Diversicare Of Ripley

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure sufficient staffing in the dietary department, which resulted in the inability to meet the nutritional needs of residents. Observations and interviews revealed that the facility did not employ adequate dietary staff to prepare and serve meals in a timely manner, leading to residents receiving cold meals and experiencing prolonged delays during meal service. The Regional Dietary Manager (RDM) confirmed the ongoing staffing issues, noting that the kitchen was consistently short-staffed, and he had to assist in meal preparation himself. Additionally, the facility's Administrator acknowledged the staffing challenges and expressed concerns about the frequent changes in dietary management. Multiple residents expressed dissatisfaction with the quality and temperature of the food served. Residents reported receiving meals that were cold, improperly cooked, and unpalatable. Specific complaints included overcooked meats, mushy vegetables, and limited food choices. Observations confirmed that meal trays were placed on uncovered tray racks, contributing to the food cooling before reaching the residents. The new RDM noted the absence of a steamer in the kitchen, which affected the quality of cooked vegetables, and highlighted the lack of insulated boxes for maintaining food temperature during distribution. The report included detailed accounts from several residents, all of whom were cognitively intact, as indicated by their Brief Interview for Mental Status (BIMS) scores. These residents had various medical diagnoses, including Chronic Obstructive Pulmonary Disease, Dysphasia, Type 2 Diabetes Mellitus, and Acute Chronic Diastolic Heart Failure. Despite their medical conditions, the residents consistently reported issues with the food service, emphasizing the facility's failure to provide meals that met their nutritional and dietary needs.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that food served to residents was palatable, attractive, and at a safe and appetizing temperature. This deficiency was observed in eight out of twelve sampled residents. The facility's policy on food quality and palatability, revised in February 2023, mandates that food should be prepared in a manner that conserves nutritive value, flavor, and appearance, and should be served at a safe and appetizing temperature. However, multiple residents reported that the food was often cold, overcooked, or undercooked, and lacked flavor and appeal. Interviews with residents revealed significant dissatisfaction with the food quality. One resident reported eating grilled cheese and soup daily due to the unpalatability of the menu items, while another described the food as not fit to eat, citing issues with overcooked and mushy vegetables and tough meat. Several residents mentioned that the food was consistently cold, with one resident stating that it was as if the food had been in the refrigerator. Observations confirmed that meal trays were left uncovered on tray racks, contributing to the food being served cold. The facility's dietary department faced staffing challenges, as noted by the Regional Dietary Manager, who highlighted ongoing staff shortages and transitions within the department. The Administrator acknowledged awareness of the dietary concerns and mentioned efforts to address them, although the issues persisted. The new Regional Dietary Manager observed that the kitchen lacked a steamer, which contributed to the poor texture of vegetables. The absence of insulated boxes for tray distribution was also identified as a factor in the food being served cold.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to adhere to safe food handling practices, which could lead to the spread of foodborne illness. During a kitchen tour, it was observed that five packs of kielbasa sausages were left to thaw at room temperature in a two-compartment sink without running water. This practice contradicts the facility's policy, which requires thawing frozen items in a refrigerator or under cold running water to prevent bacterial growth. Dietary Staff confirmed that the meat should not have been left out at room temperature, acknowledging the potential for bacteria growth. Additionally, a brown box containing raw chicken skin was found on the kitchen floor, with the skin resting on the outer edges of the box. The box was observed to drip pink-tinged watery drainage onto the floor and the drainboard of the sink. Dietary Staff admitted that the chicken skin should have been disposed of in the garbage during preparation to prevent contamination. The Regional Dietary Manager confirmed these unsafe practices and acknowledged that they could lead to illness.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to submit accurate data into the Payroll Based Journal (PBJ) system for one of the four quarters reviewed, specifically the fourth quarter of 2024. The facility's policy on PBJ entry submission, dated 2022, requires collaboration with Human Resources and Payroll to capture payroll hours for clinical team members and submit them accurately. However, interviews with the Workforce Management Coordinator and the Human Resource Coordinator revealed discrepancies in the reporting process. The Workforce Management Coordinator admitted that salary employees who worked weekends had their hours entered manually, which she believed led to inaccuracies. The Human Resource Coordinator confirmed that staff schedule changes were typically entered into the system on Monday or Tuesday after the weekend, which could result in inaccurate reports if submitted before these updates. The Administrator acknowledged the issue, noting that the PBJ submissions were sent to corporate staff on Monday mornings, and if weekend changes were not entered by then, the data was inaccurate. This resulted in the facility being flagged for low weekend staffing. A review of the facility's staffing validation computer printout confirmed that additional staff who worked were not entered into the system. Verification by the State Agency showed that these staff members were present and providing resident care, further highlighting the inaccuracies in the PBJ submissions.