Team Advocacy Inspection for July 22, 2015 Antonio-Staples Residential Care Facility Inspection conducted by Nicole Davis, P&A Team Advocate, and Cosandra Moten, Volunteer Facility Information Antonio-Staples Residential Care Facility is located in Dorchester County at 10745 Highway 78 E, Summerville, SC 29483-8710. Team arrived at the facility at 11:05 AM and exited the facility at 2:20 PM. The administrator was present for the inspection. The facility is operated by Ermelinda Staples. There were two staff members present when Team arrived. The facility is licensed for 24 beds. The census was 16 with 13 residents being present on the day of Team s inspection. The DHEC license had an expiration date of March 31, 2015. An administrator s license was current and posted. The facility had a written emergency plan to evacuate to Summerville Church of the Nazarene, 10825 Highway 78 E, Summerville, SC 29483. Overview of Visit During Team s visit we interviewed six residents; talked to residents and staff; reviewed six resident records, medications and medication administration records; and toured the facility. Lunch consisted of red rice & sausage, mixed vegetables, a slice of bread and watermelon. Team conducted a brief exit interview with the administrator. Report Summary The water fire extinguisher in the hallway was slightly undercharged. The most recent TB risk assessment was completed 6/24/14. There was an infestation of bed bugs. Some residents did not have beds in their rooms. During the inspection Team observed the administrator and a staff member wrapping and taping a mattress in plastic, returning it to a resident s room. The sharps container was overflowing and the needles were exposed. One resident reported staff yells at us. An activity calendar was not posted. One resident only Page 1 of 6
had one pair of shoes. Another resident needed a haircut. One resident s hair was dirty and needed a haircut. One resident reported needing an identification card to handle personal affairs. Resident C had a prescription for Diphenhydramine 25 mg capsule, take one capsule by mouth daily as needed. The medication was not available. Resident D had prescriptions for Prazosin 2 mg capsule, take one capsule by mouth at bedtime and Prazosin 5 mg capsule, take one capsule by mouth at bedtime. The medications were not available. The MAR noted the medications have been out for the entire month of July. Resident E had prescriptions for Zonisamide 100 mg capsule, take three capsules by mouth twice daily and Omeprazole DR 40 mg capsule, take one capsule by mouth every morning. The medications were not available. The MAR was last signed for administration on the morning of Team s inspection. Resident F had a prescription for Risperidone 3 mg tablet, take two tablets by mouth at bedtime. The medication was not available. The MAR was last signed for administration on the evening of 7/21/15. After Team s arrival, a menu was posted for the day of Team s visit only. Several items in the refrigerator and cabinets were not properly labeled and sealed. Two opened jars of jelly and an opened salad dressing was in the pantry although the bottles stated refrigerate after opening. Several snack items had expiration dates of 4/6/15, 5/24/15 and 6/15/15. Residents reported not being able to get seconds. Resident A s most recent physical examination dated 8/14/14 had unsure written next to whether the resident could self-administer medication, unsure written next to whether the resident requires the daily care of a nurse and there was no response next to whether the resident could be cared for at this type of facility. Resident B s most recent physical examination dated 6/10/15 had unsure written next to whether the resident was incontinent, if the resident has the physical ability to engage in exercise and whether the resident requires the daily care of a nurse. Resident C s most recent individual care plan dated 2/18/15 did not address his dietary needs. Resident C s most recent physical examination available was dated 3/6/13. Resident D s most recent physical examination dated 11/8/14 did not include a response on whether the resident could be cared for at this type of facility. Resident D s most recent individual care plan was dated 10/30/14. Documentation of the admission TB test for Resident A and Resident F was unavailable. Resident B s personal funds ledger was not signed for July and the ledger did not include the day the transaction occurred, only the month and year. Resident D s personal funds ledger was not signed for a 6/3/15 transaction. A savings bond and $15 were stored in a loose, open folder. The window in the medication room was off track. The flooring in the laundry room was missing in several places and contained water damage. Several windows in the front of the facility were broken or had holes in them. A part of the front porch was scorched and the ceiling was missing boards. Several rooms had a black substance and spider webs in the corners of the ceilings. Several bathrooms had strong urine smells and needed to be cleaned, including shower chairs and bath mats. Several bedrooms had broken dresser drawers and broken handles. Baseboards throughout the facility were discolored and dirty. On the front porch, several bars on the handrail were only secured at one end. In the backyard, six mattresses and one chair were propped against the fence surrounding the garbage cans. In one bathroom, the flooring was soft, cracked and sunk when stepped on. A resident complained of having roaches in my drawer sometimes. The support bar of a bench on the back porch was broken in half. In one sitting room chairs and cushions were stacked on one another, unable to be used. Page 2 of 6
