Meadowlake Estates

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure medications were stored securely to prevent unauthorized access during 1 of 2 observations of medication storage. The DON identified 109 residents received medication from the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure residents were bathed as scheduled for 1 (#1) of 5 sampled residents reviewed for assistance with ADLs. The DON identified 114 residents who resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to: a. provide incontinent care to prevent a moisture associated pressure ulcer for 1 (#5); and b. ensure care was provided as ordered by the physician for 1 (#6) of 3 residents sampled for ADL care to prevent/worsening of pressure ulcers. The DON reported 114 residents resided in the facility. Six residents had wounds.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure: a. raw meat items were stored in a manner to prevent cross contamination; b. dented cans were removed from circulation in the dry storage; c. leftover food items were discarded within the appropriate timeframe; d. food items in the refrigerator were stored in a sealed container; e. expired food items were removed from circulation; and f. food items were appropriately dated and labeled during the kitchen observation. The DON identified 106 residents received services from the kitchen.

Inspectors wroteBased on observation, record review, and interview, the facility failed to: a. provide incontinent care in a manner which prevented cross contamination for two (#33 and #42) of four sampled residents observed during incontinent care; b. handle linens in a manner which prevented cross contamination for one (#42) of four sampled residents observed during incontinent care; c. ensure proper PPE was worn in a room with a COVID-19 positive resident for three (#46, 55 and #89) of three sampled residents observed with COVID-19; d. ensure the same PPE was not worn when assisting two different residents with COVID-19 in the same room for two (#46 and #55) of three sampled residents observed with COVID-19; and e. medications were not handled with bare hands. The DON identified 67 incontinent residents and four Covid-19 positive residents resided in the facility. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure MDS entry tracking was completed per RAI guidelines for one (#45) of 27 sampled residents who were reviewed for resident assessments. ADON #1 identified 111 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure resident assessments were accurately coded for one (#111) of 27 sampled residents reviewed for resident assessments. ADON #1 identified 111 residents resided in the facility.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide incontinent care in a manner to prevent UTI's for one (#42) of four sampled residents observed during incontinent care. The DON identified 67 incontinent residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure oxygen was administered as ordered and a concentrator had a filter and was dust free for one (#1) of one sampled resident reviewed for respiratory care. The DON identified 24 residents who received oxygen therapy in the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure a outdated medication was removed from stock for one of one medication storage observation. ADON #1 identified 111 residents resided in the facility and 111 residents were administered medications by the nursing staff.

Inspectors wroteBased on observation and interview, the facility failed to ensure the walk in freezer was in safe operating condition. The DON identified 106 residents received services from the kitchen.

Inspectors wroteOn 01/03/25, an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to follow Resident #10's minced and moist level 5 diet which resulted in the resident choking. A physician's order, dated 11/29/24, documented Resident #10 was to have a minced and moist level 5 diet. An incident report, dated 12/19/24, documented Resident #10 was eating lunch in their room when a medication aide saw that the resident was choking and alerted the nurse who performed the Heimlich maneuver. It documented the brownie was expelled. It documented the nurse practitioner was notified and a x-ray was ordered. It documented family was notified. It documented the facility investigated and determined Resident #10 was given a brownie that was not on their diet. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure a discharge summary was completed for five (#41, 44, 99, and #115) of five sampled residents reviewed for discharge summaries. The DON identified 114 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to provide enough staff on a 24-hour basis to meet the needs of the residents for one (#48) of six residents reviewed for ADL care. The DON identified 114 residents resided in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow physician orders to provide diabetic residents with an HS snack and ensure snacks were served to all residents at times in accordance with resident's needs, preferences, and requests for four (#18, 26, 32, and #38) of four sampled residents reviewed for food and nutrition services. The DON identified 34 residents diagnosed with diabetes resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure residents' call lights were in reach for five (#3, 5, 21, 50 and #64) of five sampled residents who were reviewed for call light placement. The DON identified 114 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to obtain signatures by the responsible party on admissions agreements for one (#44) of one resident reviewed for admissions. The director of nursing identified 114 residents who resided in the facility. A facility policy titled, Admissions, revised 03/13/2023, read in part, .Pre- admission: .4. the director of admissions or designee will meet with the resident or the resident's agent or guardian .and will answer all questions pertaining to admission to the community .5. An acknowledgment Form, indicating that these items have been discussed with the resident/guardian, will be signed and dated by the resident/guardian and witnessed by the community representative. A copy of this signed form will be given to the resident .

