Inspection Reports for
Burns Nursing Home, Inc.
701 Monroe Street, Northwest, Russellville, AL, 35653
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
39% worse than Alabama average
Alabama average: 3.6 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Complaint Investigation
Census: 50
Deficiencies: 3
Date: Mar 2, 2023
Visit Reason
The inspection was conducted as a complaint investigation following an incident where a resident (RI #103) fell from a mechanical lift during transfer, resulting in serious injury.
Complaint Details
The investigation was triggered by complaint/report number AL00042944 regarding the fall of resident RI #103 from a mechanical lift on 01/06/2023, resulting in serious injury including a scalp laceration and a nondisplaced fracture of the C2 vertebra.
Findings
The facility failed to ensure that a Certified Nursing Assistant (EI #7) followed the resident's care plan requiring two-person assistance during mechanical lift transfers, resulting in the resident falling and sustaining a scalp laceration and a C2 vertebra fracture. Immediate jeopardy was cited and corrective actions were implemented.
Deficiencies (3)
Failure to follow resident's care plan requiring two-person assistance during mechanical lift transfer, resulting in resident fall and injury.
Failure to ensure nursing home area was free from accident hazards and provide adequate supervision to prevent accidents related to mechanical lift transfers.
Failure to electronically submit complete and accurate direct care staffing information for quarter 07/01/2022 through 09/30/2022.
Report Facts
Resident census: 50
Sutures required: 20
Resident weight: 145
PBJ data missing quarter: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| EI #7 | Certified Nursing Assistant (CNA) | Failed to follow care plan requiring two-person mechanical lift transfer, resulting in resident fall |
| EI #2 | Director of Nursing (DON) | Prepared incident report and provided assessments related to resident fall |
| EI #1 | Administrator | Notified of immediate jeopardy findings and interviewed regarding incident |
| EI #12 | Facility President | Notified of immediate jeopardy findings |
| EI #8 | Registered Nurse (RN) | Responded to resident fall and provided initial wound care |
| EI #11 | Attending Medical Doctor | Provided medical opinion on seriousness of resident's injuries |
Inspection Report
Complaint Investigation
Census: 50
Deficiencies: 5
Date: Mar 2, 2023
Visit Reason
The inspection was conducted as a complaint investigation following an incident where a resident (RI #103) fell from a mechanical lift due to staff not following the care plan requiring two-person assistance during transfers.
Complaint Details
The complaint investigation was triggered by an incident on 01/06/2023 where a resident (RI #103) fell from a mechanical lift when a CNA (EI #7) attempted to transfer the resident alone, contrary to the care plan requiring two-person assistance. The resident sustained a scalp laceration requiring 20 sutures and a nondisplaced fracture of the C2 vertebra. The facility reported the incident to the Alabama Department of Public Health and conducted an investigation. The CNA was terminated for noncompliance. Immediate jeopardy was cited and corrective actions were implemented.
Findings
The facility failed to ensure staff followed the care plan and facility policies for safe mechanical lift transfers, resulting in a resident fall causing serious injury including a scalp laceration requiring sutures and a nondisplaced C2 vertebra fracture. Immediate jeopardy was cited and corrective actions were implemented. Additional findings included failure to report staffing data for a quarter and lapses in infection control and laundry handling procedures.
Deficiencies (5)
Failure to follow care plan requiring two-person assistance during mechanical lift transfer, resulting in resident fall and serious injury.
Failure to ensure nursing home area was free from accident hazards and provide adequate supervision to prevent accidents.
Failure to electronically submit complete and accurate direct care staffing information for quarter 07/01/2022 - 09/30/2022.
Failure to perform proper hand hygiene and glove use by a nurse, risking cross contamination.
Laundry staff allowed clean sheets to touch clothing and floor during folding, risking contamination.
Report Facts
Resident census: 50
Sutures required: 20
Weight: 145
PBJ data missing quarter: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| EI #7 | Certified Nursing Assistant (CNA) | Named in fall incident for transferring resident alone against care plan |
| EI #2 | Director of Nursing (DON) | Prepared incident report and interviewed regarding fall incident |
| EI #1 | Administrator | Interviewed regarding incident and facility policies |
| EI #5 | Registered Nurse (RN) | Observed failing to perform proper hand hygiene and glove use |
| EI #6 | Housekeeping/Laundry Staff | Observed mishandling clean linen by holding against body and allowing to touch floor |
| EI #3 | Infection Preventionist | Interviewed regarding hand hygiene and contamination risks |
| EI #11 | Attending Medical Doctor | Provided medical explanation of resident's neck fracture and injury severity |
Inspection Report
Complaint Investigation
Deficiencies: 6
Date: Aug 21, 2019
Visit Reason
The inspection was conducted based on a complaint regarding medication administration and infection control practices at Burns Nursing Home, specifically concerning Resident Identifier #32.
Complaint Details
The complaint investigation focused on medication administration and infection control practices related to Resident #32. The complaint was substantiated with findings of minimal harm and potential for actual harm.
Findings
The facility failed to ensure a licensed nurse remained with Resident #32 during medication administration, and failed to properly clean and handle medication administration equipment, increasing risk of medication errors and infection.
Deficiencies (6)
Failed to ensure a licensed nurse remained with Resident #32 during administration of Miralax, who was not assessed for self-administration of medication.
Failed to clean Resident #32's nasal spray prior to recapping.
Failed to remove gloves, wash hands, and apply clean gloves after administering inhaler and before administering nasal spray to Resident #32.
Failed to clean Resident #32's inhaler prior to recapping.
Failed to clean Resident #32's Morphine syringe prior to placing it back in a plastic sleeve.
Failed to clean and dry Resident #32's nebulizer mask and reservoir prior to storing it in a plastic bag.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) | Observed administering medications and involved in deficiencies related to medication administration and infection control. | |
| Registered Nurse (RN)/Infection Control Preventionist/Minimum Data Set (MDS) Coordinator | Interviewed regarding proper medication administration and infection control procedures. |
Inspection Report
Routine
Deficiencies: 1
Date: Aug 1, 2018
Visit Reason
The inspection was conducted to evaluate the facility's compliance with infection prevention and control protocols, specifically focusing on hand hygiene practices during incontinence care.
Findings
The facility failed to ensure that a Certified Nursing Assistant performed hand hygiene between removing soiled gloves and re-gloving during incontinence care for one resident. This failure posed a minimal harm risk and affected one resident observed during care.
Deficiencies (1)
Failure to ensure a Certified Nursing Assistant performed hand hygiene between removing soiled gloves and re-gloving during incontinence care.
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