Areas of Commendation The facility has a front and back porch for residents to utilize. There was a television, couches and a bookstand with several board games and books. There was an adequate supply of food present. The water temperatures were in the appropriate ranges. A current electrical, HVAC and fire alarm inspection was available for review. Emergency evacuation routes were posted throughout the facility. Fire extinguishers were monitored monthly. Fire drills were completed monthly, on different shifts. Two residents played Bingo while Team was present. Areas Needing Improvement Health/Safety The water fire extinguisher in the hallway was slightly undercharged. The most recent TB risk assessment was completed 6/24/14. There was an infestation of bed bugs. Some residents did not have beds in their rooms. During the inspection Team observed the administrator and a staff member wrapping and taping a mattress in plastic, returning it to a resident s room. [Note: The administrator reported she had taken some mattresses outside and was treating the mattresses with Raid Bed Bug and Flea Killer.] The sharps container was overflowing and the needles were exposed. Supervision & Administrator No concerns noted. Residents Rights One resident reported staff yells at us. Recreation An activity calendar was not posted. Residents would like to do more in the community. Residents reported they have to walk to activities since the facility does not have a vehicle. Residents Activities of Daily Living (ADLs) One resident only had one pair of shoes. Another resident needed a haircut. One resident s hair was dirty and needed a haircut. One resident reported needing an identification card to handle personal affairs. Page 3 of 6
Medication Storage and Administration Resident C had a prescription for Diphenhydramine 25 mg capsule, take one capsule by mouth daily as needed. The medication was not available. Resident D had prescriptions for Prazosin 2 mg capsule, take one capsule by mouth at bedtime and Prazosin 5 mg capsule, take one capsule by mouth at bedtime. The medications were not available. The MAR noted the medications have been out for the entire month of July. Resident E had prescriptions for Zonisamide 100 mg capsule, take three capsules by mouth twice daily and Omeprazole DR 40 mg capsule, take one capsule by mouth every morning. The medications were not available. The MAR was last signed for administration on the morning of Team s inspection. Resident F had a prescription for Risperidone 3 mg tablet, take two tablets by mouth at bedtime. The medication was not available. The MAR was last signed for administration on the evening of 7/21/15. Meals & Food Storage After Team s arrival, a menu was posted for the day of Team s visit only. Several items in the refrigerator and cabinets were not properly labeled and sealed. Two opened jars of jelly and an opened salad dressing was in the pantry although the bottles stated refrigerate after opening. [Note: The administrator reported she was in the process of putting the items up when Team arrived.] Several snack items had expiration dates of 4/6/15, 5/24/15 and 6/15/15. [Note: The administrator reported the items belonged to the residents.] Residents reported not being able to get seconds. Team observed one resident ask for more watermelon. Staff responded with she had to ask the administrator. Other residents asked for more red rice and bread. Both were told there wasn t any more of either. Team observed bread in the refrigerator. Three residents reported the facility did not accommodate their high sugar diet. Resident Records Resident A s most recent physical examination dated 8/14/14 had unsure written next to whether the resident could self-administer medication, unsure written next to whether the resident requires the daily care of a nurse and there was no response next to whether the resident could be cared for at this type of facility. Resident B s most recent physical examination dated 6/10/15 had unsure written next to whether the resident was incontinent, if the resident has the physical ability to engage in exercise and whether the resident requires the daily care of a nurse. Resident C s most recent individual care plan dated 2/18/15 did not address his dietary needs. Resident C s most recent physical examination available was dated 3/6/13. Resident D s most recent physical examination dated 11/8/14 did not include a response on whether the resident could be cared for at this type of facility. Resident D s most recent individual care plan was dated 10/30/14. Page 4 of 6
Documentation of the admission TB test for Resident A and Resident F was unavailable. [Note: The residents have had been at the facility since 2005.] Resident Personal Needs Allowances Resident B s personal funds ledger was not signed for July and the ledger did not include the day the transaction occurred, only the month and year. Resident D s personal funds ledger was not signed for a 6/3/15 transaction. A savings bond and $15 were stored in a loose, open folder. Appropriateness of Placement No concerns noted. Personnel Records Two staff records reviewed did not have SLED background checks. One of the staff members did not have documentation of any training, a health assessment or TB test and was working with the residents. [Note: The administrated reported the staff was new and that she could not receive the documentation until the staff completed her second TB test.] The other staff member did not have documentation of First Aid training. Housekeeping, Maintenance, Furnishings The window in the medication room was off track. The flooring in the laundry room was missing in several places and contained water damage. [Note: Staff reported the laundry room had recently flooded.] Several windows in the front of the facility were broken or had holes in them. A part of the front porch was scorched and the ceiling was missing boards. [Note: The administrator reported a cigarette butt was not properly extinguished and caught a paper on fire in the trash can. She reported she is waiting on the insurance company so that she could get the porch repaired.] Several rooms had a black substance and spider webs in the corners of the ceilings. Several bathrooms had strong urine smells and needed to be cleaned, including shower chairs and bath mats. [Note: Staff begun cleaning during Team s inspection.] Several bedrooms had broken dresser drawers and broken handles. Baseboards throughout the facility were discolored and dirty. Some were rotted in different places. On the front porch, several bars on the handrail were only secured at one end. In the backyard, six mattresses and one chair were propped against the fence surrounding the garbage cans. In one bathroom, the flooring was soft, cracked and sunk when stepped on. One of the dining room tables was very wobbly. A resident complained of having roaches in my drawer sometimes. Page 5 of 6
The support bar of a bench on the back porch was broken in half. In one sitting room chairs and cushions were stacked on one another, unable to be used. Additional Recommendations Three residents would like to move. One resident would like to work. Residents would like to play checkers. Please Note: Residents listed in the report are assigned random gender identification. This is for the purpose of making the report easier to read. However, the gender does not identify the individuals in the report. Page 6 of 6