Manawa Com Nur Ctr

Inspectors wroteBased on staff interview and record review, the facility did not designate a person to serve as the food and nutrition services director who was a certified dietary manager, had a national certification for food service management and safety from a national accrediting body, or had an associates or higher level degree in food service management or hospitality. This practice had the potential to affect all 23 residents residing in the facility. Dietary Manager (DM)-H did not complete an approved dietary manager or food service manager certification course or other related education.

Inspectors wroteBased on observation, staff and resident interview, and record review, the facility did not ensure menus met the nutritional needs of residents in accordance with established national guidelines. This practice had the potential to affect all 23 residents residing in the facility. The facility did not implement an extended menu that delineated the differences between diet types and portion sizes for residents.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not ensure medication was secured and stored appropriately. This practice had the potential to affect more than 4 of the 23 residents residing in the facility. On 4/29/25, a bottle of aspirin 81 milligrams (mg) and a bottle of Lactobacillus 100 mg for R20 were left on top of the medication cart. The medication cart was left unlocked and unattended by a licensed nurse.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not maintain an infection prevention and control program designed to prevent the transmission of communicable disease and infection. This practice had the potential to affect more than 4 of the 23 residents residing in the facility. Infection control line lists for residents and staff did not contain last symptom dates, times, and/or return to work dates in accordance with the facility's policy. Staff did not ensure infection control procedures were maintained during the provision of care and handling of linens for R18 and R17.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not ensure 1 resident (R) (R8) of 3 sampled residents who was unable to carry out activities of daily living (ADLs) was provided assistance with nail care. R8 was not provided routine nail care.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not provide the necessary respiratory care and services for 1 resident (R) (R18) of 1 sampled resident. R18 had an order for 1 to 4 liters of oxygen as needed via nasal cannula for respiratory distress or discomfort, titrate to maintain greater than 90% (oxygen saturation level) with a start date of 3/21/22. R18 did not have an order to change or maintain R18's oxygen equipment or a care plan for respiratory therapy.

Inspectors wroteBased on staff interview and record review, the facility did not ensure adequate assistance to prevent falls was provided for 2 residents (R) (R3 and R5) of 5 sampled residents. On 8/19/24, Certified Nursing Assistant (CNA)-E transferred R3 without a gait belt which was required per R3's plan of care. R3 fell and sustained a 4 centimeter (cm) forehead laceration and a subdural hematoma that required steri-strips and neurological monitoring. CNA-E was not provided education prior to returning to work on 8/24/24 (which was before the facility's investigation was completed.) On 8/24/24, CNA-E was observed transferring R5 without a mechanical lift which was required per R5's plan of care. [...]

Inspectors wroteBased on staff interview and record review, the facility did not designate a person to serve as the director of food and nutrition services who was a certified dietary manager, a certified food service manager, had a national certification for food service management and safety from a national certifying body, or who had an associate's or higher-level degree in food service management or hospitality. This had the potential to affect all 23 residents residing in the facility. Dietary Manager (DM)-D did not complete an approved dietary manager or food service manager certification course or other related education.

Inspectors wroteBased on staff interview and record review, the facility did not ensure medical records contained complete information for 4 residents (R) (R3, R5, R6, and R8) of 5 sampled residents. Physician visit notes were not readily accessible and available in R3, R5, R6, and R8's medical records.

Inspectors wroteBased on staff interview and record review, the facility did not ensure an allegation of potential neglect was thoroughly investigated for 1 resident (R) (R3) of 5 sampled residents. On 8/19/24, Certified Nursing Assistant (CNA)-E transferred R3 without a gait belt. R3 fell and incurred a forehead laceration and hematoma. The facility did not complete the investigation or provide education to CNA-E before CNA-E returned to work on 8/24/24.

Inspectors wroteBased on staff interview and record review, the facility did not ensure 2 staff (Certified Nursing Assistance (CNA)-I and CNA-J) of 5 staff reviewed for education requirements received Quality Assurance and Performance Improvement (QAPI) training. CNA-I and CNA-J did not receive QAPI training.

Inspectors wroteBased on observation and staff, resident, and family interview, the facility did not ensure a safe, clean, and home-like environment for 4 Residents (R) (R1, R2, R3, and R4) as well as other residents who use the 100 wing lounge. Facility administration indicated water from heavy rains penetrated the exterior walls of R1, R2, R3, and R4's rooms on 7/5/24. In each of the rooms, Surveyor noted a black and/or dark green, damp, and smudgeable substance on baseboards removed from the walls and on the drywall surface of the lower walls. In addition, Surveyor observed a white fuzzy growth on the surfaces and noted a mildew-like smell in R1, R2, and R3's rooms. In addition, the 100 wing lounge contained remodeling supplies including seven approximately six-foot long wooden baseboards, three pieces of drywall, a roll of insulation, and a bed stored in the center of the room.

