Emerald Nursing & Rehabilitation Mercy

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(1) and 12-006.09(H)(iii)(2). Based on observation, interview and record review the facility failed to perform treatment for pressure ulcers according to the practitioner's orders for Resident 509, failed to accurately complete and score the Braden Scale for Resident 4 and 509, and failed to evaluate, implement and monitor interventions to prevent pressure ulcer development and to promote wound healing for 4 (Resident 4, 502, 506, and 509) of 4 residents on sample. The facility census was 79.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.01(A) Based on observations, record reviews, and interviews, the facility management failed to utilize its resources to attain or maintain the highest practicable physical and psychosocial well-being of each resident as identified by the deficient practices cited. The facility staff identified a census of 79.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.07(C) Based on observation, interview, and record review, the facility failed to ensure the Quality Assurance and Performance (QAPI, . It is a data-driven, proactive program required by the Centers for Medicare and Medicaid Services for healthcare facilities like nursing homes to continuously track and elevate patient care safety and quality) program identified and addressed concerns related to deficient practice identified on the survey and ensure correction for repeat deficient practice from previous surveys were maintained. This had the potential to affect all residents that resided in the facility. The facility census was 79.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(ii). Based on record review and interview the facility failed to ensure licensed nurse's received competency evaluations for enteral tube feedings, wound care and Enhanced Barrier Precautions (EBP, an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs) in nursing homes. Enhanced Barrier Precautions involve gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO as well as those at increased risk of MDRO acquisition (e.g., residents with wounds or indwelling medical devices) for 3 of 3 nurses employed at the facility. The facility census was 79.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on record review and interview, the facility failed to report two allegations of potential misappropriation to the State Agency within the required timeframe for 1 (Resident 501) of 1 sampled resident. Facility staff identified a census of 83.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on record review and interview, the facility failed to complete an investigation and submit the investigation to the State Agency within 5 working days for two allegations of potential misappropriation for 1 (Resident 501) of 1 sampled resident. Facility staff identified a census of 83.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(F)(iii)Based on record review and interview, the facility failed to revise the care plan to reflect resident risk for leaving the facility without signing out, without a destination, and time of return, or of potential locations the resident could be located for 1 (Resident 501) of 3 residents sampled. Facility staff identified a census of 83.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I)Based on record review and interview, the facility failed to have a comprehensive and consistent process to identify when alert and oriented residents would return to the facility after leave and steps to take if the resident failed to return for 2 (Resident 501 and 503) of 4 residents sampled. Facility staff identified a census of 83.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(vi)(3)(c)Licensure Reference Number 175 NAC 12-006.09(H)(vi)(3)(a)Based on observation, interview, and record review, the facility failed to administer the correct amount of enteral nutrition (liquid formula containing nutrients) per the provider's order on 1 (Resident 103) of 3 sampled residents, ensure flush orders were obtained for 1 (Resident 102) of 3 sampled resident's percutaneous endoscopic gastrostomy (PEG, a tube inserted directly into the stomach to administer nutrients and medications) tube, and ensure 2 (Residents 103 and 101) of 3 sampled resident's enteral nutrients were refrigerated after opening the container per the manufacturer's recommendations. The facility census was 79.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)Based on record review and interview, the facility failed to follow the plan of care for transfers resulting in significant injury and failed to complete a post-fall evaluation for 1 (Resident 100) of 3 sampled residents. The facility staff identified a census of 103.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5)Based on record review and interview, the facility failed to notify the medical practitioner of omitted body weight measurements for 2 (Residents 101 and 102) of 3 sampled residents. The facility staff identified a census of 103.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on record review and interview, the facility failed to report an allegation of potential neglect within the required timeframes for Resident 100. The facility staff identified a census of 103.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(vi)(3)(a)Based on record review, observation, and interview, the facility failed to have complete tube feeding orders, failed to date and time tube feeding equipment, and failed to account for amount of infused tube feeding for 2 (Residents 101 and 102) of 3 sampled residents. The facility staff identified a census of 103.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(6)Licensure Reference Number 175 NAC 12-006.17(A)(v)Based on record review and interview, the facility staff failed to document a post-fall evaluation for 1 (Resident 100) of 3 sampled residents. Facility staff identified a census of 103.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(B)Based on record review, observation, and interview, the facility failed to change a tube feeding pump set at the required intervals to prevent the potential for cross contamination for 1 (Resident 101) of 3 sampled residents. The facility staff identified a census of 103.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I)(i)(1). Based on interview and record review the facility failed to implement interventions to prevent a significant injury for 1 (Resident 6) of 3 residents sampled and failed to investigate and implement interventions for falls for 1(Resident 3) of 3 residents sampled. The facility census was 117.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5). Based on interview and record review the facility failed to update the resident's representative of changes in condition for 1(Resident 3) of 3 residents sampled. The facility census was 117.

