Gideon Care Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide reasonable accommodations to meet the needs of residents by not replacing an oxygen concentrator for one resident (Resident #18) out of 16 sampled residents and by not adjusting a dining table to an adequate level during meal consumption for one resident (Resident #31) out of 16 sampled residents and one resident (Resident #42) outside the sample. The facility failed to place a call light within reach for one resident (Resident #54) outside the sample. The facility census was 62. [...]

Inspectors wroteBased on interview and record review, the facility failed to issue a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) to the resident and/or the resident's representative in writing at least two calendar days before discharge from skilled services. This notice informs the beneficiary about potential non-coverage and the option to continue services with the beneficiary accepting the financial liability for those services. This practice affected one resident (Resident #8) out of three sampled residents. The facility census was 62. [...]

Inspectors wroteBased on observation and interview, the facility staff failed to post the required daily nurse staffing information which included the total number of staff and the actual hours worked by both licensed and unlicensed nursing staff directly responsible for resident care, in a prominent location readily accessible to residents and visitors for three out of four days. The facility census was 62. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement procedures to ensure medications were accurately documented, disposed of, and reconciled for two residents (Residents #34 and #37) out of 16 sampled residents. The facility census was 62. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow Enhanced Barrier Precautions (EBP) and failed to follow infection control practices for wound care for one resident (Resident #32) out of two sampled residents. The facility census was 62. Review of the facility's policy titled, Enhanced Barrier Precautions, last revised March 2024, showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed obtain a physician's order for code status and to consistently document a resident's code status with Cardiopulmonary Resuscitation (CPR- an emergency procedure consisting of chest compressions if the heart stops beating or the person stops breathing) or Do Not Resuscitate (DNR - does not want CPR) for one resident (Resident #31) out of 15 sampled residents. The facility census was 60. Review of the facility's policy titled, Do Not Resuscitate Order, last revised, [DATE], showed: - DNR orders must be signed by the resident's attending physician on the physicians' order sheet maintained in the resident's medical record; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean and comfortable homelike environment. This deficient practice had the potential to affect all residents in the facility. The facility census was 60. Review of the facility's policy titled, Homelike Environment, February 2021, showed: - Residents are provided a safe, clean, comfortable and homelike environment and encouraged to use their personal belongings to the extent possible; - The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting which include clean, sanitary, and orderly environment; - Comfortable and adequate lighting is provided in all areas of the facility to promote a safe, comfortable and homelike environment such as sufficient lighting in resident-use areas. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement a care plan with specific interventions to meet individual needs for five residents (Residents #36, #38, #41, #48 and #56) out of 15 sampled residents. The facility census was 60. Review of the facility's policy titled,Comprehensive Person-Centered Care Plans, dated March 2022, showed: - A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident; - The interdisciplinary team (IDT), in conjunction with the resident and or his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident; [...]

Inspectors wroteBased on interview and record review, the facility failed to obtain a physician order for one hospice (healthcare focused on the quality of life of a terminally ill person) resident (Resident #20) out of three sampled residents and failed to follow insulin (a hormone that helps regulate blood sugar levels by moving glucose from the bloodstream into cells for energy) administration order times for one resident (Resident #31) out of one sampled resident and two residents (Residents #10 and #15 ) outside the sample. The facility census was 60. Review of the facility's policy titled, Hospice Program, revised 2017, showed: - Hospice services are available to residents at end of life; - The resident may choose to specify his/her attending physician, or another physician/practitioner, as the hospice attending physician; [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to ensure residents with limited range of motion (ROM) received appropriate treatment and services to increase their ROM and/or prevent a further decrease in their ROM when facility staff failed to perform restorative services as ordered for three residents (Residents #23, #30 and #35) out of four sampled residents. The facility census was 60. Review of the facility's policy titled, Restorative Nursing Services, dated July 2017 showed: - Residents will receive restorative nursing care as needed to help promote optimal safety and independence; - Restorative nursing care consists of nursing interventions that may or may not be accompanied by formalized rehabilitative services; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to label and date food, follow use by dates and record daily freezer temperatures, increasing the risk of cross-contamination and food-borne illness. These deficient practices had the potential to affect all residents. The facility census was 60. Review of the facility's policy titled, Refrigerators and Freezers, revised November 2022, showed; - Monthly tracking sheets for all refrigerators and freezers are posted to record temperatures; - Tracking sheets include time, temperature, initials, and action taken if needed; - Food service supervisors or designated employees check and record temperatures daily with first opening and at closing in the evening; - All food is appropriately dated to ensure proper rotation by expiration date. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement proper infection control practices when staff were accessing and administering medications through a peripherally inserted central catheter (PICC - a thin, soft, flexible tube that is placed in a vein that leads to the heart) for one resident (Resident #36) out of one sampled resident. The facility failed to implement enhanced barrier precautions (EBP) and failed to use proper hand hygiene during incontinent care and catheter (a flexible tube placed in the bladder to drain urine) care for two residents (Residents #38 and #48) out of four sampled residents. [...]

