Premier Living And Rehab Center
Premier Living and Rehab Center in Lake Waccamaw, NC — inspection on July 2, 2024.
Found 16 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
was that the call bell in shower room should have been responded to when it was sounding.
She
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
Review of an admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #39
surgery (refers to the urinary organs of the body) that required skilled nursing care. He was administered antibiotic medication.
Review of the Consultant Pharmacist ' s Medication Regimen Review dated 05/27/24 revealed the following recommendation: This resident was admitted with an order for Amoxicillin/Clavulanate 875 MG BID (twice a day) for 7 days.
This was entered into the computer as Amoxicillin 875 MG.
This is what the pharmacy sent.
Please notify the provider of the medication error to clarify if any additional treatment is needed.
Please review with the nurses to ensure they read orders carefully and double check entries.
In an interview with the Consultant Pharmacist on 6/12/24 at 9:50 AM she stated the difference between Amoxicillin and Amoxicillin-Clavulanate was that the Clavulanate drug helped the Amoxicillin work better and more types of bacteria were affected by the addition of Clavulanate.
She would have expected the provider to be notified to report the medication error and determine if additional treatment was necessary.
In an interview with the Director of Nursing (DON) on 06/12/24 at 4:40 PM she stated she had not followed up on the pharmacy recommendation and had not notified the provider that the wrong antibiotic had been administered to Resident #39 to determine if further treatment was necessary.
In an interview with the facility physician on 06/19/24 at 9:30 AM she stated she had not been notified that Resident #39 was given the wrong antibiotic.
She noted she started at the facility last week and was not his doctor when this occurred.
However, she reported she had seen Resident #39 yesterday and he was not having any symptoms of a UTI at this time.
She did not feel any further intervention was required.
She stated she would expect to be notified whenever there was a pharmacy recommendation or a medication error so that it could be addressed when it occurred.
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
jeopardy to resident health or be educated as noted above.
This will be completed by the Social Worker, Human Resources safety Coordinator, and/or Director of Nursing.
The Social Worker, Human Resources Coordinator, and the Director of Nursing will be responsible for keeping up with new hires who have and have not been
responsible for completing the education with new hires.
The Social Worker, Human Resources Coordinator, and the Director of Nursing were notified of this responsibility on 06/13/2024 by the Administrator.
Alleged date of immediate jeopardy removal: 6/16/24 The removal plan of the Immediate Jeopardy was validated on 06/19/24. A sample of staff including the Administrator, Unit Manager, nurses and medication aides were interviewed regarding in-services they received related to the deficient practice.
All staff interviewed stated they had been in-serviced regarding the importance of staff understanding that all residents have a right to be free of neglect and understood that failing to provide the necessary care and services to residents constitutes neglect such as obtaining and administering medications as ordered, managing pain, and notifying the physician of significant changes.
The IJ removal date of 6/16/24 was validated.
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
Findings included: Review of the facility provided initial allegation report dated 06/14/24 regarding Residents #46, #51, #269, and #419 revealed no documentation of APS being notified and no record of law enforcement notification.
During an annual recertification survey and complaint investigation, the facility was officially notified of neglect on 06/13/24 at 2:15 PM and an immediate jeopardy template was issued to the Administrator.
The immediate jeopardy template was signed by the Administrator and the Administrator was verbally informed of the information regarding the situation involving neglect.
Review of the state agency records revealed the facility submitted an initial report to the State Agency within the required time frame following the notification of neglect, however documentation supported that the facility did not notify law enforcement or APS until 06/16/24.
During a phone interview with the facility Administrator on 06/17/24 at 4:30 PM, she stated she submitted an initial allegation report to the State Agency regarding the neglect information provided on the template which she had received on 06/13/24.
She stated since the neglect was identified by the state surveying staff and she received a template for the immediate jeopardy she was confused as to whether or not she would still have to notify APS and law enforcement.
She stated it was not until she was reviewing the template and the initial allegation report on 06/16/24 when she realized she should notify law enforcement and APS and on 06/16/24 she notified both.
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
because they had never heard of it.
She stated she spoke to the current Wound Care Physician on
ordering the boot.
An interview with the current Director of Nursing via phone on 06/26/24 at 3:10 PM revealed she had started on 06/19/24 and it was brought to her attention on 06/25/24 from the Nursing Supervisor that Resident #50 needed the hind off-loading boot.
The DON stated it should have been ordered by the previous DON.
She added, she ordered the hind off-loading boot today and it will be in the facility on 06/28/24.
A phone interview with the current Wound Care Physician on 06/27/24 at 9:30 AM revealed she had been attending the facility since 06/14/24 and she did mention to the Wound Treatment Nurse that the hind off loading boot should be ordered for Resident #50.
