Life Care Center of Waynesville

Inspectors wroteBased on interview and record review, the facility staff failed to maintain professional standards of care, when staff failed to document wound care and treatments as directed by the physician for two residents (Resident #1 and #2) out of three sampled residents. Staff failed to ensure one Resident's (#3) urine sample was collected and sent to the laboratory, in a timely manner as directed by the resident's physician and delayed medication administration instead of utilizing the emergency kit. The facility census was 76.1. Review of the facility's Physician Orders policy, revised 02/27/25, showed the facility is obligated to follow and carry out the orders of the prescriber in accordance with all applicable state and federal guidelines. Physician orders may include medications and treatments. [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure residents remained free of significant medication errors when staff administered Resident #6's medication ezetimibe (treats high cholesterol), simvastatin (manage high cholesterol and reduce the risk of heart attacks and strokes), Vistaril (treats anxiety), or trazodone (treats major depression) to Resident #5. The facility census was 76.1. Review of the facility Administration of Medications, reviewed 09/09/25, showed the facility will ensure medications are administered safely and appropriately per physician order to address residents' diagnoses and signs and symptoms. Medication administration is the responsibility of those individuals who through certification and licensure are authorized in their state to administer medication in a skilled nursing facility. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to identify and prevent the development of a new pressure injury for one resident (Resident #8) when they failed to follow the care plan, complete assessments as directed by facility policy, and notify the physician to obtain orders for treatment. Facility staff failed to implement interventions and assess and monitor a pressure injury for one resident (Resident #2) of 20 sampled residents. The facility census was 82. 1. Review of the facility's policy titled Skin Integrity & Pressure Ulcer/Injury Prevention and Management, dated 08/25/21, showed a resident should receive care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they are unavoidable. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to thaw frozen meat in a manner to prevent the growth of food-borne pathogens. Facility staff also failed to allow sanitized dishes to air dry prior to stacking in storage to prevent the growth of food-borne pathogens. These failures have the potential to affect all residents. The facility census was 82. 1. Review of the facility's Safe Food Handling policy, revised 04/26/23, showed Frozen food is thawed under refrigeration or in the cooking process. Thawing some foods at room temperature may not be acceptable because it may be within the danger zone for rapid bacterial proliferation. Recommended methods to safely thaw frozen foods include: a. Thawing in the refrigerator, in a drip-proof container, and in a manner that prevents cross-contamination. b. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to provide a comfortable and homelike environment for residents when staff failed to maintain walls, floors, doors, and door frames. The facility staff failed to maintain the armrest on a wheelchair for one resident (Resident #35) out of 20 sampled residents. The facility census was 82. 1. Review of facility's policy titled Housekeeping - General Policy, dated 06/12/2024, directed staff as follows: -It is the responsibility of the Executive Director through the Environmental Services Director to assure Housekeeping Policies are implemented and followed; -Equipment must be ready for use at all times of the day and night to serve the residents' needs; -Care should be exercised in the handling and in the use of all equipment to prevent damage or breakage; -The policy did not address how to report maintenance concerns. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to review and revise the care plan for Activities of Daily Living (ADLs) needs for four residents (Residents #41, #51, #54, and #60 ) and failed to review and revise the care plan with changes in the resident needs for three residents oxygen use (Resident #26, #44, and #58) out of 20 sampled residents. The facility census was 82. 1. Review of the facility policy titled Comprehensive Care Plans and Revisions, dated 09/11/24, showed staff were directed as follows: -The facility will ensure the timeliness of each resident's person-centered, comprehensive care plan, and to ensure that the comprehensive care plan is reviewed and revised by an interdisciplinary team; -A comprehensive care plan must be developed within seven days after completion of the comprehensive assessment; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to obtain physician's orders for oxygen use for two residents (Resident #44 and #58), failed to follow physician's orders for oxygen use for one resident (Resident #26), and failed to obtain a physician's order for one resident's wound treatment (Resident #58) out of 20 sampled residents. The facility census was 82. 1. Review of the facility's policy titled Oxygen Administration, dated 10/11/24, showed staff are directed to obtain oxygen orders that are written for the specific flow rate required by the resident. Review of the facility's policy titled Physician Orders, dated 02/27/25, showed staff are directed to: -Have a physician, physician assistant or nurse practitioner provide orders for the resident's immediate care and ongoing care needs; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to ensure the residents' environment remained free of accident hazards, to the extent possible, when the facility staff failed to store medications and toxic chemicals in a manner not accessible to residents. The facility census was 82. 1. Review of the facility's policy titled, Storage of Chemicals, dated 09/19/23, showed the policy directed staff to store chemicals in accordance with manufacturer guidelines while maintaining supervision while in use and out of the reach of residents when not actively in use. Observations on 03/10/25 at 1:00 P.M. and on 03/11/25 at 12:00 P.M., showed the door to the director of nursing's (DON) office open and the room unattended by staff. Observation showed a 19 ounce (oz.) aerosol can of quaternary ammonium (QUAT) based disinfectant spray and a 32 oz. [...]

