The Carrolton of Williamston

Inspectors wroteBased on record review, and interviews with resident, staff, the facility's contracted x-ray staff members, Physician, Physician Assistant (PA), and family member, for a resident who suffered from chronic pain the facility 1) failed to ensure the physician was notified when the resident's pain changed in conjunction with the resident reporting trauma to her leg 2) failed to contact the physician prior to entering orders for additional x-rays recommended by an x-ray technician and 3) failed to communicate with the physician when all ordered x-ray views could not be completed due to the resident's pain. This was for one (Resident # 1) of three residents reviewed for notification to physician.

Inspectors wroteBased on record review, and interviews with resident, staff, the facility's contracted x-ray staff members, Physician, Physician Assistant (PA), and family member, for a resident who suffered from chronic pain the facility 1) failed to ensure staff communicated effectively amongst themselves and with the provider about a difference in the resident's pain and alleged trauma the resident reported to some staff members and 2) failed to recognize when the resident's x-ray report returned negative that all views had not been completed as ordered which therefore made the x-ray limited in identifying problems. This was for one (Resident # 1) of three residents reviewed for professional standards of practice.

Inspectors wroteBased on observation, record review, and interviews with resident, staff, the facility's contracted x-ray staff members, Physician, Physician Assistant, and family member, for a resident who had not made sufficient progress in therapy to stand and pivot or use a sliding board, the facility failed to ensure she was transferred by staff by a mechanical lift as outlined in the resident's care plan. This was for one (Resident # 1) of three residents reviewed for accidents.

Inspectors wroteBased on record review and interviews with resident and staff the facility failed to ensure the accurate documentation and administration of a controlled medication in sufficient detail to enable an accurate reconciliation. This was for one (Resident # 4) of three sampled residents whose controlled drug records were reviewed.

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code a Minimum Data Set Assessment (MDS) for dialysis services for 1 of 5 residents reviewed for accuracy of assessments (Resident #2).

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure a resident receiving dialysis had a physician's order for dialysis for 1 of 1 resident reviewed for dialysis (Resident #2).

Inspectors wroteBased on record review, observations, resident interview and staff interviews, the facility failed to place a resident's call light device within reach to allow for the resident to request assistance as needed for 1 of 2 residents reviewed for accommodation of needs (Resident #90).

Inspectors wroteBased on record review and staff interviews, the facility failed to provide a Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notice (SNF-ABN) form 10555 prior to discharge from Medicare Part A skilled services for 2 of 3 residents reviewed for beneficiary protection notification review (Resident #38 and Resident #54).

Inspectors wroteBased on record review, observations, resident interview and staff interviews, the facility failed to provide maintenance services to a resident room that was observed with damaged sheetrock on the wall to the left side of the bed, a dresser with visible damage and a broken track for the bottom drawer and a bathroom cabinet with doors that did not latch and the pressboard in the bottom of the cabinet was observed sunken inward and covered with a dirty white thin board with dry white paper towel lying flat to the surface observed in the right back corner with dry black material covering over half of the paper towel for 1 of 1 resident reviewed for homelike environment on 1 of 6 halls in the facility (Resident #92).

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) assessment in the area of behaviors for 1 of 26 residents whose MDS assessments were reviewed (Resident #167).

Inspectors wroteBased on manufacturer directions, observations and staff interviews, the facility failed to remove 3 multi-dose insulin injector pens that were expired in 2 of 5 medication carts ([NAME] medication cart and Split medication cart), remove expired medication in 1 of 5 medication carts (Split medication cart), and remove 1 opened and expired vial of Pneumococcal vaccine in 1 of 1 medication storage room refrigerator reviewed for medication storage and labeling.

Inspectors wroteBased on record review, observation, and staff interview the facility failed to follow their infection control policy and procedures for enhanced barrier precautions for one (Nurse #5) of three nursing staff members observed for infection control procedures.

