Independence Manor Care Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and maintain a comprehensive, facility-specific infection prevention and control program designed to help prevent the development and transmission of Legionella (A [NAME] of pathogenic Gram-negative bacteria that includes the species L. pneumophila, causing legionellosis, all illnesses caused by Legionella, including a pneumonia-type illness called Legionnaires' disease and a mild flu-like illness called Pontiac fever) and/or other water-borne pathogens (a bacterium, virus, or other microorganism that can cause disease) that included specific assessments and contents, in accordance with State of Missouri rules and Centers for Disease Control (CDC) and Centers for Medicare and Medicaid Services (CMS) standards and guidelines. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff were cleaning Continuous Positive Airway Pressure (CPAP- a machine to deliver pressurized air through a mask to keep airways open during sleep)/Bilevel Positive Airway Pressure (BiPAP - a machine that delivers two pressure levels of air-a higher one for inhaling and a lower one for exhaling through a mask) masks daily for three sampled residents (Resident# 33, # 35, and # 41), failed to ensure the resident's distilled water (water that has been purified) used in respiratory equipment was stored in a sanitary manner for two sampled residents (Resident #35 and #33), out of 12 sampled residents The facility census was 44 residents. Review of the facility's policy, CPAP/BiPAP Support dated March 2015 showed: -Machine cleaning; [...]

Inspectors wroteBased on interview and record review, the facility failed to notify two out of three sampled residents (Residents #12 and #14) sampled for funds that receive Medicaid (program that helps with medical costs for some people with limited income and resources) benefits when the amount in the residents' accounts reached $200 less ($5,868.80) than the Supplemental Security Income (SSI) resource limit (the maximum value of assets an individual or couple can own and still be eligible for benefits) resource limit for one person ($6,068.80) and notify them that they may lose eligibility for Medicaid or SSI if they reached the SSI limit for one person. The facility census was 44 residents. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to review and revise resident care plans (a comprehensive, person-centered document detailing how a facility will meet a resident's medical, nursing, mental, and psychosocial needs) to include resident behaviors for one sampled resident (Resident #13) and/or have an correct diagnosis for ordered psychotropic (medication that affects a person's mental state) for one sampled resident (Resident #4) out of 12 sampled residents. The facility census was 44 residents. Review of the facility's Care Plans, Comprehensive Person-Centered policy, dated December 2016, showed:-A comprehensive, person-centered care plan that included measurable objectives to meet the residents psychosocial (a person's mental, emotional, social, and spiritual well-being) was developed and implemented for each resident. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide the ability to listen to books for one sampled resident (Resident #22) who had severely impaired vision and loved to read out of 12 sampled residents. The facility census was 44 residents. [...]

Inspectors wroteBased on observation, interview and record review, the facility to ensure appropriate dental care when the facility failed to provide routine dental services to one sampled resident (Resident #13) out of 12 sampled residents. The facility census was 44 residents. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to store food in a manner that prevented the potential of foodborne illnesses by not dating food wrappers and containers after they were opened; by failing to document refrigerator and freezer temperatures; and by not documenting prepared hot food temperatures prior to serving to residents. The facility census was 44 residents. Review of the facility's Preventing Foodborne Illness - Food Handling policy, dated July 2014, showed:-Food was stored, prepared, handled and served so that the risk of foodborne illness was minimized.-Functioning refrigeration was monitored at designated intervals throughout the day and documented. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a Registered Nurse (RN) worked for eight consecutive hours per day, seven days a week for four or more days for the previous four quarters of the last fiscal year July 2022 through June 2023 and from November 16, 2023, through December 4, 2023, for this survey look back. The facility census was 54 residents. Review of the facility's Nursing Services-RN policy dated 11/23/2022 showed: -It was the intent of the facility to comply with RN staffing requirements. -The facility would utilize the services of a RN for at least eight consecutive hours per day seven days per week. -The facility would designate a RN to serve as the Director of Nursing (DON) on a full-time basis. -The DON may serve as a charge nurse only when the facility had an average daily occupancy of 60 or fewer residents. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to employ sufficient dietary staff and support personnel with the appropriate competencies and skill sets to safely and effectively carry out the functions of the food and nutrition service, taking into consideration residents' dietary assessments, individual plans of care and the number, acuity and diagnoses of the facility's resident population in accordance with professional standards for food service safety. This deficient practice had the potential to affect all residents, visitors, volunteers, and staff who ate food from the kitchen. The facility's census was 54 residents with a licensed capacity for 99 residents at the time of the survey. 1. Review of the facility's dietary documentation for the month of December, 2023, provided by the Dietary Manager (DM), showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to retain operable thermometers in all refrigerators/freezers to confirm adequate temperature ranges; to maintain sanitary utensils, beverage dispensers, and food preparation equipment; to maintain plastic cutting boards and utensils in good condition to avoid food safety hazards (cross-contamination); and to record the testing of the dishwasher machine's chemical solution balance for the sanitizing of eating/serving utensils, plates, and cups/mugs, in accordance with professional standards for food service safety. These deficient practices had the potential to affect all residents, visitors, volunteers, and staff who ate food from the kitchen. The facility's census was 54 residents with a licensed capacity for 99 residents at the time of the survey. 1. Observations on 12/4/23 between 8:44 A.M. and 9:47 A.M. [...]

