Maples Health and Rehabilitation, the

Inspectors wroteBased on observations, interviews, and record review, the facility failed to store food in accordance with professional standards of practice and protect food from possible contamination when staff did not store food properly after opening and staff did not consistently label food after opening. The facility census was 89. Review of the facility policy titled, Food Receiving and Storage, revised October 2017, showed the following: -Foods shall be received and stored in a manner that complies with safe food handling practices; -Wrappers of frozen foods must stay intact until thawing; -Other opened containers must be dated and sealed or covered during storage. Record review of the 2013 Missouri Food Code showed food shall be protected from contamination by storing the food in a clean, dry location, and where it is not exposed to splash, dust, or other contamination. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure resident weight loss was unavoidable when staff failed to notify the physician and dietician of weight loss, failed to care plan actual weight loss and new interventions, and failed to implement current care planned inventions to prevent future weight loss for one resident (Resident # 43). The facility census was 89. Review of the facility policy titled Weight Assessment and Intervention, dated September 2008, showed the following: -The nursing staff will measure resident weights on admission, the next day, and weekly for four weeks thereafter. If no weight concerns are noted at this point, weights will be measured monthly; -Any weight change of 5% or more since the last weight will be retaken the next day for conformation. If the weight is verified, nursing will immediately notify the dietician; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN - form CMS-10055) or a denial letter at the initiation, reduction, or termination of Medicare Part A benefits for one resident (Resident #18) who remained in the facility upon discharge from Medicare Part A services. The facility census was 89 at the time of survey. Review of the Centers for Medicare and Medicaid Services Survey and Certification memo (S&C -09-20), dated 01/09/09, showed the following information: -The Notice of Medicare Provider Non-Coverage (NOMNC - form CMS-10123) is issued when all covered Medicare services end for coverage reasons; [...]

Inspectors wroteBased on record review and interview, the facility failed to give written information to the resident and/or resident's representative of the facility's bed-hold policy for one resident (Resident #65) who was transferred out to the hospital. The facility census was 89. Review of the facility's policy titled Bed-Holds and Returns, undated, showed the following information: -All residents/representatives were provided written information regarding the facility and state bed-hold policies, which addressed holding or reserving a resident's bed during periods of absence (hospitalizations or therapeutic leave); -Residents, regardless of payor source, are provided written notice about these policies at least twice: in the admission packet and at the time of transfer (or, if the transfer was an emergency, within 24 hours); [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan consistent with each resident's medical needs when staff failed to care plan urinary care concerns, including urine retention and urology referral, for one resident (Resident #65). The facility census was 89. 1. Review of Resident #65's face sheet (brief resident profile sheet) showed the following information: -admission date of 02/06/25; -Diagnoses included stage 5 chronic kidney disease, end stage renal disease (a condition in which the kidneys lose the ability to remove waste and balance fluids), and dependence on renal dialysis (procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly). Review of the resident's February 2025 Physician Order Sheet (POS) showed the following information: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to have a system in place to ensure each resident's code status preference was clear and accurate when staff failed to update a do not resuscitate (DNR - an order that instructs providers not to start cardiopulmonary resuscitation (CPR - an emergency procedure that is done when a person stops breathing or heart stops) if a person stops breathing or heart stops) to a full code (every possible measure, including CPR, to save a person's life) in the resident record for one resident (Resident #10). The facility census was 89. Review of a facility policy titled 'Advance Directives, dated [DATE], showed the following: -Advance directives will be respected in accordance with state and federal law policies; [...]

Inspectors wroteBased on interview, and record review, the facility failed to provide care per standards of practice for all residents when staff failed to failed to obtain ordered labs for possible infection in a timely manner for two residents (Resident #65 and #59). The facility census was 89. Review of a facility policy titled, Lab and Diagnostic Test Results - Clinical Protocol, dated [DATE], showed the following: -The physician will identify and order diagnostic and lab testing based on the resident's diagnostic and monitoring needs; -The staff will process test requisitions and arrange for tests; -The laboratory will report test results to the facility; -When test results are reported to the facility, a nurse will first review the results; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care per standards of practice when staff obtain a physician's order for the use of and complete a care plan for the use of a CPAP (continuous positive airway pressure - a machine that uses air pressure to keep airways open while a resident sleeps) for two residents (Resident #398 and #65). The facilities census was 89. Review of the facility's policy titled, CPAP/BiPAP Support, dated March 2015, showed the following: -Purpose to provide the spontaneously breathing resident with continuous positive airway pressure with or without supplemental oxygen; to improve arterial oxygenation in residents with respiratory insufficiency, obstructive sleep apnea, or restrictive/obstructive lung disease; and to promote resident comfort and safety; [...]

