Heritage of Webster County

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(A)(iii)(2)(b)(c) Based on observation, record review, and interview; the facility failed to ensure Adult Protective Service (APS)/Child Abuse Neglect (CAN) checks were completed prior to hire as required for 4 of 5 sampled staff. This had the potential for residents to be cared for by staff with adverse findings related to abuse or neglect. The facility census was 28.

Inspectors wroteLicensure Reference 175 NAC 12-006.04(A)(iii)(2)(a)Based on observation, record review, and interview; the facility failed to ensure that Nurse Aide Registry Checks (a state required record of a successful completion of training and competency to be a nurse aide and any findings of abuse, neglect, or misappropriation of property) were completed prior to hire as required for 3 of 5 sampled staff. This had the potential for residents to be cared for by staff with adverse findings related to abuse or neglect. The facility census was 28.

Inspectors wroteLicensure Reference Number 175NAC 12-005.06(D)Licensure Reference Number 175NAC 12-006.19(C)Based on observation, record review, and interview, the facility failed to utilize proper hand hygiene during meal preparation and service and failed to transport clean and soiled linens in a manner to prevent cross contamination. This had the potential to affect all residents receiving food and linen supplies in the facility. The facility census was 28.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09Based on record review, observations, and interviews, the facility failed to ensure that glucometer testing supplies were dated and discarded when expired according to the manufacturer's instructions; and the facility failed to ensure nurses had been trained adequately in the use of the continuous blood glucose monitoring systems. This affected all residents with diabetes, a total of 7 residents (Residents 1, 2, 14, 20, 24, 27, and 28), and the facility failed to ensure insulin (abnormal blood glucose) medication was administered or withheld in accordance with the prescribers' orders for 1 (Resident 1) of 1 sampled resident. The facility census was 28.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure frequency, timeliness, and required physician visits were made by a physician personally. This affected 3 of 5 sampled residents (Resident 5, Resident 6, and Resident 24). The facility census was 28.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(A)(vi) Based on Record reviews and interviews, the facility failed to ensure that Medication Record Reviews (MRRs) were completed by a pharmacist each month for those residents living in the facility. This affected 2 residents (Residents 13, and 24) of 5 residents reviewed. The facility census was 28.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10DBased on record review, observations, and interviews, the facility failed to have medication error rate less than 5%. There were 5 errors and 27 opportunities with was an actual rate of of 18.5% error rate. The facility census was 28.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G) Based on record reviews and interviews, the facility failed to provide a rationale for not conducting a Gradual Dose Reduction (GDR, Stepwise tapering of a dose to determine whether or not symptoms, conditions, or risks can be managed by a lower dose or whether or not the dose or medication can be discontinued) for 1 (Resident 23) of 5 residents sampled. The facility census was 28.

Inspectors wroteLicensure Reference Number 175NAC 12-00.02(H)Based on record review and interview, the facility failed to submit a written investigation of a possible instance of abuse or neglect to the state agency within 5 working days for 1 (Resident 29) of 1 sampled residents. The facility census was 28.

Inspectors wroteLicensure Reference Number 175NAC 12-00.09 (I)Based on observation, record review, and interview the facility failed to protect residents from accidents and or incidents for 2 residents (Resident 6 and Resident 29) of 2 sampled residents. The facility census was 28.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(E)Based on interviews and observations, the facility failed to notify the department of a change in Director of Nursing within 5 working days as required. This had the potential to affect all facility residents. The facility census was 28.

Inspectors wroteBased on interview and record review the facility failed to employee a Infection Preventionist (IP) (a facility member that looks for patterns, observes, and educate staff on infection control and compiles infection data for the facility) at least part-time, that is not the Director of Nursing (DON). This had the potential to affect all 26 residents in the facility. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(E)(iii) Based on record reviews,observation and interviews, the facility failed to develop a Care Plan (CP- written instructions needed to provide effective and person centered care of the resident that meet professional standards of quality care) to address Resident #7 regarding ambulation, Resident #18 regarding falls, and Resident # 25 regarding falls of13 sampled residents. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(F)(iii) Based on observations, record review and interviews, the facility failed to involve Resident #26 in the development of the Comprehensive Care Plan (CCP), failed to include Resident #26 was a high risk for elopement , failed to revise the care plan for Residents #11 and #17 regarding impaired skin integrity and failed to identify Resident #18 was on hospice, out of 13 sampled residents. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(B); 12-006.18(D) Based on observation, record review, and interviews, the facility failed to ensure hand hygiene and glove changes were performed according to standards to prevent the potential for cross-contamination during wound cares for 2 residents (Resident 3 and Resident 17) of 5 residents sampled for wounds, and the facility failed to implement enhanced barrier precautions (EBP- an infection control intervention designed to reduce transmission of multidrug-resistant organisms [MDROs] in nursing homes. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(B) Based on record review and interview, the facility failed to provide a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN-a notice given to Medicare beneficiaries to inform them that Medicare will most likely deny the care that they are about to receive. It must be delivered in advance to give the beneficiary time to consider the options and make an informed choice) to Resident 9 and Resident 21 or their representatives to notify them of charges for non-covered care items and services prior to a change in Medicare A coverage. This affected 2 of 2 residents sampled for Advance Beneficiary Notification. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05 (G) Based on observations, record review, and interviews, the facility failed to evaluate the need for physical restraints for 1 (Resident 2) of 1 residents. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(3) Based on observation, record review, and interviews, the facility failed to complete and document weekly non-pressure wound assessments for Resident 15 and Resident 17. This affected 2 of 4 residents sampled for impaired skin integrity. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(2) Based on record review and interviews, the facility failed to complete weekly pressure ulcer assessments for 1( Resident 3) of 1 sampled resident. The facility census was 26.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.08 Based on observation, interview and record review, the facility failed to notify the physician of weight loss for 1 (Resident 26) out of 6 residents sampled for weight loss. The facility identified a census of 30 at the time of survey.