Dove Healthcare - Spooner

Inspectors wroteBased on observation, interview and record review, the facility did not ensure proper sanitation practices to prevent the outbreak of foodborne illness which had the potential to affect all 45 residents.-The facility did not ensure dishes were dried appropriately.-The facility did not ensure proper cleaning of portable steam tables before replacing clean covers.

Inspectors wroteBased on interview and record review, the facility failed to ensure it maintained an infection prevention and control program designed to help prevent the development and transmission of communicable disease and infections such as COVID-19. This had the potential to affect all 45 residents. -The facility did not test staff or residents with symptoms of COVID-19. -Staff did not use a barrier under the graduate when emptying the catheter for R3.-The facility did not ensure proper infection control measures were conducted when providing a shower and during catheter care for R3 who is on Enhanced Barrier Precautions (EBP). [...]

Inspectors wroteBased on observation, interview and record review, the facility did not notify the physician on call of R40's new break in skin on right great toe for 1 of 12 residents (R) reviewed for activities of daily living (ADL) (R40).

Inspectors wroteBased on staff interview and record review, the facility did not provide Advanced Beneficiary Notice (ABN) of non-coverage and/or Notice of Medicare of Non-Coverage (NOMNC) appropriately for residents (R) whose Medicare Part A coverage was discontinued with benefit days remaining for 2 of 3 residents (R) reviewed. (R55, R46) R55 had a skilled Medicare A Service Episode with a start date of 03/19/25 and last covered date of 04/19/25. The facility/provider initiated the discharge from Medicare A Services when benefit days were not exhausted. [...]

Inspectors wroteBased on interview and record review, the facility did not ensure 1 of 5 residents reviewed (R2) was free from unnecessary medications.-Facility did not ensure adequate indication for use of psychotropic medications.

Inspectors wroteBased on observation, interview and record review, the facility did not ensure activities of daily living (ADLs) of toileting and incontinence cares were provided for 1 of 12 residents (R6) reviewed. This is evidenced by:R6 was admitted to the facility on [DATE], with diagnoses including Alzheimer's disease unspecified, dementia, type 2 diabetes mellitus, essential hypertension, major depressive disorder, and dysphagia. R6's minimum data set (MDS) assessment, completed on 07/05/25, confirmed R6 is incontinent of urine and frequently incontinent of bowels. R6 requires supervision assistance with eating. R6 is substantial or maximal assist on staff for personal hygiene, showering/bathing, toileting, transferring, dressing lower body, and putting on/taking off footwear. R6's care plan was initiated on 02/05/25, and included the following: [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility did not provide appropriate skin assessments and treatment by professional standards of practice to maintain a resident's highest practicable level of physical well-being for 1 of 12 residents (R40) reviewed. Staff did not assess or document R40's new break in skin on great right toe or treat the skin injury appropriately.

Inspectors wroteBased on record review and interview, the facility did not ensure acceptable parameters of nutritional status to maintain usual body weight. This occurred for 1 of 3 residents reviewed for nutritional status, Resident (R) R6. R6 was not weighed weekly to assess if he was maintaining his usual body weight. R6 had significant weight loss that was not assessed appropriately. Based on record review and interview, the facility did not ensure acceptable parameters of nutritional status to maintain usual body weight. This occurred for 1 of 3 resident reviewed for nutritional status. Resident (R) R6. R6 was not weighed weekly to assess if he was maintaining his usual body weight. R6 had significant weight loss that were not assessed appropriately. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not ensure that 1 of 4 residents (R1) reviewed for pressure injuries (PI) received care consistent with professional standards of practice to prevent potential skin breakdown and promote healing of existing PIs. R1 was on hospice and nearing end of life. R1 was at risk for PI; alternate support surfaces were not provided when skin issues were noted.

Inspectors wroteBased on observation, interview and record review, the facility did not ensure that the steam heated hot water system is maintained in a safe operating condition resulting in the return hot water temperature at fixtures used by residents fluctuating in temperature, at times not adequate temperature for bathing/handwashing. This has the potential to affect all 46 residents (R) in the facility.

Inspectors wroteBased on observations, interviews and record reviews, the facility did not provide diabetic care and treatment by professional standards of practice to maintain a resident's highest practicable level of physical well-being for 1 of 14 residents (R32) reviewed. Staff did not follow diabetic protocol to manage R32's type 1 diabetic hypoglycemia episodes by not providing glucagon when blood sugars were below 70 and re-checking low blood glucose (BG) levels within 15 minutes after intervention. Staff did not notify R32's physician when hypoglycemic and hyperglycemic episodes were occurring to change treatment. Staff did not monitor R32's vital signs, monitor and documenting signs and symptoms.

