Nashville Center For Rehabilitation And Healing Ll

Based on facility policy review, observation, and interview the facility failed to have 1 of 40 operable call lights. The findings include: Review of the undated facility policy titled, Answering the Call Light revealed .Be sure the call light is plugged in and functioning at all times . Observation and interview in Resident #62's room on 3/14/2023 at 9:22 AM, Resident #62 stated his call light was not working. Continued interview revealed I push the hell out of the button before it will come on. Observation and interview in Resident #62's room on 3/14/2023 at 9:35 AM, confirmed the Unit Manger pressed the call light and it was not working. The Unit Manager reset the call light button and the light lit up. Then she turned it off and pressed the button again and it did not work. During an interview on 3/14/2023 at 9:45 AM, the Director of Maintenance confirmed the call light cord was worn and had been dropped which caused it not to work.

Based on facility policy review, observation, and interview the facility failed to have adequate dining space for 3 of 3 rooms in the facility. The findings include: Review of the facility policy titled, TN COVID Communal Dining and Activity Programs, and Resident Outings revised 11/2022, revealed .Communal actvities and dining do not have to be paused during an outbreak, unless directed by the state or local health department . Observation in the 600 hall activties/dining room on 3/14/2023 at 7:55 AM revealed the door had a key pad which required a code before entering. There was a big TV (television) and various tables and chairs used for actvities. Contnued observation revealed games and activties stacked up aganist the wall on the shelves. Observation in the dining area for the 100, 200, 300, and 400 halls (Rehabilitation unit) on 3/15/2023 at 9:39 AM revealed one table with three chairs and two couches. Observation in the dining room on the 500 hall on 3/15/2023 at 9:55 AM revealed many items from different parts of the building stored in the room. The room had no space 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, medical record review and interview, the facility failed to revise and update a care plan for 1 resident (#46) of 52 residents reviewed. The findings include: Review of facility policy, Care Plans-Comprehensive revised September 2010 revealed .Assessments of residents are ongoing care plans are revised as information about the resident and the resident's condition change .The care planning/Interdisciplinary Team is responsible for the review and updating of care plans .When there has been a significant change in the resident's condition .When the desired outcome is not met .When the resident has been re-admitted to the facility from a hospital stay .At least quarterly . Medical record review revealed Resident #46 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included Cognitive Communication Deficit and Dysphagia. Medical record review of Resident #46's Physician Order Summary Report dated 4/12/19 revealed .Consistent CHO [carbohydrate] diet…

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 medical record review, observation and interview, the facility failed to follow physician orders to provide total assistance with meals for 1 resident (#46) of 52 residents reviewed. The findings include: Medical record review revealed Resident #46 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included Cognitive Communication Deficit and Dysphagia. Medical record review of Resident #46's Physician Order Summary Report dated 4/12/19 revealed .Consistent CHO [carbohydrate] diet mechanically altered ground texture, Nectar consistency .4/16/19 ST [Speech Therapy] downgrade patient to total feed for all meals to maximize PO [by mouth] intake and decrease weight loss . Medical record review of Resident #46's 5 day Minimum Data Set, dated [DATE] revealed the resident required extensive assistance with eating. Medical record review of Resident #46's Speech Therapy Encounter Note dated 4/16/19 revealed .Patient downgraded to total feed with staff educated on swallow…

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 facility policy review, medical record review and interview, the facility failed to maintain an accurate and complete record for 1 resident (#18) of 52 residents reviewed related to the Physician Orders and Physician Orders For Life Sustaining Treatment/Physician Orders for Scope of Treatment (POLST/POST) form not matching. The findings include: Review of the facility policy, Advance Directives-MOLST (Medical Orders For Life Sustaining Treatment) / POLST (Physician Orders For Life Sustaining Treatment), undated, revealed .Residents of the facility will have their advance directives [including MOLST and POLST] honored .These will be reviewed upon admission and periodically throughout their stay .MOLST/POLST is a medical order form that tells others the resident's/patient's wishes regarding life-sustaining treatment .It is designed to communicate the individual's wishes about a range of life-sustaining and resuscitative measures .It is a portable, valid and immediately actionable medical order consistent…

