Granby House

Inspectors wroteBased on observation, interview, and record review, the facility failed to promote and facilitate the right of self-determination for every resident when staff failed to honor reasonable shower preferences for three residents (Resident #43, #25, and #3). The facility census was 52. Review of the facility policy titled, Resident Bathing, undated, showed staff shall provide person-centered care that emphasizes the residents' comfort, independence, and personal needs and preferences. 1. Review of Resident #43's face sheet (a brief resident profile) showed the following: -admission date of 01/31/25; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to have effective procedures in place to account for all medication when the emergency kit (E-Kit - a pre-stocked set of drugs designed for rapid access) medication lock tags were not monitoring routinely and failed to accurately match the logbook, for two of three E-Kit boxes. The facility census was 52. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the nutritional needs of all residents were met when staff failed to provide the approved serving size for pureed meals. The facility census was 52. Review of the facility's policy titled, Portion Variations, dated 2020, showed portion variations for the planned and approved menu which deviate from those listed on the spreadsheet or other communication tools are available based on estimated nutritional needs, physician order, or resident preference/request. 1. Review of the facility recipe for brown sugar meatloaf showed the following:-Combine ground beef, milk, eggs, cracker crumbs, chopped onion, salt, and black pepper in a mixer bowl on low speed just until well combined. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was protected at all times from possible contamination when the ceiling in the walk-in cooler had a water leak during rain. The facility census was 52. Review of the facility policy titled, Maintenance Service, dated 2001, showed the following:-Maintenance service shall be provided to all areas of the building, grounds, and equipment;-The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times;-Functions of the maintenance personnel include maintaining the building in good repair and free from hazards and establishing priorities in providing repair service. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide all residents reasonable access to the use of a phone in a private environment when the resident use phone was located at the nurses' station providing a lack of privacy for two residents (Resident #1 and #2) when they used the phone. The facility census was 52. Review of the facility's policy titled Resident Rights, revised February 2021, showed the following: -Employees shall treat all residents with kindness, respect, and dignity; -Resident rights included the right to privacy and confidentiality; the right to access to a telephone, mail and email; and the right to communicate in person, by mail, email, and telephone with privacy. 1. Review of Resident #1's face sheet (a document that gives a patient's information at a quick glance) showed the following: -admission date of 09/12/24; [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure the resident's environment remained free of accident hazards when the front door alarm was turned off resulting in one resident (Resident #1) exiting the building and obtaining injuries from a fall. The facility also failed to document a complete investigation into the elopement and fall including a root cause analysis. The census was 54. Review of a facility policy entitled Accidents and Incidents - Investigating and Reporting (revised July 2017) showed the following: -All accidents or incidents involving residents occurring on our premises shall be investigated and reported to the administrator; -Data, as applicable, shall be included on the Report of Incident/Accident form included -the date and time the accident or incident took place; the nature of the injury/illness (e.g., bruise, fall, nausea, etc.); [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and maintain an effective infection control program when staff failed to practice proper hand hygiene while providing care for three residents (Residents #2, #3, and #4) and when staff failed to gown as required for two residents (Resident #4 and #5) who had enhanced barrier precautions (EBP - precautions for use during high-contact resident care activities for residents infected with a multidrug-resistant organism (MDRO -microorganisms that are resistant to one or more classes of antimicrobial agents) or any resident who has a chronic wound and/or indwelling medical device) in place due to wounds. The facility census was 51. Review of the facility policy, Hand washing/Hand Hygiene, revised October 2023, showed the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide care per standards of practice when for all residents when staff failed to administer one resident's (Resident #1) levothryroxine (medication for a low thyroid) as ordered. The facility census was 51. Review of the facility policy Administering Medications, revised April 2019, showed the following: -Medications are administered in accordance with prescriber orders, including any required time frame; -Medication errors are documented, reported, and reviewed by the QAPI (Quality Assurance and Performance Improvement) committee to inform of process changes and or the need for additional staff training. Review of the facility Electronic Medical Record admission Checklist, undated, showed the following: -Call and verify medications with provider and be sure to add to admission note; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a complete infection prevention and control program when the facility failed to implement their policy regarding enhanced barrier precautions (EBP - precautions for use during high-contact resident care activities for residents infected with a multidrug-resistant organism (MDRO -microorganisms that are resistant to one or more classes of antimicrobial agents) or any resident who has a chronic wound and/or indwelling medical device), resulting in staff not being trained on EBP, personal protective equipment (PPE) and signage present not being present for residents that met the guidelines for EBP, and staff not wearing PPE in accordance with the Centers for Disease Control (CDC) guidelines for one resident (Residents #36), of two sampled resident, who met the guidelines for EBP. [...]