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to implement care plans for several residents, leading to deficiencies in their care. Resident #8, who was admitted with a need for assistance with personal care and a contracture in the left hand, had a care plan that included daily nail, hair, and oral care. However, observations revealed that his fingernails were long and dirty, and his facial hair was unkempt. Despite expressing a desire for grooming, the care plan interventions were not followed, as confirmed by the MDS nurse. Resident #58, who had severe cognitive deficits and was admitted with hemiplegia and hemiparesis, also had a care plan for daily nail, hair, and oral care. Observations showed that his fingernails were dirty with a brown substance underneath, and this was confirmed by a CNA. The MDS Coordinator acknowledged that the care plan was not adhered to, as the resident's nails remained unclean. Resident #104, who was cognitively intact and had a self-care deficit, reported not receiving scheduled showers and hair care, resulting in greasy hair and a mild odor. The MDS Coordinator confirmed that the care plan, which included assistance with bathing and daily grooming, was not followed. Additionally, Resident #73, who had respiratory issues, had a care plan requiring weekly changes of oxygen tubing and humidifier bottles. Observations revealed that these were not changed as ordered, and the DON confirmed the care plan was not followed, posing a risk of infection.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide necessary assistance with Activities of Daily Living (ADLs) for three residents, leading to deficiencies in personal care. Resident #8 was observed with long, jagged fingernails with a thick brown substance underneath and an unkempt beard. Despite expressing a desire for nail and beard care, there was no documentation of recent refusals of ADL care, and the Director of Nursing confirmed that the resident should have received these services. Resident #8 was cognitively intact, as indicated by a BIMS score of 15, and had a diagnosis requiring assistance with personal care. Resident #58 was observed with a brown substance under the fingernails of his right hand on multiple occasions. CNA #5 confirmed the presence of dirt and acknowledged the responsibility to clean residents' nails during baths or showers. Resident #58 required a two-person assist with ADLs and had severe cognitive deficits, as indicated by a BIMS score of 4. His diagnoses included hemiplegia and hemiparesis following a cerebral infarction, aphasia, and chronic obstructive pulmonary disease. Resident #104 reported not having received a shower since a specific date, resulting in greasy hair and body odor. CNA #5 confirmed that Resident #104 missed a scheduled shower and should have received one to maintain cleanliness and prevent odor. The Assistant Director of Nursing verified that Resident #104's hair was oily and that she should have received her scheduled shower. Resident #104 was cognitively intact, with a BIMS score of 15, and had diagnoses including difficulty in walking and a need for assistance with personal care.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to uphold the dignity of three residents by not covering their indwelling urinary catheter bags and tubing, as required by the facility's policy. Resident #58 was observed with a catheter bag containing urine visible from the hallway without a privacy bag. Interviews with CNA #5 and the Assistant Director of Nursing confirmed that the catheter bag should have been covered to maintain the resident's dignity. Resident #58 had severe cognitive deficits, as indicated by a BIMS score of 04. Resident #99 was seen with a catheter bag attached to his wheelchair, visible from the hallway, and not covered by a privacy bag. The resident expressed discomfort with the exposure of his catheter bag. CNA #6 and the Assistant Director of Nursing confirmed that the catheter bag should have been covered. Resident #99 had moderate cognitive deficits, with a BIMS score of 11. Resident #103 was observed with an exposed catheter bag containing a brown substance, which the resident found unpleasant. LPN #1 and the Director of Nurses confirmed that the catheter bag should have been covered to respect the resident's dignity. Resident #103 was cognitively intact, with a BIMS score of 15.