Blue Circle Rehab and Nursing

Inspectors wroteBased on observation, interview and record review, the facility failed to label insulin pens per facility policy for nine of 10 insulin pens in use for residents at the facility. The census was 69. Review of the facility's Insulin Labeling and Storage policy, dated [DATE], showed:-All insulins will be stored in the refrigerator on delivery until opened for usage;-New insulins removed from the reiterator needs to be dated and include the resident's name. This includes both bottles or pens;-Insulins are only good for 28 days after opening. Observation and interview on [DATE] at 10:07 A.M., showed Licensed Practical Nurse (LPN) B identified the medication cart that contained the insulin pens in use for all residents. Observation at this time showed 10 insulin pens in the top drawer. A sticker was placed on all pens with a space for the date opened and the date expired. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident was provided adequate assistance to prevent accidents for one resident who required the use of a Hoyer lift (full body mechanical lift) when staff transferred the resident with the use of a gait belt (Resident #3). The sample was 7. The census was 69. Review of the facility's Gait Belt Transfer policy, dated October 2023, showed:-Review Kardex for number of staff transfer assistance needed;-Fasten the gait belt securely around the resident's waist with the buckle at the side;-Position one hand under the buckle;-Position the other hand under the belt;-Transfer the resident using proper body mechanics. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure Certified Medication Technician (CMT) D provided nutritional supplements as ordered to Residents #6, #15, #14, and #10. In addition, the facility failed to ensure Resident #10 received whole milk at meals as ordered. The facility identified 23 residents as receiving nutritional supplements. Four of those residents were sampled and problems were identified with all four. The census was 70. Review of the facility Weight Protocol last reviewed on 10/2025, showed:-Purpose: To provide a permanent, accessible record of residents' weights;-Procedure:-Monthly weights will be completed by the 15th of the month. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to obtain laboratory services to meet the needs of the residents by failing to ensure the quality of the labs obtained when they used expired Covid tests to test employees and residents for Covid-19. The facility failed to check with the manufacturer to see if the expiration date waiver was extended. The waiver was not extended. The census was 72. Review of the facility's Response to Covid-19 protocol, last reviewed 4/2024, showed Covid-19 testing: Covid-19 testing will be conducted in accordance with current Centers for Medicare and Medicaid Services (CMS) and Department of Health and Senior Services (DHSS) requirements, utilizing Point of Care and polymerase chain reaction (PCR) testing as appropriate. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure recipes were followed while preparing meals, for one of two meal services observed. The sample was 19. The census was 72. Observation on 12/9/24 at 8:54 A.M., of the lunch meal service prep, showed [NAME] H removed steak patties from a box and place them on the skillet top. After the steaks were cooked, [NAME] H placed the steak patties into a tin and placed the tin on the steam cart for meal service. Review on 12/10/24 at 8:20 A.M., of the Swiss steak recipe, showed: -Ingredients: beef cutlets, salt, black pepper, vegetable oil, onions, celery, and diced tomatoes; -Method of preparation: season cutlets with salt and pepper. [NAME] in hot oil. Place on baking pans. Sauté onions and celery in same fat. Place over meat. Pour tomatoes over cutlets. Cover baking pan with foil. Bake for 2 to 2 ½ hours. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete and maintain monthly account reconciliations of the facility's bank statements for 12 of 12 months. The facility also failed to reconcile the resident trust at the end of the month for two months. The census was 72. Review of the facility's undated resident rights policy, showed: -Right regarding financial affairs: Manage his or her financial affairs; -Information about available services and the charges for each service; -Personal funds or more than $100 ($50 for residents whose care is funded by Medicaid) deposited by the facility in a separate interest-bearing account, and financial statements quarterly or upon request; -Not be charged for services covered by Medicaid or Medicaid. Review of the facility's resident trust, showed: -January 2024, reconciled on 1/1/24, with a balance of $29,370.97. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide residents a safe, clean, comfortable, and homelike environment. The facility failed to launder dirty linen, leaving residents' rooms malodorous (Resident #38 and #24). Two residents with air conditioner units had gaps, allowing air to leak (Residents #23 and #37). One resident had broken or missing tile in the room (Resident #21). One resident had broken base boards and window blinds (Resident #13). The facility failed to ensure resident furniture was repaired for one resident with broken drawers (Resident #1). In addition, one resident had an active leak underneath the air conditioner unit (Resident #65). The sample size was 19. The census was 72. Review of the facility's Cleaning of Resident Rooms policy, dated July 2024, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents' Activities of Daily Living (ADL) care needs were met. The facility failed to ensure one resident was repositioned and toileted timely and did not have dirty nails (Resident #4), failed to ensure one resident's lips were cared for resulting in dry, cracked lips (Resident #65), failed to ensure one resident was free from body odor and chin hair (Resident #3), failed to ensure one resident's face was cleaned (Resident #1), and failed to ensure another resident had clean nails (Resident #24). The sample was 19. The census was 72. Review of the facility's Turning and Repositioning policy, reviewed 1/2023, showed: -When the resident is sitting up in a chair, they shall be repositioned at least every two hours or per the plan of care. [...]

