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Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician orders regarding a medication for one resident (Resident #68) that received dialysis (a treatment that filters waste and excess fluid from the blood when the kidneys can no longer do so) out of one sampled resident. The facility also failed to follow oxygen orders for two residents (Residents #14 and #24) out of two sampled residents. The facility census was 70. Review of the facility's policy titled, Medication and Treatment Orders, revised July 2016, showed: - Medications shall be administered only upon the written order of a person duly licensed and authorized to prescribe such medications in this state; - Orders for medications must include: name and strength of the drug; number of doses, start and stop dates, and/or specific duration of therapy; route of administration; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one resident (Resident #68) was free from significant medication errors when staff failed to administer medications as ordered by the physician. The facility census was 70. Review of the facility's policy titled, Medication and Treatment Orders, revised July 2016, showed: - Medications shall be administered only upon the written order of a person duly licensed and authorized to prescribe such medications in this state; - Orders for medications must include: name and strength of the drug; number of doses, start and stop dates, and/or specific duration of therapy; route of administration; clinical condition or symptoms for which the medication is prescribed; any interim follow-up requirements (pending culture and sensitivity reports, repeat labs, therapeutic medication monitoring, etc.). 1. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to wear gloves when administering insulin for two residents (Residents #7, and #49) out of two sampled residents and one resident (Resident #22) out of the sample. The facility also failed to maintain appropriate infection control practices by not following enhanced barrier precautions (EBP) and by not performing proper hand hygiene and glove changing techniques during wound care and catheter care for two residents (Residents #38 and #61) out of sampled residents. The facility's census was 70. Review of the facility's policy titled, Enhanced Barrier Precautions, not dated, showed: - Enhanced barrier precautions will be initiated for residents with any of the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and distribute food under sanitary conditions, increasing the risk of cross-contamination and food-borne illness. These practices had the potential to affect all residents. The facility census was 62. Review of the facility's policy titled, Food Preparation and Service, revised November 2022, showed: - Only pasteurized shell eggs are cooked and served when residents request undercooked, soft-served or sunny side up eggs and preparing foods that will not be thoroughly cooked example (e.g.) hollandaise sauce, French toast, ice cream, et cetera (etc); - Unpasteurized eggs are cooked until all parts of the egg (yolk and whites) are completely firm. Review of the facility's policy titled, Food Receiving and Storage, revised November 2022, showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff treated residents with dignity and in a respectful manner by leaving one resident (Resident #55) out of nine sampled residents exposed during care. The census was 62. Review of the facility's policy titled, Dignity, dated February 2021, showed: - Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem; - Residents are treated with dignity and respect at all times; - When assisting with care, residents are supported in exercising their rights; - Staff promote, maintain and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure residents and/or responsible parties were notified in a timely manner when a resident's account was within the $200.00 Social Security (SSI) limit ($5,726.00) or when the resident's account was over the SSI limit. This affected two residents (Residents #22 and #47) reviewed who received Medicaid benefits. The census was 62. Review of the facility's policy titled, Resident's Trust Fund Management, revised, June 2022, showed: - Maintain the Trust Funds module of the American Health Tech (AHT) program to track resident trust fund; - Provide for the delivery of a quarterly accounting of the activity of transactions in the resident's account to the resident or the resident's responsible party; [...]

Inspectors wroteBased on interview and record review, the facility failed to issue a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) for one resident (Resident #22) out of three sampled residents. The facility census was 62. The facility did not provide a policy for SNF ABNs. 1. Review of Resident #22's Advanced Beneficiary Notice (ABN) form showed: - The resident discharged from skilled Medicare services on 12/13/23, and remained in the facility; - The resident received and signed the form on 01/16/24; - The facility failed to provide the correct SNF ABN form to the resident at least two calendar days before the skilled Medicare services ended. During a phone interview on 03/07/24 11:40 A.M., the Director of Nursing said the Social Services Designee (SSD) was responsible for the SNF ABNs. If the SSD was not available, they go to the Business Office Manager. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement care plans with specific interventions to meet individual needs for seven residents (Residents #13, #19, #27, #34, #41, #49, and #63) out of 16 sampled residents. The facility's census was 62. Review of the facility's policy titled, Care Plans, Comprehensive Person-Centered, revised March 2022, showed: - The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident; - The comprehensive, person-centered care plan is developed within seven days of the completion of the required Minimum Data Set (MDS) (a federally mandated assessment completed by facility staff) assessment, and no more than 21 days after admission; [...]

Inspectors wroteBased on interview and record review, the facility failed to follow oxygen orders for one resident (Resident #13) out of three sampled residents. The facility also failed to follow physician orders regarding a medication on a resident (Resident #41) that received dialysis (a process for removing waste and excess water from the blood) out of one sampled resident. The facility census was 62. Review of the facility's policy titled, Medication and Treatment Orders, revised, July 2016, showed: - Orders for medications and treatments will be consistent with principles of safe and effective order writing; - Medications shall be administered only upon the written order of a person duly licensed and authorized to prescribe such medications in this state. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff utilized safe transfer techniques for one resident (Resident #7) out of one sampled resident using a sit-to-stand lift (a mechanical lift used to help a person to transfer from a seated position to a standing position or vice versa). The facility census was 62. Review of the facility's policy titled, Sit to Stand Lift, undated, showed the policy did not address the number of staff required to perform the transfer safely. Review of the instructional sticker on the sit to stand lift showed, when possible, use two staff to perform a sit to stand safely. 1. Review of Resident #7's medical record showed: - An admission date of 09/12/22; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff maintained proper positioning and placement of the indwelling urinary catheter (a tube inserted into the urinary bladder to drain urine) tubing and drainage bags and the facility also failed to ensure documentation of the catheter changes and the catheter care were maintained for two residents (Resident #19 and #55) out of three sampled residents. The facility census was 62. Review of the facility's policy titled, Catheter Care, revised on 02/26/21, showed: - The facility will ensure any resident with a urinary catheter will be maintained to prevent infection; - Staff will make sure urine flows out of the the catheter into the drainage bag; - Staff to keep the urinary drainage bag below the level of the bladder to prevent back flow of the urine; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to obtain a physician's order for oxygen use and orders for oxygen tubing (a small, flexible tube that contains two open prongs that sit in the nostrils and attaches to an oxygen source) changes for two residents (Resident #19 and #63) out of two sampled residents. The facility census was 62. Review of the facility's policy titled, Physician Medication Orders, revised April 2010, showed: - Medications shall be administered only upon the written order of a person duly licensed and authorized to prescribe such medications in this state; - No drugs or biologicals shall be administered except upon the order of a person lawfully authorized to prescribe for and treat human illnesses; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide documentation of ongoing assessments, monitoring, and communication between the facility and the dialysis (a process for removing waste and excess water from the blood) center for one resident (Resident #41) out of two sampled residents. The facility census was 62. Review of the facility's policy titled, Dialysis Critical Element Pathway, dated, May 2017, showed: - Review of Physician's orders to include: dialysis access care; dialysis schedule; and individualized dialysis prescription such as number of treatments per week length, type of dialyzer, specific parameters of the dialysis delivery system, anticoagulation, fluid restrictions, target weight, blood pressure monitoring; - Pertinent diagnosis; - Individualized care plan; [...]

Inspectors wroteBased on interview, and record review, the facility failed to identify, assess and provide supportive interventions for one resident (Resident #21) with a diagnosis of post-traumatic stress disorder (PTSD) (a mental health condition triggered by a terrifying event - either experiencing it or witnessing it; symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event) out of two sampled residents. The facility's census was 62. Review of the facility's policy titled, Trauma-Informed and Culturally Competent Care, revised August 2022, showed: - Perform universal screening of the resident, which includes a brief, non-specialized identification of possible exposure to traumatic events; - Utilize screening tools and methods that are facility-approved, competently delivered, culturally relevant and sensitive; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure an appropriate diagnosis for the use of psychotropic (medications used to treat mental health disorders) medication and to ensure a medication regimen was free from unnecessary medications when the facility failed to implement gradual dose reductions (GDR) for one resident (Resident #27) out of one sampled resident. The facility census was 62. Review of the facility's policy titled, Residents Drug Regimen Review, undated, showed: - The consultant pharmacist shall review the drug regiment of each resident at least monthly or more often if necessary; - The consultant pharmacist will report any irregularities noted in writing to the Director of Nursing (DON), the attending physician, and the facility's medical director; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an error rate of less than five percent (%) when medications were given. There were 32 opportunities with two errors made, for an error rate of 6.25 %. This affected two residents (Residents #7 and #25) out six sampled residents with the potential to affect all residents. The facility's census was 62. Review of the facility's policy titled, Insulin Administration, revised September 2014, showed the nursing staff will have access to specific instructions (from the manufacturer if appropriate) on all forms of insulin delivery system(s) prior to their use. Review of NovoLog Flex Pen (insulin in a pen-type device) instructions, revised 06/2023, showed: - Remove the cap; - Attach the needle; - Prime the pen by turning the dose selector to select two units; - Hold the pen with the needle pointing up. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to properly monitor the refrigerator temperatures in which medications, including insulin (medication used to lower blood sugar), were stored. This had the potential to affect all residents. The facility census was 62. Review of the facility's policy titled, Medication Labeling and Storage, dated February 2023, showed: - The facility stores all mediations and biologicals in locked compartments under proper temperature, humidity and light controls. Only authorized personnel have access to keys; - The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner; - Medications requiring refrigeration are stored in a refrigerator located in the medication room at the nurses' station or other secured location. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure they developed and implemented a Quality Assurance and Performance Improvement (QAPI) plan pertaining to on-going monitoring for correction of identified systemic failures. This deficient practice had the potential to affect all residents. The facility census was 42. Review of the facility's policy titled, QAPI Program, revised 2019, showed: - The primary purpose of the QAPI Program is to establish data-driven, facility-wide processes that improve the quality of care, quality of life and clinical outcomes of the residents. To develop ongoing and comprehensive procedures that ensures the facility identified and corrects facility deficiencies, identifies opportunity for improvement, and addresses failures in systems or processes; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain adequate infection control practices to prevent the transmission of infection by ensuring a clean barrier for wound care supplies in the resident's room for four residents (Resident #8, #13, #19, and #39) out of five sampled residents. The facility failed to maintain adequate infection control practices during catheter (a tube inserted into the bladder to drain urine) care for two residents (Resident #19 and #55) out of two sampled residents. The facility also failed to maintain adequate infection control practices during incontinent care for two residents (Resident #39 and #63) out of three sampled residents. The facility census was 62. Review of the facility's policy titled, Wound Care, revised October 2010, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and distribute food under sanitary conditions, increasing the risk of cross-contamination and food-borne illness. These practices had the potential to affected all residents. The facility census was 58. Record review of the facility's Steam Table Serving Temperatures policy, dated 2011, showed: - A table of safe temperatures for hot and cold foods; - Problems with the steam table heating capability will be reported to the maintenance department immediately; - All hot foods will be kept in steam table pans and placed in steam table carts or in the oven; - Foods will not be placed in the steam table more than 30 minutes before the dining service. Record review of the facility's meal times showed: - Breakfast served at 7:00 A.M., hall trays started and served out at 7:00 A.M.: [...]

