Community Nursing Home of Anaconda

Inspectors wroteBased on observation and interview, the facility failed to have a designated registered nurse to serve as the director of nursing on a full-time basis. This deficient practice resulted in a failure of clinical oversight for all residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to submit mandatory payroll-based data to CMS. This deficient practice prevented CMS review of the level of staff, employee turnover, and tenure to ensure safe staffing levels.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the QAPI team identified, reported, investigated, and documented the development, implementation, and evaluation of corrective actions for performance improvement projects related to known activities department deficient practices for 2 (#s 2 and 6) of 14 sampled residents, and this failure increased the risk of all residents being affected due to the lack of necessary or preferred activities.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the required personal protective equipment, i.e. N95 respirator, was available to staff and visitors. upon entry to the facility during a COVID-19 outbreak; failed to ensure staff properly wore N95 respirators during a COVID-19 outbreak; and failed to ensure staff wore faceshield/masks while in residents' rooms who had tested positive for COVID-19 for 4 (#s 6, 9, 12, and 16) of 4 confirmed COVID-19 positive residents, which remained on contact and droplet precautions. These failures likely contributed to the spread of COVID-19 and could affect all residents, staff, or visitors at the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure medication error rates were not 5 percent or greater by crushing medications administered to residents without a physician's order for 2 (#s 7 and 13) of 5 residents observed for medication administration. The medication error rate was 24 percent.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure catheter bags were covered for 1 (#6) of 14 sampled residents. This deficient practice resulted in resident #6 feeling embarrassed to have the catheter bag visible to others.

Inspectors wroteBased on observation, interview, and record review, the facility failed to honor a resident's preferences of not being woken up in the morning and given a breakfast tray for 1 (#2) of 14 sampled residents. This deficient practice caused resident #2 frustration and anger leading to behaviors.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff member B protected a resident's right to privacy and confidentiality of her medical record for 1 (#9) of 5 residents observed for medication administration.

Inspectors wroteBased on observations, interviews and record review, the facility failed to develop a comprehensive person-centered care plan, including the residents' preferences, for 2 (#s 2 and 6) of 14 sampled residents. This deficient practice resulted in resident #s 2 and 6 not having activities to meet their preferences.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff member B adhered to medication administration best practice by crushing a medication indicated on a Do Not Crush medication listing for 1 (#13) of 5 residents observed for medication administration.

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide activities to meet the interests and preferences of residents who remain in their rooms for 2 (#s 2 and 6) of 14 sampled residents. This deficient practice led to boredom for resident #6 and frustration for resident #2.

Inspectors wroteBased on interviews and record review, the facility failed to maintain collaborative records for medication administration and care plans which aligned with the hospice agency for 2 (#s 2 and 15) of 3 hospice patients sampled.

Inspectors wroteBased on observation, interview, and record review, staff member B failed to ensure the security of all medications in a locked storage medication cart, limiting access to unauthorized personnel, and or residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure an agency staff member, who was contracted with the facility for over 12 months, had an annual performance review completed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive care plan based on resident activity preferences and physical abilities, for 4 (#s 4, 10, 14, and 15) of 10 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide residents with group and individual activities to meet their interests and support their physical, mental, and psychosocial well-being for 4 (#s 4, 10, 14, and 15) of 10 sampled residents. 1. During an observation and interview on 8/26/24 at 11:13 a.m., resident #15 was sitting in her wheelchair in her room. The room was quiet, and she was facing the wall, looking forward. Resident #15 had trouble answering questions and was mostly nonverbal, but when asked if she was bored, she nodded her head in an up-and-down motion. During an interview on 8/28/24 at 3:56 p.m., NF2 stated, It would be nice if there were more for [Resident #15] to do. I understand it is hard because she really can't communicate, though. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide dignity for a resident when transferring the resident to the shower room for 1 (#9) of 10 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to consult wound care services consistently to promote wound healing, and failed to sufficiently document the wound measurements, severity (Stage), and characteristics of the wound, for 1 (#6) of 10 sampled residents. This failure resulted in the wound continuing to remain as a Stage II pressure ulcer for four months (4/9/24 to 8/15/24) with little improvement or intervention, and the wound first started approximately a year ago (7/21/23).

Inspectors wroteBased on observation and interview, the facility failed to remove expired medical supplies from the medical supply room and the medical supply cart for 1 of 1 sampled the medical room and medical cart.

Inspectors wroteBased on interview and record review, the facility failed to notify the physician of a severe weight loss for 1 (#7) of 2 sampled residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was free from a physical restraint, for 1 (#8) of 1 sampled resident.

Inspectors wroteBased on observation, interview and record review, the facility failed to prevent and promote healing of skin breakdown for 1 (#8) of 1 sampled resident.

Inspectors wroteBased on interview and record review, the facility failed to identify root causes of falls for 2 (#s 7 and 8) of 5 sampled residents; and implement fall interventions for 1 (#8) of 1 sampled resident.

Inspectors wroteBased on interview and record review, the facility failed to identify and provide interventions for a resident with a severe weight loss of 10% in three months, for 1 (#7) of 2 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to document a rationale for extending a PRN psychotropic medication beyond 14 days, for 2 (#s 3 and 11) of 2 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to secure a bed cane, and provide a fully functioning bed, for 1 (#14) out of 3 sampled residents. This failure resulted in discomfort for the resident, and had the potential to lead to injury for resident #14.