Granger Nursing & Rehabilitation Center

Inspectors wroteBased on observations, clinical record review, resident interviews, staff interviews and facility policy review, the facility failed to provide services and treatment to increase range of motion and to prevent further decrease in range of motion for 2 of 2 residents reviewed for limited range of motion (Resident #40 and Resident #44). The facility reported a census of 52 residents.

Inspectors wroteBased on clinical record review, pharmacy record review, staff interviews, and facility policy review the facility failed to ensure accurate control and accountability of scheduled controlled narcotic medication for 1 (Resident # 34) of 3 residents reviewed. The facility reported a census of 52 residents.

Inspectors wroteBased on observation, staff interview, pharmacy recommendation, and policy review the facility failed to store and label medications properly in 1 of 2 medication carts reviewed. The facility reported a census of 52 residents.

Inspectors wroteBased on observation, clinical record review, staff interviews, and policy review the facility failed to maintain infection control practices to ensure use of Enhanced Barrier Precautions (EBP) when required and to perform hand hygiene and infection control practices during wound care for 1 (Resident #4) of 2 residents reviewed. The facility reported a census of 52 resident.

Inspectors wroteBased on facility records and staff interviews, the facility failed to have a clinically qualified nutrition professional who met the required qualifications of a Certified Dietary Manager or a full time Registered Dietician. Findings Include: On 1/8/2025 at 1:46 PM, the Dietary Manager stated she did not have certification as a dietary manager. She stated she had completed courses to obtain certification, but the classes would not officially finish until 1/15/2025. An email provided by the Registered Dietician on 1/8/2025 at 2:53 PM stated she was only physically in the building one day a week. In an interview on 1/8/2025 at 2:42 PM with The Administrator, he stated the Registered Dietician is in the building one day a week. [...]

Inspectors wroteBased on observations, resident interviews, staff interviews, and facility document review, the facility failed to maintain a clean environment free of hazards. The facility reported a census of 40 residents.

Inspectors wroteBased on observation, staff interview, and policy review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety. The facility reported a census of 40 residents.

Inspectors wroteBased on resident interview, staff interview, and facility documentation, the facility failed to speak to residents with dignity and respect for 3 of 3 residents reviewed (Resident #12, #13, and #14). The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review, staff interview, and instructions of CMS form 10123-NOMNC, the facility failed to provide appropriate Notice of Medicare Non Coverage (NOMNC) to 2 of 3 (Resident #7 and #142) residents reviewed for Beneficiary Notification. The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review, staff interviews and facility policy review, the facility failed to revise the comprehensive Care Plan to accurately reflect the status of 2 of 16 (Resident #24 and #32) residents reviewed. The facility reported a census of 40. 1. The Minimum Data Set (MDS), dated [DATE], of Resident #24 identified a Brief Interview of Mental Status (BIMS) score of 15 which indicated cognition intact. The MDS documented diagnoses that included depression, bipolar disorder, schizophrenia and nicotine dependence. The MDS documented a presence of an open foot lesion to her foot. The Wound Treatment Plan, dated 12/19/24, documented Resident #24 was to wear a walking boot on her right foot and a Controlled Ankle Motion (CAM) boot on her left foot (a medical device used to immobilize the foot and ankle). [...]

Inspectors wroteBased on observation, staff interview, pharmacy interview, drug manufacturer administration instructions, and policy review, the facility failed to assure a medication error rate of less than 5%. Medication errors were observed for Resident #21, Resident #22 and Resident #28. A total of 25 medications being prepared and administered were observed with 4 errors, an error rate of 16%. The facility reported a census of 40 residents.

Inspectors wroteBased on clinical record review, observation, staff interviews, and policy review the facility failed to ensure staff changed gloves and utilized infection control techniques in order to prevent cross contamination for one of two residents reviewed for catheter care (Resident #8) and two of three residents reviewed for incontinence cares (Resident #31 and #43). The facility staff also failed to sanitize resident's glucometer after use and prior to putting the glucometer away for one of three residents reviewed for blood sugar checks (Resident #11). The facility reported a census of 49 residents.

Inspectors wroteBased on observations, staff interviews and facility policy review, the facility failed to treat each resident with dignity for 3 of 6 residents reviewed for dignity (Resident #1, #11, #38). The facility reported a census of 49 residents. 1. The Minimum Data Set (MDS) of Resident #1, dated 12/22/23, identified Resident #1 to have a Brief Interview for Mental Status (BIMS) score of 13 which indicated cognition intact. The MDS recorded the resident described their pain as a 10 out of 10 on a pain scale almost constantly during the 5-day look back period. The Care Plan of Resident #1 revealed a Focus Area of Chronic pain, revision date of 9/22/23. It directed staff to administer pain medications as ordered, and to monitor/document and report any signs or symptoms of non-verbal pain including moaning or calling out. [...]

Inspectors wroteBased on clinical record review and staff interview, and instructions of CMS form 10123-NOMNC, the facility failed to provide appropriate notices of Medicare Non Coverage to 1 of 3 (Resident #16) residents reviewed and failed to provide notice within the required 2 calendar days for 1 of 3 residents reviewed (Resident #7). The facility reported a census of 49 residents.

Inspectors wroteBased on observations, resident and staff interviews, and policy review, the facility failed to provide a safe, clean, and homelike environment and keep equipment and furnishings in good repair for two of three hallways observed. The facility reported a census of 49 residents.

Inspectors wroteBased on personnel file review, facility policy review, and staff interview, the facility failed to assure all employees had an Iowa criminal background check and abuse registry checks completed prior to working in the facility for 1 of 7 employees sampled (Staff G). The facility identified a census of 49 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to notify the Long Term Care Ombudsman of discharge/transfer of residents as required for 3 of 4 residents reviewed who were discharged /transferred from the facility (Residents #7, #31, #34). The facility reported a census of 49 residents.

Inspectors wroteBased on document review, record review, staff interviews, facility policy, and Resident Assessment Instrument (RAI) Manual the facility failed to complete 1 of 1 resident's Minimum Data Set (MDS) within 14 days of being discharged from hospital with significant changes in health status (Resident #7). The facility reported a census of 49 Residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review, the facility failed to refer one resident with a Level I Preadmission Screening and Resident Review (PASARR) with a previously unknown serious mental disorder for evaluation of a Level II PASARR at the time the diagnosis was known to the facility for 1 of 2 residents reviewed for PASARR (Resident #22). The facility reported a census of 49. Findings Include: The Minimum Data Set (MDS) for Resident #22 dated 12/21/23 documented a Brief Interview for Mental Status (BIMS) of 15, indicating the resident was cognitively intact. The MDS further documented diagnoses for the resident to include medically complex conditions, anxiety disorder, depression, and post traumatic stress disorder (PTSD). The MDS reflected the resident was taking antianxiety and antidepressant medications. [...]

Inspectors wroteBased on clinical record review, staff interview and facility policy review, the facility failed to revise the comprehensive care plan to accurately reflect status of 1 of 17 residents reviewed (Resident #7). The facility reported a census of 49.

Inspectors wroteBased on observation, staff interview, and facility policy review, the facility failed to maintain a safe environment by allowing a resident to keep smoking supplies in his room (Resident #18). The facility reported a census of 49 residents.

Inspectors wroteBased on clinical record review, observation, staff interview, and policy review, the facility failed to ensure staff utilized infection control techniques, and changed gloves when contaminated while providing incontinence cares for 1 of 3 residents observed for incontinence cares (Resident #8). The facility reported a census of 49 residents.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to assure a medication error rate of less than 5%. The facility reported a census of 49 residents.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to secure medications during 2 of 3 medication pass observations.