Meramec Nursing

Inspectors wroteBased on interview and record review, facility staff failed to notify one resident ( Resident #4) of an altercation with another resident and two residents (Resident #4 and #8) after falls out of five sampled residents. The facility census was 45. 1. Review of the facility's Significant Condition Change and Notification policy, dated November 2019, showed staff are directed as follows:-The purpose is to ensure that the resident's family and/or representative are notified of resident changes such as an accident or incident, with or without injury, that has the potential for needed medical practitioner intervention;-A significant change in the resident's physical, mental or psychosocial status examples include: new bruises, allegation of abuse or neglect, or other abnormal assessment findings;-Calls will be made to the resident's representative until they are reached. [...]

Inspectors wroteBased on record review and interview, facility staff failed to prevent commingling of five residents' funds (Resident #8, #27, #26, #38, and #40) out of 23 sampled personal funds, with the facility operating funds, and failed to reconcile the resident trust monthly for two of 12 months sampled. The facility census was 47. 1. Review of the facility's policy titled Resident Funds, undated, showed resident funds will be maintained by the facility and reconciled regularly. Review of the facility's policy titled Private Collections Policy and Procedures, revised 01/20/21, showed the primary responsibility of the facility's Business Office Manager (BOM) to maintain Account's Receivable (AR) amounts, with oversight provided by the Administrator. [...]

Inspectors wroteBased on record review and interview, facility staff failed to provide refunds of personal funds to the residents from the facility operating account within 30 days of discharge for three (Resident #58, #59, and #56) out of five sampled residents. The facility census was 47. 1. Review of the facility's policy titled Resident Funds, undated, showed resident funds will be maintained by the facility and reconciled regularly. Review of the facility's policy titled Private Collections Policy and Procedures, revised [DATE] showed the primary responsibility of the facility's Business Office Manager (BOM), is to maintain Account's Receivable (AR) amounts, with oversight provided by the Administrator. [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide the appropriate Center for Medicare and Medicaid Services (CMS) Notice of Medicare Non-Coverage (NOMNC) for three residents (Resident #54, #55, and #248) out of three sampled residents whom the facility-initiated discharge from Medicare Part A Services when benefit days were not exhausted. The facility census was 47. 1. Review of the facility's policy titled Advanced Beneficiary Notices, revised 07/14/22, showed a NOMNC form shall be issued to the resident/representative with Medicare covered services are ending, no matter if the resident is leaving the facility or remaining at the facility. This informs the resident/representative on how to request an appeal or expedite determination from their Quality Improvement Organization (QIO). [...]

Inspectors wroteBased on interview and record review, facility staff failed to check the Employee Disqualification List (EDL) a list of individuals who have been determined to have abused or neglected a resident or misappropriated funds or property belonging to a resident), criminal background check (CBC), Family Care Safety Registry (FCSR), and Nurse Aide (NA) Registry prior to hire in accordance with their facility policy for three employees (Licensed Practical Nurse (LPN) V, Housekeeper W, and Dietary Aide (DA) X) out of six sampled employees. The facility census was 47. 1. Review of the facility's policy titled Background Investigations, revised 12/12/23, showed employee background checks, licensure verification, and criminal conviction record checks are conducted on all personnel making application for employment. [...]