Inspectors wroteBased on record review and staff interview the facility failed to treat a resident in a dignified manner for one (Resident #4) of three residents reviewed for dignity.

Inspectors wroteBased on record review, staff interviews, and wound care physician interview the facility failed to accurately document a resident's admission skin assessment, initiate treatment for a pressure ulcer, complete a weekly assessment, and administer treatments as ordered according to the care plan for one (Resident #6) of three residents reviewed for pressure sore care.

Inspectors wroteBased on observations, record review, resident interview, staff interviews and a Physician interview, the facility failed to provide sufficient nursing staff to ensure a resident was administered morning scheduled medications in the allotted time frame for 1 of 1 resident reviewed for significant medications (Resident #211). Resident #211 not receiving her scheduled morning medications in the allotted time frame caused Resident #211 to remain in bed for fear of falling due to feeling dizzy.

Inspectors wroteBased on record review, observation, resident interview, staff interviews and a Physician interview, the facility failed to administer significant medications of a resident's medication regimen in the scheduled time frame that caused the resident to remain in bed for fear of falling due to feeling dizzy for 1 of 1 resident reviewed for administration of significant medications (Resident #211).

Inspectors wroteBased on record reviews and staff interviews, the facility failed to have a Registered Nurse (RN) for at least eight consecutive hours a day, 7 days a week, to designate a director of nursing (DON) who worked on a full-time basis, and to have the DON only serve as a charge nurse when the average daily census was 60 residents or less for 23 of 39 days reviewed for staffing.

Inspectors wroteBased on record review, North Carolina Board of Nursing Registry, observations, resident interviews, staff interviews and a Physician interview, the facility failed to provide effective leadership and oversight to ensure the Director of Nursing (DON) implemented her responsiblities in these areas: sufficiently staffing the facility to administer medications in a timely manner, having a registered nurse work eight consecutive hours daily and a DON who worked full time and only serves as a charge nurse when census was less than 60 residents, monitoring and tracking expiration of nursing licenses (Nurse #3) and nurse aide certifications (NA #9, NA # 4, NA #1, and NA #8), completing yearly performance evaluations for nurse aides (NA #4, NA #7, NA #6 and NA #5) and providing and monitoring 12 hours of annual training for nurse aides ( NA #4, NA #7, NA #6 and NA #5). [...]

Inspectors wroteBased on observation and staff interviews, the facility failed to ensure bathrooms (room [ROOM NUMBER], #60, #61, #65, #67/69, #70) on the locked unit were free of fecal matter or black/brown matter on various surfaces for 6 of 10 bathrooms reviewed for clean and homelike living environment.

Inspectors wroteBased on record review, observations, staff interviews and interviews with Wound Care Physician Assistant (PA), the facility failed to (1) perform wound care to a pressure ulcer per physician's order (Resident #19), (2) set the alternating pressure air mattress at the correct setting based on the resident's weight (Resident #104), and (3) change the treatment for a pressure ulcer when ordered by the Wound Care PA (Resident #77) for 3 of 4 residents reviewed for pressure ulcers.

Inspectors wroteBased on observations, record review and staff and physician interviews, the facility failed to obtain post dialysis vital signs, record post dialysis weights, and maintain ongoing communication with the dialysis facility for 1 of 1 resident reviewed for dialysis (Resident #58).

Inspectors wroteBased on observation, record review and staff interviews, the facility failed to monitor the North Carolina (NC) Nurse Aide (NA) Registry to ensure 5 of 47 nurse aides employed at the facility remained listed on the NC Nurse Aide Registry with an active Nurse Aide I certification (NA #6, NA #9, NA #4, NA #1,and NA #8).

Inspectors wroteBased on staff interviews and record reviews, the facility failed to complete a performance review every 12 months for 4 of 5 nursing assistants (NAs) reviewed to ensure in-service education was designed to address the outcome of the performance reviews (NA #4, NA #7, NA #6, and NA #5).

