The Health Center at Research Park

Inspectors wroteBased on interviews, medical record reviews, the facility's policy titled, Abuse Prohibition Plan, the Facility Reported Incident (FRI) received by the Alabama State Survey Agency, and the facility's investigative file, the facility failed to protect Resident Identifier (RI) #334's right to be free from physical abuse by another resident, RI #335. During lunch on 06/23/2023 RI #335 was physical and verbally abusive to staff and expressed suicidal and homicidal ideations. RI #335 was sent to the local hospital's emergency room around 1:00 PM. Upon return from the hospital around 3:00 AM, RI #335 was not supervised and went from his/her room, through the bathroom that connected to RI #334's room. [...]

Inspectors wroteBased on interviews, medical record reviews, and the facility policy titled Behavioral Health Services, the facility failed to ensure interventions were developed and implemented to address Resident Identifier (RI) #335's behaviors which included being physically and verbal aggressive towards staff and homicidal and suicidal ideation. On 06/23/2023, RI #335 was sent to the hospital emergency room after being physical and verbally abusive to staff and expressing homicidal and suicidal ideation. RI #335 returned from the hospital around 3:00 AM on 06/24/2023. The facility had not developed a plan for RI #335's return to ensure residents' safety. No new orders were provided, and no new interventions were developed or implemented. On 06/24/2023 around 4:30 AM, Certified Nursing Assistant (CNA) #27 witnessed RI #335 in RI #334's room. [...]

Inspectors wroteBased on interviews, record review, and a review of a policy titled, Behavioral Health Services, the facility failed to ensure there were sufficient staff who had the knowledge, training, competencies, and skills sets to address the behavioral health care needs of Resident Identifier (RI) #335 after RI #335 was sent to the hospital for aggressive behaviors and suicidal and homicidal ideations. The facility did not develop and implement interventions to ensure resident's safety or to provide additional supervision. On 06/23/2023 during lunch, RI #335 was physically and verbally abusive to staff and had suicidal and homicidal ideation before being sent to the hospital. Upon return from the hospital on [DATE] around 3:00 AM, the facility did not ensure interventions were developed and implemented to ensure residents' safety or to provide additional supervision. [...]

Inspectors wroteBased on observation, interview, the facility's policy for Dietary: Menus and Adequate Nutrition, the facility's 2024 S/S (Spring/Summer) Week 2 Menu, the facility's posted Disher Capacity guide, and the facility's recipes for Salisbury Steak, Seasoned [NAME] Beans, Chicken Fettuccini Alfredo, and Buttered Noodles; the facility failed to ensure the residents received nutrition as planned per the facility's menu by allowing the following: [...]

Inspectors wroteBased on observation, interview, the facility's Dish Machine Temperatures-Sanitation log for June 2024, the facility's policies for Dietary- Mechanical Dishwashing and Dietary- Hand Washing Techniques, and the 2022 United States (U.S.) Food and Drug Administration (FDA) Food Code; the facility failed to prevent cross-contamination on 06/11/2024 by allowing the following to occur: • Staff going from handling dirty dishes to handling clean dishes and not washing their hands, • Staff using a cloth to dry multiple wet trays instead of air drying, • Access to a hand sink was blocked by a plate lowerator and when staff reached over the equipment to use the hand sink, water splashed onto the stored plates, and • Staff chewing gum in the kitchen. [...]

Inspectors wroteBased on interviews and medical record review the facility failed to ensure Resident Identifer (RI) #335's representative was notifed of an incident and that he/she transfered to the hospital on [DATE]. This deficient practice affected RI #335 one of three residents reviewed for transfer and discharge. Finding Include: RI #335 was admitted to the facility on [DATE] with diagnoses of Dementia with Agitation and Major Depressive Disorder. A review of RI #335's admission MDS (Minimum Data Set) with an ARD (Assessment Reference Date) of 05/08/2023, indicated RI #335's BIMS (Brief Interview for Mental Status) as five of 15, indicating RI #335 was cognitively impaired. A review of RI #335's Clinical Notes Report dated 06/24/2024, revealed RI #335 was transferred to the hospital on [DATE] after an increase in agressive behaviors. [...]

Inspectors wroteBased on record review, interviews, the Facility Reported Incident (FRI) received by the Alabama State Survey Agency, and the facility policy titled Abuse Prohibition Plan, the facility failed to protect Resident Identifier (RI) #40's right to be free from misappropriation of property when Registered Nurse (RN) #6 placed RI #40's temazepam in her pocket and left the facility. This affected RI #40 one of seven residents sampled for abuse prevention. This was cited due to the investigation of facility reported incident/complaint/report number AL00047874. Findings Include: Review of a facility policy titled Abuse Prohibition Plan, with an effective date of 11/02/2023 documented . Purpose: . The resident shall not be subjected to . misappropriation of property . Definitions: . [...]

Inspectors wroteBased on interviews, medical record review, review of the facility reported incident and a review a of the facility policy titled, Abuse Prohibition, the facility failed to report an allegation of abuse within the time frame of two hours to the state Agency on 06/24/2023. On 06/24/2023 at 4:30 AM, the facility staff reported an allegation of physical abuse by RI #335. The facility reported the allegation of physical abuse at 8:59 AM on 06/24/2023 to ADPH (Alabama Department of Public Health) State Agency. This deficient practice affected one out of three sampled residents reviewed for abuse concerns. Finding Include: A review of the facility's policy titled, Abuse Prohibition Plan, with an effective date of 04/01/2018, revealed: . EXTERNAL REPORTING . All alleged violations are reported immediately, but not later than 2 hours after the allegations is made . [...]

