Wiregrass Rehabilitation Center & Nursing Home

Inspectors wroteBased on observations, interviews and a review of facility policies titled, Food Storage: Cold Foods, Outside Food, and Hand Hygiene, the facility failed to ensure: 1. Food items in the kitchen refrigerator were labeled with an open and use by date; 2. food items brought in from the outside and stored in the nourishment refrigerators on the unit were labeled with the resident's name and dated; 3. and dietary staff washed his/her hands when entering the kitchen on 03/23/22. This deficient practice affected 70 of 70 residents receiving meals from the kitchen. Findings Include: 1.) A review of a facility policy titled, Food Storage: Cold Foods, with a revised date of 4/2018 revealed: Policy Statement All . Temperature Control for Safety (TCS) foods, frozen and refrigerated, will be appropriately stored in accordance with guidelines of the FDA (Food and Drug Administration) Food Code. [...]

Inspectors wroteBased on interviews, review of a Physician's Progress Note, and review of the facility Resident Assessment Instrument Policy, the facility failed to develop interventions to address Resident Identifier (RI) #2's identified skin condition. This affected RI #2, one of fifteen residents, who's care plans were reviewed. Findings Include: A review of the facility policy with a subject of . RAI (Resident Assessment Instrument) Policy . DATE (S) REVISED/REVIEWED . 10/2021 . XI. Care Plans . The care plan will be revised on an ongoing basis . in order to reflect changes in the resident and the care that the resident is receiving. RI #2 was admitted to the facility on [DATE] with diagnoses to include Schizoaffective Disorder and Generalized Anxiety Disorder. A review of a Progress note by the Medical Director of the facility dated 11/10/21 revealed, . SKIN: Extensive excoriations. [...]

Inspectors wroteBased on observations, interviews and review of a facility policy titled, Food Storage: Cold Foods, the facility failed to ensure: 1. foods stored in the walk-in cooler were labeled with an open and/or use by date; and 2. Enchilada Sauce with an open date of 1/2/2020 and the manufactures label with instructions to Refrigerate after opening was not stored in the dry storage area. This had the potential to affect 78 of 78 residents receiving meals from the facility kitchen.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure that: 1. Resident (RI) #41 had heel positioner to bed, floated heels when in bed, and (specific named boot) on while in bed, as indicated by Physician orders and care plan, and 2. RI #62 had (name of specific) boots on at all times except when in shower as indicated by Physician orders and care plan. This affected two of four residents sampled for range of motion concerns.

Inspectors wroteBased on observation, record reviews, interviews and a review of the facility policy titled, STANDARD POLICIES & PROCEDURES, the facility failed to ensure that Employee Identifier (EI) #3 put on gloves before giving an insulin injection to (Resident Identifier) RI #68. This had the potential to effect one of five sample residents for insulin injection. Findings Include: A review of a facility policy titled STANDARD POLICIES & PROCEDURES, with a reviewed date of 5/2019 revealed .Procedure: Using Gloves .Purpose .To prevent the spread of infection .to resident and employees .A. Gloves must be worn during all vascular procedures. RI #68 was admitted to the facility on [DATE] with Diagnosis of type 2 diabetes mellitus without complication. A review of RI # 68's doctor's order, dated 10/1/19, revealed .Humulin 70-30 vial. ADMINISTER 20 UNITS SUBQ (subcutaneous) EVERY MORNING . [...]

Inspectors wroteBased on observations, interview, and review of a facility policy titled FOOD AND SUPPLY STORAGE, the facility failed to ensure that a box of ice cream in the walk-in freezer was not spilled with 20 individual cups on the floor and the remainder of the box on the floor. This had the potential to affect 72 residents receiving meals from the kitchen. Findings Include: A review of a facility policy titled, FOOD AND SUPPLY STORAGE with a revision date of 8/2018 revealed, .FROZEN STORAGE store food items 6 inches above the floor . On 12/17/18 at 1:51 PM, during the initial tour of the kitchen with Employee Identifier (EI) #9 the surveyor observed 20 single cups of vanilla ice cream on the floor in a corner of the walk-in freezer. Also, the box containing the remainder of the ice cream cups was on the floor. On 12/19/18 at 10:25 AM, an interview was conducted with EI # 9, Executive Chef. [...]

Inspectors wroteBased on observations, interviews and review of a facility policy titled Storage of Equipment, the facility failed to ensure resident use equipment was not stored in the open area across from the resident dining/activity room at the end of 300 hall. This was visible to residents and visitors and was noted to emit an urine odor. This was observed on three of four days of the survey and had the potential to affect 76 of 78 residents in the facility. Findings Include: A review of a facility policy titled Storage of Equipment, with a effective date of 11/2017 revealed: Policy: It is the policy of this facility for resident equipment to be stored in non-resident areas. On 12/17/18 at 1:21 PM, the surveyor observed stored equipment in an open area at the end of 300 hall, in front of the activities/dining room . The equipment was visible to residents and visitors. [...]

Inspectors wroteBased on record review, interview and review of a facility policy RESIDENT ASSESSMENT INSTRUMENT POLICY, the facility failed to ensure that Resident Identifier (RI)#65, a resident receiving anticoagulation medication had a care plan. This affected one of 24 residents whose care plans were reviewed. Finding Include: A review of a facility policy titled Resident Assessment Instrument with a date of 11/2017 revealed: Policy: Resident Assessment Instrument . XI. On admission interim care plans will implemented based on nursing assessment, resident and/or representative input RI #65 was admitted on [DATE] and readmitted on [DATE] with a diagnosis of Unspecified Atrial Fibrillation. A review of RI #65's December 2018 Physician Orders revealed: . XARELTO 15 MG(milligram) TABLET GIVE ONE TABLET BY MOUTH. MONITOR FOR EXCESSIVE BLEEDING AND BRUISING . [...]

Inspectors wroteBased on observation, interview and review a facility policy Medication Administration, the facility failed to ensure licensed staff locked the medication cart before walking away and leaving the cart on the hall. This was observed on 12/17/18 and affected one of five nurses observed. Findings Include: A review of a facility policy titled Medication Administration with a reviewed date of 8/01 revealed: POLICY: .PROCEDURE: Medication carts must be kept locked when not in use (i.e. when the nurse is in the resident's room or whenever the nurse is away from the cart) during medication pass. On 12/17/18 at 3:36 PM, Employee Identifier (EI) #2, Licensed Practical Nurse, rolled the medication cart from the medication room to the hall. EI #2 left the medication cart in the hall and went into the charting room. At 3:42 PM, EI #2 returned to the medication cart with sanitation wipes. [...]

Inspectors wroteBased on observation, interview and review of facility policy SOILED BRIEF/UNDERPAD DISPOSAL, the facility failed to ensure a Certified Nursing Assistant (CNA) did not place a trash bag of soiled items on the floor in the hall as she exited a resident room. This was observed on 12/17/18 . Findings Include: A review of a facility policy titled SOILED BRIEF/UNDERPAD DISPOSAL with a revised date of 11/2018 revealed: Procedure: Soiled Brief/Underpad Disposal .STANDARD: Soiled briefs or underpads should be disposed of in specifically designated laundry hampers or waste containers. On 12/17/18 at 3:57 PM, Employee Identifier (EI) #3, CNA was observed placing a bag of soiled items on the floor in the hall as she exited a resident's room. EI #3 then went into another resident's room and closed the door. [...]