Foxwood Springs Living Center

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the physician's order for a narcotic medication was accurately shown on the narcotic sheet and Medication Administration Record (MAR); failed to ensure the nurse accurately documented narcotic medications administered on the MAR; and failed to ensure the policy and procedure for corrections made on the narcotic sheet were followed for one sampled resident (Resident #4) out of 8 sampled residents. The facility census was 92 residents. Review of the facility's Administering Oral Medication policy and procedure dated October 2010, showed the purpose was to provide guidelines for safe administration of oral medications. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically, the facility failed to clean the kitchen floors, preparation table, shelves and drawers, stove, the grill, grill area, ovens, sides and front of the deep fat fryer, refrigerators, and the steamer/convection ovens.

Inspectors wroteBased on interviews and record review, the facility failed to maintain a Quality Assessment and Performance Improvement (QAPI) Committee with the participation of the Medical Director and Infection Control Preventionist (or designee) for three (3) out of six (6) quarterly meetings.

Inspectors wroteBased on observations, interviews, and review of the facility's cleaning checklist, the facility failed to maintain the physical environment in a safe, clean, comfortable and homelike manner on 200 Hall for two (2) residents who resided on this hall (Resident #48 and Resident #53), and failed to maintain in a safe, clean manner a lounge area and ice machine shared by residents from both 100 and 200 Halls. The combined census on the 100 and 200 Halls on 1/7/25, the first day of the survey, was 45.

Inspectors wroteBased on observation, interview and record review, the facility staff failed to ensure an environment free from accident hazards. Staff failed to secure the contents of an unattended treatment cart stored in a lounge used by residents on the 100 and 200 Halls. The cart contained medicated creams, ointments, and topical sprays, as well as bandage scissors. The unlocked treatment cart presented a potential hazard to all residents residing on 100 and 200 Halls.

Inspectors wroteBased on interviews and record review, the facility failed to ensure a resident, who was not determined by a physician to lack the ability to make informed healthcare decisions, was provided with opportunities to make decisions in their best interest for the Care Plan process. This was evidenced by one (1) of three (3) residents sampled for participation in the Care Plan process (Resident #64).

Inspectors wroteBased on interviews and record review, the facility failed to ensure the Notice of Medicare Non-Coverage and the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage were acknowledged by the resident. This was evidenced for one (1) of three (3) residents sampled for Notice of Medicare Non-Coverage and the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (Resident #64).

Inspectors wroteBased on interviews and record review, the facility failed to develop a Comprehensive Care Plan after a significant change in the status/condition of a resident. This was evidenced by Resident #10 having had an unwitnessed fall with major injury resulting in a right hip replacement and pubic bone fracture on 7/24/24. The Care Plan was not revised within seven (7) days to ensure timeliness of a person-centered comprehensive assessment to address the resident's needs for one (1) of one (1) resident sampled for Comprehensive Care Plan timeliness (Resident #10).

Inspectors wroteBased on interview and record review, the facility failed to notify the resident's responsible party to obtain consent prior to starting a new medication for one sampled resident (Resident #2) out of three sampled residents. The facility census was 88 residents. The Director of Nurses (DON) and the Administrator were notified on 7/9/24 of Past Non-Compliance which occurred on 5/10/24. All nursing staff were in-serviced on notification of responsible parties on 6/21/24. The deficiency was corrected on 6/21/24. Review of the facility's policy titled Charting and Documentation dated July 2017 showed: -Any changes in the resident's condition shall be documented in the resident's medical record. -Documentation should include notification of the family. 1. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to protect one sampled resident (Resident #3) out of 10 sampled residents from intimidation and physical abuse. On 1/25/24 at about 10:00 A.M., Licensed Practical Nurse (LPN) A, Certified Nurses Aide (CNA) A, CNA B, and CNA C forcibly made the resident shower. The resident said no and struck out at staff. The resident reported having a fear of water and doesn't like water on his/her face. The resident was visibly tearful and upset while recounting the event. The resident had a thumb size dark purple bruise with a green ring around it on the back of his/her right upper arm, thumb size dark purple bruise on the left lower arm below the elbow, and finger size dark purple bruise on the right upper outer arm. The facility had 87 residents. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide safe transfer assistance for one sampled resident (Resident #3). On 1/25/24 the resident was transferred by four staff from his/her wheelchair to a shower chair without the use of a gait belt, while the resident physically resisted. Staff grabbed the resident by his/her arms and lifted him/her up from the wheelchair, resulting in bruising on the back of his/her right upper arm, left lower arm below the elbow, and on the right upper outer arm. The facility census was 87 residents. Review of facility policy Safe Lifting and Movement of Residents, revised 7/2017, showed: -In order to protect the safety and well-being of staff and residents, and to promote quality care, this facility used appropriate techniques and devices to lift and move residents. [...]

