Adept Nursing & Rehab of North Platte

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D)Based on record review, observation, and interview, the facility failed to ensure a medication error rate below 5%. There were 28 medication administration opportunities which resulted in 5 errors for an error rate of 17.86%. This affected 2 (Resident 24 and 39) of 3 sampled residents and the facility identified a census of 67.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)Based on record reviews and interviews, the facility failed to follow physician orders for 4 (Resident 1, 3, 4, 5) of 5 sampled residents. The facility census was 66.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5)Based on record reviews and interviews, the facility failed to provide routine medications to meet the needs of the residents for 4 (Resident 1, 3, 4, 5) of 5 sampled residents. The facility census was 66.

Inspectors wroteLICENSURE REFERENCE NUMBER 12-006.09 (H)(vi)(3)Based on observations, record review, and interview, the facility failed to administer oxygen to 3 of 4 sampled residents (Resident 1, 2, and 3). The faciity identified a census of 70. A record review of a facility policy titled, Oxygen administration, last revised 3/19/25, revealed that the residents' care plans identify interventions for oxygen therapy, based on their assessments and provider orders. A. Record review of Resident 1's face-sheet revealed they were admitted on [DATE] with diagnoses of chronic respiratory failure, chronic obstructive pulmonary disease, type 2 diabetes mellitus, and obesity. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D) Based on observation, interview, and record review; the facility failed to ensure 2 (Residents 3 & 2) of 8 sampled residents were free of significant medication errors. The facility census was 74. Findings Are: A record review of facility policy Medication Reordering dated 2025 revealed a policy statement of It is the policy of this facility to accurately and safely provide or obtain pharmaceutical services including the provision of routine and emergency medications and biologicals in a timely manner to meet the needs of the resident. The policy guidelines states acquisition of medications should be completed in a timely manner to ensure medications are administered in a timely manner. Each time a nurse is administering medications and observes 6 or less doses left of one kind, that nurse will reorder the medication, time permitting. [...]

Inspectors wroteLicensure Reference Number NAC 175 12-006.11(E) Based on observations, interviews, and record review, the facility failed to store, prepare, and serve food in a manner to prevent potential for foodborne illness. This included not wearing gloves while touching food, not wearing beard covers in the food preparation area, not using water from a clean source for food preparation or steam table. This had the potential to affect all 59 residents who resided within the facility.

Inspectors wroteLicensure Reference Number NAC 175-12 006.09(G)(i)7 Based on record review and interviews, the facility failed to document a recapitulation (a complete summary of resident stay in nursing facility from admittance to discharge) for a resident-initiated discharge for 1 (Resident 50) of 6 sample resident. The facility identified a census of 59.

Inspectors wroteLicensure Reference Number NAC 175-12 006.09(F) Based on record review and interviews, the facility failed to implement a Comprehensive Care Plan (a detailed, individualized guide that outlines a residents medical, functional, and psychosocial needs) addressing the need for repositioning bars based on assessed physical needs. A review of 1 (Resident 23) out of 3 sampled residents. The facility identified a census of 59.

Inspectors wroteBased on interviews and record review, the facility failed to assess a wound and obtain wound care orders for Resident 67. The sample size was 6 with the facility identifying a census of 59.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(i)(3) Licensure Reference Number 175 NAC 12-006.09(J)(i)(1) Based on observations, record reviews, and interviews; the facility failed to implement interventions to prevent weight loss for 2 (Residents 6 & 7) of 4 sampled residents. The facility census was 68. Findings Are: A record review of the facility policy Nutritional Management with review/revise date of 4/9/24 revealed the facility provides care and services to each resident to ensure the resident maintains acceptable parameters of nutritional status in the context of (gender) overall condition. In the Care plan implementation section, the policy stated an example of an intervention was to provide physical assist or provision of assistive devices and stated that real food would be offered first before adding supplements. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09(H)(i)(3) Based on observation, interview, and record review, the facility failed to provide assistance with activities of daily living for one (Resident 4) of five sampled residents. The facility identified a census of 67.

Inspectors wroteLicensure Reference Number 175 NAC 1-005.06(D) Based on observation, interview, and record review, the facility failed to don (put on) Personal Protective Equipment (PPE) for Enhanced Barrier Precautions (EBP- infection control measures that involve targeted use of gowns, gloves, and mask during high-contact resident care activities to reduce the transmission of multidrug-resistant organisms) for one (Resident 5) of three sampled residents. The facility identified a census of 67.

