Union County Nursing Home

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, staff interviews, record review, and review of the facility's policy titled, Comprehensive Care Plan Meetings, the facility failed to implement the comprehensive care plan for one of 34 residents (R) (R82). The deficient practice had the potential to prevent R82 from receiving services according to their care needs.Findings include:Review of the facility's undated policy titled, Care Plan Meetings revealed under Purpose: .Each resident will have an individualized interdisciplinary plan of care in place.The Comprehensive Care plan will be ongoing, focusing on each induvial resident as a unitary being. Resident and their representative will play an active role in the development of goals and implementation of the residents' Comprehensive Care Plan. Under Procedure: number 2.This comprehensive care plan will address resident goals, actual and potential problems, needs, strengths, and individual preferences for the resident.Review of R82's Electronic Medical Record (EMR) revealed diagnoses…

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, staff interviews, record review, and review of the facility's policy titled, Administration of Medications, the facility failed to ensure one of four residents (R) (R82) bilateral hearing aids were applied as ordered by the physician. The deficient practice had the potential to reduce R82 quality of life by increasing the probability of impaired communication.Findings include:Review of the facility's policy titled, Administration of Medications, dated 2/2021, revealed under Procedure: D. The person administering the drugs immediately following the administration must chart medication administration as being given on the eMAR. The eMAR applies the date, time administered, dosage, ect., and e-signs by the person entering the data.Review of R82's Electronic Medical Record (EMR) revealed diagnoses that included, but were not limited to bilateral hearing loss, receptive expressive language disorder, dementia, and cognitive communication deficit.Review of R82's Quarterly Minimum Data Set (MDS)…

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, staff interviews, record review, and review of the facility's policies, titled Cleaning and Disinfection of Resident-Care Items and Equipment and Enhanced Barrier Precautions, the facility failed to ensure infection control practices were followed for four of 15 residents (R) (R7, R9, R75 and R83). Specifically, the facility failed to maintain Enhanced Barrier Precautions (EBP) when administering medications via gastrostomy tube for R9, and providing urinary catheter care for R7, the facility also failed to ensure shared medical equipment was sanitized between R75 and R83 during medication administration.Findings include:Review of the facility's policy titled, Cleaning and Disinfection of Resident-Care Items and Equipment, revised 2/2021 under Policy Interpretation and Implementation: 1.c.non-critical items are those that come in contact with intact skin but not mucous membranes. 1. Non- critical resident-care items include bedpans, blood pressure cuffs, crutches and computers. d. Reusable…

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, staff interviews, and review of the facility-provided document titled Texture Modification Inservice, the facility failed to ensure a puree recipe was followed to conserve the nutrient value of puree country-fried steak for six of six residents receiving a pureed diet. This deficient practice had the potential to cause residents receiving a pureed diet to have a decreased nutritional intake and a potential for weight loss. Findings include: Review of the undated facility-provided document titled Texture Modification Inservice revealed the section titled Guidelines for Texture Modification: Pureed Foods included Never free pour large amounts of liquids or thickeners into purees as it can impact the nutritional value and quality of the food item. Observation on 6/26/2024 at 10:45 am of the Dietary Manager in Training (DMIT) BB preparing pureed foods revealed she did not have or follow a recipe as she prepared the pureed country-fried steaks. DMIT BB prepared the pureed country-fried steak with broth and several cups of water. In an interview during 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 observation, staff interviews, and review of the facility's policy titled Receiving, the facility failed to appropriately label and date food items stored in the kitchen's walk-in freezer. The deficient practice(s) had the potential to place 96 residents who received an oral diet from the kitchen at risk of contracting a foodborne illness. The facility census was 101. Findings include: A review of the facility's policy titled Receiving revealed the Policy Statement of Safe food handling procedures for time and temperature control will be practiced in the transportation, delivery, and subsequent storage of all food items. The Procedures section documented 5. All food items will be appropriately labeled and dated either by manufacturer packaging or staff notation. An observation of the walk-in freezer in the kitchen with the Registered Dietitian (RD) and Dietary Manager (DM) on 6/25/2024 at 9:15 am revealed two open boxes of cookie dough with about 60 cookies in one box and 80 cookies in the other box. The RD confirmed the two boxes of cookie dough were opened and not labeled…