Inspectors wroteBased on interview and record review, facility staff failed to completed a pre-dialysis (procedure to remove waste products from the blood when the kidneys stop functioning properly), post-dialysis assessment and to have a system in place for ongoing communication with the dialysis clinic for one resident (Resident #35). Staff failed to complete a post-dialysis assessment for one resident (Resident #59) out of two sampled residents. Facility census was 82. 1. Review of the facility's policy titled Hemodialysis Offsite Policy, dated 09/06/24, directs staff to: -Perform ongoing assessment of the resident's condition and monitoring for complications before and after dialysis treatments received at a certified dialysis facility; -Ongoing communication and collaboration with the dialysis facility regarding dialysis care and services; [...]

Inspectors wroteBased on interview and record review, facility staff failed to communicate pharmacy recommendations to the physician for five residents (Resident #44, #49, #51, #54, and #60) out of 20 sampled residents, to prevent or minimize adverse consequences related to medication therapy to the extent possible. The facility census was 82. 1. Review of the facility policy titled Medication Regimen Review (MRR), dated 06/01/24, showed staff: -The consultant pharmacist will conduct MRRs and will make recommendations based on the information made available in the resident's health record; [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to serve food in accordance with the nutritionally calculated menus and recipes to residents who received pureed and mechanically altered diets. The facility census was 82. 1. Review of the facility's Menus, Substitutions, and Alternatives policy, revised 04/25/23, showed: -Menus are planned in advance and are followed as written in order to meet the nutritional needs of the residents in accordance with established national guidelines. Residents with known dislikes of food and be beverage items, who express a refusal of the food served or request a different meal choice are offered a substitute of similar nutritive value; -Menus are served as written, unless changed due to an unpopular item on the menu, an item that could not be procured or a special meal. [...]

Inspectors wroteBased on observation, interview, and record review facility staff failed to perform proper hand hygiene during perineal care for three residents (Resident#42, #90, and #6), failed to use proper enhanced barrier precautions (EBP) (a infection control practice requiring personal protective equipment to be worn for the care of certain residents) for two residents (Resident#2 and #42) and failed to maintain proper hygiene practices for oxygen tubing for four residents (Resident#26, #44, #51, and #58) out of 20 sampled residents. The facility census was 82. 1. Review of the facility policy titled Hand Hygiene, dated 06/03/24, showed staff are to perform hand hygiene before and after resident contact, after contact with bodily fluids or a visibly contaminated surface and after removing gloves. Use alcohol-based hand rub unless hands are visibly soiled. 2. Observation on 03/10/2025 at 3:42 P.M. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide appropriate treatment and services to prevent further decrease in range of motion (ROM), movement of a joint, for one resident (Resident #10) with contractures (shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) out of 20 sampled residents. The facility census was 82. 1. Review of the policies provided by the facility did not contain a policy for the prevention and treatment of contractures. Review of the facility policy titled Passive Range of Motion Exercises, dated 05/20/24, showed because changes in joints can occur within three days of immobility, start passive ROM exercises as soon as possible. 2. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to accurately complete a bed rail assessment and entrapment assessment for one resident (Resident #10) out of of 20 sampled residents when staff did not accurately identify the type of bed rails used by the resident. The facility census was 82. 1. Review of the facility's policy titled Safe and Effective Use of Bed Rails, dated 09/06/24, showed all alternatives should be considered, and bed rails should only be used when identified need outweighs potential risk. The interdisciplinary team will review and revise the care plan, if indicated, upon completion of each comprehensive, significant change and quarterly MDS for the need to continue use of bed rails. 2. Review of Resident #10's Quarterly Minimum Data Set (MDS), a federally mandated assessment tool, dated 02/18/25, showed staff assessed the resident as: [...]

Inspectors wroteBased on interview, and record review, facility staff failed to maintain professional standards of practice when staff failed to complete and document wound care treatments for three resident's (Resident #1, #2 and #3) out of three sampled residents. The facility census was 78. 1. Review of the facility's Treatment Orders Policy, dated 07/29/24, showed staff are directed as follows: -Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered car plan, and the resident's choices; [...]

Inspectors wroteBased on record review and interviews, facility staff failed to report allegations of misappropriation to the Department of Health and Senior Services (DHSS) within the twenty four hour required time frame for two residents (Resident #1, and Resident #2). The facility census was 81. 1. Review of the facility's policy, Incident and Reportable Event Management, reviewed 12/1/23, showed staff are directed to report all alleged violations involving abuse. [...]

