Barren County Nursing and Rehabilitation

Based on observation, interview, and review of the facility's policy, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety, which had the potential to affect 89 of the facility's 89 residents who consumed food from the kitchen. Observation of the kitchen area revealed food items were exposed to the air and/or potential contamination. Both the refrigerator and dishwasher area had strong odors, and several areas of the kitchen were soiled. One of the facility's ice machines, which was used to serve ice to the residents, was not clean. The findings include: Review of the facility policy titled, Food Receiving and Storage, revised 07/2014, revealed food shall be received and stored in a manner that complies with safe food handling practices. Per this policy, all foods stored in the refrigerator or freezer would be covered. Continued review of the policy revealed food services or other designated staff would maintain clean food storage areas at all times. 1. Observation during initial tour of the kitchen 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, record review, and policy review, the facility failed to develop and implement a comprehensive person-centered care plan for one (Resident (R) 60) of 19 sampled residents. The resident was assessed with skin tears on admission and through the Minimum Data Set (MDS) assessment process. However, the facility failed to care plan this specific, active care need. In addition, staff failed to implement care plan interventions by providing care as ordered for R60. The findings include:Review of the facility policy titled Comprehensive Care Plans, revised on 03/03/2025, revealed it was the policy of the facility to develop and implement a comprehensive person-centered care plan for each resident to meet a resident's medical, physical, mental, and psychosocial needs. The comprehensive care plan would describe services to be furnished to attain or maintain the resident's highest practical physical, mental, and psychosocial well-being, and specific interventions that reflect 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, record review, and review of facility policy it was determined the facility failed to ensure that one (Resident (R) 60) of 19 sampled residents received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan. Staff failed to provide treatment in accordance with the care plan and physician orders for R60, who had non-pressure related skin impairment. The findings include:Review of the facility policy titled Skin Integrity - Skin Tears, dated 01/02/2020 and revised on 03/24/2022, revealed it was the policy of the facility to provide proper treatment and care to maintain skin integrity. This policy pertains to the prevention and management of skin tears. The facility would utilize a systematic approach for the prevention and management of skin tears, including assessment, care planning, monitoring, and modification of interventions as appropriate.Review of the Resident Face Sheet revealed the facility admitted R60 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, the facility failed to provide respiratory care as care planned and ordered for one (Resident (R) 91) of 19 sampled residents. Staff failed to ensure that oxygen therapy was delivered in accordance with physician orders. The findings include: Review of the facility policy titled Oxygen Administration, dated 01/02/2021, revealed oxygen therapy would be administered only under the order of the physician. Per this policy, the care plan shall identify interventions to include the type of oxygen delivery system and equipment setting for prescribed flow rates.Review of the Resident Face Sheet revealed the facility admitted R91 to the facility on [DATE] with diagnoses that include chronic obstructive pulmonary disease (COPD).Review of the Comprehensive Care Plan, reviewed 06/10/2025, revealed R91 had a problem for respiratory/pulmonary. Per the care plan, R91 had a respiratory problem with impaired gas exchange related to COPD. Interventions…

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 interviews, record review, facility document review, and facility policy review, it was determined the facility failed to ensure a consistent process was in place for addressing resident grievances and maintaining evidence of efforts to resolve grievances for one (1) of one (1) sampled residents reviewed for grievance concerns (Resident #42) of a total sample of twenty-nine (29) residents. Interview with Resident #42 on 03/06/2023 at 10:46 AM, revealed the resident had expressed concerns about his/her roommate, and missing items. Further interviews revealed the facility failed to complete a grievance and make efforts to resolve the grievance. The findings include: Review of the facility's policy, Resident and Family Grievances, dated 01/04/2020, revealed the facility would support each resident's and family member's right to voice grievances without discrimination, reprisal or fear of discrimination or reprisal. The policy also revealed grievances may be voiced in the following forms: a verbal complaint to a staff member or Grievance Official, written complaint to a staff…

