Garden County Hospital & Nursing Home

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(D)Licensure Reference Number 175 NAC 12-006.11(E) Based on observation, interview, and record review; the facility failed to A) transport and then use visibly soiled utensils in a manner to prevent the potential for cross contamination B) sanitize counters and thermometers, C) have expiration or best used by dates on canned goods, and D) failed to ensure staff performed hand hygiene as required during meal delivery. This had the potential to affect all residents. The facility census was 21. A. An Observation on 8/21/2025 at 11:30 AM revealed [NAME] K removed covered food-from oven and placed the food on a Hot/Cold serving cart. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(i) Based on record review and interview, the facility failed to ensure 3 of 4 sampled employees completed initial orientation as required. The facility census was 21. Findings Are: A record review conducted on 8/21/2025 of an undated and untitled facility staff list revealed the following:-Nurse Aide (NA)-B was hired on 8/1/2025.-Housekeeper (HSK)-C was hired on 4/7/2025.-Cook-D was hired on 8/11/2025. A record review of facility provided employee file for NA-B revealed no evidence that initial orientation had been completed. A record review of facility provided employee file for HSK-C revealed no evidence that initial orientation had been completed. A record review of facility provided employee file for Cook-D revealed no evidence that initial orientation had been completed. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(ii) Based on record review and interview, the facility failed to ensure 4 of 5 sampled nurse aides (NA) completed 12 hours of ongoing training annually and failed to ensure 5 of 5 sampled staff completed the required 4 hours of Alzheimer's care and dementia care training annually. This had the potential to affect all residents. The facility census was 21. Findings Are: A record review of the Facility assessment dated [DATE] revealed in Section 3.4 that staff training/education and competencies are maintained through the Relias Learning platform and the modules are completed upon hire and annually. A record review of an undated and untitled facility document revealed the following:-NA-E was hired on 8/5/2024,-NA-F was hired on 4/7/2023,-NA-G was hired on 6/26/2023,-NA-H was hired on 1/31/2024, and -NA-I was hired on 8/3/2020. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(B) Based on record review and interview, the facility failed to submit accurate Minimum Data Set (MDS, a federally mandated comprehensive assessment tool used to determine a resident's functional capabilities and helps nursing home staff identify health problems) data related to weight loss for 1 (Resident 2) of 1 sampled residents. The facility identified a census of 21 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(J) Based on observations, record reviews, and interviews; the facility failed to evaluate and implement interventions for 2 (Residents 11 and 8) of 13 sampled residents to prevent significant weight loss. The facility census was 26. The Findings Are: A. A record review of Resident 11's Minimum Data Set (MDS,a federally mandated comprehensive assessment tool used in care planning), dated 5/14/24, revealed in Section C a Brief Interview for Mental Status (BIMS) score of 6/15, which indicated the resident had severe cognitive impairment. The MDS also revealed in Section K revealed Resident 11 had a weight loss of 5% or more in the last month or of 10% or more in the last six months and was not on a prescribed weight loss plan. [...]

Inspectors wroteLicensure Reference 175 NAC 12- 006.11(E) Based on observations, interviews, and record reviews; the facility failed to a) ensure foods were disposed of prior to the expiration date and to label open food items, b) ensure beard restraints were in use, c) implement hand hygiene as required during meal preparation and meal service and d) ensure sanitation of the kitchen environment. This had the potential to affect all 26 residents who resided within the facility. A. A record review of a facility policy Food Handling - Storage with a last revised date of 10/17/2013 revealed foods which have been opened or prepared will be enclosed container, dated and labeled. Expiration dates will be checked on a regular basis and foods which have expired will be discarded. [...]

Inspectors wroteLicensure Reference 175 NAC 12- 006.18(B) Based on observations, interviews, and record reviews; the facility failed to provide wound care for 1 (Resident 26) and failed to distribute laundry throughout the nursing unit in a manner that prevented the potential for cross contamination. The facility census was 26.

Inspectors wroteLicensure Reference 175 NAC 12-006.5(R) Based on observation, interview, and record review the facility failed to ensure private medical information was protected for 4 (Resident 2, 15, 22, and 23) of 4 sampled residents. The facility census was 26.

