New Madrid Living Center

Inspectors wroteBased on interview and record review, the facility failed to ensure a code status was accurately and consistently documented throughout the medical record for two residents (Residents #6 and #17) out of 14 sampled residents. The facility census was 54. Review of the facility policy titled, Advanced Directive, revised [DATE], showed: - Upon admission of a resident to the facility, the social services designee (SSD) will provide written information to the resident concerning his/her right to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment, and the right to formulate an advanced directive; - Upon admission of a resident, the SSD will inquire of the resident, and his/her family members, about the existence of any written advance directives; [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and the resident's representative in writing of a transfer or discharge to a hospital, including the reasons for transfer, and of the bed hold policy, including the bed hold rate at the time of the transfer, for four residents (Residents #2, #6, #10, and #21) out of five sampled residents. The facility's census was 54. Review of the facility's policy titled, Discharge/Transfer of Resident, dated March 2015, showed: - Explain transfer and reason to the resident and/or representative and give copy of signed transfer or discharge notice to the resident and/or representative or person responsible for care. If emergency transfer, transfer or discharge notice form may be completed later, but as soon as possible. - Explain and give a copy of the bed hold form to the resident and/or representative. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a baseline care plan (the minimum healthcare information necessary to properly care for a resident) upon admission with specific interventions for one resident (Resident #44) out of three sampled residents. The facility census was 54. Review of facility's policy titled, Care Plan, Temporary, dated March 2015, showed:- A temporary care plan will be implemented for the resident within 24 hours of admission to assure that the resident's immediate care needs are met and maintained;- The interdisciplinary care plan team and/or admitting nurse will review the physician orders and implement a nursing care plan to meet the immediate care needs of the resident. [...]

Inspectors wroteBased on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff) for two residents (Residents #10 and #28) out of 15 sampled residents. The facility census was 59. The facility did not provide a policy. 1. Review of Resident #10's medical record showed: - An admission date of 09/23/24; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain proper infection control practices for two residents (Residents #10 and #30) out of two sampled residents. This deficient practice had the potential to affect all residents in the facility. The facility's census was 59. Review of facility policy titled, Enhanced Barrier Precautions (EBP) to Infection Control Guidance, dated March 2024, showed: - Use of gloves and gown are required when conducting high-contact care activities to residents with indwelling medical devices. Review of the facility's policy titled, SARS-CoV-2 (Covid-19) For Long Term Care Facilities, dated 05/15/23, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the safety of one resident (Resident #1) when staff failed to follow the care plan and use proper technique during a transfer resulting in the resident entangling his/her legs together and sustaining a fractured right tibia/fibula ((tib/fib) the long bones in the lower leg). The facility census was 59. The facility did not provide a policy regarding proper transfers. 1. Record review of Resident #1's annual Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by the facility staff, dated 01/01/2024 showed: - Diagnoses of Alzheimer (a disease of the brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks), seizure disorder; - Cognition impaired; - No behavioral symptoms; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure staff provided the necessary care and services in accordance with professional standards of practice for one resident (Resident #1) out of three sampled residents. Staff failed to notify the physician of the resident's critical lab values in a timely manner which resulted in the resident being admitted to the hospital from [DATE] through 09/01/23. The facility census was 60. Review of the facility's policy titled, Lab Reporting Guidelines, dated March 2015, showed: - Once lab results are returned to the facility, the nurse will notify the physician via fax and follow-up call within 12 hours for routine labs or within one hour for stat labs; - The nurse will document on the lab report that the physician has been notified and to include how they are notified, when (time and date) and the nurse's signature. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to notify a resident's guardian after a change in the resident's condition with a critical lab value for one Resident (Resident #1) of three sampled residents. The facility census was 60. Review of the facility's policy titled, Charting and Documentation, not dated, showed the purpose of these guidelines is to provide: a completed account of the resident's care, treatment, response to the care, signs, symptoms, as well as the resident's progress; guidance to the physician in prescribing appropriate medications and treatments; the elements of quality medial nursing care; and documentation should also include any time the physician or family is called about the resident as well as their response. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to assess for the risk of entrapment and review the possible risks and benefits of the side rails prior to installation or use and the facility failed to obtain informed consent of the side rails prior to use for one resident (Resident #1) out of four sampled residents. The facility census was 60. Review of the facility's policy titled, Bed Rails, not dated, showed: - Once the Bed Rail Observation is completed, the facility will print the observation and review the associated risks and benefits with the resident and/or resident representative. After the review is complete, the resident and/or resident representative will sign the consent line and the nurse will sign as well; - Educate the resident/legal representative on the benefits and risks of bed rail use. 1. Review of Resident #1's medical record showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to document a complete and accurate Minimum Data Set (MDS, a federally mandated assessment to be completed by the facility) for one resident (Resident #53) out of 14 sampled residents. The facility's census was 55. The facility failed to provide a policy for MDS assessment. 1. Record review of Resident #53's medical record showed: - An admission date of 12/16/22; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications in the facility were not expired in one of three medication storage rooms and one of three medication carts reviewed. This deficient practice affected one resident (Resident #38) outside of the 14 sampled residents and had the potential to affect one resident (Resident #45) outside the sample. Failure to remove expired medications from circulation increased the likelihood of unintended use and side effects, which had the potential to affect all residents. The facility census was 55. Record review of professional reference from the United States Food and Drug Administration (FDA), Expiration Dates - Questions and Answers last updated 10/24/22, retrieved from https://www.fda.gov/drugs/pharmaceutical-quality-resources/expiration-dates-questions-and-answers, revealed in pertinent part: - 1. [...]