Inspectors wrote85.042 (14) cl. II* Resident #20 Resident #278 Resident #30 Resident #32 Not priming needle, walking away from resident with medications, and eye was not pulled down for eye drops. [NAME] will organize Resident #20 FTag Initiation 12/10/24 10:09 AM CMT was placing the box of eye drops under her arm, and did not pull the left eye lid down. Resident #30 FTag Initiation 12/10/24 10:13 AM Nurse did not prime insulin pen Resident #32 FTag Initiation 12/10/24 10:11 AM Nurse did not prime the insulin pen. Resident #278 FTag Initiation 12/10/24 10:24 AM CMT left resident with medications in the therapy gym and went to get resident water bottle.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure drugs and biologicals were labeled and stored per acceptable standards of practice when the facility failed to store medications, located in the Assistant Director of Nursing's (ADON) office, locked, and not accessible to individuals without authority to access the medications. The facility identified four medication carts, two treatment carts, and two medication rooms. The ADON's office was not identified as a medication storage room. The ADON failed to ensure it was secured when she left her office. The office had several shelves on the back wall that contained multiple bottles of over-the-counter medications and vitamins. An open bottle of medication was also found in the ADON's office that was not labeled. The sample was 19. The census was 72. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure call lights were in working order for two sampled residents (Residents #24 and #29). In addition, the facility found issues with call lights in 24 additional resident bedrooms. This had a potential to affect all residents who resided in rooms with non-functioning call lights. The sample was 19. The census was 72. Review of the facility's undated call light policy, showed: -Purpose: To respond to resident/patient's request and needs; -Procedure: -Answer call lights in a reasonable amount of time; -Determine resident/patient's request; -Turn off call light; -Listen to resident/patient for further requests or needs; -Respond to request. If unable to meet request obtain assistance from caregiver that can meet request; -Assist resident/patient as needed to a comfortable position with call light within reach. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to promote and facilitate resident self-determination through support of resident choice for one resident who had an order to get up before lunch and required the use of a Hoyer lift (mechanical lift) when the staff could not find a Hoyer lift pad and did not obtain another one for use (Resident #21). The sample was 19. The census was 72. Review of Resident #21's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 10/24/24, showed: -Cognitive impairment; -Dependent, helper does all the effort and resident does none of the effort to complete the activity for toileting, shower/bathing, upper and lower body dressing, and personal hygiene; -Substantial/Maximum assistance for resident to roll left and right; -Setup or clean up assistance for eating; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure privacy during care for one resident (Resident #3). The census was 72. The sample was 19. Review of the facility's Resident's Rights policy, revised 1/5/22, showed the following: -Protocol: the facility will address ethical issues and respect resident rights in providing care. The facility recognizes the resident right to a quality of life that supports privacy, confidentiality, independent expression, choice, and decision making, consistent with state law and federal regulation; -Procedure: explain rights to resident and/or responsible party at or before admission. Give resident and/ or responsible party a copy of the resident rights in writing. Involve residents/responsible party in all aspects of care. Involve resident/responsible party in resolving conflicts about care decisions. Involve residents. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide an appropriate discharge for one sampled resident (Resident #7) out of four residents sampled for discharge. Resident #7 received an immediate discharge after a resident to resident altercation that was de-escalated by staff without incident or any reported injuries. Despite the absence of severe behaviors, the facility issued an immediate discharge, citing the resident's care and protective oversight currently exceeded current capacity. The census was 72. Review of the facility's Room Changes, Transfers, and Discharge policy, revised July 2022, showed: -Protocol: [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the Ombudsman in the timely manner after an immediate discharge was issued to one resident after a resident-to-resident altercation. The facility issued an immediate discharge, citing the resident's care and protective oversight currently exceeded current capacity (Resident #7). The census was 72. Review of the facility's Room Changes, Transfers, and Discharge policy, revised July 2022, showed: -Protocol: The purpose of this Protocol is to inform residents/patients of the facility's protocol regarding room changes, transfers, and/or discharges and to provide sufficient preparation and orientation to residents/patients to ensure safe and orderly room changes, transfers, and/or discharges; -Transfers and discharges will be conducted according to State and Federal regulations; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure when a resident is being admitted to a Medicaid certified facility, regardless of payment source, a DA-124 Level 1 screen (used to evaluate for the presence of mental illness and intellectual disability, to determine if a preadmission screening\resident review (PASRR) Level 2 screen is required) was completed, for one of six residents sampled for the PASRR requirements (Resident #4). The census was 72. Review of the facility's PASRR Protocol showed: -Procedure: Review hospital records and determine PASRR. Does the resident meet level of care and/or require a Level 2 PASRR to be appropriate for admission. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide necessary services to ensure that a resident's abilities in activities of daily living do not diminish when staff failed to accommodate one resident's communication needs (Resident #3). The sample was 19. The census was 72. Review of the facility's communication board policy, undated, showed: -Purpose: communication between resident and caregiver is vital and when that ability to communicate is lost or impaired by illness, trauma, medical process or language barriers, communication is more vital; -Features: pain scale for determining where and how bad one hurts. Clear pictures depicting wants, needs, ailments, comforts, questions, emotions. Easy to understand instructions for patient response alternatives. Alphabet for spelling out words. Numbers for numerical information; -Benefits: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents receive care consistent with professional standards. One resident had physician's orders for blood sugar checks and the orders were not followed (Resident #62). One resident had a wound on the right lower leg with no documentation of assessment (Resident #23). The sample size was 19. The census was 72. Review of the facility's policy for Physicians Orders, reviewed 5/22/2023, showed: -At the time each resident is admitted , the facility will have physician orders for their immediate care. Physician's orders will be verified by the attending physician at the facility. All physician's orders will be dated and signed according to state and federal regulations. