East Jefferson General Hospital - SNF

In the surveyor’s words

From the most serious findings on record at East Jefferson General Hospital - SNF, in the surveyor’s own words.

• No harm, potential for more than minimal, isolatedF580Feb 25, 2026

  Based on interviews and record reviews, the facility failed to ensure the physician was immediately notified of a significant change in a resident's weight for 1 (Resident #45) of 1 sampled resident reviewed for weights. Findings:Review of the Facilities Nursing Standards of Practice and Documentation policy, dated 10/2024 revealed, in part, on the day weights are obtained on all patients, the primary nurse will compare the admission weight to the current weight and determine if criteria has been met to notify the attending physician and dietician. The attending physician will be notified of a weight change from time of admission +/- 10 %. Review of Resident #45's Electronic Medical Record revealed an admit date of 12/12/2025. […]

• No harm, potential for more than minimal, isolatedF684Feb 25, 2026

  Based on interviews and record reviews, the facility failed to ensure a resident was weighed daily per physician's orders for 1 (Resident #45) of 1 sampled resident reviewed for daily weights. Findings:Review of Resident #45's Electronic Medical Record revealed an admit date of 12/12/2025. Further review revealed Resident #45 had diagnoses of, in part, congestive heart failure and end stage renal disease, and was receiving hemodialysis (life-sustaining treatment for kidney failure to filter blood). Review of Resident #45's Physician's Orders revealed, in part, an order for daily weights with a start date of 12/12/2025. Review of Resident #45's Electronic Medical Record revealed, in part, Resident #45 did not have weights completed for 12/17/2025, 12/18/2025, and 12/19/2025. […]

• No harm, potential for more than minimal, isolatedF880Feb 25, 2026

  Based on observation, interviews, and record review, the facility failed to ensure respiratory staff wore personal protective equipment [PPE] (garments and gear designed to protect the wearer's body from infections and hazards) when entering the room of a resident on contact isolation precautions for 2 (S7Respiratory Therapist [RT], S8RT) of 7 staff members observed for proper PPE usage. Findings:Review of the facility's Isolation Precautions policy and procedure, revised on 01/2025, revealed, in part, staff should follow contact isolation precautions (an infection control measure consisting of the use of specific PPE in order to prevent the spread of bacteria and viruses with a resident or their environment) when coming into contact (directly or indirectly) to residents with a known or… […]

• No harm, potential for more than minimal, isolatedF761Feb 13, 2025

  Based on observation, interviews, and record reviews, the facility failed to ensure expired intravenous (IV) fluids were not available for use in 1 (Medication Supply Room a) of 1 (Medication Supply Room a) medication supply room observed for expired supplies. Findings: Review of the University Healthcare System (UHS) Policy, titled UHS Expired Supplies and Supply Rotation, last updated 04/2024, revealed in part, to ensure patients are protected from infection and other potential harm from expired or compromised supplies and devices, UHS Hospital assures that supplies are stacked to the most optimal par levels, and supply items have not passed their expiration dates. […]

• No harm, potential for more than minimal, isolatedF880Feb 13, 2025

  Based on observation, interviews, and record review, the facility failed to ensure dietary staff donned Personal Protective Equipment (PPE) while passing food trays for 1 (Patient #117) of 1 (Patient #117) patient observed for Contact Isolation Precautions. Findings: Review of the facility's Transmission Based Precautions policy and procedure, revised on 09/2024, revealed, in part, in addition to standard precautions, use contact precautions for specified patients known or suspected to be infected or colonized with epidemiological important microorganisms that can be transmitted by direct contact with the patient (hand or skin to skin contact that occurs when performing patient care activities that require touching the patient's dry skin), or indirect contact (touching) with environmental… […]