Inspectors wroteBased on observation, record review and interview, the facility did not ensure that residents are free of significant medication errors for 1 of 14 residents (R32) reviewed for medication errors. R32 has a type 1 diabetes mellitus diagnosis. Facility staff administered glucagon three times with no documentation and reasoning for giving glucagon outside of blood glucose parameters. Facility staff did not administer glucagon when R32's blood glucose levels were 30 to 54. Facility staff did not follow physician orders when insulin was held and administered insulin as R32 requested. The facility did not have a physician order to allow R32 direct the amount of insulin administered.

Inspectors wroteBased on record review and interview, the facility did not use the services of a registered nurse (RN) for at least 8 consecutive hours a day, 7 days a week. This has the potential to affect all 50 residents who reside in the facility. This is evidenced by: On 05/22/24 at 9:30 AM, Surveyor completed a record review for the month of May related to daily staff postings and noticed there were certain weekends where RN coverage hours were less than 8 hours. The dates of 05/04/24, 05/05/24, 05/18/24, and 05/19/24 all showed less than 8 hours of RN coverage. On 05/22/24 at 9:45 AM, Surveyor completed a record review of the time punches for the days of 05/04/24, 05/05/24, 05/18/24, and 05/19/24 and confirmed there were less than eight hours of coverage on those days. -On 05/04/24, only 4.5 hours were covered by a Registered Nurse. -On 05/05/24, only 4.5 hours were covered by a Registered Nurse. [...]

Inspectors wroteBased on observation, staff interview and record review, the facility did not prepare, distribute, and serve food in accordance with professional standards for food service safety. This had the potential to affect 48 of 50 residents within the facility that took nourishment from the kitchen. Opened milk in the refrigerator not labeled with open date. Staff touching ready to eat foods with contaminated gloves during food service. Staff did not perform hand hygiene between glove changes during food service.

Inspectors wroteBased on observation, interview and record review, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. This had the potential to affect all 49 residents (R). The facility did not have a clear water management process or plan in effect to prevent transmission of Legionella infection. Staff provided high-contact care to residents on Enhanced Barrier Precautions (EBP) without wearing proper Personal Protective Equipment (PPE). (R32 and R17). The facility is not tracking the type of symptoms for all staff and resident infections. The facility is not providing alternative testing to rule out influenza or RSV cases when residents and staff become sick.

Inspectors wroteBased on record review and interview, the facility did not implement policy and procedures related to screening employees for a prior history of abuse, neglect, exploitation of residents, or misappropriation of resident property for 5 of 8 staff reviewed. This had the potential to affect all residents.

Inspectors wroteBased on observation, interview and record review, the facility did not treat each resident with respect and dignity and care for each resident in a manner that promotes his quality of life. Resident (R43) was not provided privacy when lying in bed not fully clothed and covered while being visible from the hallway. For 1 of 13 sampled residents (R43).

Inspectors wroteBased on record review, observation and interview, the facility did not implement a comprehensive individualized safety care plan to meet the needs of 1 of 14 residents (R). R34. This is evidenced by: R34 was admitted to the facility on [DATE] with diagnoses that included in part Alzheimer's disease, dementia, and cognitive communication deficit. On 03/24/24, a male resident was found in R34's room with his pants down urinating. One of the interventions from this incident was a stop sign barrier added to R34's entrance to her room to help prevent other residents from wandering into R34's room. R34's care plan, dated 03/24/24, with a target date of 05/29/24, states: .[R34] has a stop sign rope across doorway in room. Stop sign will prevent others from entering her room due to wondering behaviors. Intervention: Have stop sign on [R34]'s door if she is in her room at night while sleeping . [...]

