Accura Healthcare of O'Neill

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09Based on record review and interview; the facility failed to implement physicians' orders for Residents 3, 4,12, and 50. The sample size was 12 and the facility census was 45.

Inspectors wroteLicense Reference Number 175 NAC 12-006.09(J)(i)(1)Based on observation, record review and interview; the facility failed to implement nutrition measures to prevent ongoing weight loss for Residents 1 and 14. The sample size was 3 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(I)Based on record review and interview; the facility failed to ensure the Quality Assurance Performance Improvement (QAPI) plan was effective in addressing recently identified deficient practice and preventing repeat deficient practice with similar concerns. This had the potential to affect all facility residents. The facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(E)Based on record review and interview; the facility failed to obtain the required comprehensive (including an appropriate diagnosis for use, potential affects, adverse effects and alternate treatment options) informed consent for the use of psychotropic (substance that affects how the brain works, altering a person's mood, thoughts, feelings, or behavior) medications for Residents 2, 3, 4, 14, and 29. The sample size was 5 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12 (D)(i)Based on observation, record review and interview; the facility failed to provide safe storage of drugs as: 1) Medications were left on top of the medication cart and unattended, 2) The medication cart was left unlocked with no staff in attendance. This had the potential to affect any mobile resident passing by the medication cart. The facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 006.11 (E)Based on observation, record review and interview; the facility staff failed to store, prepare and serve food in a manner to prevent the potential for cross contamination and/or food borne illness. These practices had the potential to affect all residents who were served meals from the kitchen. The facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09.18Based on observations, interview, and record review the facility failed to ensure the facility infection control program was implemented including the use of Enhanced Barrier Precautions ((EBP) -infection control measure in which the use of Personal Protective Equipment (PPE)-specialized gear, clothing, or barrier worn by individuals to protect themselves from hazards such as infection and prevent the spread of infection to others) and Hand Hygiene during the provision of care for Residents 1,4,2,7, and 12. The sample size was 12 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18 Based on record review and interview; the facility failed to implement their Antibiotic Stewardship Plan to ensure antibiotics had a defined duration of use to prevent potential adverse consequences for Residents 28, 29, and 48. The sample size was 12 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on record review and interview; the facility failed to report the potential neglect of Resident 12 (not receiving laboratory work as ordered and IV (Intravenous-administered through an intravenous (placed in a vein) catheter (fluids or medications)) to the State Agency as required. The sample size was 12 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09ABased on record review and interview; the facility failed to complete an updated Preadmission Screening and Resident Review (PASRR-federally mandated screen used to ensure persons with SMI (Serious Mental Illness), DD (Developmental Disability), or Related Conditions (RC) are appropriately placed in facilities that are able to provide needed specialized services) when Resident 5 was diagnosed with Bipolar Disorder and Schizophrenia. The sample size was 12 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(E)Based on record review and interview; the facility failed to develop and implement and/or review and revise a Comprehensive Care Plan for resident 7's Enhanced Barrier Precautions. The sample size was 3 and the facility census was 45.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09(H)(iv)(1)Based on observations, record review, and interview; the facility failed to provide appropriate care and services for the management of Resident 4's indwelling urinary catheter (a flexible plastic tube inserted into the bladder that remains there to provide continuous urinary drainage) to prevent the potential for infections. The sample size was 3 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05Based on record review and interview; the facility failed to complete Gradual Dose reductions or have documented contraindications for Resident 3's antidepressant. The sample size was 5 and the facility census was 45.

Inspectors wroteBased on observation, record review and interview; the facility failed to administer immunizations as requested to 1 of 5 sampled residents. The facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G)Based on record review and interview; the facility failed to complete gradual dose reductions or have documented contraindications for antipsychotic medications for Residents 3 and 4. The sample size was 5 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04A3b Based on record review and interview, the facility failed to ensure background checks through the State Nurse Aide registry were completed on 2 of 5 sampled employees. The facility census was 45 with a total sample size of 25.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H). Based on observation, interview and record review the facility staff failed to report an elopement to the State Agency within the required timeframes for 1(Resident 1) of 3 residents sampled. The facility census was 46.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18 Based on record review and interview; the facility failed to implement an Antibiotic Stewardship (coordinated plan aimed at optimizing antibiotic use to prevent resistance, unnecessary exposure, and adverse outcomes) Plan to identify if the facility use of antibiotic was within the criteria defined to prevent the overuse or unnecessary use, of antibiotics and/or to prevent potential adverse outcomes. This had the potential to affect all residents residing within the facility. The facility census was 45.

