Inspection Reports for Premier Estates of Dublin, LLC
1634 TELFAIR STREET, DUBLIN, GA, 31021
Back to Facility ProfileInspection Report Summary
The most recent inspection on May 14, 2025, was a follow-up survey that found all previously cited deficiencies corrected. Prior inspections showed a pattern of deficiencies related mainly to environmental maintenance, infection control, resident care including activities of daily living, and life safety code compliance such as blocked exits and fire system maintenance. Complaint investigations were mostly unsubstantiated, with one substantiated complaint in November 2023 that resulted in deficiencies but no enforcement actions or fines were listed in the available reports. Enforcement actions such as fines, immediate jeopardy findings, or license suspensions were not mentioned in the reports. The facility appears to have made improvements over time, as follow-up and re-inspection surveys frequently confirmed correction of earlier cited deficiencies.
Deficiencies (last 9 years)
Deficiencies (over 9 years)
12.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
161% worse than Georgia average
Georgia average: 4.9 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
82 residents
Based on a May 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Follow-Up
Deficiencies: 0
Date: May 14, 2025
Visit Reason
A Follow-Up Survey was conducted to verify that all previously cited survey tags have been corrected.
Findings
The surveyor noted that all previously cited deficiencies have been corrected during the follow-up survey.
Inspection Report
Deficiencies: 0
Date: May 8, 2025
Visit Reason
The document is a Statement of Deficiencies and Plan of Correction for Premier Estates of Dublin, LLC, indicating a regulatory inspection was conducted.
Findings
The report contains initial comments but does not provide specific details on deficiencies or findings.
Inspection Report
Re-Inspection
Census: 82
Deficiencies: 0
Date: May 8, 2025
Visit Reason
A revisit survey was conducted from May 7, 2025, to May 8, 2025, to verify correction of deficiencies cited in the March 31, 2025, standard survey.
Findings
All deficiencies cited as a result of the March 31, 2025, standard survey were found to be corrected.
Inspection Report
Routine
Census: 82
Deficiencies: 6
Date: Mar 31, 2025
Visit Reason
A standard survey was conducted at Dublin Trails of Journey from 3/29/2025 to 3/31/2025 to assess compliance with Medicare/Medicaid regulations for long term care facilities.
Findings
The facility was found noncompliant with several regulatory requirements including failure to provide resident trust fund quarterly statements, failure to timely report resident elopements, inadequate provision of activities of daily living such as nail care, improper cleaning and storage of respiratory oxygen equipment, failure to discard expired and unlabeled food items, and failure to perform proper hand hygiene and clean shared equipment.
Deficiencies (6)
Failed to provide resident trust fund quarterly statements for two residents.
Failed to timely report two incidents of resident elopement to the State Survey Agency.
Failed to ensure activities of daily living, specifically nail care, were provided for three dependent residents.
Failed to ensure respiratory oxygen equipment was properly cleaned and stored for three residents.
Failed to follow policy regarding expired, unlabeled, and undated food items in storage and failed to maintain a clean ice machine.
Failed to properly perform hand hygiene between residents and properly clean and disinfect reusable electronic blood pressure cuff.
Report Facts
Resident census: 82
Resident trust fund accounts: 62
Residents reviewed for ADL nail care: 32
Residents with respiratory oxygen equipment reviewed: 5
Expired food items: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shalia Jones | Licensed Practical Nurse (LPN) | Interviewed regarding hand hygiene practices and cleaning of blood pressure cuff |
| LPN AA | Licensed Practical Nurse | Observed failing to perform hand hygiene properly and not cleaning blood pressure cuff between residents |
| Business Office Manager | Responsible for resident trust fund accounts and quarterly statements | |
| Director of Nursing Service (DNS) | Confirmed residents' nails needed care and discussed nail care policies | |
| Certified Nursing Assistant (CNA) FF | Performed nail care for resident and discussed nail care policy | |
| Director of Health Services (DHS) | Interviewed about infection control expectations including hand hygiene and cleaning of blood pressure cuff | |
| Dietary Aide DD | Interviewed regarding expired and unlabeled food items and ice machine cleaning | |
| Dietary Aide BB | Interviewed regarding food storage checks and labeling | |
| CFM | Interviewed regarding food labeling, expiration, and kitchen staffing | |
| LPN II | Licensed Practical Nurse | Confirmed responsibility for oxygen equipment maintenance and cleaning |
Inspection Report
Life Safety
Census: 82
Capacity: 104
Deficiencies: 16
Date: Mar 29, 2025
Visit Reason
The inspection was conducted to review the facility's compliance with emergency preparedness and life safety code requirements, including fire safety, emergency lighting, exit signage, sprinkler systems, fire alarm systems, fire drills, and door maintenance.
Findings
The facility was found not in substantial compliance with multiple life safety code requirements including blocked exit routes, improper emergency lighting and exit sign testing, failure to maintain self-closing doors, improper fire alarm system installation and maintenance, deficiencies in sprinkler system installation and maintenance, unserviced fire extinguishers, unsealed firewalls, improper electrical equipment installation, lack of fire drills on night shift, and failure to inspect and maintain fire and smoke-rated doors.
Deficiencies (16)
Emergency Preparedness Program was not in substantial compliance with 42 CFR § 483.73.
Facility failed to maintain exit routes free of obstruction; housekeeping carts blocked exit discharge.
Facility failed to maintain clear access to public way; trailer blocked sidewalk at E Hall exit.
Facility failed to ensure proper testing and documentation of emergency lighting.
Facility failed to ensure proper testing and documentation of exit signs; some exit signs not working in emergency mode.
Facility failed to maintain proper operation of self-closing doors; door propped open with door chock in Kitchen Storage Room.
Facility failed to ensure proper installation of fire alarm system; circuit breaker not properly identified or locked.
Facility failed to ensure proper inspection, testing, and maintenance of fire alarm system; sensitivity testing of smoke detectors not conducted.
Facility failed to ensure proper installation of fire sprinkler system; gauges need recalibration and fire department connection missing protective caps.
Facility failed to ensure proper inspection, testing, and maintenance of fire sprinkler system; 5-year internal inspection overdue, corroded sprinkler heads present.
Facility failed to ensure proper inspection, testing, and maintenance of portable fire extinguishers; extinguishers not properly serviced or missing inspection tags.
