Delmar Gardens of Meramec Valley

Inspectors wroteBased on observation, interview and record review, the facility failed to follow acceptable infection control standards by not implementing Contact Precautions (CP, precautions that reduce the risk of transmission of infectious materials by direct contact.) for one resident (Resident #19), failed to implement Enhanced Barrier Precautions (EBP, an infection control intervention designed to reduce the transmission of multidrug-resistant organisms (MDROs) that employs targeted gown and glove use during high contact resident care activities) as recommended by the Centers for Disease Control and Prevention (CDC) and required by the Centers for Medicare and Medicaid Services (CMS) for four of 30 sampled residents (Residents #2, #3, #71, and #179), and failed to ensure hand hygiene was performed by staff while feeding a resident (Resident #146). The census was 153. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure respiratory services were provided consistent with professional standards of practice when staff administered a nebulizer (a medical device that administers breathing medication in an aerosol form) treatment to a resident without monitoring the resident during the treatment. In addition, the nebulizer face mask was not cleaned and stored properly after use for one resident (Resident #151). The sample was 30. The census was 153. Review of the facility's Nebulizer policy, last revised 5/2021, showed:-Purpose: To deliver prescribed medication deeply into the pulmonary (lung) airways;-Procedure: Check the physician orders for treatment specifications. Assemble equipment at bedside: Explain the procedure to the resident. Instruct the resident to sit up straight as possible. [...]

Inspectors wroteBased on interview and record review, the facility failed to promote the resident's self-determination through support of resident choices when staff failed to follow a resident's choice to be a no code (do not resuscitate (DNR), no life prolonging methods are performed), when staff performed cardiopulmonary resuscitation (CPR, an emergency lifesaving procedure performed when the heart stops beating) when the resident was found not breathing and without a pulse (Resident #1). The sample size was 3. The census was 150. The Administrator was notified on [DATE] of the past non-compliance. The facility responded appropriately when the incident occurred. Staff were provided continuing education on where to locate a resident codes status. They updated their CPR/Code Status policy and added an additional system in which staff can access a resident's current code status. [...]

Inspectors wroteBased on interview and record review, the facility failed to check for a federal indicator (identifies when an employee who has ever held a Certified Nurse Aide (CNA) certificate has ever been found to have abused, neglected, or misappropriated resident property) through the state Nurse Aide (NA) registry prior to hiring a new employee, in accordance with the facility's abuse policies, for three of eight employees files reviewed. The census was 163. The administrator was notified on 3/26/24, of the past non-compliance. The facility has changed their process on newly hired employees and in-serviced staff on the requirement to check the NA registry on all newly hired staff ongoing. The deficiency was corrected on 9/13/23. Review of the facility's Abuse, Neglect, and Exploitation, Freedom From policy revised 9/22/19, showed: -Policy: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow acceptable standards of practice for infection control for one resident observed during personal care. The resident's urinary catheter tubing disconnected and fell to the floor. Staff did not cleanse the tubing and then re-inserted the tubing into the catheter port (Resident #19). The facility also failed to ensure 3 out of 8 sampled staff's two-step tuberculin (TB) skin test were read prior to staff working with residents. In addition, staff failed to change their gloves or sanitize their hands when exiting a resident room, and handled clean linen supplies. The sample was 32. The census was 164. 1. Review of the facility's catheter care policy, revised 3/2021, showed: -Suprapubic catheter (urinary catheter surgically inserted through the abdomen and into the bladder, to drain urine): [...]

