Lenoir Health Care Center

Inspectors wroteBased on observation, interview and record review, the facility staff failed to store food in a manner to prevent potential contamination, out-dated use and reuse of single-service containers. This failure had the potential to affect residents who dined in the Woods Central and Olive [NAME] units and residents who received modified textured diets. The facility census was 48. 1. Review of the facility's Food Storage Policy, revised 10/01/20, showed: -Inspect food regularly for damage due to spoilage; -Items that arrive in their original packaging with a manufacturer's expiration date will utilize that date for discard: a. Should an item be opened and stored in a different container, it will be labeled with an open date and discard date; -Food safety practices based on ServSafe Standards will be followed at all times. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to use enhanced barrier precautions (EBP) (an infection control practice that requires staff to wear personal protective equipment (PPE) for five residents (Resident #15, #25, #27, #40, and #14) of five sampled residents who required care. The facility census was 48. 1. Review of the facility policy titled Enhanced Barrier Precautions, dated 02/25/25, showed EBP are utilized to prevent the spread of multi-drug resistant organisms (MDRO)s (bacteria or fungi that have developed resistance to one or more classes of antimicrobial agents, making them difficult to treat) to residents. EBPs employ targeted gown and glove use during high contact resident care activities when contact precautions do not otherwise apply. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to use appropriate infection control procedures to prevent the spread of bacteria or other infectious causing contaminants when staff failed to perform appropriate hand hygiene and glove changes during incontinent care for three residents (Resident #32, #35, and #36), and failed to properly handle soiled linens for one resident (Resident #36). The facility census was 49. 1. Review of the facility's Hand Hygiene policy, reviewed 01/30/24, showed all personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infection to other personnel, residents, and visitors. Review showed: -Use an alcohol-based hand rub containing at least 60% alcohol, or, alternatively soap (antimicrobial or non-antimicrobial) and water for the following situations: a. Before and after contact with residents; b. [...]

Inspectors wroteBased on observation, resident and staff interview, and record review, facility staff failed to provide safe mechanical lift transfers for four (Resident #28, #29, #32, and #35) out of 13 sampled residents. Facility staff failed to provide safe medication storage for three residents (Resident #23, #36, and #8). The facility census was 49. 1. Review of the facility's Safe Lifting and Movement of Residents policy, dated 10/14/19, showed staff were directed as follows: -Staff responsible for direct resident care will be trained in the use of a mechanical lifting devices; -Staff will be observed for competency in using mechanical lifts and observed periodically for adherence to policies and procedures regarding the use of equipment and safe lifting techniques. [...]

Inspectors wroteBased on interviews and record review, staff failed to maintain a professional standard of care when staff failed to ensure one resident's (Resident #36) care plan for advanced directives (code status - decision to start or withhold Cardiopulmonary Resuscitation - CPR) matched the physician ordered advanced directive and failed to notify the physician for further direction when an ordered supplement was unavailable. The facility census was 49. 1. Review of the facility's Advanced Directives policy, reviewed [DATE], showed: -Prior to admission or upon admission of a resident, the Social Service Director (SSD) or designee will inquire of the resident and their representative about the existence of any written advanced directive; -Information about whether or not the resident has executed an advanced directive shall be displayed in the ribbon in the Electronic Health Record (EHR); [...]

Inspectors wroteBased on observations, interviews and record review, facility staff failed to review, revise and develop individualized interventions for one resident (Resident #5) who exhibited behaviors. The facility census was 49. 1. Review of the Facility Assessment, dated July 2023 through June 2024, showed: -Twenty-eight residents with a diagnosis of Alzheimer Disease (A progressive disease that destroys memory and other important mental functions); -Twenty-one residents with a diagnosis of unspecified dementia (A group of thinking and social symptoms that interferes with daily functioning). Review of the facility's Mood and Behavior policy, undated, showed: -To provide a plan of care that is individualized to the resident's needs based on the comprehensive assessment by the interdisciplinary team; [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to properly store open food to prevent cross-contamination and outdated usage, to maintain kitchen equipment in a clean and sanitary manner, and to perform hand hygiene and change gloves as often as necessary to prevent cross contamination. This failure had the potential to affect all facility occupants. The census was 32. 1. Review of the facility's Food Storage and Safety Policies, dated 9/10/19, showed staff are directed to contain, store, label, and date everything properly. Observation on 2/1/23 at 12:20 P.M. in the Reach kitchen, showed a refrigerator contained: - Four uncovered cups of orange liquid not labeled, four uncovered cups of brown liquid not labeled, and four uncovered cups of clear liquid not labeled; - Multiple small bowls of citrus slices undated and not labeled; [...]

