NHC Healthcare Ft Oglethorpe

In the surveyor’s words

From the most serious findings on record at NHC Healthcare Ft Oglethorpe, in the surveyor’s own words.

• Actual harm, isolatedF686Apr 25, 2024

  Based on interviews, record review, and facility policy review titled, Skin Integrity Manual, the facility failed to implement pressure injury interventions, including the removal of a resident's walking boot to perform daily skin checks, to prevent the development of unstageable pressure ulcers for one of three Residents (R) (R172) reviewed for pressure ulcers. This failure caused harm to R172 who developed three avoidable facility acquired unstageable pressure ulcers on her right foot, right heel, and right calf. Findings included: A review of the facility's policy titled Skin Integrity Manual, with a review date of January 2024, indicated, Steps in Prevention of Pressure Injuries Identification of patient at risk . Interventions and Strategies . […]

• Actual harm, isolatedF689Apr 25, 2024

  Based on interview, record review, and facility policy review titled, Falls Program, the facility failed to ensure staff provided adequate supervision and assistance device to prevent falls for one of seven Residents (R) (R172) residents reviewed for falls out of a total sample of 31 residents. This failure resulted in harm to R172 who fell in the shower room, while being assisted by only one Certified Nurse Aide (CNA), and as a result she sustained fractures to her right foot, right tibia, and right fibula. Findings included: A review of the facility's policy titled, Falls Program, dated January 2024, indicated, Purpose: To identify patients at risk for falling and to implement the appropriate interventions. Objective: To reduce the patients' risk of falling and related injuries. 1. […]

• No harm, potential for more than minimal, widespreadF726Oct 14, 2022

  Based on observations, record reviews, and staff interviews, the facility failed to ensure that direct care nursing staff were evaluated to provide competent nursing care for the residents, by not completing competency/skills checklist for three Licensed Practical Nurses (LPN) and one Registered Nurse (RN). Findings include: Review of facility documentation titled Annual Nursing Competencies Check-Offs, revealed in-service education for nursing personnel were not signed and dated to indicate the personnel completed the trainings to ensure quality care of the residents. The facility was unable to provide annual competencies that were signed and dated for the following randomly selected staff: LPN GG, LPN CC, LPN PP and RN OO. Interview on 10/12/22 at 9:25 a.m. […]

• No harm, potential for more than minimal, widespreadF727Oct 14, 2022

  Based on document review, facility policy review and interview, the facility failed to provide evidence of Registered Nurse (RN) coverage in the facility at a minimum of eight hours a day, seven days a week for the period of 8/21/22. This absence of RN coverage could have a negative impact on all residents residing at the facility. Findings include: Review of the facility's policy titled Nursing Services dated February 2022 revealed .Twenty-four-hour nursing service is provided by trained partners under the direction of a registered professional nurse who is responsible to the patient for the nursing services provided and accountable to the administration for all nursing outcomes. A registered professional nurse will be on duty 24 hours per day. […]

• No harm, potential for more than minimal, widespreadF886Oct 14, 2022

  Based on record review and staff interviews, the facility failed to provide adequate documentation of outbreak testing for COVID-19 in a manner consistent with current standards of practice for all staff on dates 1/3/22 and 1/4/22 for outbreak that started on 12/23/21. Findings include: An interview with the COVID-19 Testing Coordinator/Receptionist on 10/13/22 at 3:15 p.m. revealed that when staff came into test, they were to write down their name and once they tested and the results were provided to her, she entered the results into the National Healthcare Safety Network (NHSN) database. She stated that there was no other form used in this facility. Review of staffing sheets dated for 1/3/22, 1/4/22, and 1/5/22, revealed there were no call outs due to COVID-19 symptoms. […]