Good Shepherd Community Care and Rehabilitation

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was stored, prepared, and served in a manner to protect the food from possible contamination when staff failed to store food in sealed containers; failed to discard expired and freezer burnt food; failed to ensure vents, windows, and fans were free of dirt and lint; failed to ensure the dishwasher washed and rinsed the dishes at the recommended temperature; and failed to ensure the dishwasher chemicals tested at recommended level. This had the potential to affect all residents who consumed food from the facility kitchen. The facility had a census of 62 residents. 1. Review of the 2013 Missouri Food Code showed food shall be protected from contamination by storing the food in a clean, dry location and where it is not exposed to splash, dust, or other contamination. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure the revision of comprehensive care plans to include measurable objectives and timeframes to meet the medical and nursing needs for two residents (Resident #11, and Resident #313) who sustained falls with injuries, for one resident (Resident #10) who declined requiring the use of a wheelchair, and for one resident (Resident #14) who required significant additional nutritional assistance out of 19 sampled residents. The facility census was 62. Review of the facility policy titled, Care Plans, Comprehensive Person-Centered, revised December 2016, showed the following: -The comprehensive person-centered care plan will incorporate identified problem areas; incorporate risk factors associated with identified problems; and reflect currently recognized standards of practice for problem areas and conditions; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an environment as free of accident hazards as possible when staff failed to use equipment improperly resulting a fall with injury, when staff did not update the care plan with new interventions after the fall, and when staff did not document a timely and complete assessment of the resident after the fall for one resident (Resident #11). The facility failed to ensure residents were transferred safely when staff failed to transfer one resident properly with a Hoyer lift (mechanical devised used for lifting residents) resulting in bruising to the resident's face and failed to document a full and timely assessment of the bruise received for one resident (Resident #21). [...]

Inspectors wroteBased on interview and record review, the facility failed to have a system in placed to ensure nurse aides (NA) completed their training, competencies, and testing in a timely manner when seven NAs (NA D, NA E, NA F, NA G, NA H, NA I, and NA J) failed to complete a state approved certified nursing assistant (CNA) training program, competency evaluation, and certification test timely and continued to work providing direct care to residents. The facility's census was 62. Review of the facility policy titled, Nurse Aide Qualifications & Training Requirements, revised October 2017, the facility will not employ any individual as a nurse aide for more than four months full-time, temporary, per diem or otherwise unless: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish a system of records to ensure all controlled drugs were routinely and consistently reconciled and that discontinued or expired controlled medications and disposed of in a timely manner. The facility's census was 62. Review of the facility's Storage of Medications Policy, dated April 2007, showed the following: -The facility shall store all drugs and biological's in a safe, secure and orderly manner; -Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes.) containing drugs and biological's shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others; -Drugs shall be stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for all residents that included measurable objectives and timeframes to meet a resident's medical and nursing needs as identified in the comprehensive assessment when staff did not care plan one resident's (Resident #11) use of an anticoagulant medication and did not care plan one resident's (Resident #46) oxygen usage. A sample of 19 residents was reviewed in a facility with a census of 62. Review of the facility policy titled, Care Plans, Comprehensive Person-Centered, revised December 2016, showed the comprehensive person-centered care plan will incorporate identified problem areas; incorporate risk factors associated with identified problems; and reflect currently recognized standards of practice for problem areas and conditions. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a system in place that clearly and consistently represented each resident's choice of code status (if they wished to receive cardiopulmonary resuscitation (CPR - lifesaving technique that's useful in many emergencies in which someone's breathing or heartbeat has stopped) if their heart and/or breathing stopped) when staff failed to have the physician sign one resident's (Resident #46) Outside the Hospital Do Not Resuscitate Form (DNR - do not attempt CPR) and when staff failed to ensure one resident's (Resident #20) code status was consistent throughout the medical record. The facility census was 62. Review of the facility's policy titled, Advanced Directive, revised [DATE], showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all controlled medications were stored per standards of practice when a controlled substance was not stored in a locked box. The facility's census was 62. Review of the facility's Storage of Medications Policy, dated April 2007, showed the following: -The facility shall store all drugs and biological's in a safe, secure, and orderly manner; -Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biological's shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others; -Drugs shall be stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems; [...]

Inspectors wroteBased on interview, and record review, the facility failed ensure medical records were maintained and accurate in accordance of standards of practice when staff failed to timely document an assessment and notification of the physician for one resident (Resident #313), who fell and sustained a foot fracture. A sample of 19 residents was reviewed in a facility with a census of 62. Review of the facility policy titled, Changes in a Resident's Condition or Status, revised December 2016, showed the nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition change or status. Review of the facility policy titled, Charting and Documentation, revised July 2017, showed the following: [...]