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that oxygen tubing and an oxygen concentrator humidifier water bottle were changed as ordered for a resident. The facility's policy, updated on 8/1/2024, requires that oxygen with humidification be provided according to a physician's order. For Resident #73, the order dated 12/6/24 specified that the oxygen tubing and humidifier bottle should be changed weekly, and external filters should be cleansed every Friday. However, observations on 12/15/24 and 12/16/24 revealed that the oxygen tubing was dated 11/29, and the humidifier water bottle was empty and undated, indicating that the facility did not follow the physician's order. Interviews with staff, including an LPN and the DON, confirmed that the nightshift nurses were responsible for changing the oxygen tubing and humidifier bottles weekly. The DON acknowledged that the facility failed to follow the physician's order, as the tubing and humidifier bottle had not been changed since 11/29. The resident involved, who was admitted with medical diagnoses including Acute Respiratory Failure with Hypoxia, Unspecified Asthma, and Chronic Obstructive Pulmonary Disease, had a BIMS score of 15, indicating cognitive intactness. The failure to change the equipment as ordered was recognized as important to prevent potential infections.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide sufficient nursing staff to meet the activities of daily living (ADL) needs of three residents. Resident #8, who was cognitively intact, had long, jagged fingernails with a thick brown substance underneath and an unkempt beard. He expressed a desire for personal grooming but reported that no one was available to assist him. Certified Nurse Assistant (CNA) #4 confirmed the resident's condition and attributed the lack of care to staffing shortages. Resident #58, who had severe cognitive deficits, was observed with a brown substance under his fingernails on multiple occasions. CNA #5 acknowledged the responsibility to clean the resident's nails during bathing but cited staffing issues as a barrier to providing adequate care. Resident #104, also cognitively intact, reported missing scheduled baths due to staff being too busy. Her hair was greasy, and she noted an odor, indicating a lack of personal hygiene care. CNA #5 confirmed that Resident #104's hair should have been washed on her scheduled bath days but was not. The Director of Nursing (DON) acknowledged ongoing staffing concerns, particularly on the 3 PM-11 PM shift, with frequent call-ins leading to understaffing. The facility attempted to mitigate this by offering incentives and having nurses assist with care, but the issue persisted, affecting the quality of care provided to residents.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that medications were stored appropriately, as evidenced by the observation of two inhalers and a nebulizer machine with unopened medication packages left on the bedside table of a resident. The resident, who was cognitively intact with a BIMS score of 15, stated that the inhalers were for emergency use. However, the medications were not secured in a locked compartment as required, which was confirmed by both an LPN and the Director of Nurses. The LPN acknowledged that the medications should have been returned to the medication cart, and the DON emphasized the risk of wandering residents accessing unsecured medications. The resident involved had been admitted to the facility with medical diagnoses including Chronic Respiratory Failure, Pulmonary Fibrosis, and Atelectasis. Despite the resident's cognitive intactness, the facility's lack of a specific policy for medication storage contributed to the oversight. The facility relied on medication administration competencies and standards of practice, which were not adequately followed in this instance, leading to the deficiency.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide alternative food items and honor food preferences for two residents, leading to deficiencies in dining services. Resident #59 expressed dissatisfaction with the food, stating that requests for alternative items were denied until all residents were served, due to concerns about food shortages. This was confirmed by multiple staff interviews, including a CNA and the Dietary Manager, who indicated that the practice was to ensure all residents were served before providing additional servings or alternatives. The District Dietary Manager contradicted this practice, stating there was always enough food and alternatives available. Resident #83 experienced a failure in honoring her food preferences due to a computer system glitch. Despite expressing her preference for sausage over bacon due to her inability to chew bacon without bottom dentures, she continued to receive bacon. The Dietary Manager acknowledged the issue, noting that the meal ticket incorrectly listed bacon as a preference, despite having been updated in the system. The Dietary Manager admitted to not following up adequately to resolve the issue, resulting in the resident repeatedly receiving food she could not eat.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to properly contain and dispose of kitchen trash during a kitchen tour. The facility's policy requires that all garbage and refuse be collected and disposed of safely and efficiently, with the dining service director ensuring that garbage is removed from the kitchen routinely and at the end of the workday. During an observation on 12/15/24, two trash barrels in the kitchen were found to be full, overflowing, and uncovered, with multiple empty boxes stacked on top. Dietary Staff #1 confirmed the unsanitary condition, attributing it to a lack of time to empty the garbage due to a shift change and dinner meal preparation. The Regional Dietary Manager later confirmed that kitchen trash should be emptied once per shift and as needed, with lids remaining intact to ensure safe waste disposal.