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 review of the dish machine manufacturer's recommendation, review of the manual washing protocol, and interview, the facility dietary department failed to operate the dish machine per the manufacturer's recommended temperature range, failed to sanitize items appropriately in the 3 compartment sink, and failed to maintain dietary equipment in a sanitary manner in 1 of 6 observations in the dietary department. Findings include: Review of the posted dish machine manufacturer's recommendation revealed the minimum wash and final rinse temperature was 120 degrees Fahrenheit (F). Review of the manual washing protocol revealed the items in the sanitizer solution were to be in contact with the sanitizer solution for 30 seconds. Observation on 4/10/18 at 10:12 AM in the dietary department revealed the dish machine was in operation. Further observation revealed 2 racks of dirty dome lids were processed and the wash and rinse temperatures were 110 degrees F for both. The surveyor stated aloud to the 2 dietary employees and the Certified Dietary Manager (CDM) present the temperatures…

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 facility policy review, medical record review and interview, the facility failed to obtain completed advanced directives for 8 of 31 sampled residents (Resident #90, Resident #91, Resident #98, Resident #99, Resident #590, Resident #28, Resident #83 and Resident #86) reviewed for advanced directives. Findings include: Review of the facility policy Advance Directive-MOLST (Medical Orders for Life Sustaining Treatment)/POLST (Physician Orders for Life Sustaining Treatment) undated revealed .Once the MOSLT/POLST form is completed, it must be signed by the resident or if the resident lacks capacity, the resident representatives AND the attending physician . Medical record review revealed Resident #90 was admitted to the facility on [DATE] with diagnoses of Nondisplaced Fracture of Right Acetabulum, Fracture of Right Ischium, Muscle Weakness, Difficulty in Walking, Fracture of Shaft of Left Humerus, Fracture of Left Shoulder Girdle, Wedge Compression Fracture of T9-T10 Vertebra, Moderate Laceration of Left…

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 Medical record review revealed Resident #90 was admitted to the facility on [DATE] with diagnoses of Nondisplaced Fracture of Right Acetabulum, Fracture of Right Ischium, Muscle Weakness, Difficulty in Walking, Fracture of Shaft of Left Humerus, Fracture of Left Shoulder Girdle, Wedge Compression Fracture of T9-T10 Vertebra, Moderate Laceration of Left Kidney, Fracture of Lower End of Right Ulna, Fracture of Right Patella, Fracture of Right Radial Styloid Process, Moderate Laceration of Spleen, and Multiple Fractures of Ribs, Right Side. Medical record review of Resident #90's Order Summary Report dated 4/1/18-4/30/18 revealed wound care treatment orders to his left shoulder, right hip surgical site and right flank. Continued review revealed the resident received scheduled and PRN (as needed) pain medications. Medical record review of Resident #90's Baseline Care Plan Review dated 4/5/18 revealed it did not address the immediate care and services of the resident for wound treatments or pain management. Interview…

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 facility policy review, medical record review and interview, the facility failed to ensure as needed (PRN) psychotropic medications had a 14 day limitation or a prescriber documentation with medical rationale for continuation for 5 of 12 sampled residents (Resident #60, Resident #21, Resident #35, Resident #36, Resident #82) and failed to conduct behavior monitoring for 2 of 12residents (Resident #82, Resident #86) reviewed. Findings include: Review of the facility policy Behavioral Assessment, Intervention and Monitoring revised 3/2015 revealed .When medications are prescribed for behavioral symptoms, documentation will include: Monitoring for efficacy and adverse consequences. The nursing staff and the physician will monitor for side effects and complications related to psychoactive medications; for example, lethargy, abnormal involuntary movements, anorexia, or recurrent falling . Medical record review revealed Resident #60 was admitted to the facility on [DATE] with diagnoses including Diabetes…

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 interview, the facility dietary department staff failed to ensure the resident meals were served per the menu, failed to obtain food preferences, and failed to honor resident food preferences for 6 of 86 residents receiving meals. Findings include: Observation on 4/9/18 at 12:20 PM of the dietary department resident mid-day meal tray line service revealed mashed potatoes were served to pureed diets. Further observation revealed no .mashed sweet potatoes . were available as the pureed diet indicated for residents disliking mashed (white) potatoes. Observation on 4/9/18 at 1:13 PM revealed Resident #73 with the lunch tray. Further observation of the tray card ticket revealed the diet was Pureed NAS (no added salt) and the food items included pureed ham, mashed sweet potatoes, pureed peas, pureed soup in a mug, and pureed fruit in a bowl. Observation of the food served revealed pureed ham, mashed (white) potatoes, pureed peas, and gelatin in a bowl. Further observation revealed no mashed sweet potatoes, soup in a mug or pureed fruit in a bowl had been provided.…

