Heritage Hall - Brookneal

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview and review of facility policy, the facility failed to ensure residents had the right to formulate an advance directive and/or prominently displayed information in the medical record about whether or not the resident executed an advance directive. This affected five (Residents (R)4, R12, R18, R33 and R43) of five residents reviewed for advance directives. Additionally, R4 did not receive written information regarding advance directives in accordance with facility policy. Findings include: Review of the facility's policy titled Advance Directives © 2001 MED-PASS, Inc. (Revised [DATE]) directs Upon admission, the resident will be provided with written information concerning the right to refuse or accept medical or surgical treatment and to formulate an advance directive if he or she chooses to do so .Written information will include a description of the facility's policies to implement advance directives and applicable state law .The resident's attending physician will clarify 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 record review and interview, the facility failed to provide a Form CMS-10055 (Centers for Medicaid and Medicare Services) Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) and Form CMS-10123 (Centers for Medicaid and Medicare Services) Notice of Medicare Non-Coverage (NOMNC) to two of three residents (Resident (R) 207 and R29) reviewed for beneficiary notices. This failure prevented R29 and R207 or their responsible party from making an immediate appeal of the decision to end Medicare coverage of services. Findings include: Review of the medical records revealed that R207 and R29 were given the incorrect forms when they were discharged from a Medicare covered Part A stay. These two residents were discharged back into the facility under skilled nursing. They received Form CMS-10095 NOMNC which expired on [DATE] and was under the old QIO (Quality Improvement Organization). They also received Form CMS-R-131, which is an ABN form but not for skilled nursing. These individual forms did not contain…

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, staff interview, and review of the Resident Assessment Instrument (RAI) Manual, the facility failed to ensure one resident (Resident (R) 15) out of 26 sampled residents had an accurate Minimum Data Set (MDS) assessment. Findings include: Review of the RAI Manual, dated 10/01/19, indicated, . Active Diagnoses Code diseases that have a relationship to the resident's current functional, cognitive, mood or behavior status, medical treatments, nursing monitoring, or risk of death.It is important to note here that information obtained should cover the same observation period as specified by the MDS items on the assessment and should be validated for accuracy (what the resident's actual status was during that observation period) by the IDT completing the assessment. Review of R15's electronic medical record (EMR) undated Face Sheet, located under tab titled Face Sheet indicated R15 was admitted to the facility on [DATE]. Review of a document provided by the facility titled Physician's Interim…

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, interviews, and review of facility policy, the facility failed to ensure a resident's Care Plan was revised for one of 25 residents (Resident (R) 15) sampled which accurately reflected the resident's history of Post-Traumatic Stress Disorder (PTSD). The facility also failed to ensure R29's representative was invited to care plan meetings. Findings include: 1. Review of R15's electronic medical record (EMR) undated Face Sheet, located under the tab titled Face Sheet indicated R15 was admitted to the facility on [DATE], with a diagnosis of epilepsy. Review of a document provided by the facility for R15 titled Brief Trauma Care Questionnaire, dated 12/12/19 indicated the resident had no trauma identified during this interview. The questionnaire directed the staff, if the resident answered any question in the affirmative, to refer the resident to a mental health provider and to alert the physician. The form also directed to the development of a person-center care plan to address…

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, the facility failed to assure one resident (R)22 of one reviewed for timely medication administration received ordered pain medication in a timely manner. The facility failed to reorder R22's pain medication in a timely manner. Findings include: Review of R22's electronic medical record (EMR) undated Face Sheet, located under the tab titled Face Sheet indicated R22 was admitted to the facility on [DATE], with diagnoses including hemiplegia following cerebral infarction (stroke) and congestive heart failure. Review of R22's annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) 10/28/21 indicated a Brief Interview for Mental Status (BIMS) score of 15 out of 15 which indicated R22 had intact cognition. Review of R22s Care Plan located under Care Plan tab in the EMR dated 12/10/21, indicated R22 was at risk for pain due to muscle weakness, history of low back pain, fractures, and hemiplegia to his left side. Approach was to administer pain medications per…

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, record review, interviews, policy review, review of the disinfectant label, and review of manufacturer's guidelines, the facility failed to ensure that two of four licensed nurses (Licensed Practical Nurse (LPN)1 and LPN2) cleaned and disinfected multi-use glucometers per the device manufacturer's instructions and per the EPA-approved disinfectant's instructions for use when performing fingerstick blood glucose testing (accuchecks) between residents. The failure to ensure the staff cleaned and disinfected multi-use glucometers per the device manufacturer's instructions and per the EPA-approved disinfectant's instructions for use when performing fingerstick blood glucose testing created a potential for the transmission of bacteria, viruses, and/or blood-borne pathogens between residents. Findings include: Review of the facility's policy titled Obtaining a Fingerstick Glucose Level © 2001 MED-PASS, lnc. revised October 2011 directs Always ensure that blood glucose meters intended for reuse are cleaned and disinfected between resident uses .Clean and disinfect…