Inspectors wroteBased on interview, observation, and record review, the facility failed to keep food safe from potential contamination when surfaces had a build up grease, lint, and hair on food contact areas or areas that directly affected food contact areas. The facility census was 62. Record review of the facility's policy titled Sanitation, revised October 2008, showed the following information: -The food service area shall be maintained in a clean and sanitary manner; -All kitchen areas and dining areas shall be kept clean, free from litter and rubbish; -All utensils, counters, shelves and equipment shall be kept clean and maintained in good repair; -All equipment, food contact surfaces and utensils shall be washed to remove or completely loosen soils by using the manual or mechanical means necessary and sanitized using hot water and/or chemical sanitizing solutions; [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of a transfer or discharge to the hospital for two residents (Resident #43, and #64) and failed to ensure the transfer/discharge notice contained all required information for one resident (Resident #22). The facility census was 62. Record review of the facility's policy titled, Transfer or Discharge Notice, dated December 2016, showed the following information: -The resident and/or resident representative will be notified in writing of the following information: -The reason for the transfer or discharge; -The effective date of the transfer or discharge; -The location to which the resident is being transferred or discharged ; -The name, address, and telephone number of the State Long-Term Care Appeal Agency and the State Ombudsman; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide written information to the resident and/or resident's representative of the facility's bed hold policy for three residents (Resident #22, #43, and #64). The facility census was 62. Record review of the facility's policy titled Transfer or Discharge Notice, dated December 2016, showed the resident and/or resident representative will be notified in writing of the facility bed hold policy. Record review of the facility's policy titled Bed-Holds and Returns dated March 2017, showed the following information: -Prior to a transfer, written information will be given to the residents and the resident representatives that explains in detail: -The rights and limitations of the resident regarding bed-holds; -The reserve bed payment policy as indicated by the state plan (Medicaid residents); [...]

Inspectors wroteBased on interview, observation, and record review, the facility failed maintain a sanitary environment when staff failed to keep the kitchen area clean and free of debris. The facility census was 62. Record review of the facility's policy titled Sanitation, revised October 2008, showed the following information: -The food service area shall be maintained in a clean and sanitary manner; -All kitchen areas and dining areas shall be kept clean, free from litter and rubbish; -All utensils, counters, shelves and equipment shall be kept clean and maintained in good repair; -Between uses, cloths and towels used to wipe kitchen surfaces will be soaked in containers filled with approved sanitizing solution; -Kitchen and dining room surfaces not in contact with food shall be cleaned on a regular schedule and frequently enough to prevent accumulation of grime; [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure five residents' (Resident #17, #19, #43, #49, and #51) tuberculosis (TB) ( an infectious disease that mainly affects lungs) test results were documented in millimeters (mm) and failed to ensure one resident's (Resident #43) TB tests was read within the required 48-72 hour timeframe. The facility also failed to ensure staff followed appropriate infection control standards when staff did not remove their gloves and wash their hands after providing incontinent care for one resident (Resident #43). A sample of 15 residents was selected for review in a facility with census of 59. 19 CSR 20-20.100 - General requirements for Tuberculosis Testing for Residents in Long-Term Care Facilities states the following: -Long-term care facilities shall screen their residents for tuberculosis. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs when the facility failed to care plan for exit seeking behavior of one resident (Resident #21). The facility census was 59. Review of a facility policy entitled Care Area Assessments (Revised December 2016), showed the comprehensive person-centered care plan will: -Describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being; -Incorporate identified problem areas; -Incorporate risk factors associated with identified problems; -Reflect currently recognized standards of practice for problem areas and conditions; [...]

Inspectors wroteBased on observation, record review, and interview, the facility staff failed to provide the necessary services to maintain good personal hygiene for one resident (Resident #108) who had an indwelling urinary catheter (tubing inserted into the bladder to drain urine), and one resident (Resident #29) who was incontinent of both bowel and bladder. A sample of 15 residents was reviewed; the facility census was 59. Record review of a facility policy entitled, Standard Precautions (Revised December 2007), showed the following information: -Wear gloves when you anticipate direct contact with blood, body fluids, mucous membranes, non-intact skin, and other potentially infected material; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to maintain the proper temperature of the medication refrigerator used to store multi-dose vials of insulin and other medications that required refrigeration. The facility failed to take action when the temperature in the medication refrigerator fell outside the appropriate range required for the medication. The facility census was 59. According to the American Diabetes Association, insulin does not work well when it is kept for too long or is exposed to extreme temperatures (like heating and freezing). Insulin clumps at temperatures below 36 degrees Fahrenheit (F). Cold insulin can make the injection uncomfortable. -The refrigerator must maintain a temperature between 36 and 46 degrees F. [...]