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 medical record review, observation, and interview, the facility failed to honor and/or obtain food preferences for 6 of 86 sampled residents (Resident #25, Resident #73, Resident #91, Resident #98, Resident #342) receiving a meal. Findings include: Medical record review revealed Resident #73 was admitted to the facility on [DATE] with diagnoses including Hospice, Congestive Heart Failure, Hypertension, Giant Cell Arthritis, Pain Thoracic Spine, Pain, Osteoporosis, Depression, and Anxiety. Medical record review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #73 hearing and vision were adequate and she could make herself understood and understood others. Further review revealed the Brief Interview for Mental Status (BIMS) score was 15, indicating she was cognitively intact. Further review revealed the resident was independent with eating after set-up. Further review revealed the resident had no episodes of delirium, mood, psychosis or behaviors during the review period. Medical…

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 facility policy review, medical record review, facility investigation review, and interview, the facility failed to report allegations of abuse within the 2-hour time frame as required to the State Agency for 2 residents of 7 sampled residents (Resident #82 and Resident #83) reviewed for abuse. Findings include: Review of facility policy Abuse Reporting revised 11/23/17 revealed, .All alleged suspected violations .are required to be promptly reported to appropriate state agencies .as required by law .The facility must report abuse .immediately but not later than 2 hours . Medical record review revealed Resident #82 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Altered Mental Status, Cognitive Communication Deficit, Diabetes Mellitus Type 2, Anemia, Chronic Kidney Disease Stage 3 and Metabolic Encephalopathy. Review of a facility investigation involving Resident #82 with an occurrence date of 2/8/18 at 5:40 PM revealed an allegation of abuse. Continued review…

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 medical record review and interview, the facility failed to accurately assess the Minimum Data Set (MDS) for 1 of 44 sampled residents (Resident #60) reviewed for MDS accuracy. Findings include: Medical record review revealed Resident #60 was admitted to the facility on [DATE] with diagnoses including Diabetes Mellitus, Hypertension and Malignant Neoplasm of the Bladder. Medical record review of the Physician's Order Summary dated 3/18/18, revealed an order for Humalog (insulin) inject as per sliding scale every 6 hours. Continued review revealed an order for Oxycodone (opioid pain medication) 15 mg (milligrams) every 6 hours as needed for pain. Medical record review of the Medication Administration Record (MAR) for 3/2/18 - 3/8/18 (7 day lookback period) revealed Resident #60 received insulin 2 of 7 days and an opioid 7 of 7 days of the lookback period. Medical record review of the 30 day MDS dated [DATE] revealed Resident #60 was assessed for receiving insulin 7 of 7 days and an opioid for 0 of 7 days…

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 medical record review, observation and interview, the facility failed to provide wound care treatments as ordered for 1of 44 sampled residents (Resident #98) reviewed. Findings include: Medical record review revealed Resident #98 was admitted to the facility on [DATE] with diagnoses including Encounter for Surgical Aftercare following Surgery on the Genitourinary System, Infection Following a Procedure, Malignant Neoplasm of Vulva, Acute Kidney Failure, Cellulitis of Groin, Hypertension, Need for Assistance with Personal Care and Difficulty in Walking. Medical record review of a Brief Interview for Mental Status (BIMS) dated 4/9/18 revealed Resident #98 scored a 15 indicating she was cognitively intact. Observation and interview with Resident #98 on 4/9/18 at 11:57 AM in her room revealed the resident had a large dressing across her lower abdomen. Continued observation revealed the bottom of her gown was darker in color than the top of her gown and the resident reported it was wet. Interview with 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the facility policy, medical record review, observation, and interview, the facility failed to administer the enteral feeding per the Physician's Order for 2 of 10 sampled residents (Resident #28, Resident #36) reviewed with enteral feedings. Findings include: Review of the Enteral Tube Feeding via Continuous Pump policy dated 3/2015, revealed .Preparation .Verify .there is a physician's order .Steps in the Procedure .Check the label on the enteral formula against the physician order .Initiate Feeding .On the formula label document initials, date and time the formula was hung/administered, and initial that the label was checked against the order . Medical record review revealed Resident #28 was originally admitted to the facility on [DATE] with diagnoses including Enteral Feeding. The resident was hospitalized from [DATE] to 3/19/18. The resident was readmitted to the facility on [DATE] with the Enteral Feeding. Medical record review of the Physician's Order dated 4/4/18 revealed the enteral…