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, staff interviews, and review of the facility policy titled, Storage of Medication, the facility failed to properly maintain, and store three of six medication cart as evidenced by missing end of shift controlled medication count signatures. Findings include: Review of the facility policy titled Storage of Medication revised April 2007 revealed under Policy Statement: The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Observation on 6/27/2024 at 9:45 am of three of six medication carts revealed each cart had a controlled substance book which had the current months End of Shift Controlled Drug Count sheet in each book. The Pink A Hall sheet was missing five signatures, the pink B Hall sheet was missing 10 signatures, and the blue C Hall was missing three signatures on their sheets. Interview on 6/27/2024 at 9:52 am with RN NN revealed that the Medication Room Pink B Hall had no issues and the medication cart - Pink B Hall cart had no storage issues. The interview revealed that the nurse who was coming on and the nurse who…

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 staff interviews, record review, and review of the facility policies titled, Antipsychotic Drug Use and PRN Medication, the facility failed to make recommendations to include stop dates for psychoactive medications lorazepam, used to treat anxiety, and trazodone, used to treat insomnia, which were prescribed as needed (PRN) for two of five sampled residents (R18 and R64). The deficiency had the potential to adversely affect the severity of the diagnoses for which they were prescribed. Findings include: Review of the undated facility policy titled, Antipsychotic Drug Use revealed under Policy Interpretation and Implementation: The need to continue PRN orders for psychotropic medications beyond 14 days requires that the practitioner document the rationale for the extended order. Review of the facility policy titled PRN Medication, revised 11/7/2022, revealed the Policy was The pharmacist is responsible for assuring appropriate and safe prescribing procedures are followed. The frequency with which PRN or…

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, family and staff interviews, record review, and review of the facility policy titled, Mouth Care, the facility failed to provide denture care for two of 42 sampled residents (R) (R26 and R78). The deficient practice had the potential to cause mouth pain and discomfort, that could lead to decreased oral intake of nutrition and hydration for R26 and R78. Findings include: Review of the facility policy titled Mouth Care with a revision date of February 2018 revealed that the Purposes of this procedure are to keep the resident's lips and oral tissues moist, to cleanse and freshen the residents' mouth, and to prevent oral infections. 1. Review of the Electronic Medical Record (EMR) for R26 revealed that she was admitted to the facility with diagnoses that included but were not limited to a fracture of shaft of humerus and superior rim of left pubis. Review of the admission Minimum Data Set (MDS) with a completion date of 5/10/2024 revealed that R26 had a Basic Interview of Mental Status (BIMS)…

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, staff interviews, record review, and review of facility policies titled Hand Hygiene, Perineal Care, and Administering IV Medications, the facility failed to use proper hand hygiene during perineal and catheter care for one resident (R) (R75), failed to properly close the door to a transmission-based precautions (TBP) room for one resident (R257), and to properly disinfect a needleless connector on a percutaneous intravenous central catheter (PICC) line after flushing and before connecting the intravenous antibiotic for one resident (R258). The deficient practices had the potential to place the residents at risk for serious infections. The sample size was 42 residents. Findings include: Review of the undated facility policy titled Hand Hygiene under Policy revealed, All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility. Under Policy Explanation and Compliance Guidelines revealed, Additional considerations: (a)…