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 residents were involved in physical resident to resident altercations resulting in two of the involved residents to be struck in the face, leaving a reddened area to their faces (Residents #59, #140, #129 and #21). The sample was 32. The facility census was 164. The facility was notified of past non-compliance on 3/27/24. Facility staff immediately intervened, notified administration, separated the residents, and provided assessment and services to the involved residents. Staff were in-serviced on abuse and neglect prevention. The deficiency was corrected on 3/15/24. Review of the facility's Abuse and Neglect policy, revised 9/2022, showed: -Resident safety position statement: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure services provided met professional standards of practice when staff failed to verify an intravenous (IV, medical technique that administers fluids, medication, and nutrients directly into the vein) therapy order for one resident (Resident #91). The facility also failed to ensure oxygen administration orders were completed and accurate and orders were obtained for a specialty mattress for one resident (Resident #10). The sample was 32. The census was 164. 1. Review of the Following Physician Order policy, dated 6/29/21, showed: -Purpose: To ensure that all licensed professional nurses Registered Nurses, Licensed Practical Nurses and Licensed Vocational Nurses (RN, LPN and LVN) and other healthcare professionals, follow physician orders in accordance to state, federal regulations and respective practice acts; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents had complete, accurate, and individualized care plans to address the specific needs of the residents for five out of 29 sampled residents (Residents #58, #84, #4, #35 and #95). The census was 188 with 143 residents in certified beds. Review of the facility's care management policy, undated, showed the following: Purpose: To provide for management of resident care that is conducted systematically and comprehensively by a facility-wide (interdisciplinary) Team knowledgeable in current concepts of geriatric care. Resident care management should be consistent with the medical plan of care. Nursing uses the five steps of the nursing process: Assessment, diagnosis, goal setting, implementation and evaluation as a guide. Policy: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure services provided met professional standards of practice when staff did not follow physician orders. Staff failed to ensure an arm immobilizer (used to restrict movement in and around the shoulder by reducing abduction -moving arm away from the body and arm rotation) was applied, report out of range blood sugar parameters, document weekly skin assessments, and ensure ordered weekly weights and fluid restrictions were followed. In addition, the facility failed to complete neurological assessments in accordance with their policy after a fall These affected 10 out of 29 sampled residents (Residents #16, #63, #58, #35, #84, #4 #133,#153, #70 and #357). The census was 188 with 143 in certified beds. Review of the facility's Following Physician Orders policy, dated 6/29/21, showed: -Purpose: [...]

Inspectors wroteBased on observation, interview and record review the facility failed to fully implement the facility's Restorative Therapy (RT) program and ensure residents received RT as ordered for 11 residents (Resident #63, #132, #142, #42, #65, #95, #58, #35, #357, #16 and #70). The sample was 29. The census was 188 with 143 in certified beds. Review of the facility's Restorative Therapy (RT) Program Policy, dated revised 5/21, showed, purpose: It is the policy of the facility to assist each resident to attain and/or maintain their individual highest most practicable functional level of independence and well-being, in accordance to State and Federal regulation; -Procedure: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide supervision as required for residents in an assisted dining room, utilized for residents who required assistance and/or oversight during meals. One resident was served his/her meal and consumed the meal without staff present (Resident #96). The facility also failed to ensure sharps were disposed properly. The census was 188 with 143 residents in certified beds. 1. Review of Resident #96's annual MDS, dated [DATE], showed: -Unclear speech, slurred or mumbled; -Usually understood, difficulty communicating some words or finishing thoughts but is able if prompted or given time; -Sometimes understands, responds adequately to simple, direct communication only; -No brief interview for mental status (BIMS, a screener for cognitive status) completed; -Eating: Required supervision/oversight, encouragement or cueing; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to have adequate nursing staff to meet the needs of the residents as evidenced by incontinence care and/or toileting not provided, for four of 29 sampled residents (Residents #9, #131, #120 and #101). This had the potential to affect all residents. The census was 188 with 143 in certified beds. 1. Review of Resident #9's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 2/3/22, showed: -Cognitively intact: -No behaviors; -Required extensive staff assistance with dressing, toileting and hygiene; -Diagnoses included vascular disease, diabetes and Parkinson's (a nerve disorder affecting motor control) disease; -Urinary and bowel incontinence: incomplete; -Takes a diuretic (used to remove excessive fluid from the body) medication seven days a week. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure nursing staff with the appropriate competencies and skill sets assisted residents to attain or maintain the highest practicable physical, mental, and psychosocial well-being for each resident. The facility failed to ensure nursing staff are able to demonstrate competency in skills and techniques necessary to care for residents, by failing to administer medications per physician's orders and accurately document and maintain a controlled substance record. In addition, the facility failed to ensure all staff, were adequately trained and informed of facility policies and expectations per acceptable nursing standards. The census was 188 with 143 in certified beds. Review of the facility's 2020-2021 assessment tool, showed: -Staff training/education and competencies: -All Staff: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure they had a system in place to record and document all controlled drugs with sufficient detail to enable an accurate reconciliation, for two of 29 sampled residents (Residents #9 and #115) and five out of five halls. This had the potential to affect all residents with orders for controlled substances. The census was 188 with 143 residents in certified beds. Review of the facility's Controlled Medications policy, dated as last reviewed on 6/21, showed the following: -Purpose: A controlled drug record of individual resident form is accurately maintained on all resident requiring controlled medications. Strict control of narcotics is maintained always. A physician order is required for administration of controlled drugs. Controlled drugs are administered by licensed personnel. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents' right to self-administer medications had been determined as clinically appropriate for one of 29 sampled residents (Resident #45). The census was 188 with 143 residents in certified beds. Review of facility's resident self administration of medications policy, dated 6/21, showed: -Before a resident is considered for self-administration of medications an assessment will be performed by the charge nurse and reviewed by the interdisciplinary care plan team for approval. A re-assessment will be repeated quarterly unless there is a significant change in condition affecting cognitive abilities and safety regarding self-administration; [...]

