Pruitthealth - Lakehaven, Llc

F-F600

2. Administration failed to monitor, assess, document, and effectively address Resident R1's chronic respiratory issues. This deficient practice resulted in Resident R1 being admitted to the hospital on critical care unit and initially being placed on BiPAP.

Telephone interview 6/27/2024 at 10:14 am with LPN QQ revealed she was the nurse working when Resident R1 called 911 on 6/2/2024. LPN QQ stated Resident R1 was having difficulty breathing and wanted to go the emergency room . LPN QQ further stated she witnessed Resident R1 tripoding and turning purple. LPN QQ also stated Resident R1 was sick and needed help, however, she stated she did not assess resident, implement any interventions, document the change in condition, or call the physician. LPN QQ stated the change of condition should have been documented and her respiratory status should have been assessed, but because Resident R1 was of thin frame

she could see the resident had to use her accessory muscles to breathe. LPN QQ also stated she did not stay with the resident until emergency personnel arrived and she did not alert the more experienced nurse on

the shift that something was going on. LPN QQ further stated she did not greet the emergency medical staff or give them a report when they arrived at the facility. LPN QQ also stated she did not call the physician, DHS, or Administrator to inform them of resident's condition and the situation. LPN QQ also confirmed she was aware Resident R1 had a history of respiratory distress and had several medications to treat her condition, but

she did not attempt to administer any medications or treatments. LPN QQ stated to surveyor I made too many mistakes and reacted too late.

Cross-reference:

F-F655

Level of Harm - Immediate jeopardy to resident health or safety

Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 15 115373

F-F695

3.Administration failed to develop and implement person-centered baseline care plans related to risks associated with chronic respiratory problems for resident Resident R1.

Interview with the Director of Health Services (DHS) on 6/27/2024 at 12:17 pm. DHS confirmed a baseline plan of care related to Resident R1's respiratory diagnoses was not listed, and he was not aware until now. DHS reported that a respiratory problem should be done for residents who have a known history of respiratory related illnesses. The DHS further reported Resident R1 discharged from the facility prior to a comprehensive care plan was scheduled to be completed, but the baseline care plan should have reflected resident's chronic respiratory issues.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 15 115373 Department of Health & Human Services Printed: 09/19/2025 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 115373 B. Wing 07/03/2024

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

Pruitthealth - Lakehaven, LLC 410 East Northside Drive Valdosta, GA 31602

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 0835 Cross-reference: