The Waters of Smyrna, LLC

In the surveyor’s words

From the most serious findings on record at The Waters of Smyrna, LLC, in the surveyor’s own words.

• Immediate jeopardy, patternF600Jun 21, 2024

  Based on facility policy review, medical record review, observation, and interview, the facility failed to ensure 3 of 4 vulnerable sampled residents (Residents #6, #7, and #18) reviewed for abuse were free from sexual abuse by Resident #10. On an unknown date, Resident #6, who had a Brief Interview of Mental Status (BIMS) score of 15, which indicated no cognitive impairment, and had a diagnosis of Spastic Quadriplegia with Cerebral Palsy, stated Resident #10, who had a BIMS score of 15, which indicated no cognitive impairment, made nonconsensual sexual advances toward her by touching her hair and rubbing her on the thighs without permission. Resident #6 stated Resident #10 continued to rub on her thighs and antagonized her during activities. […]

• Immediate jeopardy, patternF610Jun 21, 2024

  Based on facility policy review, medical record review, observation, and interview, the facility failed to conduct an investigation and take appropriate corrective actions for 3 of 3 sampled residents (Residents #6, #7, and #18) reviewed for allegations of sexual abuse by Resident #10. On an unknown date, Resident #6, who had a Brief Interview of Mental Status (BIMS) score of 15, which indicated no cognitive impairment, and had a diagnosis of Spastic Quadriplegia with Cerebral Palsy, stated Resident #10, who also had a BIMS score of 15, made nonconsensual sexual advances toward her by touching her hair and rubbing her on the thighs without permission. […]

• Immediate jeopardy, isolatedF604Jun 21, 2024

  Based on facility policy review, medical record review, observation, and interview, the facility failed to provide an environment free from the use of physical restraint used for staff convenience, that unnecessarily inhibited a resident ' s freedom of movement or activity for 1 of 3 (Resident #15) sampled residents reviewed for restraints. The facility also failed to obtain an order for the physical restraint, failed to document the medical symptom for which the restraint was implemented, failed to document less restrictive alternatives were implemented prior to use of the physical restraint, failed to document direct monitoring and supervision provided during use of the restraint, and failed to assess, care plan, and re-evaluate the need for the restraint. […]

• Actual harm, isolatedF600Oct 4, 2022

  Based on facility policy review, record review, observation, and interview, the facility failed to provide wound and skin care for 1 of 3 sampled residents (Resident #1), which resulted in actual harm (surgical debridement of skin due to maggot infestation). The findings include: Review of the facility's undated policy titled, Abuse Prevention Program revealed .It is the policy of this facility to prohibit and prevent resident abuse, neglect, mistreatment, and misappropriation of resident property and a crime against a resident in the facility . Review of the facility's undated policy titled, Resident Rights revealed .As a resident of this facility, you have the right to a dignified existence and to communicate with individuals and representatives of choice. […]

• No harm, potential for more than minimal, widespreadF725Jun 21, 2024

  Based on facility policy review, medical record review, observation, and interview, the facility failed to provide sufficient staff to provide care and services in assisting residents to attain or maintain their highest practicable level of physical, mental, and psycho-social well-being for all residents at the facility. The findings include: Review of the facility policy titled, GUIDELINES STANDARD SUPERVISION, dated 5/17/2023, revealed, .6. Staff assignments are based on the resident needs as far as their acuity and their assessment results and their person-centered care planning. Therefore, the requirements of meeting those needs to include physical, emotional, psychosocial, social, and spiritual, will be accomplished by provision of as much hands on care as necessary. […]