Resident #61 and Resident #78) of 4 residents reviewed for PTSD.

Inspectors wroteBased on medical record review, observation, and interviews, the facility failed to follow a physician's order for 1 resident (Residents #74) of 6 residents reviewed for weight loss.

Inspectors wroteBased on facility policy review, medical record review, observations, and interviews, the facility failed to post signage at the facility entrance to alert visitors of the current confirmed SARS-Co-V-2 (Covid-19) outbreak after Resident #17 tested positive for Covid-19 on 7/29/2024 which had the potential to affect 71 of 71 residents.

Inspectors wroteBased on facility policy review, medical record review, observations and interviews, the facility failed to ensure a resident's medications were secured for 1 resident (Resident #3) of 75 residents observed during the initial tour of the facility.

Inspectors wroteBased on review of the facility's nursing staff schedules, time clock punches, and interviews, the facility failed to provide the services of a Registered Nurse (RN) for the minimum requirement of 8 hours a day on 8 days ( 7/4/2021, and 7/18/2021-8/3/2021) of 17 days reviewed.