McKnight Place Extended Care

Inspectors wroteBased on interview and record review, the facility failed to establish a system of records for all controlled drugs with sufficient detail to enable an accurate reconciliation, for two out of two medication carts reviewed. This had the potential to affect all residents with controlled substance orders. The census was 58. Review of the facility's Counting Narcotics policy, updated 8/5/11, showed: -At the change of shift, an off-going nurse or Certified Medication Technician (CMT) and an oncoming Nurse or CMT must count all narcotics, routine and as needed (PRN); -The Nurses or CMTs counting must also verify that the count is correct and that the number of items (cards and bottles) is correct, on both green sheet and the count sheet; -Any Nurse or CMT who had access to the medication cart being counted must also stay until the count is completed. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to have a system in place to ensure drugs and biologicals in the medication room refrigerator were stored at a proper temperature for one of one medication room observed. The census was 58. Review of the facility's Storage of Medications, revised April, 2007, showed: -The facility shall store all drugs and biologicals in a safe, secure, and orderly manner; -The nursing staff shall be responsible for maintain medication storage and preparation areas in a clean, safe and sanitary manner; -Medications requiring refrigeration must be stored in a refrigerator located in the drug room at the nurses' station or other secured location; -Medications must be stored separately from food and must be labeled accordingly. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure floors and the ice cream freezer in the kitchen were clean. In addition, the facility failed to ensure proper hair restraints were worn. The census was 58. Review of the facility's food service hygiene policy, dated 4/2024, showed: -Policy: employees must meet acceptable standards of personal hygiene and appearance. -Facial hair, including overgrown sideburns, mustaches and beards is to be clean and required to be completely covered wearing protective cover gear. 1. Observation on 4/7/25, of the kitchen, showed: -At 9:17 A.M., the dry storage room had trash and food debris on the ground in various areas and a white powder spill on the floor in front of the bulk bin rack; -At 9:19 A.M., the ice cream storage cooler had ice cream smears and build up on the doors and sides; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow acceptable nursing practice when staff left medication in one resident's room who did not have a physician order for self-administration or for medications to be left at the bedside (Resident #15). The sample was 15. The census was 58. Review of the facility's Self-Administration of Medications policy, revised, December, 2016, showed: -The residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so; -As part of their overall evaluation, the staff and practitioner will assess each resident's mental and physical abilities to determine whether self-administering medications is clinically appropriate for the resident; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure activities of daily living (ADL) were provided to three of 15 sampled residents. The facility failed to ensure one resident was toileted in a timely manner (Resident #10), failed to ensure two residents received nail care (Resident #15 and Resident #42), and failed to ensure one resident received routine showers (Resident #42). The census was 58. Review of the facility's ADL policy, dated 3/2018, showed: -Policy statement: residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out ADLs. Residents who are unable to carry out ADLs independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene; -Policy implementation: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident had physician's orders for a wound dressing (Resident #42) and failed to ensure skin assessments detailed all skin concerns (Residents #42 and #15). The sample was 15. The census was 58. Review of the facility's skin assessment protocol, dated 12/3/20, showed: -A skin assessment is to be completed weekly on all residents by the charge nurse. If a new pressure ulcer develops, the initial wound assessment must be done by the charge nurse. Prior to any other assessments, consultations or obtaining orders from the physician or nurse practitioner wound consultant, the charge nurse must document the following in the resident's electronic medical record (EMR): location of pressure ulcer, stage, length, width and depth, pain, and mobility status; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident with a pressure wound (skin or soft tissue injury that develops with prolonged periods of pressure over specific areas of the body) had necessary treatments and services to promote healing (Resident #10). The sample size was 15. The census was 58. Review of the facility's Pressure Ulcer and Skin Breakdown policy, revised 3/26/14, showed: -The nursing staff and or Wound Nurse Practitioner will assess and document an individual's significant risk factor for developing pressure sores; -The wound nurse shall describe and document and report the following: -Full assessment of pressure sore including, location, stage, length, width, depth and presence of drainage or necrotic (dead) tissue; -Pain assessment; -The resident's mobility status; -Current treatments, including support surfaces; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident received adequate assistance to prevent accidents when staff transferred one resident improperly (Resident #10). The sample size was 15. The census was 58. Review of the facility's Safe Lifting and Movement of Residents policy, revised July 2017, showed: -In order to protect the safety and well-being of staff and residents, and to promote quality of care, this facility uses appropriated techniques and devices to lift and move residents; -Resident safety, dignity, comfort and medical condition will be incorporated into goals and decisions regarding the safe lifting and moving of the residents; -Manual lifting of residents shall be eliminated when feasible; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure respiratory services provided were consistent with professional standards of practice for one resident (Resident #15). The sample size was 15. The census was 58. Review of the facility's Oxygen Administration policy, revised October, 2010, showed: -The purpose of this procedure is to provide guidelines for safe oxygen administration; -Verify that there is a physician's order for this procedure; -Review the resident's care plan to assess for any special needs of the resident; -Assemble the equipment and supplies as needed. Review of the facility's Continuous Positive Airway Pressure Support (CPAP, a machine that assists with breathing when breathing slows down or stops during sleep) policy, dated March, 2015, showed: -Purpose: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident had physician's orders for dialysis (a procedure that cleanses the blood of its impurities) care and dialysis communication logs (Resident #10) and failed to ensure one resident had dialysis communication logs completed for all appointments (Resident #45). The sample was 15. The census was 58. Review of the facility's dialysis procedure, undated, showed: -The following must be done for residents each day they do out for dialysis: fill out page one of the communication form. Send page one and two of the communication form with the resident for the dialysis unit to complete and return with the resident; -If we do not receive page two of the form back when the resident returns, contact the dialysis unit and have them fax it to us. 1. [...]