Inspectors wroteBased on interview and record review, facility staff failed to start an investigation in a timely manner when one resident (Resident #1) reported missing money from his/her wallet. Facility staff failed to complete a thorough investigation when a family member reported one resident (Resident #2's) money missing from his/her wallet. The facility census was 81. 1. Review of the facility's Abuse Conducting an Investigation policy, reviewed 7/18/23, showed allegations of abuse (abuse, neglect, mistreatment, including injuries of unknown source, exploitation and misappropriation of property) are promptly and thoroughly investigated. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to maintain kitchen equipment and surfaces in a clean sanitary manner to prevent the potential for cross-contamination. Facility staff failed to perform hand hygiene as often as necessary, using approved techniques, to prevent cross-contamination. Facility staff failed to sanitize kitchen wares in a manner to prevent contamination, and to store dishwares in a manner to prevent cross-contamination when staff stacked dishwares together wet. Facility staff failed to ensure trash can remained covered when not in use to prevent the potential for food contamination. The facility census was 69. 1. Review of the facility's Food and Nutrition Services Manual, reviewed 04/25/2023, showed: -The Director of Food and Nutrition Services monitors the cleaning schedule to ensure the tasks are completed timely and appropriately; [...]

Inspectors wroteBased on observation, interviews, and record reviews, facility staff failed to provide reasonable accommodation of needs for three sampled residents, when staff failed to accommodate one visually impaired resident (Resident #18) with activities, failed to assist one dependent resident (Resident #32) with his/her meal setup, and failed to provide one resident (Resident #55) with meal options to accommodate his/her dental needs. The facility census was 69. 1. Review of the facility's policies showed the facility did not provide a policy for accommodation of needs. 2. Review of Resident #18's admission Minimum Data Set (MDS), a federally mandated assessment, dated 12/26/23, showed staff assessed the resident as follows: -admission date of 12/26/23; -BIMS of 15 out of 15, cognitively intact; -No behaviors; -Highly impaired ability to see in adequate light; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to provide a safe mechanical lift transfer for two residents (Residents #17 and #22) when staff did not assist with guiding the residents while being transferred. The facility census was 69. 1. Review of the facility's policy titled, Limited Lift Program (Safe Patient Handling), dated 08/22/22, showed staff were directed to the following: -Associates will be responsible for utilizing mechanical lifting devices, transferring devices, proper body mechanics to lift, transfer, and/or pivot non-ambulatory patients as indicated; -The facility must ensure that each resident receives adequate supervision and assistance devices to prevent accidents; -The facility will provide education upon hire and annually to associates on the proper use of lifts in accordance with the manufacturer guidelines. [...]

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 wash or sanitize their hands in between glove changes during perineal care for two residents (Resident #14 and #17). Staff failed to provide a barrier for blood sugar care supplies and failed to appropriately sanitize a multiple use glucometer (used to measure blood sugar) between use on one resident (Resident #17). [...]

Inspectors wroteBased on observations and interviews, staff failed to maintain a professional standard of care, when staff left medictions at the bedside and failed to verifying the resident took the medications for one resident (Residents #37) out of 3 sampled. The facility census was 69. 1. Review of the facility's policies showed the facility did not provide a policy for leaving medications at the bedside. Review of the Missouri Department of Health Certified Medication Technician (CMT) Student Manual, Unit 4: Preparation & Administration, LESSON PLAN: 13, showed staff should remain with resident until medication is swallowed. 2. Review of Resident #37's admission Minimum Data Set (MDS), a federally mandated assessment tool, dated 11/29/23, showed staff assessed the resident had a severe cognitive impairment. [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure one (Resident #18) received care and services for the provision of hemodialysis (the clinical purification of blood by dialysis, as a substitute for the normal function of the kidney) consistent with professional standards of practice when staff failed to provide orders, ongoing assessments of the resident's condition, and monitoring for complications after dialysis treatments. The facility census was 69. 1. Review of the facility's Hemodialysis Offsite Policy, reviewed 08/23/23, showed staff are directed to provide: -Ongoing assessment of the resident's condition and monitoring for complications before and after dialysis treatments received at a certified dialysis facility; -Ongoing communication and collaboration with the dialysis facility regarding dialysis care and services. 2. [...]

