Montgomery Children's Specialty Center

Based on observation, interview, the facility's policy for Dispose of Garbage and Refuse, and the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code; the facility failed to ensure the side door of the dumpster was closed on 5/22/2023 at 6:45 PM to prevent the potential for rodents being attracted to and possibly entering the facility. This had the potential to affect 45 of 45 residents in the facility. Findings include: The facility's policy for Dispose of Garbage and Refuse, dated August 2017, included the following: Policy Statement All garbage and refuse will be collected and disposed of in a safe and efficient manner. The U.S. FDA 2022 Food Code included the following: . 5-5 Refuse, Recyclables, and Returnables . 5-501.13 Receptacles. (A) . receptacles and waste handling units for REFUSE, recyclables, and returnables and for use with materials containing FOOD residue shall be durable, cleanable, insect- and rodent-resistant, leakproof, and nonabsorbent. 5-501.15 Outside Receptacles. (A) Receptacles and waste handling units for REFUSE, recyclables, 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.

Based on observation, interview, review of the facility's policy for Menus, the facility's menu and diet guides for Week 1, Tuesday (Day 3) for Lunch on 5/23/2023, the residents' Diet Cards (sub-heading: Category Information) for Lunch on 5/23/2023, and the residents' Tray Tickets for Lunch on 5/23/2023; the facility failed to ensure food was portioned as specified by the approved menu for lunch on 5/23/2023. The facility also failed to ensure nutritional adequacy and appropriate modification of texture by not consulting with the Registered Dietitian before making substitutions to the menu for lunch on 5/23/2023. This had the potential to affect 7 of 17 residents receiving meals from the kitchen at the facility. Findings include: The facility's policy for Menus, dated September 2017, included the following: Policy Statement Menus will be planned in advance to meet the nutritional needs of the residents/patients in accordance with established national guidelines. Menus will be developed to meet the criteria through the use of an approved menu planning guide. Procedures 1. Menu cycles…

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, the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code, the facility's policies for Food: Preparation and Equipment, and the facility's inservice information for Time and Temperature Control and Recording Inservice; the facility failed to prevent possible cross-contamination from a soiled manual can opener and a food preparation sink drain without an air gap on 5/23/2023. The facility further failed to ensure the food thermometer was properly checked and calibrated to check food temperatures accurately on 5/23/2023. This had the potential to affect 17 residents receiving meals from the kitchen and 17 of 45 residents in the facility. Findings include: The facility's policy for Food: Preparation, dated September 2017, included the following: Policy Statement All foods are prepared in accordance with the FDA Food Code. The facility's policy for Equipment, dated September 2017, included the following: Policy Statement All foodservice equipment will be clean, sanitary, and in proper working order. Procedures 1. All equipment will be…

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 resident record review, interviews, and review of the Centers for Medicare & Medicaid Services Long Term Care Facility Resident Assessment Instrument Manual, the facility failed to ensure Resident Identifier (RI) #7's quarterly Minimum Data Set (MDS) dated [DATE] and RI #29's quarterly MDS dated [DATE] were coded accurately to reflect current diagnosis. This affected two of 12 residents for whom MDS assessments were reviewed. Findings include: Review of the Centers for Medicare & Medicaid Services Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual Version 1.17.1, dated October 2019, revealed: . SECTION I: ACTIVE DIAGNOSES Intent: The items in this section are intended to code diseases that have a direct relationship to the resident's current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death. One of the important functions of the MDS assessment is to generate an updated, accurate picture of the resident's…

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, CLEAN (ASEPTIC) TREATMENT TECHNIQUE, the facility failed to ensure Employee Identifier (EI) #1, Registered Nurse (RN), Assistant Director of Nursing (ADN), Infection Control Nurse, did not place a clear plastic wound measuring tool that was lying on the resident's overbed table without a barrier, against the resident's skin to measure the resident's wound. This affected RI #6, one of two residents sampled with pressure ulcers in the facility. Findings Include: A facility policy titled, CLEAN (ASEPTIC) TREATMENT TECHNIQUE, with a revised date of 4/2018, stated: .II. Set up a clean field . e. Place a pad on the table, a water resistant pad or a clean towel on the table. f. Put all needed supplies (dressings, topical medications, cleansing solutions, etc.) on the clean field . RI #6 was readmitted to the facility on [DATE], with a diagnosis of Cerebral Palsy. On 10/08/2019 at 4:40 p.m., the surveyor observed wound care being provided by EI #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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review and interview, the facility failed to ensure a licensed staff member did not pick up a paper towel from the floor then touch the clean feeding syringe while returning it to the clean plastic bag. This deficient practice affected Resident Identifier (RI) #16, one of the four residents observed during medication administration. Findings include: RI #16 was admitted to the facility on [DATE], with diagnoses including but not limited to Other Feeding Problems of Newborn, Gastrostomy Status and Feeding Difficulties. On 10/10/19 at 8:19 a.m., the surveyor observed Employee Identifier (EI) #2, Licensed Practical Nurse (LPN) give RI #16 his/her medication. EI #2 rinsed the feeding syringe and gathered brown paper towels to dry the feeding syringe. EI #2, while drying the syringe, dropped one of the brown paper towels on the floor, picked the brown paper towel up, then placed the clean syringe into the plastic bag. While holding the contaminated brown paper towel, EI #2 touched…

