Somerset Court of Goldsboro

The facility failed to respond immediately to a resident who was discovered unresponsive without a pulse. Despite the resident having a full code status, staff failed to administer cardiopulmonary resuscitation (CPR) as required by facility policy.

The facility failed to respond immediately to a resident who was discovered unresponsive without a pulse. Despite the resident having a full code status, staff failed to administer cardiopulmonary resuscitation (CPR) as required by facility policy.

The facility failed to ensure that three out of seven exit doors accessible to residents with known disorientation or wandering behaviors were equipped with audible sounding devices. Specifically, no alarms were heard when the front exterior/interior doors and the side doors on the 100 and 200 halls were opened. This lack of notification poses a risk to residents, such as Resident #2, who has a history of elopement.

The facility failed to ensure that three out of seven exit doors accessible to residents with known disorientation and wandering behaviors were equipped with audible sounding devices. Specifically, no alarms were heard when the front exterior/interior doors or the side doors on the 100 and 200 halls were opened.

The facility failed to administer medications as ordered for 2 of 5 sampled residents, including errors with insulin and the administration of discontinued medications. Additionally, there were delays in administering antibiotics and certain medications, as well as instances where necessary medications were not available at the facility.

The facility failed to ensure that medication preparation and administration by staff were according to physician orders, facility policies, and state rules. Specifically, the facility failed to maintain adequate medication on hand for residents, as evidenced by a continuing Type B violation.

The facility failed to administer medications as ordered for two residents, including errors with insulin and the administration of discontinued medications. Additionally, there were delays in administering antibiotics and medications for high potassium levels, as well as a lack of availability for several other prescribed medications.

The facility failed to ensure the implementation of physician orders for several residents. Specifically, staff did not follow protocols for notifying primary care providers regarding blood sugars or blood pressures outside of ordered parameters, and failed to perform ordered checks for pulse and oxygen levels.

The facility failed to ensure the implementation of physician's orders for 2 of 5 sampled residents. Specifically, the facility did not follow orders for monthly vital signs, monthly blood pressures, and daily weights, nor did they notify the primary care provider of blood sugars outside of ordered parameters.