Inspectors wroteBased on interview and record review, facility staff failed to purchase a surety bond in an amount sufficient to assure security of all resident funds the facility holds. The facility census was 69. 1. Review of the resident trust fund account for January 2023 through December 2023, showed an average monthly balance of $48,168.23, which required a surety bond of $72,000.00. Review of the Department of Health and Senior Services (DHSS) database, showed the facility's approved non-cancelable Escrow Agreement Account in the amount of $69,000.00. During an interview on 02/01/24 at 1:15 P.M., the Corporate Financial Manager said it is the business office managers (BOM) responsibility to check it quarterly and corporate office will update the bond as necessary. He/She said ultimately it is both parties responsibility to keep track, it was overlooked. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to post the telephone number for the Department of Health and Senior Services (DHSS) Adult Abuse and Neglect Hotline (used to report allegations of abuse and neglect), the name, address, and phone number for the Long-Term Care Ombudsman (a program serving residents of nursing homes and residential care facilities to provide support and assistance with their problems or complaints) and the resident rights in a form and manner accessible to residents and visitors on the secured memory care unit (MCU). The facility census was 69. 1. Review of the facility's policies showed the facility did not provide a policy for the required postings. 2. [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide written information to the resident and/or the resident's representative of the bed hold policy at the time of transfer to the hospital for three (Resident #3, #42, and #53) out of three sampled residents. The facility's census was 69. 1. Review of the facility's Resident admission Agreement, revised 2022, showed at the time a resident is to leave the facility for a temporary stay in a hospital or for therapeutic leave, (or within 24 hours in case of an emergency transfer) the resident or legal representative will be given a written copy of the Bed Hold Policy and may elect to hold open the residents room and bed until his/her return. At this time, the resident or his/her legal representative will indicate in writing whether the resident desired or decline the bed hold. 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to provide a clean, homelike and comfortable environment when staff failed maintain resident rooms and medical device equipment. The facility census was 69. 1. Review of the facility's policies showed the facility did not provide a policy for environmental concerns. Review of the facility's policy titled, Medical Equipment Management Plan, dated 01/11/24, showed staff were directed to the following: -The facility will utilize the Medical Equipment Management Plan to provide a safe and supportive environment for the efficient and effective provision of resident care services; -The facility must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide an ongoing program of activities designed to meet the residents' interests for 17 of 17 residents who reside on the memory care unit. The facility census was 69. 1. Review of the facility's policy titled, Therapeutic Activities Program, 09/21/23, showed the facility should implement an ongoing resident centered activities program that incorporates the resident's interests, hobbies and cultural preferences which is integral to maintaining and/or improving a resident's physical, mental, and psychosocial well-being and independence. To create opportunities for each resident to have a meaningful life by supporting his/her domains of wellness (security, autonomy, growth, connectedness, identity, joy and meaning). Review of the facility's Activity Calendar, dated January 2024, showed the following: [...]

Inspectors wroteBased on observation, interview, and record review facility staff failed to ensure medications were stored in a safe and effective manner for three out of four medication carts. The facility census was 69. 1. Review of the facility's Storage and Expiration Dating of Medications Policy, dated [DATE], showed the policy directs staff as follows: -Facility should ensure that medications and biologicals that: (1) have an expired date on the label, (2) have been retained longer then recommended by manufacturer or supplier guidelines, or (3) have been contaminated or deteriorated, are stored separate from other medications until destroyed or returned to the pharmacy or supplier; -Facility should ensure that the medications and biologicals for each resident are stored in the containers in which they were originally received; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide an ongoing program of activities designed to meet the residents' interests for seven residents (Resident #9, #10, #13, #22, #30, #53, and #57) and failed to provide more than one structured activity Monday through Friday or an structured activities on the weekend for the residents. The facility census was 62. 1. Review of the facility's Activities Policy, dated 11/2/21 showed staff are instructed to: -Schedule activities, both individual and groups, implementing and/or delegating the implementation of programs, monitoring the response to the programs to determine if the activities meet the assessed needs of the resident, and making revisions as necessary; -Implement an ongoing resident centered activities program that incorporates the residents' interests, hobbies, and cultural preferences; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to complete the siderail/bedrail risk of entrapment assessment, complete initial and/or annual entrapment assessments, and/or obtain consent for the use of side rails for three (Residents #22, #29 and #57). The facility census was 62. 1. Review of the Facility's Bed Rails Policy, revised 9/12/22, showed staff are directed as follows: -To prevent entrapment and other safety hazards associated with bed rail use. Procedure: -Residents will be assessed upon admission, readmission, or upon initiation utilizing the Evaluation for Use of Bed Rails Assessment (Admission/Readmission/Initial). [...]

Inspectors wroteBased on observation, interview, and record review the facility staff failed to perform appropriate hand hygiene in a manner to prevent or reduce the spread of bacteria and other infection causing organisms during blood glucose checks for three residents (Resident #3, #52 and #362), during perineal care for three residents (Resident #9, #13 and #46) and failed to provide catheter care in a manner to prevent the spread of infection for one resident (Resident #46). The facility census was 62. 1. Review of the facility's Hand Hygiene Policy, revised July 15, 2022, showed staff are instructed as follows: Unless hands are visibly soiled, an alcohol-based hand rubs (ABHR) is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. [...]