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 interview, clinical record review, and facility document review, the facility staff failed to prepare, store, and distribute food under sanitary conditions in the dietary department and for 2 of 18 Residents, Residents #40 and #45. The findings included: 1. The facility failed to dispose of expired milk and the #2 refrigerator had an inside temperature of 50 degrees. This refrigerator was in use at the time of the survey. On 01/23/19 at approximately 9:35 a.m., the surveyor toured the dietary department (kitchen) with the dietary manager. The refrigerator included milk with an expiration date of 01/22/19. The dietary manager placed the loose cartons of expired milk together in a cardboard case that held 48 cartons. The dietary manager stated there was 45 cartons of milk in this box and she would dump them. Refrigerator #2 had an outside temperature of 41 and an inside temperature of 50 degrees. The dietary manager stated the inside of the refrigerator felt warm and she would have it checked. This refrigerator contained pimento cheese, mayonnaise, pot…

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 staff interview and clinical record review, the facility staff failed to ensure that a copy of the comprehensive care plan goals were sent upon transfer to the emergency room for 1 of 18 Residents in the survey sample, Resident # 210. The findings included: The facility staff failed to ensure that a copy of the comprehensive care plan goals were sent with Resident # 210 upon transfer to the emergency room on 3/14/18. Resident # 210 was an [AGE] year-old male who was admitted to the facility on [DATE]. Diagnoses included but was not limited to: cognitive communication deficit, coronary artery disease, and dementia. The clinical record for Resident # 210 was reviewed on 1/23/18 at 10:30 am. The most recent MDS (minimum data set) assessment was a discharge assessment with an ARD (assessment reference date) of 3/14/18. Section C of the MDS assesses cognitive patterns. In Section C0500, the facility staff documented that Resident # 210 had a BIMS (brief interview for mental status) score of 0 out of 15,…

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 staff interview and clinical record review, the facility staff failed to give written notice of reason for transfer and discharge for 1 of 18 Residents in the survey sample, Resident #210. The findings included: The facility staff failed to ensure that the Resident # 210 and his representative received a written notice for reason of transfer to the emergency room on 3/14/18. Resident # 210 was an [AGE] year-old male who was admitted to the facility on [DATE]. Diagnoses included but was not limited to: cognitive communication deficit, coronary artery disease, and dementia. The closed clinical record for Resident # 210 was reviewed on 1/23/18 at 10:30 am. The most recent MDS (minimum data set) assessment was a discharge assessment with an ARD (assessment reference date) of 3/14/18. Section C of the MDS assesses cognitive patterns. In Section C0500, the facility staff documented that Resident # 210 had a BIMS (brief interview for mental status) score of 0 out of 15, which indicated that Resident # 210'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, staff interview, and facility document review, the facility staff failed to dispose of an expired medication and failed to store drugs in a sanitary environment in 1 of 1 medication rooms. The findings included: The facility staff failed to discard expired Tuberculin solution and failed to ensure that the refrigerator in the medication room was clean and defrosted. On 1/23/19 at 9:55 am, the surveyor reviewed medication room along with the unit manager, LPN # 1 (licensed practical nurse). The surveyor observed mildew on the upper strip of the medication refrigerator. The surveyor brought the mildewed area that was observed on the upper strip of the medication refrigerator to the attention of LPN # 1. LPN # 1 observed the area and agreed that there was a mildew on the upper strip of the medication refrigerator. The surveyor also observed a large amount of ice in the freezer area of the medication refrigerator. LPN # 1 observed the large amount of ice in the freezer area of the medication refrigerator and agreed that the refrigerator needed to be defrosted. 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 observation, resident and staff interview and clinical record review it was determined the facility staff failed to provide Resident #19 with physician ordered adaptive eating equipment. Findings: Resident #19 was admitted to the facility on [DATE]. Her diagnoses included diabetes, atrioventricular block, dysphagia, hypertension and obstructive sleep apnea. Resident #19's physician's orders, signed and dated on 6/27/17, stated, Adaptive utensils at meals (built-up utensils) as requested. The latest MDS (minimum data set) assessment, dated 11/23/18, coded the resident as cognitively unimpaired. She could eat her meals with set-up and over site by staff members. She was coded with limited ROM (range-of-motion) in upper and lower limbs, bilateral. The CCP (comprehensive care plan), reviewed and revised on 1/22/19, documented the resident at risk for continued health concerns due to her refusal to get out of bed and refusing to sit up to eat. The interventions included, Adaptive utensils at meals as…

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, staff interview and clinical record review, it was determined the facility staff failed to perform hand washing appropriately during wound care. Findings: Resident #24 was admitted to the facility on [DATE]. Her clinical record was reviewed on 1/23/19 at 2:00 PM. The resident's latest MDS (minimum data set) dated 12/23/18 coded the resident as cognitively intact. She was coded with a stage IV pressure ulcer. 01/23/19 at 1:30 PM LPN I is in the resident's room to change the dressing on her back. The dressing is observed on the right side of her buttocks. The dressing is saturated with drainage and is not dated. LPN I got the dressing materials together to change the dressing. The facility DON was to assist with the wound care. LPN I notes the pressure ulcer is a stage 4 and the wound doctor had changed it yesterday onsite. LPN I washed her hands and donned gloves. LPN I cleaned the wound with derma clenz in a clockwise motion inner to outer edges. She then placed a 4x4 gauze soaked in Dakins…

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.