Inspectors wroteBased on observation, record review, and interview, the facility staff failed to ensure the facility was maintained in a sanitary and comfortable fashion when light fixtures in the kitchen and dining area had dead bugs present, were not clean, were missing covers, and were not good working order; when the lower shelf of the prep table was not good repair with rust visible; when staff failed to keep the outside of the ice machine clean; and when the floor in the stock room had debris present and was dirty. The facility census was 46. Review of the facility's policy titled Sanitization, dated November 2022, showed the following: -All kitchens, kitchen areas, and dining areas are kept clean, free from garbage and debris, and protected from rodents and insects; [...]

Inspectors wroteBased on interview and record review, the facility failed follow their abuse prevention policy when staff failed to ensure the Nurse Aide (NA) Registry was checked and staff did not have a Federal Indicator (a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prohibiting them to work in a certified facility for two staff members (Maintenance Supervisor and Registered Nurse (RN) P) and did not check the NA registry in a timely manner for one staff (Interim Director of Nursing (DON)). The facility census was 46. Review of the facility's policy titled, Abuse Prevention Program, revised September 2021 , showed the following: -The nurse aide registry will be checked prior to employment for each state where a nurse aide has shown to have worked, or has listed certification. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide services all dependent residents to maintain good grooming and personal hygiene when three dependent residents (Resident #7, #29 and #246), of four sampled residents, did not receive timely showers and had hair that appeared matted or unkept. The facility's census was 46. Review of the facility's policy titled, Resident Bathing, undated showed staff shall provide person-centered care that emphasizes the residents' comfort, independence. personal needs, and preferences. 1. Review of Resident #7's face sheet (gives basic profile information) showed the following information: -admission date of 12/22/23; [...]

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 eighteen NA's 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 64. Review of the facility policy titled, Nurse Aide Qualifications and Training Requirements, revised August 2022, showed 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 maintain an effective pest control program to control the fly population when multiple flies were present in and around three residents (Residents #5, #12, and #29) and in resident common areas. The facility census was 46. Review of the facility policy titled Pest Control, revised May 2008, showed the following: -The facility shall maintain an effective pest control program; -This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. 1. Review of Resident #5's face sheet (admission data) showed the resident admitted to the facility on [DATE]. Review of the resident's quarterly minimum data sheet (MDS - a federally-mandated assessment form completed by facility staff), dated 04/25/24, showed the following: -Memory problems; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to promote each resident's right to self-determination when staff failed to provide routine baths or showers to one resident (Resident #196) out of a sample of four residents. The facility had a census of 46. Review of the facility's policy titled, Resident Bathing, undated showed staff shall provide person-centered care that emphasizes the resident's comfort, independence, personal needs, and preferences. 1. Review of Resident #196's face sheet (admission data) showed the following: -admission date of 06/18/24; -Diagnoses included major depressive disorder, muscle weakness, and pain. Review of the resident's care plan, revised 06/19/24, showed the following: -Staff to provide the resident with assistance to gather items for bathing and assistance to the bathing area as needed; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete the required Preadmission Screening and Resident Review (PASARR - a two level tool used to screen each resident in a nursing facility for a mental disorder or intellectual disability prior to admission) prior to or at admission for one resident (Resident #21), out of five sampled residents, to ensure the resident received appropriate care and services. The facility census was 46. Review of the facility's policy titled Fiscal Management and Control, dated December 2021, showed the following: -DA-124C (form completed prior to admitting the resident to a skilled nursing facility to ensure the resident doesn't trigger a level II screening, part of the PASARR process) must be dated on or before the date of admission; -No resident will be admitted without a level II screening if the diagnosis indicates that one is required. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all residents received care per professional standards of practice when staff failed to obtain ordered blood tests in a timely fashion for one resident (Resident #19), out of five sampled residents. The facility census was 46. Review of the facility's policy titled, Laboratory, Radiology and other Diagnostic Services, undated, showed the following: -Provide or obtain laboratory, and other diagnostic services only when ordered by a physician, in accordance with state law, including scope of practice laws; -The facility is responsible for assuring the quality and timeliness of laboratory services; -The facility must provide or obtain laboratory, and other diagnostic services to meet the needs of its residents. Review showed the facility did not provide a policy regarding physician's orders. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all dialysis residents received services consistent with professional standards of practice when staff failed to routinely communicate and collaborate with the dialysis (a process of filtering and removing waste products from the bloodstream when the kidneys can no longer sufficiently do so) center after appointments for one resident (Resident #15) out of a sample of one resident. The facility census was 46. Review of the facility's policy titled 'Hemodialysis Catheters (a flexible tube inserted through a narrow opening into a body cavity), revised February 2023, showed the nurse should document in the resident's medical record every shift as follows: -Any part of report from dialysis nurse post-dialysis being given; -Observations post-dialysis. (The policy did not refer to use of a communication form.) 1. [...]

