Limestone Nursing And Rehabilitation Center, LLC

Based on observations, interviews, review of the 2017 Food and Drug Administration (FDA) Food Code, and review of the facility's policies titled, General Food Preparation and Handling, General Sanitation of Kitchen, Food Storage, Cleaning Dishes/Dish Machine, Cleaning Instructions: Ovens, Cleaning Instructions: Floors, Tables and Chairs, and Cleaning Instructions: Refrigerators, the facility failed to ensure: 1) seven items in the reach in cooler were discarded on the used by date, 2) the floors in the dry food storeroom were clean from rodent droppings, underneath the shelving, 3) there was not a white substance on a pan observed on the clean rack, 4) open food items in the walk-in freezer were sealed, 5) the interior of the walk-in cooler was clean and dry, 6) the convection oven did not have a heavy build-up of dark black residue inside the oven, 7) a pole with chipping, flaking paint was not hanging directly beside and above a food preparation area, and 8) a frying pan did not have a non-stick coating peeling off. This had the potential to affect 149 of 149 residents receiving…

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 review of a facility policy titled, Urinary Catheter Care, the facility failed to ensure Resident Identifier (RI) #84's Foley catheter bag was in a privacy bag and not visible from the hallway on 02/11/20. This deficient practice affected RI #84, one of one resident sampled with a Foley catheter. Findings Include: A review of a facility policy titled, Urinary Catheter Care, with an effective date of 01/16/14, and a supersedes date of 11/01/01, documented: . PROCESS: . i) . Bags should be covered to provide privacy. RI #84 was admitted to the facility on [DATE], with a diagnosis to include Neurogenic Bladder. A Quarterly Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 12/22/19, assessed RI #84 as having an indwelling catheter. On 02/11/20 at 10:16 a.m., RI #84's Foley urinary catheter bag was observed uncovered, attached to the left lower side of bed. The bag contained clear yellow urine that was visible from the hallway. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, medical record review, and review of a facility policy titled Hand Hygiene, the facility failed to ensure: 1) a Licensed Practical Nurse (LPN) washed hands or used hand sanitizer after administering Resident Identifier (RI) #213's nebulizer treatment and placing a garbage bag in the medication cart garbage can, prior to reentering RI #213's room to clean RI #213's facemask; and 2) a Certified Nursing Assistant (CNA) washed hands or used hand sanitizer after she emptied RI #105's urinal, prior to exiting RI #105's room. This affected one of four residents observed during medication administration pass and one of one sampled resident for whom a CNA was observed emptying a urinal. Findings Include: A review of a facility policy titled Hand Hygiene, with a date of 7/30/2016, revealed . Hand Hygiene procedures include the use of alcohol-based hand rubs . and handwashing with soap and water . Always perform hand hygiene in the following situations . Before exiting the patient's care…

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 review of facility policies titled, FOOD STORAGE, CLEANING DISHES/DISH MACHINE AND CLEANING INSTRUCTIONS OVEN, the facility failed to ensure: 1. a plastic bag of riblets in the refrigerator was labeled with a date and use by date, 2. staff air dried sectional plates; and 3. the main baking oven was free of a thick black substance. This had the potential to affect 128 of 128 residents receiving meals from the kitchen. Findings Include: A review of a facility policy titled, FOOD STORAGE, with a 2013 date revealed: PROCEDURE: . 14. Refrigerated Food Storage: . f. All foods should be covered, labeled and dated. All foods will be checked to assure that foods (including leftovers) will be consumed by their safe use by dates . A facility policy titled, CLEANING DISHES/DISH MACHINE with a 2013 date revealed: PROCEDURE: . 9. Allow the dishes to air dry on the dish racks. A facility policy titled, CLEANING INSTRUCTIONS: OVENS with a 2017 date revealed: Policy: Ovens will be cleaned as needed . Spills and food particles will be removed after each use. 1. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and review of a facility policy titled, Dressing - Clean, the facility failed to ensure staff gloves were removed and hand hygiene was performed after cleaning a sacral wound and before applying ointment and touching other parts of the resident's body, pillow, blanket and bed remote. This affected Resident Identifier (RI) #65, one of 2 residents observed for wound care. Findings include: A facility policy titled, Dressings-Clean, with an effective date of November 1, 2001, revealed: . Process: . 13. Remove gloves and wash hands. A facility policy titled, Hand Washing, with an effective date of November 1, 2001, revealed: . Standard: Hand washing should be performed between procedures with residents. RI #65 was readmitted to the facility on [DATE] with two sacral ulcers. Diagnoses included Parkinson's disease, morbid obesity and paraplegia. Review of the resident's Physician's Orders revealed a new treatment order, dated 3/14/19, to Clean Sacrum Pressure Injury with Normal Saline,…

