Adept Nursing & Rehab of Gretna

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(vi)(3)(g). The facility failed to obtain settings and ensure tubing and mask was changed for the use of a noninvasive ventilator for 1 (Resident 3) of 1 residents sampled, failed to monitor oxygen saturations to ensure oxygen blood levels were maintained for 1 (Resident 1) of 4 residents sampled and failed to ensure oxygen tubing was dated for 2 (Residents 2 and 42) of 4 residents sampled. The facility census was 40.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D). Based on observation, interview and record review the facility failed to ensure a medication error rate of 5% or less as evidenced by 3 errors out of 25 opportunities for error resulting in a medication error rate of 12%. The facility census was 40.

Inspectors wroteBased on record review and interview the facility failed to update advanced directives in the medical record for 1 (Resident 1) of 17 residents sampled. The facility census was 40.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G)Based on record review and interview, the facility failed to identify and monitor specific target behaviors and side effects for the use of psychotropic medications for Residents 42 and 43 and failed to ensure AIMS testing had been completed for Resident 6 and failed to monitor and evaluate sleep patterns for the continued use of hypnotic medications for 3. A total of 5 residents were reviewed for unnecessary medication use. The census was 40.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(F0(iii) Based on 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 residents medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment) to ensure the correct advanced directive information was identified for 1(Resident 8) of 1 resident reviewed for Hospice. The facility census was 40.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on observation, interview and record review the facility failed to implement a fluid restriction for 1(Resident 28) of 2 residents sampled. The facility census was 40.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(2). Based on interview and record review the facility failed to obtain orders for treatment of a pressure ulcer for 1(Resident 51) of 2 residents sampled. The facility census was 40.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(vi)Based on record review and interview the facility failed to ensure a rationale was provided for the continued use of ibuprofen for Resident 43. The facility identified a census of 40.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.11(E) Based on observation, interview, and record review, the facility failed to ensure the chemical low-temperature (temp) dish machine reached a minimum temp of 120 degrees Fahrenheit (F)(a temperature scale) during all wash and rinse cycles. This had the potential to affect 43 residents that consumed food from the kitchen. The total facility census was 44.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I)Licensure Reference Number 175 NAC 1-009.04(D)(i)(1)Based on observation, interview, and record review, the facility failed to ensure bathing and showering water temperatures (temps) did not exceed 110 degrees Fahrenheit (F)(a temperature unite of measure) to prevent potential accidents. The facility census was 44.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09(H)(iii)(1 & 2)Based on observations, interviews, and record review, the facility failed to evaluate causal factors and failed to implement interventions to prevent pressure wounds for 1 (Resident 3) of 4 sampled residents. The facility staff identified a census of 44.

Inspectors wroteLICENSURE REFERENCE NUMBER175 NAC 1-005.06 (D & E)LICENSURE REFERENCE NUMBER175 NAC 12-006.18 (B & D)Based on observation, interview, and record review, the facility failed to utilize a gown during personal cares for a resident who was identified as being in Enhanced Barrier Precautions (EBP, an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs) in nursing homes. EBP involve gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO as well as those at increased risk of MDRO acquisition [e.g., residents with wounds or indwelling medical devices]) for 1 (Resident 4) of 3 sampled residents; and the facility failed to ensure staff performed hand hygiene between glove changes to prevent cross contamination for 1 (Resident 4) of 5 sampled residents. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(1) and 12-006.09(H)(iii)(2) Based on observation, interview and record review the facility failed to evaluate, monitor and implement interventions for pressure ulcer prevention and to promote wound healing for 2 (Resident 2 and 3) of 3 residents sampled. The facility census was 43.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5) Based on interview and record review the facility failed to provide bathing services in accordance with the resident's preferences for 4 (Resident 1, 2, 3 and 5) of 4 residents sampled. The facility census was 43.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(E). Based on observation, interview and record review the facility failed to notify the medical practitioner of new pressure ulcers for 2 (Resident 2 and 3) of 3 residents sampled. The facility census was 43.

Inspectors wroteBased on observation, record review and interview; the facility failed to ensure nurse staffing information was posted daily at the beginning of the shift and included the facility name, date, census, and the total number and actual hours worked per shift for Registered Nurses, Licensed Practical Nurses, and Nurses Aides who were responsible for resident care. This had the potential to affect all residents that resided in the facility. The facility census was 44.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18 Based on observation and interview, the facility failed to maintain the cleanliness and condition of walls, floors, fixtures, closet doors, lights, bathroom ceiling ventilation covers in 9 resident rooms (rooms 104, 106, 112, 116, 203, 204, 206, 210 and 212) of 33 occupied resident rooms in the facility. The facility census was 44.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12E Based on observation, interview, and record review, the facility failed to secure residents medications and treatments in medication carts. The facility identified a census of 43.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D2a Based on observation, interview, and record review, the facility staff failed to obtain treatment orders for pressure ulcers for 2 (Resident 1 and Resident 3) of 3 sampled residents. The facility identified a census of 43.

Inspectors wroteLicensure reference: 175 NAC 12-006.09D8a Based on observation, interview, and record review, the facility failed to ensure physician ordered therapeutic diet was provided for 1 [Resident 1] of 4 sampled residents. The facility had a total census of 44 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(1) Based on record review and interview, the facility failed to provide a notice of Medicare non-coverage (NOMNC-a form that gives the last day that Medicare will cover costs and provides instructions for appealing that decision) at least 48 hours prior to discharge from Medicare services for 2 (Residents 16 and 18) of 3 sampled residents and failed provide the required Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN-a form that lists the items or services that the facility expects Medicare will not pay for, along with an estimate of the costs for the items and services and the reasons why Medicare may not pay) for 3 of 3 (Residents 16, 18 and 140) sampled residents. The facility census was 31.

Inspectors wroteLicensure reference number 175 NAC 12-006.09D3 Based on record review and interviews, the staff failed to provide care and services for bowel elimination by failing to provide as needed medications to promote regular bowel movements for 2 (Resident 8 and 3) of 5 sampled residents. The facility staff identified a census of 31.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10D Based on observation, interview, and record review; the facility staff failed to ensure a medication error rate of less than 5%. Observations of 25 medications administered revealed there were 2 errors resulting in an error rate of 8%. The error affected 2 (Resident 134 and 139) of 3 residents reviewed for medication administration. The facility identified a census of 31.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.17B Based on observation, interview and record review; the facility failed to ensure 1 (Resident 4) of 1 sampled resident's Trilogy Ventilator Non-Invasive (a machine used to deliver positive pressure to the lungs to prevent the airway from restricting) mask was cleaned and stored in a manner to prevent the potential for cross contamination and failed to provide suprapubic catheter (a tube inserted directly into the bladder to drain urine) care to for 1 (Resident 9) of 1 sampled residents . The facility census was 31.