Inspectors wroteBased on staff interview and record review, the facility did not ensure allegations of abuse were reported to Nursing Home Administrator (NHA)-A, the State Agency (SA), and/or local law enforcement for 4 residents (R) (R1, R2, R3, and R6) of 6 sampled residents. On 5/29/24 and 6/9/24, R1 verbally abused R2. Staff did not report the allegations of abuse to NHA-A in a timely manner. In addition, the allegations of abuse were not reported to the SA. On 6/2/24, R1 verbally abused R3. Staff did not report the allegation of abuse to NHA-A in a timely manner. In addition, the allegation of abuse was not reported to the SA. On 6/7/24, R6 allegedly sexually abused R2. Staff did not report the allegation of abuse to NHA-A in a timely manner. In addition, the allegation of abuse was not reported to the SA or local law enforcement.

Inspectors wroteBased on staff interview and record review, the facility did not ensure allegations of abuse were thoroughly investigated for 4 residents (R) (R1, R2, R3, and R6) of 6 sampled residents. On 5/29/24 and 6/9/24, R1 verbally abused R2. The facility did not thoroughly investigate the allegations of abuse. On 6/2/24, R1 verbally abused R3. The facility did not thoroughly investigate the allegation of abuse. On 6/7/24, R6 allegedly sexually abused R2. The facility did not thoroughly investigate the allegation of abuse.

Inspectors wroteBased on staff interview and record review, the facility did not ensure allegations of abuse and misappropriation were reported to the Nursing Home Administrator (NHA), the State Agency (SA), or local law enforcement in a timely manner for 4 residents (R) (R2, R4, R5, and R3) of 5 sampled residents. On 4/9/24, Licensed Practical Nurse (LPN)-C administered a dose of R4's lorazepam (a sedative medication) to R2 to stop R2 from pacing. R2 did not have a physician's order for lorazepam or consent from R2's Power of Attorney for Healthcare (POAHC). Staff did not report the allegations of abuse and misappropriation to administration or local law enforcement in a timely manner. On 4/10/24, Hospitality Aide (HA)-E alleged that Certified Nursing Assistant (CNA)-J physically abused R5 with a hot washcloth on an undisclosed date. [...]

Inspectors wroteBased on staff interview and record review, the facility did not ensure all allegations of abuse and misappropriation were thoroughly investigated for 4 residents (R) (R2, R4, R5 and R3) of 5 sampled residents. On 4/9/24, Licensed Practical Nurse (LPN)-C administered a dose of R4's lorazepam (a sedative medication) to R2 to stop R2 from pacing. R2 did not have a physician's order for lorazepam and the facility did not obtain consent from R2's Power of Attorney for Healthcare (POAHC) to administer lorazepam. The facility did not thoroughly investigate the allegations of abuse and misappropriation. On 4/10/24, Hospitality Aide (HA)-E alleged Certified Nursing Assistant (CNA)-J physically abused R5 with a hot washcloth on an undisclosed date. The facility did not thoroughly investigate the allegation of abuse. [...]

Inspectors wroteBased on staff interview and record review, the facility did not ensure 1 resident (R) (R2) of 5 sampled residents was free from a chemical restraint administered for behavior and not prescribed to the resident. On 4/9/24, Licensed Practical Nurse (LPN)-C administered lorazepam (a sedative medication) to R2 to stop R2 from pacing. R2 did not have a physician's order for lorazepam and consent was not obtained from R2's activated Power of Attorney for Healthcare (POAHC).

Inspectors wroteBased on record review and staff interview, the facility did not ensure a Registered Nurse (RN) worked for at least eight consecutive hours per day seven days per week on multiple dates in November 2023, December 2023, and January 2024. This had the potential to affect all residents who resided in the facility on those dates. The facility did not have an RN on duty for at least eight consecutive hours on 9 days from 11/4/23 through 1/7/24.

Inspectors wroteBased on staff interview and record review, the facility did not designate a person to serve as the director of food and nutrition services who was a certified dietary manager, a certified food service manager, had a national certification for food service management and safety from a national certifying body, or who had an associate's or higher level degree in food service management or hospitality. This had the potential to affect all 23 residents residing in the facility. Dietary Manager (DM)-H did not complete an approved dietary manager or food service manager certification course or other related education.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not ensure food was prepared and served under sanitary conditions. This practice had the potential to affect all 23 residents residing in the facility. The facility did not have an internal surface temperature monitoring device used to routinely monitor and ensure the warewashing machine (dishwasher) was functioning correctly. Dietary Manager (DM)-H did not ensure the dishwasher consistently reached the required minimum temperatures for the wash and rinse cycles.