Inspectors wroteBased on record review and interview, facility staff failed to thoroughly complete a quarterly Minimum Data Set (MDS), a federally mandated assessment tool, as directed by the Resident Assessment Instrument (RAI) manual for four residents (Resident #1, #2, #4, and #11) out of twelve sampled residents. The facility census was 47. 1. Review of the RAI manual, dated 10/1/2024, showed the Quarterly assessment is an Omnibus Budget Reconciliation Act of 1987 (OBRA) non-comprehensive assessment for a resident that must be completed at least every 92 days following the previous OBRA assessment of any type. It is used to track a resident's status between comprehensive assessments to ensure critical indicators of gradual change in a resident's status are monitored. -The RAI process has multiple regulatory requirements. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to review and revise the comprehensive care plan for two residents (Resident #4 and #5) for changes in Activities of Daily Living (ADL) needs, one resident (Resident #8) who developed a pressure ulcer, and for one resident (Resident #11) with weight loss out of a sample of 12 residents. The facility census was 47. 1. Review of the facility policy titled, Comprehensive Care Plans, dated 06/02/2022, showed it is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, professional standards of practice, medical provider orders, and resident's goal and preferences. [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to ensure the residents' environment remained free of accident hazards when facility staff failed to provide safe mechanical lift for two (Residents #1 and #4) out of two sampled residents and failed to store razors/sharps and hazardous chemicals in a safe manner not accessible to residents. The facility census was 47. 1. Review of the facility's undated policy, How to Use a Mechanical Lift, showed staff should spread the base of the lift to its widest possible position to maximize stability when raising the resident. When transferring a resident from the bed the legs of the base should be open and locked prior to attaching the resident sling. 2. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to reconcile narcotics at the change of shift when the medication cart changed from one staff member to another for four of four medication carts. The facility census was 47. 1. Review of the facility's policy titled Controlled Substance administration and Accountability, revised 04/07/22, showed the facility will have safeguards in place in order to prevent loss, diversion, or accidental exposure. All controlled substances obtained from the medication cart or cabinet are recorded on the designated usage form, written documentation must be legible with all information provided. Areas without automated dispensing systems utilize a substantially constructed storage unit with two locks and a paper system for 24 hour recording of controlled substances. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to implement Enhanced Barrier Precautions (EBP) to prevent the spread of bacteria and other infection causing contaminants during the provision of care for two residents (Residents #40 and #53) out of a sample of two residents. Staff failed to perform appropriate hand hygiene during incontinence care for two residents (Residents #1 and #4) out of a sample of 12. The facility census was 47. 1. Review of the facility's policy titled Enhanced Barrier Precautions, revised 12/12/23, showed the facility will implement EBP for the prevention of transmission of multidrug-resistant organisms (MDRO). [...]

Inspectors wroteBased on interview and record review, facility staff failed to maintain an infection prevention and control program to provide a safe and sanitary environment to help prevent potential spread of COVID-19 (an acute respiratory illness in humans caused by the coronavirus, SARS-CoV-2 and other infections), when staff failed to separate rooms for one resident (Resident #2) who tested negative on 08/07/24 after the residents roommate (Resident #1) tested positive for COVID on 08/07/24. Resident #2 remained in the same room with Resident #1 and tested positive for COVID on 08/10/24. The facility census was 45. Review of Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, dated March 18, 2024, showed a patient with suspected or confirmed SARS-CoV-2 infection should be placed in a single-person room. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to maintain the mechanical lift slings in proper working condition which resulted in one resident (Resident #1's) sling strap to tear causing the resident to lean forward hitting the front left side of his/her head on the floor which resulted in a large scalp laceration and subarachnoid bleed (bleeding in space surrounds the brain). The facility census was 42. 1. Review of the facility's mechanical lift, transfer, and repositioning sling care policy, dated 1/4/24, showed staff are directed to carefully inspect the sling before each use for wear and damage to seams, fabric, straps, and strap loops. Review showed torn, cut, frayed or broken slings can fail, resulting in serious personnel injury to the user and only slings that are in good condition. 2. [...]

Inspectors wroteBased on interview and record review, facility staff failed to properly document the resident's discharge summary and failed to arrange for the resident's medications to be sent to the pharmacy upon discharge from the facility for one resident. (Resident #1) The facility census was 47. 1. Review of the facility's Medications and Discharge policy, undated, showed staff are directed as follows: -A post-discharge plan of care that is developed with the participation of the resident and his/her family, which will assist the resident to adjust to his/her new living environment. A post-discharge plan of care means the discharge planning process which includes: assessing continuing care needs and developing plan designed to ensure the individual's needs will be met after discharge from the facility; [...]