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 facility policy review, it was determined the facility failed to ensure food was covered during transport to two (2) (Gold and [NAME] Hall) of five (5) resident hallways to prevent potential contamination of residents' food. This deficient practice had the potential to affect forty-six (46) residents who resided on the Gold and [NAME] Halls. Observations on 03/07/2023 and 03/08/2023, revealed staff parked a covered meal tray cart between Room nine (9) and Room ten (10) on the Gold Hall. Continued observation revealed staff carried residents' meal trays to Rooms #1 (one), #10 (10), and #12 (twelve). The meal trays contained sugar cookies, salads, and beverages that were uncovered and exposed to air. The findings include: Review of the facility's policy, Assistance with Meals, not dated, revealed the policy did not address covering food items during meal delivery. Observation on 03/07/2023 at 11:32 AM, revealed staff parked a covered meal tray cart between room [ROOM 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure the care plan was reviewed and revised for one (1) of eighteen (18) sampled residents (Resident #40). Resident #40 was on anti-coagulant therapy and required diabetic care for insulin dependent diabetes; however, there were no interventions documented on the Certified Nurse Aide (CNA) care plans so the CNA's would know what care/precautions to provide the resident. The findings included: Review of the facility policy titled, Care Plans, Comprehensive Person-Centered, dated December 2016 revealed a Comprehensive, person-center care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. The comprehensive, person-centered care plan will include measurable objectives and timeframe's and will describe the services that are to be furnished to attain or maintain 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.

Based on observation, interview, and record review, it was determined the facility failed to ensure two (2) of three (3) sampled residents reviewed for respiratory care in the selcted sample of eighteen (18) received necessary respiratory care and services that is in accordance with professional standards (Residents #69 and #72). Observations on 12/02/19, 12/03/19, and 12/04/19, revealed Resident #69's nebulizer was not being stored properly when not in use. Further observation revealed Resident #72 did not have a No Smoking/Oxygen in use sign posted outside the door. The findings include: Review of the facility policy, Oxygen Administration, not dated, revealed in order to ensure safe oxygen administration a No Smoking/Oxygen in Use sign should be placed outside of the room entrance door. Review of the facility policy, Administering Medications through a Small Volume Nebulizer, not dated, revealed equipment should be stored in a plastic bag when not in use. Record review revealed the facility admitted Resident #69 on 07/27/15, with diagnoses which include Chronic Obstructive…

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 the facility's policy, it was determined the facility failed to ensure drugs and biological's used in the facility must be labeled in accordance with currently accepted professional principles, and include the the expiration date when applicable related to four (4) insulin pens not being dated when opened; and a bottle of Tums not being stored appropriately. The findings include: Review of the facility's policy, titled, Storage of Medication, not dated, revealed if a medication was not dated the facility was to use the pharmacy dispense date as the date opened. Further review of the policy revealed Review of the facility's policy revealed the facility shall store all drugs and biological's in a safe, secure, and orderly manner. Observation of two (2) of four (4) medication carts, on 12/02/19 at 2:06 PM, revealed one (1) medication cart with four (4) insulin pens not dated when opened. Interviews on 12/02/19 with Licensed Practical Nurse (LPN) #1 at 2:15 PM and LPN #2 at 2:20 PM revealed any multi-dose vial of medication…

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 policy, it was determined the facility failed to serve food in accordance with professional standards for food service safety related to lack of hand sanitation during meal pass. The findings include: Review of facility policy,Assisting the Resident with In-Room Meals, not dated, revealed if there is contact with soiled dishes, clothing or the resident's personal effects, the employee must wash his/her hands before serving food to the next resident. Observation during a meal pass on 12/02/19 at 12:06 PM, on the one-hundred [NAME] Hall (100) hall, revealed a staff member failed to sanitize her hands while distributing and setting up trays for three residents. Further observation revealed she pulled soiled privacy curtains twice during the tray pass and failed to sanitize her hands. Interview with Certified Nurse Aide (CNA) #1 on 12/02/19 at 12:19 PM, revealed she should have sanitized her hands after touching contaminated items and in between residents while passing trays. Interview with the Director of Nursing (DON) on 12/04/19…

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.