Macclenny Nursing and Rehab Center

In the surveyor’s words

From the most serious findings on record at Macclenny Nursing and Rehab Center, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF583Oct 21, 2021

  Based on observations, staff interviews, and record review, the facility failed to ensure each resident had the right to personal privacy and confidentiality for all aspects of care and services, specifically concerning dietary orders and personal care posted in public areas for 12 (Residents #17, #30, #7, #76, #18, #23, #32, #68, #6, #33, #82, and #2) out of a total of 35 sampled residents. The findings include: On October 19, 2021 at 8:20 a.m., a piece of paper was observed taped to a white board in the East Wing hallway. It was across from nurses station in public view and read, 10-18-2021 Dining Room. For staff information: The following residents will be eating in the East Wing Dining Room for lunch and dinner only. […]

• No harm, potential for more than minimal, isolatedF584Oct 21, 2021

  Based on observations, staff interviews, clinical record reviews and policy and procedure reviews, the facility failed to provide a clean and homelike environment for one (Resident #65) of three residents with enteral feedings (nutrition provided via feeding tube through the gastrointestinal tract) from a total of 35 sampled residents. Specifically, enteral food product was observed splattered on the resident's feeding pump, the pole, the floor, the wall, the mattress, and the resident's bed frame. The findings include: On 10/20/2021 at 2:59 p.m., Resident #65's enteral feeding pump and pole were observed beside her bed. A large amount of different shades of a beige substance was splattered on the pump, the pole, the floor, the wall, the mattress, and the bed frame. […]

• No harm, potential for more than minimal, isolatedF684Oct 21, 2021

  Based on observation, staff interviews, and medical record review, the facility failed to provide treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan for one (Resident #12) of 35 residents in the sample. The findings include: A review of Resident #12's medical record revealed a history of venous ulcers on her right lower extremity (leg) which required wound care two times per week and as needed. On 10/19/2021 at 10:30 a.m., wound care was observed for Resident #12 in her room. Wound care was performed by Licensed Practical Nurse (LPN) I/Wound Care Nurse. She was asked how long she had been the facility's wound care nurse and she replied, About two weeks, but I've been an LPN for a couple of years. […]

• No harm, potential for more than minimal, isolatedF690Oct 21, 2021

  Based on observation, staff interview, clinical record review, and facility policy and procedure review, the facility failed to ensure appropriate catheter care was provided to one (Resident #65) of six residents with indwelling urinary catheters from a total of 35 residents in the sample. Failure to ensure proper catheter care is provided, creates a potential for urinary tract infections and negative health outcomes for the resident. The findings include: On 10/20/2021 at 2:59 p.m., Resident #65 was observed resting in bed with her eyes closed. She did not respond to her name being called or open her eyes. Resident #65's urinary catheter tubing and bag were hanging from the side of the bed frame. The bag, exposed at the bottom, was resting on the floor. […]

• No harm, potential for more than minimal, isolatedF697Oct 21, 2021

  Based on observations, staff and resident interviews, medical record review, and facility policy and procedure review, the facility failed to ensure that pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one (Resident #101) of a total of 35 residents in the sample. The findings include: On October 18, 2021 at 1:08 p.m., Resident #101 was observed sitting in his wheelchair in his room with the television on. He was asked how he was doing, and he replied, My back hurts. He was asked whether he had made anyone aware of that, and he replied No, net yet. He was encouraged to ring his call bell to let the staff know he was in pain. […]