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, interview of the Certified Dietary Manager (CDM), Employee Identifier (EI) #4, and a record review of the Food Code U.S. Public Health Service (USPHS) and FDA (Food and Drug Administration) 2013, the facility failed to assure: 1. adequate immersion time for food preparation equipment sanitized in hot water which measured 175 degrees Fahrenheit (3-compartment sink). 2. effective cleaning/sanitizing of utensils and equipment to prevent the potential growth of foodborne organisms, a. assure dinnerware, sectional plates, was cleaned to sight/touch (machine dishwashing) and air dried, b. assure equipment, a Tea Urn/spigot a non Time/Temperature control for safety, was cleaned every 24 hours. The spigot was observed with a brown solid build-up, 3. the dishmachine, which sanitizes with chemical, maintained chemical efficacy, by testing, monitoring/documenting the concentration prior to use, These failures had the potential to affect all 132 residents receiving meals from the facility's kitchen. Findings include: 1. Review of the 2013 Food Code by the United States…

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, record review, interviews, and review of a facility policy titled RESIDENT SELF ADMINISTRATION OF MEDICATION, the facility failed to ensure Resident #293 was assessed for self-administering nebulizer treatments. This affected one of one resident reviewed for self administration. Findings include: Review of the facility's policy titled RESIDENT SELF ADMINISTRATION OF MEDICATION, updated 10/31/2017, revealed the following: POLICY: Each resident who desires to self-administer medication may be permitted to do so if Facility Interdisciplinary Care-Plan Team has determined that the practice would be safe for the resident and other residents of the facility. 1. The medication self-administration assessment is conducted by the interdisciplinary team . 2. The results of the interdisciplinary team assessment are recorded on the Self-Administration Assessment Form, which is placed in the resident's medical record. Resident #293 was admitted to the facility on [DATE] with diagnoses of Flu, Heart…

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 of incontinent care on 02/14/18, medical record review, staff interviews, and review of facility policies titled Urinary Catheter Care, and a facility document titled Perineal/Catheter Care, the facility failed to ensure the Certified Nursing Assistant (CNA) properly cleaned Resident #33's catheter tubing. Further, the CNA failed to clean Resident #33's perineal area of fecal matter, prior to the completion of care. These failures were observed during one of one catheter and incontinence care observations. Findings Include: A review of a facility policy titled: Urinary Catheter Care with an effective date of January 16, 2014 documented: . PURPOSE: Urinary catheter care helps to prevent urinary tract infection . PROCESS: . II. Catheter Care . c) Wash the catheter itself by holding on to the catheter at the insertion site; wash with one stroke downward . A review of a facility document titled: . Perineal/Catheter Care . with a date of 12/18/16 documented: . CATHETER CARE . 2 . Gently . 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, record review, interviews, and review of the facility's policy titled FOOD PREFERENCES, the facility failed to ensure Resident #117 was served foods in accordance with his/her assessed preferences. This affected one of 132 residents for whom meals were observed. Findings include: Review of the facility's undated policy titled FOOD PREFERENCES revealed the following: POLICY: Information will be gathered upon admission to inform the dietary department of the resident/patient's food preferences and diet history. PROCEDURE: 1. Interview the resident for the following information: . *Food preferences, intolerances, allergies . Resident #117 was admitted to the facility on [DATE] with diagnoses including Hyperlipidemia and Gastro-Esophageal Reflux Disease. On 02/14/18 at 12:00 PM, Resident #117 was observed eating the lunch meal. Resident #117 said he/she was not supposed to get any fried foods but did so today. The tray card on Resident #117's lunch tray listed fried foods as a dislike.…

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 of incontinent care on 02/14/2018 and medication administration on 02/13/2018, a review of the facility's policy's titled Urinary Catheter Care and Hand Hygiene, as well as staff interviews, the facility failed to ensure: 1) A Licensed Practical Nurse (LPN) did not place her ungloved fingers inside medication crush pouches to empty the crushed medications for administration of Resident #58's medications: 2) A Certified Nursing Assistant (CNA) failed to wash her hands after removing soiled gloves and before putting on clean gloves during the provision of incontinence care. The CNA then touched clean items, including linens and Resident Identifier (RI) #33's clean brief and gown. These failures affected one of four nurses observed during medication pass observations and one of one incontinent care observations, involving RI #58 and RI #33. Findings Include: A review of [NAME] and [NAME], Ninth Edition: FUNDAMENTALS OF NURSING Chapter 32 Medication Administration, page 656, documented: . (1) .…

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.