Inspectors wroteBased on interview and record review, the facility failed to protect all resident from misappropriation of property, when a facility staff member (Certified Nurse Aide (CNA) A) took one resident's (Resident #1's) bank debit card without permission and made fraudulent purchases totaling over $90.00 on the resident's card. The facility census was 96. Review of the facility policy titled, Abuse, Neglect, Exploitation or Misappropriation Prevention Program, revised April 2021, showed, in part, the following: -Residents have the rights to be free from abuse, neglect, misappropriation of resident property and exploitation. -The resident abuse, neglect, and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives including protect residents from abuse, neglect, exploitation, or misappropriation from anyone; [...]

Inspectors wroteBased on interviews and record review , the facility failed to have a process in placed to ensure all residents food preferences were honored and meal alternatives were available to all residents when facility failed to ensure five residents (Resident #1, #2, #3, #4, and #5), who routinely ate in their rooms, were unable to have their preferred drink and the ability to obtain an alternative meal. The facility census was 91. Review of the facility policy titled, Food and Nutrition Services, revised October 2017, showed the following: -Each resident is provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide medication administration per professional standards when staff failed have a system in place for timely administration of medications to residents when one resident (Resident #1), out of six sampled residents, received their medications late. The facility census was 95. Review of the facility's policy titled, Adverse Consequences and Medication Errors, dated 04/2014, showed the following: -Medication error is defined as the preparation or administration of drugs or biological which is not in accordance with physician's orders, manufacturer specifications, or accepted professional standards and principles, errors include wrong time. Review of the facility's policy titled, Documentation of Medication Administration, dated 11/2022, showed the following; [...]

Inspectors wroteBased on record review, observation, and interview, the facility failed to document reason for reduction in pain medication, failed to notify the physician when pain medication did not relieve pain, and failed to stop a dressing removal after the resident verbalized severe pain and exhibited nonverbal signs of severe pain for one resident (Resident #330) out of a sample of two. The facility census was 85. Review of the facility's policy Pain - Clinical Protocol, revised March 2018, showed the following: -The physician and staff will identify the individuals who have pain or who are at risk for having pain; -The staff and physician will identify the characteristics of pain such as location, intensity, frequency, pattern and severity; -The staff will use a consistent approach and a standardized pain assessment instrument appropriate to the resident's cognitive level; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to employ a qualified dietary manager for food and nutrition services when the dietitian was not employed full-time by the facility. The facility census was 85 . Review of the facility's job description titled Director of Food Services/Dietary Manager/Supervisor, undated, showed the following: -The primary purpose of the job position is to work with the corporate dietitian in planning, organizing, developing, and directing the overall operation of the dietary department in accordance with current federal, state, and local standards, guidelines, and regulations governing the facility, and, as may be directed by the Administrator, to assure that quality nutritional services are provided on a daily basis and that the dietary department is maintained in a clean, safe, and sanitary manner; [...]

Inspectors wroteBased on interview and record review, the facility failed ensure staff checked the employee disqualification list (EDL - a list of individual unable to work in long-term care), Nurse Aide (NA) Registry was checked to ensure they did not have a Federal Indicator (a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prohibiting them to work in a certified facility, and request a Criminal Background Check (CBC) prior to contact with residents for two employees (Dietary Manager (DM) and Nursing Assistant (NA) F) out of ten sampled employee files. The facility census was 85. Review of the facility's policy titled Abuse Prevention Program, revised 12/2016, showed the following: [...]

Inspectors wroteBased on interview and record review, facility staff failed follow the facility's infection control policies and maintain infection control system to help prevent possible transmission of communicable diseases/infection when staff failed to ensure the required two step tuberculosis (TB-a communicable disease that affects the lungs characterized by fever, cough, and difficulty breathing) screening test was administered timely, per facility policy, for seven out of ten sampled staff members. The facility census was 85. Review of the facility's policy titled Employee Screening for Tuberculosis, revised 07/2010, showed the following: -All employees shall be screened for tuberculosis (TB) infection and disease, using a two-step tuberculin skin test (TST) or blood assay for Mycobacterium tuberculosis (BAMT) and symptom screening, prior to beginning employment. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician orders for wound treatment and failed to contact physician to obtain new orders using wound supplies that were available for one resident (Resident #330) out of a sample of two residents. The facility census was 85. Review of the facility's Wound Care Procedure Policy, revised October 2010, showed instructions to verify there was a physician's order for the procedure. 1. Review of the Resident #330's face sheet (resident's information at a quick glance) showed the following: -admission date of 06/19/23; -Diagnoses included general anxiety disorder (worrying constantly and cannot control the worrying), infection following a procedure, osteomyelitis of vertebra (a spine infection), and postlaminectomy syndrome (condition characterized by chronic back or neck pain following surgery). [...]