Inspectors wrote2. Review of the facility's Perineal (area between the genitals and anus) Care Policy, dated February 2018, showed: -The purpose of this procedure was to provide cleanliness and comfort to the resident, to prevent infections and skin irritation and to observe the resident's skin condition. -Preparation: --Review the resident's care plan. --Assemble the equipment and supplies needed. -Equipment and supplies included: --Wash basin. --Washcloths. --Personal protective equipment (PPE - gowns, gloves, mask as needed). -Procedure: --Place the equipment on the bedside stand, arrange supplies so they can be easily reached. --Wash and dry hands thoroughly. --Fill wash basin. --Fold bedspread or blanket toward the of the bed. --Raise the gown or lower the pajamas. --Put on gloves. --Wet washcloth and soap the skin. --Wash perineal area front to back. --Rinse wash cloth and gently dry the area. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide an ongoing program of activities to meet the interests as well as the physical, mental and psychosocial well-being for four sampled residents (Residents #17, #47, #30 and #42) out of 14 sampled residents. The facility census was 54 residents. Review of the facility's Activity Evaluation Policy, dated June 2018, showed: -To promote the physical, mental and psychosocial well-being of the residents, an activity evaluation was conducted and maintained for each resident at least quarterly and with any change of condition that could affect his/her participation in planned activities. -An activity evaluation was conducted as part of the comprehensive assessment to help develop any activities plan that reflected the choices and interests of the resident. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the residents' prescribed medications were stored in the medication refrigerator; to ensure the residents' prescribed medications that had been opened, had the date written that they had been opened written on the container; and to ensure non medical items were not stored with the residents' medications. The facility census was 54 residents. Review of the facility's policy, Administering Medications, dated December 2012 showed: -The Director of Nursing Services would supervise and direct all nursing personnel who administer medications and/or have related functions. -When opening a multi-dose container, the date opened should have been recorded on the container. Review of the facility's policy, Storage of Medications, dated April 2007 showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to include parameters for monitoring a resident's pulse when monitoring for medication administration and for failing to clarify a physician's order for administering an as needed blood pressure medication when the resident's blood pressure was elevated for one sampled resident (Resident #35) out of five residents sampled for medication review. The total sample was 14 residents. The facility census was 54 residents. Review of the facility's policy titled Medication Orders dated September 2014 showed it did not address parameters or order clarification. 1. Review of Resident #35's care plan dated 2/16/23 and updated on 7/30/23 showed the resident had high blood pressure and included instructions to staff to administer blood pressure medications as ordered and monitoring the resident's blood pressure. [...]

