Nhc Healthcare, Tullahoma

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 ensure a nebulizer mask was stored appropriately for 1 resident (Resident #219) of 3 residents observed on nebulized medications. The findings include: Review of the facility's policy, Specific Medication Procedures .Oral Inhalation Administration, revised 2/25/2025, revealed .Turn on the nebulizer and check outflow port for visible mist .Remain with the resident for the treatment .Administer therapy until medication is gone .When treatment is complete, turn off nebulizer and disconnect .When equipment is completely dry, store in a plastic bag with the resident's name and date on it . Review of the medical record revealed Resident #219 was admitted to the facility on [DATE] with diagnoses including Aftercare Following Joint Replacement Surgery and Emphysema. Review of a physician's order for Resident #219 dated 6/5/2025, revealed .albuterol sulfate [a medication used to relax the muscles in the airway 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.

Based on facility policy review, observation and interview, the facility failed to ensure dietary workers wore protective hair coverings during food preparation in the kitchen, which had the potential to affect 89 of 90 residents residing in the facility. The findings include: Review of the facility's policy, Hygienic & Safety Practices, dated 11/2017, revealed .provide a safe product for all customers .wear hair restraints such as hats, hair coverings, or nets, beard restraints .worn effectively to keep their hair from contacting exposed food . During an observation in the food preparation area on 6/9/2025 at 9:22 AM, the Assistant Dietary Manager (ADM) was preparing desserts for the lunch meal service. Further observation revealed the ADM had hair protruding from her protective hair covering which allowed hair from her forehead and the back of the head to remain uncovered. During an observation in the food preparation area on 6/9/2025 at 11:13 AM, the Lead [NAME] was plating resident meals for the lunch meal service and did not have on a protective beard covering to cover his…

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 Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual, medical record review and interview, the facility failed to complete quarterly assessments, using the Centers for Medicare & Medicaid Services specified RAI process, within the regulatory time frames for 7 residents (Resident #19, #21, #48, #62, #82, #85 and #95) of 28 sampled residents reviewed for MDS assessment. The findings include: Review of the MDS 3.0 RAI Manual v (version) 1.19.1, dated 10/2024, pages 2-35, revealed, .The Quarterly assessment is an OBRA (Omnibus Budget Reconciliation Act) non-comprehensive assessment for a resident that must be completed at least every 92 days following the previous OBRA assessment of any type. It is used to track a resident's status between comprehensive assessments to ensure critical indicators of gradual change in a resident's status are monitored .The MDS completion date must be no later than 14 days after the ARD [Assessment Reference Date] . 1. Review of the 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, observation and interview, the facility failed to revise the care plan for 1 resident (Resident #5) of 18 residents reviewed for care plans. The findings include: Review of the facility's policy, Documentation Guidelines, updated 5/2024, revealed .The center .ensure an interdisciplinary and comprehensive approach .development of patient's care plan of care .updating .care plans .problems are handled as they arise .added to current care plan . Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with diagnoses including Heart Failure, Malignant Neoplasm of Pancreas and Anxiety. Review of an admission Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #5 scored an 11 on the Brief Interview for Mental Status (BIMS) assessment which indicated moderate cognitive impairment. Review of the comprehensive care plan for Resident #5 dated 5/15/2025, revealed .Indwelling Catheter . Review of the medical record revealed…

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 document review, observations and interviews, the facility failed to ensure medications were stored and secured properly for 2 residents (Resident #5 and #219) of 90 residents observed. The findings include: Review of the facility's policy, Medication Storage in the Facility, updated 2/25/2025, revealed .Medications .stored safely .securely .and properly .medication supply .accessible only to licensed nursing personnel .medications .stored in medication cart . Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with diagnoses including Heart Failure, Malignant Neoplasm of Pancreas and Anxiety. Review of a physician's order for Resident #5 dated 6/2/2025, revealed .Incruse Ellipta [medication used to treat chronic respiratory conditions] .62.5 mcg [microgram] .1 puff once a day . Review of the Medication Administration Record (MAR) for Resident #5 dated 6/2/2025-6/10/2025, revealed the resident received .Incruse…

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 facility policy review, observations and interviews, the facility failed to ensure garbage and refuse were properly contained and failed to ensure the outside dumpster area was maintained in a sanitary and orderly condition. The findings include: Review of the facility's policy, Waste Management, dated 11/2017, revealed .refuse containers and dumpsters kept outside the facility shall .be in a safe and sanitary manner .checked routinely for .debris .items shall be removed from premises that will minimize the development of odors and other conditions that attract or harbor insects and rodents . During an observation of the outside dumpster area on 6/9/2025 at 9:32 AM, with the Food and Nutrition Director (FND) revealed 2 dumpsters (dumpster A and dumpster B) for waste disposal. Further observation revealed the area behind dumpster A and B had 4 broken wooden pallets, 1 broken chair, 1 broken television, 1 broken table, and 15 disposable gloves on the ground. During an interview on 6/9/2025 at 9:34 AM, the FND stated the 4 broken wooden pallets, 1 broken chair, 1 broken…

