Medicalodges Nevada

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food served was appetizing when staff served pasta salad and mixed vegetables as a cold food that was not within normal temperature limits. The facility census was 39. Review of the facility policy titled Serving Temperature for Hot and Cold Foods, dated 2016, showed the following:-Staff will follow the guidelines below when serving hot and cold beverages and food;-Foods will be served at the following temperatures to ensure a safe and appetizing dining experience. The minimum serving temperatures do not reflect the required temperatures needed for preparation, cooking, or cooling of foods;-Fruits, desserts, and salads will be 41 degrees Fahrenheit (F) or below;-The cook will take temperatures of hot and cold food items during approved food thermometers prior to each meal service. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards when staff failed to perform proper hand hygiene during food prep and service and when staff failed to ensure nonfood contact surfaces were clean. The facility census was 39. 1. Review of the facility's policy titled, Hazard Analysis Critical Control Point (HACCP) and Foodborne Illness, dated 2016, showed the following: -Community staff will be well trained in state and federal food sanitation and preparation procedures. Dining services manager will implement a safety system, such as HACCP, to prevent contamination of food and the spread of foodborne illness; -Community staff will know and understand the definition of a foodborne illness, potential hazards, common factors, high-risk populations, and potentially hazardous food; [...]

Inspectors wroteBased on interview and record review, the facility failed to implement a completed abuse/neglect policy and procedure that ensured complete screenings and back ground checks were completed for all new staff members when the facility failed to complete a Nurse Aide (NA) Registry Check (a listing of individuals who have had abuse/neglect findings making them ineligible to work in long term care) for three staff members (Minimum Data Set (MDS) Coordinator, Director of Nursing (DON), and Licensed Practical Nurse (LPN) H). The facility census was 39. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate of below 5% when a nurse failed to prime insulin pens prior to administration to three residents (Resident #10, #14, and #17) resulting in an error rate of 11% (three errors out of 27 opportunities). The facility census was 39. Review of the facility's pharmacy form titled, Insulin Drug Chart, updated February 2025, showed:-NovoLog FlexPen(insulin aspart). Pen priming requirements of two units;-Humalog KwikPen (lispro insulin). Pen priming requirements of two units. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent significant medication errors, when a nurse did not prime insulin pens prior to administration to three residents (Resident #10, #14, and #17). The facility census was 39. Review of the facility's pharmacy form titled, Insulin Drug Chart, updated February 2025, showed:-NovoLog FlexPen(insulin aspart). Pen priming requirements of two units;-Humalog KwikPen (lispro insulin). Pen priming requirements of two units. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to protect the self-determination rights of all residents when staff failed to honor the resident's request for food outside of the scheduled mealtimes for one resident (Resident #6). The facility census was 39. Review of the facility policy titled, Your Rights and Protections as a Nursing Home Resident, undated, showed the following: -As a nursing home resident, you have certain rights and protections under federal and state law that help ensure you get the care and services you need. You have the right to be informed, make you own decisions, and have your personal information kept private; -At a minimum, federal law specifies that nursing homes must protect and promote the following rights of each resident; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care per standards of practice when staff failed to update the care plan with all identified skin areas, failed to obtain physician orders time for all identified skin areas, and failed to document completion of, or reason for not completing, wound treatments for one resident (Resident #9) out of a sample of four residents. The facility census was 39. Review of the facility's policy titled Wound Prevention and Management, revised December 2018, showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and maintain an infection and prevention and control program when the facility failed to care plan the use of and follow enhanced barrier precautions (EBP- infection control intervention designed to reduce transmission of multidrug- resistant organisms (MDROs) in nursing homes. EBP to include gown and gloves during high-contact resident care activities) during wound care for two residents (Resident #2 and Resident #27). The facility census was 39. Review of the facility policy titled Infection Control Surveillance, dated November 2025, showed the following information: -Staff is to be educated on hand hygiene and other infection control prevention practices upon hire and thereafter routinely; [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide each resident with a diet that met each resident's special dietary needs when staff served a regular texture meal to the one resident (Resident #1) who had a physician's order for a mechanically altered diet resulting in the resident choking. The facility had a census of 35. On 06/18/25, the Administer was notified of the non-compliance. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement and maintain an effective infection control and prevention program when staff failed to follow the facility's infection control policies and guidance by the Centers for Disease Control (CDC) when staff failed to wear N95 masks (a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles) appropriately after two staff tested positive, with possible contact with other staff, for Covid-19. The facility census was 37. Review of the CDC's Infection Control Guidance: SARS-CoV-2 (Covid-19), updated 06/24/24, showed the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all allegations of abuse and neglect were reported immediately to facility management and to the State Survey Agency (Department of Health and Senior Services - DHSS) within the required two-hour time frame when staff failed to immediately report an allegation of employee to resident abuse of involving three residents (Resident #1, #2 and #3). The facility census was 31. The Administrator was notified on the morning of 12/17/24 of the Past Non-Compliance which occurred on 12/15/24 between 3:00 A.M. and 5:00 A.M. The accused certified nurse aide was suspended on 12/17/24. Staff assessed both residents for injuries and none were found. On 12/17/24, in-service of all staff was started. Staff began the full investigation on 12/17/24 and completed interviews on 12/17/24. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to employ a qualified dietary manager for food and nutrition services with accredited education in food service management. The facility census was 45. Review showed the facility did not provide written policy regarding the certification requirements of the dietary manager. 