Inspectors wroteBased on interviews, record reviews and a facility policy titled Baseline Careplan, the facility failed to ensure Resident Identifier (RI) #72 received a copy of his/her Baseline Care plan Summary within 48 hours of admission. The facility further failed to ensure RI #72's Baseline Care Plan was developed within 48 hours of admission. This deficient practice affected one out three sampled residents whose baseline care plans were reviewed. Findings Include: RI #72 was admitted to the facility on [DATE] with admitting Diagnoses of Pleural Effusion, Pneumonia, Chronic Respiratory Failure with Hypoxia. A review of a facility policy titled, Baseline Careplan, dated 11/2016, Revised 10/25/2023: .Purpose: The facility shall develop and implement a baseline care plan for each resident that meet professional standards of quality care. Policy: 1. ''The baseline careplan shall a. [...]

Inspectors wroteBased on interviews, record review and a review of a facility's policy titled, Oxygen Concentrator and Oxygen Storage, the facility failed to ensure: Resident Identifier (RI) #5 had a physician order for his/her oxygen and his/her oxygen tubing was labeled/dated. The facility further failed to ensure RI #52's nebulizer mask was stored in a plastic bag when not in use. This deficient practice affect RI #5 and RI #52, two of three residents sampled for respiratory care. Findings Include: A review of a facility's policy titled, Oxygen Concentrator . with an effective date of 12/01/2023 documented: . Purpose: To administer oxygen for the treatment of certain diseases or conditions . Policy: . Oxygen should be administered only under orders of the attending physician . Procedure: . 1. Care of the Resident . a. [...]

Inspectors wroteBased on observations, interviews, and review of a facility policy Infection Prevention and Control Program, the facility failed to ensure staff washed their hands and stored resident hygiene supplies in a manner to prevent cross-contamination. On 06/12/2024 and 06/13/2024 two unlabeled bath basins were observed on the bathroom of adjoining resident rooms for Resident Identifier (RI) #22 and RI #66. On 06/14/2024 the facility Treatment Nurse failed to perform hand hygiene after cleaning RI #14's wound and before applying the treatment. This affected RI #22, RI #66, and RI #14.

Inspectors wroteBased on record review, interview, a review of Facility Reported Incidents, the facility's investigative files, and review of a facility policies Medication Administration, and AMPharm Delivery Service, the facility failed to ensure controlled medications records were maintained and able to be reconciled when licensed staff failed to add medication to the control sheets and failed to place the controlled medications in the narcotic drawer after receiving from the pharmacy for Resident Identifier (RI) #57 and RI #47. This affected RI #47 and RI #57 and was cited as a result of the investigation of complaint/report AL00045923. Findings Include: A review of a facility policy AMPharm Delivery Services with an effective date of 11/2021 documented Policy: Nightly delivery is provided to each facility on a preset schedule. Procedure: . c. [...]

Inspectors wroteBased on observations and review of the facility documents, the facility failed to ensure dishware was completed dried before storage; expired items were discarded; and the can opener and microwave were cleaned after use. These deficient practices had the potential to affect all residents who received food from the kitchen.

Inspectors wroteBased on observation, record review, interviews, and review of the facility policy, the facility failed to follow the recipes for pureed diets for four residents on pureed diets out of 80 residents that received food from the kitchen.

Inspectors wroteBased on observation, record review, interviews, and review of facility policy, the facility failed to follow the menu for scoop size of the pureed entrees for four of four residents that received a pureed diet of 80 residents that received food from the kitchen.

Inspectors wroteBased on observation, record review, interviews, and review of facility policy, the facility failed to serve food in a form designed to meet the individual needs for seven residents on a mechanically altered diet out of 80 total residents that received food from the kitchen.

Inspectors wroteBased on observations, interviews, review of Resident Identifier (RI) #58's medical record and the facility's policy titled Restraint Policy the facility failed to provide medical justification of a physical restraint for RI #58, one of one sampled residents reviewed for physical restraints. RI #58, who is assessed as requiring limited assistance with transfers and mobility was observed in a locked, reclined Geri-chair that prevented the resident from getting up and walking.

Inspectors wroteBased on interview, review of Resident Identifier (RI) #38's medical records and an undated document titled Use of dashes, the facility failed to ensure RI #38's admission and Quarterly Minimum Data Set (MDS) were complete. This deficient practice affected RI #38, one of 23 sampled residents.

Inspectors wroteBased on observation, medical record review, interviews, and review of a facility polity titled Enteral (Tube) Nutrition, the facility failed to ensure Resident Identifier (RI) #73's tube feeding water flush was infusing at 55 ml (milliliters) /(an) hr( hour) as ordered by the physician. This was observed on 3/26/2019 and affected one of one resident sampled to receive a feeding tube water flush. Findings Include: A review of a facility policy titled, Enteral (Tube) Nutrition, with a revised date of 11/2018, revealed, .Policy Explanations and Compliance Guidelines . 8. The nurse will . 4. Verify that . flushes are administered per the . physician's order . RI # 73 was admitted to the facility on [DATE] with diagnoses of Dysphagia, Unspecified, Encounter for Attention to Gastrostomy, and Gastro-Esophageal Reflux. [...]

Inspectors wroteBased on interviews and review of a facility policy titled, Resident Rights, the facility failed to ensure the residents' mail was delivered on Saturdays. This had a potential to affect all seventy-eight residents residing in the facility. Findings Include: A facility policy titled, Resident Rights, with a revision date of 11/28/2017, revealed the following: .7. Information and communication . i. The resident has the right to .receive mail, and to receive letters, packages and other materials delivered to the facility for the resident through a means other than a postal service . On 3/27/19 at 10:39 a.m., four of four residents present for the Resident Council meeting stated they were unsure if the facility was delivering their mail on Saturdays. None of them could recall receiving any mail on a Saturday. [...]