Darby Glenn Nursing and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Darby Glenn Nursing and Rehabilitation Center, in the surveyor’s own words.

• Actual harm, isolatedF686Feb 11, 2022

  Based on medical record review, observations, interviews with staff, a family member and Nurse Practitioner (NP) #263, and review of information from the National Pressure Ulcer Advisory Panel (NPUAP), the facility failed to implement pressuring relieving interventions for a resident at risk for further skin breakdown due to existing pressure ulcers and failed to complete weekly skin assessments. This resulted in Actual Harm when staff failed to implement pressure relieving interventions to prevent further skin breakdown for Resident #49 resulting in the development of an avoidable Deep Tissue Injury (DTI) to the left heel. Resident #49 also had increased measurements in the coccyx and heel pressure ulcers and experienced discomfort during a dressing change. […]

• No harm, potential for more than minimal, widespreadF812Jul 25, 2024

  Based on observation, interview, and record review, the facility failed to ensure pests were not in the kitchen. This deficient practice had the potential to affect all residents. The census was 91. Findings include: Observation on 07/22/24 at 10:06 A.M. with Dietary Supervisor #104 revealed one flying insect around the clean dishware storage in the kitchen. Observation on 07/22/24 at 10:26 A.M. with Dietary Supervisor #104 revealed four flying insects located around the windowsill near the handsink in the kitchen. Interview on 07/22/24 at 10:27 A.M. with Dietary Supervisor #104 confirmed four flying insects around the windowsill and one flying insect around clean dishware storage in the kitchen. […]

• No harm, potential for more than minimal, widespreadF802Dec 13, 2022

  Based on observation and interviews the facility failed to ensure adequate staffing levels to ensure the resident's had a clean and homelike dining experience. This had the potential to affect 92 of 92 residents residing in the facility. Findings included: 1. Interview on 12/08/22 at 11:40 A.M., with Dietary Aide (DA) #401 revealed the dietary department has been short staffed because the dietary department have lost a lot of staff. The facility had been utilizing Styrofoam due to being short staffed in the kitchen. DA #401 reported last Monday she was the only server for the entire building. She served one side of the building, and she was not sure who served the other side since she was the only server. The facility has four kitchenette they serve from when they are fully staffed. […]

• No harm, potential for more than minimal, widespreadF812Dec 13, 2022

  Based on observations, review of pest control service reports, and staff interview, the facility failed to store, prepare, and serve food under sanitary conditions. This could affect 92 of 92 residents residing in the facility. Findings include: 1. Review of a pest control service report 09/19/22 revealed it stated sanitation needs drastically improved upon in the kitchen and serverys throughout (the facility has four serverys, two on each side of the building, which are small kitchenettes from which meals are served). The report further stated there was debris, spillage, trash, and other sanitation factors creating breeding sites and attractants for pests specifically flying pests. […]

• No harm, potential for more than minimal, widespreadF925Dec 13, 2022

  Based on observations, review of pest control service reports, and staff interview, the facility failed to maintain an effective pest control program. This could effect 92 of 92 residents residing in the facility. Findings include: Review of a pest control service report 09/19/22 revealed it stated sanitation needs drastically improved upon in the kitchen and serverys throughout (the facility has four serverys, two on each side of the building, which are small kitchenettes from which meals are served). The report further stated there was debris, spillage, trash, and other sanitation factors creating breeding sites and attractants for pests specifically flying pests. Be sure to use actizyme as this will help breakdown oils, grease, etc that pests like to breed in and feed off of. […]