Medicalodges Kinsley

Inspectors wroteThe facility reported a census of 24 residents, with four residents reviewed for abuse. Based on observation, interview, and record review, the facility failed to ensure Resident (R) 1 remained free from verbal abuse and mistreatment. This deficient practice placed the resident at risk for fear and decreased quality of life.

Inspectors wroteThe facility reported a census of 24 residents, with four residents reviewed for abuse. Based on observation, interview and record review, the facility failed to report an allegation of abuse for one resident, Resident (R) 1 when on 06/08/24 at approximately 01:30 AM, Certified Nurse Aide (CNA) M verbally threatened R1 with physical violence was witnessed by CNA O, however the incident was not reported to Administrative Nurse D until 06/11/25 at approximately 02:00 PM. This deficient practice allowed CNA M to work an additional three shifts, which had the potential to have a negative psychosocial impact for the residents in the facility.

Inspectors wroteThe facility reported a census of 22 residents with 10 residents sampled and one resident reviewed for pain management and two additional residents reviewed for unnecessary medication use. Based on observation, interview, and record review the facility failed to assess pain and failed to take appropriate action to manage severe pain despite repeated complaints from Resident (R)74. Additionally, the facility lacked effective communication between nurses, doctors, and other healthcare providers regarding R74's pain management. This failure led to R74 reporting waves of severe pain over approximately a month, until her death on [DATE], and placed R74 in immediate jeopardy. Findings Included: [...]

Inspectors wroteThe facility reported a census of 22 resident. Based on interview and record review the facility failed to submit complete and accurate staffing information to the federal regulatory agency through Payroll Based Journaling (PBJ) when the facility failed to submit staffing hour data for all nursing personnel by the required deadline.

Inspectors wroteThe facility reported a census of 22 residents. The sample included 10 residents. Based on interview and record review, the facility failed to issue accurate and complete Beneficiary Protection Notification forms to Resident (R) 16.

Inspectors wroteThe facility reported a census of 22 residents with 10 residents sampled. Based on observation, interview, and record review the facility failed to identify a significant change and complete an assessment for two residents reviewed for significant change assessments. Resident (R) 19 had a decline with ambulation, toileting hygiene, transfers, bed mobility and dressing. R11 had a decline with ambulation, transfers, toileting hygiene, and bed mobility. This deficient practice had the potential to lead to uncommunicated needs, which could lead to negative impacts on the resident's physical, mental and psychosocial well-being.

Inspectors wroteThe facility reported a census of 22 residents with 10 residents sampled. Based on observation, interview, and record review the facility failed to complete a weekly skin assessment for one resident. Observation during the survey revealed Resident (19) with a dressing on his right elbow and no skin notes, or progress notes in the Electronic Health Record (EHR) regarding the right elbow dressing. This deficient practice had the potential to lead to uncommunicated needs, which could lead to negative impacts on the resident's physical, mental and psychosocial well-being.

Inspectors wroteThe facility reported a census of 22 residents with 10 included in the sample and five residents reviewed for unnecessary medication use. Based on observation, interview and record review the facility failed to ensure the consultant pharmacist identified Residents (R) 16 lacked administration for heart medication.

Inspectors wroteThe facility reported a census of 22 residents. Based on observation, interview, and record review, the facility failed to store, prepare, and serve food in a sanitary manner to prevent possible food-borne illness to the residents of the facility.

Inspectors wroteThe facility reported a census of 20 residents. Based on interview and record review, the facility failed to use the services of a registered nurse for at least 8 hours a day, seven days a week, as required, for five days of the six months reviewed. This had the potential to affect all residents.

Inspectors wroteThe facility reported a census of 20 residents with 12 included in the sample. that included one resident reviewed for respiratory care. Based on observation, interview, and record review, the facility failed to ensure necessary respiratory care and services on the one Resident (R)10 reviewed, who required inhalation respiratory treatments, to prevent possible respiratory illness.

Inspectors wroteThe facility reported a census of 21 residents. The facility had one main kitchen where food was stored and prepared for one dining room. Based on observation, interview, and record review the facility failed to ensure dietary staff who worked in the kitchen wore a hairnet. The facility also failed to properly store food items in a refrigerator and freezers by the failure to ensure all food items were dated after being opened. These failures had the ability to affect all residents in the facility.

Inspectors wroteThe facility census totaled 21 residents. Based on interview and record review, the facility failed to ensure that all facility staff were trained in Abuse, Neglect, and Exploitation (ANE) annually.