Facility failed to ensure proper inspection, testing, and maintenance of fire extinguishers near dining room, smoking porch, and employee break room.
Facility failed to ensure continuity of firewalls; unsealed penetrations found in firewalls in A Hall, B Hall, and C Hall.
Facility failed to ensure proper installation of electrical equipment; power strip lying on floor in Administrator's Office.
Facility failed to ensure proper staff training on fire drills; no fire drills conducted for night shift during third quarter.
Facility failed to ensure proper inspection, testing, and maintenance of fire and smoke-rated doors; no documentation available.
Report Facts
Census: 82
Total Capacity: 104
Deficiencies cited: 16
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Confirmed multiple findings during facility tour on 3/29/2025 | |
| Staff A | Confirmed Emergency Preparedness Program findings |
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Mar 8, 2024
Visit Reason
This document is a Statement of Deficiencies and Plan of Correction for Premier Estates of Dublin, LLC, indicating a regulatory inspection was conducted and deficiencies were identified requiring correction.
Findings
The report contains initial comments but does not specify any detailed deficiencies or findings within the provided page.
Inspection Report
Re-Inspection
Census: 71
Deficiencies: 0
Date: Mar 8, 2024
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited during the November 30, 2023, Recertification survey and Complaint Investigation.
Findings
All deficiencies cited in the prior November 30, 2023 survey and complaint investigation were found to be corrected during this revisit survey.
Inspection Report
Re-Inspection
Census: 4
Deficiencies: 4
Date: Jan 23, 2024
Visit Reason
A State Licensure revisit was conducted at Premier Estates of Dublin on January 23, 2024, to verify correction of previously cited deficiencies related to environmental sanitation and housekeeping.
Complaint Details
This revisit was conducted in response to a prior Complaint Investigation and State Licensure survey on November 30, 2023, with a Plan of Correction due by January 14, 2024.
Findings
The facility failed to maintain a homelike environment due to rusty and dirty vents, chipped paint on the nurse's station countertop, peeling kitchen ceiling paint, and torn or missing floor tiles in multiple hallways. Observations and interviews confirmed ongoing issues despite some corrective actions.
Deficiencies (4)
Rusty and dirty vents in dining room and kitchen areas.
Chipped paint on nurse's station countertop between halls D and E.
Peeling and loose ceiling paint and material in the kitchen.
Torn and missing floor tiles in D and E hallways, including multiple broken tiles in room E10.
Report Facts
Air vents observed: 7
Kitchen vents: 5
Residents in E Hall: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Director | Maintenance Director | Interviewed regarding vent replacements, tile repairs, and countertop condition. |
| Assistant Dietary Manager | Assistant Dietary Manager | Interviewed about kitchen vent replacements and ceiling condition. |
| Administrator | Administrator | Interviewed about awareness of facility deficiencies and renovation plans. |
Inspection Report
Re-Inspection
Census: 72
Deficiencies: 4
Date: Jan 23, 2024
Visit Reason
A revisit survey was conducted to assess the facility's compliance with Medicare/Medicaid regulations following a prior Complaint Investigation and State Licensure survey.
Findings
The facility failed to maintain a homelike environment due to rusty and dirty vents, chipped paint on the nurse's station countertop, unpainted and peeling kitchen ceiling, and torn and missing floor tiles in two of five halls. Maintenance efforts were ongoing but incomplete at the time of inspection.
Deficiencies (4)
Rusty and dirty vents in the dining room and kitchen.
Chipped paint on the nurse's station countertop between halls D and E.
Unpainted and peeling kitchen ceiling with loose ceiling material.
Torn and missing floor tiles in D and E halls, including multiple missing and broken tiles in room E10.
Report Facts
Census: 72
Air vents observed: 7
Kitchen vents: 5
Missing floor tiles: 2
Residents in E Hall: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Director | Maintenance Director | Interviewed regarding vent and floor tile conditions and repairs |
| Assistant Dietary Manager | Assistant Dietary Manager | Interviewed about kitchen vent replacements and ceiling condition |
| Administrator | Administrator | Interviewed about awareness of facility conditions and renovation plans |
Inspection Report
Follow-Up
Deficiencies: 0
Date: Jan 19, 2024
Visit Reason
A Follow-Up Survey was conducted to verify correction of previously cited survey deficiencies.
Findings
All previously cited survey tags have been corrected as noted by the surveyor.
Inspection Report
Annual Inspection
Census: 69
Deficiencies: 3
Date: Nov 30, 2023
Visit Reason
A State Licensure survey was conducted at Premier Estates of Dublin from November 28, 2023 through November 30, 2023 to assess compliance with state health regulations and facility licensure requirements.
Findings
The survey identified deficiencies related to infection control practices during fingerstick testing and enteral feeding, environmental sanitation issues including peeling paint and damaged fixtures, and failures in employee background screening processes.
Deficiencies (3)
Failure to provide a safe and sanitary environment for residents receiving fingerstick testing and enteral feeding, with lapses in hand hygiene and equipment cleaning.
Failure to maintain a sanitary, orderly, and comfortable interior by not repairing peeling wall paint, ceiling light issues, and torn floor tiles in one hall.
Failure to ensure pre-employment screening including fingerprints for three employees and background check for one employee.
Report Facts
Residents receiving fingerstick testing: 15
Residents receiving enteral feeding: 1
Facility census: 69
Employees missing fingerprint screening: 3
Employees missing background check: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN FF | Licensed Practical Nurse | Observed performing fingerstick testing and insulin administration with lapses in hand hygiene |
| LPN DD | Licensed Practical Nurse | Observed performing tube feeding with lapses in hand hygiene and equipment sanitation |
| LPN EE | Licensed Practical Nurse | Provides wound care and works in Infection Preventionist Program; interviewed about hand hygiene practices |
| Director of Nursing | Director of Nursing | Interviewed regarding hand hygiene expectations and background check missing |
| Certified Nursing Aide AA | Certified Nursing Aide | Hired without fingerprint process completed |
| Certified Nursing Aide BB | Certified Nursing Aide | Hired without fingerprint process completed |
| Certified Nursing Aide CC | Certified Nursing Aide | Hired without fingerprint process completed |
Inspection Report
Routine
Census: 69
Deficiencies: 4
Date: Nov 30, 2023
Visit Reason
A standard survey was conducted from 11/28/2023 through 11/30/2023, including investigation of multiple complaint intake numbers, to assess compliance with Medicare/Medicaid regulations for Premier Estates of Dublin.
