McLoud Nursing Center

Inspectors wroteBased on observation, record review, and interview, the facility failed to: a. ensure assistive devices were used to prevent accidents for 1 (#4) of 15 sampled residents reviewed for accidents; andb. ensure the temperatures of the hot water in residents' rooms and bathrooms were safe to prevent potential burns. The DON identified 16 residents required the assistance of a mechanical lift and 55 residents required assistance with showers.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure staff were educated on how to access care plans for 1 (CNA #1) of 5 sampled staff reviewed for competent nursing staff. The DON identified 47 staff provided direct care to the residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure RN coverage for eight consecutive hours a day, seven days a week. The administrator identified 43 residents who resided in the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure proper food service sanitation and storage requirements were followed. The DON identified 43 residents who received their meals from the kitchen.

Inspectors wroteBased on record review and interview, the facility failed to complete a SNF ABN for two (#1 and #42) of three sampled residents reviewed for beneficiary notices. The administrator reported 43 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure a new PASARR Level I screening was conducted when a new serious mental illness diagnosis was received for one (#13) and the PASARR level I included the mental health diagnoses for one (#14) of two sampled residents reviewed for PASARR assessments. The administrator identified 43 residents who resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a care plan was updated to include oxygen therapy and enhanced barrier precautions for one (#14) of eight residents reviewed for care plans. The DON identified four residents who had catheters, two residents who had wounds, and seven residents who utilized oxygen.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a portable electric space heater was not utilized in resident rooms for one (#3) of one sampled resident observed with a portable electric space heater in their room. The DON identified 43 residents who resided in the facility and two residents who utilized electric space heater in their rooms.

Inspectors wroteBased on observation, record review, and interview, the facility failed to post the required staffing information. The DON identified 43 residents who resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure medication was necessary to treat a specific condition indicated in the clinical record for one (#42) and failed to ensure a rationale was documented for declining a gradual dose reduction for one (#3) of five sampled residents reviewed for unnecessary medications. The DON identified 30 residents who received psychotropic medication.

Inspectors wroteBased on record review and interview, the facility failed to guarantee the person designated to serve as the DM met the State requirement for DM. The administrator identified all 43 residents received their meals from the kitchen.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure: a. nebulizer masks were stored in a manner to prevent cross contamination for two (#12 and #32) of two sampled residents observed for infection control with breathing treatments; b. staff wore appropriate PPE and performed hand hygiene during wound care for one (#14) of two sampled residents who were observed during wound care. c. staff wore appropriate PPE during provision of care for two , (#17, and #38) of three sampled residents reviewed for enhanced barrier precautions; and d. IV tubing was changed per facility policy for intermittent use for one(#17) of one sampled resident who was reviewed for IV therapy. The DON identified seven residents who were placed on enhanced barrier precautions, five residents who received nebulizer treatments, and one resident who received IV medication.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the hot water was at a comfortable temperature for one (#12) of one sampled resident who was observed for hot water temperatures. The administrator identified 43 residents who resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure professional accepted standards of quality were met related to a mental health diagnoses given to one (#42) of five sampled residents reviewed for unnecessary medication and diagnoses. The administrator identified 43 residents who resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to complete a discharge summary with a recapitulation of stay for one (#47) of one sampled resident reviewed. The administrator identified 49 residents who had been discharged in the last six months.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure an indwelling urinary catheter was anchored to prevent dislodgement and injury for one (#14) of three sampled residents who had a urinary catheter. The administrator identified four residents who had urinary catheters.