Inspectors wroteBased on record review and interview, the facility did not review and revise the comprehensive toileting care plan for 1 of 14 sampled residents, Resident (R)7. This is evidenced by: The facility policy, entitled Incontinence, Catheters, & Urinary Tract Infections, last reviewed in January 2017, states in part: 7. The following items may be addressed in the care plan according to individualized resident needs: . interventions specific enough to guide the provision of services and treatment that are also dependent on resident choices and preference. R7 was admitted to the facility on [DATE] and has diagnoses that include hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, unspecified osteoarthritis, unspecified site, anxiety disorder, unspecified, pain in unspecified hip, and constipation, unspecified. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not ensure activities of daily living (ADLs) of meal set-up, repositioning, and incontinence cares were provided for 1 of 15 residents (R21) reviewed. This is evidenced by: R21 was admitted to the facility on [DATE], with diagnoses including alcohol induced persisting dementia, malignant neoplasm of esophagus, Wernicke's encephalopathy, aphasia following cerebral infarction, and depressive disorder. R21's minimum data set (MDS) assessment, completed on 04/04/24, confirmed R21 is incontinent of urine and frequently incontinent of bowels. R21 requires supervision assistance with eating. R21 is dependent on staff for personal hygiene, showering/bathing, toileting, transferring, dressing lower body, and putting on/taking off footwear. R21's care plan was initiated on 03/28/24, and included the following: BED MOBILITY: [...]

Inspectors wroteBased on observation, interview and record review, the facility did not ensure a resident received adequate supervision and assistance to prevent falls and injury. This occurred for 1 of 3 residents (R) reviewed for falls, (R40). The facility was not following the intervention of utilizing a pressure alarm that was set in place to prevent further falls for R40. This is evidenced by: R40 was admitted to the facility on [DATE] with diagnoses that included in part unspecified mood disorder, cognitive communication deficit, illiteracy and low level literacy, major depressive disorder, and insomnia. R40's care plan, dated 12/06/23, states: .[R40] is a risk for falls due to impaired balance, poor safety awareness, impulsiveness, and history of falling .Intervention: Pressure alarm for bed and chair . R40's fall risk assessment, completed on 12/06/23, showed moderate fall risk. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not ensure residents (R) with indwelling Foley catheters received care and treatment consistent with professional standards of practice to prevent complications or urinary tract infections (UTI) from the catheter. This occurred for 2 of 4 residents reviewed for urinary catheters. (R43 and R29). R43 was recently hospitalized with UTI and sepsis. Surveyor observed staff perform improper catheter care and did not use proper infection control practices for R43's catheter care. R29's Foley catheter was changed on a routine monthly basis without clinical indications and not following professional standards of practice.

Inspectors wroteBased on observation, interview and record review, the facility did not ensure residents (R) who are fed by enteral means receive the appropriate treatment and services of tube placement and storage of supplies to prevent complications of enteral feeding. This occurred for 2 of 2 residents observed for tube feedings. (R32 and R43). This is evidenced by: R32 was admitted to the facility on [DATE] with diagnoses including in part, type 1 diabetes mellitus with diabetic chronic kidney disease and ketoacidosis without coma, metabolic encephalopathy, chronic kidney disease stage 4, vascular dementia unspecified severity with agitation, paroxysmal atrial fibrillation, gastrostomy status, and dysphagia oropharyngeal phase following cerebral infarction. [...]

Inspectors wroteBased on interview and record review, the facility did not notify the resident or the resident's representatives of a transfer and the reasons for the move in writing and in a language and manner they understand when transferred to the hospital for 5 residents (R) reviewed for hospitalizations. (R23, R43, R100, R46, R40) This had the potential to affect all 50 residents that reside in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility did not have an effective Infection Prevention and Control Program to prevent the spread of COVID 19, hand hygiene was not performed appropriately for 2 of 2 residents observed for cares. The infection control surveillance was not accurate. There was no documentation of R40 being put on isolation, or on the line list accurately when symptoms started. Staff and resident line lists are not complete. Staff were not washing hands properly while providing cares for R21. R102 was provided morning bathing cares in which staff did not conduct hand hygiene when moving from a dirty task to a clean task. This is evidenced by: Example 1 Surveyor reviewed the facility policy titled, Surveillance for Infections. This policy is dated 2017. Under Collection and Recording it stated: [...]

Inspectors wroteBased on observation and interview, the facility did not ensure residents (R) had the right to choose schedules consistent with their interests, for 5 of 5 residents (R4, R17, R21, R23, and R151). Facility developed a schedule for care, for staff convenience and without resident considering resident preference. Residents are placed at the medication cart to receive medications. Residents waited for nursing staff to administer medication, after receiving medication waited for staff to assist them to the dining room for breakfast. Residents waited approximately 50 minutes at medication cart. This is evidenced by: R4 has diagnoses of severe visual impairment and Type 2 Diabetes Mellitus with insulin dependence. Minimum Data Set (MDS), dated [DATE], R4 scored 5/15 during Brief Interview for Mental Status (BIMS), indicating severely impaired cognition. [...]