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident who is incontinent of bowel and bladder received appropriate treatment and services after an incontinence episode, when staff placed two briefs on a resident. The resident's briefs became very saturated with urine and uncomfortable. Staff also failed to cleanse all areas of the skin potentially contaminated by urine for the same resident (Resident #21). The sample was 19. The census was 72. Review of the facility's Care of Incontinent Resident Policy and Procedure Policy, revised 1/2022, included: -Purpose: To have residents clean and dry; -Policy: All resident who are identified as being incontinent will have incontinence care provided every two hours and as needed. Note: There is a half hour leeway to round times; -Procedure: -Explain procedure; -Wash hands and put on gloves; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure respiratory services provided were consistent with professional standards of practice for one resident (Resident #37) when staff failed to follow the physician orders for the rate of the oxygen, and to change and date the oxygen tubing. The sample size was 19. The census was 72. Review of the facility's Oxygen Safety Precautions policy, revised 8/29/22, showed: -Oxygen is very safe when you use it properly. Oxygen will not explode or burn. Oxygen will cause anything that is burning to burn faster and hotter. By following these safety rules, you will create a safe environment for the use of oxygen; -Administer oxygen per physician orders. Review of the facility's Cleaning and Disinfection of Environmental Surfaces and Equipment, reviewed 7/2024, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to post the correct date for staffing information on a daily basis for 4 out of 5 days. The daily staffing sheet includes the total number of hours worked by categories of licensed staff, identifying Registered Nurse (RN) hours and Licensed Practical Nurse (LPN), directly responsible for resident care per shift. The census was 72. Review of the nurse staffing information, posted at the front entrance of the facility, showed: -On 12/5/24 at 10:30 A.M., the staffing sheet was dated 11/27/24; -On 12/6/24 at 10:15 A.M., the staffing sheet was dated 11/27/24; -On 12/9/24 at 8:30 A.M., the staffing sheet was dated 12/6/24; -On 12/10/24 at 9:15 A.M., the staffing sheet was dated 12/6/24. At 11:45 A.M., the staffing sheet was dated 12/10/24; -On 12/11/24 at 9:25 A.M., there was no staffing sheet posted at the front desk. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication error rate of less than 5%. Out of 28 opportunities observed, four errors occurred, resulting in a 14.28% error rate when the insulin pens were not primed prior to administering to residents, medication was not given in the form as ordered by the physician, and eye medication was not administered properly (Residents #32, #30, #21 and #20). The sample was 19. The census was 72. Review of the facility's Medication Administration-Insulin policy, undated, showed: -Standard of Practice: the nurse will ensure prior to administering each dose of insulin that the correct type and dose of insulin and number of units ordered are checked against the physician's order, the insulin vial, and syringe before the patient receives the insulin; -Standard of care: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow acceptable standards of practice for infection prevention and control when staff failed use enhanced barrier precautions while providing care for a resident who had an indwelling catheter and a feeding tube and failed to prevent infection by leaving a gravity bag (urinary collection device) lay on the ground (Resident #3) and failed to change gloves while providing care (Resident #21). In addition, staff placed medication under their arm while administering medications (Residents #10 and #20). The sample was 19. The census was 72. Review of the facility's Infection Control policy, dated 7/2022, showed: -Policy Statement: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident's right to be free from abuse was not violated, when one resident was abused by another resident resulting in a cigarette burn to the forehead (Residents #4 and #5). The census was 75. Review of the facility's Abuse and Neglect Policy, dated as revised on August 1, 2022, showed: -Abuse --Willful infliction of injury; -In the case of resident-to-resident interaction, the residents are separated from one another until the investigation has been completed. Review of Resident #4's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 12/9/23, showed: -Cognitively intact; -No behaviors; -Diagnoses included schizophrenia (a serious mental disorder in which people interpret reality abnormally) and anxiety disorder. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure nurses completed and documented the weekly risk skin assessments and weekly wound assessments and failed to upload wound reports to resident's electronic medical record (EMR) in a timely manner. In addition, the facility failed to document when a new wound was found, who was contacted and what measures were put in place and also failed investigate a wound caused by trauma, and report and repair a broken wheelchair which caused a wound on a resident (Resident #1). The sample size was three. The census was 75. Review of the facility's skin program policy and procedure, undated, showed: -Purpose: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide protective oversight for one resident (Resident #5) who was intentionally burned on the forehead with a cigarette by another resident (Resident #4). The census was 75. Review of the facility's Smoking Policy, revised on 8/1/22, showed: -Policy: Residents who smoke will be assessed for needed assistance upon admission, quarterly and with a significant change; -All residents are to be supervised while smoking; -Staff will light all smoking products and provide other assistance and protective devices as needed; -Residents are not allowed to supervise or assist other residents in smoking; -The failure of residents and visitors to comply with these rules places others at risk for injury. The facility may have to insist that resident and family find alternative placement if smoking and safety rules are not followed; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow the facility's hairnet/beard net policy when handling food, and failed to keep the kitchen equipment clean and floors free of dust, grease and grime. In addition, the facility failed to ensure staff followed the facility's handwashing policy. The census was 66. Review of the facility's dietary/food handling policy, revised 1/22/09, showed the following: -Purpose: To provide guidelines for the safe preparation, handling, and storage of perishable food and proper environmental cleaning; -Policy: Clean uniforms must be worn daily. Hairnets or caps must be worn in food service areas. Environmental surfaces shall be sanitized per facility guidelines. Review of the facility's kitchen cleaning schedule, undated, showed the following: -Day shift responsibilities: [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to maintain resident dignity by not speaking to and assisting one resident (Resident #29) during personal care in respectful and timely manner. Additionally, the facility failed to ensure two residents were not left exposed to the hallway when they were in their rooms (Resident #38 and Resident #262) and ensure one resident's brief was not exposed when brought to the main dining room by nursing staff (Resident #5). The sample was 17. The census was 66. Review of the facility's Resident's Rights policy, reviewed 1/5/22, showed the following: -Protocol: The facility will address ethical issues and respect resident rights in providing care. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide quarterly statements to residents and/or their representatives (Residents #4, #29, #21 and #38) during the previous 12 months. This deficient practice affected 46 residents whose funds were handled by the facility. The census was 66. Review of the facility's Resident Fund Management Service (RFMS) policy, last revised January 2022, showed: -Protocol. The facility will safeguard and manage resident funds in accordance with state regulation; -Procedure includes: All written accounts of the residents' funds shall be reconciled monthly and a written statement showing the current balance and all transactions shall be given to the resident, his/her designee, guardian and conservator, or conservator on a quarterly basis. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a clean, comfortable and homelike environment for all residents when staff failed to ensure shower rooms were clean and accessible for residents (Residents #6 and #21). The facility failed to ensure soiled linen and trash bins were emptied and cleaned appropriately to reduce offensive odors in resident areas. The sample was 17. The census was 66. 1. Observations of the 200 hall shower room, showed: -On 10/23/23 at 12:24 P.M., a bathtub filled with pillows. The bathtub was inaccessible, surrounded by equipment, including mechanical lifts, a wheelchair, and shower beds and chairs. The floor was grimy throughout the shower room. Feces were smeared on the toilet seat; -On 10/24/23 at 11:11 A.M., 10/25/23 at 11:16 A.M., 10/25/23 at 12:31 P.M., and 10/25/23 at 2:30 P.M., a bathtub was filled with pillows. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure drugs and biologicals are labeled and stored in accordance with currently accepted practices. These deficient practices affected two of four medication carts reviewed and two out of two medications rooms reviewed. The census was 66. Review of the facility's Medication Storage policy, dated November 2021, showed; -Controlled substances that require refrigeration are stored within a lock box within the refrigerator. This box must be secure to the inside of the refrigerator; -Drugs dispensed in the manufacturer's original container will carry the manufacturer's expiration date. Once opened, these will be good to use until the manufacturer's expiration date is reached unless the medication is: -In a multi-dose injectable vial; -An item for which the manufacturer has specified a usable life after opening; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dietary staff followed recipes while cooking in order to provide residents with the required nutrition. In addition, the facility failed to provide Resident #261 with double portions per the resident's personal preference. The sample was 16. The census was 66. 1. Observation on 10/24/23, showed: -9:49 A.M., [NAME] I got a package of meatballs out of the freezer to use as an alternate to pork steaks. [NAME] I said there were not enough pork steaks for all the residents due to the delivery truck being late; -10:46 A.M., [NAME] I put a pot on the stove with butter and pepper to melt for the mashed potatoes. He/She did not measure the butter or the amount of pepper used; -10:54 A.M., [NAME] I poured from a jug of barbecue sauce over the eight pork steaks without measuring the amount used. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure food was delivered to residents at an appetizing temperature, which affected the residents on the 100 and 200 hallways and included three out of the 16 sampled residents (Residents #41, #6, and #38). The census was 66. Review of the facility's Dietary/Food Handling policy, revised 1/22/09, showed the following: -Purpose: To provide guidelines for the safe preparation, handling, and storage of perishable food and proper environmental cleaning. -Policy: Temperatures must be maintained at the following (Fahrenheit (F)) settings for the items indicated below: Cold food -45 degrees or below, Frozen food -0 (zero) degrees or below, Hot food -140 degrees or above, All potentially hazardous food must be kept below 45 degrees or above 140 degrees during transportation. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an effective pest control system when multiple bugs were noted throughout the hallways, resident rooms (Residents #6, #21, and #2), and in the kitchen. The facility census was 66. Review of the Cleaning the Resident's Room policy, updated 7/2022, showed the following: -Purpose: The purpose of this procedure is to provide guidelines for cleaning and disinfecting residents' rooms and identify potential pest control concerns; -General Guidelines: Personnel should remain alert for evidence of rodent activity (droppings) and report such findings to the Environmental Services Director; -Note: Any signs of pests (ants, rodents) are to be reported immediately to the Housekeeping Supervisor and/or Administrator and reported to the pest control company. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide reasonable accommodations of needs by failing to ensure one resident (Resident #2) with hemiplegia (paralysis on one side of the body) had a call system he/she was able to use, and by failing to ensure call systems were within reach for two residents with impaired mobility (Residents #2 and #5). The sample was 17. The census was 66. 1. Review of Resident #2's electronic medical record (EMR), showed diagnoses included hemiplegia, epilepsy (seizure disorder), high blood pressure, abnormal posture, dementia without behavioral disturbance, depression, anxiety, and psychotic disorder. Review of the resident's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 10/8/23, showed: -Severe cognitive impairment; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to promote and facilitate self-determination for one resident who was dependent on staff for transfer assistance, by failing to ensure the resident was out of bed daily, in accordance with the resident's preferences (Resident #2). The sample was 17. The census was 66. Review of Resident #2's electronic medical record (EMR), showed diagnoses included hemiplegia (paralysis of one side of the body), epilepsy (seizure disorder), high blood pressure, abnormal posture, dementia without behavioral disturbance, depression, anxiety and psychotic disorder (mental disorder characterized by a disconnection from reality). Review of the resident's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 10/8/23, showed: -Severe cognitive impairment; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure resident requests for less than $100.00 ($50.00 for Medicaid residents) are honored within the same day (Resident #21). The sample was 17. The census was 66. Review of the facility's Resident Fund Management Service (RFMS) policy, last revised January 2022, showed: -Protocol. The facility will safeguard and manage resident funds in accordance with state regulation; -Procedure includes: A petty cash fund up to fifty ($50) for each resident for whom the facility is holding funds may be kept in the facility and shall be maintained separately from the facility's funds; -The policy did not provide guidance for staff to ensure resident requests for less funds than $100.00 or $50.00 are honored within the same day. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate code statuses were entered into the medical record for 3 out of 17 residents reviewed for code status orders at the facility (Residents #16, #11 and #5). The census was 66. Review of the facility's Advanced Directives clinical operations policy, revised [DATE], showed: -The facility will comply with a resident's advanced care directives in pre-determining their healthcare future, whenever possible, should they become terminally ill and unable to communicate or in an emergency situation; -The facility will actively seek to obtain information regarding advanced directive wishes from each resident; -Any existing or active directives will be reviewed and copied into the medical record at the time of admission. 1. Review of Resident #16's medical record, showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain accurate care plans individualized for each resident's needs for 3 of 17 sampled residents. The facility failed to update care plans to ensure weight loss and nutritional interventions were included after two residents suffered unplanned weight loss (Residents #41 and #43) and failed to update a care plan after removal of a catheter (Resident #48). The census was 66. Review of the facility's Policy for Comprehensive Care Planning, revised on 1/2022, showed: -Purpose: to develop and maintain an individualized care plan for residents residing in the facility; -Goal: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure services provided met professional standards of practice when skin assessments were not completed on a weekly basis by a licensed nurse in accordance with the facility's policy, for two residents identified as very high risk for developing pressure ulcers (Residents #2 and #5). In addition, the facility failed to ensure one resident received a medicated shampoo, as ordered by his/her physician (Resident #38). The sample was 17. The census was 66. Review of the facility's Skin Program Policy and Procedure policy, showed: -Purpose: The purpose of the skin program is to ensure that every resident's skin condition is observed/evaluated on admission and a comprehensive and interdisciplinary care plan is developed and maintained to treat actual and/or prevent potential skin problems; -Policy: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide Activities of Daily Living (ADL) care by failing to ensure residents were cleaned following incontinence in a timely manner for two residents (Residents #29 and #38) and failed to ensure one resident's feet were assessed and treated for dry skin (Resident #36). The sample was 17. The census was 66. Review of the facility's Personal Care Needs policy, revised on 1/10/19, showed the following: -Protocol: The facility strives to promote a healthy environment and prevent infection by meeting the personal care needs of the residents. The facility also provide the needed support when the resident performs their ADLs. The Interdisciplinary Plan of Care (IPOC) will address the individual needs and preferences of the resident. Personal care and ADL support will be provided according to the resident Plan of Care. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents received care consistent with professional standards. One resident had a change in his/her respiratory condition and staff failed to notify the physician and perform respiratory assessments (Resident #4). One resident was admitted to the facility with a chronic (long term) wound under his/her left arm and staff failed to document the wound on admission or obtain treatment orders for the wound (Resident #163). In addition, staff failed to identify a skin rash and obtain treatments orders for one resident (Resident #38). The sample was 17. The census was 66. Review of the facility's Episodic and Narrative Documentation Policy, reviewed 1/5/22, showed: -Protocol: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to document an unwitnessed fall, complete fall documentation after the fall, notify the responsible party and physician of the fall and have fall interventions in place for one resident (Resident #163). The sample was 17. The census was 66. Review of the facility's Fall Programs policy, reviewed January, 2023, showed: -Purpose: To identify all residents who have a high risk for fall and to ensure adequate interventions are in place to prevent a major injury; -Procedure: -The fall risk assessment will be completed on every resident upon admission and re-admission by the nurse on the shift that the resident is admitted on ; -When a resident is identified as being at high risk for fall, this will be identified on the baseline care plan upon admission. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure respiratory services provided were consistent with professional standards of practice for one resident (Resident # 4) when staff failed to obtain physician orders related to changing oxygen tubing and nebulizer (route in which breathing medicine is administered) tubing and follow the physician orders for oxygen. The sample was 17. The census was 66. Review of the facility's Disinfection and Cleaning policy, updated July, 2022, showed: -Oxygen tubing is to be dated, changed out weekly and as needed and placed in a plastic bag when not in use. High humidity nebulizer (HHN) equipment is to be dated and washed after each use and is to be changed out weekly and placed in a plastic bag when not in use. [...]

Inspectors wroteBased on interview and record review, the facility failed to establish a system of record for all controlled drugs with sufficient detail to enable an accurate reconciliation for two out of four medication carts reviewed. This had the potential to affect all residents with controlled substance orders. The census was 66. Review of the facility Medication Storage policy, dated November 2021, showed: -At each shift change, or when keys are transferred, a physical inventory of all controlled substances, including refrigerated items, is conducted by two licensed nurses and is documented on the shift change form; -Controlled substance accountability records are kept in the medication administration record, or designated book. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident (Resident #163) was free from significant medication error by not informing the pharmacy that a script from the physician was required for the resident's Drobnabinol (a controlled substance that stimulates appetite and helps control nausea and vomiting) and Tramadol (a pain reliever). The resident missed 11 doses of his/her Drobnabinol and his/her Tramadol was not readily available to administer to the resident if the resident requested it. The sample size was 17. The census was 66. Review of Resident #163's admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 10/12/23, showed: -admission date 10/5/23; -Cognitively intact. Review of the resident's face sheet, showed diagnoses that included: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure permanent facility Certified Nurse Aides (CNAs) received a minimum of 12 hours of ongoing clinical education annually. One out of one staff, identified as a permanent facility CNA working at the facility for over a year, did not complete the required 12 hours of ongoing clinical education required within the hire date to hire date annual anniversary timeline. The facility census was 67. 1. Review of the facility's Center Assessment Tool, updated 11/10/22 showed the following, regarding staff training and ongoing education requirements: -All new employees will receive ongoing education at the time of hire and as necessary; -All team members will receive annual education; -CNAs are required to have 12 hours of education annually; -Education can be added at any time due to the needs of the Center and/or residents. 2. [...]

Inspectors wroteBased on observation and interview, the facility failed to post the name, address, and telephone number for the State Survey Agency, and a statement that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation, including but not limited to resident abuse, neglect, exploitation, and misappropriation of resident property. The census was 66. Observations throughout the survey from 10/23/23 through 10/27/23, showed no contact information for the State Survey Agency posted in the facility. During a Resident Council meeting on 10/24/23 at 2:00 P.M., six out of seven residents, whom the facility identified as alert and oriented, said they did not know where contact information for the State Survey Agency was located. They did not know how to report a complaint to the State Survey Agency. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the safety of one of seven sampled residents (Resident #1) when staff allowed a resident with moderate cognitive impairment to leave the building unaccompanied. On 9/10/23 at approximately 8:00 A.M., Housekeeper G entered the front door keypad code to allow Resident #1 out of the building. The resident told Housekeeper G he/she was a staff member. Registered Nurse (RN) D witnessed the housekeeper open the door for the resident, but was not familiar enough with the resident to realize the housekeeper allowed a confused resident to leave the building. At least two other staff saw someone outside in the neighborhood during the day, but they were also not familiar enough with the resident to report this to management in a timely manner. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to adequately monitor one resident who had a physician's order and a speech therapist's recommendation for NPO (nothing by mouth). The facility staff allowed the resident to continue to eat solids foods and drink liquids after being identified as a high risk for aspiration (choking). The facility identified two residents who had orders for NPO. Both residents were sampled and problems were identified with one (Resident #18). In addition, the facility failed to implement resident-directed care and treatment consistent with the resident's preferences, physician's orders, and professional standards of practice by failing to reposition a resident with total dependence on staff for mobility, and consistently apply treatment to the resident's skin, which was 90% covered in burns (Resident #23). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one of one resident (Resident #192), who the facility identified as receiving intravenous (IV) antibiotics, received a dose at the correct infusion rate and failed to ensure IV antibiotics were administered to the resident as prescribed by the physician. The resident received three different IV antibiotics due to an abcess that occurred after brain surgery. The sample size was 16._The facility census was 65. 1. Review of Resident #192's facility face sheet, showed the following: -admitted to the facility on [DATE]; -Diagnoses included high blood pressure, stroke and cerebral aneurysm-unruptured (a bulge or ballooning of a blood vessel in the brain). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure adequate staffing numbers to provide consistent resident care for activities of daily living (ADL)s and restorative therapy (RT). This had the potential to affect all residents residing in the facility. The census was 65. During an interview on 10/29/20 at 11:09 A.M., Certified Nurse Aides (CNA)s M and BB said they feel like the facility is always short staffed. There are usually four CNAs on the day shift and that is not enough. CNA BB said yesterday he/she was assigned four showers and he/she only had time to complete two of them. Today he/she was assigned three showers and may only have time to complete two but had not had time yet to complete even one. