How To Inspect A Nursing Home

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1 Team Advocacy Inspection for August 20, 2013 Robin s Residential Care Facility Inspection conducted by Brenda Stalzer, P&A Team Advocate; And Brandy Earle, Volunteer Facility Information The administrator refused to allow Team to take a photo of the front of the facility. Robin s Residential Care Facility is located at 1216 Hyatt Avenue, Columbia, SC Team arrived at the facility at 8:27 AM and exited the facility at 11:47 AM. The administrator was the only staff person present during the inspection. The facility is operated by Robin s Residential Care Inc. One staff person, the administrator, was present during the inspection. The facility is licensed for nine beds. According to the administrator, there were four residents living in the facility on the day of Team s inspection. The DHEC license had an expiration of 8/31/13. The administrator s license was current and posted. The facility had a written emergency plan to evacuate to Miles Residential Care Facility, 490 Koon Store Road, Columbia, SC Overview of Visit During Team s visit we interviewed three residents; talked to residents and the administrator; reviewed three residents records, medication, and MARs; and toured the facility. Breakfast was served while Team was at the facility. However, the administrator refused to allow Team to observe breakfast. Team was told to wait outside while the residents ate. The menu was left out on a counter in the kitchen. The meal listed on the menu was oatmeal, raisin toast, bologna, juice, coffee, and milk. Residents reported the meal served was Cheerios, a small cup of coffee, and two pimento cheese sandwiches. Team offered to conduct an exit interview with the administrator. The administrator declined. Team arrived at the facility at 8:27 AM. Everette Williams, SC DHEC, accompanied Team to the facility. [Note: DHEC accompanied Team on the inspection because Team had been unable to complete an inspection or was denied access to the facility seven times since December 7, 2012.] Team knocked on the door and rang the bell to the facility several times. Team could hear a television inside the facility. No one initially came to the door. After waiting for twenty minutes, the administrator allowed Team and DHEC into her facility at 8:49 AM. At 8:58 AM the administrator told Team and DHEC to wait outside the facility again while she served breakfast. Team explained we wanted to observe breakfast but the administrator refused. Team exited the facility and was allowed to return at 9:12 AM. The Administrator made several disparaging remarks to the inspectors during the visit. These included attacks on an inspector s personal life and expressions of disregard for inspectors. When Team was leaving the facility, Team informed the administrator we would be taking a photo of the front of the facility. The administrator told Team not to take a photo of her facility and told Team to leave. The administrator informed Page 1 of 8

2 the Team Advocate she was in the process of getting a restraining order to prevent the Team Advocate from entering her facility. The administrator took pictures of Team s vehicle while Team was leaving the facility. Report Summary The administrator made it very difficult for Team to complete the inspection and made several disparaging remarks to inspectors. Team was particularly concerned about the administrator s delay in allowing Team to enter the facility and her refusal to allow Team to observe breakfast. Team was also concerned by the fact that the administrator completed handwritten medication administration records while Team was present. The facility had numerous housekeeping, maintenance, and furnishing issues including several signs of insect infestation. Of particular concern was the basement which served as the resident living room. The basement was dank and musty and flooded when it rained. There was water damage on basement walls. Furnishings in the basement were in poor condition. The administrator informed Team there were four residents living in the facility. However, Team observed five residents in the facility. Areas of Commendation The first floor and front yard of the facility contained some attractive potted plants. The dining room was clean with nice placemats and flowers on the table. There was a large fish tank with live fish in it in the dining room. Staff had appropriate CPR and First Aid training. Residents care plans and annual physicals were current. Emergency lights in the basement were functioning properly. Areas Needing Improvement Health/Safety Team observed a roach crawling in the front living room. Team also observed a roach crawling in the office area, a bug in the kitchen, and a dead roach on the basement floor. The resident living room was in the basement of the facility. The basement floods when it rains and there is water damage on the wood paneling. The air in the basement was dank and musty. Team found three bars of soap in the vanity and one bar of soap in the bathtub. One of the dogs in the facility did not have any paperwork indicating he had been examined or vaccinated. [Note: The administrator reported the dog was a three month old puppy.] Supervision & Administrator Team requested a copy of the administrator s criminal background check. The administrator was the only staff person present when Team was at the facility. The administrator refused to present Team with a copy of her background check. The administrator reported her background check was on file Page 2 of 8

