Heart of the Ozarks Healthcare Center

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 two NA's failed to complete a state approved certified nursing assistant (CNA) training program, competency evaluation, and certification test within four months of hire and continued to work providing direct care to residents. The facility's census was 71. Review of the facility policy titled Nurse Aide Qualifications and Training Requirements, dated 08/2022, showed the following: -Nurse aide is any individual providing nursing or nursing related services to residents in a facility; -Facility will only employ those nurse aides who meet the requirements set forth in the federal and state statutes concerning the staffing of long-term care facilities; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to keep all food safe from potential contamination when staff failed to keep dented cans separate from other canned goods and failed to ensure food from a dented cans was not served to residents. The facility census was 81. Review of the 2022 Food and Drug Administration (FDA) Food Code showed the following information: -Depending on the circumstances, rusted, and pitted or dented cans may present a serious potential hazard; -Damaged or incorrectly applied packaging may allow the entry of bacteria or other contaminants into the contained food; -If the integrity of the packaging has been compromised, contaminants may find their way into the food. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed ensure residents only self-administered medications if it had been determined it was clinically appropriate when staff left medication in one resident's room (Resident #1) to self-administer without a documented assessed and orders of the self-administration . The facility census was 81. Review of the facility's policy titled Administering Medications, dated April 2019, showed the following: -Medications are administered in accordance with prescriber orders; -The individual administering the medication checked the label three times to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the medication. 1. Review of Resident #1's face sheet (brief resident profile sheet) showed the following information: -admission date of 04/24/19; [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure a resident's choice of code status (the level of medical interventions a resident wishes to have if their heart or breathing stops) was clearly and consistently documented throughout the resident's medical record for one resident (Resident #73) out of a sample of 22 residents. The facility census was 81. Review of the facility's policy titled, Do Not Resuscitate Order, revised [DATE], showed the following: -The facility will not use cardiopulmonary resuscitation (CPR - an emergency procedure that is performed when a person's heartbeat or breathing has stopped) and related emergency measures to maintain life functions on a resident where there is a do not resuscitate (DNR - do not attempt CPR) order in effect; [...]

Inspectors wroteBased on observation, record review, and interview, the staff failed to ensure an environment as free from hazards as possible when staff failed to care plan use of and document monitoring of a personal electronic monitoring device as ordered for one resident (Resident #50), out of a sample of three residents, with a prior elopement attempt and history of wandering. The facility's census was 81. Review of the facility's policy entitled, Elopement precautions/Missing Resident, revised 2007, showed the following: -If an electronic monitoring system is available in the facility, any resident who is an elopement risk shall have a device placed on their wrist, ankle, or assistive devise. -The monitoring device is to be checked according to manufacturer specifications to assure ongoing working order. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure any resident weight loss was unavoidable when staff failed identify weight loss risk timely, care plan interventions, and implement new interventions after continued weight loss one resident (Resident #64). The facility also failed to identify weight loss risk timely and failed to notify the physician regarding one resident's (Resident #26) weight loss. A sample of 22 residents was reviewed in a facility with a census of 81. Review of the facility policy titled 'Weight Assessment and Intervention, revised March 2022 showed the following: -Resident weights are monitored for undesirable or unintended weight loss or gain; -Residents are weighed upon admission and at intervals established by the interdisciplinary team; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a medication error rate of less than 5% when the facility staff made two errors out of 26 opportunities resulting in an error rate of 7.69% when facility staff failed to administer the correct dose of two medications for two residents (Resident #44 and Resident #54). The facility census was 81. Review of the facility's policy titled Administering Medications, dated April 2019, showed the following: -Medications are administered in accordance with prescriber orders; -The individual administering the medication checks the label three times to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the medication. 1. Review of Resident # 44's face sheet (brief resident profile sheet) showed the following information: [...]