Inspectors wroteBased on interview and record review, the facility failed to document pertinent education provided to the residents or the resident's representative regarding benefits, side effects or warnings of the influenza (a viral respiratory infection) and/or the pneumococcal (an infectious lung disease) vaccine for four residents (Residents #7, #21, #30, and #56) out of five sampled residents. The facility's census was 60. Review of the facility's policy titled, Vaccination of Resident, revised October 2019, showed: - Prior to the vaccination, the resident (or resident's legal representative) will be provided information and education regarding the benefits and potential side effects of the vaccinations. Provision of such education shall be documented in the resident's medical record; - If vaccines are refused, the refusal shall be documented in the resident's medical record. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean and comfortable homelike environment. This deficient practice had the potential to affect all residents in the facility. The facility census was 64. Review of the facility's policy titled, Homelike Environment, revised February 2021, showed: - Residents are provided with a safe, clean, comfortable and homelike environment and encouraged to use their personal belongings to the extent possible; - Clean, sanitary and orderly environment; - Comfortable and adequate lighting is provided in all areas of the facility to promote a safe, comfortable and homelike environment. Observations made on 11/07/23 at 10:09 A.M., and 11/08/23 at 10:35 A.M., of the 100 Hall showed: - A two inch (in.) X 24 in. [...]

Inspectors wroteBased on interview and record review, the facility failed to notify residents of the availability and location of the most recent survey results in an accessible location to the residents. This deficient practice affected one resident (Resident #41) out of 16 sampled residents and three residents (Resident #5, #19 and #34) outside the sample and had the potential to affect all residents and visitors. The facility census was 64. Review of the facility's policy titled, Resident Rights, revised February 2021, showed: - Employees shall treat all residents with kindness, respect and dignity; - Federal and state laws guarantee certain basic rights to all residents of this facility; - These rights include be free of abuse, neglect misappropriation of property, exploitation, voice grievances to the facility and examine survey results. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure care plan conferences were conducted and care plans reviewed by the interdisciplinary team (IDT) (team members from different disciplines working together with a common purpose) at least quarterly for 11 residents (Resident #2, #6, #13, #17, #22, #27, #33, #38, #40, #53, and #114) out of 16 sampled residents. This deficient practice had the potential to affect all residents at the facility. The facility census was 64. Review of the facility's policy titled,Care Plan-Interdisciplinary Team, dated March 2022 showed: - The IDT is responsible for the development of resident care plans; - Resident care plans are developed according to the timeframes and criteria established by Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, Regulatory reference number 483.21(b). 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an error rate of less than five percent (%) when medications were administered. There were 33 opportunities with four errors made, for an error rate of 12%. Out of six residents observed, this affected two sampled residents (Resident #10 and #40) and two residents outside the sample (Resident #7 and #26). The facility census was 64. The facility did not provide a medication error policy. Review of the Insulin Flexpens manufacturer's instructions for use, revised 09/11/15, showed - Priming the pen means removing the air from the needle and cartridge that may collect during normal use and ensures that the pen is working correctly; - If not primed before each injection, the pen may inject the person with too much or too little insulin. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to properly monitor the refrigerator temperatures in which medications, including insulin (medication used to treat diabetes), were stored. This had the potential to affect all residents. The facility census was 64. Review of the facility's policy, titled Medication Labeling and Storage, dated February 2023 showed: - The facility stores all mediations and biologicals in locked compartments under proper temperature, humidity and light controls. Only authorized personnel have access to keys; - The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner; - Medications requiring refrigeration are stored in a refrigerator located in the medication room at the nurses' station or other secured location. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the required annual competency of Abuse Prevention to one Certified Nurse Aide (CNA) (CNA A) out of two sampled CNAs and had the potential to affect all residents. The facility's census was 64. Review of the facility's policy titled, In- Service Training, Nurse Aide, revised August 2022, showed: - The facility completes a performance review of nurse aides at least every 12 months; - In-service training is based on the outcome of the annual performance reviews; - Annual in-services ensure the continuing competence of nurse aides and include training in dementia management and resident abuse prevention; - Required training topics for all staff include: abuse, neglect, and exploitation. 1. Review of CNA A's in-service record showed: - A hire date of 05/15/18; - Abuse prevention training program completed on 09/14/22; [...]