Inspection Reports for Florence Nursing And Rehabilitation Ctr, Llc

AL, 35630

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Deficiencies (last 2 years)

Deficiencies (over 2 years) 7 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

94% worse than Alabama average
Alabama average: 3.6 deficiencies/year

Deficiencies per year

8 6 4 2 0
2018
2020

Inspection Report

Routine
Deficiencies: 5 Date: Jan 14, 2020

Visit Reason
The inspection was conducted to assess compliance with food safety, infection prevention, and control standards in the nursing home facility.

Findings
The facility failed to ensure outdated food was not stored in the walk-in cooler, the ice machine was clean and free of black substance buildup, and the meat slicer was cleaned properly between uses. Additionally, licensed nurses failed to perform proper hand hygiene during medication administration, potentially risking resident infections.

Deficiencies (5)
Outdated food was stored in the walk-in cooler, including cabbage with discard date 12/25/19 and fruit cobbler with discard date 1/10/20.
Ice machine was observed with a black substance buildup inside, which could contaminate ice served to residents.
Meat slicer was not cleaned properly between uses, with food particles observed on the slicer.
Licensed Practical Nurse (LPN) failed to wash or sanitize hands after oral medication administration and before administering eye drops to a resident.
Registered Nurse (RN) failed to wash or sanitize hands after removing gloves post medication administration and before opening resident's door and handling medication cart.
Report Facts
Residents affected: 135 Residents affected: 2 Residents observed during medication pass: 6 Nurses observed during medication pass: 6

Employees mentioned
NameTitleContext
Dietary CookObserved and interviewed regarding outdated food in walk-in cooler
Certified Dietary Manager (CDM)Observed and interviewed regarding food safety and cleaning procedures
Licensed Practical Nurse (LPN), Employee Identifier #1Failed to perform hand hygiene between medication administrations
Registered Nurse (RN), Employee Identifier #2Failed to perform hand hygiene after glove removal and before handling medication cart
Infection Control Preventionist, Registered Nurse (RN), Employee Identifier #3Interviewed regarding infection control concerns

Inspection Report

Annual Inspection
Deficiencies: 5 Date: Oct 24, 2018

Visit Reason
The inspection was conducted to evaluate the facility's compliance with regulatory requirements related to resident care plans, catheter use and care, and food safety standards.

Findings
The facility failed to ensure baseline care plans addressed smoking and catheter use for certain residents, did not obtain timely physician orders for catheter use, failed to provide catheter care on several days, and stored outdated food items in the kitchen and nourishment refrigerators, posing risks of infection and foodborne illness.

Deficiencies (5)
Baseline care plans did not address smoking for Resident Identifier (RI) #112 and did not address use of a foley catheter and antipsychotic medications for RI #186.
Failed to obtain physician orders for use of RI #186's foley catheter until seven days after admission.
Failed to ensure catheter care was provided for RI #186 on multiple dates (10/16, 10/17, 10/18, 10/19, 10/20, and 10/22/18).
Failed to ensure medical diagnosis justified continued use of foley catheter for RI #186.
Stored outdated hot dog buns, lettuce, sweet and sour sauce, and bacon bits in kitchen and nourishment refrigerators.
Report Facts
Residents sampled: 25 Residents sampled with catheters: 3 Residents affected by food safety deficiencies: 127 Dates catheter care not provided: 6

Employees mentioned
NameTitleContext
Director of NursingInterviewed regarding baseline care plans, catheter orders, catheter care, and concerns about deficiencies
Certified Dietary ManagerInterviewed regarding food storage, use, and discard practices
Kitchen ManagerInterviewed regarding food storage and expiration dates

Inspection Report

Complaint Investigation
Deficiencies: 4 Date: Jan 25, 2018

Visit Reason
The inspection was conducted based on complaints regarding unclean bed linens for Resident Identifier (RI) #109, failure to complete smoking safety evaluations for RI #95, food safety concerns including improper hot food holding temperatures and unclean utensils, and infection control deficiencies observed during medication administration and incontinence care.

Complaint Details
The visit was complaint-related, triggered by allegations of unclean bed linens for RI #109 and failure to complete smoking safety evaluations for RI #95. The complaints were substantiated based on observations and interviews.
Findings
The facility was found deficient in maintaining clean and safe resident environments, including unclean pillowcases for RI #109, failure to complete timely smoking evaluations for RI #95, improper food temperature control and sanitation practices affecting all residents receiving dining services, and lapses in infection prevention practices by nursing staff and CNAs affecting multiple residents.

Deficiencies (4)
Failed to ensure RI #109's pillowcase was free of a brown colored substance.
Failed to complete a smoking evaluation on RI #95, a resident identified as a smoker.
Failed to maintain hot food holding temperatures at 135 degrees or above and failed to clean tea urn spigot and utensils properly.
Failed to ensure licensed nurse changed gloves and washed hands appropriately during medication administration and failed to ensure CNA followed proper hand hygiene and glove use during incontinence care.
Report Facts
Residents affected: 28 Residents affected: 2 Residents affected: 141 Residents affected: 27 Temperature: 119 Temperature: 120 Temperature: 145

Employees mentioned
NameTitleContext
RN Unit ManagerObserved unclean pillowcase for RI #109 and identified CNA responsibility for linens
CNA EI #5Provided care to RI #109 and did not change pillowcase on 01/23/2018
CNA EI #6Provided care to RI #109 on 01/24/2018 and could not recall changing pillowcase
RN Unit Manager EI #3Responsible for smoking evaluations and acknowledged breakdown in communication for RI #95
Director of Nursing EI #1Confirmed RI #95 was identified as a smoker and acknowledged failure to complete timely smoking evaluation
Certified Dietary Manager EI #2Interviewed regarding food temperature and sanitation deficiencies
Licensed Practical Nurse EI #7Observed failing to follow infection control practices during medication administration for RI #72
CNA EI #8Observed failing to follow infection control practices during incontinence care for RI #93

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