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure all residents were treated with dignity and respect by all staff when one staff member (Certified Medication Technician (CMT) A) spoke to one resident (Resident #1) in an undignified manner, including raising his/her voice and arguing. A sample of eight residents was reviewed in a home with a census of 78. Review of the facility's policy titled Dignity, dated 02/2021, showed the following: -Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem; -Residents are treated with dignity and respect at all times; -The facility culture supports dignity and respect for residents by honoring resident goals, choices, preferences, values and beliefs. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was stored, prepared, and served in a manner that prevent possible contamination when the ice machine has a black substance present, wet cups were stacked, and staff failed to keep potential food contact surfaces clean. The facility census was 78. 1. Record review of the 2013 Missouri Food Code showed the following information: -Equipment food-contact surfaces and utensils shall be clean to sight and touch. Record review of the facility's policy regarding Sanitization of the Kitchen, revised on October 2008, showed the following: -Ice machines and ice storage containers will be drained, cleaned and sanitized per manufacturer's instructions and facility policy. Record review of the daily cleaning sheets, dated 10/29/22 through 10/31/22, the cleaning schedule did not include cleaning the ice machine. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain equipment in the kitchen in a safe operating condition when nine stove knobs were missing. The facility census was 78. Record review showed the facility did not provide a policy regarding upkeep of kitchen appliances. 1. Observations on 10/31/22, beginning at 10:40 A.M., and on 11/03/22, at 9:30 A.M., showed the following: -The cook stove located in the kitchen had nine of the twelve burner control knobs missing. During an interview on 11/03/22, at 9:25 A.M., Dietary Aide (DA) B said the following: -The knobs have been missing a long time; -They use pliers to turn the stove off/on and there have been no issues. During an interview on 11/03/22, at 9:25 A.M., DA C said the following: -Didn't know how long the knobs had been missing, at least a year; -He/she uses pliers to turn the stove off/on; [...]

Inspectors wroteBased on record review and interview, facility staff failed to complete a quarterly Minimum Data Set (MDS - a federally mandated comprehensive assessment instrument completed by facility staff) assessment for four residents (Residents #14, #47, #57 and #72) within 14 days from the assessment reference date (ARD). The facility had a census of 78. Record review of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, Chapter 2, Assessments for the RAI, showed the following information: -The quarterly assessment is an Omnibus Budget Reconciliation Act of 1987 (OBRA) non-comprehensive assessment for a resident that must be completed at least every 92 days following the previous OBRA assessment of any type; [...]

Inspectors wroteBased on observation, interview, and record review the facility facility failed to provide a sanitary environment when the floors and light fixtures of the kitchen were not kept clean and free of debris and pests. The facility census was 78. 1. Record review of the 2013 Missouri Food Code showed the following information: -Nonfood-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris; -The physical facilities shall be cleaned as often as necessary to keep them clean. Record review of the facility's policy regarding Sanitization of the Kitchen, revised October 2008, showed the following: -All kitchens, kitchen areas and dining areas shall be kept clean, free from litter and rubbish and protected from rodents, roaches, flies and other insects; [...]

Inspectors wroteBased on record review and interviews, facility staff failed to complete an annual Minimum Data Set (MDS - a federally mandated comprehensive assessment instrument completed by facility staff) assessment for one resident (Resident #29) within the required 14 days from the assessment reference date (ARD). The facility had a census of 78. Record review of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, Chapter 2, Assessments for the RAI, showed the following information: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure physician's orders were obtained regarding placement and care of a catheter (sterile tube inserted into the bladder to drain urine) for one resident (Resident #22). The facility census was 78. Record review of facility's policy titled Medication Orders, revised November 2020, showed the following: -A current list of orders must be maintained in the clinical record of each resident. Record review showed the facility did not provide a policy specific to orders for catheters. 1. Record review of Resident #22's face sheet (a document that gives a resident's information at a quick glance) showed the following: -admission date of 12/12/18; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care in accordance with professional standards of practice when facility staff failed to administer physician ordered supplement oxygen to one resident (Resident #27). The facility had a census of 78. Record review of facility's policy titled Medication Orders, revised November 2020, showed the following: -A current list of orders must be maintained in the clinical record of each resident; -Oxygen orders should specify the rate of flow, route, and rationale for use. 1. Record review of Resident #27's face sheet (a document that gives a resident's information at a quick glance) showed the following: -admission date of 4/6/2022; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide a comfortable and homelike environment by failing to ensure the facility was in good repair. The facility census was 93. 1. Record review of a blank copy of the Facility's admission Agreement with Residents showed the following: -Attachment B, Residents Rights; -The facility shall care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life. Record review of emails regarding the roof included the following information: -On 12/13/18, from roofing company, work proposal for flat roof and shingle roof; -On 12/26/18, at 10:36 A.M., from roofing company, please call with your questions and a time I can come go over in detail each bid and procedure; -On 2/12/19, from roofing company, asking if the roofing company got the job; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the facility's bed-hold policy to eight residents (Resident #12, #37, #70. #73, #83, #87, #92, and #142), out of 19 sampled residents, prior to being transferred/discharged to the hospital. The facility census was 93. Record review of the facility's undated policy titled, Bed Hold Policy, showed the following information: -When a resident is transferred to a hospital or goes out on therapeutic leave, the resident and/or responsible party has 24 hours from the time of transfer to request that the bed be held; -Residents leaving the facility for an overnight stay, for any length of time, to any location may elect to hold the bed by paying the daily rate; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure three residents (Resident #46, #51, #84) had a physician's order indicating where and when the resident was to go to dialysis (a process of cleaning the blood by a special machine necessary when the kidneys are not able to filter the blood) treatment. A sample of 19 residents was selected in a facility with a census of 93. Record review of the facility policy titled, End-Stage Renal Disease, Care of a Resident with, from 2001 Med Pass, last revised September 2010, showed the following: -Residents with end-stage renal disease (ESRD-chronic kidney disease) will be cared for according to currently recognized standards of care; (The policy did not address orders for the dialysis.) Record review of the undated facility agreement with the dialysis facility showed the following information: [...]

