Miller County Care and Rehabilitation Center

Inspectors wroteBased on interview and record review, the facility staff failed to designate a person to serve as the Director of Food and Nutrition Services (DFNS) with the appropriate qualifications, when the facility did not employ a qualified dietitian or other clinically qualified nutrition professional full-time. This failure has the potential to affect all residents. The facility census was 60. 1. Review of the facility's Dietitian policy, revised November 2022, showed: -If a dietician is not employed full time (35 or more hours per week) a director of food and nutrition services will be designated. The individual will: a. be a certified dietary manager; or b. be a certified food service manager; or c. be nationally certified in food service management and safety; or d. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to thaw frozen meat in a manner to prevent the growth of food-borne pathogens. This failure has the potential to affect all residents. The facility census was 60 . 1. Review of the 2022 United States Food and Drug Administration Food Code, section 3-501.13 Thawing, showed: -Except as specified in paragraph (D) of this section, time/temperature control for safety food shall be thawed: (A) Under refrigeration that maintains the food temperature at 41 degrees Fahrenheit (dF) or less; or (B) Completely submerged under running water: [...]

Inspectors wroteBased on interview and record review, facility staff failed to complete an accurate Level I Pre-admission Screening (used to evaluate for the presence of psychiatric conditions to determine if a Pre-admission Screening and Resident Review (PASARR) level II screen is required) as required for two residents (Resident #6 and #56) out of 18 sampled residents with new mental health diagnoses. The facility census was 60. 1. Review of the facility's policy titled admission Criteria, revised March 2019, showed staff are directed to use the PASRR to screen all potential admissions to determine if they meet the criteria for mental disorder, intellectual disabilities, or related disorders regardless of payer source. 2. [...]

Inspectors wroteBased on interview and record review, facility staff failed to accurately complete the Pre-admission Screening and Resident Review (PASRR) process prior to admission for two residents (Residents #18, and #44) out of 18 sampled residents. The facility census was 60. 1. Review of the facility's policy titled admission Criteria, dated March 2019, showed all new admissions and readmissions are assessed for mental disorders, intellectual disabilities or related disorders RD per the Medicaid PASSAR process. The facility conducts a Level I PASSAR screen for all potential admissions, regardless of payer source, to determine if the individual meets the criteria for mental disorders, intellectual disabilities or related disorders. 3. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide appropriate treatment and services to prevent further decrease in range of motion (ROM), movement of a joint, for one resident (Resident #23) out 18 sampled residents, who had a contracture (shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) to the left hand. The facility census was 60. 1. Review of the facility's policy titled, Resident Mobility and Range of Motion, dated July 2017, showed residents will not experience an avoidable reduction in ROM. Residents with limited ROM will receive treatment and services to increase and/or prevent a further decrease in ROM. Residents with limited mobility will receive appropriate services, equipment and assistance to maintain or improve mobility unless reduction to mobility is unavoidable. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to perform hand hygiene as often as necessary using approved techniques to prevent cross-contamination and reduce the risk of infection during the provision of perineal care for two residents (Resident #2 and Resident #8) and during food preparation and service. Facility staff also failed to develop and implement complete policies and procedures for the inspection, testing and maintenance of the facility's water systems to inhibit the growth of waterborne pathogens and reduce the risk of an outbreak of Legionnaire's Disease (LD). The facility census was 62. 1. Review of the facility's policy, titled Handwashing/Hand Hygiene, revised August 2019, showed the policy directed staff as follows: -Wash hands with soap and water when hands are visibly soiled; [...]

Inspectors wroteBased on interview and record review, facility staff failed to notify one resident's physician (Resident #4) when his/her blood sugar reached a level greater 450 milligrams/deciliter (mg/dL). The facility census was 62. 1. Review of the policies provided by the facility did not contain a policy for physician notification instruction, physician orders, or professional standards. 2. Review of Resident #4's Quarterly Minimum Data Set (MDS), a federally mandated assessment tool, dated 12/09/23, showed staff assessed the resident as follows: -Cognitively intact; -Rejection of care not exhibited; -Insulin injections received seven out of the last seven days; -Diagnosis of Diabetes Mellitus (the body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in blood and urine). [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to ensure one resident (Resident #53), who required continuous oxygen, received continous oxygen as ordered by the physician. The facility census was 62. 1. Review of the facility's policy titled, Oxygen Administration, revised October 2010, showed staff are directed to: -Review the physician's orders or facility protocol for oxygen administration; -Review the resident's care plan to assess for any special needs; -Assemble the equipment and supplies as needed. Did not contain direction for staff in regard to continuous oxygen use. 2. Review of Resident #53's Quarterly MDS, dated [DATE], showed staff assessed the resident as follows: -Cognitively intact; -Rejection of care not exhibited; -Independent with transfers and ambulation; -Uses a walker; -Requires oxygen therapy; [...]