Inspectors wroteBased on interview and record review, facility staff failed to check the Certified Nurses' Assistant (CNA) Registry before hire for all staff in accordance with their policy to ensure they did not have a Federal Indicator (a marker given by the federal government to individuals who have committed abuse/neglect) for three employees (Housekeeper J, Dining Service K and Security L) out of ten sampled employees hired since the last survey. The census was 32. 1. Review of the Pre-Employment Screening Procedures Policy, Revised 3/6/20, showed the following: Background check -Concurrent to the candidate completing the pre-employment testing, the HR Representative will run all required background checks. The HR Representative will log into the background check vendor's site to order the appropriate background check. This includes: -Missouri Nurse Aide Registry (CNA). 2. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to maintain professional standards of practice by not completing neurological assessments (evaluation completed by staff for early detection of nervous system damage following head trauma) following unwitnessed falls, and falls with a known head injury, for five residents (Resident #6, #16, #20, #23, and #25). The facility census was 32. 1. Review of the facility's Fall and Fall Risk, Managing policy, dated September 2022, showed staff are directed as follows: -A fall without injury is still a fall; -Unless there is evidence suggesting otherwise, when a resident is found on the floor, a fall is considered to have occurred; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to propel residents in wheelchairs in a manner to prevent accidents by failing to use foot rests, for four residents (Residents #4, #7, #17, and #24). The facility census was 32. 1. Review of the facility's policy titled Assistive Equipment Devices, dated 10/01/18, showed the community provides, maintains, trains, and supervises the use of assistive devices and equipment for residents. The policy shows staff will be trained and will demonstrate competency on the use of devices and equipment prior to assisting or supervising residents. Residents, family, and visitors will be trained, as indicated, on the safe use of equipment and devices. The Assistive Equipment Device policy does not address the use of foot pedals when propelling a resident in a wheelchair. 2. [...]

Inspectors wroteBased on observation, interview and record review facility staff failed to assess for risk of entrapment upon initiation and/or quarterly, and/or obtain informed consent for bed rails for two residents (Resident #23 and #288). The facility census was 32. 1. Review of the facility's Proper Use of Bed Assistive Devices policy, revised 9/16/22, showed: -An assessment will be made to determine the resident's symptoms or reason for using the bed assistive device upon initiation, quarterly, and as needed; -The use of bed assistive devices will be addressed in the resident's care plan; -Consent for using bed assistive devices will be obtained from the resident or resident representative and documented by community protocol; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to ensure 100% of staff were fully vaccinated for COVID-19 (a highly contagious virus that causes serious illness or death). One employee, (Registered Nurse (RN) F), of eight employees sampled, had a medical exemption form that did not include an exemption recognized by the CDC. The facility Census was 32. 1. Review of the facility's COVID-19 Vaccination Policy, revised 8/17/22 showed: To protect residents, guests, clients, employees, family members and the community from Sars-Cov-2 (COVID-19) infection, all employees as well as regularly scheduled contracted personnel (e.g. rehab therapy staff) must be fully immunized against COVID-19. For purposes of this policy, fully immunized means all doses in the primary series and all recommended booster doses, when eligible, as required by law. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide appropriate personal hygiene care for six dependent residents (Resident #5, #6, #10, #17, #25, and #30). The facility census was 32. 1. Review of the facility's policies showed the staff did not provide a bath (shower) policy. 2. Review of Resident #5's quarterly Minimum Data Set (MDS), a federally mandated assessment tool, dated 11/19/22, showed staff assessed the resident as follows: -Required extensive assistance of one staff member for bed mobility, dressing, and personal hygiene; -Required extensive assistance of two staff members for transfers and toileting; -Totally dependent on staff for bathing; [...]