The Healthcare Center at Buck Creek

Inspectors wroteBased on interviews, record review, and a review of the facility's policy titled, Abuse, Neglect, Misappropriation, Exploitation Policy, the facility failed to protect Resident Identifier (RI) #4 from being physically abused by RI #5. On 05/16/2024 Certified Nursing Assistant (CNA) #5 witnessed RI #5 slap RI #4 on the face in their room. This deficient practice affected RI #4 and RI #5, two of 19 residents sampled for abuse. Findings Include: A review of the facility's policy titled, Abuse, Neglect, Misappropriation, Exploitation Policy, with an effective date of January 2019, revealed: .Purpose: To prohibit and prevent abuse . Definitions: Abuse: The willful infliction of injury . resulting physical harm, pain, or mental anguish. [...]

Inspectors wroteBased on record review, interview, the facility policy titled Abuse, Neglect, Misappropriation, Exploitation Policy, and review of facility reported incidents (FRIs) information submitted to the Alabama Department of Public Health (ADPH) via the Online Incident Reporting System; the facility failed to submit their five-day investigative summary or results of their investigations for two of 18 FRIs concerning allegations of abuse, neglect, or misappropriation of resident property reviewed for timely reporting. This deficient practice affected Resident Identifier (RI) #6 and RI #22 two of 19 residents reviewed for abuse concerns. Findings Include: A review of a policy titled Abuse, Neglect, Misappropriation, Exploitation Policy with an effective date of January 2019. documented the following: .7. [...]

Inspectors wroteBased on interviews, record review, review of a facility policy titled Abuse, Neglect, Misappropriation, Exploitation Policy, and review of information from the Alabama Department of Public Health (ADPH) Online Reporting System, the facility failed to protect the Resident Identifier (RI) #5's right to be free from verbal, mental, and physical abuse by a staff. On 04/25/2024 Certified Nursing Assistant (CNA) #9 observed Licensed Practical Nurse (LPN) #12 stand up and say she was going to go to RI #5's room and call his/her dead mother a bitch. On approximately 04/27/2024 or 04/28/2024 CNA #10 overheard LPN #12 on the phone during a break say she went in RI #5's room and called him/her an ugly bitch and called his/her dead mother an ugly bitch. On 04/26/2024 the Social Worker (SW) was informed by LPN #12 that RI #5 was wandering in other resident's room. [...]

Inspectors wroteBased on interviews, record review, review of a facility policy titled, Abuse, Neglect and Misappropriation, Exploitation Policy, and review of information from the Alabama Department of Public Health's (ADPH) Online Reporting System, the facility failed to ensure Resident Identifier (RI) #1 was free from misappropriation of funds from his/her personal funds. On 04/13/2024 the facility administrator was informed by the Business Office Manager (BOM) that she had been arrested for elder abuse. According to information received from local law enforcement detective the BOM used RI# 1's personal bank account information to pay her personal credit card in the amount greater than $16,000. The survey team applied the Reasonable Person Concept to determine the severity of psychosocial harm rose to the level of actual harm that was not immediate jeopardy. [...]

Inspectors wroteBased on interviews, record review and facility policies titled Room & Roommate Change Policy, the facility failed to notify Resident Identifier (RI) #5 of a room change prior to the move. This affected Resident Identifier (RI) #5, one of one resident who expressed dissatisfaction with their room change. This deficiency was cited as a result of the investigation of complaint/report number AL00047738.

Inspectors wroteBased on record reviews, interviews, and a facility policy titled Abuse, Neglect, Misappropriation, Exploitation Policy, and review of information from the Alabama Department of Public health's (ADPH) Online Reporting System, the facility failed to ensure staff implemented the facility's abuse policies and procedures when: staff failed to identify an allegation of abuse, protect residents from further potential abuse, and immediately report an allegation of verbal abuse on [DATE] involving Resident Identifier (RI) #5 and Licensed Practical Nurse (LPN) #12. Certified Nursing Assistant (CNA) #9, and CNA #10 became aware of the allegation, but did not report the incident for three days following the incident. [...]

Inspectors wroteBased on an interview, review of facility personnel files, review of a facility policy titled Abuse, Neglect, Misappropriation, Exploitation Policy, the facility failed to ensure Certified Nursing Assistant (CNA) #6 and CNA #7 had initial Alabama Certified Nurse Aide Registry and criminal background checks completed before being hired by the facility. This deficient practice affected CNA #6 and CNA #7, two of six CNAs whose personnel files were reviewed.

Inspectors wroteBased on interviews, review of the facility's RECORD OF MEDICATION DISPOSAL sheets for the Non-Controlled Drugs, and review of a facility policy titled, RULES OF ALABAMA STATE BOARD OF HEALTH ALABAMA DEPARTMENT OF PUBLIC HEALTH CHAPTER 420-5-10 NURSING FACILITIES, the facility failed to ensure the required signatures were on the non-controlled medication destruction sheets. This deficient practice affected one of 12 months of non-controlled medication destruction sheets reviewed for 2023.

Inspectors wroteBased on observations and an interview, the facility failed to ensure the DAILY ASSOCIATE POSTING form contained the name of the facility, the Resident Census at Start of Shift and the date for each shift. This was observed on 01/23/2024, one of four days of the survey, and had the potential to affect all 162 residents residing in the facility.

Inspectors wroteBased on interviews, record reviews and a review of a facility policy titled, Pain Assessment and Management, the facility failed to ensure Resident Identifier (RI) #11, a resident with a diagnoses of chronic pain, received pain medication as ordered by physician on 10/12/2022 at 10:00 PM and 10/13/2022 at 6:00 AM. This affected one of three residents sampled for pain concerns. Findings Include: A facility policy titled, Pain Assessment and Management, with an effective date of 05/2021, documented, . The purposes of this procedure are to help the staff identify pain in the resident, and to develop interventions that are consistent with the resident's goals and needs and that address the underlying causes of pain. [...]

Inspectors wroteBased on observation, interviews, review of resident records, review of a facility policy titled Physician Medication Orders the facility failed to ensure medications were reordered from the pharmacy in a timely manner to have the medication available for administration to RI #55 on 10/13/2022 and RI #11 on 10/12/2022 and 10/13/2022. This had the potential to affect two of 28 sampled residents.

Inspectors wroteBased on observation, interviews, and review of the facility policy titled Controlled Substances, the facility failed to ensure controlled medications were stored in the Building Two refrigerator in a permanently affixed compartment. This was observed on 10/14/2022 in one of four unit medication refrigerators observed.

Inspectors wroteBased on observation, record review, interviews and review of a facility procedure guide titled Perineal Care, the facility failed to ensure a staff member changed gloves and performed hand hygiene to prevent the spread of infection. On 03/16/2022, during incontinent care, Employee Identifier (EI) #3, a Certified Nursing Assistant (CNA), removed a dirty incontinent brief from Resident Identifier (RI) #15. The CNA failed to perform hand hygiene and put on clean gloves before placing a clean brief on the resident. This deficient practice affected RI #15, one of two residents observed for incontinent care. Findings Include: An undated facility procedure guide titled Perineal Care documented, . Hand Hygiene. Perform hand hygiene. Apply clean gloves . Prevents transmission of microorganisms. RI #15 was readmitted to the facility on [DATE] and had a history of Urinary Tract Infections. [...]