Inspectors wroteBased on observation, interviews, and record review, the facility staff failed perform hand hygiene as often as necessary and to wash, rinse, and sanitize the food preparation sink between uses to prevent cross-contamination and the growth of food-borne pathogens. Facility staff also failed to to store dishes in a safe and sanitary manner, utilize hair restraints while in the kitchen, store the sanitation rag submerged in the sanitation liquid, ensure the ice bin drained through an air gap, and properly store open food to prevent outdated usage. This had the potential to affect all facility residents. The census was 61. 1. Review of the facility's handwashing policy, undated, showed staff were instructed to wash hands after eating, after touching the face, and before putting on new gloves. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to create an environment in which residents could make choices in regard to significant aspects of their lives when staff implemented a new smoking policy, and did not allow four residents (Resident #23, #48, #54 and #62) to smoke as they previously could. The facility census was 61. 1. Review of the facility's Smoking Policy, revised 11/14/22, showed staff were directed when the outside temperatures are below 32 degrees and/or above 100 degrees, residents will not be allowed to go outside and smoke. 2. Review of Resident #23's Significant Change Minimum Data Set (MDS), a federally mandated assessment tool completed by facility staff, dated 10/15/22, showed staff assessed the resident as follows: -Cognitively Intact; -Required no physical assistant from staff for Activities of Daily Living (ADLs); -Used a walker. [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide consistent documentation in regard to residents' Physician's Orders for Life-Sustaining Treatment (designed to improve patient care by creating a medical order form that records residents' treatment wishes so staff know what treatments the resident wants in the event of a medical emergency) for four residents (Resident #4, #8, #24 and #50). The facility census was 61. 1. Review of the facility's Emergency Procedure - Cardiopulmonary Resuscitation (CPR) policy, undated, showed: -If an individual is found unresponsive and not breathing normally, a licensed staff member who is certified in CPR shall initiate CPR unless it is known that a Do Not Resuscitate (DNR) order that specifically prohibits CPR exists for the individual or there are obvious signs of irreversible death (e.g. [...]

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) in accordance with their policy for existing staff quarterly, for nine out of ten sampled employees. The facility census was 61. 1. Review of the facility's Employee Disqualification List Policy, dated 11/14/22, showed in addition to pre-employment EDL checks, the facility must also check all their current employees against each quarterly EDL update to assure that no one employed, in any capacity has been added to the EDL, since the initial EDL check. 2. Review of Certified Nurse Aide (CNA) D's personnel records, showed the CNA with a hire date of 8/2/21. [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide written information to the resident and/or the resident's representative of the bed hold policy for three sampled residents (Resident #3, #8, and #12). The facility census was 61. 1. Review of the facility's Notice of Bed-hold and readmission policy, undated, showed: -If a resident requires transfer to an acute hospital, the facility will offer the resident the opportunity of electing to have the bed held for a maximum of 30 days; -Before a resident is transferred to a hospital or goes on therapeutic leave, the facility will provide written information to the resident and a family member or legal representative specifying: -The duration of the bed-hold policy under the State plan, during which the resident is permitted to return and resume residence in the facility; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to ensure the residents' environment remained free of accident hazards when staff failed to properly propel two residents (Resident #8 and #19) in wheelchairs in a manner to prevent accidents. The facility census was 61. 1. Review of the facility's Wheelchair, Use of policy, undated, showed the purpose is to provide mobility for the non-ambulatory residents with safety, comfort and learning to become independent in activities of daily living (ADLs) and directed staff to: -Do not remove foot rests unless resident uses feet on floor to enable mobility; -Lower foot rests and place resident's feet on foot rests if used. Position feet in good body alignment and elevate legs as ordered. 2. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide wound care in a manner to reduce the risk of infection for two residents (Resident #24 and Resident #4). The facility census was 61. 1. Review of the facility's Hand Washing policy, undated, directed staff to wash hands before beginning work, before and after direct resident contact, before and after handling equipment, before and after eating, after using the restroom and anytime they are noticeably soiled. The policy did not contain direction regarding hand hygiene between glove changes. Review of the facility's Wound Care policy dated October 2010, directed staff to: -Use a disposable cloth (paper towel is adequate) to establish clean field on resident's overbed table. Place all items to be used during procedure on the clean field. Arrange supplies so they can be easily reached; [...]