Inspectors wroteLicensure Reference Number 12-006.09(J)(i)(1). Based on observation, interview and record review the facility failed to accurately record meal intakes, implement interventions to prevent a significant weight loss, and failed to implement practitioner orders to ensure adequate nutrition after a bariatric surgery for 1 (Resident 3) of 1 residents sampled. The facility census was 117.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H). Based on observation, interview and record review the facility failed to evaluate, monitor and implement interventions for severe pain and failed to ensure pain medications were available for use for 1(Resident 3) of 3 residents sampled. The facility census was 117.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09. Based on observation, interview and record review the facility failed to monitor daily fluid intake, and failed to ensure medications and treatments were coordinated with the provision of dialysis services for 1 (Resident 5) of 1 residents sampled. The facility census was 117.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(1). Based on interview and record review the facility failed to develop and implement interventions and arrange services for behavioral management for 1 (Resident 3) of 3 residents sampled. The facility census was 117.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D). Based on interview and record review the facility failed to ensure residents were free from significant medication errors for 1(Resident 5) of 5 residents sampled. The facility census was 117.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H) Based on record review and interview, the facility failed to include enough information to ensure a thorough investigation had been completed into an injury for 1 (Resident 1) of 3 reviewed with an injury. The facility census was 115.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I) Based on observations, interviews and record reviews, the facility failed to ensure interventions (what was put in place to prevent it from happening again) were implemented for falls on 2 (Resident 3 and 4) of 3 sampled residents. The facility census was 115.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(1) and 12-006.09(H)(iii)(2). Based on observation, interview and record review the facility failed to evaluate, monitor and implement interventions for pressure ulcer prevention and to promote wound healing for 2 (Resident 2 and 3) of 2 residents sampled. The facility census was 115.

Inspectors wroteLicensure reference: 12-006.11(E)Based on observations, interviews, and record review, the facility failed to ensure temperatures of food on the steam table were hot enough to protect from potential food borne illness. This has the potential to affect 40 of 41 residents residing on the second floor of the facility.

Inspectors wroteLicensure reference: 12-006.10A(i)Based on observation, interview, and record review, the facility to ensure 1 [Resident 3] of 6 sampled residents was evaluated for ability to self-administer laxative medication. The facility had a total census of 115 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5). Based on record review and interview, the facility failed to notify the provider of new pressure ulcers for 1 (Resident 2) of 2 residents sampled. The facility census was 115.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09F(iii). Based on record review and interview, the facility failed to review and revise the care plan related to pressure ulcers, amputation, and infection for 1 (Resident 2) of 3 residents sampled. The facility census was 115.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on interview and record review, the facility failed to evaluate weight changes according to practitioner orders and failed to monitor and provide ongoing PICC line care for 1 (Resident 2) of 1 residents sampled. The facility census was 115.

Inspectors wroteLicensure reference: 12-006.12(D)(i)Based on observation, interview and record review, the facility failed to ensure medication was stored securely in accordance with facility policy for 2 [Resident 2 and 3] of 6 residents. The facility had a total census of 115 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(B) Based on observation, interview and record review, the facility failed to utilize Enhanced Barrier Precautions (EBP) during wound care for 1 (Resident 2) of 2 residents sampled. The facility census was 115.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(3)Based on observation, interview and record review, the facility failed to use the prescribed wound dressing for 1 (Resident 2) of 3 residents and failed to conduct weekly skin evaluations for 1 (Resident 1) of 4 residents sampled. The facility census was 101.

Inspectors wroteLicensure reference: 175 NAC 12-006.10(D) Based on record review and interview, the facility failed to ensure medications were provided in accordance with physician's orders for 2 [Resident 4 and 6] of 6 sampled residents. The facility had a total census of 92.

Inspectors wroteLicensure reference: 175 NAC 12-006.04(F)(i)(5) Based on record review and interview, the facility failed to ensure notification of physician of sliding scale insulin not being administered to 1 [Resident 4] of 6 sampled residents. The facility had a total census of 92.