Inspectors wroteBased on staff interview and record review, the facility did not ensure high-risk medications were monitored for 3 Residents (R) (R2, R7, and R14) of 5 residents reviewed for unnecessary medications. The facility failed to monitor R2, R7, and R14 for potential side effects or adverse reactions of opioid medication.

Inspectors wroteBased on staff interview and record review, the facility did not ensure vaccinations were reviewed, offered, and administered for 3 Residents (R) (R14, R10, and R4) of 5 residents reviewed for vaccines. The facility did not review R14, R10, and R4's vaccination history or offer R14, R10, and R4 the PCV20 (Prevnar 20®) vaccine.

Inspectors wroteBased on observation, resident and staff interview, and record review, the facility did not provide adequate supervision to prevent further abuse following a visitor-to-resident altercation for 1 Resident (R) (R3) of 2 residents. Assisted Living Resident (ALR)-G visited ALR-G's spouse (R4) in the facility and had a known history of physical aggression. On 2/13/24, R3 was struck in the face by ALR-G during an altercation. Following the incident, the facility did not implement measures to supervise ALR-G while ALR-G was in the facility. Although R3 did not recall the incident due to a diagnosis of dementia, the reasonable person standard was implemented as a person who was hit in the face by a visitor in their home would likely incur mental anguish.

Inspectors wroteBased on staff interview and record review, the facility failed to implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act following a physical altercation for 1 Resident (R) (R3) of 3 sampled residents. R3 was struck in the face by Assisted Living Resident (ALR)-G during an altercation in the facility on 2/13/24. Law enforcement was not notified of the incident.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not ensure food was prepared and served under sanitary conditions which had the potential to affect all 21 residents residing in the facility. The facility did not have an internal surface temperature monitoring device used to routinely monitor and ensure the warewashing machine (dishwasher) was functioning correctly. Dietary Manager (DM)-D and Dietary Aide (DA)-E did not ensure the dishwasher consistently reached the required minimum temperatures for the wash and rinse cycles. DM-D and DA-E did not wash hands when moving from dirty dishes to clean dishes.

Inspectors wroteBased on resident and staff interview, the facility did not ensure an allegation of abuse was reported to the State Agency (SA) for 1 Resident (R) (R16) of 2 residents reviewed for abuse. The facility did not submit an initial facility-reported incident (FRI) to the SA within 24 hours of R16's allegation of physical abuse.

Inspectors wroteBased on staff interview and record review, the facility did not ensure pharmacy recommendations regarding resident medications were acted upon for 2 Residents (R) (R7 and R16) of 5 residents reviewed for medications. The facility did not take action in response to a pharmacy recommendation, dated 12/7/22, to monitor R7 for signs and symptoms of bleeding, evaluate the risks versus benefits of continued use of Meloxicam (a non-steroidal anti-inflammatory drug which increases the risk of gastrointestinal bleeding, especially in high risk groups), and consider a proton pump inhibitor (PPI) for gastroprotection. [...]

Inspectors wroteBased on staff interview and record review, the facility did not ensure behavioral interventions and symptom/behavior monitoring related to antipsychotic medication were in place for 1 Resident (R) (R16) of 5 residents reviewed for medications. The facility did not identify symptoms/target behaviors related R16's psychosis/psychotic features, identify the impact of the symptoms on R16, establish monitoring for the symptoms/behaviors, or develop a care plan to identify non-pharmacological interventions to use when R16 experienced psychosis/psychotic features.

Inspectors wroteBased on observation and staff interview, the facility did not ensure medications were stored in a locked compartment for 1 Resident (R) (R2) of 4 residents during medication administration. Licensed Practical Nurse (LPN)-C dispensed and attempted to administer R2's AM medication. After R2 refused the medication, LPN-C left R2's medication unattended on top of the medication cart while LPN-C passed medication and assisted other residents.

Inspectors wroteBased on staff interview and record review, the facility did not establish and maintain an infection prevention and control program based on current standards of practice designed to provide a safe environment and to help prevent the development and transmission of communicable disease and infection. The deficient practice had the potential to affect all 21 residents residing in the facility. The facility's Water Management Plan was not based on current standards of practice and did not: - Include water management team members who were knowledgeable about Legionella (a bacteria that causes legionellosis, including a pneumonia-type illness called Legionnaire's disease and a mild flu-like illness called Pontiac fever) and the facility's water system. - Describe the building's water system using text and an accurate flow diagram of the system. [...]