Andalusia Manor

Based on observations, interviews, the facility's document Associate In-Service Record, and the 2022 United States (U.S.) Food and Drug Administration (FDA) Food Code, the facility failed to ensure food stored in the walk-in cooler was completely covered, sealed, labeled properly, and outdated food was discarded on 01/02/2024 during the initial kitchen observation. This had the potential to affect 82 of 82 residents receiving food from the kitchen. Findings include: A facility in-service record dated 05/08/2023, documented: . Topic: Labeling, Dating, and Expired Foods Procedures Refresh For Already Refrigerated Foods: All Refrigerated Food, assumed as Ready To Eat, must contain the following: Item Description ., In On Date ., Opened On Date ., and Use By Date . Once Deli Meats are opened, they have a 7 (seven) day life span. The day it was opened is counted as Day 1. Food Storage and Retention Guide . Ready-to-Eat/Prepared Foods- Food in a form that is edible without additional preparation to achieve food safety. (Example: leftovers, deli salads, cut produce) Up to 7 (seven) days…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interview, resident record review, and review of a facility policy titled Oxygen Therapy, the facility failed to ensure Resident Identifier (RI) #33, one of one resident sampled for Respiratory Care, received oxygen (O2) at two liters per minute (2 l/m) as ordered by physician, on 01/02/2024 and 01/03/2024, two of three days of the survey. Findings include: An undated facility policy titled Oxygen Therapy documented: Policy: Oxygen is administered to residents who need it, . Oxygen is only administered with a Physician's order. RI #33 was admitted to the facility 02/13/2023 and readmitted on [DATE] and had diagnoses to include: Chronic Obstructive Pulmonary Disease. RI #33's Physician Order List documented an as needed order dated 03/26/2023 for RI #33 to receive oxygen at two liters per minute. On 01/02/2024 at 5:36 PM RI #33 was observed receiving O2 at three liters per minute. On 01/03/2024 at 9:38 AM RI #33 was observed receiving O2 at three liters per minute per nasal cannula. On…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and a review of a facility policy titled,Manual Warewashing, the facility failed to ensure 10 metal pans were not wet and stacked on a shelf, ready for use. This was observed on 10/16/19, and had the potential to affect 132 of 132 residents receiving meals from the kitchen. Findings Include: A review of a facility policy titled, Manual Warewashing with a revised date of 9/2017, revealed: . Procedures . 3. All serviceware and cookware will be air dried prior to storage . On 10/16/19 at 5:10 PM, the surveyor observed 10 pans stacked on a shelf wet with water. The surveyor, along with Employee Identifier (EI) #4, Certified Dietary Manager (CDM), observed the wetness of the pans. EI #4 began to remove the pans that were wet. A total of 10 pans were removed from the shelf. EI #3, Dietary Manager, was asked if the pans that were wet were supposed to be clean. EI #3 replied, yes. On 10/17/19 at 1:50 PM, an interview was conducted with EI #3. EI #3 was asked if the metal pans were ready for use. EI #3 replied, yes. EI #3 was asked, what was the potential for…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record review and a review of a facility policy titled, OXYGEN THERAPY AEROSOL TREATMENT, the facility failed to ensure Resident Identifier (RI) #220's breathing treatment mask was stored in a Ziploc bag and the mask and the tubing was dated. This affected RI #220, one of two residents sampled with respiratory treatments. Findings Include: A review of a facility policy titled, OXYGEN THERAPY AEROSOL TREATMENT with no date, revealed: .7. Store nebulizer sets in plastic bag change weekly and as needed. 8. Change oxygen and nebulizer sets and bags weekly. Date when changed. RI #220 was admitted to the facility on [DATE] and re-admitted [DATE], with diagnoses of Chronic Diastolic Heart Failure and Chronic Obstructive Pulmonary Disease. A review of physician orders for RI #220, dated 9/12/19, revealed the order for Ipratropium Bromide 0.02% solution 0.5% (Atrovent) inhaled every six hours. On 10/15/19 at 3:29 PM, RI #220 was resting in bed watching TV. A nebulizer machine was on the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews and review of facility policies titled, Food Preparation, Service Line Checklist and Manual Warewashing, the facility failed to ensure: 1. staff washed hands before putting on a new pair of gloves; 2. the temperatures of all food items on the tray line were taken; and 3. spoons, forks and trays were not wet at the tray line. This was observed on 10/10/2018 and had the potential to affect 128 of 128 residents receiving meals from the kitchen. Findings Include: 1) A review of a facility policy titled, Food Preparation with a revised date of 9/2017 revealed: .Procedures 1. All staff will practice proper hand washing techniques and glove use. On 10/10/2018 at 11:09 a.m., the surveyor observed (Employee Identifier) EI #14, dietary assistant, touch the trash can lid to put her gloves in the trash can. EI #14 then did not wash her hands prior to putting on a clean pair of gloves and started washing dishes in the three compartment sink. On 10/10/2018 at 11:28 a.m., EI #14 came out of dish room and put on clean gloves. EI #14 did not wash her hands. EI #14…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure Resident Identifier (RI) # 112's Significant Change Minimum Data Set (MDS) assessment, dated 9/4/18, reflected hospice. Findings Include: RI #112 was admitted to the facility on [DATE] with a diagnosis to include Alzheimer's disease with late onset. On 10/11/18 at 1:48 PM a review of RI #112's September 2018 Physician orders revealed, . Admit to . Hospice 8/29/18 . A review of RI #112's Significant Change MDS