Inspectors wroteBased on observation and interview, the facility failed to provide accessible information on the location of the State Long-Term Care Ombudsman program or the State Survey Agency hotline number that was readily available to residents in the facility without assistance. The census was 58. Observation throughout the survey on 4/7/25 through 4/9/25, showed the information regarding the State Agency hotline number and Ombudsman program was not visible throughout the facility. During a group interview on 4/8/25 at 11:00 A.M., five residents, who the facility identified as alert and oriented, attended the group meeting. All residents said they did not know where the State Agency hotline number or the Ombudsman information was posted. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff provided care to one resident, (Resident #1) in a manner which maintained his/her dignity when Licensed Practical Nurse (LPN) A berated the resident for pressing his/her call light several times, removing his/her brief, and asking for a soda. Additionally, LPN A, Certified Nurse Assistant (CNA) B and CNA C, yelled at the resident after he/she had an unwitnessed fall. The census was 54. Review of the facility policy titled, Quality of Life Dignity Policy, revised August 2009, showed: -Each resident shall be cared for in a manner which promotes and enhances quality of life, dignity, respect, and individuality; -Residents shall be treated with dignity and respect at all times; -Treated with dignity means the resident will be assisted in maintaining and enhancing his/her self-esteem and self-worth; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to assess a resident, (Resident #1) and properly transfer the resident from the floor to the bed, after an unwitnessed fall. The census was 54. Review of the facility's Answering the Call Light Policy, revised October 2010, showed: -Turn off the signal light; -Identify yourself and call the resident by his/her name; -Listen to the resident's request; -Do what the resident asks of you, if permitted. If you are uncertain as to whether a request can be fulfilled or if you cannot fulfill the resident's request, ask the nurse supervisor for assistance; -If assistance is needed when you enter the room, summon help by using the call signal. Review of the facility's Fall Protocol Policy, revised September 2012, showed: -The nurse shall assess and document/report the following: -Vital signs; [...]

Inspectors wroteBased on record review, interviews, and facility policy review, the facility failed to ensure a quarterly Minimum Data Set (MDS) assessment was completed at least every three months for 3 of 3 residents (Residents #27, #46, and #58) reviewed for timely completion of MDS assessments.

Inspectors wroteBased on record review, interviews, and facility policy review, the facility failed to ensure the comprehensive care plan addressed the care and monitoring required related to the use of Ativan (an antianxiety medication) and apixaban (a blood thinner) for 1 (Resident #43) of 5 residents sampled for medication review.

Inspectors wroteBased on record review, interviews, and facility policy review, the facility failed to ensure antipsychotic medication prescribed on an as-needed (PRN) basis was limited to a 14-day duration in the absence of a physician's documented evaluation to support the continued use of the medication for 1 (Resident #44) of 5 residents reviewed for unnecessary medication.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, the facility failed to ensure staff followed infection control standards for hand hygiene for during catheter care to prevent potential infection for 1 (Resident #46) of 1 resident reviewed for catheter care.

