Comer Health And Rehabilitation

F-F656

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 9 115289 Department of Health & Human Services Printed: 09/11/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115289 B. Wing 01/16/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Comer Health and Rehabilitation 2430 Paoli Road Comer, GA 30629

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Level of Harm - Minimal harm or 50170 potential for actual harm Based on observation, staff interview, and review of facility policy titled Menus, the facility failed to properly Residents Affected - Some prepare foods to conserve nutritive value during the preparation of puree food for nine residents who received a puree diet. The deficient practice had the potential to place nine of nine residents who received a pureed diet at risk of decreased nutritional intake.

Findings include:

Review of the facility policy titled Menus, review date 12/29/2023, revealed, Menu items should be nutritionally adequate, attractively served, palatable, at a safe and appetizing temperature, and within cost or budget projections.

Observation and interview on 1/15/2025 at 10:16 am with Dietary [NAME] EE revealed he was preparing pureed carrots for nine residents. Dietary [NAME] EE added water and thickener to the puree machine along with the carrots and blended until he stated it was the correct consistency. Dietary [NAME] EE revealed that

he did not use vegetable broth when preparing puree and wasn't sure if they had any vegetable broth.

A review of the recipe for Carrots Herb Pureed Thick revealed that low-sodium chicken base should have been used to ensure a smooth consistency.

In an interview on 1/15/2025 at 11:07 am, the Dietary Kitchen Manager (DKM) revealed Dietary [NAME] EE should have used broth when mixing the pureed carrots to give it flavor.

In an interview on 1/15/2025 at 11:33 am, the Registered Dietician (RD) confirmed that chicken broth should have been added to the recipe for carrot glazed puree. She stated that she would have staff pull the puree carrots from the line and have the broth added and tested to ensure proper consistency.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 9 115289 Department of Health & Human Services Printed: 09/11/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115289 B. Wing 01/16/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Comer Health and Rehabilitation 2430 Paoli Road Comer, GA 30629

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 50272 potential for actual harm Based on observation, staff interviews and review of facility's policy titled, Infection Prevention Plan, the Residents Affected - Few facility failed to prevent the spread of infections by not properly securing and storing clean linen in one out of three halls (Hall A). This deficient practice had the potential to cause the spread of infection throughout the facility. The facility census was 76 residents.

Findings include:

Review of facility's policy titled Infection Prevention Plan dated 12/29/2023 under section titled Goals revealed, The goals of the infection prevention program are as follows: To prevent and control the transmission of infectious and communicable diseases; To prevent healthcare associated infections . Under

the section titled Scope revealed, The center provides services on an in-patient basis to a geriatric population with various medical conditions, including hospice, hemodialysis and other special needs . Implementation of Preventive Measures: Prevention of a spread of infections is accomplished by use of standard precautions and other barriers.

An observation and interview conducted on 1/16/2025 at 11:08 am on Hall A revealed, an opened bag of chips found on the inside of the clean linen cart, which was also used for storing personal protective equipment (PPE) gowns. When asked about the opened bag of chips, Certified Nursing Assistant (CNA) AA revealed, it was hers and confirmed that it was not supposed to be stored on the clean linen cart. CNA AA acknowledged the potential risks of cross contamination, resident safety and that storing food inside the clean linen cart could compromise its cleanliness.

An interview conducted on 1/16/2025 at 11:37 am with Registered Nurse/Infection Prevention Nurse (RN/IPN) BB when asked about the opened bag of chips found on the inside of the clean linen cart revealed, that anyone could have grabbed the food and consumed it, which could lead to infection risks, particularly if

the food was contaminated by someone with an infectious condition.

An interview conducted on 1/16/2025 at 11:44 am with the Director of Nursing (DON) confirmed that the opened bag of chips should not have been stored on the cleaned linen cart. The DON expressed concern that the contamination of food in the clean linen cart could result in the transfer of germs to the linens and PPE, which could negatively impact residents, especially those with open wounds or compromised immune systems.

An interview conducted on 1/16/2025 at 12:11 pm with the Administrator confirmed that incidents like this should not occur. The Administrator revealed that food in the clean linen cart could contaminate the linens and PPE, posing risks to resident safety. The Administrator confirmed that CNAs had received in-service training on infection control practices to help prevent such occurrences.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 9 115289

F-F677

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 9 115289 Department of Health & Human Services Printed: 09/11/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115289 B. Wing 01/16/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Comer Health and Rehabilitation 2430 Paoli Road Comer, GA 30629

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 50272 potential for actual harm Based on observations, resident and staff interviews, record review, and review of the facility's policies titled Residents Affected - Few Patient Plan of Care and Care of Hearing Aids, the facility failed to assist one out of four sampled residents (R) (Resident R2) with the use of hearing aids. Specifically, the facility failed to assist with the proper use of hearing aids by not placing them in and removing them. This failure to provide the necessary support could result in communication barriers.