1. Review of the facility's new hire list, generated on 06/10/24, showed the Dietary Manager (DM) was hired on 02/09/23. Review showed the facility did not provide documentation of the DM's training, experience, or qualifications that met the required certification requirements for the DM position. During an interview on 06/12/24, at 12:05 P.M., the DM said he/she had six years of experience in cooking and ten years experience as a food industry manager. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a complete infection prevention and control program when the facility failed to implement the policy regarding enhanced barrier precautions (EBP-precautions for use during high-contact resident care activities for residents infected with a multidrug-resistant organism (MDRO-microorganisms that are resistant to one or more classes of antimicrobial agents) or any resident who has a chronic wound and/or indwelling medical device) and failed to train staff on EBP. Staff failed to practice proper hand hygiene to prevent possible infection when completing wound care for two residents (Resident #30 and #40). The facility census was 45. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to designate one or more individuals with specialized training in infection prevention and control (IPC) as the infection preventionist (IP) for the facility's infection prevention control program. The census was 45. Review showed the facility did not provide a policy related to the position of infection preventionist and required certification. 1. During an interview on 06/10/24, at 10:55 A.M., the Administrator said the interim Director of Nursing (DON), in the position for about two months, was currently enrolled in the State's online IPC program, but had not completed the certification. The Administrator said the facility was offering the other staff nurses the chance to enroll and become certified, but none had completed the course as yet. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff treated all residents with dignity and respect when the staff failed to provide a dignity bag for a catheter (a sterile tube inserted into the bladder to drain urine) bag for three residents (Resident #40, #10, and #16), failed to knock before entering the room of one resident (Resident #41), and when staff stood over three residents (Resident #33, #23, and #24) when assisting the residents with a meal. The facility census was 45. Review of the facility's policy titled State and Federal Regulation, dated 10/2019, showed the following information: -A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an qualified individual was designated as the activities program director. The facility census was 45. Review showed the facility did not provide a policy pertaining to the activity program or requirements of the program director. 1. Review of the facility's current staff listing, provided on 06/10/24, showed no individual listed as an activities program director. Review of the facility's staffing schedules for the months of May 2024 and June 2024 showed no individual scheduled to lead activities. Observation on 06/10/24, at 3:10 P.M., showed six to eight residents in the dining room area playing Bingo. A resident was calling the numbers. No staff was present. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide care per standard of practice when the facility failed to complete ordered labs/x-rays for two residents (Resident #26 and #29) resulting in a possible delay in care and when staff failed to provide restorative therapy for one resident (Resident #33). The facility census was 45. Review showed the facility did not provide a policy or procedure related to following physician orders for laboratory or diagnostic imaging. 1. Review of Resident #26's face sheet showed the following information: -admission date of 10/04/22; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper assessment and documentation was completed before side rail use when staff used side rails for two residents (Resident #39 and #40) who has been assessed as not appropriate for side rail use and when staff failed to document risk versus benefit review, failed to obtain informed consent for use, failed to care plan side use, failed to obtain physician orders for the use of side rails, and failed to complete measurements to reduce risk of entrapment for two residents (Resident #10 and #29). The facility census was 45. Review showed the facility did not have a policy regarding side rail/grab bar use that were not restraints. 1. Review of Resident #39's face sheet (resident's information at first glance) showed the following information: -admission date of 09/29/23; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure three nurse aides (NA) (NA A, NA H, NA J) of six sampled NAs, completed a certified nurse aide (CNA) training program within four months of employment in the facility. The facility census was 45. Review showed the facility did not provide a policy regarding nurse aide certification or training. 1. Review of NA H personnel file showed the following: -Date of hire on 09/07/23; -No documentation NA H had completed the nurse aide training program. During an interview on 06/13/24, at 9:50 A.M., NA H said that he/she was hired in September 2023. He/she was unsure when he/she had started the CNA classes online. He/she said that he/she had almost completed the online classes. 2. Review of NA J personnel file showed the following: -Date of hire on 09/11/23; -No documentation NA J had completed the nurse aide training program. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure suitable, nourishing snack alternatives were available and provided to residents outside of schedule mean services for diabetic residents. The facility census was 45. 1. Review of facility records showed there were 13 diabetic resident at the facility. Observation on 06/17/24, at 8:20 P.M., showed a tray on a shelf in the nurses' station containing multiple pre-packaged cookies and other sweet or salty snacks and a coffee carafe with assorted creamers/sugars. During the observation, Licensed Practical Nurse (LPN) L said the dietary staff usually put a few sandwiches on the tray when they bring it to the station at 7:00 P.M. nightly, but the sandwiches always went fast and none were left at that time. None of the present snacks were considered protein by the nurse. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a properly working and monitored call light system was in place when staff failed to fix one resident's (Resident #41) nonfunctional call light, failed to answer one resident's (Resident #200) call light before it automatically reset, and failed to ensure the call lights alerted to a central location and all care staff have access to pagers that alerted to call lights. The facility census was 45. Review showed the facility did not provide have a written policy regarding the call system. 1. Review of Resident #41's face sheet (first glance at resident's information) showed the following information: -admission date of 02/21/24; [...]

