Murphy Rehabilitation & Nursing

Based on observations and staff interviews, the facility failed to prevent the potential for cross contamination by storing a plastic scoop inside the dry flour ingredient bin allowing the handle to touch the dry flour for 1 of 1 observation. The facility also failed to ensure staff had their hair restrained in the kitchen while bagging utensils for 1 of 1 staff observed bagging utensils and failed to ensure staff changed gloves before touching resident foods for 2 of 3 staff observed preparing food. These practices had the potential to affect food served to all the residents. Findings included: a. During an observation of the kitchen on 12/16/24 at 9:50 AM, the flour scoop was observed in the flour bin and the handle was visibly touching the flour. During an interview on 12/16/24 at 9:50 AM, the Dietary Manager stated the staff had just forgotten to take the scoop out of the flour. b. During an observation of the kitchen on 12/17/24 at 11:45 AM, Dietary Aide #1 was observed to be bagging eating utensils. He was not wearing a hair restraint or hat. He was observed to have short dark…

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 staff interviews the facility failed to utilize an official form for code status (official portable Do Not Resuscitate [DNR] or Medical Order for Scope of Treatment [MOST] form) recognized by emergency medical services and pursuant to North Carolina (NC) general statute for residents who chose a code status of DNR (did not want chest compressions if their heart stopped beating) for 5 of 24 residents (Resident #52, #51, #73, #20, and #43) reviewed for advance directives. The findings included: The North Carolina Office of Emergency Medical Services (EMS) website indicated the following: Pursuant to N.C. General Statute 90-21.17, the department, through the Office of Emergency Medical Services, has adopted an official portable Do Not Resuscitate (DNR) form and Medical Order for Scope of Treatment (MOST) form for use by physicians and other licensed healthcare facilities to assist in providing information relating to a patient ' s desire for resuscitation or life-prolonging measures. 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 record reviews, the facility failed to discard expired eye drops from the medication carts as specified by the manufacturer's guidelines and failed to remove expired over the counter (OTC) medications from the medication cart in accordance with the manufacturer's expiration date for 2 of 7 medication carts (600 halls and 700 halls). The findings included: a. The manufacturer's package inserts for Latanoprost eye drops revealed an unopened bottle should be stored under refrigeration between the temperature of 36° to 46° Fahrenheit (F) and protected from light. Once it was opened, Latanoprost could be stored at room temperature up to 77° F for up to six weeks. A medication storage audit was conducted on 12/18/24 at 2:34 PM for 700 halls medication cart in the presence of Nurse #1. One opened bottle of Latanoprost 0.005% eye drops was found in the medication cart under room temperature and ready to be used. The handwriting on the label indicated it was opened on 11/03/24. The eye drops expired on 12/15/24 after they were opened and stored in…

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 family and staff interviews, the facility failed to immediately notify a resident's Responsible Party of a new order for antibiotic medication to treat a bacterial infection for 1 of 1 sampled resident reviewed for notification of change (Resident #4). Findings included: Resident #4 was admitted to the facility on [DATE]. The annual Minimum Data Set (MDS) dated [DATE] assessed Resident #4 with severe impairment in cognition. Review of Resident #4's profile revealed her family member was listed as her Responsible Party (RP). Review of Resident #4's urine culture results dated 12/12/24 revealed an abnormal value positive for Escherichia coli (type of bacteria that can cause urinary tract infections). A physician order for Resident #4 dated 12/12/24 read, amoxicillin potassium clavulanate (antibiotic medication used to treat bacterial infections) 875-125 milligrams (mg) - give one tablet by mouth every 12 hours for cystitis (type of urinary tract infection that affects the bladder) for 7…

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 2. Resident #23 was admitted to the facility on [DATE] with diagnoses which included diabetes mellitus and non-Alzheimer's dementia. The quarterly Minimum Data Set (MDS) dated [DATE] was coded for a nutritional approach which included a feeding tube while a resident. Review of physician's orders revealed no order for a feeding tube. Resident had an order dated 9/26/24 for controlled carbohydrate diet with regular texture and regular, thin consistency liquids. An interview with the MDS Coordinator on 12/18/24 at 8:19 AM revealed the Assistant Dietary Manager was responsible for coding the nutrition section of the MDS. An interview with the Assistant Dietary Manager on 12/18/24 at 8:45 AM revealed she had coded the nutrition section of Resident #23's quarterly MDS. She stated the resident did not have a feeding tube and she had mistakenly coded the resident as having a feeding tube. An interview with the Administrator on 12/19/24 at 9:49 AM indicated the resident's MDS assessments should be coded accurately. Based…

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, and resident and staff interviews, the facility failed to apply offer application of tubing grip stockings (compression stockings used to treat swelling) to a resident as ordered by the physician 1 of 1 resident (Resident # 73) with a physician order for tube grip stockings. The findings included: Resident #73 was admitted to the facility on [DATE]. Review of a physician's order dated 11/5/2024 revealed Resident #73 was ordered to have tubing grip stockings (compression stockings used to treat swelling) applied every day shift for edema (swelling). Review of a quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #73 was cognitively intact with no behaviors or rejections of care. Resident #73 had impairment on both sides of her lower extremities and was dependent for lower body dressing. Review of a care plan dated 11/7/2024 revealed Resident #73 was to be free from skin alterations with interventions which included to elevate her legs while in bed and staff should…

