NHC Healthcare, Desloge

Inspectors wroteBased on interview and record review, the facility failed to notify a resident's Responsible Party (RP) after a change in condition when one resident (Resident #43) out of 16 sampled residents had behavioral issues and was transferred to the hospital for evaluation. The facility census was 64. Review of the facility's Change in Patient Status Policy, dated March 2024, showed: - The patient or patient's representative is encouraged to be involved in all decision-making regarding changes in plan of care; - The charge nurse on duty is notified of any changes in condition, the patient will be assessed, the physician, physician extender and patient's representative will be notified; - The patient may not be transferred to hospital without first notifying the patient's representative unless to delay would be harmful to the patient; [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of a transfer or discharge to a hospital, including the reason for transfer for two residents (Resident #5 and #31) out of 16 sampled residents. The facility census was 64. Review of the facility's Patient Care Policies, titled, Transfer/Discharge, revised 3/2024, showed: - A patient may be transferred or discharged to another healthcare institution or discharged home upon the written order of the attending physician; - Sufficient information will be provided to the patient to assure continuity of care, regardless of destination of the patient or the reason for the transfer. 1. Review of Resident #5's medical record showed: - Resident transferred to the hospital on [DATE], and readmitted to the facility on [DATE]; [...]

Inspectors wroteBased on interview and record review, the facility failed to inform the resident and/or the resident representative of their bed hold policy at the time of transfer to the hospital for three residents (Resident #5, #31, and #65) out of 16 sampled residents. The facility census was 64. Review of the facility's Social Work Services Manual titled, Bed hold/Bed Reservation Policy, last revised 11/2016, showed: - Patient's bed hold rights provided to the patient/patient representative during the admission process in the admission and Financial Agreement; - In the event of the patient's transfer from the center, the social services department is responsible for contacting the patient/legal representative to discuss the center's bed hold policy and to ascertain the plans of the patient to reserve the bed; [...]

Inspectors wroteBased on interview and record review, the facility failed to document an accurate Minimum Data Set (MDS-a federally mandated assessment completed by facility staff) for two residents (Resident #27 and #62) out of 16 sampled residents. The facility census was 64. The facility did not provide a policy regarding MDS coding for accuracy. The facility follows the RAI (Resident Assessment Instrument) manual. 1. Review of Resident #27's medical record showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to update and revise care plans with specific resident centered interventions to meet individual needs for three residents (Resident #15, #55, and #62) out of 16 sampled residents. The facility census was 64. Review of the facility's policy, Patient Care Policies, revised 03/2024, showed: - Patients are assessed initially and at regular intervals using a Federal/State specified, standardized, comprehensive resident assessment instrument to identify functional capacity and health status, Care Area Assessments (CAAs) document the additional assessment and review performed and serve as the basis for planning individual patient care; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to label and store medications in a safe and effective manner. This deficient practice affected three residents (Resident #10, #27 and #31) out of 16 sampled residents and one resident (Resident #34) outside the sample and had the potential to affect all residents. The facility census was 64. Review of the facility's Medication Storage policy, revised 02/25/25, showed: - Medications and biologicals are stored safely, securely and properly, following manufacturer's recommendations or those of the supplier; - Outdated, contaminated or deteriorated medications and those in containers that are cracked, soiled or without secure closures are removed from inventory and disposed of according to procedures for medication disposal; [...]