Inspectors wroteBased on observation and interview, the facility failed to place the date on the tray of when the turkey breasts and chicken pieces were taken from the freezer for defrosting; to remove encrusted deposits of burnt-on debris from the stove top; to refrigerate items (dessert toppings, steak sauce, grape jelly); to protect several glasses of juice and plates of apple crisp from a dusty fan in the [NAME] Bridge dining room; to maintain the fans the [NAME] Bridge Kitchenette free from a heavy buildup of dust; failed to measure the temperature of non-pasteurized eggs before they were placed on a plate for service; and to remove debris from the nozzles of the spray wand of the automated dishwasher. This practice potentially affected 80 residents who ate food from the kitchen. The facility census was 80 residents. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a bed-hold form was completed and sent for three sampled residents who were discharged to the hospital (Resident #3, #7 and #328) out of 19 sampled residents. The facility census was 80 residents. Review of the facility's policy titled Bed-Holds and Returns dated March 2022 showed: -All residents/representatives are provided written information regarding the facility bed-hold policies, which address holding or reserving a resident's bed during periods of absence (hospitalization or therapeutic leave). -Residents are provided written information about these policies at least twice: --Well in advance of any transfer (in the admission packet). --At the time of transfer (or, if the transfer was an emergency, within 24 hours). 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain hot foods at or close to 120 ºF (degrees Fahrenheit) for two sampled residents (Residents #35 and #43) who received room trays on 6/29/23. This practice potentially affected at least four residents who received room trays on that date. The facility census was 80 residents. 1. Review of Resident #43's Significant Change Minimum Data Set (MDS-a federally mandated assessment tool completed by the facility for care planning), dated 5/24/23, showed the resident had moderate cognitive impairment. During an interview on 6/29/23 at 8:58 A.M., Certified Nursing Assistant (CNA) A said he/she worked 3 to 4 days per week and had not seen anyone from the dietary department go out to the hallways to measure the food temperatures. Observation on 6/29/23 at 9:12 A.M., showed: [...]

