Smoky Ridge Health and Rehabilitation

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) assessment in the areas of falls, medications received, and hospice for 4 of 21 residents reviewed for accuracy of MDS assessments (Resident #12, #7, #9 and #10).

Inspectors wroteBased on record review and staff interviews, the facility failed to submit a request for a Level II Preadmission Screening and Resident Review (PASRR) reevaluation after a significant change in physical or mental status was identified for a resident previously determined to have a Level II PASRR. This deficient practice affected 1 of 2 sampled residents reviewed for PASRR (Resident #90).

Inspectors wroteBased on record review and staff interviews the facility failed to maintain accurate advance directive information throughout the electronic and paper medical records for 1 of 3 residents reviewed for advance directive (Resident #73).

Inspectors wroteBased on record review, observations, and interviews with staff, the facility failed to protect a resident's right to be free from misappropriation of a controlled narcotic pain medication for 1 of 10 residents reviewed for abuse (Resident #93).

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code Minimum Data Set (MDS) assessments in the areas of pressure ulcer care (Resident #96), fall (Resident #35), and discharge (Resident #84) for 3 of 20 residents reviewed for MDS accuracy. 1. Resident #96 was admitted to the facility 05/28/24 with a diagnosis including rhabdomyolysis (breakdown of muscle tissue). Review of Resident #96's physician orders dated 05/30/24 included to apply betadine three times a day to bilateral (both sides) knee unstageable wounds, left forearm unstageable wound, right cheek unstageable wound, right thigh unstageable wound, and unstageable wound to right heel. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure a Preadmission Screening and Resident Review (PASRR) level II was completed after a new mental health diagnosis for 1 of 3 residents (Resident #77) reviewed for PASRR.

Inspectors wroteBased on record review and staff interviews, the facility failed to request a Preadmission Screening and Resident Review (PASRR) re-evaluation after a significant change in physical or mental status for 1 of 3 sampled residents reviewed for PASRR (Resident #7).

Inspectors wroteBased on record review and resident, Family Member, and staff interviews, the facility failed to protect the resident's right to be free from employee to resident abuse for 1 of 3 residents reviewed for abuse (Resident #1). Nurse #1 reported that Resident #1 hit Nurse Aide (NA) #1 in the face while she was providing care to him. Nurse #1 observed NA #1 grab Resident #1's arm and push it towards his stomach and hold it there while leaning in Resident #1 face and saying, don't you ever hit me again, do you understand?. Three days after the incident Resident #1 was observed to have a small round circular bruise on top of his right forearm and a faded circular bruise on the side of his right forearm. A reasonable person would expect to be free from abuse in their own home and could experience anger, fear, anxiety, and depressed mood.

Inspectors wroteBased on observations and staff interviews the facility failed to maintain clean ceiling vents located in the dry storage room and in the kitchen, failed to maintain a clean walk-in refrigerator and remove food with signs of spoilage from the walk-in refrigerator. Additionally, the facility failed to clean and maintain 3 of 3 ice makers, and clean and maintain ice cooler scoops and holders (the kitchen ice maker, North and South nourishment room ice makers). This practice had the potential to affect food and beverages served to residents.

Inspectors wroteBased on observations, record review, and interviews the facility's Quality Assessment and Assurance (QAA) committee failed to maintain implemented procedures and monitor interventions previously put in place following a COVID-19 focused survey that occurred 12/04/20. This failure was for one deficiency that was originally cited in the area of Infection Control (F-880) and was subsequently recited on the current recertification and complaint investigation survey of 12/01/23. The continued failure during two federal surveys of record showed a pattern of the facility's inability to sustain an effective quality assurance program.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to assess the facility's water system to identify where Legionella and other waterborne pathogens could grow and spread which had the potential to affect 92 of 92 residents. The facility also failed to ensure staff implemented their infection control policies and procedures when Nurse #1 did not place a barrier between the wound care supplies and an overbed table that had crumbs and dried debris on the surface and did not change her gloves after removing a wound dressing and before cleaning the wound for 1 of 1 sampled resident (Resident #54).