Findings include:

A review of the facility's policy titled, Care of Hearing Aide dated 12/29/2023 under section titled Intent revealed, The primary intent of caring for a hearing aid is to maintain the patients hearing aid in good order.

A review of the Electronic Health Record (EHR) for Resident R2 revealed, she was admitted to the facility with diagnoses that included but not limited to, need for assistance with personal care, unspecified dementia with mood disturbance, chronic systolic (congestive) heart failure, chronic respiratory failure with hypoxia, neuropathy, and fracture of body of sternum.

A review of Resident R2's 5-day Minimum Data Set (MDS) dated [DATE REDACTED] revealed, Section B (Hearing, Speech and Vision) revealed, Resident R2 had moderate difficulty in hearing and that the speaker must increase volume and speak distinctly; Section C (Cognitive Patterns) a Brief Interview for Mental Status (BIMS) of 14, which indicated little to no cognitive impairment.

A record review of Resident R2's Activities of Daily Living (ADLs) Plan of Care on 1/15/2025 revealed, under section Resident Caution and Diagnosis hearing aids to both ears. Assist with placement in the morning and remove

after supper and place on charger.

An interview and observation conducted on 1/14/2025 at 11:28 am with Resident R2 revealed, she was not wearing her hearing aids. Resident R2 stated that she had hearing aids, which she was able to put in herself in the morning, but no one was available to assist her with taking them out. Resident R2 revealed, that some staff members were helpful while others were not. Resident R2 explained that her hands were numb, and she was unable to remove the hearing aids on her own due to neuropathy. The resident expressed feeling helpless and stated that she tries to communicate using the call light speaker, but she was unable to hear the staff's responses.

An interview and observation conducted on 1/15/2025 at 9:51 am with Resident R2 revealed, she still did not have her hearing aids in, which made communication difficult. Resident R2 indicated that nurses had been in and out of her room to administer medications but had not assisted with hearing aids.

An interview conducted on 1/16/2025 at 12:34 pm with a Family Representative (FR) revealed, Resident R2 has voiced concerns about the staff not being able to assist her with her hearing aids. FR also stated that when speaking to Resident R2, he notices that she does not have her hearing aids in, which makes communication difficult. FR emphasized that Resident R2 having her hearing aids properly in place would significantly improve Resident R2's quality of life and ability to hear.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 9 115289 Department of Health & Human Services Printed: 09/11/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115289 B. Wing 01/16/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Comer Health and Rehabilitation 2430 Paoli Road Comer, GA 30629

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 An interview conducted on 1/15/2025 at 9:55 am with Certified Nursing Assistant (CNA) CC revealed, that

she was not aware that Resident R2 had hearing aids, but she learned about it the previous day. CNA CC explained Level of Harm - Minimal harm or that she does not typically check the Activities of Daily Living (ADLs) unless necessary, such as when potential for actual harm documenting care. CNA CC clarified that protocol requires CNAs to review the ADLs before providing care. However, due to a busy workload, CNA CC sometimes cannot check them beforehand but does so after Residents Affected - Few providing care.

An interview and observation conducted on 1/15/2025 at 10:32 am with Licensed Practical Nurse (LPN) DD revealed that CNAs were expected to review the ADL plan of care (POC) to understand what assistance the resident required. LPN CC confirmed that it is expected for CNAs to consult the ADL POC before delivering care. LPN CC acknowledged that she was aware Resident R2 has hearing aids but was uncertain if this was included

in the resident's ADL POC. After reviewing the ADL POC together, it was confirmed that Resident R2 required assistance with both hearing aids. LPN CC stated that both the CNA and nurse were responsible for assisting the Resident R2 with hearing aids and that staff should be aware of this need.

An interview was conducted on 1/16/2025 at 11:44 am with the Director of Nursing (DON) confirmed that staff were expected to review the ADL POC to understand the services a resident need and to ensure their preferences were respected. The DON highlighted that failing to provide services could lead to missed care, potentially resulting in a negative experience for the resident.

An interview was conducted on 1/16/2025 at 12:07 pm with Administrator revealed, that staff should regularly

review the ADL POC to ensure they are providing the appropriate services and meeting the resident's needs.

The Administrator stated staff were also involved in care plan meetings, where they learn what ADLs should be provided. The Administrator noted that failure to follow the resident's ADL POC could result in neglecting

the resident's needs, and staff should use nurses as a resource to ensure proper care.

Cross Reference