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff treated residents with dignity by leaving one resident (Resident #190) laying on a Hoyer sling (large piece of material that cradles the resident during transfer) for at least two hours after the resident requested to be transferred from the bed into a chair. The facility also failed to ensure one resident's (Resident #236's) colostomy bag (a small waterproof pouch to collect waste from the body) was clean. The resident sat in his/her room with towels underneath the colostomy bag as he/she waited for staff to clean it. The facility also left two residents (Resident #22 and Resident #18) exposed in their personal bedrooms in stages of undress while staff and other residents walked past their rooms. This deficient practice affected four of 16 sampled residents. The census was 65. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to follow acceptable accounting principles by allowing a resident's account to have a negative balance (Resident #303) and not having updated and accurate authorization forms for approximately 45 residents whose funds the facility held. The census was 65. 1. Review of Resident #303's resident trust account, showed the following: -Expired [DATE]; -Balance on [DATE], zero; -Balance on [DATE], -$858.00; -Balance on [DATE], -$858.00; -Balance on [DATE], -$50.00; -Balance on [DATE], -$50.00; -Balance on [DATE], $500.26; -Balance on [DATE], $0.00. During an interview on [DATE] at 2:10 P.M., the business office manager/dietary manager (BOM/DM) said the resident was admitted , and he/she expired soon after admission. She received the check and deposited it in the bank and then it was withdrawn. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure third party liability (TPL) forms were completed for the final accounting for residents who expired, within 30 days. This affected four residents who expired and had money in their account (Resident's #301, #302, #303 and #304). The census was 65. 1. Review of Resident #301's resident fund account, showed the following: -He/she expired on [DATE]; -He/she had a balance of $395.12; -TPL completed [DATE]. 2. Review of Resident #302's resident fund account, showed the following: -He/she expired on [DATE]; -He/she had a balance of $2630.83; -TPL completed [DATE]. 3. Review of Resident #303's resident fund account, showed the following: -He/she expired on [DATE]; -He/she had a balance of $500.27; -TPL completed [DATE]. 4. Review of Resident #304's resident fund account, showed the following: -He/she expired on [DATE]; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure they maintained an adequate bond in the amount of one and one-half times the average monthly balance for the past 12 months. The census was 65. Review of the resident trust account, showed the following: -From October 2019 to September 2020, the average monthly balance was $35,043.77. This would require a bond in the amount of $52,500; -Review of the Department of Health and Senior Services data base for approved bonds, showed the facility had a bond in the amount of $50,000; -Review of the resident current balance report for October 2020, showed an amount of $33,967.35 in the trust account. During an interview on 10/27/20 at 1:12 P.M., the administrator said the corporate office over sees the bond amount to make sure it is sufficient.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the residents' environment and equipment was maintained to be in good repair, when the front door alarm went off repeatedly. Furthermore, the facility failed to prevent the potential misappropriation of property for eight of 16 sampled residents, two expanded sample residents and one closed sample resident. (Residents #137, #15, #27, #32, #24, #19, #34, #136, #140, #190 and #192) when facility staff did not complete an admitting and discharge personal inventory form or ensure their accuracy, or follow their policy for investigating lost items. The facility census was 65. 1. Observations of the front door alarms, showed the alarm sounded loudly at the following times: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure newly hired employees were screened to rule out the presence of a Federal Indicator with the Certified Nurse Aide (CNA) Registry for eight of ten sampled employees hired since the last survey. The census was 65. According to the Department of Health and Senior Services (DHSS), Section for Long Term Care LTC Bulletin Volume 6, winter of 2008, showed providers are required to check the registry before hiring any individual and may not continue to employ a person whose name appears on the registry with a federal indicator. Providers must seek verification from all states believed to have information on the individual. Review of the facility's undated Onboarding a New Hire policy, showed the following: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement person centered comprehensive care plans to accurately reflect individual care needs for one resident requiring topical ointment due to his/her skin 90% covered in burns, who was unable to use a push-button call light, and had preferences to be out of bed and to smoke cigarettes (Resident #23), one resident requiring catheter care (Resident #32) and another resident with recent weight loss (Resident #7). The sample size was 16. The census was 65. 1. Review of Resident #23's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 9/3/20, showed the following: -admitted [DATE]; -Cognitively intact; -Rejection of care not exhibited; -Total dependence of two (+) person physical assistance required for bed mobility and transfers; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure services provided met professional standards of practice when staff failed to obtain parameters of when to notify the physician due to high or low blood glucose levels for one resident and failed to follow the physician's order to notify the physician when one resident's blood glucose levels exceeded the ordered parameters. The facility identified 14 residents with orders to obtain blood glucose levels. Of those 15, four were sampled and four were selected from an expanded sample. Problems were identified with two of the four residents from the expanded sample. (Residents #1 and #88). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents that require assistance with activities of daily living received that assistance with showers, nail care and facial care as scheduled. Problems were identified with 13 of the 16 sampled residents (Residents #10, #24, #32, #34, #7, #11, #19, #23, #27, #31, #186, #190 and #192). In addition, one resident did not receive appropriate perineal care during an observation of perineal care. (Resident #22). The census was 65. 1. Review of Resident #10's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 7/4/20, showed the following: -admission date of 7/28/20; -Understood/understands; -BIMS score of 12 (a score of 8-12 indicates moderately impaired cognition); -Extensive assistance of two (+) persons required for bed mobility; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure appropriate care and services were provided to residents to prevent the development of pressure ulcers and treat those residents with pressure ulcers. Facility staff failed to consistently ensure pressure ulcer treatments were completed as ordered and per acceptable nursing standards and failed to thoroughly assess residents' skin and obtain orders for new wounds. One resident was chosen as a closed record and problems were identified (Resident #38). The facility identified five residents with pressure ulcers. Of those five, one was sampled (Resident #24) and one was discovered during the survey (Resident #19). The sample size was 16. The census was 65. Review of the facility Skin Program Policy and Procedure, dated 5/28/19, showed the following: Purpose: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents received restorative therapy services as needed either due to contractures or limited range of motion. The facility identified 19 residents admitted with contractures and 15 residents that received restorative nursing services. Of those 15, four were part of the survey sample and two were selected as an expanded sample. Problems were identified with all six residents. (Residents #140, #141, #24, #16, #186 and #19). The census was 65. 1. Review of Resident #140's medical record, showed the following: -admission date of 11/25/19; [...]

