Florala Health And Rehabilitation Llc

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, record reviews and review of a facility check sheet titled PERINEAL CARE, the facility failed to ensure Certified Nursing Assistants (CNAs) performed incontinent care for Resident Identifier (RI) #37 with handwashing and glove changes to prevent the spread of infection. Employee Identifier (EI) #2 and EI #3 cleaned RI #37's perineum, then applied a clean brief to RI #37, while wearing the same soiled gloves. This was observed on 8/23/22 and affected one of two residents observed for incontinent care.
Findings Include:
Review of an undated facility check sheet titled, PERINEAL CARE revealed, . Washes hands before applying gloves and after removing gloves. Removes any fecal matter thoroughly or urine . Remove gloves, wash hands and re-apply gloves.
RI #37 was admitted to the facility on [DATE].
Review of RI #37's quarterly Minimum Data Set with an Assessment Reference Date of 7/13/22 revealed RI #37 to be totally dependant on staff for toileting needs.
On 8/23/22 at 4:10 PM EI #2 CNA and EI #3 CNA provided incontinent care to RI #37. EI #2 loosened RI #37's brief and folded it down, then EI #3 wiped the front of RI #37's perineum. Both CNAs assisted the resident to turn to the left side. EI #2 wiped RI #37's buttocks and removed the soiled brief from under RI #37. EI #2 placed a clean brief under RI #37 and EI #3 pulled the brief in place and both secured the brief. Both EI #2 and EI #3, without performing hand hygiene and while wearing the same soiled gloves, cleaned RI #37's perineum and buttocks, then placed and secured a clean brief on RI #37.
On 8/23/22 at 4:20 PM, both EI #2 and EI #3 were interviewed. Both were asked, what was the policy for glove changes during incontinent care. EI #3 replied, they should change gloves after cleaning the resident's perineal area, before they place the clean brief. Both were asked, when should staff change gloves during incontinent care. EI #2 replied, after touching dirty, then before touching a clean item like the brief. EI #3 was asked, when did she and EI #2 change gloves after cleaning RI #37, but before placing the clean brief. EI #3 replied, they did not change their gloves and had on the same gloves worn while they cleaned the perineum and buttocks. Both were asked, what would be the harm in not changing gloves when going from a dirty area before touching and placing a clean brief on the resident. EI #3 replied, the resident could get an infection like a UTI (Urinary Tract Infection).
On 8/24/22 at 4:01 PM, an interview was conducted with EI #1, Director of Nursing and Infection Control Nurse. EI #1 was asked, what was the policy regarding glove changes during incontinent care. EI #1 replied, if soiled, when going from dirty to clean, and before touching clean items such as the brief. EI #1 was asked, when should staff change gloves during perineal care. EI #1 replied, after cleaning the resident, if soiled if cleaning bowel movement from a resident, and before placing the clean brief. EI #1 was asked, what would the harm be in the staff not changing gloves during the provision of incontinent care. EI #1 replied, cross contamination, spread contaminates, and could cause a UTI.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record reviews, and a review of the facility's policy titled, Voting, the facility failed to ensure residents were provided absentee ballots and voted in the November 2018 election.
This affected six of eight residents, Resident Identifier (RI) #12, #13, #41, #48, #61, and RI #74, who attended the Resident Council meeting.
Findings Include:
A review of the facility's policy titled, Voting with an effective date of 05/01/2002, revealed the following: PURPOSE: To assist residents in the exercise of their rights as a citizen of the United States .
On 12/12/18 at 3:13 PM, during the Resident Council meeting, RI #12, #13, #41, #48, #61, and RI #74 voiced the following:
1. staff did not remind them of the voting day;
2. they were not provided with absentee ballots to vote; and
3. they did not participate in the November 2018 election.
1. RI #12 was admitted to the facility on [DATE], with a diagnosis of Other Polyosteoarthritis.
A review of RI #12's current Quarterly Minimum Data Set (MDS), dated [DATE], revealed RI #12's Brief Interview for Mental Status (BIMS) score of 9, indicating moderate impairment in cognition.
2. RI #13 was admitted to the facility on [DATE], with a diagnosis of Essential Hypertension.
A review of RI #13's Significant Change MDS, dated [DATE], revealed RI #13's BIMS score of 14, indicating intact cognition.
3. RI #41 was re-admitted to the facility on [DATE], with a diagnosis of Essential Hypertension.
A review of RI #41's current Annual MDS, dated [DATE], revealed RI #41's BIMS score of 13, indicating intact cognition.
4. RI #42 was re-admitted to the facility on [DATE], with a diagnosis of Type II Diabetes.
A review of RI #42's current Quarterly MDS, dated [DATE], revealed RI #42's BIMS score of 15, indicating intact cognition.