Penalty

Inspection fine: $14,544

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to implement a comprehensive care plan for a resident who required assistance with transfers due to a physical functioning deficit. The care plan specified the use of a total lift with an extra-large blue sling, appropriate for the resident's weight of 376.3 pounds. However, during a transfer, two CNAs used a green sling, which was not suitable for the resident's weight, leading to the sling breaking and the resident falling to the floor, resulting in a fracture. The incident occurred when the CNAs, who were responsible for transferring the resident from her bed to a wheelchair, used the wrong sling. They admitted to using the green sling because it was the one they had always used, without checking the care plan or the Kardex for the correct sling size. The CNAs were unaware that the care plan specified the use of the extra-large blue sling, which was necessary due to the resident's weight and physical condition. The MDS Coordinator confirmed that the care plan was not followed, which directly led to the resident's fall and injury. The facility's policy required that care plans be developed and maintained according to RAI guidelines, but this was not adhered to in this case. The failure to follow the care plan and use the correct equipment resulted in a significant injury to the resident.

Removal Plan

• Resident #1 was assessed by Nurse Practitioner immediately after the fall and was sent out to the emergency room.
• Lift was inspected following the incident with no identified concerns by Maintenance.
• The lift and sling involved in the accident were removed from the floor by Administrator and remained out of service immediately.
• All lifts and slings were assessed for any disrepair by Administrator and four yellow slings, one blue sling and one green sling were removed due to being worn, and in ill repair. New replacements were ordered.
• New lift slings arrived, they were numbered, dated, and put in service.
• The Kardex was reviewed for all residents for appropriate lift and sling use by the Director of Clinical Education (DCE).
• CNA #1 and CNA #2 were educated on proper lift and sling use and return demonstration was completed by the DCE.
• Checkoffs were completed by the DCE with all staff which were initiated and continue throughout all shifts until everyone completed.
• New Lift Transfer assessments were completed by the ADON on all current residents and care plans were updated.
• Therapy referrals were made as needed by the ADON for anyone who required a lift and lift sling.
• Care Plans and Kardex updated as needed by the ADON.
• Team huddles with lift/transfer education completed by the DCE.
• State Agency, Ombudsman, and Attorney General (AG's) office notified by Director of Nursing.
• In-Service on Lift/Transfer Program and Transfer Belts, Abuse/Neglect/Exploitation, and Elder Justice Program were completed by the DCE for all staff members with 100% compliance.
• Topics included: Performance of lift usage, inspecting the sling prior to use, laundering slings and where to find them, and on the Kardex - only using care planned sling colors.
• In-Services initiated with Housekeeping and Laundry Manager on sling inspection and guidelines by the DCE.
• Hoyer Lift Policy and Procedures were reviewed with CNA #1 and CNA #2 and all other staff by the DCE.
• Audits on all Lift Assessments were completed and are on-going by the ADON.
• Quality Assurance and Performance Improvement (QAPI) meeting was held and all required staff members were in attendance. Plan to continue the weekly audits and bring results to the monthly QAPI meetings for three months.