Complaint Details
Multiple complaint intake numbers were investigated; four were unsubstantiated, one was substantiated with no deficiencies, and one was substantiated with deficiencies.
Findings
The facility was found not in substantial compliance with Medicare/Medicaid regulations, with deficiencies in maintenance of a safe and homelike environment, pre-employment screening, PASARR coordination, and infection prevention and control practices.
Deficiencies (4)
Failure to maintain a sanitary, orderly, and comfortable interior including peeling wall paint, ceiling light issues, and torn floor tiles in one of five halls.
Failure to ensure pre-employment screening with fingerprints for three employees and background check for one employee.
Failure to conduct a Level II PASARR screening for one resident following a new diagnosis of schizophrenia.
Failure to provide a safe and sanitary environment related to infection prevention and control during fingerstick testing and enteral feeding procedures.
Report Facts
Resident census: 69
Number of staff files reviewed: 10
Number of residents sampled for PASARR screening: 9
Units of insulin administered: 8
Volume of water given during tube feeding: 285
Employees mentioned
| Name | Title | Context |
|---|---|---|
| AA | Certified Nursing Aide | Named in deficiency for missing fingerprint process. |
| BB | Certified Nursing Aide | Named in deficiency for missing fingerprint process. |
| CC | Certified Nursing Aide | Named in deficiency for missing fingerprint process. |
| Director of Nursing | Director of Nursing | Named in deficiency for missing background check. |
| FF | Licensed Practical Nurse | Observed during fingerstick testing and insulin administration with infection control deficiencies. |
| DD | Licensed Practical Nurse | Observed during tube feeding with infection control deficiencies. |
| EE | Licensed Practical Nurse | Provides wound care and works in Infection Preventionist Program; interviewed about hand hygiene expectations. |
Inspection Report
Life Safety
Census: 69
Capacity: 104
Deficiencies: 12
Date: Nov 28, 2023
Visit Reason
The visit was a Life Safety Code Survey conducted to assess compliance with Medicare/Medicaid participation requirements and NFPA 101 Life Safety Code standards.
Findings
The facility was found not in substantial compliance with several Life Safety Code requirements including blocked exits, failure to test and operate emergency lighting, lack of vent hood cleaning and suppression reports, sprinkler system maintenance issues, improper storage near sprinkler heads, electrical hazards such as improperly installed multi taps and missing light fixtures, use of prohibited portable space heaters, and unsafe use of power strips and extension cords.
Deficiencies (12)
Exits blocked by cart and tables, obstructing means of egress.
Failure to test emergency lighting; no records of testing found.
Emergency lighting failed to operate in B hall and dining room.
Failure to provide vent hood cleaning and suppression reports.
Sprinkler system yellow tagged, indicating failure to comply with NFPA 25.
Storage in patient room closets within 18 inches of sprinkler heads.
Wires supported by sprinkler piping above A hall smoke doors.
Improper installation of multi tap power strips on floors in multiple rooms.
Missing light fixtures in room B-2 and electrical room.
Use of prohibited portable space heater in Amy's office without thermostatic documentation.
Missing emergency lighting in both medication rooms.
Use of multiplug adapters in housekeeping and social services electrical sockets.
Report Facts
Census: 69
Total Capacity: 104
Smoke Compartments Affected: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Staff member who confirmed observations during the facility tour |
Inspection Report
Abbreviated Survey
Census: 69
Deficiencies: 0
Date: Jan 25, 2023
Visit Reason
An abbreviated survey was conducted to investigate complaints #GA00231755 and #GA00231204.
Complaint Details
Complaints #GA00231755 and #GA00231204 were investigated and found to be unsubstantiated.
Findings
The complaints were unsubstantiated and no regulatory violations were cited during the survey.
Inspection Report
Re-Inspection
Census: 68
Deficiencies: 0
Date: Dec 1, 2022
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited in the 9/29/2022 Standard Survey.
Findings
All deficiencies cited in the previous 9/29/2022 Standard Survey were found to be corrected during the revisit survey.
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Dec 1, 2022
Visit Reason
This document is a Statement of Deficiencies and Plan of Correction for Premier Estates of Dublin, LLC, indicating a regulatory inspection was conducted.
Findings
The report contains initial comments but does not provide specific details on deficiencies or findings within the visible content.
Inspection Report
Follow-Up
Deficiencies: 0
Date: Nov 22, 2022
Visit Reason
A Follow-Up Survey was conducted to verify correction of previously cited survey deficiencies.
Findings
All previously cited survey tags have been corrected as noted by the surveyor.
Inspection Report
Renewal
Deficiencies: 4
Date: Sep 29, 2022
Visit Reason
A Licensure Survey was conducted from 09/26/22 through 09/29/22 to assess compliance with licensure requirements and facility policies.
Findings
The facility failed to ensure nursing staff had the competencies to care for a resident with a chest tube, admitted a resident with a chest tube without proper facility assessment or staff training, and lacked documentation of staff training. Additionally, deficiencies were found in nursing care related to assistance with activities of daily living, catheter care, and dialysis shunt assessment and documentation.
Deficiencies (4)
Facility failed to ensure nursing staff had competencies and skills necessary to provide care for a chest tube for one resident.
Failed to ensure one resident received assistance with activities of daily living including personal hygiene and eating.
Failed to ensure one resident's catheter bag was kept below the level of the bladder during transport and transfer.
Failed to ensure dialysis shunt was assessed and documented consistently and dialysis communication forms were completed for one resident.