Inspectors wroteB. A record review of the Unavailable Medications Policy dated September 2024 revealed the facility was to utilize uniform guidelines for unavailable medications. The following guidelines were identified; -the facility was to maintain a contract with a pharmacy provider to supply the facility with routine, as needed and emergency medications. -a supply of commonly used medications was to be maintained in-house for the timely initiation of medications. -staff were to take immediate action when it was known a medication was not available: 1) determine the reason for unavailability, length of time the medication was unavailable and what efforts had been attempted by the facility or the pharmacy provider to obtain the medication; 2) notify the physician of inability to obtain medication upon notification or awareness that medications were not available. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I) Based on observations, record review and interviews; the facility failed to assure a safe environment as the staff failed to 1) utilize safe transfer techniques with use of the mechanical lift to prevent potential accidents for Resident 31; 2) revise current interventions or develop new interventions to prevent ongoing falls for Resident 5; and 3) implement assessed fall interventions for Residents 29, 34 and 40. The sample size was 8 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(A) Based on record reviews and interviews, the facility failed to address gradual dose reductions (GDR, stepwise tapering of a dose to determine whether or not symptoms, conditions, or risks can be managed by a lower dose or whether or not the dose or medication can be discontinued) in a timely manner for Residents 31 and 14; and to document a clinical rationale as to why GDRs were not attempted for Residents 5, 14, and 31. The sample size was 5 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(D)(vi) Based on observation, interview and record review, the facility failed to ensure insulin pens for 4 (Residents 5, 8, 10, and 14) of 6 sampled residents were dated when opened to ensure the insulin was not given beyond the recommended effective date. The facility census was 45.

Inspectors wroteE. A record review of the facility policy Enhanced Barrier Precautions (EBP) dated September 2024 revealed the following: -an order would be obtained for enhanced barrier precautions wound be obtained for residents with wounds or an indwelling medical device (urinary catheters/feeding tubes) or if they had an infection or colonization with a Center's for Disease Control (CDC) targeted Multi-Drug-Resistant Organism (MDRO) when contact precautions did not otherwise apply, -gloves and gowns would be available near or outside the resident room, -Personal Protective Equipment (PPE) for EBP was only necessary when performing high-contact care activities, -PPE would be discarded prior to exit of the room, -high-contact resident care activities included: [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(S) Based on observation, record review, and interview; the facility failed to ensure a privacy bag was utilized for a catheter bag to promote dignity for Resident 5. The sample size was 1 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5) Based on record reviews and interviews, the facility failed to; notify Resident 23's practitioner of the unavailability of an anticoagulant medication and to notify Resident 33's practitioner of the resident's non-compliance with fluid restriction and edema wear and failure to administer the resident's steroid eye drops after a surgical procedure. The sample size was 2 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G) Based on record review and interview; the facility failed to ensure Gradual Dose Reduction (GDR, stepwise tapering of a dose to determine whether or not symptoms, conditions, or risks can be managed by a lower dose or whether or not the dose or medication can be discontinued) had a documented clinical rationale as to why they were not attempted for Resident 5; and failed to ensure as needed antipsychotic medications (a type of psychoactive medication which alters chemicals in the bran to effect changes in behavior, mood, and emotion) were limited to 14 days for Resident 34. The sample size was 5 and the facility census was 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(2) Based on record reviews and interviews, the facility staff failed to obtain pressure ulcer treatment for 1 (Resident 196) of 1 sampled resident. The facility staff identified a census of 45.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on record review and interview; the facility failed to develop/implement a water management program which identified a risk assessment and control measures/testing protocols to address potential hazards. This had the potential to affect all facility residents. The facility census was 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.06B Based on record review and interviews; the facility failed to maintain a system to identify repeat resident grievances, and to ensure sustainable resolutions of resident concerns. The sample size was 7 and the facility census was 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12B2 Based on observation, interview and record review, the facility failed to ensure 8 residents (Residents 12, 138, 139, 140, 141, 142, 143 and 144) medications had a record of accounting to prevent loss or theft of medications while awaiting disposition. The sample size was 8 and the facility census was 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11E Based on observation, interview, and record review; the facility failed to ensure food service equipment was cleaned and maintained, outdated food was not available for consumption, and staff safe handling of ready to eat food was in place to prevent the potential spread of food borne illness. The sample size was 28 and the facility census was 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(1) Based on record review and interview, the facility failed to provide Resident 35 or the resident's representative the required bed hold notification when the resident was transferred to the hospital. The sample size was 1 and the facility census was 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09B Based on interview and record review, the facility failed to ensure a PASARR [Preadmission Screening and Resident Review - used to determine individuals with a mental disorder, intellectual disability, or a related condition receives care and services in a setting appropriate to their needs] had been completed after 2 residents (Residents 22 and 24) were diagnosed with a serious mental disorder and received antipsychotic medications (used to treat psychiatric conditions) while residing in the facility. The sample size was 2 and the facility census was 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(8) Based on record review and interview, the facility failed to report a fall with injury as a potential allegation of abuse/neglect to the State Agency for 1 (Resident 1) of 6 sampled residents. The facility census was 42.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04C3a(6) Based on record review and interview, the facility failed to notify resident's responsible parties about falls for 2 (Resident's 1 and 3) of 3 sampled residents. The facility census was 48.