Carlyle Senior Care Of Florence

F-F223 for abuse, which is no longer the federal regulation for abuse. The goal was there would be no abuse in the facility. There was no documentation to go along with this PIP. When the Administrator was questioned on the effectiveness of this PIP, he stated Our goal is to have zero abuse. When asked if he feels that this PIP is achievable, he did not reply. The survey team entered the facility with three abuse complaints that were all substantiated. Three weeks prior,

the State Agency (SA) investigated several abuse complaints. The PIP did not contain a summary, how this was identified to QAPI, a sub-committee, or a summary and analysis of the process. When the Administrator was asked if he understood the purpose of QAPI and an annual PIP, he stated Yes.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 12 425163 Department of Health & Human Services Printed: 09/03/2025 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 425163 B. Wing 03/27/2025

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

Carlyle Senior Care of Florence 133 West Clarke Road Florence, SC 29501

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 0881 Implement a program that monitors antibiotic use.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 43050 potential for actual harm Based on review of the facility policy, record review and interviews, the facility failed to monitor and evaluate Residents Affected - Some antibiotic usage for four of five residents (Resident (R) 24, Resident R81, Resident R55, and Resident R15) reviewed for antibiotic usage out of 28 sample residents. This failure had the potential to affect residents' safety related to antibiotic usage.

Findings include:

Review of the facility's policy titled, Antibiotic Stewardship Program dated 09/30/24 revealed, It is the policy of this facility to implement an Antibiotic Stewardship Program as part of the facility's overall infection prevention and control program. The purpose of this program is to optimize the treatment of infections while reducing the adverse events associated with antibiotic use .Antibiotic orders obtained from consulting, specialty, or emergency providers shall be reviewed for appropriateness .Random audits of antibiotic prescriptions shall be performed to verify completeness and appropriateness (process measure) .

1. Review of Resident R24's Admission Record located under the Profile tab of the electronic medical record (EMR) revealed Resident R24 was admitted to the facility on [DATE REDACTED]. Resident R24 was sent to the emergency room (ER) on 02/18/25 for an indwelling urinary catheter. A urine analysis (UA) was completed, and an antibiotic was started. Resident R24 returned to the facility and completed the antibiotic. A culture was not done by the ER and the Infection Preventionist (IP) did not question the antibiotic.

2. Review of Resident R81's Admission Record located under the Profile tab of the EMR revealed Resident R81 was admitted to the facility on [DATE REDACTED]. Resident R81 was sent to theER on [DATE REDACTED] for urinary retention, was catheterized, and came back to the facility on an antibiotic. No UA or culture was completed.

3. Review of Resident R55's Admission Record located under the Profile tab of the EMR revealed Resident R55 was admitted to the facility on [DATE REDACTED]. Resident R55 was sent on 03/04/25 to the ER for a change in condition and came back to the facility on an antibiotic. A UA was completed by the ER; however, a culture was not ordered to be completed.

4. Review of Resident R15's Admission Record located under the Profile tab of the EMR revealed Resident R15 was admitted to the facility on [DATE REDACTED]. Resident R15 has a Stage IV pressure ulcer to the sacrum. The Wound Doctor was alerted to

an odor coming from the sacrum and ordered an antibiotic (Doxycycline) for 14 days. No culture was order by the provider to determine if antibiotic was needed or appropriate.

During an interview on 03/25/25 at 12:43 PM, Licensed Practical Nurse (LPN9) revealed, I noticed a foul odor coming from the sacrum with drainage. I notified the wound doctor, and he came and evaluated the resident. A culture was not completed on the wound. Doxycycline was ordered for 14 days. I informed the IP that an antibiotic was started.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 12 425163 Department of Health & Human Services Printed: 09/03/2025 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 425163 B. Wing 03/27/2025

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

Carlyle Senior Care of Florence 133 West Clarke Road Florence, SC 29501

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 0881 During an interview on 03/27/25 at 2:45 PM, the IP stated, I told LPN9 and the wound doctor that a culture should have been done on Resident R15. The wound doctor usually does a culture, but for some reason, did not do Level of Harm - Minimal harm or one on this resident. I have learned that I must get cultures from the hospital to see if a resident did have a potential for actual harm Urinary Tract Infection (UTI) and that they are on the correct antibiotic. If I do not have a culture, I will call the hospital to get one. Residents Affected - Some

During an interview on 03/27/25 at 3:43 PM, the wound doctor revealed, I normally do a culture. I am not sure why I did not do one. I understand that a culture should always be completed before an antibiotic is given.

During an interview on 03/27/25 at 6:53 PM, the Administrator revealed, My expectation for antibiotic stewardship is to follow the Centers for Medicare and Medicaid Services (CMS) guidelines.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 12 425163