Inspection Reports for Central Care

The facility failed to provide undamaged window blinds in 4 of 10 sampled resident rooms and failed to provide a comfortable chair for each resident in 3 of 10 sampled rooms. Additionally, the facility did not meet minimum aide staffing hours for 21 of 42 sampled shifts and failed to ensure mandatory annual infection control training was completed for 2 of 3 sampled staff.

The inspection included a complaint investigation as stated in the initial comments section.

The facility was found deficient in multiple areas including housekeeping and furnishings, personal care and staffing, health care referral and follow-up, nutrition and food service, activities program, pharmaceutical care, and infection control training. Specific issues included damaged window blinds, inadequate bed linens, lack of comfortable chairs, insufficient aide staffing hours, failure to notify providers of weight changes, missing laboratory tests, lack of therapeutic diet menus, absence of a posted activity calendar, failure to implement medication changes, and incomplete infection control training for staff.

This follow-up survey was conducted concurrently with the complaint survey, and deficiencies remaining from the complaint are noted in this report. The complaint deficiencies include unclean floors and ceilings in Room A10, broken blinds in Room A9, and unsafe mechanical equipment.

The facility had multiple deficiencies remaining from the prior complaint and construction survey, including unclean and unrepaired walls, ceilings, floors, and furnishings; mechanical equipment not maintained safely such as exposed heating elements and unsecured plumbing fixtures; and fire safety system failures like unsealed ceiling joints.

The facility was found to have multiple deficiencies including unsecured oxygen tanks in a resident room, missing and damaged window blinds in several resident rooms, failure to provide comfortable chairs for residents, lack of matching therapeutic diet menus for residents with physician-ordered diets, failure to administer medications as ordered for a resident, inaccurate medication administration records, and failure to ensure mandatory infection control training was completed by staff.

The facility was found deficient in multiple areas including physical environment, housekeeping and furnishings, medication administration, personal care and supervision, health care, nutrition and food service, activities program, staff qualifications, and controlled substances management. Specific issues included non-functioning exit door alarms, unclean and unsafe resident rooms, medication errors, lack of supervision for a resident with dementia who eloped, incomplete referrals for therapies, inaccurate medication records, and insufficient activities provided.

The facility failed to ensure the Activities Director completed required training within 9 months of employment, failed to competency validate a medication aide for licensed health professional support tasks, failed to ensure diabetic care training for a medication aide, and failed to administer medications as ordered including insulin and probiotic supplements. Additionally, the facility did not consistently enforce proper face mask use among staff and visitors and lacked proper COVID-19 screening procedures for visitors.

The complaint investigation was initiated by the Surry County Department of Social Services on 11/21/19 and included failure to administer medications as ordered to Resident #5.

The facility failed to administer medications as ordered to Resident #5, who had diagnoses including hepatic encephalopathy, resulting in the resident not receiving two prescribed medications to lower ammonia levels, placing the resident at risk for liver damage, behavioral changes, and increased ammonia levels. The failure was detrimental to the health, safety, and welfare of residents and constitutes a Type B Violation.

The facility was found deficient in maintaining current sanitation and fire safety reports, fire safety rehearsals documentation, building equipment safety and operation, fire door functionality, fire rated wall integrity, electrical hazards, fire suppression system compliance, fire extinguisher inspections, plumbing fixture maintenance, and prohibition of portable electric heaters.

The facility failed to assure that exit doors accessible to residents with wandering and exit-seeking behaviors were alarmed, resulting in elopements of two residents without staff knowledge. The facility also failed to provide adequate supervision for these residents. Additionally, the facility did not notify primary care providers regarding refusals of medication and bed bug bites. Medication administration errors were observed, including missed doses and administration of expired insulin.

The facility failed to assure implementation of physician orders for finger stick blood sugar rechecks and insulin administration for diabetic residents, failed to serve therapeutic diets as ordered, failed to clarify medication orders, failed to administer medications as ordered, and failed to implement infection control procedures consistent with CDC guidelines for glucometer use.

The facility was found deficient in providing privacy in bathrooms with multiple commodes, maintaining ventilation systems, securing oxygen cylinders, maintaining plumbing equipment, and ensuring fire safety equipment and corridor doors were in safe and operating condition. Some deficiencies were corrected before surveyors departed.

Multiple deficiencies were cited including failure to meet building code requirements at the time of construction or alteration, lack of current sanitation and fire safety inspection reports, inadequate bathroom privacy, ventilation system failures, unsafe housekeeping and furnishings, fire safety rehearsal deficiencies, unsafe building equipment and fire safety issues, use of prohibited portable electric heaters, and failure to maintain hot water temperature within required limits.

The facility failed to maintain a current fire inspection report, had multiple missing and broken slats in vertical window blinds compromising resident privacy in many rooms and common areas, and failed to provide diabetic care training and annual infection control training to medication aides prior to insulin administration.

The followup survey revealed that all deficiencies have not been corrected. Specifically, the required one-hour fire rated walls and/or ceilings were compromised in several locations including holes in ceilings of the closet off the laundry, laundry next to the hinge on the disappearing stairway, and community bath next to the hinge on the disappearing stairway.

The facility was found not to be maintained in a safe manner due to improper handling of portable medical oxygen cylinders and multiple fire safety deficiencies including a damaged heat detector, malfunctioning fire door, compromised fire-rated walls and ceilings, and non-functioning emergency lighting.

The facility was found deficient in tuberculosis testing compliance for one staff member, improper limitation of housekeeping duties for a nurse aide, and failure to provide two fruit servings including a citrus fruit or equivalent juice as required on the menu.