Inspectors wroteLicensure reference: 175 NAC 12-006.10 (A)(ii) Based on observation, interview, and record review, the facility failed to ensure insulin was administered in accordance with standards of practice for 3 [Residents 1, 3, and 4] of 6 sampled residents. The facility had a total census of 92 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5). Based on record review and interview the facility failed to notify the resident's physician of a change of condition for 2 (Resident 1 and 3) of 4 sampled residents. The facility census was 101.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(2). Based on observation, interview and record review the facility failed to evaluate, monitor and implement interventions for pressure ulcer prevention and to promote wound healing for 1 (Resident 3) of 4 resident sampled. The facility census was 101.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H) Based on record review and interview the facility failed to perform pre and post dialysis (a life-sustaining treatment used when kidneys fail to filter waste and excess fluid from the blood) assessments for 2 (Residents 2 and 3) of 3 sampled residents, failed to assess the dialysis access sites (the locations where a dialysis machine can access the blood stream to perform dialysis) on each shift for 2 (Residents 2 and 3) of 3 sampled residents who had a dialysis access site, and failed to ensure the physician was notified of missed dialysis treatment for 1 (Resident 1) of 3 sampled residents. The facility had a census of 108.

Inspectors wroteLicensure Reference Number 175 NAC 1-005.04 Based on record review and interview the facility failed to investigate and resolve grievances for 2 (Resident 5 and 6) of 3 residents sampled. The facility census was 105.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iv)(5) Based on record review and interview the facility failed to monitor bowel movements for 1(Resident 4) of 3 residents sampled. The facility census was 105. Record review of Resident 4's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 04-04-2025 revealed the facility staff assessed the following about the resident: -BIMS was scored as a 15. -required total assistance with toileting, lower body dressing, bed mobility, and transfers. -required extensive assistance with upper body dressing. -was always incontinent of bowel and bladder. -a trial toileting plan was not attempted. Record review of Resident 4's progress note dated 3-29-2025 revealed Resident 4 had been readmitted to the facility after hospitalization for a small bowel obstruction. [...]

Inspectors wroteLicensure Reference Number 12-006.09(H)(iv)(2) Based on record review and interview the facility failed to implement a toileting program for 2 (Resident 1 and 4) of 3 sampled residents. The facility census was 105.

Inspectors wroteLicensure reference: 175 NAC 12-006.11(E) Based on observations, interviews, and record reviews, facility failed to label and date foods and to ensure food is disposed of in accordance with facility policy to ensure food safety. This has the potential to effective 110 of 111 residents residing in the facility.

Inspectors wroteLicensure Reference Number 175 NAC 1-005.06(D, E & F) Licensure Reference Number 175 NAC 12-006.18(B) Based on observation, interview and record review; the facility failed to perform hand hygiene between glove changes during toileting care for 1 (Resident 84) of 4 sampled residents. The facility failed to utilize enhanced barrier precautions (EBP, an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs) in nursing homes. Enhanced Barrier Precautions involve gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO as well as those at increased risk of MDRO acquisition [e.g., residents with wounds or indwelling medical devices]) during wound cares for 1 (Resident 75) of 4 sampled residents. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5) Based on interview and record review; the facility failed to notify the family of the development of a new wound and new treatment orders for 1 (Resident 108) of 4 sampled residents reviewed for wounds. The facility identified a census of 111.

Inspectors wroteLicensure reference: 12-006.09(H)(i)(3) Based on interview and record review, the facility failed to ensure baths were provided in accordance with resident choice for 2 [Resident 68 and 75] of 37 sampled residents and failure to ensure assistance with eating for 1 [Resident 84 ] of 37 sampled residents. The facility had a total census of 111 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10 Based on interview and record review; the facility failed to obtain an order prior to administration of the Covid-19 vaccine for 1 (Resident 84) of 6 sampled residents. The facility identified a census of 111. Record review of facility policy entitled Quality of Care - Immunizations Vaccination of Residents Dated revised 1/2024 revealed: -All residents will be offered vaccines that aid in preventing infectious diseases unless the vaccine is medically contraindicated, or the resident has already been vaccinated. -7. Certain vaccines (e.g., influenza and Pneumococcal vaccines) may be administered per the physician approved facility protocol (standing orders) after the resident has been assessed by the physician for medical contraindications for each vaccine. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(2) Based on observations, record reviews and interviews, the facility failed to provide a pressure ulcer treatment as ordered for 1 one (Resident 112) of 5 residents reviewed for wound management. The facility census was 111.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I) Based on observation, record review and interview; the facility failed to implement interventions to prevent falls for 1 (Resident 119) of 4 residents. The facility census was 111.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(A)(vi) Based on record review and interviews, the facility failed to ensure recommendations for pharmacy requests were reviewed and actions taken related to Gradual Dose Reduction (GDR, Stepwise tapering of a dose to determine whether or not symptoms, conditions, or risks can be managed by a lower dose or whether or not the dose or medication can be discontinued), discontinued medications, and stops dates not updated for Resident 46, and failed to follow up on pharmacy recommendations for gradual dose reduction for antidepressant medications used for Resident 47. This affected two (Residents 46 and 47) of five residents reviewed for unnecessary medications. The facility census was 111.