Inspectors wroteBased on observation and interviews, the facility staff failed to designate a person to serve as the Director of Food and Nutrition Services with the appropriate qualifications, when the facility failed to employ a qualified dietitian or other clinically qualified nutrition professional full-time. The census was 49. 1. Observation on 10/31/23 from 10:03 A.M. through 12:15 P.M., showed [NAME] N directed and assisted facility kitchen and nursing staff in the completion of kitchen tasks while he/she prepared and served the lunch meal. During an interview on 10/31/23 at 10:07 A.M., [NAME] N said the facility did not have a full-time Certified Dietary Manager (CDM). He/She said the last CDM left the facility about eight weeks ago and [NAME] T was filling in. He/She also said [NAME] T is not a CDM. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to develop a comprehensive person-centered care plan for each resident to meet the resident's medical, and nursing needs when staff failed to address advanced directives, hospice, use of heel boots, use of a Broda chair (reclining wheelchair), and Activities of Daily Living (ADL)s (meal assistance, transfer techniques) specific to one resident (Resident #5), failed to address bowel and bladder, advanced directives, pressure ulcer prevention, and hospice for one resident (Resident #27), and failed to address meal assistance and risk of/actual weight loss for one resident (Resident #30). The facility census was 49. 1. Review of the facility's Care Planning-Interdisciplinary Team policy, reviewed 01/2017, showed facility staff are directed to: [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to maintain professional standards of documentation when staff failed to document wound measurements and appearance of wounds weekly for two residents (Resident #5 and #27), failed to follow physician orders for one resident (Resident #5) who was ordered the application of heel boots to both feet, failed to obtain and document weights as ordered daily for one resident (Resident #1) and weekly weights and dietary assistance for one resident (Resident #30). The facility census was 49. 1. Review of the facility's Skin and Wound Management policy, dated July 2017, showed: -The nurse shall describe and document/report the following: a full assessment of the pressure sore including location, stage, length, width and depth, presence of exudate (drainage), or necrotic (dead) tissue; -Pain assessment; [...]

Inspectors wroteBased on observation, interview, and record review facility staff failed to provide safe mechanical lift transfers for three residents (Resident #2, #5, and #27). The facility census was 49. 1. Review of the facility's policy titled, Safe Resident Handling/Transfers, revised 11/02/23, showed staff were directed to do the following: -Ensure residents are handled and transferred safely to prevent or minimize risk for injury; -Mechanical lifting equipment or other approved transferring aides will be used based on the resident's needs; -Staff will inspect the equipment prior to use to ensure functionality and alert maintenance or other designee if not functioning properly; -Two staff members must be utilized when transferring residents with a mechanical lift; [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to use appropriate infection control procedures to prevent the spread of bacteria or other infectious causing contaminants during incontinent care for four residents, (Resident #2, #5, #23, and #27), during wound care for one resident (Resident #16) and during medication administration and insulin administration for three residents (Resident #32, #35, and #44). In addition, facility staff failed to sanitize a mechanical lift between three residents (Resident #2, #5, and #27) and perform hand hygiene. The census was 49. 1. Review of the facility's policy titled, Hand Hygiene, reviewed 11/2/23, showed staff are instructed to do the following: -Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice; -Hand hygiene when using soap and water: 1. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to follow physician orders for monitoring one resident's (Resident #15) dialysis port (a place to reach the blood for dialysis which is a procedure to purify the blood of a person whose kidneys are not working normally) and failed to maintain ongoing communication with the dialysis clinic. The facility census was 49. 1. Review of the facility's Hemodialysis policy, reviewed 11/2/23, showed this facility will provide the necessary care and treatment, consistent with professional standards of practice, medical provider orders, the comprehensive person-centered care plan, and the resident's goals and preference, to meet the special medical nursing, mental, and psychosocial needs of residents receiving hemodialysis. This will include: [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide written information to the resident and/or the resident's representative of their bed hold policy at the time of transfer to the hospital for three sampled residents (Resident #26, #27, and #48). The facility census was 49. 1. Review of the facility's Bed Hold Notice Upon Transfer Policy, reviewed and revised 11/2/23, showed: -At the time of transfer for hospitalization or therapeutic leave, the facility will provide to the resident and/or the resident representative written notice which specifies the duration of the bed-hold policy and addresses information explaining the return of the resident to the next available bed. [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure three Nurse Aides (NAs) (NA A, NA B, and NA C) completed the nurse aide training program within four months of their employment in the facility. The facility census was 49. 1. Review of NA A's personnel file showed a hire date of 07/13/22. Review showed the NA's file did not contain documentation the NA completed a nurse aide training program. During a telephone interview on 9/15/23 at 9:29 A.M., the administrator said she did not know why NA A had not been certified and said, I didn't realize he/she hadn't been certified. I assumed the instructor had been doing that. I realize now she was not. During a telephone interview on 9/26/23 at 9:21 A.M., the nurse aide instructor said NA A kept missing classes. 2. Review of NA B's personnel file showed a hire date of 4/3/23. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to develop a comprehensive person-centered care plan for each resident to meet the residents' medical and nursing needs when they failed to address personal hygiene and grooming for four residents (Resident #7, #19, #35, and #42). The facility census was 43. 1. Review of the facility's Minimum Data Set (MDS), a federally mandated assessment tool completed by facility staff, 3.0 and Care Planning Policy, undated, showed: -The Comprehensive Care Plan will be individualized to each resident; -Included in the Comprehensive Care Plan will be the resident's right to refuse treatment, and any specialized services the facility will provide; -The Comprehensive Care Plan will be revised on an ongoing basis to reflect changes in the resident and/or changes in the care the resident is receiving; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to revise the care plan for one resident (Resident #32) who utilized bed rails, and one resident (Resident #38) who utilized palm protectors, psychotropic medications, and who did not require the use of bed rails. The facility census was 43. 1. Review of the facility's Minimum Data Set (MDS), a federally mandated assessment tool completed by facility staff, 3.0 and Care Planning Policy, undated, showed: -The Comprehensive Care Plan will also be individualized to each resident; -Comprehensive Care Plan will be updated when a change of condition is warranted; -Included in the Comprehensive Care Plan will be the resident's right to refuse treatment, any specialized services the facility will provide, the resident's goals for admission, desired outcomes, and discharge plans; [...]