Inspectors wroteBased on observation and interview, the facility failed to store and distribute food under sanitary conditions, increasing the risk of cross-contamination and food-borne illness. This had the potential to affect all residents and staff. The facility census was 64. Review of the facility's Refrigerated Food Storage Guide, last revised November 2017, showed: - Food items shall be rotated, using First In, First Out (FIFO), in order to ensure product quality; - Foods should be covered and dated with a use by date; - Foods such as cottage cheese, cheese, cream cheese, sour cream and yogurt should be refrigerated immediately. Review of the facility's Equipment Cleaning Schedule, last revised November 2017, showed: - Clean spills, and splashes as soon as possible, daily, after use and weekly; - Clean and sanitize shelves and racks as soon as possible, daily, after use and weekly; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain infection control practices to prevent the development and transmission of infection during perineal care (peri care-cleaning the genitals and anal area of the body) for one resident (Resident #40) outside of the 16 sampled residents. The facility failed to implement enhanced barrier precautions (EBP) during wound care for one resident (Resident #28) out of 16 sampled residents. The facility census was 64. Review of the facility's Handwashing/Hand Hygiene Policy, last revised August 2015, showed: - The facility considers hand hygiene the primary means to prevent the spread of infections; - Wash hands with soap and water when hands are visibly soiled and after contact with a resident with infectious diarrhea; - Use an alcohol-based hand rub or soap and water before and after coming on duty; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident (Resident #26) out of two sampled residents received treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the resident's choices, related to pain management. The facility's census was 62. Review of the facility's policy titled, Pain Management, undated, showed: - Every patient is assessed for pain on admission, daily, as needed, and with all quarterly Minimum Data Set (MDS) (a federally mandated assessment completed by the facility) assessments; - Interventions for pain consist of pharmacological and non-pharmacological; - Medications will be given per physician orders, as needed orders will be assessed for effectiveness. Physicians will be notified if current medications or non-pharmacological interventions are not effective. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff treated residents with dignity and in a respectful manner by leaving one resident (Resident #45) out of nine sampled residents exposed during care. The facility census was 62. Review of the facility's policy titled, Dignity, dated August 2009, showed: - Each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality; - Staff promote, maintain and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. 1. Review of Resident #45's medical record showed: - admission date of 01/11/24; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure residents and/or responsible parties were notified in a timely manner when a resident's account was within the $200.00 Social Security (SSI) limit ($5,726.00) or when the resident's account was over the SSI limit. This affected two residents (Resident #2 and #8) reviewed who received Medicaid benefits. The census was 62. Review of the facility's policy titled, Bookkeeping Manual, dated, August 2007, showed: - Patient trust files and related information must be maintained and properly stored by the bookkeeping office for legal compliance and operational efficiency; - Patient trust file must include quarterly statement documentation that residents have been notified of their balance. 1. Review of the Resident Trust Statement for the period 01/31/24 through 03/31/24, showed Resident #2 had the following balances: [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to administer medications in a safe and effective manner for one resident (Resident #23) out of six sampled residents. The facility census was 62. The facility did not provide a policy regarding medication administration. 1. Review of Resident #23's medical record showed: - Date of admission [DATE]; - Diagnosis of kidney failure and required dialysis (process of purifying the blood of a person whose kidneys aren't working normally); - An order for sevelamer carbonate (medication to treat too much phosphate in the blood) 800 milligram (mg) five tablets by mouth with meals at 7:00 A.M., 11:00 A.M., 4:00 P.M., when food is in front of resident, dated 02/05/24; - No documentation of an order for the resident to administer his/her own medication; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure proper placement of a Foley catheter (a tube inserted into the bladder to drain urine) tubing and drainage bags for two residents (Residents #10 and #307) out of five sampled residents. The facility census was 62. Review of the facility's policy titled, Urinary Cath Care, undated, showed: - Catheter care is performed appropriately; - Wash hands or hand sanitize before any manipulation of the catheter site and/or apparatus; - The only place in the closed system intended to be open is the empty spout at the bottom of the drainage bag; - The drainage bag should be kept below the level of the bladder. The facility did not provide a policy regarding Foley catheter placement, keeping the catheter tubing off of the floor for infection control issues or keeping the catheter bag covered for privacy/dignity. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure proper care of the enteral feeding (the intake of food through a gastrostomy tube (G-tube) (a tube placed directly through the abdomen into the stomach for feeding and/or medication administration) for two residents (Residents #46 and #308) out of a sample of two residents. The facility census was 62. The facility did not provide a tube feeding policy. 