Inspectors wroteLicensure Reference 175 NAC 12- 006.05(S) Based on observations, interviews, and record review; the facility failed to provide meal service that enhanced dignity by ensuring all residents were served at a table before serving the next table for 1 (Resident 5) of 1 sampled resident. The facility census was 26.

Inspectors wroteLicensure Reference 175 NAC 12-006.04(F)(i)(5) Based on interviews and record review; the facility failed to notify the physician of significant weight loss for 2 (Residents 8 and Resident 11) of 2 sampled residents. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G) Based on observation, record review, and interviews; the facility failed to evaluate 1 (Resident 13) of 2 sampled residents of a potential use of a physical restraints. The facility census was 26. The Findings Are: A record review of facility policy Restraints with revised date of 9-99 revealed that restraints would only be used as a last resort to prevent a patient from injuring self or others and only when alternatives to restraints are not effective. The policy also stated that restraints were to have a physician's order except in the case of an emergency. [...]

Inspectors wroteLicensure Reference 175 NAC 12-006.09(E) Based on record reviews and interview; the facility failed to develop a comprehensive care plan regarding Activities of Daily Living (ADL) for 2 (Resident 1 and Resident 8) of 13 sampled residents. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(F)(iii) Based on record reviews and interview; the facility failed to revise a care plan when the current interventions were ineffective for preventing significant weight loss for 1 (Resident 8) of 13 sampled residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H) Based on observations, record review, and interviews; the facility failed to implement a physician ordered treatment for 1 (Resident 25) of 1 sampled resident's edema and failed to ensure a hypertension medication was administered in accordance with the Prescribers' orders for 1 (Resident 6) of 5 sampled residents. The facility census was 26. The Findings Are: A. A record review of Resident 25's progress note dated 7/8/2024 revealed that Resident 25's left arm was swollen, and that the resident had been seen by a provider two days prior. A record review of Resident 25's progress note dated 7/16/24 revealed that Resident 25's provider had seen the resident that day for a follow up appointment related to their left arm swelling. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I) Based on observation, record review, and interview; the facility failed to ensure 1 (Resident 12) of 2 sampled residents' oxygen concentrator was not left on when unattended. The facility census was 26. The Findings Are: A record review of website www.inogen.com revealed that oxygen itself is not a flammable gas, but it does support combustion. This means that fires ignite and burn more easily, and hotter, in an oxygen-rich environment. In order to maintain a safe environment while using supplemental oxygen, it is important to adhere to safe practices. The website also listed a safe oxygen storage guideline of Turn off your oxygen when you're not using it. Don't set the cannula or mask on the bed or a chair if the oxygen is turned on. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure an antibiotic had a stop date for 1 (Resident 13) of 1 sampled residents. The facility census was 26. The Findings Are: A record review of facility policy Antimicrobial Stewardship Program Committee with revised date of 7/24, revealed the goal of the Antimicrobial Stewardship Program was to ensure proper use and duration of antimicrobials within the entire facility. The policy stated that this would help reduce antimicrobial resistance and adverse reactions to antimicrobials. A record review of Center for Disease Control's (CDC) document The Core Elements of Antibiotic Stewardship for Nursing Homes APPENDIX A: Policy and Practice Actions to Improve Antibiotic Use revealed Surveys of antibiotic use have shown that (Urinary Tract Infection) UTI prophylaxis accounts for a significant proportion of antibiotic prescriptions. [...]

Inspectors wroteLicense Reference Number NAC 175 12-006.11E Based on observations, record reviews, and interviews, the facility failed to 1) follow recipes during meal preparation, 2) failed to change gloves as required, and 3) failed to perform hand hygiene as required during meal preparation. This had the potential to affect all the residents who resided at the facility. The facility identified a census of 29 residents at the time of the survey.

Inspectors wroteReference Number 175-NAC 12-006.09B Based on record review and interview; the facility failed to ensure the MDS (Minimum Data Set, a comprehensive assessment tool used to develop a resident's care plan) reflected the current status of 1 (Resident 12) of 1 sampled residents related to a Serious Mental Illness diagnosis. The facility identified a census of 29.