Cambridge Post Acute Care Center
CAMBRIDGE POST ACUTE CARE CENTER in SNELLVILLE, GA — inspection on February 10, 2025.
Found 7 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Review of R432's physicians orders revealed, [name] ophthalmic solution 0.5% (percent), Instill one drop in both eyes every 12 hours for glaucoma.
Review of the Self Administration of Medication assessment dated [DATE] revealed, R432 was not capable for self-administration of medication.
During an observation on 2/8/2025 at 8:44 am in R432's room revealed there was an eye drop medication ([name] ophthalmic solution) sitting on her bedside table position next to her.
During an interview on 2/8/2025 at 12:17 pm with LPN DD confirmed the eyedrop medication on R432's bedside table.
She stated R432 was a new admission and was not aware that her family had brought the eyedrops in from the hospital.
115771 02/10/2025
Cambridge Post Acute Care Center 2020 McGee Road Snellville, GA 30078
Review of R6's clinical records revealed a physician order for continuous oxygen (O2) at 2 (two) LPM (liters per minute) via nasal cannula with a start date of 10/26/2024.
A review of R6's comprehensive care plans revealed that it did not include an oxygen therapy plan.
Interview with LPN/MDS Coordinator BB on 2/10/2025 at 10:30 am confirmed that R6 did not have a care plan for oxygen therapy.
During an interview with the DON on 2/10/2025 at 10:40 am, she stated if a resident was receiving oxygen continuously and depends on oxygen therapy, she would expect the care plan to reflect oxygen therapy.
Cross Reference F-F695
115771 02/10/2025
Cambridge Post Acute Care Center 2020 McGee Road Snellville, GA 30078
During an observation on 2/9/2025 at 7:57 am revealed the filer on the oxygen concentrator contains a thick layer of gray fuzzy substance.
Review of the clinical records for R105 revealed she was admitted to the facility with diagnoses that included but not limited to other asthma and cough variant asthma.
Observation on 2/8/2025 at 8:32 am revealed R105's oxygen concentrator's built-in filter was dirty with a thick dark brown substance.
Observation on 2/9/2025 at 8:03 am revealed R105's oxygen concentrator's built-in filter was dirty with a thick dark brown substance.
Interview on 2/9/2025 at 10:10 am with the Director of Nursing (DON) stated on every Sunday night shift, the nurse assigned to that resident's hall was responsible for the maintenance and cleaning of the oxygen machine filter, ensuring the nebulizer machine was stored properly when not in use and oxygen tubing was stored in a bag when not in use.
She stated, it is my expectation for all my unit nursing manager staff to make rounds on Monday morning to make sure all the maintenance and cleaning of the oxygen equipment were properly done on that Sunday night.
Observation and interview on 2/9/2025 at 10:18 am with DON and Licensed Practical Nurse (LPN) CC both confirmed that R6's oxygen concentrator's built-in filter was dirty with a thick dark brown substance and tank setting was on three liters. LPN CC checked R6's physician orders in the facility's electronic records and confirmed that physician order was two liters.
Observation and interview on 2/9/2025 at 10:30 am with LPN DD confirmed the Sunday night shift nurses were responsible for the respiratory maintenance cleaning of equipment weekly which includes the oxygen concentrators' filters.
She stated she does her round every Monday morning to ensure staff cleaned all the equipment.
She confirmed R98 and R64 oxygen concentrators' spongy-foam filter was dirty with a thick fuzzy gray substance.
She also confirmed that R105's oxygen concentrator's built-in filter was dirty with a thick dark brown substance.
115771 02/10/2025
Cambridge Post Acute Care Center 2020 McGee Road Snellville, GA 30078
During further interview, the DON stated she expected nurses
pen to ensure the resident received the ordered insulin dose.
She further stated that if the pen was
outcome.
She stated the Nurse Practitioner had recently provided education on insulin administration and she planned further education on medication administration.
During an interview with the Infection Control Preventionist (ICP) on 2/9/2025 at 4:48 pm, she stated the Certified Nursing Assistants (CNAs) were supposed to check all the resident's rooms to ensure all basins, urinals, and bedpans were off the floor.
All items were to be bagged in a clear bag and labeled with the resident name.
The ICP confirmed that numerous bathrooms contained unlabeled and unbagged items.
She acknowledged several items sitting directly on the floor, unbagged and unlabeled.
115771 02/10/2025
Cambridge Post Acute Care Center 2020 McGee Road Snellville, GA 30078
Review of the clinical records revealed R98 was admitted to the facility with diagnoses that included but not limited to chronic obstructive pulmonary disease with acute exacerbation (COPD) (reduction of lung function).
Review of R98's physician's order revealed, oxygen at 2 liters per minute (lpm) via nasal cannula to keep O2 saturation greater than 90 percent.
Review of R98's physician's order revealed, change and date all respiratory supplies and tubing weekly. If oxygen concentrator is present, clean filter.
During an observation on 2/8/2025 at 10:10 am revealed the filter on the oxygen concentrator contained a thick gray fuzzy substance.
During an observation on 2/9/2025 at 7:59 am revealed the filter on the oxygen concentrator contained a thick gray fuzzy substance.
115771
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 115771 B.
Wing 02/10/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Cambridge Post Acute Care Center 2020 McGee Road Snellville, GA 30078
Review of the clinical records revealed R6 admitted to the facility with diagnoses that included but not limited to asthma, dependence of supplemental oxygen, and malignant neoplasm of unspecified bronchus or lung.
Review of R6's clinical records revealed a physician order for continuous oxygen (O2) at 2 (two) LPM (liters per minute) via nasal cannula with a start date of 10/26/2024.
Observations on 2/8/2025 at 10:58 a.m. and 2/9/2025 at 8:45 a.m. revealed R6 receiving oxygen therapy via nasal cannula at 3 (three) LPM.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.