Diversicare of Foley

In the surveyor’s words

From the most serious findings on record at Diversicare of Foley, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jun 19, 2023

  Based on observations, interviews, record reviews, and facility guidelines, the facility failed to implement the facility's guidelines for Elopement. This occurred when Resident #98 was assessed as being at risk of elopement and no individualized plan was established and no interventions were developed to mitigate the risk until after Resident #98 exited the facility without staff's knowledge on 02/06/2023. In addition, the facility also failed to ensure Resident #320, a resident assessed by the facility as an elopement risk, was wearing a WanderGuard on 06/16/2023 as ordered. […]

• Immediate jeopardy, isolatedF600Aug 27, 2021

  Based on interviews, review of the facility's Abuse, Neglect, Misappropriation, Exploitation Policy, Resident Identifier (RI) #1's medical record, and the facility's investigation file, the facility failed to ensure RI #1 was not abused by Employee Identifier (EI) #4, a Certified Nursing Assistant (CNA) on 7/1/2021. On 7/1/2021 around 2:00 PM, EI #3, a CNA witnessed EI #4, a CNA hit RI #1. EI #4 was then witnessed to restrain the resident by holding RI #1's arms to his/her chest. When the resident asked EI #4 to stop, EI #4 spanked (struck) the resident's hands several times as if he/she was a child. EI #4 was overheard telling the resident, You ain't stronger than me old (man/lady). […]

• Immediate jeopardy, isolatedF607Aug 27, 2021

  Based on interviews, review of the facility's Abuse, Neglect, Misappropriation, Exploitation Policy, the In-Service Training Record, the facility's assignment sheets and Employee Identifier (EI) #4's time sheet, the facility failed to ensure EI #3, a Certified Nursing Assistant (CNA) implemented two of seven components of the facility's abuse policy. On 7/1/2021 around 2:00 PM, EI #3, a CNA witnessed EI #4, a CNA hit Resident Identifier (RI) #1. EI #4 was then witnessed to restrain the resident by holding RI #1's arms to his/her chest. When the resident asked EI #4 to stop, EI #4 spanked (struck) the resident's hands several times as if he/she was a child. EI #4 was overheard telling the resident, You ain't stronger than me old (man/lady). […]

• No harm, potential for more than minimal, widespreadF812Jun 19, 2023

  Based on observations, interviews, and facility policy review, it was determined the facility failed to ensure food storage/preparation items were maintained in a clean and sanitary condition to ensure food safety for 113 of 114 residents who received nourishment from the kitchen. The facility also failed to provide evidence of a routine cleaning schedule for the kitchen. Findings included: Review of a facility policy titled, Environment, revised September 2017, indicated, All food preparation areas, food service areas and dining areas will be maintained in a clean and sanitary condition . […]

• No harm, potential for more than minimal, patternF600Feb 3, 2022

  Based on interviews, record review, a review of the, Facility Investigative Files, and a review of the facility's policy titled, Abuse, Neglect, Misappropriation, Exploitation Policy, the facility failed to identify physical abuse for RI (Resident Identifier)'s #4 and RI #7 perpetrated by a RI #3 a resident who resided on the secured Alzheimer's Care Unit (Dementia Unit) in the facility. This deficient practice affected RI #4 and RI #7 two out of six sampled residents for abuse and three out of six incident reports reviewed for abuse. Findings Include: A review of the facility's policy titled, Abuse, Neglect, Misappropriation, Exploitation Policy, with an effective date of January 2019, revealed: .Purpose: To prohibit and prevent abuse in accordance with the Federal and State Laws. […]