Inspectors wroteBased on record review, observation, and interview, failed to follow appropriate infection control measures when completing a wound treatment and failed to follow physician's order in the timeliness of a treatment for one resident (Resident #331), who had a pressure injury on his/her neck, in a selected sample of six residents. The facility census was 85. Review of the facility's Wound Care Procedure Policy, revised October 2010, showed the following: -Wash and dry your hands thoroughly; -Put on exam gloves. Loosen tape and remove dressing; -Pull glove over dressing and discard into appropriate receptacle. Wash and dry hands thoroughly; -Put on gloves. Use no-touch technique. Use sterile tongue blades and applicators to remove ointments and creams from their containers; -Dress wound. [NAME] tape with initials, time, and date and apply to dressing; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure staff followed physician orders regarding administration of the oxygen at the correct liters per minute (LPM - measurement of oxygen) used with supplemental oxygen for one resident (Resident #73) out of two sampled residents. The facility census was 85. Review of the facility's policy titled Oxygen Administration, revised 10/2010, showed the following: -The purpose of this procedure is to provide guidelines for safe oxygen administration; -Unless otherwise ordered, start the flow of oxygen at the rate of 2 to 3 liters per minute; -Observe the resident upon setup and periodically thereafter to be sure oxygen is being tolerated. 1. Review of Resident #73's face sheet (a document that gives a patient's information at a quick glance) showed the following: -admission date of 03/03/23; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain signed informed consent and physician orders for side rails, failed to add side rails to the resident's care plan, and failed to complete side rail assessments on a regular basis for one resident (Resident #32) out of six sampled residents. The facility census was 85. Review of the facility's policy titled Proper Use of Side Rails, revised 12/2016, showed the following: -The purposes of these guidelines are to ensure the safe use of side rails as resident mobility aids and to prohibit the use of side rails as restraints unless necessary to treat a resident's medical symptoms; -Side rails are only permissible if they are used to treat a resident's medical symptoms or to assist with mobility and transfer of residents; [...]

Inspectors wroteBased on observation and interview, the facility failed to provide the required air gap between two ice machine drains and floor drains that would prevent the backflow of wastewater. This facility practice could lead to contamination of ice and possible food-borne illness, potentially affecting all residents at the facility. The facility had a census of 78. According to the Missouri Food Code, adopted by the Missouri Department of Health and Senior Services (DHSS) June 3, 2013, in order to prevent backflow, a direct connection may not exist between the sewage system and a drain originating from equipment in which food is placed. A backflow prevention device or an air gap must be in place to prevent wastewater back-siphonage. 1. Observations on 2/11/20, at 10:25 A.M., showed one of the facility's kitchen ice machine with a drainpipe leading out of the machine. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff administered medications with an error rate of less than five percent when staff made two errors out of 25 opportunities, resulting in an error rate of eight percent affecting two residents (Resident #83 and #247). The facility census was 78. According to Medscape website (medical reference website for healthcare professionals) showed the following: -Rapid-acting insulin can cause hypoglycemia (low blood glucose). This may occur when enough calories are not consumed after taking the insulin within the time frame; -Older adults may be more sensitive to the side effects of low blood glucose from rapid-acting insulin's. Record review of the Novolog (a rapid-acting insulin) undated manufacturer's insert showed the following: -Novolog starts acting fast; [...]

Inspectors wroteBased on observation, interview and record review the facility failed to use appropriate infection control procedures to prevent the spread of bacteria or other infectious causing contaminants when staff failed to use appropriate hand hygiene during pericare and urinary catheter (a hollow, partially flexible tube maintained within the bladder for the purpose of continuous drainage of urine) care for two residents (Resident #6 and #8), and failed to prevent contamination of a nasal cannula (tubing split into two prongs placed in the nostrils used to deliver oxygen) for one resident (Resident #6) in a selected sample of 18 residents. The facility's census was 78. According to the Center for Disease Control's (CDC) Guideline for Hand Hygiene in Healthcare Settings, 2002, volume 51 showed the following: -The hands are the most common mode of transmitting pathogens (microorganisms); [...]