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 policies titled Receiving, Food Storage: Dry Goods, and Food Storage: Cold Foods, the facility failed to ensure opened food items in the dry storage area were labeled and dated; failed to discard expired food items in the walk-in freezer, two reach in freezers and two of two resident pantries. This deficiency had the potential to affect 90 of 91 residents receiving an oral diet. Findings include: 1. Review of the policy titled Receiving revised 9/2017, revealed the policy is that safe food handling procedures for time and temperature control will be practiced in the transportation, delivery, and subsequent storage of all food items. Procedure: 5. All food items will be appropriately labeled and dated either through manufacturer packaging or staff notation. 6. All food items will be stored in a manner that ensures appropriate and timely utilization based on the principals of first in-first out inventory management. Review of the policy titled Food Storage: Dry Goods revised 9/2017, revealed the policy is all dry goods 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 observations, interviews, and policy review, the facility failed to ensure that essential equipment in the kitchen was in working order as evidenced by ice buildup inside the walk-in freezer on an air flow vent above the doorway, ice formation down the interior door frame, and across the floor. This deficiency had the potential to affect 90 of 91 residents receiving an oral diet. Findings include: Review of the policy titled Equipment revised 9/2017, revealed the policy statement is all foodservice equipment will be clean, sanitary, and in proper working order. Procedure: number 1. All equipment will be routinely cleaned and maintained in accordance with manufacturer's directions and training materials. Number 4. All non-food contact equipment will be clean and free of debris. During the initial tour of the kitchen on 1/10/2023 at 9:25 a.m. with the Certified Dietary Manager (CDM) and the Registered Dietician (RD), the walk-in freezer was observed to have ice formation measuring approximately four…

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, staff interviews, and review of the facility policy titled Bathrooms, the facility failed to maintain a safe, clean, comfortable, and homelike environment related to dust build up on bathroom air vents on one of six resident halls, rooms 201 through 217. Findings include: Review of the facility policy titled Bathrooms revised 4/2006, revealed the policy statement is bathrooms shall be maintained in a clean and sanitary manner and shall be cleaned on a daily basis. Observation on 1/10/2023 at 11:57 a.m. and 1/11/2023 at 11:25 a.m. revealed the bathroom air vents in resident rooms 201 through 217 were noted to have dust buildup on and in them. Observation and interviews on 1/12/2023 at 11:26 a.m. with the Administrator, Engineering Supervisor, and the Housekeeping Supervisor, verified the dust buildup on the vents in the bathrooms of rooms 201 through 217. The Engineering Supervisor indicated they take the vents down yearly and clean them. The Administrator indicated that housekeeping should be cleaning them as needed when dust is visible. The Administrator…

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 policy review, the facility failed to ensure the environment was free from potential accident hazards by not ensuring that medications, biologicals, or other potentially harmful material was not left within the reach of one resident (R) (R#94). The sample size was 32. Findings include: Review of the policy titled Copy of 5.d Storage and Expiration of Medications, Biologicals, Syringes, and Needles dated 1/2023 revealed procedure: C. General storage procedures: 3. Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. M: Bedside medication storage: 1. Facility should not administer/provide bedside medications or biologicals without a physician/prescriber order and approval by the interdisciplinary care team and facility administration. 2. Facility should store bedside medication or biologicals in a locked…

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 facility policies, the facility failed to clean and ensure proper storage continuous positive airway pressure (CPAP) mask in a manner to prevent cross contamination for one of three residents (R) R#85, receiving CPAP administration. The census was 91. Findings include: 1. Review of the policy titled Cleaning and Disinfection of Resident-Care Items and Equipment revised 10/2018, revealed the Policy Interpretation and Implementation number 1. The following categories are used to distinguish the levels of sterilization/disinfection necessary for items in resident care: b.) Semi-critical items consists of items that may come in contact with mucus membranes or non-intact skin (e.g., respiratory therapy equipment). 2. Critical and semi-critical items will be sterilized/disinfected in a central processing location and stored appropriately until use. 2. Review of the policy titled CPAP/BiPAP Support revised 3/2015 revealed: General Guidelines section number…

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.