Report Facts
Residents with indwelling catheters: 6
Residents observed for hygiene and grooming: 25
Residents with dialysis treatment: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN1 | Licensed Practical Nurse | Documented performing chest tube drainage for Resident 18. |
| LPN2 | Licensed Practical Nurse | Assigned to care for Resident 18 but had not received chest tube training and was unsure how to drain chest tube. |
| LPN3 | Licensed Practical Nurse | Confirmed lack of training for chest tube care and uncertainty about care procedures. |
| LPN4 | Licensed Practical Nurse | Documented performing chest tube drainage for Resident 18. |
| Director of Nursing | Director of Nursing | Confirmed Resident 18 had chest tube with Aspira drainage system and lack of staff training and documentation. |
| Nurse Practitioner | Nurse Practitioner | Confirmed expectation for staff training on chest tube care and dialysis shunt assessment. |
| Certified Nurse Aide 4 | Certified Nurse Aide | Assigned to Resident 18 and Resident 27; confirmed lack of training on chest tube care and observed inadequate assistance with Resident 27. |
| Physical Therapy Assistant | Physical Therapy Assistant | Provided therapy to Resident 18; confirmed lack of training on chest tube care. |
| Assistant Director of Nursing | Assistant Director of Nursing | Observed improper catheter bag positioning during resident transport. |
| Certified Nurse Aide 1 | Certified Nurse Aide | Involved in transport of Resident 19 with catheter bag improperly positioned. |
| Certified Nurse Aide 2 | Certified Nurse Aide | Involved in transport of Resident 19 with catheter bag improperly positioned. |
| Administrator | Administrator | Stated staff should assist with personal hygiene after meals but no specific policy existed. |
| MDS Coordinator | MDS Coordinator | Confirmed lack of training for chest tube care. |
Inspection Report
Routine
Census: 69
Deficiencies: 9
Date: Sep 29, 2022
Visit Reason
A standard survey was conducted to assess the facility's compliance with Medicare/Medicaid regulations and resident care standards.
Findings
The facility was found noncompliant with multiple regulatory requirements including resident self-determination, ADL care, medication administration, incontinence care, nutrition and hydration, respiratory care, dialysis care, nursing staff competency, and environmental safety. Specific deficiencies included failure to honor resident bathing preferences, inadequate assistance with ADLs, missed medication administration, improper catheter care, lack of nutritional support during dialysis, incorrect oxygen therapy administration, incomplete dialysis shunt assessments, insufficient nursing competency for chest tube care, and unsafe water temperatures and wall conditions in resident rooms.
Deficiencies (9)
Failed to determine and honor waking time/shower schedule preferences for one resident.
Failed to ensure one resident received necessary assistance with ADLs including personal hygiene and eating.
Failed to administer requested medication (Sodium Bicarbonate) to one resident.
Failed to ensure urinary catheter bag was maintained below bladder level for one resident.
Failed to provide nutritional services for one resident during dialysis appointments three days a week.
Failed to provide oxygen therapy at correct flow rate and by licensed nursing staff for one resident.
Failed to ensure dialysis shunt was assessed and documented consistently and dialysis communication forms completed for one resident.
Failed to ensure nursing staff competency for care of chest tubes for one resident.
Failed to maintain warm water temperatures in resident rooms and maintain walls in good condition for residents.
Report Facts
Resident census: 69
Medication dose missed: 1
Dialysis days per week: 3
Oxygen flow rate ordered: 3
Oxygen flow rate observed: 2
Water temperature: 61
Water temperature: 114
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN 2 | Registered Nurse | Named in medication administration deficiency for failing to administer Sodium Bicarbonate |
| Director of Nursing | Director of Nursing | Named in multiple findings including medication administration, catheter care, oxygen therapy, dialysis care, and chest tube care |
| LPN 1 | Licensed Practical Nurse | Named in oxygen therapy and chest tube care deficiencies |
| CNA 4 | Certified Nurse Aide | Named in ADL care and chest tube care deficiencies |
| Nurse Practitioner | Nurse Practitioner | Named in medication administration, dialysis care, and chest tube care deficiencies |
Inspection Report
Re-Inspection
Census: 69
Deficiencies: 0
Date: Sep 26, 2022
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited during the 8/9/22 Complaint Survey.
Complaint Details
This visit was a follow-up to a complaint survey conducted on 8/9/22; all cited deficiencies were corrected.
Findings
All deficiencies cited as a result of the 8/9/22 Complaint Survey were found to be corrected.
Inspection Report
Re-Inspection
Census: 69
Deficiencies: 0
Date: Sep 26, 2022
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited during the 8/9/22 Complaint Survey.
Complaint Details
The visit was a follow-up to a complaint survey conducted on 8/9/22; all cited deficiencies were corrected.
Findings
All deficiencies cited as a result of the 8/9/22 Complaint Survey were found to be corrected.
Report Facts
Census: 69
Inspection Report
Life Safety
Census: 76
Capacity: 105
Deficiencies: 12
Date: Sep 26, 2022
Visit Reason
Life Safety Code Survey conducted to assess compliance with Medicare/Medicaid participation requirements and NFPA 101 Life Safety Code 2012 edition.
Findings
The facility was found not in substantial compliance with life safety requirements, including issues with self-closing doors, sprinkler system installation and maintenance, fire extinguisher maintenance, smoke barrier construction, electrical safety, fire drills, portable space heaters, gas equipment storage, and oxygen cylinder security.
Deficiencies (12)
Patient room doors missing door hardware to keep doors closed; smoke doors failed to close properly.
Sprinkler heads obstructed by insulation in attic.
Wires supported by sprinkler piping above smoke doors.
Items stored too close to sprinkler head in C hall storage room.
Fire extinguishers and hood suppression system out of date for maintenance.
Penetrations above A hall smoke doors firewall not properly sealed.
Power strips improperly installed on floor in nursing station and DON office.
Open spaces in electrical panels in kitchen and B hall.
Extension cords used as permanent wiring in C hall electrical room.
Missing fire drill documentation for first, second, and third quarters.
Activities room failed to provide documentation that space heater element does not exceed 212 degrees Fahrenheit.
Oxygen cylinder in room C-6 was not secured.
Report Facts
Census: 76
Total Capacity: 105
Smoke Compartments Affected: 4
Smoke Compartments Affected: 1
Smoke Compartments Affected: 4
Smoke Compartments Affected: 1
Smoke Compartments Affected: 6
Smoke Compartments Affected: 2
Smoke Compartments Affected: 2
Smoke Compartments Affected: 2
Smoke Compartments Affected: 1
Smoke Compartments Affected: 1
Smoke Compartments Affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Confirmed findings during facility tour and inspection |
Inspection Report
Original Licensing
Deficiencies: 4
Date: Aug 9, 2022
Visit Reason
A Licensure Survey was conducted from 8/1/22 through 8/9/22 to assess compliance with licensure requirements for the facility.
