NHC Healthcare, Maryland Heights

Inspectors wroteBased on interview and record review, the facility failed to follow their Abuse Policy when they failed to notify the Department of Health and Senior Services (DHSS) following an allegation one resident was hit by a staff (Resident #1). The sample size was five. The census was 200. Review of the facility's policy for Allegations/Incidents of Abuse, Neglect, Misappropriation of Property and Exploitation, revised on 2/1/23, showed:-Definition: Abuse, Neglect, Misappropriation of Patient Property and exploitation, as hereafter defined, will not be tolerated by anyone, including staff, patients, consultants, volunteers, family members or legal guardians, friends, visitor or any other individual in this center. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure three-compartment sink sanitizer levels were at the appropriate levels and failed to use appropriate chemicals as a substitute. The facility also failed to ensure dietary staff stored scoops in a sanitary manner when scoops were observed inside containers of food products. This failure had the potential to affect all facility residents. The facility census was 200. 1. Observation and interview on 3/19/26 at 12:56 P.M., showed the Dietary Manager tested the sanitizing solution in the three-compartment sink with the facility's test strips. The test strip changed from light blue to light yellow upon entering the water. The Dietary Manager said the light yellow on the strip did not show the amount of sanitizing solution in parts per million (ppm) on the container, so the ppm level was unknown. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure services provided met professional standards when staff failed to clarify wound care orders for one resident (Resident #140) and failed to provide wound care per physician orders for one resident (Resident #195). Five residents with wounds were chosen for an in-depth review and issues were found with two. The sample was 35. The census was 200. Review of the facility's Medication and Treatment Orders policy, dated revised April 2014, showed:-Medication shall be administered only upon the written order of a person duly licensed and authorized to prescribe such medications in this state;-The signing of orders shall be by signature or personnel computer key. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure drugs and biologicals were stored in accordance with acceptable standards of practice. The facility identified four medication rooms and eight medication/treatment carts. Two medication rooms and five medication/treatment carts were checked for medication storage. Issues were found in both medication rooms and three medication/treatment carts. Staff failed to dispose of expired medications and treatment supplies and failed to date opened insulin pens and over-the-counter (OTC) medications. The sample was 35. The census was 200. Review of the facility's Medication Storage policy, revised 2/25/25, showed:-Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a clean and homelike environment when staff failed to ensure furniture in the common area on the Ivy hall was free from visible soiling and stains. The facility failed to ensure resident rooms on the Meadow unit were adequately supplied with toilet paper and hand towels, and to ensure toilets were maintained with all standard parts. The sample was 35. The census was 191. Review of the facility's Procedures for Housekeeping, undated, showed: -When you enter the room: --Fill soap and paper towel dispensers. 1. Observations on 5/1/24 at 10:24 A.M., 5/2/24 at 7:20 A.M., and 5/3/24 at 6:40 A.M., showed four rocking recliners and a navy blue plaid couch located on the Ivy Hall in the common area. The recliners had worn arm rests, cracked and faded seats. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff took appropriate precautions to prevent potential injury while assisting one resident in propelling their wheelchair (Resident #45). The facility failed to ensure a shower room floor was clear of trip hazards for one resident at risk of falls (Resident #77). The facility failed to ensure chemicals were stored properly on the Meadow memory care unit, where the facility identified 20 out of 27 residents with wandering behavior, including one resident with known behavior of rummaging (Resident #4). The facility failed to ensure chemicals were stored properly in the 300 hall shower room and to ensure cleaning chemicals were utilized in a manner to prevent potential injury (Resident #45). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that medications kept in the facility medication rooms and on medication carts were within the date of expiration, for 2 of 4 medication rooms checked and 2 of 7 medication/treatment carts checked. The facility census was 191. 1. Review of the facility's Medication Storage in the Facility policy, revised in [DATE] showed: -Medications and biologicals are stored safely, securely, and properly, following manufacturers recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff performed hand hygiene during meal service in the main dining room. The census was 191. The sample was 35. Review of a Texas Health and Human Services document the facility used to in- service staff on hand washing, dated 12/2022, showed: -Key elements: Infection control in dining and meal service is important to prevent the spread of infectious diseases to vulnerable people living in long term care facilities. -Best practices include but are not limited to: Hand hygiene performed prior to and during meal service by facility staff, hand hygiene any time contact is made with contaminated surfaces. 1. Observation on 5/1/24 at 12:19 P.M., showed (Certified Nursing Assistant) CNA F picked up two clothing protectors and placed them on two different residents. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure respiratory services were provided, consistent with professional standards of practice for one resident (Resident #81) when staff failed to follow the facility policy and obtain physician orders related to cleaning the resident's Bi-level Positive Airway Pressure (BiPAP, non-invasive ventilation therapy). Three residents were sampled with BiPAP machines. The sample was 35. The census was 191. Review of the facility's Non-invasive Positive Pressure Ventilation Continuous Positive Airway Pressure (CPAP), a device that uses mild air pressure to keep breathing airways open while sleeping, BiPAP policy, revised July, 2014, showed: -Purpose: -The purpose of a CPAP and BiPAP are to: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to obtain laboratory services to meet the needs of the residents by failing to ensure the quality of the labs obtained when staff failed to follow manufactures directions for blood glucose (sugar) test strips to ensure accurate results. The census was 191. Review of the facility's Centers for Medicare and Medicaid Services (CMS) Clinical Laboratory Improvement Amendments (CLIA) certification of waiver, effective 9/1/22 and expiration 8/31/24, showed: -Laboratory name and address, listed the facility name and address; -The above named laboratory located at the address shown hereon may accept human specimens for the purpose of performing laboratory examinations or procedures. [...]

