Smyrna Care Center

Inspectors wroteBased on facility policy review, MedicineNet.com article titled, Normal Blood Sugar Levels in Adults with Diabetes, American Diabetic Association (ADA) factsheet Understanding A1C Test (Glycated Hemoglobin-Blood test that measures average blood glucose levels over the past 2 to 3 months) review, medical record review, and interview, the facility failed to ensure the provider was contacted following Blood Glucose (BG) readings that fell outside of the parameters for notification for 5 of 7 (Resident #1, #2, #3, #6 and #7) sampled residents reviewed for medication administration. The facility's failure to ensure staff followed the facility policy and physician's orders to notify the physician of BG levels that fell outside of the listed parameters placed Resident #1 at the likelihood of developing adverse effects and complications related to uncontrolled blood glucose levels. [...]

Inspectors wroteBased on facility documentation review and interview the facility failed to post complete daily staffing sheets of nursing hours for 18 months.

Inspectors wroteBased on facility policy review, medical record review, observation and interview, the facility failed to post signage for 1 of 1 resident (Resident #85) on contact isolation. The facility failed to transport and store laundry in a safe and sanitary manner to 1 of 3 clean linen storage rooms. The facility failed to apply proper PPE (Personal Protective Equipment) before entering 1 of 1 contact isolation room.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to treat 1 of 5 residents (Resident #391) who required an indwelling urinary catheter with dignity related to not covering the resident's indwelling urinary catheter drainage bag with a privacy cover, and failed to treat 4 of 17 residents with dignity who were referred to as feeders during the breakfast tray pass on 2/25/2020.

Inspectors wroteBased on facility documentation review, medical record review, observation, and interview the facility failed to have a call light in reach for 1 of 41 residents (Resident #27) reviewed for call light placement.

Inspectors wroteBased on facility policy review, facility documentation review, medical record review, and interview, the facility failed to prevent abuse for 1 of 2 residents (Resident #42) involved in a resident to resident altercation.

Inspectors wroteBased on medical record review and interview, the facility failed to capture Hospice Services on the Quarterly Minimum Data Set (MDS) assessment for 1 of 4 residents (Resident #19) who received hospice services.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to ensure 1 of 41 residents (Resident #31) had clean and groomed fingernails.

Inspectors wroteBased on medical record review and interview the facility failed to implement physician's orders for 1 of 41 residents (Resident #88) reviewed for physician orders.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to label and date oxygen tubing and store nebulizer tubing in a safe and sanitary manner for 2 of 18 residents (Residents #27 and #390) receiving respiratory treatments.

Inspectors wroteBased on observation and interview, the facility failed to sanitize a thermometer while obtaining food temperatures in 1 of 5 observations of the dietary department.

Inspectors wroteBased on medical record review, observation and interview, the facility failed to serve food in a safe and sanitary manner for 1 (#56) of 14 residents during the noon meal on 3/4/19; the facility dietary department failed to label and date leftovers stored in the walk-in refrigerator, and failed to dispose of expired food items stored in the walk-in refrigerator in 1 of 5 observations of the dietary department.

Inspectors wroteBased on facility policy review, medical record review, observation and interview, the facility failed to store medications and biologicals in accordance with currently accepted professional standards of Practice for 1 resident (#62) of 85 residents observed and in 5 of 7 medication storage areas.

Inspectors wroteBased on medical record review, observation and interview, the facility failed to provide 1 (#16) of 5 residents with dignity during the noon meal on 3/4/19 related to Certified Nurse Aide (CNA) standing while assisting Resident #16 with the meal.

Inspectors wroteBased on medical record review and interview, the facility failed to perform a level 2 Preadmission Screening and Resident Review (PASARR) for 1 resident (#27) of 11 residents receiving antipsychotics.

Inspectors wroteBased on facility policy review, facility's performance skill checklist oxygen delivery form review, medical record review, observation and interview, the facility failed to properly store oxygen tubing, nebulizer mask and tubing for 1 resident (#62) of 14 residents reviewed receiving respiratory treatments.

Inspectors wroteBased on Pharmacy contract review, observation and interview, the pharmacy services failed to ensure medications and biologicals were stored and labeled according to current professional standards of practice for 3 of 5 medication carts.

Inspectors wroteThis REQUIREMENT is not met as evidenced by: Based on medical record review and interview, the facility failed to notify the Physician when Resident #68 incurred substantial injury related to a fall, had a decline in status, and needed treatment alterations regarding a Thoracic Lumbar Spinal Orthopedic (TLSO) brace. Failure for the facility to notify the Physician on 11/1/17 resulted in Resident #68 developing an axillae pressure ulcer while experiencing pain from the TLSO brace (HARM).

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to provide skin assessments for Resident (#68). Resulting in development of skin pressure ulceration to the right axilla and arm resulting in (HARM). Medical record review revealed Resident #68 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Dementia without Behavioral Disturbance, Dysphagia, Essential Hypertension, Major Depressive Disorder, Type 1 Diabetes, Fracture of Unspecified Thoracic Vertebra, and Fracture of Unspecified Lumbar Vertebra. Medical record review of the Care Plan dated 6/12/17, revealed the problem of .altered integument [skin] .fragile and poorly perfused skin . with approaches including .weekly skin assessment to be performed/documented by nursing . [...]

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to provide timely treatment after a fall for 1 resident (#2), a fall resulting in Thoracic and Lumbar fractures for 1 resident (#68) and failed to utilize interventions to achieve maximum function of a hemiplegic limb for 1 resident (#74) of 16 residents reviewed. The facility's failure to prevent falls resulted in HARM for Resident #2 and #68.

Inspectors wroteBased on facility policy review, medical record review, and interview, the facility failed to prevent a pressure ulcer for 1 resident (#68) of 7 residents reviewed. The facility's failure to prevent a pressure ulcer for Resident #68 resulted in HARM.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to update the Care Plan with interventions for Resident #68 after first fall on 8/6/17, which resulted in a second fall on 10/31/17 with multiple fractures. The failure to develop interventions to prevent falls for Resident #68 resulted in HARM from a fall. Medical record review revealed Resident #68 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Dementia without Behavioral Disturbance, Dysphagia, Essential Hypertension, Major Depressive Disorder, Type 1 Diabetes, Fracture of Unspecified Thoracic Vertebra, and Fracture of Unspecified Lumbar Vertebra. Medical review of the Minimum Data Set, dated [DATE] revealed Resident #68 had a Brief Interview for Mental Status (BIMS) score of 0, indicating severe cognitive impairment. [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain dietary equipment in a clean and sanitary manner in 1 of 3 kitchen observations affecting 92 of 93 residents.

Inspectors wroteBased on facility policy review, observation, and interview, the facility failed to ensure call lights were within reach for 10 residents (#3, #27, #35, #37, #43, #44, #65, #68, #71, #80) of 93 residents reviewed.

Inspectors wroteBased on medical record review and interview, the facility failed to revise the care plan for 2 residents (#45, #68) of 19 residents reviewed for care plans.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to utilize devices to improve range of motion for 1 resident (#74) of 16 residents reviewed.

Inspectors wroteBased on observation and interview, the facility failed to post the current staffing for 1 of 3 days.

Inspectors wroteBased on medical record review and interview, the facility failed to complete behavior monitoring for 1 resident (#81) of 5 residents reviewed for psychotropic medications.

Inspectors wroteBased on facility policy review, observation, and interview the facility failed to lock 1 of 5 medication carts.

Inspectors wroteBased on facility policy, observation, and interview, the facility failed to ensure call lights were functioning properly in 7 of 55 resident rooms and in 6 of 55 resident bathrooms on 2 of 5 halls.