Findings
The facility failed to maintain a clean, comfortable, homelike environment free from damaged walls, missing baseboards, damaged flooring, missing bathroom fixtures, and uncomfortably warm air temperatures in multiple areas including three of five halls and the front lobby.
Deficiencies (4)
The air conditioning unit for the front lobby and offices was not working, resulting in uncomfortably warm air temperatures in the front lobby, office area, and front nursing station.
Multiple areas of missing paint on the wall in room A10, bathroom light not fully illuminating, missing toilet seat, and only one bracket of a toilet paper holder remaining.
Flooring in the bathroom of room C1 was detached and rolling up behind the toilet.
Flooring in room D4 had multiple warped and damaged areas; damage to lower portion of closet walls from missing baseboards; hole in drywall; exposed screw point where door knob was missing; and missing baseboard section in bathroom.
Report Facts
Air temperature: 78.8
Air temperature: 81.3
Air temperature: 75.9
Air temperature: 79.7
Air temperature: 79.7
Air temperature: 88
Inspection Report
Abbreviated Survey
Census: 76
Deficiencies: 2
Date: Aug 9, 2022
Visit Reason
An Abbreviated/Partial Extended Survey was conducted to investigate multiple complaints filed against the facility, some of which were substantiated with deficiencies cited.
Complaint Details
The survey investigated complaints GA00217877, GA00220515, GA00221930, GA00223599, GA00225690, and GA00226415. Complaints GA00217877, GA00220515, GA00221930, and GA00223599 were unsubstantiated. Complaints GA00225690 and GA00226415 were substantiated with deficiencies cited.
Findings
The survey found that the facility failed to notify the Responsible Party of a room change for two residents, and failed to maintain a safe, clean, comfortable, and homelike environment, including issues with damaged walls, missing baseboards, damaged flooring, missing bathroom fixtures, and uncomfortably warm air temperatures in multiple areas.
Deficiencies (2)
Failed to notify the Responsible Party of a room change for two residents.
Failed to maintain a safe, clean, comfortable, and homelike environment including damaged walls, missing baseboards, damaged flooring, missing bathroom fixtures, and uncomfortably warm air temperatures.
Report Facts
Facility census: 76
Room air temperature: 88
Room air temperature: 81.3
Room air temperature: 79.7
Room air temperature: 75.9
Inspection Report
Abbreviated Survey
Deficiencies: 0
Date: Aug 5, 2021
Visit Reason
An abbreviated/partial extended survey was conducted to investigate complaint GA00215215.
Complaint Details
Complaint GA00215215 was investigated and found to be unsubstantiated with no regulatory violations cited.
Findings
The complaint GA00215215 was unsubstantiated and no regulatory violations were cited during the survey.
Inspection Report
Routine
Census: 78
Deficiencies: 0
Date: Jan 6, 2021
Visit Reason
A COVID-19 Focused Emergency Preparedness and Infection Control Survey was conducted to assess the facility's compliance with CMS and CDC recommended practices related to COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to emergency preparedness and 42 CFR §483.80 related to infection control regulations for COVID-19.
Report Facts
Total census: 78
Inspection Report
Abbreviated Survey
Deficiencies: 0
Date: Oct 7, 2020
Visit Reason
An abbreviated/partial extended survey was conducted to investigate multiple complaints identified by their codes GA00207196, GA00201841, GA00206737, GA00207099, and GA00203419.
Complaint Details
The complaints investigated during the survey were unsubstantiated.
Findings
The survey was completed on 10/6/2020 and all the complaints investigated during this abbreviated survey were found to be unsubstantiated.
Inspection Report
Routine
Census: 75
Deficiencies: 0
Date: Sep 30, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness and Infection Control Survey was conducted on September 29-30, 2020 by Ascellon on behalf of the Georgia Department of Community Health.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to emergency preparedness and 42 CFR §483.80 related to infection control regulations, implementing CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Routine
Census: 80
Deficiencies: 0
Date: Aug 12, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness and Infection Control Survey was conducted on August 11-12, 2020 by Ascellon on behalf of the Georgia Department of Community Health (DCH).
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to emergency preparedness and 42 CFR §483.80 related to infection control regulations, implementing CMS and CDC recommended practices to prepare for COVID-19.
Report Facts
Total census: 80
Inspection Report
Routine
Census: 89
Deficiencies: 0
Date: Jul 21, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness and Infection Control Survey was conducted to assess compliance with CMS and CDC recommended practices related to COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.73 and §483.80 infection control regulations and has implemented recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Census: 88
Deficiencies: 0
Date: Oct 8, 2019
Visit Reason
An Abbreviated/Partial Extended Survey was initiated to investigate GA00199702.
Findings
The investigation substantiated GA00199702 with no deficiencies cited.
Inspection Report
Re-Inspection
Census: 88
Deficiencies: 0
Date: Oct 7, 2019
Visit Reason
A revisit survey was conducted on 10/7/19 to verify correction of deficiencies cited during the 8/8/19 revisit to the Recertification Survey.
Findings
All deficiencies cited as a result of the 8/8/19 revisit to the Recertification Survey were found to be corrected.
Inspection Report
Follow-Up
Deficiencies: 0
Date: Jul 31, 2019
Visit Reason
A follow-up survey was conducted to verify that all previously cited survey deficiencies had been corrected.
Findings
The follow-up survey noted that all previously cited survey tags had been corrected.
Inspection Report
Annual Inspection
Census: 93
Deficiencies: 9
Date: Jun 13, 2019
Visit Reason
A standard survey was conducted from 6/10/19 through 6/13/19, including investigation of Complaint Intake Number GA00197281, to assess compliance with Medicare/Medicaid regulations.
Complaint Details
Complaint Intake Number GA00197281 was investigated in conjunction with the standard survey.
Findings
The facility was found not in substantial compliance with multiple regulatory requirements including failure to obtain signatures on Medicare Non-Coverage notices, failure to implement comprehensive care plans for pressure ulcers and ADL care, medication administration errors, unsafe storage of personal care items, and infection control deficiencies.