Inspectors wroteBased on interview and record review, the facility failed to perform an annual review of code status, full code (if the heart stops beating or breathing ceases, all life-saving methods are performed) or no code (do not resuscitate, no life prolonging methods are performed), for eight of 35 sampled residents (Residents #20, #22, #75, #86, #107, #122, #134, and #138). The census was 190. Review of the facility's Advanced Directives policy, revised 1/2013, showed the policy failed to include the process to ensure advanced directives are to be reviewed annually. 1. Review of Resident #20's electronic medical record (EMR), showed -admission date, 9/1/20; -Advanced directives dated 9/2/20; -No documented annual review of the advanced directives for 2021 and 2022. 2. Review of Resident #22's EMR, showed: -admission dated, 5/31/18; -Advanced directive dated 7/27/21; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a personal inventory sheet was completed upon admission to track residents' personal belongings brought in to provide a homelike environment and assist in investigating missing items, for four residents (Resident #107, #112, #52 and #315 ) and failed to update an inventory sheet for one resident (Resident #143). The sample was 35. The census was 190. Review of the facility's Personal Inventory Sheet Policy, undated, showed the personal inventory sheet should be completed, dated, and signed by staff member and patient or family member on the day of admission. If unable to obtain the appropriate signature, the reason must be charted on the form. Professional title should follow signature of the staff member. 1. Review of Resident #107's medical record, showed: -admit date [DATE]; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to complete the controlled substance inventory sheets appropriately to maintain accurate accountability of the inventory of all controlled substances administered at all times. The facility had incomplete controlled substance sheets for three of six narcotic count sheets sampled. The sample size was 35 and the census was 190. Review of the medication ordering and receiving controlled substances policy, revised 1/1/19, showed: -Policy: medications included in the drug enforcement administration (DEA) as controlled substances and medications classified as controlled substances by state law are subject to special ordering, receipt and record keeping requirements by the facility in accordance with federal and state laws and regulations; -Controlled substances will be tracked from delivery to disposition: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to storage drugs and biologicals in accordance with State and Federal laws, when narcotic medications were not stored in double locked compartments. In addition, staff pre-pulled medications and stored them unlabeled in the top drawer of the medication cart for two residents (Resident #134 and #47). For one of two medication room refrigerators reviewed and two of four medication carts reviewed. The census was 190. Review of the medication ordering and receiving controlled substances policy, revised 1/1/19, showed: -Policy: [...]

Inspectors wroteBased on interview and record review the facility failed to ensure all staff providing services to residents within the facility were fully vaccinated against COVID-19 or had an approved exemption. The facility had a vaccination rate of 98.9% of staff fully vaccinated or with an approved exemption and had no resident infections in the last four weeks. The facility had 285 staff members. Of those, three staff members had not completed a vaccination series and had not been approved for an exemption. The facility census was 190. Review of the facility's staff vaccination policy, revised 4/25/22, showed: -Purpose: to ensure all staff have received the final dose of a primary vaccination series by the Phase Two effective date of March 15, 2022; -Staff who do not receive the COVID-19 vaccination are considered to be at-risk for transmitting COVID-19 to other staff and patients; [...]