The Green House Cottages of Belle Meade

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure hands were washed between residents while serving dinner, and to ensure utensils were not used after contamination during meal preparation for one of one puree meal observed.

Inspectors wroteBased on interview and record review, the facility failed to ensure an as needed psychotropic medication was reviewed and updated every 14 days for one (Resident #137) of five residents reviewed.

Inspectors wroteBased on record reviews, observation, interviews, and facility policy review, the facility failed to ensure personal protective equipment (PPE) was disposed of before walking out of one (Resident #4) of one resident’s room that was on Enhanced Barrier Precautions (EBP).

Inspectors wroteBased on observations, record review, document review, and interviews, the facility failed to ensure staff followed a resident's care plan, as evidenced by Resident #1 sliding off the side of the bed while 1 staff assisted with dressing, despite the care plan indicating the need for 2 staff, for 1 (Resident # 1) sampled resident. The failed practice resulted in noncompliance at the level of immediate jeopardy (IJ), which caused major injury to Resident # 1, who was at high risk for falls. It was determined the facility's non-compliance with one or more requirements of participation had caused, or was likely to cause, serious injury, harm, impairment, or death to residents. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a meaningful program of activities for 5 (Residents #4, #10, #66, #80, and #120) sampled residents and failed to ensure the activity program was designed to meet the individual activity needs, interests, and abilities of each resident.

Inspectors wroteBased on observation and interview, the facility failed to ensure the nurse completed hand sanitation before and after giving a resident medication and before giving another resident medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who required assistance with personal hygiene was regularly offered to have fingernails cleaned to maintain good grooming and hygiene for 1 (Resident #47) sampled resident.

Inspectors wroteBased on observation and interview, the facility failed to ensure pureed food was smooth items were blended to a smooth, lump-free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meals observed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure food items stored in the refrigerator, freezer and dry storage areas, were sealed or covered and stored in accordance with the manufacturer's instructions; expired food items were promptly removed from stock; staff washed their hands between dirty and clean tasks and before handling clean dishes or food items; ice machines were maintained in clean and sanitary condition; and hot foods were maintained at or above 135 degrees Fahrenheit (F.) while awaiting service to prevent potential food borne illness for residents who received meals from 11 (Cottages #1, #2, #3, #4, #5, #6, #7, #8, #9, #10 and #11) of 11 kitchens. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Quality Assessment and Assurance (QAA) committee put forth good faith attempts to correct, monitor, and reassess its own quality deficiencies for proper respiratory care for residents who were on oxygen therapy.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Minimum Data Set (MDS) assessment accurately reflected an active diagnosis for 1 (Resident #27) of 10 (Residents #3, #11, #16 #27, #30, #57, #60, #69, #108 and #109) sampled residents who had Physician Orders for Insulin; 1 (Resident #59) of 12 (Residents #21, #27, #34, #37, #59, #66, #69, #70, #81, #95, #170 and #370) sampled residents who had Physician Orders for oxygen therapy and 1 (Resident #74) of 1 sampled resident who had Physician Orders for Hospice services. This failed practice had the potential to affect all 117 residents according to the Census and Conditions of Residents provided by the Administrator on 01/31/22 at 10:03 am.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure individualized comprehensive Care Plans were implemented to meet the resident's medical and nursing needs, to promote continuity of care for 2 (Residents #27 and #69) of 10 (Residents #3, #11, #16, #27, #30, #57, #60, #69, #108 and #109) sampled residents on Insulin and 1 (Resident #69) of 12 (Residents #21, #27, #34, #37, #59, #66, #69, #70, #81, #95, #170 and #370) sampled residents who had Physician Orders for oxygen (O2) therapy. This failed practice had the potential to affect all 117 residents according to the Census List provided by the Administrator on 01/30/23 at 10:15 am.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the doors to the laundry rooms in 6 (Cottages #2, #3, #4, #5, #9 and #11) cottages were locked to prevent the potential of an injury to residents/elders, failed to ensure electrical cords were safely secured out of water for 1 (Cottage #1) to prevent the potential of injury and/or fire and failed to ensure dryer lint traps were appropriately maintained in 6 (Cottages #2, #3, #4, #9, #10 and #11) of 11 (Cottages #1, 2, #3, #4, #5, #6, #7, #8, #9, #10 and #11) cottages to prevent the potential for a fire.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure oxygen (O2) was administered at the physician ordered flow rate for 4 (Residents #21, #34, #59 and #66); failed to obtain a Physicians Order for 2 (Resident #170 and #370) who received oxygen therapy; failed to ensure oxygen tubing was dated for 1 (Resident #170), and failed to ensure CPAP (Continuous Positive Airway Pressure) mask, updraft masks and nebulizer mouthpieces were properly stored when not in use to prevent the potential for cross contamination and respiratory infections for 3 (Residents #21, #37 and #370) of 13 (Residents #21, #27, #34, #37, #59, #66, #69, #70, #81, #95, #170, #370 and #371) sampled residents who received updrafts and/or oxygen therapy or used a CPAP machine as documented on a list provided by the Assistant Director of Nursing (ADON) on 02/03/23 at 8:32 AM.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure meals were prepared and served in accordance with the planned, written menu to meet the nutritional needs of the residents for 2 of 2 meals observed. This failed practice had the potential to affect 5 residents who received pureed diets, 22 residents who received mechanical soft diets, and 74 residents who received regular diets (total census:117), according to the Diet List provided by the Dietary Supervisor on 02/01/23.