Deficiencies (9)
Failed to obtain resident or responsible party signatures on Notice of Medicare Non-Coverage forms for three residents.
Failed to implement pressure ulcer care plan treatments as ordered and failed to document wound care on multiple occasions for one resident.
Failed to implement restorative therapy services after skilled therapy was terminated, resulting in decline in transfers and mobility for one resident.
Failed to maintain resident abilities in activities of daily living by not providing restorative services after skilled therapy ended for one resident.
Failed to ensure resident environment was free of accident hazards due to damaged flooring with sharp edges in a bathroom used independently by one resident.
Failed to ensure medications were not left unattended at bedside for one resident and failed to secure cigarettes immediately after shopping for another resident.
Failed to ensure indwelling catheter tubing and drainage bags were kept off the floor and catheter tubing secured to resident's leg for two residents.
Medication error rate exceeded 5% with four errors in 37 opportunities including failure to administer sliding scale insulin, incorrect laxative given, and missed medication.
Failed to ensure personal care items such as bath basins, urinals, and bedpans were stored in a sanitary manner, with unlabeled and unbagged items stored on floors or hooks in multiple bathrooms.
Report Facts
Residents reviewed: 36
Medication error opportunities: 37
Medication errors: 4
Medication error rate: 10.81
Resident census: 93
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN HH | Licensed Practical Nurse | Named in medication error findings for incorrect laxative and missed insulin dose |
| LPN FF | Licensed Practical Nurse | Named in medication error findings and medication left unattended at bedside |
| Social Services Director | Responsible for beneficiary notices and signatures | |
| Wound Care Physician | Provided wound care recommendations | |
| Occupational Therapist CC | Occupational Therapist | Interviewed regarding restorative therapy services |
| Physical Therapy Assistant DD | Physical Therapy Assistant | Interviewed regarding restorative therapy services |
| Certified Nursing Assistant AA | Certified Nursing Assistant | Observed providing ADL care |
| Certified Nursing Assistant BB | Certified Nursing Assistant | Observed providing ADL care |
| Director of Nursing | Interviewed regarding multiple deficiencies | |
| Maintenance Director | Interviewed regarding damaged flooring | |
| Activity Director | Interviewed regarding cigarette purchases and storage |
Inspection Report
Routine
Deficiencies: 3
Date: Jun 13, 2019
Visit Reason
The inspection was conducted to assess compliance with medical, dental, nursing care, environmental sanitation, and housekeeping regulations at Premier Estates of Dublin, LLC.
Findings
The facility failed to implement ordered wound care treatments for one resident with a pressure ulcer and failed to provide restorative nursing services for another resident after skilled therapy was terminated. Additionally, the facility failed to store personal care items in a sanitary manner, risking cross-contamination.
Deficiencies (3)
Failed to implement pressure ulcer care plan treatments as ordered for resident #36, including failure to use Leptospermum honey as prescribed and failure to document wound care on multiple days.
Failed to implement activity of daily living care plan and restorative nursing services for resident #69 after skilled therapy was terminated, resulting in decline in transfers and mobility.
Failed to ensure personal care items such as bath basins, urinals, and bedpans were stored in a sanitary manner to prevent potential cross-contamination in multiple shared bathrooms.
Report Facts
Days wound care not documented: 17
Wound size: 5
Wound size dimension 2: 10.5
Wound size dimension 3: 1.2
Undermining size: 2.3
Physical therapy minutes: 175
Hemodialysis frequency: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA AA | Certified Nursing Assistant | Observed performing ADL care for resident #69 and interviewed regarding resident's decline. |
| CNA BB | Certified Nursing Assistant | Observed performing ADL care for resident #69 and interviewed regarding resident's decline. |
| LPN Treatment Nurse | Licensed Practical Nurse | Observed wound care for resident #36 and interviewed about wound care documentation and treatment. |
| OT CC | Occupational Therapist | Interviewed regarding resident #69's therapy and restorative services. |
| PT-A DD | Physical Therapy Assistant | Interviewed regarding resident #69's need for restorative services after skilled therapy. |
| Director of Nursing | Director of Nursing | Interviewed about wound care responsibilities and inservice training on storage of personal items. |
| CNA EE | Certified Nursing Assistant | Interviewed about inservice training on storage and labeling of personal items. |
| CNA JJ | Certified Nursing Assistant | Interviewed about inservice training on storage and labeling of personal items. |
Inspection Report
Life Safety
Census: 93
Capacity: 105
Deficiencies: 3
Date: Jun 10, 2019
Visit Reason
A Life Safety Code Survey was conducted to assess compliance with fire safety regulations and the National Fire Protection Association (NFPA) 101 Life Safety Code 2012 edition.
Findings
The facility was found not in substantial compliance with life safety requirements, including failure of magnetic locks on egress doors to release upon fire alarm activation, improper corridor openings with a louvered door, and inadequate protection of oxygen cylinders from weather exposure.
Deficiencies (3)
Magnetic locks on egress doors did not release upon activation of the fire alarm system.
The room door to the ice machine room had a louver, failing to properly maintain corridor openings.
Oxygen cylinders stored outside were not protected from weather or tampering.
Report Facts
Census: 93
Total Capacity: 105
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Confirmed findings during facility tour and interview |
Inspection Report
Re-Inspection
Deficiencies: 0
Date: Dec 13, 2018
Visit Reason
A Revisit Survey was conducted to verify correction of deficiencies cited during the standard survey on 2018-10-17.
Findings
All deficiencies cited in the prior standard survey were found to be corrected during this revisit survey.
Inspection Report
Complaint Investigation
Census: 82
Deficiencies: 0
Date: Oct 24, 2018
Visit Reason
An unannounced visit was made to the facility on October 24, 2018 by a State Surveyor to investigate complaint # GA00192268.
Complaint Details
Complaint # GA00192268 was investigated; the Ombudsman was contacted and made aware of the investigation, and a message was left for the complainant.
Findings
The investigation included observations, staff and resident interviews, record reviews, and review of relevant facility documents.
Inspection Report
Re-Inspection
Census: 100
Deficiencies: 0
Date: Jun 7, 2018
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited in the Recertification Survey of April 19, 2018.
Findings
All deficiencies cited in the prior Recertification Survey were found to be corrected during this revisit survey.
