Signature Healthcare of Monteagle Rehab & Wellness

In the surveyor’s words

From the most serious findings on record at Signature Healthcare of Monteagle Rehab & Wellness, in the surveyor’s own words.

• Actual harm, isolatedF600Jul 31, 2024

  Based on facility policy review, medical record review, facility investigation review, and interviews, the facility failed to protect the residents' right to be free from physical abuse by another resident for 2 residents (Resident #6 and Resident #74) of 26 residents reviewed for abuse. The facility's failure to prevent resident to resident altercations resulted in actual harm for Resident #6. On 6/27/2024, Resident #283 struck Resident #6 with a water pitcher causing a laceration and bruising to the left eye on 12/15/2023 and Resident #74 when Resident #31 struck resident #74 with a walker causing a small cut to Resident #74's right earlobe and a skin tear to the resident's left hand, which resulted in actual HARM to Residents #6 and #74. […]

• Actual harm, isolatedF600Aug 3, 2023

  Based on review of facility policy, medical record review, review of a facility investigation, observation, and interview the facility failed to prevent abuse of 3 residents (#5, #1, #9) of 13 residents reviewed for abuse of 19 sampled residents. The facility's failure to prevent resident to resident altercations resulted in actual harm for Resident #5 when Resident #4 grabbed Resident #5's wrist and twisted her arms and wrist and caused Resident #5 to cry out in pain. The findings included: Review of a facility policy Abuse, Neglect and Misappropriation of Property last reviewed 10/17/2022, showed .it is the organization's intention to prevent the occurrence of abuse, neglect, exploitation, injuries of unknown origin, and misappropriation of resident property .Abuse is defined as the… […]

• No harm, potential for more than minimal, widespreadF727Sep 17, 2025

  Based on review of the facility's assessment, facility's nursing staff schedules, daily nursing staff posting sheets, time clock punches, and interviews, the facility failed to provide the services of a Registered Nurse (RN) for the minimum requirement of 8 consecutive hours a day 7 days per week for 10 days from 4/1/2025 - 6/30/2025 and 13 days from 8/14/2025 - 9/17/2025 of 123 days reviewed. The findings include:Review of the Facility assessment dated [DATE]-[DATE], revealed .Staffing plan .Based on our resident population and their needs .we ensure we have sufficient staff .at any given time .Review of the facility's policy titled Scheduling and Staffing, last revised 1/31/2025, revealed .It is the policy of this organization to establish consistent work shift scheduling practices to… […]

• No harm, potential for more than minimal, widespreadF732Jul 31, 2024

  Based on facility policy review, observation and interviews, the facility failed to post accurate daily staffing information for 7 days of 1 of 1 days observed for staff posting. The findings include: Review of the facility's policy titled, Posting of Nurse Staffing, revised 5/13/2024, revealed .The facility will post the daily staffing on a daily basis .Facility name .The current date .The total number and actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift .registered nurses .licensed practical nurses .certified nurse aides .Resident census .The facility will post the nurse staffing data .at the beginning of each shift . […]

• No harm, potential for more than minimal, widespreadF812Jul 31, 2024

  Based on facility policy review, observations, and interviews the facility failed to maintain kitchen equipment in a sanitary condition and failed to discard expired food which had the potential to affect 71 of 71 residents. The findings include: Review of the facility's policy titled, Food: Preparation, dated ,d+[DATE], revealed .food contact equipment .will be cleaned and sanitized after every use . During an observation and interview with the Dietary Manager (DM) on [DATE] at 8:42 AM, in the food preparation area, revealed the food processor had dried white food debris present to the inner bowl, in multiple areas. The DM stated the white substance was probably bread and was unsure when the food processor was last used. […]