Inspectors wroteBased on a lunch meal tray line observation, staff interviews and record review the facility failed to provide a pureed food item with a smooth consistency. This failure had the potential to affect 9 of 105 residents with diet orders for a pureed diet texture.

Inspectors wroteBased on observations, record review, North Carolina Board of Nursing (NCBON) verification registry and staff interviews, the facility failed to ensure Nurse #3, who was observed providing resident care at the facility, maintained a current and active professional nursing licenses with the NCBON for 1 of 12 nurses reviewed.

Inspectors wroteBased on observation, resident interview, Wound Care Physician Assistant interview, staff interviews and record review, the facility's Quality Assessment and Assurance (QAA) Committee failed to maintain implemented procedures and monitor interventions put into place by the Committee following the recertification and complaint investigation surveys of 6/10/21 and 11/18/22 and the complaint investigation surveys of 2/27/23 and 9/7/23. This was for 6 deficiencies that were recited on the current recertification and complaint investigation survey of 3/13/24 in the areas of Resident Rights (F550), Environment (F584),Treatment and Services for Pressure Sores (F686), Supervision to Prevent Accidents (F689), Medication Storage (F761), and Complete/Accurate Medical Records (F842). [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure at least 12 hours of annual training to include dementia and areas of weakness as determined in the nursing aides' performance reviews were completed for 4 Nursing Assistants (NA #4, NA #7, NA #6, and NA #5) of 5 reviewed for staffing.

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure staff communicated to a resident in a respectful and dignified manner for 1 of 2 resident reviewed for dignity (Resident #93). The reasonable person concept was applied to this deficiency as individuals have the expectation to be addressed by staff using language and tone that portrays respect and dignity.

Inspectors wroteBased on record review, resident interview, and staff interviews, the facility failed to implement effective interventions to prevent a severely cognitively impaired resident (Resident #46) from hitting another resident (Resident #31) in the face two days after he initially exhibited physically aggressive behaviors directed toward another resident (Resident #55). Resident #31 sustained a scratch to the face as a result of the incident. This was for 1 of 4 residents reviewed for accidents (Resident #46).

Inspectors wroteBased on observations and staff interviews, the facility failed secure the keys for a medication cart when Medication Aide #7 left the medication cart keys for the skilled-hall medication cart in Resident #211's room. This deficient practice was for 1 of 5 medication carts in the facility.

Inspectors wroteBased on record review, observation and staff interviews, the facility failed to complete an accurate medical record related to documentation of the treatment for pressure ulcers for 1 of 4 residents reviewed for pressure ulcers (Resident #19).

Inspectors wroteBased on record review and staff interviews, the facility failed to display accurate daily nursing staffing information, the resident census on each shift, and/or maintain the daily nurse staff posting on file for 39 out of 39 days from February 2024 and March 2024 reviewed for staffing.

Inspectors wroteBased on record review and staff interview the facility failed to complete quarterly Minimum Data Set (MDS) assessments within the 14-day required timeframe for 3 of 41 residents reviewed for quarterly Minimum Data Set (MDS) assessments (Resident #29, Resident #16, and Resident #75).

Inspectors wroteBased on record review and interviews, the facility failed to maintain accurate documentation on the Treatment Administration Record (TAR) for physician ordered wound treatments for 3 of 3 residents (Resident #1, Resident #2, Resident #3) reviewed for wound care.

Inspectors wroteBased on interviews with the Resident Council members and facility staff, the facility failed to post information and contact information about the State Survey Agency and the local ombudsman program. This occurred for 6 of 6 cognitively intact residents who regularly attended the Resident Council meetings (Residents #35, 55, 22, 41, 390, and 25).

Inspectors wroteBased on observations, record review, and interviews with staff and residents, the facility failed to ensure residents who had perishable food items brought into the facility had a location to store their food. This deficient practice affected 5 members of the Resident Council (Residents #22, #25, #35, #41, #55) and 1 of 3 residents reviewed for choices (Resident #56).