1. Review of Resident #46's medical record showed: - admission date of 04/20/23; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow a physician's order for oxygen for one resident (Resident #33) and failed to obtain a physician's order for oxygen for one resident (Resident #307) out of two sampled residents. The facility census was 62. Review of the facility's policy titled, Respiratory Therapy, undated, showed: - Oxygen therapy will be initiated only by a Respiratory Therapist, a Registered Nurse (RN) or Licensed Practical Nurse (LPN) on the order of a physician or physician extender, except in case of emergency. When oxygen therapy is initiated without an order in an emergency situation, the physician will be contacted as soon thereafter as possible; - Respiratory therapy will be given only upon the order of a physician. 1. Review of Resident #33's medical record showed: - An admission date of 12/04/23; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide documentation of ongoing assessments, monitoring, and communication between the facility and the dialysis (a process for removing waste and excess water from the blood) center for two residents (Resident #23 and #27) out of two sampled residents. The facility census was 62. Review of the facility's policy titled, Care of a Resident Who Receives Hemodialysis, undated, showed: - Obtain a physician order, may include dialysis schedule, number of treatments per week, and fluid restrictions; - If needed, weights to be obtained if in addition to routine weights; - Pre and post dialysis weight may be obtained at the dialysis center or at the facility; - This should be communicated between the dialysis clinic and facility; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify, assess and provide supportive interventions for two residents (Resident #27 and #44) with a diagnosis of Post-Traumatic Stress Disorder (PTSD) (a mental health condition triggered by a terrifying event - either experiencing it or witnessing it; symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event) out of five sampled residents. The facility's census was 62. Review of the facility's policy titled, Trauma-Informed Care, undated, showed: - Use the attached abbreviated Trauma Screen; - Use the two item version of the Trauma screen at the time of admission to determine the need for further investigation; - This should be done within seventy-two hours of admission and with the patient if at all possible; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident diagnosed with dementia (a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities) had a personalized plan of care to ensure services to promote the resident's highest level of functioning and psychosocial needs for two residents (Residents #10 and #50) out of three sampled residents. The facility census was 62. Review of the facility's policy titled, Dementia - Clinical Protocol, revised March 2015, showed: - For the individual with confirmed dementia, the interdisciplinary team (IDT) will identify a resident-centered care plan to maximize remaining function and quality of life; - The IDT will identify and document the resident's condition and level of support needed during care planning and review changing needs as they arise; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain proper infection control practices during incontinent care for three residents (Resident #10, #16, and #19) out of five sampled residents, Foley catheter (a tube inserted into the bladder to drain urine) care for one resident (Resident #10) out of five sampled residents and one resident (Resident #43) outside the sample, and wound care for one resident (Resident #307 ) out of two sampled residents. The facility failed to maintain proper infection control practices during medication administration for one resident (Resident #46) out of six sampled residents when staff touched a pill with his/her bare hand. The facility census was 62. Review of the facility's policy titled, Hand Hygiene, last revised May 2023, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and distribute food under sanitary conditions, increasing the risk of cross-contamination and food-borne illness. These practices had the potential to affect all residents. The facility census was 61. Record Review of facility's Food Service Department Preventative Maintenance policy, dated January 2011, showed: - For the hood, clean the inside and the outside, clean or change the filters; - For the air conditioner, clean or change the filter; - For the ice machine, clean the condenser and the filter, check for the correct air gap in the drain, and consider professional cleaning twice each year; - For the refrigerators and the freezers, clean the dust from the motor and the condensers. Check the door closures, the gaskets, and the heat strips for proper operation. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a safe, clean, comfortable and homelike environment. This deficient practice had the potential to affect all residents at the facility. The facility census was 61. The facility did not provide a policy regarding a homelike environment for the residents. 1. Observation on 9/21/22 at 8:57 A.M., of Room C3 showed: - The bathroom sink loose and pulled away from the wall with an approximate 1 inch (in.) to 1.5 in. gap from the top of the sink to the wall; - The door frames near the floor on both bathroom doors with a rust colored substance; - The metal air vent to the left of the bathroom sink with a rust colored substance; - No escutcheon (a flat piece of metal for protection) plate on the toilet supply line; - No caulking around the base of the toilet; - The floor in the room covered with a sticky substance; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain infection control practices during medication administration for four residents (Resident #27, #34, #40, and #54) out of 12 sampled residents and the prevention of communicable disease in regards to Tuberculosis (TB) (a communicable disease that affects the lungs characterized by fever, cough and difficulty breathing) screening of five residents (Resident #3, #12, #19, #48 and #259) out of five sampled residents. The facility's census was 61. Record review of the facility's Administering Medication policy, revised December 2012, showed: - Staff shall follow established facility infection control procedures (e.g. handwashing, antiseptic technique, gloves, isolation precautions, etc.) for the administration of medications, as applicable. [...]

