Pruitthealth - Monroe

In the surveyor’s words

From the most serious findings on record at Pruitthealth - Monroe, in the surveyor’s own words.

• Immediate jeopardy, isolatedF656Oct 4, 2022

  Based on staff interviews, record review and review of the facility policy titled Care Plans, the facility failed to develop care plan interventions based on the assessed number of people required to provide care for one resident (R#4). The sample size was 10. On 9/27/22 a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation caused or had the likelihood to cause serious injury, harm, impairment, or death to residents. The facility's Administrator and Senior Nurse Consultant were informed of the Immediate Jeopardy for F656 and F689 on 9/27/22 at 11:23 a.m. The noncompliance related to the Immediate Jeopardy was identified to have existed on 5/20/21. […]

• Immediate jeopardy, isolatedF689Oct 4, 2022

  Based on interviews, record review, and review of facility policy titled Occurrences, the facility failed to ensure one resident (R) (#4) who was totally dependent on staff was properly positioned in bed when the Certified Nursing Assistant (CNA) turned to get supplies from the nightstand while providing care for the resident. The resident subsequently fell to the floor, sustained a hematoma to the forehead and died later that same evening from [CONDITION(S)]. The sample size was 10. On [DATE] a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation caused or had the likelihood to cause serious injury, harm, impairment, or death to residents. […]

• No harm, potential for more than minimal, widespreadF812May 5, 2024

  Based on observations, staff interviews, and review of the facility policy titled, Pot/Pan Washing and Sanitation and review of the Sanitizing Solution Product Specification document, the facility failed to ensure dishware was air dried before usage to prevent the potential for cross contamination and bacteria contamination. The deficient practice had the potential to affect 62 of 63 residents receiving an oral diet. Findings include: Review of the facility policy titled Pot/Pan Washing and Sanitation revealed Air dry pots and pans on the drain board. […]

• No harm, potential for more than minimal, widespreadF908May 5, 2024

  Based on observations and staff interview, the facility failed to properly maintain the walk-in freezer to prevent ice build-up on food storage shelves and food products. The deficient practice had the potential to affect 62 of 63 residents receiving an oral diet. Findings include: Observation on 5/3/2024 at 8:30am of the walk-in freezer revealed ice build-up on the food storage shelf under the air condenser. The food storage shelf had six mounds of ice, the mounds were two inches in height and two inches in diameter. Continued observation revealed ice build-up on the top of food item inside a clear, plastic, resealable bag. The ice build-up on the plastic bag had a mound of ice on the left side that was about three inches in height and two inches in diameter. […]

• No harm, potential for more than minimal, widespreadF812Oct 23, 2022

  Based on observations, interviews, and policy review the facility failed to ensure opened food items in the walk-in refrigerator were dated; failed to discard food items after Best If Use By date; and failed to properly thaw food items to prevent food borne illness. This deficient practice had the potential to effect 49 of 51 residents receiving an oral diet. Findings include: Review of the facility policy titled Labeling, Dating, and Storage with a reviewed date of 1/8/21 revealed: Foods will be stored in their original containers or in an approved container or wrapped tightly with film, foil, etc and clearly labeled with the name of the item and the use by date. […]