Inspectors wroteBased on observation, interviews and record reviews, the facility did not complete care plan revisions for 6 of 13 residents (R) sampled. R5's care plan and orders were not updated to reflect the current dose of O2 and were not specific to how often it should be used. R21's care plan was not updated with information to use a washcloth in the right contracted hand. Facility did not complete assessment, monitoring, or update care plan for prescribing of Melatonin for R6. Facility did not update care plan to reflect R15's wanderguard. Facility did not update R3's care plan to reflect current and individualized activities. This is evidenced by: Example 1 R5 was admitted to the facility on [DATE]. R5 receives oxygen therapy due to a diagnosis of Acute Respiratory Failure with Hypoxia and Chronic Obstructive Pulmonary Disease. [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility did not provide an ongoing, individualized, and meaningful program to support the residents in their choice of activities, which was designed to meet their interests and support their physical, mental, and psychosocial well-being. This affected 4 of 4 residents (R3, R6, R15, and R40) reviewed for activity participation. Facility did not complete, implement, or revise activity assessments to obtain individualized preferences and interventions. This is evidenced by: Example 1 R3 was admitted to facility on 4/26/17. Diagnoses include Alzheimer's disease, dementia with agitation, osteoarthritis, history of falling, and pain. Minimum Data Set (MDS) MDS, dated [DATE], R3 scored 2/15 during Brief Interview for Mental Status (BIMS), indicating severe cognitive impairment. [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility did not ensure 1 of 1 Medication Technicians (MT E), completed appropriate competency to administer insulin. During the Medication Administration task, Surveyor observed MT E administer insulin to R41 (Resident). Upon review, the facility was unable to provide evidence that MT E completed the appropriate training and competency to administer insulin under the supervision of a registered nurse. This is evidenced by: On 04/12/23, Surveyor was observing medication administration. MT E administered 8 units of Insulin Novolin N to the right abdomen of R41 at 7:29 AM utilizing the correct technique. At 9:45 AM, Surveyor interviewed MT E on the procedure for insulin administration. MT E was able to verbalize the correct technique. [...]

Inspectors wroteBased on observation, interview, and record review, the facility did not provide the services necessary to maintain ROM (range of motion) for 1 of 1 resident (R) reviewed. (R21) R21's plan of care states under category Pressure ulcer that R21 should be wearing a palm protector at all times as he allows. Remove only for daily cleaning and PROM (Passive range of motion). To encourage physical activity, mobility, and ROM to maximal potential. This is evidenced by: R21 was a [AGE] year old admitted to the facility on [DATE]. R21 had a DX of Hemiplegia and hemiparesis following a CVA (stroke), Alzheimer's disease, Dementia. R21 stroke affected the right side of the body resulting in a contracture to the right hand. On 4/11/23 at 7:00AM, Surveyor observed CNA F doing cares with R21. [...]

Inspectors wroteBased on interviews and record reviews, the facility did not provide services and treatment to restore or improve as much bladder function to the extent possible for 1 of 1 residents (R29) reviewed for bladder function. R29 (Resident) was admitted to the facility with an Indwelling Foley catheter following a Cerebrovascular Accident (CVA) affecting the left non-dominant side. The catheter has since been removed and the facility did not complete a comprehensive bladder assessment to assist R29 to improve or restore as much bladder function as possible. This is evidenced by: R29 was admitted to the facility 1/26/23 from another facility in which he resided for a short time following a stroke (CVA) with Hemiplegia and Hemiparesis that affected his left (non-dominant) side of the body. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not provide respiratory services in a manner consistent with professional standards of care for 1 of 1 residents reviewed for respiratory care. Oxygen (O2) was being delivered to R5 at a rate higher than what was ordered by the physician. There was no documentation or evidence that the tubing was being changed. This was evidenced by: R5 was admitted to the facility on [DATE]. R5 was [AGE] years old with diagnosis of Acute Heart Failure, Chronic Respiratory failure with Hypoxia, Chronic Obstructive Pulmonary Disease, and Obstructive Sleep Apnea among others. R5 was an interviewable resident. On 4/10/22 at 10:00 am, Surveyor observed R5 in his recliner with O2 on per nasal cannula at 3L per min. Surveyor observed that the O2 tubing had no date on it indicating the last time it was changed. [...]