Inspection Report
Re-Inspection
Census: 100
Deficiencies: 0
Date: Jun 6, 2018
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited in the March 6, 2018 Complaint Survey.
Complaint Details
The revisit survey was conducted as a follow-up to the March 6, 2018 Complaint Survey to verify correction of cited deficiencies.
Findings
All deficiencies cited during the March 6, 2018 Complaint Survey were found to be corrected during this revisit survey.
Report Facts
Census: 100
Inspection Report
Follow-Up
Deficiencies: 0
Date: Jun 1, 2018
Visit Reason
A follow-up survey was conducted to verify that all previously cited survey tags had been corrected.
Findings
The follow-up survey noted that all previously cited survey tags had been corrected.
Inspection Report
Routine
Census: 94
Deficiencies: 6
Date: Apr 19, 2018
Visit Reason
A standard survey was conducted to assess compliance with Medicare/Medicaid regulations related to long term care facilities.
Findings
The facility was found noncompliant with multiple regulatory requirements including environmental safety and maintenance issues, inaccurate resident assessments, pain management deficiencies, psychotropic medication management, resident record documentation, and infection control practices.
Deficiencies (6)
Failed to provide an environment free from scuffing, chipped and peeling paint, broken doors and broken floor tiles in multiple resident areas.
Failed to accurately code Minimum Data Set assessments for pressure ulcers and dialysis treatment status for two residents.
Failed to ensure availability of ordered pain medications for one resident, resulting in missed doses and undocumented administration.
Failed to document intended duration of PRN psychotropic medication therapy and failed to follow physician orders for gradual dose reduction of antipsychotic medication for two residents.
Failed to ensure insulin and blood sugar testing were properly documented on the Medication Administration Record for one resident.
Failed to maintain infection prevention and control practices, including improper storage of basins and toothbrushes and inadequate glucometer cleaning technique.
Report Facts
Resident census: 95
Resident census: 94
Sample size: 33
Pressure ulcer measurement: 4.4
Pressure ulcer measurement: 2.4
Pressure ulcer measurement: 0.4
Medication doses missed: 5
Medication doses missed: 6
Medication dose: 90
Medication dose: 40
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN CC | Licensed Practical Nurse | Named in medication availability and administration issues for resident B |
| Director of Nurses | Director of Nursing | Provided interviews regarding medication administration, psychotropic medication management, and infection control |
| MDS Coordinator | Interviewed regarding inaccurate resident assessments for residents #60 and #73 | |
| LPN FF | Licensed Practical Nurse | Interviewed regarding medication availability and administration for resident B |
Inspection Report
Routine
Census: 94
Deficiencies: 5
Date: Apr 19, 2018
Visit Reason
Routine inspection to assess compliance with state and federal regulations regarding pharmacy management, infection control, nursing care, medication administration, record keeping, and facility safety.
Findings
The facility was found deficient in multiple areas including failure to document duration of PRN antianxiety medication and improper dose reduction of antipsychotic medication, inadequate infection control practices, failure to ensure availability and administration of ordered pain medications, incomplete recording of insulin and blood sugar testing, and unsafe environmental conditions such as chipped paint, broken doors, and floor tiles.
Deficiencies (5)
Failed to document intended duration of therapy for PRN antianxiety medication beyond 14 days and failed to follow physician orders for gradual dose reduction of antipsychotic medication.
Failed to ensure infection control practices including improper storage of basins and toothbrushes and improper glucometer cleaning technique.
Failed to ensure availability of two ordered and scheduled pain medications for one resident.
Failed to ensure insulin and blood sugar testing was recorded as ordered on the Medication Administration Electronic Record.
Failed to maintain environment free from hazards including scuffing, chipped and peeling paint, broken doors, and broken floor tiles in multiple resident rooms and bathrooms.
Report Facts
Census: 94
Sample size: 33
Medication doses missed or unavailable: 11
Undocumented insulin doses: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| BB | Licensed Practical Nurse (LPN) | Noted wiping glucometer improperly during medication pass |
| FF | Licensed Practical Nurse (LPN) | Made calls to pharmacy regarding medication availability and confirmed giving first dose of Lyrica |
| CC | Licensed Practical Nurse (LPN) | Made calls to pharmacy and physician regarding medication availability and confirmed giving insulin |
| EE | Certified Nursing Assistant (CNA) | Provided information about resident's pain and condition |
| Director of Nursing (DON) | Provided multiple interviews regarding medication errors, infection control, and medication administration | |
| Resident's Psychiatrist | Interviewed regarding antipsychotic medication orders and dose reduction | |
| Registered Pharmacist II | Interviewed regarding medication ordering process and pharmacy policies | |
| Maintenance Director | Confirmed needed repairs and painting delays | |
| Administrator | Interviewed regarding painting and maintenance staffing |
Inspection Report
Life Safety
Census: 95
Capacity: 105
Deficiencies: 4
Date: Apr 16, 2018
Visit Reason
Life Safety Code Survey conducted to assess compliance with Medicare/Medicaid participation requirements related to fire safety and NFPA 101 Life Safety Code 2012 edition.
Findings
The facility was found not in substantial compliance with life safety requirements, including failure to maintain means of egress guards, inadequate emergency lighting battery backup, failure to conduct quarterly fire drills on each shift, and improper use of power strips for oxygen concentrators.
Deficiencies (4)
Exterior landing at D hall egress door lacked guards at least 42" in height with 4" pickets; landing was only 32" in height.
Emergency lighting did not have at least 90 minute battery backup and was not tested for 30 seconds during February and March.
Fire drills were not conducted at least quarterly on each shift; no fire drills documented for 4th quarter 2017.
Power strips used for oxygen concentrators in rooms A-9 and B-7 were not approved for patient care electrical equipment.
Report Facts
Residents at risk due to means of egress deficiency: 19
Total residents at risk due to emergency lighting and fire drill deficiencies: 95
Certified beds: 105
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Confirmed findings during tour and staff interviews related to means of egress, emergency lighting, fire drills, and electrical equipment deficiencies. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Mar 6, 2018
Visit Reason
An Abbreviated/Partial Extended Survey was conducted to investigate complaint GA00185751 regarding the facility's compliance with respiratory/tracheostomy care regulations.