Inspectors wroteBased on interview and record review, the facility to identify target behaviors to ensure adequate monitoring for 1 [Resident 68] of 4 sampled residents receiving antipsychotic medications. The facility had a total census of 111 residents.

Inspectors wroteLiscensure Reference Number 175 NAC 12-006.09 Based on record review and interviews; the facility failed to conduct neurological assessments after unwitnessed falls and falls with head injuries for 3 (Residents 1,2, and 4) of 4 sampled residents. The facility census was 101.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.04(G)(i) Based on record review and interviews; the facility failed to ensure 4 of 4 nursing staff sampled had competency evaluations. This had the ability to affect all residents that reside in the facility. The facility census was 101.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10 Based on record review and interview, the facility failed to follow the medical provider's orders for 1 (Resident 2) of 3 sampled residents. The facility identified a census of 106.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5) Based on interview and record review the facility failed to notify the resident's physician prior to transfer to the hospital for 1(Resident 5) of 3 residents sampled. The facility census was 99.

Inspectors wroteLicensure Reference Number 175 NAC 71-71-6022 (1) Based on record review and interview, the facility failed to document the basis for transfer and failed to provide a report the receiving provider for 1 (Resident 5) of 3 residents sampled who had transferred to the hospital. The facility census was 99.

Inspectors wroteNebraska Statute 71-6022(2) Based on interview and record review the facility failed to provide a discharge notice 30 days prior to a facility-initiated discharge for 1 of 3 (Resident 5) sampled residents. The facility census was 99. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I)(i)(1) Based on observation, interview, and record review the facility failed to implement fall interventions for 1 (Resident 1) of 3 sampled residents. The facility census was 99.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D) Based on observation, interview and record review the facility failed to ensure residents were free of significant medication errors for 1 of 5 (Resident 6) sampled residents. The facility census was 99.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04D2 Based on record review and interview, the facility failed to employ a qualified dietary manager. This has the potential to affect all residents residing at the facility. The facility census was 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11A1 Based on observation, record review and interview, the facility failed to ensure an approved recipe was followed to meet the nutritional needs of the residents. This had the ability to affect 88 of the 89 residents served food from the kitchen. The facility identified a census of 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11E Based on observation, record review, and interview, the facility failed to provide clean and sanitary conditions for food preparation and failed to prevent the potential for food borne illnesses due to expired food and improper hand hygiene during food preparation. This had the potential to affect 88 of 89 resident served food from the kitchen. The facility identified a census of 89.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.17a(2) LICENSURE REFERENCE NUMBER 175 NAC 12-006.17b Based on observations, record reviews and interviews; the facility staff failed to identify organisms for infection in their infection control program in real time and failed to utilize handwashing and gloving techniques during the provision of cares for 2 (Resident 33 and 26) of 4 sampled residents. The facility staff identified a census of 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D1d(1) Based on record review and interview, the facility failed to assist in scheduling an eye appointment for 1 (Resident 57) of 3 sampled residents. The facility census was 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D4 Based on record review and interview; the facility staff failed to evaluate 1 (Resident 44) of 3 sampled residents for a Restorative Nursing Program (RNP). The facility identified a census of 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D4 Based on observations, record review, and interview; the facility staff failed to complete catheter (tube placed into bladder) care for 1 (Resident 33) and failed to complete incontinence care for 1 (Resident 44) of 4 sampled residents. The facility staff identified a census of 89.

Inspectors wroteLicensure Reference Number175 NAC 12-006.09D8a Based on interviews, record review, and observation, the facility failed to provide nutritional interventions for continued weight loss on 1 (Resident 84) and failed to have a method of accurately and consistently obtaining weights for 1 (Resident 44) of 3 sampled residents. The facility has a census of 89.