Inspectors wroteBased on observation, record review, and interview, the facility staff failed to follow approved menus for all residents when staff failed to provide cornbread, or comparable substitute, at a meal for two resident (Resident #3 and #40), out of two sampled residents, who received pureed diets. The facility census was 46. Review of the facility's policy titled, Menu and Diet Guidelines, dated 2022, showed the following: -The pureed diet is designed for those individuals who have difficulty swallowing or cannot chew foods of the dental soft consistency; -Serve with appropriate scoop number or divide equally to provide number of portions; -All of the pureed food must be used in order to deliver the correct nutrient density to each resident. 1. Review of the facility menu, dated 06/26/24, showed turkey crunch, peas, cornbread, and pudding for the noon meal. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to protect all residents from misappropriation of property, including medications, when one resident's (Resident #1) fentanyl patch (a schedule IV controlled substance used for adults who have chronic pain) went missing from the resident while in the facility. The facility census was 42. On 05/26/24, the Administrator was notified of the Past Non-Compliance that occurred on 05/26/24. The Administrator and the charge nurse conducted an audit to ensure all other fentanyl patches were intact as placed on residents per documentation and accounted for in storage behind two locks. The Administrator notified the physician, hospice agency, police department, and the resident's family. The Administrator interviewed staff and residents and reviewed the camera surveillance. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to monitor and adjust sanitizing levels and water temperatures in the dish washing machine, and failed to ensure staff followed acceptable practices to ensure dishware was sufficiently clean and sanitized. These failures could potentially affect all residents who eat at the facility. The facility census was 51. According to the Missouri Food Code, adopted by the Missouri Department of Health and Senior Services (DHSS) June 3, 2013, food contact surfaces and equipment shall be sanitized. Sanitization means the application of cumulative heat or chemicals on cleaned food-contact surfaces that, when evaluated for efficacy, is sufficient to yield a reduction which is equal to 99.999% reduction of representative disease microorganisms of public health importance. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident (Resident #7) with a Foley catheter (a flexible tube that is inserted through the urethra into the bladder to drain urine), received timely care and services for a urinary tract infection. The facility census was 51. Record review of the facility policy titled, Culture Tests, revised January 2012, showed the following: -Culture tests will only be performed when ordered by a physician; -Should the attending physician order cultures, they shall be obtained and completed as soon as practical; -All tests results shall be reported to the physician as soon as the results are obtained; -Urine cultures may be obtained by the charge nurse if a resident develops cloudy urine or other signs of urinary tract infection. An order from the physician must be obtained before the specimen is sent to the laboratory. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide appropriate psychosocial care and services, failed to care plan related to psychocosocial needs, and failed to ensure staff were aware of a the psychiatric history for one resident (Resident #41) with a history of attempted suicide, a history of suicidal ideation, and a history of personal trauma. The facility census was 51. Record review of the facility protocol titled, Depression-Clinical Protocol, revised [DATE], showed the following: -The physician and staff will review available information and inquire further to identity and document individuals who have a history of depression or another mood disorder, other psychiatric disorder, psychiatric treatment or hospitalizations, or suicide attempts; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate below five percent when staff made two errors out of 27 opportunities, resulting in an error rate of 7.41 percent, affecting two residents (Resident #8 and #52). The facility census was 51. Record review of the facility policy titled, Insulin Administration, revised September 2014, showed the following: -Purpose of the policy is to provide guidelines for the safe administration of insulin (medication used to help control blood sugar levels) to residents with diabetes; -The type of insulin, dosage requirements, strength, and method of administration must be verified, to assure that it corresponds with the order on the medication sheet and the physician's order; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all residents were free from significant medication errors when staff failed to prime an insulin (medication used to control blood sugar levels) pen prior to administration for two residents (Resident #8 and #52). The facility census was 51. Record review of the facility policy titled, Insulin Administration, revised September 2014, showed the following: -Purpose of the policy is to provide guidelines for the safe administration of insulin to residents with diabetes (a chronic condition that affects how a person process blood sugar); -The type of insulin, dosage requirements, strength, and method of administration must be verified, to assure that it corresponds with the order on the medication sheet and the physician's order; [...]