Inspectors wroteLicensure Reference 175 NAC 12-006.09(I) Based on interviews and record reviews, the facility failed to identify causative factors, and develop and implement new interventions for falls for 3 (Resident 1, 3, 4) of 4 sampled residents. The facility also failed to develop and implement interventions for 1 (Resident 5) of 4 sampled resident at-risk for elopement. The facility identified a census of 54. The facility was notified on 10/16/2024 at 8:40 PM of an Immediate Jeopardy (IJ) which began on 7/4/2024. The IJ was removed on 10/17/2024, as confirmed by the surveyor onsite verification.

Inspectors wroteD. A record review of Resident 28's MAR (Medication Administration Record) revealed resident was admitted to the facility on [DATE]. A record review of Resident 28's medical chart revealed a diagnosis of Monoarthritis. A record review of MDS dated [DATE] revealed in Section GG0115. Functional Limitation in Range of Motion of upper and lower extremity marked 0 indicating no impairment for: upper extremity (shoulder, elbow, wrist, hand) and lower extremity (hip, knee, ankle, foot). A record review of Resident 28's Care Plan did not reveal that the resident had limited ROM, positioning devices or preventive skin care for the left hand. An observation on 6/24/24 at 7:49 AM revealed Resident 28 was in bed with [gender] left hand closed. The resident was unable to open it [gender] left hand. The observation did not reveal any positioning or protective devices in place. [...]

Inspectors wroteLicensure Reference 175 NAC 12- 006.10(D) Based on observations, interviews, and record review; the facility failed to ensure medications were administered at the right time for 3 (Resident 10, 11, and 21) of 3 sampled residents and to ensure the medication error rate was less than 5%. The medication error rate was 12%. The facility census was 47.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(B) Based on observations, record reviews, and interviews; the facility failed to distribute residents' laundry in a manner that prevented the potential for cross contamination, and failed to ensure the cleanliness of nebulizer equipment for 1 (Resident 29) of 1 sampled resident to prevent the potential for cross contamination. The facility census was 47. The Findings Are: A. A record review of facility policy Infection Prevention and Control Program with implementation date of 4/1/24, revealed that laundry and direct care staff would handle, store, process, and transport linens to prevent the spread of infection and that clean linen would be delivered to resident care units on covered linen carts with the covers down. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(B) Based on observations, record review, and interviews; the facility failed to ensure 1 (Resident 13) of 14 sampled resident's MDS (Minimum Data Set, a federally mandated comprehensive assessment tool utilized for care planning) was coded with current level of assist. The facility census was 47.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on observations, record reviews and interviews; the facility failed to ensure 1 (Resident 5) of 1 sampled resident had labs completed per the physicians' order. The facility census was 47.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on record review and interview; the facility failed to follow dialysis instructions for assessment of the arterial venous (AV) graft (an abnormal connection between an artery and a vein in an arm or leg) and a dialysis catheter (a flexible tube used for dialysis treatment) for 1 (Resident 30) of 1 sampled resident. The facility census was 47.

Inspectors wroteBased on interviews and record reviews; the facility failed to obtain a clinically valid rationale for the continuance of a psychotropic medications for 1 (Resident 26) of 5 sampled residents. The facility census was 47.

Inspectors wroteLicense Reference Number 175 NAC 12-006.11E Based on observation, record review, and interview, the facility failed to provide clean and sanitary conditions for food preparation. This had the potential to affect 46 of 47 residents who resided in the facility and received meals prepared by dietary services. The facility identified a census of 47 residents at the time of the survey.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09C1a Based on record review and interview the facility failed to complete the required baseline care plan (a written plan required to be developed within 48 hours of admission detailing the instructions needed to provide initial effective and person-centered quality care for a resident) for 1 resident (Resident 14); and failed to ensure that a written summary of the baseline care plan was reviewed and provided to the resident/resident representative for 3 residents (Residents 1, 14, and 7). This prevented the resident/resident representative from participating in the care plan and identifying any additional care needed by the resident. The facility census was 47.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D1 Based on observation, record review, and interview the facility failed to provide bathing to residents as required for 5 residents (Residents 3, 43, 7, 104, and 105). The facility census was 47.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17D Based on observation, record review, and interview the facility failed to ensure that staff performed hand hygiene (hand washing using soap and water or an alcohol-based hand rub (ABHR) to remove germs for reducing the risk of transmitting infection among patients and health care personnel) as required during laundry delivery to prevent the potential for cross-contamination and infection for 30 residents (Residents 31, 10, 24, 1, 17, 35, 43, 108, 29, 107, 47, 6, 45, 154, 36, 39, 44, 37, 9, 6, 32, 40, 23, 7, 38, 8, 4, 34, 30, and 18); and the facility failed to ensure that staff performed hand hygiene between resident contacts to prevent the potential for cross contamination for 3 residents (Residents 38, 2, and 20). The facility census was 47.