Gordon Countryside Care

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(B) Based on record review and interview, the facility failed to ensure accuracy of the 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) related to an active diagnosis for Resident 14 and weight loss for Resident 1. The sample size was 12 and the facility census was 33. Findings Are: [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iv) Based on record review and interview, the facility failed to follow their bowel protocol to prevent constipation for 1 (Resident 4) of 5 sampled residents. The facility census was 33. Findings Are: A record review of facility policy Bowel Management Policy dated 8/1/2024 revealed all residents will have a bowel management plan tailored to their individual needs, preferences, and medical conditions. In the Documentation section the policy states staff are to document absence of bowel movements for 3 days or more and initiate appropriate action. In the Intervention Protocol for Constipation section the policy states that on Day 1 staff are to monitor and encourage natural bowel movement and offer fluids and dietary fiber. On Day 2, staff are to administer prescribed stool softener or laxative. [...]

Inspectors wroteLicensure Reference 175 NAC 12-006.09(I) Based on record review, observation, and interview, the facility failed to ensure developed interventions were implemented to prevent falls for 1 (Resident 19) of 3 sampled residents. The facility identified a census of 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(D) Based on record reviews, observations, and interviews, the facility failed to ensure staff followed proper glove use of hand hygiene practices prior to food preparation or between tasks in accordance with the food code and Center for Disease Control (CDC) guidelines during meal service to prevent the potential for cross-contamination. This had the potential to affect 1 resident who resided within the facility. The facility identified with a census of 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5) Based on record review and interviews; the facility failed to notify the family or responsible party of a change in condition for 2 (Resident 1 and Resident 2) of 3 sampled residents. The facility identified a census of 30.

Inspectors wroteLicensure Reference 175 NAC 12- 006.11(E) Based on observations, interviews, and record reviews; the facility failed to ensure foods were disposed or consumed prior to best-by and use by dates, store foods at least six inches off the floor as required, and to implement hand hygiene practices as required to prevent the potential for cross contamination and foodborne illness. This had the potential to affect all 26 residents who resided within the facility.

Inspectors wroteLicensure Reference 175 NAC 12- 006.18(B) Based on observations, interview, and record review; the facility failed to disinfect multi-use equipment during medication administration for 3 (Residents 1, 16, and 23) of 3 sampled residents and implement infection control practices during wound to prevent the potential for cross-contamination for 1 (Resident 23) of 1 sampled resident.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I) Based on observations, record review, and interviews; the facility failed to ensure 1 (Resident 18) of 2 sampled residents' oxygen concentrator was turned off when not in use and unattended. The facility census was 26. The Findings Are: A record review of facility policy Oxygen Administration with revision date of October 2010 revealed that the facility would instruct the resident, their family, visitors, and roommate (if any) of the oxygen safety precautions. The policy also stated that the facility would provide the resident with a written copy of the Oxygen Safety Handout. A record review of undated facility provided document Using Oxygen Safely, revealed instruction to Turn off your oxygen when you're not using it. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure 1 (Resident 8) of 2 sampled residents was free from unnecessary medications related to a) the long-term use of an antibiotic medication which did not specify a duration and b) the use of an antibiotic which had no supporting documentation for clinical use based on laboratory results. The facility census was 26. The Findings Are: A record review of facility policy Antibiotic Stewardship Program with revision date of 3/4/24 revealed that all prescriptions for antibiotics would specify the dose, duration, and indication for use. The policy also stated that the facility would monitor resident response to antibiotics, and laboratory results when available, to determine if the antibiotic was still indicated or adjustments should be made. A. [...]

Inspectors wroteLicensure Reference 175 NAC 12-002.10 Based on observations, interviews, and record reviews; the facility failed to ensure medications were administered at the right time for 2 (Residents 1 and 15) of 6 sampled residents and to ensure the medication error rate was less than 5%. The medication error rate was 5.4% (37 medications administered with 2 medication errors.) The facility census was 26.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.11E Based on observations, interviews, and record reviews, the facility staff failed to ensure cleaning agents were not next to food, failed to ensure high risk food preparation splashing did not contaminate clean dishes and equipment to prevent the potential food contamination. This had the potential to affect all 25 residents who resided at the facility. The facility identified a census of 25 residents at the time of the survey.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.14 Based on record review, observations, and interviews, the facility staff failed to ensure 1(Resident 2) of 3 sampled residents received routine dental services. The facility staff identified a census of 25 residents at the time of the survey.