Inspectors wroteBased on interview, and record review the facility failed to ensure there was documentation of the contracted hospice (end of life care) company's visits for one sampled resident, (Resident #29) out of 14 sampled residents. The facility census was 54 residents. Review of the facility's policy, Coordination of Hospice Services, dated 11/23/22 showed: -The facility maintained written agreements with hospice providers that specify the care and services that were to have been provided and the process for hospice and the nursing home communication of necessary information regarding the resident's care. -The facility would maintain communication with hospice as it related to the resident's plan of care and services to ensure each entity was aware of their responsibilities. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident's oxygen tubing was not on the floor; to ensure the plastic storage bag for the oxygen tubing was not on the floor; to ensure his/her nebulizer (a machine that turned liquid medication into a mist that was easily inhaled) was not on the floor; to ensure the resident's oxygen tubing was changed weekly with the date written on the storage bag for one sampled resident (Resident # 29) out of 14 sampled residents. The facility census was 54 residents. Review of the facility's undated policy, Oxygen Tubing and Cannula (part of the oxygen tubing that goes into a person's nose) Storage Policy and Procedures, showed: -Oxygen Tubing and cannulas would be replaced weekly and as needed by the nursing staff. -When not in use Oxygen tubing or cannulas for each resident would be confined in a bag. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one sampled resident (Resident # 42) had a diagnosis for Levothyroxine (Synthroid a medication used to replace thyroid hormones) a medication prescribed by the physician; to notify the physician of one sampled resident's (Resident #31) continued refusals to take his/her Levothyroxine; to ensure Levothyroxine was not given with other medications or foods according to the manufacturer's instructions for three sampled residents (Resident #39, #42, and #56) and to administer medications within one hour of the medication administration time for one sampled resident (Resident #56) out of 18 sampled residents. The facility census was 70 residents. Record review of the facility's policy, Medication Monitoring/Medication Management, dated August 2014 showed: [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure a medication cart on the secured unit was locked while staff went into a resident's room to administer a medication. The facility census was 70 residents. Record review of the facility's policy, Administering Medications, dated April 2019 showed, during the administration of medications, the medication cart was to be kept closed and locked when out of sight of the medication nurse or aide. 1. During an interview on 5/13/22 at 11:55 A.M. Licensed Practical Nurse (LPN) A said on the secured unit staff have to be very careful because there were two residents who were shoppers and would take belongings that did not belong to them, including off the medication cart. Observation on 5/13/22 at 12:02 P.M. during the medication pass with LPN A showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to meet sanitary conditions and practice sanitary procedures for food and non-food contact surface areas before, during and after food preparation tasks. This deficient practice of not keeping food and non-food contact surfaces sanitary could, potentially, promote microorganisms and bacterial growth which could adversely affect the health and well-being of the residents and staff who partake of the meals prepared by the dietary staff. The facility census was 70 residents at the time of the survey. 1. Observations on 5/11/22 at 8:34 A.M. during an initial brief tour of the kitchen and on 5/13/22 between 5:07 A.M. and 1:10 P.M. in the kitchen during the facility's kitchen inspection, showed the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure they completed a check of the Employee Disqualification List (EDL) and/or Criminal Background Check (CBC) and/or the Nurse Aide (NA) Registry to ensure they did not have a Federal Indicator (FI-a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prior to hire for two sampled staff out of 10 staff sampled. The facility census was 70 residents. Record review of the facility's abuse prevention policy updated November 2017 showed: -A request for a CBC would be completed no later than two working days of the date an applicant for a position to have contact with residents is hired. -An EDL check would also be completed. -The policy did not address the NA registry. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure diagnoses were listed on the Physician Order Summary (POS) and the Medication Administration Record (MAR) for two psychotropic medications (any drug capable of affecting the mind, emotions, and behavior including stimulants, antidepressants, antipsychotics, mood stabilizers, and antianxiety agents) and to ensure the resident had diagnoses for their medications for one sampled resident (Resident #5) out of 18 sampled residents. The facility census was 70 residents. Record review of the facility's Medication Monitoring Medication Management policy dated August 2014 showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure Hospice (end of life care) staff were documenting their visits for two sampled residents (Resident #18 and #25) out of 18 sampled residents and failed to have a designated direct contact who was a member of the Interdisciplinary Team (IDT- facility managers and the physician) for the Hospice companies. The facility census was 70 residents. Record review of the facility's Policy Hospice Program dated July 2017, showed: -Hospice providers who contract with this facility; must have a written agreement with the facility outlining in detail the responsibilities of the facility and the hospice agency. -Hospice providers were held responsible or meeting the same professional standard and timeliness of service as any contracted individual or agency associated with the facility. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to use proper infection control practices by blowing on and sticking a finger in one supplemental resident's food (Supplemental Resident #12) and to ensure infection control practices were implemented to prevent cross contamination during Foley Catheter (a tube with retaining balloon passed through the urethra into the bladder to drain urine) care for one sampled resident (Resident #58) who was at risk for urinary tract infections (UTI- an infection in any part of the urinary system-kidneys, ureters, bladder and urethra) out of 18 sampled residents and seven supplemental residents. The facility census was 70 residents. Record review of the facility Handwashing/Hand Hygiene policy, dated August 2019, showed: -Handwashing/hand hygiene is the primary means to prevent the spread of infections. [...]