Inspectors wroteBased on observation, record review and interviews, the facility did not ensure that residents (R) were free from unnecessary medication for 2 (R48 and R15) of 5 Residents. Facility did not ensure that as needed orders (PRN) for psychotropic drugs are limited to 14 days unless documented rationale is indicated and avoid duplicate therapy of same pharmacological class for R48. Facility did not implement non-pharmacological interventions, indicate rationale for continued and duplicate use for R15's psychotropic medications. This is evidenced by: Example 1: The facility policy for Psychotropic Medication Use states, in part .2. psychotropic medications are subject to prescribing, monitoring, and review requirements specific to psychotropic medications .12(a) PRN orders for psychotropic medications are limited to 14 days .12(a)(1) For psychotropic medications that are NOT antipsychotics: [...]

Inspectors wroteBased on observation, interview and record review, the facility did not ensure an intermediate-acting insulin administration was given timely within meal or beverage service for 1 of 2 residents (R41) observed for insulin administration. During the Medication Administration task, Surveyor observed MT E (Medication Technician) administer Insulin N, an intermediate-acting insulin to R41 (Resident). Beverages or meals were not served within the allotted time frame of onset of effects of the insulin. This is evidenced by: Medscape. com states the following in relation to Novolin N insulin: - Novolin N is a combination medicine of Insulin isophane, an intermediate-acting insulin and Regular, a short-acting insulin. This combination insulin starts to work within 10 to 20 minutes after injection, peaks in 2 hours, and keeps working for up to 24 hours. [...]

Inspectors wroteBased on record review and interview, the facility did not ensure that each resident eligible for influenza or pneumococcal vaccine was offered it to prevent pneumonia and influenza. This was discovered for 2 of 5 residents reviewed for immunizations. R5 and R9 did not have declinations on file, nor was there a progress note stating that these residents refused the vaccine and were educated on the importance of being immunized. This is evidenced by: On 4/12/23, Surveyor reviewed the resident vaccination matrix. Those that refused the vaccine for COVID 19 were included in the sample of 5. It was noted that R9 had refused the pneumococcal vaccine and the influenza vaccine. It was noted that R5's last influenza vaccine was 9/27/21. There was no information on the 2022 influenza vaccination. [...]

Inspectors wroteBased on record review and interview, the facility did not ensure that the medical record included documentation that the Resident or Resident Representative were educated on the risks and benefits of the COVID 19 vaccine for 3 of 5 residents reviewed for immunization. R5, R9, and R6 did not have documentation of having declined or been educated on the COVID 19 vaccine. This was evidenced by: On 4/12/23, Surveyor reviewed the resident vaccination matrix. Per the infection control task instructions 5 residents were chosen for review of Immunizations. Those that refused the vaccine for COVID 19 were included in the sample of 5. It was noted that R5, R6, and R9 had refused the COVID 19 vaccine. [...]

Inspectors wroteBased on interview and record review, the facility did not document that testing was completed for staff or residents with signs or symptoms of COVID 19. This has the potential to affect all 50 residents. This is evidenced by: Facility policy for testing in part; Testing of Staff and Residents with COVID-19 Symptoms or Signs Staff with symptoms or signs of COVID-19, regardless of vaccination status, must be tested as soon as possible and are expected to be restricted from the facility pending the results of COVID-19 testing. If COVID-19 is confirmed, staff should follow Centers for Disease Control and Prevention (CDC) guidance On 04/12/23, Surveyor noted on staff line list for February of 2023 that CNA Q began S/S on the PM shift of 02/22/23 and tested positive on the PM shift; first day off of work was 02/23/23. CNA Q had a stuffy nose, cough, and fever. CNA Q returned to work on 3/2. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not implement policies and procedures to decrease the spread of COVID 19. The facility did not have a staff vaccination policy to mitigate those employees who were unvaccinated for COVID-19. The 16 staff members who were not vaccinated for COVID 19 were not required to take any extra precautions. At the time of the survey, the community transmission level was substantial. The facility chose to make facemasks optional. This is evidenced by: Facility policy for mitigation in part, Unvaccinated Staff: Staff who have a valid exemption on file will be required to wear protective face covering regardless of county transmission levels or CDC recommendations as a form of mitigation to support basic infection control strategies in preventing the spread of communicable disease. On 04/10/23 after 10:00 a.m. [...]