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, and staff interviews the facility failed to obtain an order for a resident who required oxygen oxygen (Resident #51) and failed to place post cautionary safety signs that indicated the use of oxygen (Resident #52) for 2 of 4 residents reviewed for oxygen use. The findings included: 1) Resident #51 was admitted to the facility on [DATE] with diagnoses which included chronic obstructive pulmonary disease (COPD, lung disease that makes it difficult to breathe). Review of a quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #51 was severely cognitively impaired and was not on oxygen. Review of Resident #51's physician's orders revealed there were no orders for supplemental oxygen. An observation was conducted on 12/16/2024 at 11:10 am of Resident #51. Resident #51 was observed lying in bed with oxygen on at 3 liters per minute via nasal canula. Resident #51 had cautionary oxygen signage posted on the door frame. An observation was conducted on 12/17/2024 at 8:58 am…

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 and interviews with the Dental Representative, family, resident and staff, the facility failed to obtain dental services for a resident with a broken partial denture for 1 of 1 resident reviewed for dental services (Resident #4). Findings included: Resident #4 was admitted to the facility on [DATE]. A care plan initiated on 10/27/22 revealed Resident #4 had her own natural teeth with some missing and had an upper partial denture. Interventions included to assist in arranging dental exams as needed, requested or ordered. The annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #4 had severe cognitive impairment. Resident #4 was independent with eating, was not receiving a mechanically altered or therapeutic diet and there were no oral/dental concerns. A staff progress note dated 11/21/24 written by Social Worker (SW) #2 revealed in part, Resident #4's Responsible Party (RP) called the SW to discuss Resident #4's broken partial denture and requested the SW 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, resident and staff interviews, the facility failed to ensure accurate medical records when a resident's edema (swelling) stockings were incorrectly documented as applied for 1 of 1 resident (Resident # 73) reviewed for medical record accuracy. The findings included: Resident #73 was admitted to the facility on [DATE]. Review of a physician's order dated 11/5/2024 revealed Resident #73 was ordered to have tubing grip stockings (compression stockings used to treat swelling) applied every day shift for edema (swelling). Review of a quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #73 was cognitively intact with no behaviors or rejections of care. Resident #73 had impairment on both sides of her lower extremities and was dependent for lower body dressing. Review of the Treatment Administration Record (TAR) for December 2024, for the period of 12/1/2024 through 12/17/2024 revealed the Treatment Nurse had documented he had applied Resident #73's tubing grip…

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 and staff interviews the facility failed to remove expired food in 1 of 2 kitchen refrigerators. The facility failed to clean and maintain 1 of 4 ice machines. This practice had the potential to affect food and beverages served to residents. Findings Included: On 7/24/23 at 08:22 AM an observation of the walk-in refrigerator with the Dietary Manager (DM) was conducted. The observation revealed one 4-quart container closed with a lid labeled tuna salad with the dates 7/16 use by 7/19 located on the second shelf of the walk-in refrigerator. The container was 1/4 full, and was immediately removed by the DM. The DM stated on 7/24/23 at 8:36 AM the tuna salad should not have been in the walk-in refrigerator. The DM stated the evening cook checked for expired foods daily and he (DM) checked for expired food in the morning when working. The DM said the tuna salad was overlooked. On 7/26/23 at 11:00 AM an observation of the Maple Unit nourishment room ice machine with the DM was conducted. The observation revealed the inside roof of the ice machine to contain grey…

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 and staff interviews the facility's Quality Assurance Activity (QAA) committee failed to maintain implemented procedures and monitor interventions that the committee had previously put into place following the facility's 1/28/22 recertification survey. The failure was related to one deficiency that was originally cited during the 1/28/22 recertification survey and was cited on the current recertification and complaint survey of 7/27/23. The recited deficiency was in the area of food safety requirements to store, prepare, distribute and serve food in accordance with professional standards for food service safety. The continued failure of the facility during two surveys of record in the same area showed a pattern of the facility's inability to sustain an effective Quality Assurance program. The Findings included: This tag is cross referenced to: F 812 Based on observations and staff interviews the facility failed to remove expired food in 1 of 2 kitchen refrigerators. The facility failed to clean and maintain 1 of 4 ice machines. This practice had the potential 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, record review, and interviews with resident and staff, the facility failed to maintain a wheelchair in good repair for 1 of 1 resident reviewed for a safe, comfortable, homelike environment (Resident #86). The findings included: Resident #86 was admitted to the facility on [DATE]. Review of weekly skin assessment from 05/06/23 through 07/22/23 revealed Resident #86 did not have any skin issues. Review of the admission Minimum Data Set (MDS) dated [DATE] assessed Resident #86 with moderately impaired cognition and her primary mobility device was a wheelchair. During an observation conducted on 07/24/23 at 09:12 AM, Resident #86 was seen sitting in her wheelchair in the hallway outside of her room. The left armrest of Resident #86's wheelchair was in disrepair with a torn spot approximately 2 by 0.5 inches along with multiple cracked and ripped lines. The right arm rest had multiple cracked and ripped lines as well. Resident #86 was wearing short sleeves sitting in the wheelchair and both of…

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.