Milford Meadows Care Center

Inspectors wroteLicense Reference Number: 175 NAC 12-006.2(H) Based upon record review and interview, the facility failed to submit an investigation to the State Agency within five working days. The facility census was 68. FINDINGS ARE:A record review of Facility policy Notification of Changes Policy dated 5-17-2024 revealed that notification of physician and resident representative is required when an accident results in injury and may require physician intervention, when a significant change in resident condition is noted, when there is a need to alter treatment or the resident with be transferred or discharged from the facility. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(E) Licensure Reference Number 175 NAC 12-006.18(B) Based on observation, interview, and record review, the facility failed to ensure the final cooking temperatures (temps) of the food were obtained to prevent the potential for foodborne illness. The facility also failed to ensure the dishwashing machine temps were greater than 120 degrees Fahrenheit (F) during the wash and rinse cycles, the ceiling fan and light covers were free from debris, and food temperatures were taken following microwaving food to prevent the potential for foodborne illness. This had the potential to affect all residents in the facility that consumed food from the kitchen. The facility census was 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18B Licensure Reference Number 175 NAC 12-006.18D The facility failed to ensure infection control measures were followed related to lack of signage indicating Enhanced Barrier Precautions (EBP, an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs) in nursing homes. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(S) Licensure Reference Number 175 NAC 12-006.19(A) Based on observation, interview, and review; the facility failed to ensure that the food and beverages were not served to residents with disposable dishware and cutlery to protect the residents' rights to be treated with dignity and to preserve a homelike environment. This affected the 25 facility residents who received their meals in their rooms. The facility census was 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(S) Licensure Reference Number 175 NAC 12-006.19(A) Based on observation, interview, and review, the facility failed to ensure that comfortable sound levels were maintained in the facility to protect the residents' right to be treated with consideration, respect, and the choices of the residents. The facility census was 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09H Based on observation, interview, and record review, the facility failed to cleanse the resident's wounds prior to applying treatment and failed to cleanse another wound in a circular motion from the center of the wound outward for 1 (Resident 9) of 4 sampled residents. The facility census was 63.

Inspectors wroteBased on interview and record review the facility failed to ensure behavior monitoring was completed to support the use of multiple psychotropic medications (drugs that affect the brain and nervous system, influencing mood and behavior) for one (Resident 17) of two sampled residents. The facility identified a census of 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D2b Based on record review, observation, and interview; the facility failed to monitor a pressure ulcer for 1 (Resident 4) of 3 sampled residents. The facility staff identified a census of 61.

Inspectors wroteLicensure Reference Number175 NAC 12-006.11E Based on observation, interview and record review, the facility failed to prevent the potential for food borne illness related to low dishwasher temps. This had the potential to affect 65 of 66 residents who receive food from the kitchen. The facility failed to monitor remvoal of room trays this affected Resident 59. The facility identified a census of 66.

Inspectors wroteB. A record review of the document titled admission Record printed on 3/28/24 revealed that the facility had admitted Resident 13 on 6/19/20 with a primary diagnosis of a TBI (Traumatic Brain Injury). A record review of the MDS (Minimum Data Set, a comprehensive assessment of each resident's functional capabilities) dated 2/22/24, Section C revealed no BIMS (Brief Interview for Mental Status, a test used to get a quick snapshot of a resident's cognitive function, scored from 0-15, the higher the score, the higher the cognitive function) score for Resident 13. The record review revealed Section C did contain the following questions related to cognitive patterns: C0700 Seems or appears to recall after 5 minutes with an answer of 1. Memory problem. C1000 Made decisions regarding tasks of daily life with an answer of 3. Severely impaired. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18 Based on observation, interview and record review; the facility failed to maintain equipment and personal property in good condition as evidenced by: dried light beige-colored streaks on top of and down the front of a dresser, dried light beige-colored areas on the base of a tube feeding pole, and grey substance build up on a bed side tray, suction machine, nebulizer machine and CD player for 1 (Resident 6) of 1 sampled residents. The facility census was 66.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09B Based on record review and interview; the facility failed to ensure the Minimum Data Set (MDS-a comprehensive assessment of each resident's functional capabilities used to develop a resident's plan of care) reflected a Level II PASARR (Preadmission Screening and Resident Review-that is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care. Level 2 screening is triggered by evidence of a serious mental illness (MI), Intellectual or Developmental Disabilities (IDD) or condition related to Intellectual or Developmental Disabilities (RC) as defined by Medicaid) for 1 (Resident 7) of 1 sampled resident. The facility census was 66.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09A Based on record review and interview; the facility failed to ensure a new PASARR (Preadmission Screening and Resident Review-that is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care. Level 2 screening is triggered by evidence of a serious mental illness (MI), Intellectual or Developmental Disabilities (IDD) or condition related to Intellectual or Developmental Disabilities (RC) as defined by Medicaid) screen was completed related to a new mental health diagnosis for 1 (Resident 59) of 1 sampled resident. The facility census was 66.

Inspectors wroteLicensure Reference Number 175NAC 12-006.09C Based on interview and record review, the facility failed to develop and implement a resident centered Comprehensive Care plan (CCP-a written interdisciplinary comprehensive plan detailing how to provide quality care for a resident) that reflected the care needs of Resident 2. This affected 1 of 1 sampled resident. The facility census was 66.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04C2 Based on interview and record review; the facility failed to ensure a Registered Nurse (RN) was present in the facility for at least 8 consecutive hours on 3/9/24 and 3/24/24, which had the potential to affect all residents. The facility census was 66.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12E7 Based on observations, interview and record review, the facility failed to ensure multiuse medications were appropriately labeled with the date opened in accordance with currently accepted professional principles for 2 (Resident 9 and 61) of 4 sampled residents. The facility census was 66.

Inspectors wrote175 NAC 12-006.11D Based on observations and interviews, the facility failed to ensure food was palatable which affected 4 residents (Resident 15, Resident 33, Resident 37, Resident 53) of 4 sampled residents who eat in their room. The facility census was 65.

Inspectors wrote175 NAC 12-006.09D3(5) Based on record review and interview, the facility failed to assess and treat Resident 67 for constipation. This affected 1 of 1 sampled residents for constipation. The facility census was 65.