3 with DHEC and she was no longer required to keep a copy in the facility. [Note: Team contacted DHEC and DHEC confirmed the administrator is required to keep a copy at the facility.] The administrator would not show Team a copy of her TB test. The administrator said she no longer needed a TB just a TB risk assessment. [Note: Team contacted DHEC and DHEC confirmed the administrator is required to have a TB test and a record of the test must be kept on file at the facility.] Residents Rights Residents reported they were not allowed in the front living room of the facility. Residents spent most of their time in the facility s basement. Residents reported they wash their own clothing every Saturday. A resident reported sometimes residents are locked inside the facility. A resident reported the administrator and staff are argumentative and don t treat residents with respect. DHEC inspections were not posted in the facility. [Note: Copies of inspection reports were kept on file at the facility.] Recreation There was no activity calendar. Residents reported they did not participate in any activities at the facility. Residents ADLs Two residents expressed an interest in moving. Resident A s clothing was really worn and not well fitted. His toe nails needed to be cut. Resident B had only one pair of shoes. His clothing appeared dirty and not well fitted. Resident C had only one pair of shoes. Medication Storage and Administration The administrator hand wrote medication administration records for each of the three residents whose medications were reviewed by Team. Team was asked to wait until the records were completely filled out before Team was allowed to review the medication administration records and medications. [Note: All medications listed on the handwritten medication administration record were in stock.] A container of Resident C s medication was left out on a kitchen counter next to a container of dog treats. Meals & Food Storage The administrator refused to allow Team to observe breakfast. As a result, Team does not know if residents received a balanced diet, if residents received enough food, and if residents received seconds when requested. Pans were stored on the floor of the pantry. Page 3 of 8

4 A bag of fish in a Ziploc bag in the freezer was not dated. A bag of vegetables in the refrigerator was not labeled or dated. Resident Records No concerns noted. Resident Personal Needs Allowances Two residents did not receive any personal needs allowance. [Note: These residents were not OSS recipients. One resident received a total of $1600 per month in benefits but was not given a personal needs allowance.] Appropriateness of Placement The administrator reported there were four residents living in the facility. However, Team observed five residents. Four residents were inside the facility during Team s inspection. Team observed a fifth resident leaving the facility to go to a Doctor s appointment while Team was waiting outside the facility. [Note: The administrator claimed the individual who went to a Doctor s appointment was not a resident.] Personnel Records See supervision and administrator. Housekeeping, Maintenance, Furnishings The basement of the facility served as a living room for residents. In the basement Team found: o Part of the cement floor was covered with linoleum. The linoleum is torn and ripped in several areas. o There was an old television in the room which residents were watching. The picture on the television was fuzzy. o There were several sofas in the basement. Sofas were dirty, stained, and torn. (See Attachment A.) o The finish was coming off the wood furniture in the basement. o There was an old vending machine in the basement which residents reported was empty. o A coffee table in the basement was warped at the bottom. o The carpet on the stairs leading into the basement was dirty, stained, and torn. (See Attachment B.) o There was a disorganized pile of poles, Christmas lights, cords, and other items stored behind a dirty curtain in the basement. In Resident B s bedroom the floor was dirty. Walls in the foyer near the bedrooms were dirty with worn paint. In the resident bedroom with a bathroom: Page 4 of 8

5 o Walls were dirty. o One resident s pillow was thin. His pillowcase and sheets were dirty and mildewed. The resident did not have a top sheet and his comforter was dirty. (See Attachment C.) o On another bed in this room, Team observed a small bug crawling on a resident s pillow. o The floor vent in this room was dirty. o Paint was peeling off of one of the headboards. o There was a dirty towel hanging between two wardrobes. o The ceiling was stained. There was one resident bathroom in the facility. The bathroom was located inside one of the resident bedrooms. o The floor and the toilet in the bathroom were dirty. o Tiles around the vanity were broken. o There was no toilet paper, hand soap, or paper towels in the bathroom. o The bathroom door was dirty with worn paint. According to residents they were not allowed to use the living room of the facility. However, they had to walk past the living room to get to the front door. This room was extremely cluttered with empty drink bottles, books, boxes, bags, magazines, kids toys, knick knacks, and trash. A section of the backyard was overgrown with grass. Please Note: Residents listed in the report are assigned random gender identification. This is for the purpose of making the report easier to read. However, the gender does not identify the individuals in the report. Page 5 of 8

6 Attachment A The resident living room was in the basement of the facility. The basement floods when it rains. This picture shows some of the resulting water damage on the wood paneling. The air in the basement was dank and musty. Additional photo of water damage in the basement (resident living room). Page 6 of 8