Inspection Reports for
Harborview Thomasville

The facility failed to follow the care plan for one resident regarding a non-functioning wander guard bracelet, placing residents at risk for elopement and potential harm. Interviews and observations confirmed the bracelet was not functioning and should be checked daily and replaced as needed.

Complaint Intake Numbers GA00253641 and GA00253612 were investigated. GA00253641 was unsubstantiated and GA00253612 was substantiated without deficiency.

The survey revealed multiple deficiencies including failure to prevent abuse between residents, failure to report abuse to law enforcement, inadequate PASARR assessments, failure to follow care plans for assistance and bed positioning, unsafe environment hazards including unsecured housekeeping carts, medication administration errors, improper medication storage, unsanitary kitchen conditions, improper storage of resident care items, and failure to maintain resident privacy with adequate curtains.

The facility was found deficient in multiple areas including failure to complete accurate PASARR Level I assessments, failure to implement care plans for residents including assistance during meals and bed positioning to prevent falls, inadequate infection prevention practices related to storage of personal care items, and failure to provide adequate privacy with functional curtains in resident rooms.

The complaint investigation was initiated due to allegations of resident abuse where one resident struck another with a broom and a cane on separate occasions. The facility failed to report these incidents to law enforcement and failed to protect residents from abuse. Additional concerns included care plan noncompliance, safety hazards, medication errors, infection control issues, and privacy violations.

The facility failed to prevent abuse between residents, failed to report abuse to law enforcement, failed to follow care plans for assistance and bed positioning, failed to maintain safe bed rails, had medication administration errors, improper medication storage, unsanitary kitchen conditions, improper storage of personal care items, and inadequate privacy curtains.

The survey revealed deficiencies related to employee health requirements, specifically the failure to ensure that three long-term employees received the required annual tuberculin skin test as mandated by state regulation.

The investigation was triggered by complaint intakes GA00252250 and GA00255395, which were substantiated. Immediate Jeopardy was identified related to resident safety and care failures involving suicidal ideations and self-harm attempts.

The facility was found to be in Immediate Jeopardy due to failure to protect a resident (R2) with suicidal ideations who wrapped call light and bed remote cords around his neck multiple times, with inadequate psychiatric services, failure to remove choking hazards, failure to report incidents, and failure to implement appropriate care plans and supervision. The facility implemented corrective actions including staff education, resident audits, and policy reviews.

The investigation was complaint-driven, focusing on resident R2's multiple suicide attempts using call light and bed remote cords, failure to report these incidents, inadequate care planning, lack of behavioral health services, and unsafe environment. The facility was found out of compliance with immediate jeopardy to resident health and safety.

The facility failed to timely report suspected abuse and neglect related to resident R2's suicidal attempts using call light and bed remote cords. The facility did not implement adequate care plan interventions, failed to provide necessary behavioral health services, and did not remove choking hazards from the resident's reach. Staff education and oversight were insufficient, resulting in immediate jeopardy to resident health and safety. The facility developed and implemented a plan of correction, including staff education and resident audits, which was validated and removed the immediate jeopardy.

Complaint intake GA00249788 was substantiated with deficiencies cited.

The facility failed to maintain a clean and homelike environment in seven of 33 resident rooms, with issues including cracked wall molding, missing floor tiles, broken or missing toilet paper holders, missing ceiling tile pieces, holes in walls, black scuff marks on walls, and a dirty pillowcase. Observations were confirmed with the Maintenance Director and Housekeeping Supervisor.

The facility failed to maintain a clean and homelike environment in seven of 33 rooms, with issues including cracked wall molding, missing floor tiles, broken or missing toilet paper holders, missing ceiling tile pieces, holes in walls, black scuff marks on walls, and dirty pillowcases. Observations were confirmed with the Maintenance Director and Housekeeping Supervisor.

The facility failed to maintain a clean and homelike environment in seven of 33 rooms, with issues including cracking wall molding, missing floor tiles, broken or missing toilet paper holders, missing ceiling tile pieces, holes in walls, black scuff marks on walls, and dirty pillowcases. Observations on both days revealed no changes in these deficiencies.

The facility was found non-compliant in managing residents' personal funds, failing to pay final refunds within 30 days after discharge for two residents. Additionally, the facility failed to provide a 30-day written notice for a facility-initiated transfer or discharge for one resident.