She stated it was not a unique type of boot or difficult to find and she could not speak to as to why it took so long for the boot get ordered.
The Wound Care Physician stated she sent a link to the Nursing Supervisor of where to purchase the boot.
She added, not having the boot would not contribute to the wound worsening, it was ordered as a protective device.
She stated despite the resident not having the boot for the past month, his wound was healing but it should be ordered and utilized to add that extra protection.
Additionally, the Wound Care Physician stated Resident #50's wound dressing was ordered daily and she would expect the dressing to get changed daily for continued wound healing.
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
no documenation about Resident #119's coccyx ulcer from admission [DATE] through discharge on
An interview was conducted on 06/12/24 at 3:45 PM with Unit Manager #2 (previous treatment
should have reported Resident #119's sacral pressure ulcer to her for evaluation and possible treatment which she did not.
An interview was conducted on 06/13/24 at 10:50 AM with the Administrator.
She said it was her expectation that Resident #119's admission coccyx pressure ulcer should have been identified, treated, and tracked more closely by nursing staff.
An interview was conducted on 06/14/24 at 10:20AM with the Nurse Practitioner (NP).
She stated it was her expectation that on 04/05/24 the day nurse assigned to Resident #119 should have reported the coccyx pressure ulcer to the wound treatment nurse that same morning it was reported to her and did not.
The NP said all nursing staff are responsible for reporting all wounds timely to the treatment nurse so she can obtain appropriate orders and start treatment. NP stated it was important to her and the treatment nurse to know what wounds were in the facility and what treatments were being utilized, which had not happened in this case.
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
was the nurse assigned to the 100 hall on 05/17/24 where Resident #50 resided.
She stated Resident
stated she had learned from NA #8 that she and Nurse #7 left the building to go to the store, but it
#50 was in the shower or that they were going to the store.
Nurse #9 stated she did not recall hearing the call light going off.
An interview was conducted with NA #4 via phone on 06/18/24 at 10:39 AM. NA #4 reported she had worked at the facility as agency nurse aide for about 8 weeks.
She stated she was assigned to Resident #50 on the 100 hall on 05/17/24. NA #4 reported she did not what had actually happened on 05/17/24 but was told someone put Resident #50 in the shower, but they did not inform her or NA #5 who was also assigned to Resident #50. NA #4 reported Resident #50 and Nurse #9 approached her and NA #5 while they were doing resident care for another resident and Resident #50 was yelling at us for leaving him in the shower, but they had no idea he was even in the shower and did not hear the call light because they were in another room down another hall. NA #4 stated whenever she gave Resident #50 a shower, she would assist him getting undressed, removing his prosthetic, and transferring him from the wheelchair to the shower chair.
She stated she would provide privacy while he would bathe himself, but that in order to provide safety for the resident, she would not leave the shower area and leave the resident unattended.
She stated no resident should be left in the shower area alone because they could fall and hurt themselves.
An interview was conducted with the Director of Nursing (DON) on 06/14/24 at 11:00 AM.
The DON reported that a nursing staff member should always be with a resident whenever they were getting a shower.
The DON stated she did not know NA #8 and Nurse #7 left the building and it was not okay for them to leave without telling anyone.
She stated her expectation of nursing staff was that residents should not be left in the shower alone because of the potential for an accident.
The DON added Resident #50 had a mobility risk due to his impairment and he required supervision while in the shower.
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changes without obtaining weekly weights as ordered.
The RD stated she was aware the weekly
An interview was conducted with Nurse #7 on 06/13/24 at 11:45 AM.
Nurse #7 reported the nurse
electronic medical record.
She stated she was not aware Resident #52 had an order for weekly weights because nothing populated in the electronic medical record to notify her that a weekly weight was needed.
She stated any newly admitted residents should have weekly weights for one month and then changed to monthly thereafter.
An interview was conducted with Nurse Aide (NA) #8 on 06/14/24 at 1:11 PM. NA #8 reported she was usually given a list at the beginning of the month of residents who needed a monthly weight. NA #8 added, if a nurse needed a weekly or daily weight she would let her know. NA #8 stated she had not been told to obtain Resident #52's weight and had not received a list of residents who needed monthly weights as of this time.
She stated when the weights were obtained she would give them to the assigned Nurse and she believed they would enter them in the electronic medical record.
An interview was conducted with Unit Manager (UM) #2 on 06/14/24 at 2:00 PM. UM #2 stated she was responsible for ensuring the weekly and monthly weights were obtained.
She stated with new admissions, part of the admission process was to initiate batch orders for weekly weights.