Inspectors wroteBased on observation, interview, the facility failed to do or maintain the following area in a clean, sanitary or comfortable manner: maintain the ceiling vents in the employee breakroom, free of a buildup of dust; ensure the screen over the outdoor vent in the laundry room was completely secured to the wall to prevent the entrance of pests; to maintain the commode seat in resident room [ROOM NUMBER], without any indentations; to ensure there was negative air flow in the shower rooms and the restrooms of the resident rooms on the 600 Hall; to maintain the ceiling vent without a heavy buildup of dust in the 800 Hall shower room; and to maintain the [NAME] Bridge kitchenette at a comfortable temperature during the breakfast meal preparation on 6/29/23. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide supporting documentation for the use of a wandering type bracelet (are monitoring devices that are attached to patients and electronically notify nurses when the patient attempts to leave the ward or unit to which the patient is assigned) safety device to include changes in resident behavior, or exit seeking behaviors for one sampled resident who was his/her own responsible person and who's Brief Interview for Mental Status (BIMS) score was 15 (A score of 13 to 15 would indicate the resident was cognitively intact); and to document the resident's right to consent either verbal or written consent, for the use of a wandering safety device for one sampled resident (Resident #16); [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the privacy of one sampled resident (Resident #4) during a blood glucose test (a test that measures the amount of glucose (sugar) levels in the blood) and when receiving insulin (a hormone produces in the pancreas which regulates the amount of sugar in the blood) out of 19 sampled residents. The facility census was 80 residents. Review of the facility's policy titled Dignity dated February 2021 showed staff promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. 1. Review of Resident #4's face sheet showed he/she admitted to the facility with the following diagnoses: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow professional standards by not aspirating (draw fluid by suction) or flushing an peripheral intravenous catheter (PIVC or IV-a thin plastic tube inserted into a vein using a needle) prior to administering medication for one sampled resident (Resident #278) out of 19 sampled residents. The facility census was 80 residents. Review of the facility's policy, titled Dispensing and Administration of Saline and Heparin Flushes for IV Catheters dated February 2017, showed staff were required to flush any type of IV catheter: -With 10 milliliters (ml) of Normal Saline (a sterile solution that is a mixture of sodium chloride and water) prior to administering medication through the IV. -With 10 ml of Normal Saline after administration of any medication through the IV. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the wheels on all mobile devices were locked prior to transferring and repositioning one sampled resident (Resident #278) out 19 sampled residents. The facility census was 80 residents. A copy of the facility's policy on accidents and transferring of residents was requested and not received at the time of exit. 1. Review of Resident #278's face sheet showed he/she was admitted with the following diagnoses: -Abnormalities of gait and mobility. -Muscle Weakness. -Fall from chair. Review of the resident's Significant Change Minimum Data Set (MDS-a federally mandated assessment instrument completed by facility staff for care planning), dated 5/25/23, showed: -The resident had a Brief Interview for Mental Status (BIMS) of six, indicating the resident had severe cognitive impairment. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a suprapubic (a surgically created connection between the urinary bladder and the skin used to drain urine from the bladder in individuals with obstruction of normal urinary flow) catheter (flexible tube) was monitored, cleaned as ordered, and that an assessment of the resident's ability to perform the task had been completed, for one sample resident (Resident #20) out of 19 sampled residents. The facility census was 80 residents. The facility's policy for self-care of catheters was not received at time of exit. Review of the facility's policy, dated October 2010, titled Suprapubic Catheter Care showed staff were to: -Observe urine for any unusual appearance. -Check the resident frequently to ensure tubing was free of kinks. -Empty the collection bag. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure one sampled resident (Resident #278) was free from unnecessary medications by ordering and administering an incorrect medication multiple times, out 19 sampled residents. The facility census was 80 residents. Review of the facility's Medication Therapy policy, dated April 2007, showed each resident's medication regimen was to include only medications necessary to treat existing condition. Review of the facility's undated policy titled General Guidelines for Transcribing Orders onto the Medication Administration Record (MAR) showed staff were to transcribe the information as it was written on the order. Review of missouricareereducation.org's undated Certified Medication Technician Student Manual, Lesson Plan 6, Transcribing Physician's Orders-General Principles showed: -All transcriptions were to be error-free. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure one sampled resident (Resident #278), out of 19 sampled residents, was free from a significant medication error by administering the incorrect antibiotic for three days. The facility census was 80 residents. Review of the facility's Medication Therapy policy, dated April 2007, showed each resident's medication regimen was to include only medications necessary to treat existing condition. Review of the facility's undated policy titled General Guidelines for Transcribing Orders onto the MAR (Medication Administration Record) showed staff were to transcribe the information as it was written on the order. Review of missouricareereducation.org's undated Certified Medication Technician Student Manual, Lesson Plan 6, Transcribing Physician's Orders-General Principles showed: -All transcriptions were to be error-free. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to offer and provide dental services for one sampled resident (Resident #37) out of 19 sampled residents. The facility census was 80 residents. The facility did not provide a copy of their dental policy at time of exit. 1. Review of Resident #37's face sheet showed he/she was admitted [DATE] with the following diagnoses: -Adult failure to thrive (syndrome of weight loss, decreased appetite and poor nutrition, and inactivity). -Dysphagia (difficulty swallowing). Review of the resident's admission Note, dated 1/16/23, showed Licensed Practical Nurse (LPN) A documented: -The resident had no teeth. -Broken or ill-fitting dentures were not assessed. -Abnormal mouth tissue was not assessed. -Lack of natural teeth was not assessed. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to use adequate handwashing to prevent cross contamination during resident care for one sampled resident (Resident #45); to ensure the intravenous (IV-a medical technique that administers fluids, medications and nutrients directly into a person's vein) medication tubing's luer connector (the male end of the IV tubing that is inserted into the female end of an IV line that has been placed in a person's vein to form a secure yet detachable leak-proof connection) remained sterile while administering IV antibiotics; and to ensure supplies were placed on a barrier for one sampled resident (Resident #278) out of 19 sampled residents. The facility census was 80 residents. The facility's policy and procedure for administering IV fluids was requested and not received at time of exit. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure narcotic counts were completed and signed by two staff each shift for five medication carts and three medication rooms. The facility census was 84 residents. Record review of the facility's Controlled Substance policy dated 4/2019 showed: -Controlled substances are reconciled upon receipt, administration, disposition, and at the end of each shift. -Controlled medications are counted at the end of each shift. The nurse coming on duty and the nurse going off duty determine the count together. -The Director of Nursing (DON) investigates all discrepancies in controlled medication reconciliation to determine the cause and identify any responsible parties, and reports the findings to the administrator. 1. Record review of the 100 and 200 hall medication room Eight Hour Verification of Controlled Substances Count showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure multi-dose medications were dated when opened, including insulin pens and liquid narcotics. The facility census was 84 residents. Record review of the facility's Medication Storage Guidance dated April 2019 located in a medication room showed: -Multidose vials for injection (not specifically mentioned elsewhere): Date when opened and discard unused portion after 28 days or in accordance with manufacturer's recommendations. -Tuberculin: Date when opened and discard unused portion after 30 days. -Ativan oral solution: If kept in the refrigerator, date when opened and discard 90 days after opening. -Novolog: good for 28 days after opening. -Lantus: good for 28 days after opening. Record review of the Storage of Medications policy dated November 2020 showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a coordination of care with hospice (end of life care) for one sampled resident (Resident #31) out of 12 sampled residents. The facility census was 84 residents. 1. Record review of Resident #31's admission Record showed he/she was admitted to the facility on [DATE] and had the following diagnoses: -Anaplastic large cell lymphoma (a cancer of the lymph system, part of our immune system). -Dementia (a progressive organic mental disorder characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses) with behavioral disturbances. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure behaviors were documented when a resident has increased behaviors to warrant the use of a Pro Re Nata (PRN-as needed) anti-anxiety medication (a controlled substance medicine that calm and relax people with excessive anxiety, nervousness, or tension), and to document non-pharmacological interventions (any sort of intervention not directly involving a medication) prior to the administration of a PRN anti-anxiety medication for one sampled resident (Resident #12) out of 12 sampled residents. The facility census was 84 residents. Record review of the facility's policy Behavioral Assessment, Intervention and Monitoring revised 3/2018 showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate of less than 5 percent (%). Out of 30 observed medication opportunities, five errors occurred resulting in an error rate of 16.67%. Facility staff crushed medications not approved for crushing for one resident (Resident #9) and to apply pressure to the corner of the eye following administration of eye drops for one resident (Resident #77). The facility census was 84 residents. Record review of ophthalmioprofessional.com, September 2013 issue Administering Eye Medication showed: - Applying light pressure on the inner canthus (the inner or outer corner of the eye, where the upper and lower lids meet) for one or two minutes while keeping the eyes closed prevents the absorption of medication systemically. [...]