Inspectors wroteBased on observation, record review, and interview, the facility to ensure food was prepared by methods that maintained the flavor and encouraged good nutritional intake for residents who received regular diets, mechanical soft diets, and pureed diets for 1 of 1 meal observed. This failed practice had the potential to affect 5 residents who received regular diets and 5 residents who required mechanical soft diets in Cottage #2 according to lists provided by the Dietary Supervisor on 02/01/23.

Inspectors wroteBased on observation, and interview, the facility failed to ensure pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 3 of 3 meals observed. The failed practice had the potential to affect 5 residents who received pureed diets in Cottage #1, #2, #5 and #6 as documented on a list provided by the Dietary Supervisor on 02/02/23 at 4:52 PM.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure standard infection control precautions were followed for 1 (Resident #60) of 10 (Residents #11, #27, #57, #60, #66, #69, #75, #95, #96 and #108) sampled residents who had Physician Orders for Accucheck Glucose Monitoring and failed to ensure transmission-based precautions were followed for 1 (Resident #78) of 1 sampled resident who was on contact and droplet precautions. This failed practice had the potential to affect all 117 residents according to the Census and Conditions of Residents provided by the Administrator on 01/31/22 at 10:03 AM.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure an individualized comprehensive Care Plan was implemented to meet the resident's medical and nursing needs and promote continuity of care for 1 (Resident #69) of 12 (Residents #21, #27, #34, #37, #59, #66, #69, #70, #81, #95, #170 and #370) sampled residents whose Care Plan was reviewed. This failed practice had the potential to affect all 117 residents who had Care Plans according to the Census list provided by the Administrator on 01/30/23 at 10:15 am.

Inspectors wroteBased on interview, and record review, the facility failed to ensure COVID-19 vaccinations were provided to eligible residents in a timely manner who consented to the immunization for 1 (Resident #67) and documented accurately in the immunization records consents and declinations for COVID-19 vaccinations for 1 (Resident #75) of 5 (Residents #14, #32, #67, #75 and #108) sampled residents whose COVID-19 immunizations were reviewed. This failed practice had the potential to affect all 117 residents who resided in the facility as documented on the Resident Matrix provided by the Minimum Data Set (MDS) Coordinator #2 on 01/30/23.

Inspectors wroteBased on interview, and record review, the facility failed to ensure all staff received complete primary COVID-19 vaccinations, had an approved or pending medical or religious exemption, or a temporary delay per the Center for Disease Control (CDC) per the Centers for Medicare and Medicaid Services (CMS) COVID-19 Health Care Staff Vaccination Regulations Quality Service and Oversight (QSO).