Mason City Area Nursing Home

Inspectors wroteBased on observation, interview and record review, the facility failed to promote and facilitate resident self-determination through support of a resident's choice of eating some meals in bed rather than in a wheelchair, affecting one resident (R2) in a sample of five residents.

Inspectors wroteBased on observation, interview and record review the Facility failed to maintain Resident dignity and follow a personalized toileting plan of care to maintain urinary continence for a staff dependent mechanical lift for one of three Residents (R1) reviewed for toileting assistance in a sample of six. This failure resulted in R1 suffering severe mental anguish and emotional distress from being placed in incontinence briefs and not being offered toileting privileges.

Inspectors wroteBased on observation, interview and record review the Facility failed to maintain skin integrity after placing a continent Resident in incontinence briefs due to transfer status and not offering toileting services, leading to skin irritation, pain, redness and an open area on a peri area labia fold for one of three continent Residents (R1) reviewed for toileting assistance in a sample of six.

Inspectors wroteBased on observation, interview and record review the Facility failed to staff a Registered Nurse for eight consecutive hours a day and assigned the Director of Nursing as a direct Resident care floor nurse. This failure has the potential to affect all 79 Residents residing in the Facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from abuse for two (R1 and R2) of three residents reviewed for abuse in a sample of three.

Inspectors wroteBased on interview and record review, the facility failed to prevent abuse for one resident (R7) of three reviewed for abuse in a total sample of 14.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement individualized care planned interventions to prevent a resident (R1) from sustaining multiple burns, failed to identify a hot water/coffee dispenser used in the main room as a potential burn hazard, and failed to establish protocols and provide adequate monitoring to ensure hot water within a water/coffee dispenser located in the main dining room were kept below temperature levels to prevent burns. [...]

Inspectors wroteBased on interview, record review and observation, the facility failed to ensure residents were free from unnecessary physical restraints(s), failed to identify the specific medical symptoms warranting the use of physical restraints, failed to obtain physician orders with medical justification for the placement of a physical restraint(s), and failed to obtain resident or responsible party consent for the use of a physical restraint for two (R1, R2) of 12 residents reviewed for restraint usage in the sample of 12. These failures resulted in R1 and R2 being physically restrained to their wheelchair with a gait belt placed around their torso and fastened behind their back with the inability to rise from their chair and suffering psychosocial harm of humiliation and embarrassment that any reasonable person would experience being improperly restrained. [...]

Inspectors wroteBased on record review and interview the facility failed to ensure a Registered Nurse (RN) worked at least eight hours daily. This failure has the potential to affect all 56 residents residing within the facility.

Inspectors wroteBased on interview and record review the facility failed to immediately report inappropriate use of a physical restraint to the facility's Abuse Coordinator for two of 12 residents (R1, R2) reviewed for restraint usage in the sample of 12.

Inspectors wroteBased on interview and record review, the facility failed to have a Registered Nurse for eight consecutive hours in a 24-hour period on four of 30 days per the Facility's November Nursing Schedule, and on four of 31 days per the Facility's October Nursing Schedule. This has the potential to affect all 52 residents living in the facility.

Inspectors wrote3. R34's current Physician's Orders document the following medication orders: Seroquel (antipsychotic) 25 milligrams by mouth every Monday, Tuesday, Wednesday, Thursday, Friday and Saturday for Dementia with Behavioral Disturbance; Venlafaxine (antidepressant) 150 milligrams by mouth in the morning related to Depression; Xanax (benzodiazepine/anti-anxiety) 0.25 milligrams by mouth every 8 hours as needed for Anxiety (date of order 11/11/24); and Xanax 0.25 milligrams by mouth twice daily for Anxiety Disorder. R34's current care plan documents the following focuses: (R34) has diagnosis for Depression and has a potential for a decline in her mood. Mood interview conducted as needed; I (R34) use anti-anxiety medications related to Anxiety Disorder; I (R34) use antidepressant medication related to Depression. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow Enhanced Barrier Precautions while performing wound care, perineal care, and hand hygiene for one of three residents (R39) reviewed for wound care in a sample of 33.

Inspectors wroteBased on interview and record review the facility failed to ensure mail was delivered on Saturdays. This failure has the potential to affect all 57 residents who reside in the facility.

Inspectors wroteBased on interview and record review, the facility failed to provide the services of a registered nurse eight hours a day, seven days a week. This failure has the potential to affect all 57 residents residing in the facility.

Inspectors wroteBased on interview and record review, the Facility failed to ensure a resident's allegation of staff abuse was reported to the Abuse Coordinator for one (R22) of 14 Residents reviewed for Abuse in a sample of 29.

Inspectors wroteBased on interview and record review, the facility failed to provide transfer/discharge notification, to the Ombudsman, for one (R11) of one resident reviewed for transfer/discharges in a sample of 29.

Inspectors wroteBased on interview and record review, the facility failed to notify R11 or R11's representative of the facilities bed-hold in writing for one (R11) of one resident reviewed for transfer/discharges in a sample of 29.

Inspectors wroteBased on observation, interview, and record review, the facility failed to have physician's orders, for adaptive equipment, for one resident (R1) of 29 residents reviewed for physician's orders in a sample of 29.

Inspectors wroteBased on interview and record review, the facility failed to implement appropriate interventions to prevent two falls out of bed for one (R46) of six residents reviewed for falls in a sample of 29.

Inspectors wroteBased on observation, interview and record review the facility failed to provide necessary equipment or devices for pressure relief for residents at risk for developing pressure ulcers or who required extensive or total assistance from staff for positioning, placing those residents at increased risk for the development of pressure ulcers or the worsening of existing wounds which affected two of two residents (R37, R49) reviewed for pressure ulcers in a sample of 20. This failure resulted in R37 developing multiple pressure ulcers including a right buttocks stage two pressure ulcer which deteriorated to a stage 4 pressure ulcer; and R49 developing an abrasion to the right iliac crest which deteriorated to a stage 3 pressure ulcer.

Inspectors wroteBased on interview and record review the facility failed to notify the physician for one resident (R25) reviewed for physician notification out of a sample of 20.