Smoky Mountain Health and Rehabilitation Center

Based on observations and staff interviews, the facility failed to dispose of food stored past the use by date in 1 of 1 dry food storage area, failed to keep beverages off the floor and failed to clean 1 of 1 walk-in refrigerator for food storage. The deficient practice had the potential to affect food served to residents.Findings Included a. On 3/16/26 at 10:40 AM, an observation of the walk-in refrigerator was conducted with the Dietary Manager. The floor under the food storage racks contained a buildup of grey white debris that crumbled when touched. Several areas of the floor were raised, white, and fuzzy in appearance. The food storage racks also had a thick, grey, sticky substance on the metal shelving.During the observation, the Dietary Manager stated that the food storage racks were last cleaned in January of the current year. She reported that the walk-in refrigerator floor was scheduled to be replaced and, for that reason, had not been cleaned. She did not know when the replacement would occur but stated she would clean the floor.b. At 10:48 AM on 3/16/26, the dry food…

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 and interviews with resident, staff and the Medical Director, the facility failed to ensure an as needed (PRN) psychotropic medication, Clonazepam (a medication primarily used for panic disorder), had a stop date of 14 days for 1 of 5 residents reviewed for unnecessary medications (Resident #44).Findings included:Resident #44 was admitted to the facility on [DATE] with diagnoses that included anxiety disorder.The quarterly Minimum Data Set assessment dated [DATE] indicated Resident #44 was cognitively intact and that she received antianxiety medications during the assessment period.Resident #44's care plan last reviewed on 2/11/26 indicated the use of psychotropic medications with the potential for adverse effects. The goal was to show improvement in mood/decreased behaviors with minimal side effects of the medications taken through next review. Interventions included administering medications per physician's orders.A review of the physician's orders in Resident #44's medical record…

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 interviews with residents, Responsible Party and staff the facility failed to explain the arbitration agreement document in a manner understood by residents and their Responsible Parties. This was for 3 of 3 residents reviewed for arbitration agreement (Resident #1, Resident #3, Resident #4).Findings includedThe facility's arbitration agreement was reviewed. The arbitration agreement wrote Agreement is not a precondition to admission or the furnishing of services to the resident by the Facility, and (3) this agreement may be rescinded by written notice to the facility within thirty (30) days of signature. If not rescinded within thirty (30) days, this agreement shall remain in effect for all care and services subsequently rendered at the facility, even if such care and services are rendered following the resident's discharge and readmission to the facility. The document included a signature line below verbiage for the resident or responsible party with no further indication 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, the facility failed to complete the Care Area Assessment (CAA) comprehensively to address the underlying causes and contributing factors of the triggered areas for 2 of 5 sampled residents reviewed for unnecessary medications (Residents #10 and Resident #11). The findings included: a. Resident #10 was admitted to the facility on [DATE] with diagnoses including non-Alzheimer's dementia, anxiety disorder, and osteoarthritis. A review of Section V (CAA Summary) of the significant change in status MDS assessment dated [DATE] revealed 10 care areas were triggered for Resident #10. The MDS Coordinator did not provide any information in the analysis of findings for 9 of the 10 triggered areas to describe the nature of Resident 10's problems, possible causes, contributing factors, risk factors related to the care area, and reasons to proceed with care planning for the following triggered care areas: 1. Delirium 2. Cognitive loss/dementia 3. Visual functions 4. Communication…

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 ensure a Preadmission Screening and Resident Review (PASRR) application was completed for a resident who had a new psychiatric diagnosis for 1 of 1 resident (Resident #10) reviewed for PASRR. The findings included: Resident #10 was admitted to the facility 9/2/23 with diagnoses that included polyosteoarthritis, and generalized anxiety disorder. Resident #10's care plan initiated on 4/8/24 indicated Resident #10 had actual acute confusional state characterized by behaviors, altered thought process, delusions and hallucinations related to legal blindness and hearing deficit. A review of Resident #10's medical record indicated hallucinations was added to her diagnoses list effective 8/1/24. There was no information in Resident #10's medical record regarding the PASRR number or if a new application for PASRR was completed by facility staff after Resident #10 was diagnosed with hallucinations. The most recent quarterly Minimum Data Set assessment…