Inspectors wroteBased on record review, interviews, and facility document and policy review, the facility failed to ensure 1 (Resident #46) of 5 sampled residents reviewed for immunizations was offered a pneumococcal vaccination.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure care plans were updated to reflect the residents' current needs by not including falls, the use and monitoring of anticoagulants, a cardiac pacemaker, a chest drain, compression stockings, oxygen therapy, orthotic devices, nutritional needs and long term care status for five of 14 sampled residents (Residents #33, #7, #49, #31 and #39). The census was 56. 1. Review of Resident #33's significant change Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 12/16/19, showed the following: -Moderately impaired cognitive skills; -Limited assistance of staff for most activities of daily living (ADL's); -One fall with major injury; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all physician orders were followed by not applying positioning devices and providing nutritional supplements as ordered for one resident (Resident #39), not applying TED hose (thromboembolic disease, elastic hose that compress the superficial veins in the lower limbs) as ordered for one resident (Resident #31) and not applying lymphadema (swelling) wraps to one resident's lower legs as ordered (Resident #44). The sample size was 14. The census was 56. 1. Review of Resident #39's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 1/10/20, showed the following: -Diagnoses included hypotension (low blood pressure), arthritis, Alzheimer's disease, dementia and and anxiety; -Required extensive care from staff for activities of daily living. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow the manufacturer's recommendations during three of four resident transfers with a Hoyer lift (mechanical lift used to transfer a resident from one surface to another) observed (Residents #55, #14 and #15). The sample size was 14. The census was 56. Review of the facility's Lifting Machine, Using a Mechanical Lift Policy, dated 2001 and last revised July 2017, showed the following: -Purpose: The purpose of this procedure is to establish the general principles of safe lifting using a mechanical lifting device. It is not a substitute for manufacturer's training or instruction; -Steps in the Procedure: -1. Before using a lifting device, assess the resident's condition including physical/cognitive and emotional; -2. Measure the resident for proper sling size and purpose, according to manufacturer's instructions; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff followed the facility policy and acceptable professional standards for labeling and discarding insulin vials and pens. Two of two medication rooms were observed. The facility census was 56. Review of the facility policy for insulin administration, revised September 2014, showed: -Check expiration if drawing from an unopened multi-dose vial. If opening a new vial, record expiration date and time on the vial (follow manufacturer recommendations for expiration after opening). Review of the manufacturer's insulin recommendations, showed: -Humulin insulin (short-acting insulin) vials expire 28 days after opening. Observation of the Fountain View medication room on 3/5/20 at 10:39 A.M., showed: -One Humulin insulin vial, dated as opened 1/21/20; [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure staff prepared and served food under sanitary conditions, by not changing gloves and washing hands, touching the surface of plates and utensils with soiled gloved and bare hands, and touching food items with soiled gloved hands. These deficient practices had the potential to affect all residents who ate at the facility. The census was 56. Observation of the kitchen, on 3/5/20 at 6:45 A.M., showed the following: -Dietary Aide (DA) J did not wear gloves and stood at the counter and wiped utensils with a dry cloth before wrapping them in a cloth napkin. DA J's bare hands touched the surfaces of the eating utensils; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to follow their policy and acceptable infection control practices to prevent the spread of infection by not practicing appropriate hand hygiene during resident contact for four residents (Residents #259, #15, #49 and #31) and failed to keep the supra pubic catheter (SP cath- small rubber tube inserted through the abdomen in to the bladder to drain urine) and indwelling urinary catheter (small rubber tube inserted in to the bladder to drain urine) tubing and drainage bag off of the floor for two residents (Residents #33 and #5). The sample size was 14. The census was 56. Review of the facility's Infection Control Guidelines for All Nursing Procedures Policy, dated 2005 and last revised April 2013, showed the following: -Purpose: To provide guidelines for general infection control while caring for residents: [...]

Inspectors wroteBased on interview and record review, the facility failed to collaborate with hospice in the development of a coordinated plan of care for residents receiving hospice care. The facility identified six residents on hospice care and three of those residents were selected for the sample of 14. Problems were found with two of them (Residents #16 and #36). The census was 56. 1. Review of Resident #16's admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 11/25/19, showed the following: -No cognitive impairment; -Did not have a condition or chronic disease that might result in a life expectancy of less than 6 months; -Section O, special treatments and programs, hospice care not indicated; -Diagnoses included heart failure, high blood pressure and thyroid disorder. [...]