Inspectors wroteBased on observation, interview and record review, the faility failed to follow their smoking policy for residents that smoke. Residents were observed with their own lighters and smoking unsupervised. The facility identified 15 residents that smoke. Of those 15, two were sampled and three were selected for an expanded sample and problems were identified with all five. One of those five residents had a history of falls and the facility failed to follow their falls program policy by failing to complete the required post fall documentation and assessments. (Residents #130, #9, #19, #87, and #236). In addition, the facility failed to ensure staff followed their policy and safety guidelines while transferring residents with mechanical lifts. Three residents were observed being transferred, two that required a hoyer lift and one that required a sit to stand lift. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their Bed Rail policy for residents using bed rails, by not having physician orders or assessments for use or safety. The facility identified six residents that used bed rails. Of those six, one was sampled (Resident #18) and two were selected as expanded sample (Residents #23 and #39) and problems were identified with all three. The census was 65. Review of the facility Bed Rail policy, dated 11/27/19, showed: -The facility will attempt to use appropriate alternatives prior to installing a side rail or bed rail. If a bed/side rail is used the facility will verify correct installation, use, and maintenance of bed rails; -Protocols: 1) Assess the resident for risk of entrapment from bed rails prior to installation; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that nursing staff have the specific competencies and skill sets necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care and are able to demonstrate competency in skills and techniques necessary to care for residents' needs when a nurse provided care outside of his/her scope of practice for one resident (Resident #192) by administering intravenous (IV) antibiotics without proper certification. The facility failed to ensure staff had the competent skills to properly assess a resident receiving dialysis services (process for removal of waste and excess water from the blood due to kidney failure) for one resident (Resident #21). [...]

Inspectors wroteBased on interview and record review, the facility failed to follow their policy and properly document narcotic counts for controlled substances on two of two medication carts. The census was 65. 1. Review of the narcotic count sheet, dated 9/1 through 9/30/20, for resident halls 100, 500 and the back half of 400, showed the following: -No documentation of the total number of narcotic cards on 20 shifts; -No signature by the on-coming nurse on 27 shifts; -No signature by the off-going nurse on 26 shifts. 2. Review of the narcotic count sheet, dated 10/1 through 10/25/20, for resident halls 100, 500 and the back half of 400, showed the following: -No documentation of the total number of narcotic cards on 33 shifts; -No signature by the on-coming nurse on 22 shifts; -No signature by the off-going nurse on 38 shifts. 3. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication error rate of less than 5%. Out of 28 opportunities for error, four errors occurred resulting in a 14.29 % medication error rate (Residents #192, #35 and #140). The census was 65. 1. Review of Resident #192's facility face sheet, showed the following: -admitted to the facility on [DATE]; -Diagnoses included high blood pressure, stroke and cerebral aneurysm-unruptured (a bulge or ballooning of a blood vessel in the brain). Review of the physician's order sheet (POS), showed an order, dated 10/20/20, to administer intravenous (IV) Vancomycin (antibiotic) 200 milliliters (ml) every 12 hours. Review of the medication administration record (MAR), showed scheduled administration times for Vancomycin as 8:00 A.M. and 9:00 P.M. [...]

Inspectors wroteBased on observation and interview, the facility failed to label, date and properly store opened food items in the freezer during four of seven days of observation. This deficient practice affected all residents who ate at the facility. The census was 65. Observation of the freezer on 10/22/20 at 8:24 A.M., showed the following unlabeled and undated food items: -Approximately four bags of unidentified food substances, opened, white in color and freezer burned; -One bag of what appeared to be bread sticks, opened and freezer burned; -Three bags of a square shaped patty, opened and freezer burned; -Two bags of an unidentified food substance, brown in color, opened and freezer burned. Observation of the freezer on 10/23/20 at 5:54 A.M., showed the following unlabeled and undated food items: -Two bags of what appeared to be pork riblets, opened and freezer burned; [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records on each resident that are complete and readily accessible in accordance with accepted professional standards and practices. The sample was 16 and issues were found with seven resident records reviewed (Residents #27, #34, #186, #140, #19, #24 and #31) and two additional sampled residents (Residents #137 and #15). This had the potential to affect residents if the electronic medical records (EMR) were not available. The census was 65. 1. Review of Resident #27's quarterly Minimum Data Set (MDS), a federally mandated assessment completed by facility staff, dated 9/4/20, showed: -admission date of 5/20/20; -Diagnoses included pneumonia, Parkinson's disease (a disorder of the central nervous system that affects movement, often including tremors) and human immunodeficiency virus (HIV). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff followed acceptable infection control practices during care. One staff member was observed laying clean towels in a dirty sink, then using the towels to clean one resident (Resident #18). In addition, staff failed to wash their hands prior to and after providing perineal care (washing the genitalia and buttocks) and assessing a pressure ulcer (Residents #198 and #32). The facility also failed to adhere to the Center for Disease Control and Prevention (CDC) guidelines for the 2019 Novel Coronavirus Disease (COVID-19). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their Bed Rail policy by not checking bed rails monthly by maintenance to verify they are secured and installed properly to the resident's bed frame. The facility identified six residents that used bed rails. Of those six, one was sampled (Resident #18) and two were selected as expanded sample (Residents #23 and #39) and problems were identified with all three. The census was 65. Review of the facility Bed Rails policy, dated 11/27/19, showed: -The facility will attempt to use appropriate alternatives prior to installing a side rail or bed rail. If a bed/side rail is used the facility will verify correct installation, use, and maintenance of bed rails; -Protocols: 1) Assess the resident for risk of entrapment from bed rails prior to installation; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide reasonable accommodations of individual needs and preferences by failing to ensure a resident with hemiplegia (paralysis to one side) had a call system they were able to use and within their reach (Resident #23). The sample size was 16. The census was 65. Review of Resident #23's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 9/3/20, showed: -admitted [DATE]; -Cognitively intact; -Total dependence of one or two person physical assist required for bed mobility, transfers, eating, dressing, and personal hygiene; -Upper and lower extremities impaired on both sides; -Diagnoses include dementia, hemiplegia or hemiparesis, depression, and burns involving 90% or more of body surface with 90% or more of third degree burns. [...]

