White Oak at North Grove Inc

Inspectors wroteBased on interview, record review and review of facility policy, the facility failed to ensure R1 was free from accidents. Specifically, R1 was being ambulated with the assistance of Certified Nursing Assistant (CNA)1, who failed to use a gait belt to assist with ambulation. R1 suffered a fall resulting in a fracture of the left hip, for 1 of 2 residents reviewed for falls.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the residents' code status documented in the electronic medical record and facility code status binder accurately reflected the residents' end of life wishes for three residents (R)328, R82, and R23) reviewed for code status. R328 who wished to have a Do Not Resuscitate (DNR) status was listed as having a Full code status in the electronic medical records. R82 and R23 were listed as having a DNR status in the EMR but were listed as having a full code and DNR in the facility code status binder. These failures placed all residents who were admitted and/or readmitted to the facility at risk for their end-of-life code status wishes not to be honored. An Immediate Jeopardy was identified on [DATE] and was determined to exist on [DATE], when R82's DNR order was signed, at §483.10 F578: Request/Refuse/Discontinue; [...]

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to keep food scoops, food preparation and service pans, a kitchen drawer, and a kitchen shelf clean. The facility also failed to discard lettuce that had signs of spoilage and failed to cover or date food that was stored in the kitchen's refrigeration and freezer units. These failures had the potential to create an environment for food-borne illnesses which could affect 128 residents who consumed food prepared from the facility's kitchen.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to promote a dignified dining experience which included timely meal service and eating meals at the same time as tablemates for two of two residents (Resident (R) 67, and R78) reviewed for dignity in dining out of a total sample of 32. This failure had the potential to cause R67 and R78 to feel less dignified.

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to administer oxygen as ordered by the physician for one of two residents (Resident (R) 23) out of a total sample of 32. This failure had the potential for R23 to experience adverse reactions by not receiving the prescribed oxygen concentration.

Inspectors wroteBased on interview, record review, policy review, and review of the Centers for Disease Control and Prevention (CDC) guidelines, the facility failed to offer pneumococcal vaccinations per CDC recommendations for two of five residents (Residents (R)14 and R31) reviewed for immunizations out of a total sample of 32. This failure had the potential to place the residents at increased risk of pneumonia.

Inspectors wroteBased on observations, interviews, and review of the facility policy, the facility failed to correctly label, date, and remove expired foods for 2 of 6 kitchens reviewed for storage and sanitization.

Inspectors wroteBased on observations, interviews, record reviews, and review of Facility Policy, the facility failed to implement an infection prevention and control program (IPCP) designed to provide a safe and sanitary environment to help prevent the possible development and transmission of infections and communicable diseases. Specifically, the facility failed to: 1. Ensure that during dining services, staff wore gloves instead of using bare hands to grab and serve baked potatoes to residents. 2. Ensure that during laundry services, the laundry attendant (LA) did not contaminate a clean linen cart while wearing soiled personal protective equipment (PPE) and ensure that the laundry attendant removed PPE without contaminating herself with the dirty gown.

Inspectors wroteReview of the facility's policy titled Comprehensive Team Care Planning revision date 01/09/12 revealed, Residents and/or their designated representatives are encouraged to participate in the development of their plan of care. Each resident will be invited by the Social Services Department to participate to the extent practicable or designate a representative to participate on his behalf. If a resident is unable due to mental or physical impairment, the resident ' s representative must be afforded the opportunity to represent the resident. An explanation must be included in the resident ' s medical record if the participation of the resident and his resident representative is determined not practicable for the development of the resident Care Plan . [...]

Inspectors wroteBased the facility procedure for Advanced Beneficiary Notice, record reviews, and interviews, the facility failed to provide the correct form for notice of financial liability. The form CMS-10055 was not issued to Resident #112 (R112) notifying them of full financial responsibility for 1 of 3 residents reviewed for advance beneficiary notice. Review of the facility procedure titled, Skilled Nursing Facility Advance Beneficiary Notice, states: Providers are requires to give a notice of financial liability anytime a Medicare beneficiary is or will be receiving a service, normally covered by Medicare, but which the Provider believes is not (a) medically necessary or (b) is custodial care. This notice allows the beneficiary to make a choice about receiving the service with the knowledge the Medicare, probably, will not pay and the full financial liability will be theirs. [...]

Inspectors wroteBased on facility policy, record reviews and interviews, the facility failed to ensure Resident #62 (R62) and Resident #46 (R46) and/or their personal representative received the Bed Hold Policy which specifies the duration of the bed hold and the bed hold amount in a timely manner for 2 of 2 residents reviewed for hospitalization. Review on 06/27/2024 at 02:43 PM of the facility policy titled, Bed Hold Policy, A medicaid resident cannot pay to hold a bed prior to admission. Medicaid will pay up to 10 days to hold a bed only if the resident is hospitalized . The resident continues to pay the recurring income during the ten day bed hold. A medicaid resident can pay to hold a bed following this 10 day period by making prior arrangements with the Business Office or Social Worker. [...]

Inspectors wroteBased on interview, observation, record review, and review of facility policy, the facility failed to provide needed care and services consistent with the professional standards of practice for 2 of 2 (Residents (R)10 and R26) reviewed for dressing changes, Specifically R10 was observed on multiple occasions without appropriate labeling on her foam dressing and R26 was observed without appropriate labeling on her tube feed dressing.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were safely stored. Specifically, Resident (R)69's medications were left at the resident's bedside.

Inspectors wroteBased on interviews, record reviews, and review of facility policies, the facility failed to ensure the right to be free from restraints was exercised for one of one resident (Resident (R) 62) reviewed for restraints. Specifically, staff physically restrained (restrict freedom of movement) R62 to obtain nasal swab for COVID-19 test after R62 refused the procedure. The facility's deficient practice had potential to inflict mental anguish and/or physical harm to R62.

Inspectors wroteBased on interviews, record reviews, and review of facility policies, the facility failed to ensure one of one resident (Resident (R) 62) reviewed for abuse were protected during the facility's investigation of an allegation of abuse. Specifically, the facility failed to ensure the staff (perpetrators) were suspended pending outcome of R62's facility investigation for allegation of abuse. The facility deficient practice had potential for R62 to suffer alleged abuse to include mental anguish and/or physical harm.

Inspectors wroteBased on record review, interview, and review of the Resident Assessment Instrument (RAI) Manual, the facility failed to accurately code hospice services on the Minimum Data Set (MDS) assessment for one of one residents (Resident (R) 81) reviewed for hospice services.