She stated the order for the weekly weights that she entered into the electronic record was not entered correctly to populate to the medication administration record to alert nursing staff that a weight was due. UM #2 added due to this error, the weekly weight order also did not populate on to her weekly weight report so she was not aware that Resident #52 needed weekly weights for 3 weeks and that was why they were not done.
An interview was conducted with the Director of Nursing (DON) on 06/14/24 at 4:10 PM.
The DON stated weights were not obtained timely and accurately.
The DON stated she was hired through an agency a few months ago and had not implemented a process for obtaining weights yet but indicated it was an important part of the resident's care and was necessary to evaluate the resident's condition.
An interview was conducted with the Facility Physician on 06/18/24 at 1:24 PM.
The Facility Physician stated she started in the position on 06/07/24 and indicated monitoring of weights was the facility's responsibility and was important to evaluate the resident's nutritional status.
The Facility Physician further stated weights were to be obtained as ordered.
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
had increased pain, trouble sleeping, was anxious, irritable, nauseous and unable to get up out of bed
jeopardy to resident health or stated it was horrible and the staff told her she would just have to wait it out until the medication safety came in.
stated she was familiar with Resident #46. NA #1 stated Resident #46 complained of pain at times, but this was not common for her.
An interview was conducted via phone with NA #9 on 6/27/24 at 4:40 PM. NA #9 stated Resident # 46 was pleasant, quiet and did not usually complain of pain. NA #9 stated Resident #46's normal routine was to get up out of bed to the wheelchair and attend activities daily.
An interview was conducted via phone with Nurse #5 on 6/27/24 at 6:44 PM.
Nurse #5 stated she was aware that suddenly stopping gabapentin could lead to withdrawal symptoms including insomnia, nausea, tremors and anxiety.
Nurse #5 stated the symptoms Resident #46 reported could have been withdrawal symptoms. <b[TRUNCATED]
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
not being available.
jeopardy to resident health or An interview was conducted with Nurse #5 on 6/14/24 at 9:00 AM.
Nurse #5 stated there was a safety problem with running out of medications and medications not being available.
Nurse #5 stated she used the computer to reorder medications, but they frequently did not come in and she did not know
pharmacy.
Nurse #5 stated she did not know if a written or electric prescription was needed to reorder gabapentin.
Nurse #5 stated she was assigned to Resident #46 on 5/17/24 for the 7:00 AM to 7:00 PM shift.
Nurse #5 stated she did not administer the scheduled gabapentin on 5/17/24 at 9:00 AM, did not call the pharmacy to obtain the medication and observed Resident #46 to have increased pain which was abnormal for the resident.
Nurse #5 stated she the medication was on order, so she did not attempt to obtain it.
An
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
board with the new Homework check list she had instituted for reviewing new orders.
jeopardy to resident health or In an interview with Pharmacy Tech #1 on 09/13/24 at 9:15 AM she stated the pharmacy had only safety received the orders for Resident #39 through the computer system and had not received a copy of the hospital discharge summary. If the pharmacy received a discharge summary for a new admission the
any differences the facility
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Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
During a meeting with the Infection Preventionist (IP) on 6/14/24 at 3:49 pm she stated she started this position on 5/06/24 and was still in orientation.
She was unable to provide any documentation of tracking or surveillance of infections, infection risks for the facility from May 2023 through May 2024.
The IP provided a binder with monthly computer printouts of infections in the facility from January 2024 through June 18, 2024.
During an interview with the Director of Nursing (DON) on 6/12/24 at 11:00 am she stated she began her position as DON on 3/25/24 and was not responsible for infection control.
An interview with the Administrator on 6/14/24 at 4:00 pm revealed she had been the Administrator since 2/02/24 and was Statewide Program for Infection and Epidemiology (SPICE) certified.
The Administrator stated the IP had not been monitoring or tracking the infections within the facility.
She indicated she was helping the IP who was trying to get infection control in order.
The Administrator further stated the facility should have been monitoring and tracking infections.
F-F580: Based on record review, and staff, resident, and Physician interviews, the facility failed to notify the physician that the scheduled medication gabapentin, a medication ordered for nerve pain that is not to be
jeopardy to resident health or times daily for nerve pain. Resident #51 missed a total of 21 doses of the medication from 5/8/24 through safety 5/13/24 and had complaints of constant pain up to a 10 (on a scale of 0 to 10 with the 10 being the worst pain possible), numbness in her legs, and spasms and the physician was not notified of this. Resident #46
Resident #46 missed 14 doses of the medication from 5/10/24 through 5/17/24 resulting in trouble sleeping, anxiety, irritability, nausea, and being unable to complete her normal routine due to pain in her legs.
