Centerville Care and Rehab Center Inc

Inspectors wroteBased on South Dakota Department of Health (SD DOH) facility reported incident (FRI), interview, record review, and policy review, the provider failed to protect the residents' right to be free from physical abuse for one of one sampled resident (1) who was pinched and scratched on her hand by one of one certified nursing assistant (CNA) D while she was assisting resident 1 to eat.

Inspectors wroteBased on interview and Certification and Survey Provider Enhanced Reports (CASPER) reporting data review, the provider failed to ensure their Payroll Based Journal (PBJ) (information of the provider's daily staffing hours for the appropriate care of the residents) had been completed and submitted to the Center for Medicare and Medicaid Services (CMS) for the months of May and June in Quarter 3 of fiscal year (FY) 2024 to support licensed nurse coverage 24 hours a day had occurred.

Inspectors wroteBased on observation, interview, and policy review, the provider failed to follow standard food safety practices to ensure one of one kitchen had been cleaned to maintain a sanitary environment to store, prepare, and serve food to residents. Multiple areas within the kitchen appeared unclean.

Inspectors wroteBased on interview and review of Certification and Survey Provider Enhanced Reports (CASPER) reporting data, the provider failed to ensure their Payroll Based Journal (PBJ) (information of the providers daily staffing hours for the appropriate care of the resident)s had been complete and the data had been submitted to the Center for Medicare and Medicaid Services (CMS) for the months of May and June in Quarter 3 of FY 2024. 1. Review of the provider's CASPER reporting data revealed that PBJ data submitted for the following dates in Quarter 3 2024 demonstrated the provider failed to ensure Licensed Nursing Coverage 24 hours per day: -May 1 through 31 for a total of 22 days. -June 1 through 30 for a total of 21 days. Interview on 5/21/25 at 11:00 a.m. with emergency permit holder administrator A (EPH administrator A) revealed: *She was hired at the facility on 1/20/25. [...]

Inspectors wrote8. Observation and interview on 5/19/25 at 1:09 p.m. with resident 1 in his room revealed: *He had a suprapubic catheter (a tube surgically placed in the bladder through the abdomen to drain urine). *He had wounds to his coccyx (tailbone) and buttock. *There was no personal protective equipment (PPE) such as gowns, available for use in his room. *He stated staff wore gloves, but no gowns when they emptied his catheter and when completing his wound care. *There was no signage in his room for enhanced barrier precautions (EBP). 9. Review of resident 1's electronic medical record (EMR) revealed: *He was admitted on [DATE]. *His Brief Interview for Mental Status (BIMS) assessment score was 15 which indicated he was cognitively intact. *He had acquired a wound on 3/3/25 to his right inner gluteus (buttock) fold. *He had acquired a wound on 3/3/25 to his coccyx (tailbone). [...]

Inspectors wroteBased on interview and record review, the provider failed to ensure that one of one designated infection preventionist Minimum Data Set (MDS) coordinator C had completed specialized training in infection prevention and control as required by the Centers for Medicare and Medicaid Services (CMS).

Inspectors wroteBased on record review, interview and Centers for Medicare and Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual review, the provider failed to ensure the Minimum Data Set (MDS) assessments were completed accurately for one of one sampled resident (29) who was not taking a diuretic medication.

Inspectors wroteBased on observation, interview, record review and policy review the provider failed to ensure resident care plans had been revised to reflect their current needs for three of three sampled residents (1, 5 and 25) that required the use of Enhanced Barrier Precautions (EBP) for catheter care and/or wound care.

Inspectors wroteBased on South Dakota Department of Health (SD DOH) complaint intake review, interview, and policy review, the provider failed to report an allegation of suspected abuse for one of one sampled resident (27).

Inspectors wroteBased on South Dakota Department of Health (SD DOH) facility reported incident (FRI), observation, interview, record review, and policy review, the provider failed to ensure adequate supervision for one of one sampled resident (18) identified at risk for wandering to prevent him from leaving the building without staff knowledge or supervision. Failure to provide supervision while the resident was outside of the building put the resident at risk for potential accident and/or injury. This citation is considered past non-compliance based on the provider's corrective actions implemented following the incident.

Inspectors wroteBased on interview, record review, policy review, and South Dakota Department of Health (SD DOH) facility reported incident (FRI) the provider failed to ensure two of two sampled residents (1 and 2) had been assessed, care plans were updated, and education was provided to staff regarding having been fondled by a co-located resident (4).

Inspectors wroteBased on Certification and Survey Provider Enhanced Reports (CASPER) data review, staff schedule and timecard review, and interview, the provider failed to ensure Payroll Based Journal (PBJ) (information of the provider's daily staffing hours for the appropriate care of the residents) data was accurately completed prior to submission to the Center for Medicare and Medicaid Services (CMS) for three of four federal fiscal quarters (2, 3, and 4) of 2023.

Inspectors wroteA. Based on observation, interview, and policy review, the provider failed to ensure as needed (PRN) medications stored in blister pack cards with pharmacist determined expiration dates had been monitored for expiration and removed for destruction for four of four sampled residents (7, 10, 17, and 22) in two of two medication carts (100/200 and 300/400).

Inspectors wroteBased on observation, interview, record review, and policy review, the provider failed to ensure six of six sampled residents (8, 9, 28, 32, 35, and 141) had: *Received the risks versus the benefits education for side rail use. *Obtained a signed informed consent forms for side rail use. *Quarterly assistive safety device assessments completed for side rail use. *Alternatives to side rails were attempted prior to the installation of side rails on the residents beds.

Inspectors wroteBased on record review, interview, and policy review, the provider failed to ensure the accuracy of current diagnoses and resident events had been captured on the Minimum Data Set (MDS) assessment for two of two sampled residents (7 and 28).

Inspectors wroteBased on observation, interview, record review, and policy review the provider failed to ensure care plans were reviewed and revised to ensure care needs were accurately reflected for one of one sampled resident 35.

Inspectors wroteBased on observation, interview, record review, and policy review, the provider failed to: *Assess and complete documentation for one of one sampled resident (4) who had her Foley catheter removed. *Assess and provide interventions for one of one resident (28) who was constipated. *Assess two of two sampled residents (7 and 26) to ensure they had been safe to self-administer medications after set-up by nursing staff.

Inspectors wroteBased on interview and Certification and Survey Provider Enhanced Reports (CASPER) reporting data review, the provider failed to ensure their Payroll Based Journal (PBJ), (information of the provider's daily staffing hours for the appropriate care of the residents) had been complete and the data had been submitted to the Center for Medicare and Medicaid Services (CMS) for three of three quarters in 2022.

Inspectors wroteBased on observation, interview, record review, and policy review, the provider failed to ensure infection prevention and control practices had been maintained for the following: *Hand hygiene during one of one observed dressing change by one of one director of nursing B. *Handling and cleaning of a glucometer by one of one registered nurse (E) during use for one of one observed resident (16).

Inspectors wroteBased on record review, interview, and policy review, and Centers for Disease Control and Prevention (CDC) recommendations, the provider failed to ensure three of five randomly sampled residents (19, 21 and 28) had documented pneumonia vaccination administration or the refusal of the vaccine in their medical records.