Lawndale Manor

The facility failed to ensure all exit door locks were easily operable by a single hand motion from the inside without keys. Observations in the theater room revealed a plastic object wedged in the door handles preventing easy operation, a missing door closer, and an exit door that could be pushed open without using the push bar. Additionally, staff reported using the metal rods to manually pull doors closed and noted that the theater room entrance door could not be locked.

The facility failed to ensure that the electrically operated call system for 43 residents met required standards. Specifically, call bells in some rooms could not be activated with a single action, were not within reach of the resident's bed, and failed to provide audible and visual signals accessible to staff.

The facility failed to ensure that the electrically operated call bell system for 43 residents was functional and met required standards. Specifically, call bells in several rooms could not be activated with a single action, were not within reach of residents, and failed to provide audible or visual signals at the nurse's station or above resident doors.

The facility failed to ensure that one of three sampled medication aides had completed the required state-approved 5, 10, or 15-hour medication aide training courses. Additionally, the staff member was observed making medication errors and using improper insulin administration techniques during a medication pass.

The facility failed to provide adequate supervision for one of five sampled residents. This resident experienced 18 falls within a 7-month period, resulting in injuries that required emergency room evaluation and treatment.

The facility failed to ensure that one of three sampled staff members who administered medications had completed the required state-approved 5-hour, 10-hour, or 15-hour medication aide training courses. Additionally, during an observation of a medication pass, the staff member committed two medication errors and failed to use proper technique when administering insulin.

The facility failed to implement CDC and NC DHHS guidance regarding COVID-19 screening for residents. Specifically, there was no documentation of daily temperature checks or symptom monitoring in medication administration records, and temperature logs had not been updated since July 2021.

The facility failed to ensure that 2-step tuberculosis (TB) testing was completed upon admission for 2 of 5 sampled residents. Specifically, for Resident #1, there was documentation of a first TB test but no evidence that the required second step was administered or screened for during admission.