Inspectors wroteBased on observation, interview, and record review, staff failed to obtain an order for one resident (Resident #42)'s dialysis (the clinical purification of blood by filtering, as a substitute for the normal function of the kidney), and failed to facilitate communication with the dialysis clinic. The facility census was 43. 1. The facility could not provide a physicians order policy. 2. Review of the facility's Dialysis Communication Policy, dated 2/21, showed: - It is the policy of the facility to communicate openly and effectively with any provider of dialysis for a resident of the facility; -DON or designee will contact dialysis unit to establish the communication, explain the facility will be sending a communication form that will facilitate the sharing of resident information surrounding dialysis; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide appropriate care and services to assist residents with Activities of Daily Living (ADLs) (everyday tasks), for four residents (Resident #19, #28, #35 and #42). The facility census was 43. 1. Review of Resident #19's Annual Minimum Data Set (MDS), a federally mandated assessment tool, dated 4/7/22, showed staff assessed the resident as: -Severe cognitive impairment; -Required supervision and setup help from one staff member for eating; -Required assistance from one staff member for toileting and personal hygiene; -Did not reject care. Review of the care plan, dated 5/31/22, showed it directed staff to check the resident's fingernail length, and trim and clean the nails on shower days, and as necessary (PRN). [...]

Inspectors wroteBased on interview and record review facility staff failed to maintain monthly pharmacist documentation, and ensure the Pharmacist Medication Regimen Review (MRR) was completed for two residents (Resident #9 and #38) out of five sampled residents. The facility census was 43. 1. Review of the facility's Medication Regimen Review (MRR) Policy, dated 6/1/2018, showed: -The consultant pharmacist performs a comprehensive review of each resident's medication regimen and clinical record at least monthly. MRR's involve reporting of findings with recommendations for improvement. All findings and recommendations are reported to the Director of Nursing (DON), the attending physician, the medical director, and the administrator; -Recommendations are acted upon and documented by the facility staff and/or the prescriber. 2. [...]