Accura Healthcare of Tekamah

Inspectors wroteBased on record review and interview, the facility failed to ensure Registered Nurse [RN] coverage was provided at least 8 consecutive hours a day for 7 days a week. This had the potential to affect all residents. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04 Based on record review and interview, the facility failed to ensure 12 hours of yearly training was completed for 2 Nursing Assistant (NA) ( D and F) of 5 employees. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G) Based on interview and record review, the facility failed to monitor for side effects related to psychotropic medication (medications that affect the mind, emotions, and behaviors) use for 3 (Residents 4, 6, and 33) of 5 sampled residents. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(E) Based on observation, record review and interview; the facility failed to develop the Comprehensive Care Plan (CCP, a document that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment) to include activity of daily living needs for 3 (Resident's 21 and 28 and a Bilevel Positive Airway Pressure (BiPAP, a device that helps you breath by pushing pressurized air into your lungs) for Resident 3 of 26 sampled residents. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(vi)(3)(g) Based on observation, interview, and record review, the facility failed to obtain a valid order for Positive Airway Pressure (PAP)(a machine used to treat sleep apnea) device for 3 (Residents 11, 28, and 3) of 3 sampled residents. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.18(B)Licensure Reference Number 175 NAC 12.006.18(D)Licensure Reference Number 175 NAC 12.006.19(A)(i) Based on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene (cleaning) and glove changes during wound care on 1 (Resident 11) of 2 sampled residents and insulin administration on 1 (Resident 20) of 1 sampled resident, keep staff clothing off the floor in 1 (Resident 11) of 3 sampled resident's room that was in Enhanced Barrier Precautions (EBP), and clean Positive Airway Pressure (PAP)(a machine used to treat sleep apnea) masks daily for 2 (Residents 28 and 11) of 3 sampled residents to prevent potential cross contamination. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-007.04D Based on observation and interview, the facility failed to ensure that ventilation systems were operational in resident bathrooms in 12 [Rooms 1E, 5E, 10E, 11E, 15E, 16E, 17E, 18E, 1S, 2S, 3S and 4S] of 27 occupied resident rooms in the facility. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.02(8) Based on observation, record review, and interview; the facility failed to thoroughly investigate and report an injury of unknown origin to Adult Protective Services [APS] and Department of Health and Human Services [DHHS] for 1 (Resident 16) of 1 resident identified with an injury of unknown origin. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(F)(iii)Based on observation, record review and interview; the facility failed to review and revise the Comprehensive Care Plan (CCP, a document that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment) to include specific interventions related to skin breakdown for 1 (Resident 16) of 26 sampled residents. The facility census was 33.

Inspectors wroteLicensure reference number 175 NAC 12-006.09E(iii) Based on observation, record reviews and interviews, the facility failed to develop and implement a Comprehensive Care Plan (CCP, a written interdisciplinary comprehensive plan which detailed how to provide quality care for a resident) catheter for 1 (Resident 5) of 1 sampled resident. The facility census was 28.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(h) Based on observation, record review, and interview, the facility failed to monitor resident behavioral symptoms to ensure the effectiveness or continued need for an antipsychotic (a drug or other substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behavior) medication for 1 resident (Resident 1) out of 15 sampled residents and the facility failed to have a stop date on a PRN (as needed) antianxiety medication for 1 resident (Resident 11) out of 15 sampled residents. The facility census was 28.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(D) Based on observation, record review, and interviews, the facility staff failed to perform hand hygiene (hand washing using soap and water or an alcohol based hand rub) for 15 seconds or more during the provision of wound care to prevent potential cross contamination for 1 (Resident 8) of 1 sampled resident and failed to place Resident 5's catheter bag to prevent potential cross contamination for 1of 1 sampled residents. The facility census was 28. A. Record review of Resident 8's admission record dated 10/29/24 revealed admission was 12/23/2018. [...]

Inspectors wroteLicensure reference number 175 NAC 12-006.04B2a Based on interviews and record reviews, the facility failed to ensure a nursing assistant/medication aide had 12 hours of ongoing inservice training for this past year. This had the potential to affect all 28 residents who reside within the facility. The facility census was 28.

Inspectors wroteLicensure reference number 175 NAC 12-007.04D Based on observation, interview, and record review the facility failed to ensure the ventilation system was in working order in 6 resident bathrooms (rooms 4E, 9S, 8S, 4S, 6S, and 15S) out of 13 sampled resident rooms. The facility census was 30.

Inspectors wroteLicensure Reference 175 NAC 12-006.09B1(2) Based on record review and interviews, the facility failed to complete a Significant Change of Status Assessment (SCSA) Minimum Data Set (MDS-a comprehensive assessment of each resident's functional capabilities. The SCSA is required when there is a significant change in those capabilities) for Resident 25. This affected 1 of 13 residents reviewed for MDS completion. The facility census was 30.