Nixa Nursing & Rehab

Inspectors wroteBased on interview and record review, the facility failed to ensure each resident's choice of to receive Cardiopulmonary Resuscitation (CPR - an emergency treatment that's done when someone's breathing or heartbeat has stopped) or not was consistently and clearly documented when staff documented conflicting CPR choice information for 10 residents (Resident #11, #12, #17,#23, #26, #30, #40, #41, #46 and #58) out of a sample of 16 residents. The facility census was 65. Review of the facility's policy and procedure titled, Advanced Directives from the Nursing Guidelines Manual, undated, showed the following: -The facility will respect advance directives in accordance with state law; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all allegations of possible misappropriation were reported to the State Survey Agency (Department of Health and Senior Services, DHSS) within the required 24-hour time frame when staff failed to report an allegation of misappropriation of property made by one resident (Resident #122). The facility census was 65. Review of the facility's policy titled Reporting - Abuse Policy, undated, showed the following: -It is the policy of the facility that each resident will be free from abuse. Abuse can include verbal, mental, sexual, or physical abuse, misappropriation of resident property and exploitation, corporal punishment, or involuntary seclusion. The facility will strive to educate staff and other applicable individuals in techniques to protect all parties; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete investigations of all allegations of misappropriation when staff failed to investigate one resident's (Resident #122) allegation of misappropriation. The facility census was 65. Review of the facility's policy titled Investigation, undated, showed the following: -It is the policy of this facility that reports of abuse (mistreatment, neglect, or abuse, including injuries of unknown source, exploitation, and misappropriation of property) are promptly and thoroughly investigated; -The investigation is the process used to try to determine what happened. The designated facility personnel will begin the investigation immediately. A root cause investigation and analysis will be completed; -The facility staff will complete an active search for missing item(s) including documentation of investigation; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a medication error rate of less than 5% when the facility staff made three errors out of 26 opportunities resulting in an error rate of 11.53% when staff failed to prime the insulin pens for three residents (Resident #1, #2, and # 3), failed to follow manufacturer recommendations to ensure the full dose of insulin was administered for three resident(Resident #1, #2, and #3), and staff failed to ensure one resident (Resident #3) had meal intake within 30 minutes of insulin administration during two medication pass observations. The facility census was 62. Record review of a facility document titled Medication, Administration Guidelines, dated March 2015, showed the following: [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure residents were free of significant medication errors when staff failed to prime the insulin pens for three residents (Resident #1, #2, and # 3) during one medication pass observation and failed to follow manufacturer recommendations to ensure the full dose of insulin was administered for three residents during two mediation pass observations (Resident #1, #2, and #3). The facility census was 62. Record review of a facility document titled Medication, Administration Guidelines, dated March 2015, showed the following: -It is the purpose of this facility that residents receive their medication on a timely basis and in accordance with establish policies; [...]

Inspectors wroteBased on observation and interview, the facility failed to post daily nurse staffing information, in a clear and readable format, in a prominent place readily accessible to residents and visitors. The facility census was 62. 1. Observation on 9/12/2022, at 1:25 P.M., showed the nurse staffing information not posted at the nurses' station, the front desk, or any other common areas. Observation on 9/13/2022, at 10:53 A.M., showed the nurse staffing information not posted at the nurses' station, the front desk, or any other common areas. Observation on 9/14/2022, at 11:39 A.M., showed the nurse staffing information not posted at the nurses' station, the front desk, or any other common areas. Observation on 9/15/2022, at 2:22 P.M., showed the nurse staffing information not posted at the nurses' station, the front desk, or any other common areas. [...]

Inspectors wroteBased on record review and interview, the facility failed to notify the resident and the resident's representative in writing of a transfer or discharge to the hospital, including the reason for the transfer for two residents (Resident #19 and Resident #48), and failed to provide the ombudsman (a resident advocate who provides support and assistance with problems and/or complaints regarding the facility) a copy of the notification for two residents (Resident #19 and Resident #48). A sample of 16 residents selected for review. The facility census was 47. Record review of the facility policy titled, Discharge/Transfer of Resident, dated March 2015, showed the following information: -Obtain physician order for transfer unless it is a 991 emergency; [...]

Inspectors wroteBased on interview and record review, the facility failed to inform residents and families/legal representatives of the facility bed hold protocol at the time of transfer to the hospital for two residents (Resident #19 and #48). A sample of 16 residents selected for review. The facility census was 47. Record review of the facility's undated policy titled, Bed Hold Guidelines, showed the following information: -The facility will notify all residents and/or their representative of the bed hold guidelines. This information shall be given on admission to the facility, at the time of transfer to the hospital, and at the time of non-covered therapeutic leave; -The facility guidelines for bed holds are as follows: -Medicare Part A-Medicare does not pay for any type of bed hold. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly disinfect glucometers (small hand-held devices that check blood glucose (sugar) levels for residents) while collecting blood glucose samples on residents with diagnoses of diabetes mellitus (a chronic disease that affects how a person's body utilizes insulin and controls glucose levels in the blood). This practice involved three residents (Resident #46, Resident #3, and Resident #11) out of a sample of three. The facility census was 47. Record review of the Centers for Disease Control and Prevention (CDC) website showed the following information: -Blood glucometers approved for use for more than one person must be cleaned and disinfected. [...]