Inspectors wroteBased on record review and interview, the facility failed to ensure a medication had a diagnosis for use for one (#3) of five sampled residents reviewed for unnecessary medications. The DON identified 43 residents who resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to convey remaining funds to the legal representatives of deceased residents within 30 days for two (#1 and #2) three sampled residents reviewed for finances. The assistant administrator identified 10 residents who had discharged from the facility with funds remaining. Finds: A policy titled Conveyance of Resident Funds documented .The resident's personal funds and a final accounting of funds are returned to the resident, the resident's representative or to the resident's estate (individual or probate jurisdiction per state law), as applicable, within thirty (30) days from the date of the resident's discharge or eviction from the facility, or death . 1) Res #1 was admitted to facility on [DATE] and discharged on [DATE]. A form documented invoice search with a check request date identified as [DATE]. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure mechanical lifts were completed with two staff members for two (#25 and #26) of two sampled residents reviewed for accidents. The Resident Census and Conditions of Residents report, dated 05/04/23, documented 38 residents resided in facility. The DON identified 16 residents used a mechanical lift for transfers.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure sufficient staff to complete mechanical lift transfers for two (#25 and #26) of two residents reviewed for staffing. The Resident Census and Conditions of Residents report, dated 05/04/23, documented 38 residents resided in facility. The DON identified 16 residents used mechanical lifts for transfers.

Inspectors wroteBased on observation and interview, the facility failed to ensure survey results were readily accessible/available to residents and visitors. The Resident Census and Conditions of Residents report, dated 05/04/23, documented 38 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure insulin was administered as ordered for one (#6) of six sampled residents reviewed for medication administration. The DON identified six residents received insulin.

Inspectors wroteBased on observation, record reviews, and staff interviews, it was determined the facility failed to ensure physician's orders had been obtained and/or implemented for a stage three pressure ulcer for one (#45) of two sampled residents reviewed who had pressure ulcers. The Resident Census and Conditions of Residents, form, dated 02/19/20, identified two residents who had pressure ulcers.

Inspectors wroteBased on observations, record reviews and interviews, it was determined the facility failed to maintain safe water temperatures in residents' rooms for 13 (#13, 17, 20, 24, 27, 30, 33, 44, 50, 55, 56, 110, and #111) of 14 residents whose rooms were observed for safe water temperatures. The DON (director of nurses) identified 30 residents who were able to utilize the sinks in their rooms.

Inspectors wroteBased on record reviews and interviews, it was determined the facility failed to ensure: a. reference checks were conducted for potential employees for five (CNA [certified nurse aide] #1, 2, and #4 and LPN [licensed practical nurse] #2) of five employee files reviewed; b. allegations of resident to resident abuse were reported and reported timely to the OSDH (Oklahoma State Department of Health) for one (#21) of one sampled resident reviewed with an allegation of abuse; c. allegations of resident to resident abuse were investigated and thoroughly investigated and documentation of a thorough investigation was maintained for one (#21) of one sampled resident reviewed with an allegation of abuse; and d. residents were protected from further potential abuse by one (#21) of one sampled resident reviewed with an allegation of resident to resident abuse. [...]

Inspectors wroteBased on record reviews and interviews, it was determined the facility failed to ensure allegations of resident to resident abuse were reported and reported timely to the OSDH (Oklahoma State Department of Health) for one (#21) of one sampled resident reviewed with an allegation of resident to resident abuse. The DON (director of nurses) identified one resident who had behaviors directed toward others. The Resident Census and Conditions of Residents, form, dated 02/19/20, identified 60 residents who resided in the facility.

Inspectors wroteBased on record reviews and interviews, it was determined the facility failed to ensure: a. allegations of resident to resident abuse were investigated and thoroughly investigated and documentation of a thorough investigation was maintained for one (#21) of one sampled resident reviewed with an allegation of resident to resident abuse; and b. residents were protected from further potential abuse by one (#21) of one sampled resident reviewed with an allegation of resident to resident abuse. The DON (director of nurses) identified one resident who had behaviors towards other residents. The Resident Census and Conditions of Residents, form, dated 02/19/20, identified 60 residents who resided in the facility.

Inspectors wroteBased on observation, record reviews, and interviews, it was determined the facility failed to ensure proper hand hygiene was conducted during the provision of wound care for one (#59) of two sampled residents observed during the provision of wound care. The DON (director of nurses) identified two residents with physician's orders for pressure ulcer wound care treatments.