Penalty

Inspection fine: $14,544

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure the safety of a dependent resident during a lift transfer, resulting in a fall and subsequent injuries. The incident involved the use of an inappropriate lift sling for a resident who was morbidly obese. The staff used a green sling, which was not suitable for the resident's weight, instead of the care-planned blue sling designed for bariatric use. During the transfer from bed to wheelchair, the right shoulder strap of the green sling broke, causing the resident to fall to the floor and sustain fractures. The resident, who was cognitively intact and required assistance with personal care due to severe obesity, experienced a traumatic fall. The fall was witnessed by two CNAs who were performing the transfer. The resident landed on her right side, hitting her head and complaining of pain in her right shoulder and left hip. Emergency medical services were called, and the resident was transported to the hospital, where she underwent surgery for a comminuted mildly displaced left intertrochanteric femur fracture. Interviews with staff revealed that the CNAs were unaware of the correct sling to use, as they had always used the green sling for this resident. The facility's policy required the use of appropriate slings based on lift evaluations, but this was not adhered to. The CNAs admitted to not checking the care plan or Kardex for the correct sling, leading to the use of an unsuitable sling that could not support the resident's weight, ultimately resulting in the fall and injury.

Removal Plan

• Resident #1 was assessed by Nurse Practitioner immediately after the fall and was sent out to the emergency room.
• Lift was inspected following the incident with no identified concerns by Maintenance.
• The lift and sling involved in the accident were removed from the floor by Administrator and remained out of service immediately.
• All lifts and slings were assessed for any disrepair by Administrator and four yellow slings, one blue sling and one green sling were removed due to being worn, and in ill repair. New replacements were ordered. New lift slings arrived, they were numbered, dated, and put in service.
• The Kardex was reviewed for all residents for appropriate lift and sling use by the DCE.
• CNA #1 and CNA #2 were educated on proper lift and sling use and return demonstration was completed by the DCE.
• Checkoffs were completed by the DCE with all staff which were initiated and continue throughout all shifts until everyone completed.
• New Lift Transfer assessments were completed by the ADON on all current residents and care plans were updated.
• Therapy referrals were made as needed by the ADON for anyone who required a lift and lift sling.
• Care Plans and Kardex updated as needed by the ADON.
• Team huddles with lift/transfer education completed by the DCE.
• State Agency, Ombudsman, and Attorney General (AG's) office notified by Director of Nursing.
• In-Service on Lift/Transfer Program and Transfer Belts, Abuse/Neglect/Exploitation, and Elder Justice Program were completed by the DCE for all staff members with 100% compliance.
• Topics included: Performance of lift usage, inspecting the sling prior to use, laundering slings and where to find them, and on the Kardex - only using care planned sling colors.
• In-Services initiated with Housekeeping and Laundry Manager on sling inspection and guidelines by the DCE.
• Hoyer Lift Policy and Procedures were reviewed with CNA #1 and CNA #2 and all other staff by the DCE.
• Audits on all Lift Assessments were completed and are on-going by the ADON.
• Quality Assurance and Performance Improvement (QAPI) meeting was held and all required staff members were in attendance. Plan to continue the weekly audits and bring results to the monthly QAPI meetings for three months.

Penalty

Inspection fine: $14,544

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide palatable and properly prepared meals to its residents, as evidenced by multiple complaints and observations. Residents reported that the food was often hard, overcooked, and difficult to chew, with specific issues noted with pancakes, meat, and bread. For instance, Resident #2 and Resident #3 both reported that their pancakes were too hard to cut and eat, and Resident #5, who is the Resident Council President, mentioned that she often did not eat the food because it was not appetizing. Staff members, including a Registered Nurse and a Certified Occupational Therapy Assistant, confirmed the residents' complaints, noting that the food was often too tough and hard to chew, particularly for residents with dentures or no teeth. The District Dietary Manager acknowledged the issues with the food, attributing some of the problems to overcooking and leaving food on the steam table for too long. The Social Worker also confirmed that there had been numerous complaints about the food being cold and tough, and that the facility had experienced significant staff turnover in the dietary department. The report highlights that the facility's policy requires meals to be nourishing, palatable, and attractive, yet the observations and interviews indicate a failure to meet these standards. Residents with specific dietary needs, such as those with dysphagia, were particularly affected by the poor quality of the meals. Despite the presence of a new District Dietary Manager, the issues with meal preparation and palatability persisted, impacting the residents' satisfaction and nutritional intake.