Complaint Details
Investigation of complaint GA00185751 found noncompliance with respiratory care regulations related to emergency tracheostomy equipment availability and staff practices.
Findings
The facility failed to ensure that an emergency tracheostomy tube and obturator were available for one resident with a tracheostomy. Staff interviews confirmed that emergency tracheostomy kits were not kept in the facility and that nurses were not allowed to reinsert tracheostomy tubes without physician orders.
Deficiencies (1)
Facility failed to ensure availability of an emergency tracheostomy tube and obturator for a resident with a tracheostomy.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| AA | Licensed Practical Nurse | Interviewed regarding tracheostomy care and emergency equipment availability. |
| BB | Licensed Practical Nurse | Interviewed regarding tracheostomy care and emergency equipment availability. |
| Director of Nursing | Interviewed regarding facility policy on emergency tracheostomy kits. | |
| Administrator | Interviewed regarding policy review and staff training on tracheostomy care. |
Inspection Report
Complaint Investigation
Census: 98
Deficiencies: 0
Date: Feb 21, 2018
Visit Reason
An unannounced complaint survey and a revisit were conducted to investigate complaint # GA 00185337 at Premier Estates of Dublin.
Complaint Details
Investigation of complaint # GA 00185337; facility found in substantial compliance.
Findings
The complaint survey revealed the facility was in substantial compliance with Medicare/Medicaid regulations at 42 CFR Part 483 for Long Term Care Facilities.
Inspection Report
Follow-Up
Census: 98
Deficiencies: 0
Date: Feb 20, 2018
Visit Reason
A revisit was conducted on 2/20/18 to complaint #GA00183017 to verify correction of deficiencies cited in the complaint survey of 1/5/18.
Complaint Details
Complaint #GA00183017; deficiencies from the complaint survey were corrected as verified by the revisit.
Findings
All deficiencies cited as a result of the complaint survey of 1/5/18 were found to be corrected during the revisit on 2/20/18.
Report Facts
Facility census: 98
Inspection Report
Complaint Investigation
Census: 97
Deficiencies: 1
Date: Jan 5, 2018
Visit Reason
An abbreviated/partial extended survey was conducted to investigate complaint #GA00183017 regarding the facility's compliance with bed hold policy notification requirements.
Complaint Details
The complaint was partially substantiated. The facility did not consistently provide written bed hold policy information at the time of transfer or within 24 hours for residents "A", #2, and #3 as required.
Findings
The facility failed to provide written bed hold policy information at the time of hospital transfer or within 24 hours for three sampled residents, despite having documented procedures to do so.
Deficiencies (1)
Failure to provide written bed hold information at the time of hospital transfer or within 24 hours for three residents.
Report Facts
Residents with missing bed hold notification: 3
Resident hospitalizations without timely bed hold notice: 4
Resident hospitalizations without timely bed hold notice: 1
Resident hospitalizations without timely bed hold notice: 1
Facility census: 97
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Business Office Manager | Interviewed regarding bed hold notification practices and documentation. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 17, 2017
Visit Reason
The inspection was conducted as a complaint survey to determine compliance with Federal and State Long Term Care Requirements under 42 CFR Part 483, Subpart B.
Complaint Details
The complaint survey was conducted and no deficiencies were found, indicating no substantiated issues.
Findings
No deficiencies were cited during the complaint survey conducted on November 17, 2017.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Sep 29, 2017
Visit Reason
The inspection was conducted to investigate a complaint against Premier Estates of Dublin, LLC.
Complaint Details
The complaint was investigated and found to be unsubstantiated.
Findings
Based on record review and staff interviews, the complaint was not substantiated.
Inspection Report
Follow-Up
Deficiencies: 0
Date: May 30, 2017
Visit Reason
A follow-up visit was conducted to verify correction of deficiencies identified in the prior recertification survey.
Findings
All deficiencies identified in the previous recertification survey had been corrected at the time of this follow-up visit.
Inspection Report
Follow-Up
Deficiencies: 0
Date: May 30, 2017
Visit Reason
A follow-up survey was conducted to verify that all previously cited survey tags had been corrected.
Findings
The follow-up survey noted that all previously cited deficiencies had been corrected.
Inspection Report
Abbreviated Survey
Census: 92
Deficiencies: 1
Date: Apr 14, 2017
Visit Reason
A standard survey in conjunction with an abbreviated survey was conducted, including a complaint investigation (Intake Number GA0016990) which was substantiated with deficiencies.
Complaint Details
Complaint Intake Number GA0016990 was substantiated with deficiencies related to failure to administer pain medication timely for resident #97.
Findings
The facility was found not in substantial compliance with Medicare/Medicaid regulations related to failure to administer pain medication in a timely manner for one resident (#97), resulting in elevated pain levels during the delay.
Deficiencies (1)
Failure to ensure pain medication was administered as care planned in a timely manner for one resident (#97).
Report Facts
Resident census: 92
Sample size: 24
Medication dosage: 5
Pain level: 7
Pain level: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN AA | Licensed Practical Nurse | Failed to administer ordered oxycodone timely and failed to document new physician's orders in resident's chart. |
| Hospice RN BB | Registered Nurse | Evaluated resident on 12/18/16, reordered medications, and confirmed last call regarding resident's pain was at 4:32 p.m. |
Inspection Report
Life Safety
Census: 89
Capacity: 104
Deficiencies: 2
Date: Apr 11, 2017
Visit Reason
The visit was a Life Safety Code survey conducted to assess compliance with Medicare/Medicaid participation requirements related to fire safety and the National Fire Protection Association (NFPA) Life Safety Code standards.
Findings
The facility was found not in substantial compliance with NFPA 101 Life Safety Code 2012 edition due to deficiencies in the fire sprinkler system installation and smoke barrier construction. Specific issues included lack of electronically supervised outside water control valve for the sprinkler system and failure to maintain smoke barriers with required fire resistance rating.
Deficiencies (2)
Fire sprinkler system was not installed in accordance with NFPA 13; specifically, the system lacked an outside water control valve electronically supervised through the fire alarm system.
Facility failed to construct and maintain smoke barriers with at least a 30 minute fire resistance rating; penetrations in smoke barriers were not sealed properly and some walls did not extend to the deck.
Report Facts
Census: 89
Total Capacity: 104
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Staff member who confirmed findings during the facility tour |
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