Inspectors wroteBased on interview and record review, the facility failed follow their abuse prevention policy when staff failed to request a criminal background check (CBC) and complete a Nurse Aide (NA) Registry check to ensure staff did not have a Federal Indicator (a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prohibiting them to work in a certified facility prior to one staff member's (Housekeeping S) contact with residents. A sample of 10 employees was reviewed in a facility with a census of 45. Review of the facility's policy entitled Abuse, Neglect and Exploitation, undated, showed the following: -All new employees will be investigated prior to employment for a previous history of abuse, neglect, or exploitation; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete the required Preadmission Screening and Resident Review (PASARR - a two level tool used to screen each resident in a nursing facility for a mental disorder or intellectual disability prior to admission) prior to or upon admission to the facility and after changes in condition for one resident (Resident #8), out of five sampled residents, to ensure the resident received appropriate care and services. The facility census was 45. Review showed the facility did not provide a policy or procedure addressing completion of PASARR forms. 1. Review of Resident #8's face sheet (brief information sheet about the resident) showed the following information: -admission date of 09/30/14; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide care to all pressure ulcers per standards of practice when the facility failed to have a system in place to ensure timely implementation of new wound care orders, to ensure timely physician notification of wounds, and to document and track wound timely and completely for one resident (Resident #40). A sample of 15 residents was reviewed in the facility with a census of 45. Review of the facility's policy titled, Wound Prevention and Management, revised 12/2018, showed the following information: -All residents will be assessed in the first four hours of admission using the Braden Scale (a standardized tool used in health care to assess a patients risk of developing pressure ulcers or pressure injuries) to determine the risk for skin breakdown. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an environment as free of accident hazards as possible when staff transferred one resident (Resident #39), who was non-weight bearing, with a gait belt. The facility census was 45. Review showed the facility did not provide a policy regarding transferring residents, gait belt use, or mechanical lift use. Review of the American Nurse Journal, titled Gait Belts 101, dated 05/03/19, showed the following information: -Before using a gait belt, conduct a mobility assessment which includes four elements - cognition, strength, balance, and endurance. If the patient passes to mobility test, still address any concern that a knee might buckle, a patient could become dizzy, or something could go wrong; -After the belt is properly secured, ensure that the patient's feet are placed flat on the floor (no dangling feet); [...]