Inspectors wroteBased on interview and record review, the facility failed to enforce restrictions placed on one employee by the state Board of Nursing. The employee was not allowed to work without supervision, and the facility failed to ensure this happened for six out of seven shifts reviewed. The census was 65. Review of Nurse N's employee file, showed the following: -A finding by the Missouri State Board of Nursing, dated 6/12/19, showed: -Employment Restrictions (two years) included: Respondent (Nurse N) shall only work as a nurse where there is on-site supervision by someone with the authority to send Respondent home. Respondent shall not work in home healthcare, hospice or durable medical equipment; -An application, dated 10/8/20, showed: -Position applied for: Registered Nurse; -Have you been charged/convicted of a felony and/or misdemeanor/or served time? Yes; -If yes, please describe: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to remove an indwelling catheter (a sterile tube inserted into the bladder to drain urine) as ordered, failed to obtain complete physician orders for indwelling urinary catheters, and failed to maintain proper placement of catheter tubing and drainage bags. The facility identified four residents as having indwelling and/or supra pubic urinary catheters (a sterile tube inserted into the bladder through the abdominal wall to drain urine). Of those four, three were chosen for the sample and problems were found with two residents (Residents #34 and #32). The sample size was 16. The census was 65. 1. Review of Resident #34's admission Minimum Data Set (MDS), a federally mandated assessment completed by facility staff, dated 10/2/20, showed the following: -An admission date of 9/25/20; -Cognitively intact; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement approaches for weight loss by failing to consistently provide nutritional supplements and feeding assistance for one resident identified with severe weight loss (unplanned loss greater than 5% of body weight in one month, greater than 7.5% in three months, or greater than 10% in six months) (Resident #7). The sample size was 16. The census was 65. Review of Resident #7's medical record, showed the following: -admitted [DATE]; -On 6/8/20, weight of 129.0 pounds (lbs.); -July 2020 weight not documented; -admitted to hospice on 7/9/20, due to stroke; -A physician order, dated 7/15/20, for med pass (nutritional supplement) three times a day, and feeding assistance; -Diagnoses included abnormal weight loss, dementia, and dysphagia (swallowing disorder) following stroke. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff followed the facility's policy regarding the administration of medications through a gastronomy tube (g-tube, a small rubber tube surgically inserted through the abdomen in to the stomach to administer nutrition, fluids and medications) by administering one resident's morning medications together instead of individually (Resident #192). The sample size was 16. The facility census was 65. Review of Resident #192's facility face sheet, showed the following: -admitted to the facility on [DATE]; -Diagnoses included high blood pressure, stroke and cerebral aneurysm-unruptured (a bulge or ballooning of a blood vessel in the brain). [...]

Inspectors wroteBased on interview and record review, the facility failed to act upon irregularities identified by a licensed pharmacist's medication regimen reviews (MRR), and to document the physician's response to irregularities noted, for four of 16 sampled residents (Residents #23, #7, #11, and #18). The census was 65. 1. Review of Resident #23's electronic medical record (EMR), showed the following: -admitted on [DATE]; -Diagnoses included chronic kidney disease, squamous blepharitis (chronic inflammation of the eyelid border), abnormal weight loss, depression, high blood pressure, epilepsy (seizure disorder), and burns involving 90% or more of body surface with 90% more of third degree burns; -A progress note, dated 7/10/20, showed pharmacy review complete. Nursing request; -No documentation specifying the pharmacist's recommendation from 7/10/20; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a thorough facility assessment to determine what resources were necessary to care for residents competently during both day to day operations, as well as during emergencies, by not addressing the use of, and need for, agency staff. This had the potential to affect all residents. The census was 65. 1. Review of the Facility Assessment, last reviewed on 10/22/20, showed the following: -Average daily census: 60-75 residents; -Assistance with activities of daily living (ADLs, self care activities): -Dressing: 50 residents required assist of 1-2 staff, 5 residents dependent on staff; -Bathing: 48 residents required assist of 1-2 staff, 13 residents dependent on staff; -Transfers: 37 residents required assist of 1-2 staff, 16 residents dependent on staff; -Eating: [...]

Inspectors wroteBased on interview and record review, the facility failed to develop a plan that identified and corrected quality deficiencies as well as opportunities for improvement, which would lead to improvement in the lives of the nursing home residents, through continuous attention to quality of care, quality of life, and resident safety, by not informing their medical director of ongoing resident care issues. This deficient practice had the potential to affect all residents living in the facility. The census was 65. Throughout the survey process from 10/22/20 through 10/23/20 and 10/26/20 through 10/30/20, the survey team identified activities of daily living (ADLs, self care such as showers, shaving and grooming) and the restorative treatment (RT) programs (exercises for range of motion to joints and assistance with walking) were not being completed as scheduled. [...]