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 post cautionary and safety signage outside a resident's room that indicated the use of oxygen for 1 of 1 resident reviewed for respiratory care (Resident #239). The findings included: Resident #239 was admitted to the facility on [DATE] with diagnoses that included acute respiratory failure with hypoxia (a condition in which there is an inadequate supply of oxygen to the body's tissues). A review of Resident #239's physician orders revealed an order dated 01/17/25 for oxygen to be administered continuously via nasal cannula at 2 liters per minute, may titrate to keep oxygen (O2) saturation greater than 90%. A review of the admission Minimum Data Set (MDS) dated [DATE] indicated Resident #239 was cognitively intact and coded for oxygen use. An observation on 02/02/25 at 11:54 AM revealed Resident #239 sitting in his wheelchair by his bed with oxygen being administered by an oxygen concentrator. He was holding the nasal cannula 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.

Based on observations, staff interviews and record review, the facility failed to remove expired medication in accordance with manufacturer's expiration date and failed to date a time sensitive eye drops after it was opened and stored at room temperature for 1 or 2 medications carts observed during medication storage checks (Medication Cart #1). The findings included: Review of the manufacturer's package insert for Latanoprost eye drops revealed an unopened bottle should be stored under refrigeration between 36° to 46° Fahrenheit (F) and protected from light. Once opened, Latanoprost may be stored at room temperature up to 77° F for up to six weeks. An observation was conducted on 02/03/25 at 3:49 PM for Medication Cart #1 in the presence of Nurse #2. The observation revealed the following: - One opened bottle of Latanoprost 0.005% eye drop (medication used to treat glaucoma) for Resident #14 was stored at room temperature without an opening date and ready to be used. A sticker for the nurse to record the opening date remained blank. - One opened bottle of docusate sodium liquid…

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 a lunch meal tray line observation, record review, and staff interviews the facility failed to serve cod in a three-ounce portion per the menu. This failure had the potential to affect 15 residents with orders for mechanical soft diet texture. Findings included: The menu for the lunch meal on 09/26/23 for residents receiving a mechanical soft diet was 3 ounces of baked cod, a half cup of au gratin potatoes, a half cup of green peas, and a dinner roll. A continuous observation of the lunch meal tray line on 09/26/23 from 12:00 PM through 12:15 PM revealed [NAME] #1 began plating food and used a number 16 scoop (contained 2-2.25 ounces) to plate cod for residents receiving a mechanical soft diet. [NAME] #1 was observed giving a level scoop of cod using the number 16 scoop. During the observation [NAME] #1 dropped the number 16 scoop into an open area on the steam table and retrieved a number 8 scoop (contained 4-5 ounces) from a drawer close to the steam table and continued plating the cod for residents receiving a mechanical soft diet texture. [NAME] #1 did not use 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and staff interviews the facility failed to maintain a resident's privacy by checking her fingerstick blood glucose in the dining room in the presence of other residents and a visitor for 1 of 1 resident (Resident #17). The reasonable person concept was applied to this deficiency and a reasonable person would expect privacy when their fingerstick blood sugar was checked. Findings included: Resident #17 was admitted to the facility 03/06/18 with diagnoses including diabetes and non-Alzheimer's dementia. Review of Resident #17's Physician orders revealed an order dated 07/06/23 to check her blood sugar three times a day and as needed. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #17 was severely cognitively impaired. An observation of Resident #17 on 09/26/23 at 12:26 PM revealed she was sitting in the dining room eating lunch. Three other residents were observed sitting at the table with Resident #17 and were also eating lunch. Nurse #1 approached…

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, observations, and interviews with staff, the facility failed to ensure personal and oral hygiene was provided for a resident dependent on staff to trim and clean visibly dirty fingernails and brush and clean visibly dirty dentures for 1 of 2 residents reviewed for activities of daily living (Resident #35). Findings included: Resident #35 was admitted to the facility on [DATE] with diagnoses including dementia, Alzheimer's disease, and cerebrovascular accident (stroke). The quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #35 cognition was significantly impaired and extensive assistance was needed for personal hygiene. The MDS assessment did not identify Resident #35 had rejection of care behaviors during the lookback period. Resident #35's care plan for activities of daily living (ADL) and personal care revised on 09/25/23 read in part, Care would be completed with staff support as appropriate to maintain or achieve the highest practical level of functioning.…

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.