Inspectors wroteBased on interview, and record review, the facility failed to develop and implement a baseline care plan consistent with the resident's specific conditions, needs, and risks within 48 hours of admission which included the minimum healthcare information necessary to provide care for three residents (Residents #1, #12, and #210) out of four sampled residents. The facility's census was 61. Record review of the facility's Patient Care Plan guidelines, updated October 2021, showed: - A baseline care plan must be developed and implemented within 48 hours of the patient's admission; - The center must provide the patient and/or their representative with a summary of the care plan that includes goals, medications and dietary instructions, services, and treatments to be administered, and any other information pertinent to the overall care of the patient; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to address oxygen use for two residents (Resident #18 and #36) out of 15 sampled residents. The facility census was 61. Record review of the facility's Documentation Guidelines for Patient Care Plans policy, revised on October 2021, showed: - Problems related to the patient condition, needs, or weaknesses which currently do, or potentially could, prevent the patient from achieving or maintaining the highest practicable level of well-being; - Problems may be identified in terms of treatment issues and may include all areas in which the patient would receive professional care; - Goals should be realistic, measurable, and with a time frame for completion or evaluation; - Care Plan approaches will be specific, individualized steps partners and patients will take together to assist the patient to achieve the goal; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure proper training documentation of staff responsible for administering peritoneal dialysis (PD) (a type of dialysis that uses the peritoneum (a membrane lining the cavity of the abdomen covering the abdominal organs) as the membrane through which fluid and dissolved substances will be exchanged with the blood) for one resident (Resident #1) out of one sampled resident. The facility census was 61. Record review of the facility's Dialysis-Peritoneal Catheter (a thin flexible tube that carries fluids into or out of the the body) and Site Care policy and procedure, undated, showed: - Designated partner will perform site care as ordered by the physician; - The objective will be to keep the skin clean and free of debris that might harbor bacteria; - The step by step site care explained; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident diagnosed with dementia (a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities) had a personalized plan of care to ensure services to promote the resident's highest level of functioning and psychosocial needs for one resident (Resident #36), out of three sampled residents. The facility census was 61. Record review of the facility's Documentation Guidelines for Patient Care Plans policy, revised on October 2021, showed: - Problems related to the patient condition, needs, or weaknesses which currently do, or potentially could, prevent the patient from achieving or maintaining the highest practicable level of well-being; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to label and store medications in a safe and effective manner. This had the potential to affect all residents. The facility census was 61. Record review of the facility's Administering Medications policy, revised [DATE], showed: - When opening a multi-dose container, the date opened shall be recorded on the container. Record review of the facility's Medication Storage in the Facility policy, revised [DATE], showed: - For products that require shortened expiration dates upon opening, the nurse will document the date opened on the label; - Medication rooms, carts, and medication supplies will be locked when not attended by persons with authorized access. 1. Observation on [DATE] at 2:10 P.M., of the medication cart on C hall showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure trash receptacles were covered. The facility census was 61. Record Review of the facility's Safety and Sanitation Best Practice Guidelines for Waste Management, dated November 2017, showed: - Receptacles and waste handling units shall be kept covered if the receptacles and units contain food residue and not in continuous use or after filled. 1. Observation of the main kitchen on 9/21/22 at 10:43 A.M., showed: - An uncovered 32 gallon trash can located near the food preparation table and sink, filled with trash near the rim; - An uncovered 32 gallon trash can located in the dishwashing area filled with trash near the rim. 2. Observation of the main kitchen on 9/22/22 at 11:29 A.M., showed: - An uncovered 32 gallon trash can located near the food preparation table and sink, filled with trash near the rim; [...]

Inspectors wroteBased on interview and record review, the facility failed to document accurate immunization status, provide information and education to each resident or the resident's representative of the influenza vaccine (a vaccine used to protect against influenza), pneumococcal vaccines (a vaccine used to protect against pneumonia bacteria) for five residents (Residents #5, #24, #48, #50, and #259) out of five sampled residents. The facility's census was 61. Record review of the facility Patient Immunization policy, revised February 2022, showed: - Influenza recommend annually for all residents; - Pneumococcal recommended for resident 65 years and older; [...]