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 reviews, interviews and a review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF, the facility failed to ensure a staff member did not verbally abuse Resident Identifier (RI) #39 on 8/28/18, during the provision of care. This affected RI #39, one of one sampled resident reviewed for abuse. Findings Include: A review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF with a revised date of 8/13, revealed the following: Abuse means the willful infliction of injury, . intimidation, . with resulting . mental anguish . Verbal Abuse is defined as the use of oral . language that willfully includes disparaging and derogatory terms to residents . or within the hearing distance . RI #39 was admitted to the facility on [DATE], with diagnoses including Other Obesity Due to Excess Calories, Muscular Dystrophy, Heart Failure and Scoliosis. A review of RI #39's current Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 09/12/18, revealed RI #39…

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 reviews, interviews and a review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF, the facility failed to ensure Employee Identifier (EI) #3, Certified Nursing Assistant (CNA), followed the reporting component of the abuse policy in order to report an allegation of abuse immediately to the facility Administrator, EI #1 and/or the Director of Nursing (DON) on 8/28/18. This affected Resident Identifier (RI) #39, one of one sampled resident reviewed for abuse. Findings Include: A review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF with a revised date of 8/13, revealed the following: .Reporting/Response: The facility employee . who becomes aware of abuse . shall immediately report the matter to the facility Administrator and/or the Director of Nursing . Abuse means the willful infliction of injury, . intimidation, . with resulting . mental anguish .Verbal Abuse is defined as the use of oral . language that willfully includes disparaging and derogatory…

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 reviews, interviews and a review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF, the facility failed to ensure an allegation of abuse was reported to the Administrator or the State Agency within a two hour time frame. This affected Resident Identifier (RI) #39, one of one sampled resident reviewed for abuse. Findings Include: A review of the facility's policy titled, ABUSE, PREVENTION AND PROHIBITION OF with a revised date of 8/13, revealed the following: .Reporting/Response The facility employee . who becomes aware of abuse . shall immediately report the matter to the facility Administrator and/or the Director of Nursing. An employee .may directly make a report to the state agency . The facility .employee .who has reasonable cause to believe any resident with whom they have direct contact has been subjected to abuse .or any allegation of abuse shall report or cause a report to be made to the mandated state agency per reporting criteria . Abuse means the willful infliction…

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 a review of a facility policy titled, Using the Care Plan, the facility failed to develop and implement a baseline care plan for Resident Identifier (RI) #202 for the use of a divided plate and straw. This affected one of 14 residents observed during meals. Findings Include: A review of the facility's policy titled, Using the Care Plan with a revised date of August 2006, revealed the following: Policy Statement The care plan shall be used in developing the resident's daily care routines . RI #202 was admitted to the facility on [DATE], with diagnoses including Generalized Idiopathic Epilepsy and Epileptic Syndromes, Not Intractable with Status Epilepticus, and Dependence on Wheelchair. A review of RI #202's NURSING ADMISSION/readmission DATA COLLECTION form dated 10/11/18 revealed: .Eating Needs Focus: The resident has an ADL Self Care Performance Deficit .Intervention: EATING: The resident requires total assistance to eat. A review of RI #202's ADL(Activities…

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 the facility's policy titled, Assistive Devices, the facility failed to ensure Resident Identifier (RI) #202 received a divided plate and a straw for the supper meal on 10/16/18. This affected one of 14 residents observed during meals. Findings Include: A review of the facility's policy titled, Assistive Devices with a revised date of 09/17, revealed the following: Policy Statement Assistive devices/utensils will be provided as identified in the individualized plan of care to maintain or improve a resident's/patient/s ability to eat or drink independently. RI #202 was admitted to the facility on [DATE], with diagnoses including Generalized Idiopathic Epilepsy and Epileptic Syndromes, Not Intractable with Status Epilepticus, and Dependence on Wheelchair. A review of RI #202's Tray Card revealed the following for Breakfast, Lunch and Dinner: .(RI #202) - C-Hall . DIVIDED PLATE STRAW . A review of RI #202's current October Order Summary Report dated…

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 a review of [NAME] and Perry's FUNDAMENTALS OF NURSING, the facility failed to ensure a licensed staff member washed her hands after removing unclean gloves and before applying clean gloves. This affected one of five nurses and RI (Resident Identifier) #49, one of six residents observed during medication administration. Findings Include: A review of [NAME] and Perry's FUNDAMENTALS OF NURSING Ninth Edition, Copyright 2017, page 458 revealed: .Hand Hygiene .3. If hands are not visibly soiled .use an alcohol based, waterless antiseptic agent for routinely decontaminating hands in the following clinical situations: Before, after, and between direct patient contact . After removing gloves . RI #49 was admitted to the facility on [DATE] with diagnoses of Depression and Diabetes. On 10/17/18 at 8:40 AM, the following was observed during medication administration: Employee Identifier (EI) #6, Licensed Practical Nurse/LPN, assisted RI #49 from the dining room to the therapy gym 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.