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 facility policy review, medical record review, observation, and interview, the facility failed to administer pain medication in a timely manner as ordered for 3 of 44 sampled residents (Resident #90, Resident #342, and Resident #99) reviewed. Findings include: Review of facility policy Pain-Clinical Protocol revised March 2015 revealed .Strategies that may be employed when establishing the medication regimen include: Combining long-acting medications with PRNs[as needed] for breakthrough pain. Implementing the medication regimen as ordered, carefully documenting the results of the interventions. Administer pain medication as ordered. The staff will reassess the individual's pain and related consequences at regular intervals; at least each shift for acute pain or significant changes in levels of chronic pain at least weekly in stable chronic pain . Medical record review revealed Resident #342 was admitted to the facility on [DATE] with diagnoses including Fracture, Diabetes Mellitus, Heart Failure, 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, medical record review, document review and interview, the facility failed to conduct a drug regimen review for 1 of 8 sampled residents (Resident #60) reviewed. Findings include: Review of the facility policy Drug Regimen Review undated, revealed .The consultant pharmacist performs a comprehensive Drug Regimen Review (DRR) at least monthly on all residents of the facility . Medical record review revealed Resident #60 was admitted to the facility on [DATE] with diagnoses including Diabetes Mellitus, Hypertension and Malignant Neoplasm of the Bladder. Review of the document Medication Regimen Review dated 3/14/18 revealed .The following residents' medication regimens were reviewed on the dates specified . The document did not include the name of Resident #60 indicating a drug regimen review was not performed for March 2018. Interview with the Director of Nursing on 4/11/18 at 2:29 PM in the conference room confirmed the facility failed to conduct a drug regimen review in March 2018…

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 facility policy review, observation, and interview, the facility failed to properly store a medication in 1 of 3 medication rooms, failed to maintain current refrigeration temperature logs in 2 of 4 medication rooms, and failed to ensure 1 of 1 treatment cart and 1 of 7 medication carts were locked when not in use by staff. Findings include: Review of facility policy Storage of Medication, revised April 2007, revealed Compartments (including, but not limited to, drawers, cabinets, room, refrigerators, carts, and boxes) containing drugs and biologicals shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others Medications must be stored separately from food and must be labeled accordingly . Review of facility policy Labeling of Medication Containers revised April 2007, revealed .Labels for each floor's stock medications shall include all necessary information . Observation on 4/9/18 at 10:15 AM of 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and interview, the facility failed to maintain accurate and complete medical records for 2 of 44 sampled residents (Resident #28 and Resident #36) reviewed. Findings include: Medical record review revealed Resident #28 was originally admitted to the facility on [DATE] and was readmitted to the facility on [DATE] with diagnoses including Gastrostomy (Enteral/Tube Feeding). Medical record review of the Physician's Order dated 3/1/18 for enteral feeding of Jevity 1.5 at 70 cc/hour (cubic centimeter per hour) continuous for 22 hours. This order was discontinued on 4/4/18. Medical record review of the Physician's Order dated 4/4/18 revealed the enteral feeding of .Jevity 1.5 .at 86 ml/hr [milliliters per hour] x [for] 18 hrs/d [hours per day] . Review of the March 2018 through 4/4/18 Medication Administration Records (MAR) revealed no documentation of the tube feeding administration. Interview with the Director of Nursing (DON) on 4/12/18 at 9:29 AM in conference room confirmed 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 and interview, the facility dietary department failed to maintain the slicer in a safe operating condition. Findings include: Observation on 4/10/18 at 10:25 AM in the dietary department with the Certified Dietary Manager (CDM) present revealed a plastic covered slicer. The cover was removed and the blade was not flush with the slicer table. Further observation revealed the thickness adjustment knob would not rotate to adjust the blade. Interview with the CDM on 4/10/18 at 10:25 AM in the dietary department confirmed the facility failed to maintain the slicer in a safe operating condition.