Inspectors wroteBased on interview and record review, the facility failed to notify a resident's representative when the resident developed a wound on his/her right foot. (Resident #505). The sample was 29. The census was 188 with 143 residents in certified beds. Review of the facility's Condition Change of the Resident (Observing, Recording and Reporting), revised 7/21, showed the following: -Purpose: To observe, record and report any condition change to the attending physician so proper treatment will be implemented; -Procedure: After all resident falls, injuries or change in physical or mental function, monitor the following: -Document the change in the Process Notes on the respective event; -Notify resident's responsible party; -Monitor the resident condition frequently until stable. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of five sampled residents reviewed for unnecessary medications was free from chemical restraints. Staff administered Lorazepam (Ativan, a benzodiazepine medication used to treat anxiety) as well as other bedtime medications that included Donepezil (medication used to treat dementia) and Trazodone (antidepressant) to Resident #65, outside the parameters ordered by the physician in an attempt to prevent behaviors. Two additional residents from the memory care unit were sampled and two residents were identified in which staff did not document behaviors and notify the physician of changed administration times (Residents #82 and #152). The sample size was 29. The census was 188 with 143 in certified beds. [...]

Inspectors wroteBased on observation, interview and record review,, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice by failing to follow the facility policy for wound management. The staff failed to document weekly skin assessments in the electronic medical record (EMR), failed to document the discovery of a wound and the wound assessment and also failed to ensure an ordered treatment remained in place. When assessed by the wound management company several days later, the resident's newly developed wound was documented as an unstageable pressure ulcer (Resident #131). In addition, facility staff failed to report one newly developed opened area to the charge nurse for 24 hours and when assessed by the surveyor the next day, the resident had developed two open areas. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to ensure drugs and biologicals used in the facility are stored and labeled in accordance with accepted professional principles, when staff failed to date four out of six insulin pens, on the 200 hall after opened and check and/or record the refrigerator temperature daily for five out of five medication refrigerators. The census was 188 with 143 in certified beds. Review of the facility's Insulin Administration via a Pen Device policy, dated as reviewed 5/21, showed: -Purpose: To safely administer insulin via pen devices according to physician orders and the facility's policy and procedures; -Procedure: If a pen is being used for the first time, date the pen on the label. 1. Observation on the 200 hall on 2/18/22 at 10:00 A.M., of the top drawer of the treatment cart, showed six insulin pens. [...]

Inspectors wroteBased on record review and interview, the facility failed to establish a system to ensure all staff followed requirements from the state board of nursing for one registered nurse who held a nursing license on probation at the time of hire. The census was 188 with 143 residents in certified beds. Review of Registered Nurse (RN) GG's employment record, showed: -Employment application: Date of hire: 5/4/21; -Status: Full time; -Job Title: Registered Nurse; -Review of RN GG's license verification report, showed: -License original date: 4/14/11; -License status: Probation; -Date of action take: 4/6/21; -Basis for action: Failure to maintain adequate or accurate records; -Effective dates: 4/6/21 through 4/6/2024. Review of RN GG's State Board of Nursing Hearing Commission, dated 4/6/21, showed: -Employment Restrictions: [...]

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 administering medications outside parameters and ensuring the narcotic sheets are accurate, completed and maintained. This deficient practice had the potential to affect all residents living in the facility. The census was 188 with 143 in certified beds. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to fully implement their staff vaccination policy for COVID-19 by failing to ensure a process for tracking and documenting the COVID-19 vaccination status for all staff, to include staff who provide services via contract or other arrangement. This failure included facility staff and corporate staff, who were either employed by the facility or provided care to resident via an agreement. The census was 188 with 143 residents in certified beds. Review of the facility's undated COVID-19 Vaccine Policy, showed: -This facility is obligated to adhere to the federal vaccine mandate for healthcare facilities as a condition of participation in the Medicare-Medicaid program. [...]