Additionally, the facility failed to notify the physician that 14 doses of the antibiotic Amoxicillin 875 mg was administered to Resident #39 instead of the antibiotic Augmentin (Amoxicillin-Clavulanate 875 mg-125 mg) that was ordered by the physician on discharge from the hospital.
This deficient practice affected 3 of 10 residents reviewed for notification.
F-F697: Based on record review, staff, resident, Consultant Pharmacist, and Physician interview, the facility failed to provide effective pain management and manage symptoms of withdraw for 2 of 10 residents (Resident #51 and Resident #46) reviewed for pain management. Resident #51 was prescribed gabapentin 800 milligrams (mg) four times daily for nerve pain.
The medication was not available to administer and resulted in a total of 21 doses of the prescribed medication not administered from 5/8/24 through 5/13/24. Resident #51 had complaints of constant pain at up to a 10 (on a scale of 0 to 10 with the 10 being the worst pain possible), numbness in her legs, and spasms.
She was transferred to the Emergency Department (ED) per her request on 5/12/24 in the middle of the night where she was treated for acute pain with gabapentin and returned to the facility the same day. Resident #51 missed 3 more doses of gabapentin on 5/12/24 and returned to the ED that evening per her request for worsening muscle spasms.
She was again treated for acute pain with gabapentin and returned to the facility where she proceeded to miss 4 more doses of the medication prior to the facility obtaining the medication for administration. Resident #46 was prescribed gabapentin 800 mg two times daily for nerve pain.
The medication was not available to administer on 5/10/24 and Resident #46 missed 14 doses of the medication from 5/10/24 through 5/17/24 resulting in increased pain at a sustained 8-9 pain level, trouble sleeping, anxiety, irritability, nausea, and being unable to complete her normal routine due to pain in her legs.
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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 345185 B.
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NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
F-F755: Based on record review, staff, resident, Consultant Pharmacist, Pharmacy Quality Assurance Specialist, and Physician interview, the facility failed to ensure scheduled medication was obtained and
jeopardy to resident health or medications. Resident #51 was prescribed gabapentin 800 milligrams (mg) four times daily for nerve pain. safety The medication was not obtained from the pharmacy and Resident #51 missed a total of 21 doses of the medication from 5/8/24 through 5/13/24. Resident #51 had complaints of constant pain up to a 10 (on a scale
transferred to the Emergency Department (ED) on 5/12/24 in the middle of the night after missing 14 doses of the medication.
She was treated for acute pain with gabapentin and returned to the facility the same day. Resident #51 missed 3 more doses of gabapentin on 5/12/24 and returned to the ED that evening for worsening muscle spasms.
She was again treated for acute pain with gabapentin and returned to the facility where she proceeded to miss 4 more doses of the medication prior to the facility obtaining the medication for administration. Resident #46 was prescribed gabapentin 800 mg two times daily for nerve pain.
The medication was not obtained from the pharmacy and Resident #46 missed 14 doses of the medication from 5/10/24 through 5/17/24 resulting in trouble sleeping, anxiety, irritability, nausea, and being unable to complete her normal routine due to pain in her legs.
Additionally, Resident #8 was prescribed Oxycodone/Acetaminophen (opioid medication) 10/325 mg and this medication was not obtained from the pharmacy resulting in multiple missed doses of the medication.
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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 345185 B.
Wing 07/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
Findings included:
Review of the facility provided initial allegation report dated 06/14/24 regarding Residents #46, #51, #269, and #419 revealed no documentation of APS being notified and no record of law enforcement notification.
During an annual recertification survey and complaint investigation, the facility was officially notified of neglect on 06/13/24 at 2:15 PM and an immediate jeopardy template was issued to the Administrator.
The immediate jeopardy template was signed by the Administrator and the Administrator was verbally informed of the information regarding the situation involving neglect.
Review of the state agency records revealed the facility submitted an initial report to the State Agency within the required time frame following the notification of neglect, however documentation supported that the facility did not notify law enforcement or APS until 06/16/24.
During a phone interview with the facility Administrator on 06/17/24 at 4:30 PM, she stated she submitted an initial allegation report to the State Agency regarding the neglect information provided on the template which she had received on 06/13/24.
She stated since the neglect was identified by the state surveying staff and she received a template for the immediate jeopardy she was confused as to whether or not she would still have to notify APS and law enforcement.
She stated it was not until she was reviewing the template and the initial allegation report on 06/16/24 when she realized she should notify law enforcement and APS and on 06/16/24 she notified both.
345185
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 345185 B.
Wing 07/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Premier Living and Rehab Center 106 Cameron Street Lake Waccamaw, NC 28450
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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.