Lawton Skilled Nursing & Rehabilitation Center

Inspectors wroteBased on interview, and record review, the facility failed to obtain required screening documents to determine whether one of two sampled residents (Resident 47) required active treatment or other care services appropriate for mental health condition when Resident 47 had no Level II Pre-admission Screening and Resident Review (PASRR - a federal requirement that aims to confirm presence of mental illness and/or intellectual disabilities, to assess applicant's need for nursing facility service, and to assess whether the applicant requires specialized services or specialized rehabilitative services) evaluation in the presence of schizophrenia (a chronic and severe mental disorder that affects how a person thinks, feels, and behaves) diagnosis. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the required square footage per resident in multiple bedrooms for 17 out of 28 rooms (Rooms 101, 102,103, 104, 105, 106, 107, 108, 111, 115, 126, 127, 131, 132, 134, 136 and 139). This failure had the potential for inadequate usable space for the provision of residents' care and may impact their quality of life. Review of the facility's request for a waiver dated 4/3/26, indicated the following bedrooms failed to meet the requirement of 80 square feet per resident. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to store foods and maintain kitchen utensils in a sanitary manner. When: 1. An opened Thousand Island dressing container was found undated, and 2. A drawer with kitchen utensils was found to have bread crumbs on the floor of the drawer. These deficient practices will potentially have negative ill effect to the residents' health outcome, and a continous practice of cross contamination of kitchen utensils to food served to all residents in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure controlled medications (medications that can be easily abused and are under strict government control) were fully accounted for when they were signed out of the Controlled Drug Record (CDR, an inventory or count sheet) but not documented on the medication administration record (MAR) for three out of five residents (Residents 12, 19, and 202); and a controlled medication for a resident (Resident 204) was destroyed without a witness' signature as per facility policy and procedure. The failures had the potential for medication errors and controlled drug abuse or diversion (when healthcare providers obtain or use prescription medicines illegally).

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the required square footage per resident in multiple bedrooms for 17 out of 28 rooms (Rooms 101, 102,103, 104, 105, 106, 107, 108, 111, 115, 126, 127, 131, 132, 134, 136 and 139). This failure had the potential for inadequate usable space for the provision of residents' care and may impact their quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility had a medication error rate of 7.69% when two medication errors occurred out of 26 opportunities during the medication administration for one out of six residents (Resident 18). The failures resulted in the nursing staff not following the facility's policy and procedures (P&P) and had the potential for the resident not receiving full therapeutic effects or causing side effects for the residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a safe and sanitary environment when an unlabeled basin containing exposed personal care items were kept on an overbed table in between the beds of Resident 6 and Resident 15. This failure had the potential to result in cross contamination and spread of infection in the facility.

Inspectors wroteBased on observation, interview, and record review, on March 20, 2023, the facility failed to ensure that the residents in both the South side and the North side receive their prescribed medications in a timely manner, and the wasted medication (refused med) was disposed of safely according to professional standards when . 1. RN1 observed administering the scheduled 9:00 AM medication on the South side on 3/20/23 between 10:20 AM to 12:20 PM to three of his 27 residents. 2. RN2 observed administering the scheduled 9:00 AM medication on the North side on 3/20/23 at 11:30 AM to two of her 29 residents. 3. RN1 observed discarding (disposing) the resident's refused medication in a regular uncovered garbage bin on the side of the medication cart instead of discarding the pill in the incinerator. [...]

Inspectors wroteBased on observation, interview, and record review on 3/22/23 in the medication room, the facility failed to ensure that the biologicals were labeled and stored according to acceptable professional standards when . 1. Two quality control solutions (high and low) were found on the shelf opened but not dated. 2. A refrigerator storing laboratory (stool) specimen was found in the clean medication storage room. Note: Cross referenced in F880, Infection Control. 3. An opened package of unused, Lidocaine Patch was found in Resident 17's room on 3/20/23. This deficient practices have the potential to: 1. Result in inaccuracies in blood sugar monitoring, 2. Contaminate drugs, biologicals and nutritional supplements, 3. Result in overdosage to the resident or diversion of this drug (illegal use of drugs).

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety when: 1. There was no hands-free trash bin for disposal of used paper towels after handwashing in the kitchen. 2. Unlabeled, undated, and expired food items stored in the kitchen were available for resident consumption. 3. A cart holding two opened jugs of cooking oil was lined with parchment paper soaked in oil. The base and legs of the cart was covered with grimy, gray-colored, fuzzy substance. 4. An exposed and uncovered metal scoop with yellow-colored powdery substance was placed on top of a container of food seasoning. 5. A plastic bottle containing vinegar had a broken plastic cap with an irregular sized hole with jagged, sharp edges. [...]

Inspectors wroteBased on observation, interview, and record review on 3/22/23 at 9:45 AM the facility failed to maintain infection control practices in the clean medication storage room when . 1. A hazardous waste or biohazard refrigerator used to store laboratory specimens was found in the medication room. 2. The biohazard refrigerator contained an unlabeled container with stool specimen in the lowest shelf. 3. LVN2 was observed taking out the old unlabeled stool specimen from inside the refrigerator with her bare hands. 4. LVN2 discarded the unlabeled stool specimen in the regular garbage bin in the hallway by the sink near the entrance of the nurses' station instead of in the biohazard container in the biohazard room. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure patient care equipment were maintained in safe operating condition when preventive maintenance was not done for 6 out of 6 Low Air Loss (LAL) mattresses (composed of inflatable air tubes that alternately inflate and deflate which relieves pressure under the body to help ensure proper air circulation, and help prevent and treat the occurrence of pressure wounds [injuries to skin and underlying tissue resulting from prolonged pressure on the skin]) used by residents. This failure did not ensure patient care equipment used were safe and maintained according to the manufacturer's recommendations to ensure optimal function and performance.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide the required square footage per resident in multiple bedrooms for 17 out of 28 rooms (Rooms 101, 102,103, 104, 105, 106, 107, 108, 111, 115, 126, 127, 131, 132, 134, 136 and 139). This failure had the potential for inadequate usable space for the provision of residents' care and may impact their quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide resident rooms that were maintained and kept in good repair for 6 out of 6 sampled rooms, occupied by residents, (Rooms A, Rooms B, Rooms C, Room D, Room E, and Room F) out of 28 total resident rooms in the building. This failure did not provide a safe, functional, and comfortable environment for the residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure a person-centered, comprehensive care plan was developed, for a medication prescribed for anxiety, for one of three sampled residents (Resident 7) on psychotropic (any drug affecting brain activities associated with mental processes and behavior) medications. This failure had the potential to not meet and address the resident's preferences and goals to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that one of sampled residents (Resident 5) was free from accident and hazards when the facility failed to monitor Resident 5 to prevent Resident 5 from an avoidable fall. The resident was at high risk for falls; Resident 5 was found to have fallen face down in the resident's room on 3/13/23 with injuries. This failure resulted in Resident 5 sustaining laceration on her forehead, some abrasions on her face and cervical injury.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the physician-prescribed diet order of double portions for all meals for one of 12 sampled residents (Resident 45) when Resident 45 was plated one scoop of rice instead of two scoops. This failure had the potential to result in decreased food intake, and could result in unplanned weight loss that could further compromise the medical and nutritional status of Resident 45.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure policies and procedures regarding use and storage of foods brought to residents by family were implemented when 2 expired peanut butter jars were found in Resident 17's room. This failure had the potential to cause unsafe consumption of expired foods by Resident 17.