Inspectors wroteBased on observation, interview, and record review showed the facility failed to maintain an effective pest control program for five residents (Resident #18, #26, #48, #61 and #63) out of 15 sampled residents and two residents outside of the sample (Residents #33 and #41). This practice had the potential to affect all residents in the facility. The facility's census was 58. Record review of facility's Pest Control policy, revised on May 2008, showed: - The facility maintains an on-going pest control program to ensure the building will be kept free of insects and rodents; - Pest Control Services provided by Orkin Pest Control Services in Sikeston, MO; - Windows will be screened at all times; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to update and revise care plans with specific interventions tailored to meet individual needs for three residents, (Resident #1, #61, and #215) or include the resident and/or the guardian of two residents (Resident #48 and #54) out of 15 sampled residents. The facility census was 58. Record review of the facility's Record Review of the Facility's Care Planning - Interdisciplinary Team policy, dated 9/30/13, showed: - The purpose of care planning shall be to identify problem areas and their causes, and develop interventions targeted and meaningful to the resident; - The assessments of residents will be ongoing and care plans will be revised as information about the residents and their conditions change; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide consistent resident care for activities of daily living (ADL's) for two residents (Resident #19 and #215) out of 15 sampled residents. The facility census was 58. Record review of the facility's Resident Self Determination and Participation policy dated, February 2021, showed: - Each resident allowed to choose their own activities and schedule their health care and healthcare providers consistent with his/her interests, values, assessments and plans of care; - Each resident allowed to choose their own personal care needs, such as bathing methods, grooming styles, and dress. Record review of the residents' scheduled shower sheets showed: - The residents should receive two showers weekly. 1. Record review of Resident #19's admission evaluation showed: - An admission date of 4/6/22; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were transferred with safe transfer techniques for three residents (Residents #15, #61, and #215) and smoking safety interventions were followed for one resident (Resident #48) out of 15 sampled residents. The facility census was 58. Record review of the facility's Resident Handling policy, dated 2000, showed: - Mandatory gait belts for handling of all resident with the exception of bed mobility and medical contraindications. Record review of the facility's Sit to Stand Lift procedure evaluation, undated, showed: - Position the sling around the resident's back with approximately two inches above the waistline; - Position the resident's arms outside of the sling; - Fasten the safety belt around the resident's waist; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a proper diagnosis for a psychotropic medication for one resident (Resident #47) out of six sampled residents. The facility census was 58. Record review of Mosby's 2019 Nursing Drug Reference for quetiapine (an antipsychotic medication), showed: - Drug not indicated for use in elderly patients with dementia-related psychosis; - Watch for extrapyramidal (nerves associated with motor activity) effects; - May have a drug-to-drug interaction with the QT interval (a measurement used to assess some of the electrical properties of the heart) prolonging medications. Record review of the facility's Antipsychotic Medication Use policy, revised 12/16, showed: - Residents will only receive antipsychotic mediations, when necessary, to treat specific conditions when indicated and effective; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow the recipe for preparing a pureed consistency (food prepared with an applesauce consistency) meal. This affected four residents on a pureed diet. The facility census was 58. Record review of the facility's Standardized Recipes policy, dated 2020, showed: - Standardized recipes will be used for all menu items, including purred and therapeutic diets; - Each recipe will include the name of the product, number of servings or yield, ingredients, measurement and/or weight of ingredients, procedures for assembling/method of production, size of pan needed, serving sizes, modification for therapeutic diets if applicable, recipes will be scaled to the number served; - The Registered Dietitian will approve recipe changes or new recipes utilized for a menu item. [...]