Inspectors wrote4. a. An observation of room [ROOM NUMBER] on 11/27/23 at 11:50 AM revealed multiple scrapes with exposed dry wall behind the resident's bed. On wall behind the residents over bed table contained 4 to 5 quarter sized dried red/brown spots on the wall. Subsequent observations made on 11/28/23 at 9:30 AM and 11/30/23 at 2:15 PM revealed the room unchanged. b. On 11/27/23 at 12:12 PM an observation of the dining room entrance doors revealed the bottom corner of both doors contained a broken door covering that was sticking out from the door. The Door covering was jagged to touch and contained sharp edges and was at foot and ankle level. Subsequent observations made on 11/29/23 at 8:39 AM and 11/30/23 at 2:15 PM revealed the door to be unchanged. c. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to refer residents who were admitted with mental health disorders for a Level II Preadmission Screening and Resident Review (PASRR) evaluation and determination of specialized services for 3 of 3 residents reviewed for PASRR (Residents #14, #43 and #1).

Inspectors wroteBased on record review, staff and medical director interviews the facility failed to monitor a resident's blood sugar for a resident with insulin-dependent diabetes for 1 of 5 residents reviewed for unnecessary medication (Resident # 69).

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure physician progress notes were documented and completed as required for each physician visit for 2 of 2 sampled residents (Residents #14 and #84).

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to store a 30 dose bubble pack of Metformin (an hyperglycemic medication) in the medication cart for 1 of 4 carts observed during medication pass. The facility failed to dispose of an expired medication, an unopened bottle of expired medication, Ferrex (an iron supplement), which was discovered in the 100/200 hall medication room for 1 of 2 medication rooms reviewed. The facility also failed to secure medicated creams, powder and sprays that were in clear view at the bedside for 1 of 1 sampled resident (Resident #14).

Inspectors wroteBased on observation, record review, resident and staff interviews the facility failed to provide an alternative meal choice when requested for 1 of 3 residents reviewed for accommodating resident allergies, intolerances, and preferences (Resident #14). Additionally, the facility failed to provide a nutrional supplement as ordered by a physcian for 1 of 3 residents (Resident #37) . This practice had the potential to impact other residents.

Inspectors wroteBased on observations, and staff interviews the facility failed to protect private resident health information by leaving confidential medical information unattended in an area accessible to the public on 1 of 4 medication carts (400 hall medication cart).

Inspectors wrote2. Resident #8 was admitted to the facility on [DATE] with diagnoses including hypertension. Review of the Smoking Safety Screen dated 01/24/23 for Resident #8 revealed he was able to verbalize he understood the smoking policy and indicated Resident #8 required supervision with smoking. The admission MDS assessment dated [DATE] indicated Resident #8 did not use tobacco. During an interview on 12/01/23 at 11:33 AM the MDS Coordinator stated Resident #8 used tobacco during the lookback period of the admission MDS assessment dated [DATE]. The MDS Coordinator confirmed the assessment was incorrectly coded no for tobacco use and she would make a modification to indicate Resident #8 used tobacco. An interview was conducted on 12/01/23 at 12:41 PM with the Administrator and DON. The Administrator stated the MDS should be correctly coded and reflect Resident #8 used tobacco. 3. [...]

Inspectors wroteBased on record review and staff interviews the facility failed to develop a person-centered comprehensive care plan for 2 of 21 (Resident #241 and Resident #62) residents reviewed for comprehensive care plans.

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to ensure a resident did not receive a straw for 1 of 7 residents (Resident #54) reviewed for accidents. This failure placed Resident #54 at risk for choking/aspiration (inhaling food or fluids into the lungs).

Inspectors wroteBased on observations, staff interviews, and a test tray, the facility failed to provide warm and palatable food for regular and mechanical soft diets for 1 of 1 resident reviewed for food palatability(Resident #84).