Inspectors wroteBased on interview and record review, the facility failed to have a process in place to ensure pharmacist recommendations were follow-up and implemented if approved by the physician, when the facility failed to to adjust one resident's (Resident #23) medication as recommended by the pharmacist and agreed to by the physician. The facility census was 45. Review showed the facility did not provide a policy or procedure regarding following physician orders for pharmacist recommendations. 1. Review of Resident #23's face sheet showed the following information: -admission date of 08/31/23; -Diagnoses included left sided hemiplegia (paralysis of one side of the body), dementia, diabetes, and heart failure. Review of the resident's care plan, revised on 09/01/23, showed the following information: [...]

Inspectors wroteBased on interview, and record review, the facility failed to follow approved menus to ensure the nutritional needs of all residents were met when staff did not provide the approved pureed meals to two residents (Residents #24 and #95) and substituted nonequivalent items. The facility census was 45. Review showed the facility did not provide a policy regarding pureed diets. 1. Review of diet cards showed Residents #24 and #95 required puree textured diets. Review of the Pureed menu, for 06/13/24, showed the following: -Pureed honey glazed pork loin; -Pureed roasted sweet potatoes; -Pureed crunchy cabbage bake; -Pureed Gooey Butter Bar; -Pureed buttered dinner roll. During an interview on 06/13/24, at 11:00 A.M., the Dietary Manager (DM) said he/she did not know how to puree cabbage, so they were substituting with cottage cheese. [...]

Inspectors wroteBased on interview and record review, the facility's governing body failed to ensure the staff appointed in the role of administrator had a active administrator licensed recognized in the state of operations. The facility census was 46. Review showed the facility did not provide a policy regarding qualification for the role of administrator. 1. Observation, on [DATE], showed Staff Member A was identified as the administrator of the facility. Review of the Missouri Board of Nursing Home Administrators website, dated [DATE], showed Staff Member A did not have an active administrator licensed for the State of Missouri. During an interview on [DATE], at 5:40 P.M., Staff Member A said his/her administrator license had expired [DATE]. He/she sent in the paperwork to recertify his/her license in [DATE]. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff stored, prepared, and served food in a sanitary conditions and protected against possible contamination when staff failed to clean a metal shelf in the kitchen from an accumulation of lint and dust; failed to repair and clean fluorescent light covers; failed to clean a window air conditioner pointed towards prepared foods in the kitchen; and failed to ensure the dishwasher chemicals tested at recommended level. The facility had a census of 32 residents. 1. Record review of the 2013 Missouri Food Code showed the following information: -Equipment food-contact surfaces and utensils shall be clean to sight and touch; -The food-contact surfaces of cooking equipment and pans shall be kept free of encrusted grease deposits and other soil accumulations; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a clean, comfortable, homelike environment in the dining room, when fluorescent light fixtures contained dead bug. The facility census was 32. Record review showed the facility did not provide a policy regarding maintaining the cleanliness of the light covers/fixtures. 1. Observation of the dining room area closest to the door exiting to the smoking area for staff and residents showed the following: -On 06/06/22, at 2:30 P.M., ten of the eleven fluorescent light fixtures had dead bugs, too numerous to count, in the light fixture; -On 06/07/22, at 12:40 P.M., ten of eleven fluorescent light fixtures were had dead bugs, too numerous to count, in the light fixture;. -On 06/08/22, at 11:30 A.M., ten of eleven fluorescent light fixtures were had dead bugs, too numerous to count, in the light fixture. [...]

Inspectors wroteBased on record review and interview, the facility failed to follow facility policy to ensure staff completed employee tuberculosis (TB-a potentially serious infectious bacterial disease that mainly affects the lungs) screening tests on hire for three staff members. The facility census was 32. Record review of the facility's policy, Infection Control-Employee Infection Control Procedures, dated 06/04/2014, showed the following information: -All employees (including consultants and contract employees) will have a health screen and a two-step TB test (PPD) on employment to determine they are free of communicable disease. Thereafter, they shall have a TB test annually on or about their anniversary date; -Testing should be performed prior to or on the first date of employment and read in millimeters, using the measuring devices provided with the serum, within 48 to 72 hours. [...]