5. RI #61 was admitted to the facility on [DATE], with a diagnosis of Type II Diabetes.
A review of RI #61's current Quarterly MDS, dated [DATE], revealed RI #61's BIMS score of 15, indicating intact cognition.
6. RI #74 was re-admitted to the facility on [DATE], with a diagnosis of Heart Failure, Unspecified.
A review of RI #74's current Quarterly MDS, dated [DATE], revealed RI #74's BIMS score of 14, indicating intact cognition.
On 12/12/18 at 4:30 PM, during an interview Employee Identifier (EI) #1, Licensed Social Worker, the surveyor asked who was responsible to ensure residents voted, whether by transportation or by absentee ballots. EI #1 stated, I do the absentee ballots. The surveyor asked did all the residents who wanted to vote get to vote in the last election. EI #1 stated, We had two residents who voted . The surveyor asked EI #1 what happened with the other residents. EI #1 stated, (RI #74) was only one that brought the voting concern to me that I had spoken with. The surveyor asked what about (RI #12, #13, #41, #48, and #61), who did not vote, ballots were not brought to them nor were they reminded of the voting day. EI #1 stated, I did not have any concerns or grievances with them regarding voting. The surveyor asked EI #1 how did he ensure all residents who wanted to vote absentee were provided that opportunity. EI #1 stated, I asked each cognitive residents if they would like to vote. The surveyor asked did he speak with those residents (RI #12, #13, #41, #48 and #61). EI #1 stated, I only spoke to (RI #74). The surveyor asked EI #1 should he have spoken with all of the cognitive residents regarding voting for the last election. EI #1 stated, Yes. The surveyor asked was that the facility's policy regarding voting, and was he responsible to ensure all cognitive residents were asked by him if they wanted to vote. EI #1 stated, Yes. The surveyor asked EI #1, regarding this last election, what was it for and when. EI #1 stated, November, 2018, we had a general election voting for house and senate. The surveyor asked for this last general election in November 2018, was policy and procedure followed. EI #1 stated, Not in full.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and a review of the facility's policy titled, Medication Administration Procedures Eye Drops, the facility failed to ensure a licensed staff member did not put Resident Identifier (RI) #63's eye drop (gtt) container in her pocket prior to the administration of the eye gtts to RI #63.
This affected RI #63, one of 14 residents observed during medication administration who received eye drops.
Findings Include:
A review of the facility's policy titled, Medication Administration Procedures Eye Drops dated 03/11, revealed the following: .Opthalmic solutions are to be administered into .the eye in a safe .manner .
RI #63 was admitted to the facility on [DATE] with diagnosis of Hypertension.
A review of RI #63's current Quarterly Minimum Data Set, dated [DATE], revealed RI #63's Brief Interview for Mental Status score was 9, indicating moderate impairment in cognition.
On 12/12/18 at 11:45 AM, Employee Identifier (EI) #7 was observed preparing medication for RI #63. EI #7 removed the Neomycin (eye gtt medication) container/bottle out of the box and placed the Neomycin container in the right pocket of her scrub top. EI #7 entered RI #63's room. EI #7 reached inside of the right pocket of her scrub top with a gloved hand and obtained the Neomycin bottle. EI #7 removed the cap and administered the Neomycin to RI #63's right and left eye. EI #7 placed the Neomycin container back in her right scrub pocked with her gloved right hand. EI #7 removed her gloves and washed her hands. EI #7 exited RI #63's room, and removed the Neomycin container from her right scrub pocket and placed the medication in the medication cart drawer.
On 12/12/18 at 12:20 PM, during an interview with EI #7, the surveyor asked why was RI #63 receiving Neomycin eye gtts. EI #7 said for irritation in both eyes. The surveyor asked EI #7 where did she place the eye gtt bottle after she took it out of the medication box. EI #7 said she put it in her scrub pocket. The surveyor asked EI #7 why she put the eye gtt bottle in her scrub pocket. EI #7 said to keep the bottle from becoming contaminated, and because she was going into the bathroom to wash her hands. The surveyor asked EI #7 was her scrub pocket considered clean. EI #7 said no the scrub pocket was dirty. The surveyor asked EI #7 what was the potential harm in placing the eye gtt medication bottle in her scrub pocket, reaching in the pocket with her gloved hand to obtain the bottle, and administering the eye gtt medication. EI #7 said contamination.
On 12/13/18 at 7:22 PM, during an interview with EI #6, Director of Nurses (DON) Infection Control, the surveyor asked what was the facility's policy for handling the eye gtt medication container during medication administration. EI #6 said place a barrier on the overbed table. The surveyor asked why should staff not place an eye gtt bottle in their scrub pocket. EI #6 said that would be contamination. The surveyor asked what was the potential harm in placing the eye gtt container in a scrub pocket, reach in the pocket with gloved hand, take the eye gtt bottle out and administer the eye gtt medication to the resident. EI #6 said that would be contamination and infection.