The survey investigated complaints GA00240732, GA00243031, GA00244675, and GA00245112. Complaints GA00240732, GA00244675, and GA00245112 were unsubstantiated. Complaint GA00243031 was substantiated.

The facility failed to ensure timely payment of final refunds for two discharged residents and did not provide a 30-day discharge notice for one resident who was discharged after behavioral incidents. Deficiencies were cited related to accounting of personal funds and transfer/discharge notice requirements.

Deficiencies were cited related to management of personal property/financial affairs, specifically delayed refunds to residents after discharge, and failure to provide a 30-day notice for a facility-initiated transfer or discharge for one resident. The facility did not ensure timely refunds for two residents and failed to provide proper discharge notice for one resident who was discharged after behavioral concerns.

The investigation involved four complaints; three were unsubstantiated and one was substantiated (GA00243031). The substantiated complaint involved failure to timely refund residents' personal funds and failure to provide proper discharge notice.

The facility failed to ensure timely refund of residents' personal funds within 30 days after discharge for two residents, and failed to provide a 30-day notice of discharge for one resident who was discharged after behavioral incidents. Deficiencies were cited related to accounting of personal funds and transfer/discharge notice requirements.

The complaint investigation found that two residents (R4 and R8) did not receive their final refunds within 30 days after discharge. One resident (R4) did not receive a 30-day discharge notice and was not allowed to return to the facility after a behavioral health stay. The findings were based on staff interviews, record reviews, and policy evaluations.

The facility failed to pay final refunds to two residents within 30 days of discharge and improperly withheld funds from one resident. Additionally, the facility did not provide a 30-day discharge notice to one resident and refused to allow the resident to return after a behavioral facility stay.

The facility failed to ensure that food items in various storage areas were labeled and dated with expiration or use-by dates, and lacked a step-to-open trashcan by the handwashing sink, risking cross contamination. These deficiencies impacted 60 of 64 residents receiving oral diets.

The facility failed to ensure that food items in various storage areas were labeled and dated with expiration or use-by dates, and lacked a step-to-open trashcan by the handwashing sink, posing a risk of cross contamination. These deficiencies impacted 60 of 64 residents receiving oral diets.

The inspection revealed multiple deficiencies including failure to follow infection control policies related to linen handling and laundry processes, inadequate nursing care regarding nail trimming for a resident, and improper food storage and labeling in the kitchen. Additionally, maintenance issues such as unclean dryer vents and kitchen fan dust were noted.

Complaint Intake Numbers GA00237445, GA00236393, GA00235203, GA00234994, and GA00232758 were investigated and found to be unsubstantiated.

The facility was found not in substantial compliance with Medicare/Medicaid regulations, with deficiencies including inaccurate resident assessments related to PASRR, failure to ensure nail care for a resident, improper food labeling and cleanliness in the kitchen, and infection control lapses in laundry handling and storage.

The facility was found deficient in ensuring accurate resident assessments, providing adequate personal care such as nail trimming, maintaining proper food labeling and storage, and implementing effective infection prevention and control practices in laundry and kitchen areas. These deficiencies posed potential risks to resident health and safety.

The facility was found deficient in ensuring accurate resident assessments, providing adequate nail care for residents, properly labeling and dating opened food items, maintaining cleanliness of kitchen equipment, and following infection control policies in laundry handling and processing. These deficiencies had potential to affect resident care and safety.

The facility was found not in substantial compliance with life safety requirements, including blocked exit discharge, damaged vertical openings, inadequate hazardous area protections, lack of fire alarm and sprinkler system maintenance, malfunctioning smoke doors, improper electrical installations, and unlabeled electrical circuits.

The complaint investigation found that the facility did not have a Physician's Order for DNR for resident R#46 despite the resident's expressed wishes. The resident's care plan did not reflect these wishes, and staff interviews revealed that code status documentation was missing or inconsistent in the medical record and physical charts.

The facility failed to document and clarify the DNR code status for one resident (R#46), with no Physician's Orders for DNR or POLST found in the medical record. The care plan did not align with the resident's wishes, and staff interviews confirmed gaps in documentation and communication regarding code status.