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, facility contract review, medical record review, observation and interview, the facility failed to ensure a coordinated plan of care with the hospice provider was available in the medical record for 1 resident (Resident #111) of 4 residents reviewed for hospice services. The findings include: Review of the facility's undated policy, HOSPICE SERVICES, revealed .the hospice will guide the plan of care in collaboration with the center . Review of the facility's hospice contract with the hospice entity providing care for Resident #111, dated 10/11/2013, revealed .Plan of Care .means a written care plan established, maintained, reviewed and modified .the Plan of Care includes .an identification of the Hospice Services .detailed statement of the scope and frequency of such Hospice Services .Hospice and Facility will jointly develop and agree upon a coordinated Plan of Care which is consistent with the hospice philosophy and is responsive to the unique needs of Hospice patient .The Plan…

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 ensure appropriate Personal Protective Equipment (PPE) was donned for 2 residents (Residents #218 and #221) of 6 residents observed on Enhanced Barrier Precautions (EBP) and failed to offer hand hygiene assistance prior to meals to 3 residents (Residents #32, #89, and #62) on 1 of 6 hallways observed for meal tray distribution. The findings include: Review of the facility's policy, INFECTION CONTROL MANUAL VOLUME 1, reviewed 2/2025, revealed .Enhanced Barrier Precautions (EBP) refers to an infection control intervention designed to reduce transmission of multidrug-resistant organisms [MDRO] that employs targeted gown and glove use during high contact activities .used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact patient care activities that provide opportunities for transfer of MDRO to staff hands and clothing .EBP are indicated 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 Resident Assessment Instrument (RAI) Manual, medical record review, observation, and interview, the facility failed to accurately complete a Minimum Data Set (MDS) assessment for 1 resident (#47) of 18 residents reviewed. The findings include: Review of the Resident Assessment Instrument (RAI) Manual dated 10/2023 showed .The RAI process has multiple regulatory requirements .the assessment accurately reflects the resident's status .a registered nurse conducts or coordinates each assessment with the appropriate participation of health professionals .one of the most important functions .accurate picture of the resident's current health status . Resident #47 was admitted to the facility on [DATE] with diagnoses including Displaced Intertrochanteric Fracture of the Left Femur, Chronic Obstructive Pulmonary Disease, Heart Failure, and a Stage 1 Pressure Ulcer of the Sacral Region. Review of the admission MDS assessment dated [DATE] showed the residents Brief Interview for Mental Status (BIMS) 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 facility policy review, medical record review, observations, and interview, the facility failed to revise the comprehensive care plan to include the added fall prevention interventions after a fall for 2 residents (Resident #5 and #27) of 18 residents reviewed for care plans. The findings include: Review of the facility's undated policy titled, Falls Program, showed .to identify patients at risk for falling and to implement the appropriate interventions .initiate a falls care plan .revise the plan of care as needed . Review of the facility policy titled, Patient Care Plans, dated 11/2023, showed .New problems are handled as they arise and are to be added to the current care plan . Resident #5 was admitted to the facility on [DATE] with diagnoses including Osteoporosis, Pathological Fracture to the Left Femur, Dementia, and History of Falling. Review of a post fall event report dated 1/28/2024, showed Resident #5 was found on floor in the dayroom, after sliding out of the wheelchair. The immediate…

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 ensure practices to prevent the potential spread of infection were followed when the Wound Care Nurse (WCN) failed to perform proper hand hygiene during wound care for 1 (Resident #6) of 3 residents reviewed for wound care. The findings include: Review of the facility's policy titled, Aseptic Treatment Technique Procedure, dated 1/2024, showed .aseptic technique will be used for all types of dressings and wound care .remove old dressing .discard .remove dirty gloves .discard .perform hand hygiene . Resident #6 was admitted to the facility on [DATE] with diagnoses including Multiple Sclerosis, Pressure Ulcer (stage 3) of the Sacral Region, and Muscle Wasting. Review of an admission Minimum Data Set (MDS) assessment dated [DATE], showed Resident #6 scored 15 on the Brief Interview for Mental Status (BIMS) assessment, which indicated the resident was cognitively intact, required partial/moderate assistance…

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 documentation review, and interview, the facility failed to protect 1 resident (Resident #1) from abuse of 5 residents reviewed for abuse. The findings include: Review of the facility's policy titled, Patient Protection and Response Policy for Allegations/Incidents of Abuse, Neglect, Misappropriation of Property and Exploitation, revised on 2/1/2023, showed .The patient has the right to be free from abuse .The center administrator is responsible for assuring that patient safety, including free from risk of abuse or neglect, holds the highest priority .DEFINITIONS .Abuse: the will infliction of injury .Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm .Physical Abuse: includes hitting, slapping, pinching and kicking .PREVENTION POLICY .The center will provide supervision and support services designed to reduce 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 facility policy review, medical record review and interview, the facility failed to follow a physician's order for 1 resident (Resident #3) of 5 residents sampled. The findings include: Review of the facility's undated policy titled, PATIENT RIGHTS, showed .Medications and treatments are ordered by and given under the supervision of your attending physician . Review of Resident #3's Post Hospitalization Transition Discharge Instructions dated 2/22/2023, showed .SKIN AND/OR WOUND CARE .Surgical Incision .Midline sternal incision- cleanse daily with soap and water. Keep clean and dry. REMOVE STAPLES on March 8, 2023 . Resident #3 was admitted to the facility on [DATE] with diagnoses including .Encounter for orthopedic aftercare following surgical amputation .L [Left] BKA [Below Knee Amputation] .Encounter for Surgical Aftercare Following Surgery on the Circulatory System .(MV [Mitral Valve] replacement and CABG [Coronary Artery Bypass Graft x1) . Review of the medical record showed an order dated…

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.