Inspectors wroteBased on record review, observation, and interviews, the facility failed to identify, assess, and monitor a fistula site for 1 resident (Resident 25) of 1 sampled resident. The facility identified a census of 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D5 Based on observations, record review and interview; the facility staff failed to evaluate and implement interventions to manage triggers for 1 (Resident 33) of 1 resident with a diagnosis of Post Traumatic Stress Disorder (PTSD). The facility staff identified a census of 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.14 Based on record review and interview, the facility failed to ensure dental services were provided for 1 of 4 sampled residents (Resident 57). The facility census was 89.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04E1 Based on record review and interview the facility failed to ensure the Social Service Coordinator had the qualifications to hold that position in a facility with over 120 licensed beds. This had the potential to affect all residents. The facility census was 89.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.05(4). Based on record review and interview: the facility failed to ensure that bathing was provided according to the comprehensive plan of care for 2 (Resident 2 and 3) of 6 sampled residents. The facility staff reported a census of 86.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D7 Based on record review and interview; the facility staff failed to implement interventions to prevent elopement and failed to implement action plans to identify the location of 1 (Resident 14) of 3 sampled residents. The facility staff identified a census of 94.

Inspectors wroteBased on record review and interview; the facility staff failed to ensure the Facility Assessment (tool used to identify all the resources needed to meet the needs of the facility residents) identified if the facility Administrator, Director of Nursing (DON), Assistant Director of Nursing's, Social Services Director, Human Resources Director, Minimum Data Set,(MDS, a federally mandated assessment tool use for care planning) Coordinator, Business Office Manager, Environmental Services/Maintenance Director and the Dietary Manager were full or part time, failed to identify the needs for an Activities Director or Infection Control Preventionist and the amount of time needed to meet all the facility resident's needs. This had the potential to effect all residents in the facility. The facility staff identified a census of 94.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04B2a Based on record review and interview; the facility staff failed to ensure 6 Nursing Assistants (NA D, NA E, NA G, NA H, NA I and NA J) of 8 NAs employed a year or longer received the required 12 hours of training yearly. The facility staff identified a census of 94.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17A1 Licensure Reference Number 175 NAC 12-006.17D Licensure Reference Number 175 NAC 12-006.17B Licensure Reference Number 175 NAC 12-006.18B Licensure Reference Number 175 NAC 12-006.18C1 Based on observation, interview, and record review, the facility failed to ensure staff wore surgical masks above the nose and below the chin while serving meals and in resident care areas to prevent the potential spread of COVID-19, failed to perform hand hygiene (cleaning) between residents to prevent cross-contamination (spread of bacteria from one surface to another), failed to ensure oxygen nasal cannula (a tube inserted in the resident's nose to deliver oxygen) was off the floor, failed to sanitize (clean) and store nebulizer administration set (a device used to deliver liquid medication to the lungs) per facility policy, failed to sanitize COVID-19 [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(21) Based on observation and interview, the facility failed to provide a homelike environment for all 10 residents in the dining room by leaving plates with food, cups with fluid, and silverware on the plastic serving trays in front of the residents. This affected Residents 80, 82, 26, 67, 2, 33, 18, 24, 88, and 64. The total facility census was 96.

Inspectors wroteBased on record review and interview; the facility staff failed to identify and communicate Advance Directive to nursing staff for 1 (Resident 77) of 1 sample resident. The facility census was 96.

Inspectors wrote175 NAC 12-006.09b1(2) Based on record review and interviews, the facility failed to ensure the completion of a Significant Change in Status Assessment (SCSA) Minimum Data Set (MDS-a comprehensive assessment of each resident's functional capabilities) for 1 Resident (16) after the resident had a significant change in condition. The facility's census was 96.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D6(7) Based on observation, interview, and record review, the facility failed to ensure 1 (Resident 249) of 3 sampled resident's oxygen tank was full and working to provide the resident's oxygen as ordered. The total facility census was 96.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09 Based on record review and interview; the facility staff failed to follow pre-dialysis instructions identified on a Dialysis Communication Sheet and failed to provide post-dialysis monitoring in accordance with physicians orders for 1(Resident 68) of 1 sampled resident.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12E1 Licensure Reference Number 175 NAC 12-006.12E8 Based on observation, interview, and record review, the facility failed to ensure 2 (Residents 58 and 248) of 3 sampled resident's medications were secured and not stored in the resident's rooms and failed to ensure an unidentified medication in room [ROOM NUMBER] was stored safely. The total facility census was 96.