Inspectors wroteBased on observation, staff interviews, and record review the facility failed to provide residents with access to the use of a telephone in a place where calls could be made without being overheard for 1 of 3 residents reviewed for privacy. (Resident #2).

Inspectors wroteBased on observation and staff interviews the facility failed to maintain resident walls and lighting fixtures in good repair. This occurred on 3 of 4 halls ([NAME], Skilled and Sparks halls) reviewed for environment.

Inspectors wroteBased on record review, observation, staff and Physician interview, the facility failed to initiate new treatment orders for pressure ulcer treatment and perform pressure ulcer treatment as ordered by the Physician for 1 of 4 resident (Resident #25) reviewed for pressure ulcers.

Inspectors wroteBased on observation, record review, staff and Physician interviews, the facility failed to follow infection control practices when 4 of 4 staff members (Medication Aide #2, Medication Aide #4, Treatment Nurse, and Housekeeper #2) failed to perform hand hygiene between tasks and don a gown when entering a resident's room (Resident #79) who was on contact precautions.

Inspectors wroteBased on record review, observations, and staff interviews, the facility failed to maintain an effective pest control program for 1 of 4 halls reviewed for pests ([NAME] Hall).

Inspectors wroteBased on observation, staff interviews, and record review the facility failed to treat residents in a dignified manner by scolding a resident after the resident overturned a mop bucket for 1 of 3 residents reviewed for dignity (Resident #71).

Inspectors wroteBased on record review, staff and resident interviews the facility failed to invite 1 of 1 resident (Resident #389) reviewed for care plan meetings.

Inspectors wroteBased on record review, observation, resident, staff and Physician interview the facility failed to assess 1 of 4 resident (Resident #45) to determine if self-administration of medication through a feeding tube was clinically appropriate.

Inspectors wroteBased on observations, record review and staff interviews the facility failed to revise the comprehensive care plan in the areas of pressure ulcers (Resident #67) and antianxiety medication (Resident #50). This was for 2 of 23 residents whose care plans were reviewed.

Inspectors wroteBased on observation, staff and resident interviews, and record review the facility failed to provide a hazard free environment by leaving an electrical outlet uncovered with exposed wires for 1 of 6 residents reviewed for accidents (Resident #4).

Inspectors wroteBased on observation and staff interviews the facility failed to keep medications locked while unattended for 1 of 1 treatment carts observed and failed to refrigerate insulin for 1 of 3 medications carts observed (Treatment Cart #1, Medication Cart #1).

Inspectors wroteBased on observations and staff interviews the facility failed to have a barrier between a nurse aide's (Nurse Aide #1) bare hands and ready to eat food for 1 of 4 dining observations. This practice had the potential to affect food served to a resident.

Inspectors wroteBased on observations, resident and staff interviews and record review, the facility's Quality Assurance (QA) process failed to implement, monitor, and revise as needed the action plan developed for the survey 11/22/19 and 6/10/21 in order to achieve and sustain compliance. This was for 5 recited deficiencies on a recertification survey on 11/18/22. The deficiencies were in the areas of dignity, the right to forms of communication in private, care plan timing and revision, storage of drugs and biologicals, and sanitary food service. The continued failure during these federal surveys of record showed a pattern of the facility's inability to sustain an effective QA program.

Inspectors wroteBased on record review and staff interviews the facility failed to provide a pneumococcal vaccine (a vaccine which can prevent a type of bacterial lung infection) in accordance with the signed informed consent. This was for 1 of 5 residents (Resident #80) reviewed for immunizations.

Inspectors wroteBased on interviews with the Resident Council members and facility staff, the facility failed to inform residents of the location of the state inspection results. This occurred for 6 of 6 cognitively intact residents who regularly attended the Resident Council meetings. (Residents #35, 55, 22, 41, 390, and 25).

Inspectors wroteBased on staff and resident interviews and record review the facility failed to provide access to resident funds during the weekend for 2 of 2 residents reviewed for personal funds. (Resident #4, Resident #12)