assessment, dated 9/4/18, did not indicated hospice service checked. On 10/11/18 at 2:00 PM, an interview was conducted Employee Identifier (EI) #10, Registered Nurse MDS/Care Plan Coordinator. EI #10 was asked if RI #112 was receiving hospice services. EI #10 replied, yes. EI #10 was asked when was RI #112 admitted to hospice. EI #10 replied, 8/29/18. EI #10 was asked if a Significant Change MDS was completed. EI #10 replied, yes. EI #10 was asked if hospice was coded on the 9/4/18 MDS. EI #10 replied, no. When asked why not, EI #10…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview and the review of a facility policy titled, Medication Administration, the facility failed to ensure a licensed nurse did not prepare medication for Resident Identifier (RI) # 73 and then give the medication to a Certified Nursing Assistant (CNA) to give to the resident. This practice resulted in the CNA accidentally giving the medication to another resident, RI # 175. This occurred on 4/26/18 and was cited as a result of the investigation of complaint # AL00035677. Findings Include: A review of an undated facility policy titled, MEDICATION ADMINISTRATION: revealed .POLICY : Medications are administered only by licensed nursing personnel . PROCEDURES: .11. Give the resident the medication . RI #73 was admitted to facility on 3/17/17 with diagnoses to include Parkinson's disease, Dementia with Lewy Bodies, History of Transient Ischemic Attack (TIA) and Cerebral Infarction. A review of RI #73's April 2018 Physician Orders revealed: .SENOKOT .BID (two times a day) .SINEMET .BID…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, record review and review of facility policy titled, DRESSING CHANGE CLEAN, the facility failed to ensure licensed staff did not: 1. place the wound cleaner bottle on Resident Identifier (RI) #176 and RI #105's bed, then return the bottle to the treatment cart; 2. use the same gloves to clean the wounds and then place the treatment and clean dressing on RI #176 and RI #105 wounds and 3. remove a pen from her uniform pocket with soiled gloves and initial and date the outer dressing, then return the pen to her pocket and remove and use again on another resident. This was observed on 10/10/18 and affected RI #176 and RI #105, two of five residents identified by the facility with pressure ulcers. Findings Include: A review of an undated facility policy titled, DRESSING CHANGE CLEAN revealed .PROCEDURE: .2. Wash Hands 3. Assemble equipment and take to bedside, cover bedside table with clean towel . 8. Wash hands 9. Open dressing supplies and cleaning solution. Assure that area is clean and free of contaminates. 10. Put on gloves . RI #176 was admitted to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interview, record reviews and review of facility policy titled, Tube Feedings, the facility failed to ensure Resident Identifier (RI) # 83's and RI #8's tube feeding were running at the correct rates, as ordered by the physician for the tube feeding and the hourly water flush. This was observed on 10/11/2018 and affected two of two residents sampled who were receiving tube feedings Findings Include: A review of a facility policy, no date, titled, Tube Feedings revealed .POLICY: . A physician order specifying type of solution, amount, and frequency is required. PROCEDURE: . Pump Feeding . 4. set prescribed rate . 1) RI #83 was readmitted to the facility on [DATE] with diagnoses of anoxic brain damage and gastrostomy status. A review of RI #83's Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 8/20/18, revealed: RI #8 had a Brief Interview for Mental Status (BIMS) of severe impairment for daily decision making and short/long term memory deficit. Section K -…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, interview and review of the facility Job Description and Performance Standards Position Title Charge Nurse and Position Title Certified Nursing Assistant (CNA),the facility failed to ensure a licensed nurse did not give prepared medication to a CNA to give to a resident, which in turn was given to the wrong resident. This deficiency is cited as a result of the investigation of complaint # AL00035677, and affected two of two residents. Findings Include: A review of a facility JOB DESCRIPTION AND PERFORMANCE STANDARDS Charge Nurse revealed .1. Follow established standards of nursing practices and implement facility policies and procedures.18. Administer and document direct resident care, medications and treatments per physicians orders and accurately record all care provided. A review of an undated policy MEDICATION ADMINISTRATION revealed .POLICY: Responsibility of the nursing professional . Medications are administered only by licensed nursing personnel . A review of Job Description for Certified Nursing Assistant revealed .Purpose of this position . is to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review and review of facility policy titled, MEDICATION ADMINISTRATION, the facility failed to ensure a licensed staff did not remove gloves from her uniform pocket and put them on prior to administering medications by a gastrostomy tube for Resident Identifier (RI) #30. This was observed during medication administration on 10/10/18 and affected one of five nurses observed. Findings Include: A review of an undated facility policy titled, MEDICATION ADMINISTRATION revealed .PROCEDURES: 1. c. Clean gloves to be worn as appropriate when risk of contact with secretions/excretions blood or body fluids . RI #20 was admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis to include Gastrostomy status. A review of RI #20's October 2018 Physician Orders revealed . DEMECLOCYCLINE 300 MG (milligram) GIVE 1 TABLET PER GTUBE (gastrostomy tube) . at . 1200 . On 10/10/18 at 11:15 AM Employee Identifier (EI) #12, Licensed Practical Nurse, was observed preparing and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.