Accura Healthcare of Sioux City, LLC

Inspectors wroteBased on observations, staff interviews, and facility policy review the facility failed to ensure proper sanitary conditions in the kitchen area, where staff prepared food. The facility identified a census of 41 residents.

Inspectors wroteBased on clinical record review, family interview, staff interview, and policy review the facility failed to notify the Long-Term Care Ombudsman of a transfer to a hospital for 2 of 3 residents (Resident #31, and #43) reviewed. The facility reported a census of 41 residents.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to refer 1 resident with a negative Level I result for the Preadmission Screening and Resident Review (PASRR), who was later identified with newly evident or possible serious mental disorder, intellectual disability, or other related condition, to the appropriate state-designated authority for Level II PASRR evaluation and determination for 1 out of 1 residents (Resident #7) reviewed for PASRR requirements. The facility reported a census of 41 residents.

Inspectors wroteBased on record review and staff interviews the facility failed to provide professional standards of care by not following physician orders to include the updated order and the correct medication end date in the electronic record for 1 out of 13 residents reviewed (Resident #8). The facility reported a census of 41 residents. The Minimum Data Set (MDS) dated [DATE] for Resident #8 documented diagnoses of anemia, obstructive sleep apnea, insomnia. The MDS showed the Brief Interview for Mental Status (BIMS) score of 14 which indicated no cognitive impairment. [...]

Inspectors wroteBased on a review of clinical records, staff interviews, and facility policy, the facility failed to complete assessments and interventions for necessary care and services related to dialysis. Clinical record review revealed that nursing staff did not complete all required dialysis evaluations for 1 of 1 residents reviewed (Resident #2). The facility reported a census of 41 residents.

Inspectors wroteBased on a review of the clinical record, facility policy, and staff interviews, the facility failed to notify the physician when the resident's blood pressure exceeded the established notification parameters for 1 of 13 residents reviewed (Resident #2). The facility reported a census of 41 residents.

Inspectors wroteBased on record review, staff interview, and document review the facility failed to notify the physician with a change in condition for 2 of 2 residents reviewed (Residents #7 and #22).

Inspectors wroteBased on document review, observations, policy, and staff interview the facility failed to employ sufficient staff with the appropriate competencies and skills sets to effectively carry out the functions of the food and nutrition service department. The facility reported a census of 43. residents.

Inspectors wroteBased on observation, document review and staff interview the facility failed to follow the menu and prepare food to meet the nutritional needs of the residents. The facility reported a census of 43 residents.

Inspectors wrote2. On 7/19/23 at 12:21 PM during the continuous observation of the lunch service witnessed Staff G fill the scoops used to serve the mechanical soft diet and the pureed diets only partially full. Witnessed Staff G picked up a peanut butter and jelly sandwich with gloved hands, placed the sandwich on a plate then picked up tongs for pork, placed pork on plate, picked up strainer spoon for sweet potatoes, and then picked up the lids for room trays. Then with the same gloves and without hand hygiene, Staff G picked up bread, picked up a plate, placed the bread on the plate, picked up the room tray lid, applied the lid to the plate, picked up the strawberry cobblers, and put the cobblers on the tray. Staff G used both hands for each task and repeated these tasks through the entire lunch service without changing her gloves or performing hand hygiene. [...]

Inspectors wroteBased on observations, record review, staff interviews, and policy reviews, the facility failed to provide proper hand hygiene after catheter care for 1 of 1 residents reviewed (Resident #13). In addition, the facility failed to complete hand hygiene during a medication administration for 1 out of 3 residents reviewed (Resident #17).

Inspectors wroteBased on observation, clinical record review, resident, and staff interviews, the facility failed to respect each resident's dignity by speaking a foreign language in the presence of residents for 2 out of 13 residents reviewed (Residents #3 and Resident #25).

Inspectors wroteBased on observations, resident interviews, and staff interviews the facility failed to provide residents with ready access to their personal funds managed by the facility for 5 of 43 residents reviewed (Resident #5, #7, #14, #16, and #18). The facility set a limit of $20 for all residents for their resident trust account for less than 24-hour notice.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to refer 1 resident with a negative Level I Preadmission Screening and Resident Review (PASRR), who was later identified with newly evident or possible serious mental disorder, intellectual disability, or other related condition, to the appropriate state-designated authority for a Level II PASRR evaluation and determination for 1 out of 1 residents (Resident #22) reviewed for PASRR requirements.

Inspectors wroteBased on record review, resident interviews, resident family interview, and staff interviews the facility failed to provide an opportunity for a resident and/or a Resident's Representative to participate in a Care Conference to discuss the residents care 1 of 12 residents reviewed (Resident #33).

Inspectors wroteBased on record review, staff interviews, and policy review the facility failed to complete a discharge summary after a resident discharged on 1 of 1 resident reviewed (Resident #141).

Inspectors wroteBased on record review, resident, and staff interviews the facility failed to assess a resident's blood sugar after a drop in level with a low rise rate for over an hour and half (Resident #92). Following this assessment, no staff assessed Resident #92 for over three hours. Resident #92 developed a change in condition that required an admission to the hospital due to her hypoglycemic (low blood sugar) status. Findings Included: Resident #92's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. The MDS included a diagnosis of diabetes mellitus. The Care Plan dated 6/19/23 identified Resident #92 as a diabetic with a goal not to have any ill effects from hypoglycemia or hyperglycemia. On 7/17/23 at 2:05 PM Resident #92 reported that she went to the hospital a few weeks ago for low blood sugars. [...]

Inspectors wroteBased on observations, record review, and interviews the facility failed to properly use a mechanical lift to avoid hazards and prevent accidents for 1 of 1 residents reviewed (Resident #13).

Inspectors wroteBased on clinical record review, staff interview, and facility policy review, the facility failed to manage oxygen usage for 1 out of 1 residents reviewed (Resident #13) for oxygen use.

Inspectors wroteBased on clincial record review and staff interviews, the facility failed to ensure that staff who took a resident's blood pressure knew when to notify the nurse of a low result for one of one residents reviewed (Resident #36).

Inspectors wroteBased on record review and staff interviews the facility failed to maintain accurate medical records for 1 out of 13 residents reviewed (Resident #92). Findings Included: Resident #92's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. The MDS included a diagnosis of diabetes mellitus. The Care Plan dated 6/19/23 identified Resident #92 as a diabetic with a goal not to have any ill effects from hypoglycemia or hyperglycemia. On 7/17/23 at 2:05 PM Resident #92 reported that she went to the hospital a few weeks ago for low blood sugars. The Health Status Note dated 7/5/23 at 2:59 AM indicated that 1:00 AM the nurse observed Resident #92 with her C-Pap (machine to help treat sleep apnea while sleeping) and her leg hanging over the bed. She had slurred speech and did not make sense. [...]