Inspectors wroteBased on record review and interview, the facility staff failed to read five residents' (Resident #37, #75, #87, #242, and #84) tuberculosis (TB-an infectious disease that mainly affects lungs) test within the required 48-72 hour timeframe and failed to document the test results in millimeters (mm) for five residents (Resident #37, #75, #87, #242, and #84). The facility failed to document isolation for one resident (Resident #30) when the resident received topical treatment for scabies, failed to provide treatment for scabies timely for one resident (Resident #23), and failed to ensure staff followed proper infection control practices. The facility census was 93. 1. 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 maintain an effective pest control system for the control of roaches and flies. The facility census was 93. Record review of the facility policy titled Pest Control, from 2001 Med Pass, last revised May 2008, showed the following information: -The facility shall maintain an effective pest control program; -The facility maintains and on-going pest control program to ensure that the building is free of insects and rodents; -Pest control services are provided by an extermination company; -Windows are screened at all times; -Only approved Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) insecticides and rodenticides are permitted in the facility and all such supplies are stored away from food storage areas; -Garbage and trash are not permitted to accumulate and are removed daily; [...]

Inspectors wroteBased on interview and record review, the facility failed to report possible resident abuse to the state licensing agency (Department of Health and Senior Services - DHSS) within the required time frame for one resident (Resident #18). A sample of 19 residents was selected in a facility with census of 93. Record review of the facility's protocol titled, Abuse Prevention Program, dated June 1999, and revised August 2017, showed the following information: -The facility has an Abuse Prevention Program and the program requires employees to report witness or suspected mistreatment of residents to the supervisor, the resident's charge nurse, the Director of Nurses, or the administration immediately; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete an investigation of possible resident-to-resident abuse for one resident (Resident #18). A sample of 19 residents was selected in a facility with a census of 93. Record review of the facility's protocol titled, Abuse Prevention Program, dated June 1999 and revised August 2017, showed the following information: -The facility has an Abuse Prevention Program and the program requires employees to report witness or suspected mistreatment of residents to your supervisor, the resident's charge nurse, the Director of Nurses, or the Administration Immediately; -If an incident occurs, or there is any allegation that incident might have occurred, of abuse, neglect, mistreatment, or misappropriation of resident property, the Administrator, or designee, will investigate; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to timely report observed darkened areas on the foot for one resident (Resident #13). The facility census was 93. 1. Record review of Resident # 13's face sheet showed the following: -admission date of 1/3/14 and readmission date of 10/12/17; -Diagnosis of dementia. Record review of the resident's annual Minimum Data Set (MDS - a federally mandated assessment completed by facility staff), dated 10/13/19, showed the following: -Severe cognitive impairment; -At risk for pressure ulcers; -No pressure ulcers; -On hospice. Record review of the resident's undated care plan showed the following interventions: -Stage II (partial-thickness loss of skin with exposed dermis, presenting as a shallow open ulcer) wound to right hip; -Inspect skin for changes daily; -Provide skin audit per schedule and as needed; [...]