Inspectors wroteBased on observation and interview, the facility failed to post nurse staffing information, which included all the required components, in an area where it could be reviewed by all residents and visitors. The DON identified 114 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to administer medications as ordered for two (#2 and #79) of six sampled residents reviewed for medications. ADON #1 identified 105 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure resident records were accurate for two (#51 and #98) of two sampled residents for accurate records. ADON #1 identified 105 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure an appointment was scheduled for a resident to see a specialist for one (#75) of one sampled resident reviewed for choices. ADON #1 identified 105 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure neurological checks were completed after a fall with head injury for one (#35) of two sampled residents reviewed for accidents. The ADON identified 105 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure there was ongoing communication with the dialysis center and ongoing assessment of a resident after dialysis for one (#363) of one sampled resident reviewed for dialysis services. Corporate Nurse #1 identified four residents received dialysis services.

Inspectors wroteOn 09/14/23 at 10:50 a.m., the Oklahoma State Department of Health (OSDH) confirmed the existence an immediate jeopardy situation existed due to the facilities failure to have a system in place to ensure residents were not missing from the facility. On 09/08/23 the facility was notified by someone in the community that Resident #8 was outside behind the facility on the ground. During an interview with LPN #1, they stated Resident #8 had been outside 30 minutes or less. They stated Resident #8 was found with wet muddy shoes and pants. They stated the resident was able to exit through the back door that went to the smoking area due to the door being broke, and the code and alarm do not work. LPN #1 stated it appeared that the resident had exited a gate behind the facility, as it was found to be open when they went to the back where Resident #1 was located in the alley behind the facility. [...]

Inspectors wrote5. Resident #77 had diagnoses which included non-pressure chronic ulcer of other part of left lower leg with necrosis of bone, pressure ulcer of sacral region, stage 4, and unspecified atrial fibrillation. Resident #77's quarterly assessment, dated 05/27/22, documented the resident was cognitively intact and required physical assistance for the task of bathing. A Care Plan, dated 12/12/22, documented Resident #77 preferred a bed bath for bathing. A review of the bathing records for October 2022 documented the resident had one shower on 10/17/22. There was no other documentation the resident received a shower/bath any other day in the month of October. A review of the bathing records for November 2022 documented the resident received a shower/bath on 11/08/22, 11/10/22, 11/14/22, and 11/17/22. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure physician ordered appointments were scheduled for two (#47 and #72) of three sampled residents reviewed for outside appointments. The Resident Census and Conditions of Residents report, dated 12/07/22, documented 107 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure personal care was provided in a manner which prevented cross contamination for two (#1 and #301) of six sampled residents observed during incontinent care. The Resident Census and Conditions of Residents report, dated 12/07/22, documented 34 residents who were occasionally or frequently incontinent of bowel and 66 residents who were occasionally or frequently incontinent of bladder.

Inspectors wroteBased on record review and interview, the facility failed to assess a change in the resident's skin condition for one (#201) of four sampled residents reviewed for wound care. The regional nurse identified 15 residents with non-pressure ulcer wounds resided in the facility.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure incontinent care was provided in a manner which removed all stool from a resident for one (#1) of six sampled residents reviewed for ADLs. The Resident Census and Conditions of Residents report, dated 12/07/22, documented 34 residents who were occasionally or frequently incontinent of bowel.

Inspectors wroteBased on record review and interview, the facility failed to ensure timely transportation to the facility from dialysis for one (#7) of one sampled residents reviewed for dialysis. The Resident Census and Conditions of Residents report, dated 12/07/22, documented 6 residents received dialysis services outside of the building.

Inspectors wroteBased on record review and interview, the facility failed to administer medications as ordered by the physician for one (#96) of six sampled resident reviewed for medication. The Resident Census and Conditions of Residents report, dated 12/07/22, documented 107 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure meals were served in a timely manner for one of two meal services observed. The regional nurse identified 104 residents received meals from the kitchen.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure a pest free environment for two (#88 and #202) of 32 sampled residents reviewed for pest control. The Resident's Census and Conditions report, dated 12/07/22, documented 107 residents resided in the facility.