The Blossoms at Nashville Rehab and Nursing Center

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on observations, record review, interview and facility policy review, the facility failed to ensure staff followed Enhanced Barrier Precautions (EBP) and wore appropriate Personal Protective Equipment (PPE) to prevent the potential for cross contamination when administrating medications through a feeding tube for one (Resident #5) of three residents observed for medication administration.

Inspectors wroteBased on record review, interviews, and facility policy review, it was determined that the facility failed to develop, implement, and update a comprehensive person-centered care plan for three (Resident #1, #2, and #4) of four residents whose care plans were reviewed.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure room deodorizer spray, disinfectant wipes, and medications were not stored at the bedside of an empty room to prevent diversion, accidents and injuries. The facility failed to ensure medications were not stored in reach of residents, on the counter of the nursing station, to prevent accidents or injuries of 2 sampled (Residents 4, and Resident #15) residents sitting near the nurse ' s station.

Inspectors wroteBased on observation and interview, the facility failed 1) to ensure food items were labeled with an accurate use by date to ensure food was not used beyond its safety period, 2) to ensure food was stored in accordance with professional standards of food service safety.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure appropriate hand hygiene was performed during peri-care to reduce the risk of cross contamination and infection for 1 sampled (Resident #15) resident of 2 residents reviewed for bowel and bladder. The facility failed to ensure an effective infection control program was implemented to prevent the potential spread of infections. Specifically, the facility failed to ensure proper signage was posted on residents' doors to indicate which personal protective equipment (PPE) should be in utilized in the rooms of 1 (Residents #26) of 2 residents reviewed for precautions.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure a resident was not served carrots from a resident ' s dislike list to prevent weight loss and ensure proper nutrition for 1 (Resident #16) resident of 1 sampled resident reviewed for choices.

Inspectors wroteBased on observation, record review, interview, and facility policy review, it was determined the facility failed to ensure that resident ' s personal information was protected according to policy to prevent others from having access and provide a dignified existence for 1 (Resident #4) resident of 1 sampled (Resident #4) resident reviewed for privacy.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure controlled narcotics were properly stored in the medication room refrigerator, in the locked narcotic box separate from other medications to prevent misappropriation of resident owned medications.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, the facility failed to ensure a resident who required extensive assistance with personal hygiene was regularly offered trimming of their nails to maintain good grooming and hygiene for 2 (Residents #1 and #2) of 3 sampled residents reviewed for activities of daily living (ADLs).

Inspectors wroteBased on observation and interview the facility failed to ensure personal drinks were not stored with resident food, and the facility failed to ensure staff distributed and served food in a safe and sanitary manner. This failed practice had the potential to affect 10 sampled (Residents #14, #27, #28, #30, #31, #98, #99, #148, #149, and #150) that eat food from the kitchen.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality for the following sampled Residents (#1, #9, and #30).

Inspectors wroteBased on observations, interviews and record reviews, that facility failed to ensure that keys to the medication room and treatment cart were secure this had the potential to all resident who wonder, ambulate, or self-propel the following are sampled (Resident #1, #14, #27, #28, #30, #45, #150, and #200). The facility also failed to ensure that Resident #99 received the adequate assistance devices to aide with transfers this failed practice had to potential to cause accidents/injury to 6 sampled Residents (#1, #14, #31, #45, #99, and #150).

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure Residents had sufficient water at the bedside to maintain hydration and health. This failed practice affected 2 Resident (Resident #14 & #31) of 6 sampled residents (#14, #28, #31, #148, #149 & #150).

Inspectors wroteBased on observation interview and record review the facility failed to ensure tube feedings were turned off when Residents were laid flat for personal care to prevent the risk for aspiration for 2 (Residents #11, and #12) with the potential to affect 2 (Residents #11, and #12) that receive enteral feeding.

Inspectors wroteBased on observations, interviews and record review, the facility failed ensure that medication cart and medication room was free from expired medication, and that refrigerator used to store narcotic had separately permanently affixed locked compartment. The Facility failed to ensure that Resident #9 received a full dose of ordered medication and that medication was not left at the bedside.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure peri care supplies were transported to resident rooms in a manner to prevent cross contamination for 8 sampled (Residents #1, #9, #11, #12, #30, #45, #98, and #99) receiving peri care on 200 hall, and with the potential to affect 25 residents on 200 hall requiring peri care. The facility failed to implement and plan a text and flow diagram of the facilities water, and the facility failed to use hand sanitizer between resident ' s care to prevent the spread of infection. This failed practice had the potential to affect all 54 residents.

Inspectors wroteBased on record review and interview, the facility failed to implement a procedure in place to monitor activities of daily living [ADL] decline in Residents to accurately record resident assessment. This failed practice had the potential to affect all 54 Residents residing in the facility.

Inspectors wroteBased on observations, interviews and record reviews the facility failed to provide Resident #9 with adequate incontinence/catheter care this failed practice had the potential to cause infection/irritation for 4 sampled Residents (#9, #11, #12, and #45).

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure resident was receiving oxygen at the flow rate ordered by the physician, nebulizer and oxygen tubing was changed as ordered for 1 (Resident #27) of 5 sampled (Residents #1, #9, #11, #27, and #45) on 200 hall, and failed to ensure humidifier bottle was changed as ordered for 1 (Resident #148) of 3 sampled (Residents #28, #31, and #148) residing on 300 hall.

Inspectors wroteBased on observation and interview, the facility failed to ensure trash was properly contained within the trash can in the kitchen to minimize the presence of foul odors and decrease the potential for pest infestation.