Norseland Nursing Home

Inspectors wroteBased on observation, interview, and record review, the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. This has the potential to affect 34 of 34 residents. Surveyor observed food to have been removed from the original packaging and not dated with an expiration date, an open date, or a use by date. Surveyor observed undated and expired seasoning to be in circulation. Evidenced by: The Wisconsin Food Code 2020 states, in part, at 3-501.17 .(D) A date marking system that meets the criteria stated in (A) and (B) of this section may include: . [...]

Inspectors wroteExample 3 On 6/16/25 at 12:15 PM, Surveyor interviewed R8 who indicated that the ham they were having today, as well as beef and meats in general, are tough. R8 indicated the staff will assist with cutting but they can't help chew it. Based on observation, interview and record review, the facility did not ensure that each resident receives food and drink that is palatable and at a safe and appetizing temperature. This has the potential to affect 4 of 14 sampled residents (R27, R32, R11, and R8). R27 voiced concerns with her food being cold. R11 voiced concerns with food being cold. R32 voiced concerns with food being cold and tough to chew. R8 voiced concerns with meats being tough to chew. Surveyors conducted 2 test trays; both were not palatable. Evidenced by: Facility policy, entitled Infection Control - Preparing and Cooking Foods, last revised 7/20/2016, includes, in part: . [...]

Inspectors wroteBased on interview and record review, the facility did not ensure a resident maintains acceptable parameters of nutritional status and weight. This affected 1 (R24) of 5 reviewed for nutrition and hydration. R24 did not receive cueing/reminders during meal times per her plan of care and R24 has had a significant weight loss over the last 6 months. Evidenced by: The facility policy, titled, Nutrition Support, dated 5/22/17, states, in part: I. Inadequate Oral Intake A. The Registered Dietician or Nursing staff will offer oral commercial nutrition supplements to residents with inadequate oral intake . III. Initiation of Nutrition Support A. The Physician's Order for nutrition support will be communicated to the Nutrition Services Department by Nursing . [...]

Inspectors wroteBased on observation, interview, and record review, the facility did not ensure adequate supervision and safety to prevent accidents from occurring for 1 of 3 residents reviewed (R30) of a total sample of 15. R30 has a history of multiple falls. Facility staff did not implement and/or follow through on fall interventions. R30 had two falls with major injury: one unwitnessed fall that resulted in a 1.5 cm head laceration over left eyebrow with 2 stitches placed and another unwitnessed fall that resulted in a closed fracture of rib on left side. This is evidenced by: Facility Fall Prevention Policy and Procedure, dated 12/31/2009 with last revision date of 7/29/21 states in part: [...]

Inspectors wroteBased on observation, interview, and record review, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, this has the potential to affect the total census of facility, 42 residents. The facility allowed staff to return to work too soon after reporting respiratory symptoms and were not requiring staff to be tested for COVID-19 per Centers for Disease Control and Prevention (CDC) guidance. The facility allowed staff to return to work too soon after gastrointestinal (GI) symptoms. This is evidenced by: The facility's policy titled Infection Control Measures for Acute Respiratory Illness Outbreak revised on 10/19/23 states in part .3. Surveillance 1. [...]

Inspectors wroteBased on interview and record review, the facility did not ensure a resident with limited range of motion receives appropriate treatment and services to increase their range of motion and/or to prevent a further decrease in range of motion for 3 of 16 total sampled Residents (R7, R8, R16) and 1 of 1 supplemental resident's (R31). R8 has therapy recommendations for restorative therapy including the [NAME] Med bike four times weekly for twelve minutes and passive range of motion exercises daily that are not being completed. R16 has orders to participate in a walking program twice a day-AM (morning) and PM (evening), CGA (contact guard assist) with four-wheeled walker, wheelchair to follow-distance as tolerated that is not being completed. R31 is on the restorative walking program and the facility does not have documentation to show R31 is being walked. [...]

Inspectors wroteBased on record review and interview, the facility did not ensure that Physician Orders were signed and dated timely for 4 of 19 residents (R7, R5, R2, R16) and 1 supplemental resident reviewed for physician orders. R5's telephone orders are not signed by a physician. R7's telephone orders are not signed by a physician. R2's physician telephone orders were not signed and dated by a physician in a timely manner. R16's physician telephone orders were not signed and dated by a physician in a timely manner. Evidenced by: The facility policy, entitled Physician Services, dated 4/1/24, states, in part: . Policy: It is the responsibility of Norseland Nursing Home to ensure that physician services are available to the residents of this facility. Procedure: I. Physician Services 483.30 . 3. Physician Visits- The Physician must: a. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that all residents were able to formulate an advance directive, specifically related to code status, for 1 of 19 sampled residents (R5) reviewed for advance directives. The facility does not have R5's advance directives in her medical record. Evidenced by: The facility policy, entitled POLST (Physician Orders for Life Sustaining Treatment)/Advance Directives, dated 2/1/22, states, in part: . Advance Directives: 1. Upon resident move in, the Social Worker will determine if the resident has any advance directives (i.e., Power of Attorney for Health Care, Power of Attorney for Finances). 2. [...]

Inspectors wroteBased on interviews and record reviews, and facility policy review, the facility failed to develop and implement a baseline care plan within 48 hours of admission that included the minimum healthcare information necessary to properly care for R36's immediate needs related to his mental health diagnosis upon admission for one of three residents (Resident (R) 36) of 15 sampled residents.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure physician's orders were followed according to professional standards for one resident (R) out of 19 sampled (R16). Specifically, the facility failed to follow physician daily weight orders and orders to check R16's O2 saturation on room air every shift to wean R16 off oxygen. This had the potential to cause R16 not to receive the necessary care for treatment of R16's congestive heart failure (CHF) and the use of unnecessary oxygen.

Inspectors wroteBased on staff interview and record review, the facility did not ensure that pain management was provided consistent with standards of practice for 1 of 2 residents reviewed (R7) reviewed for pain out of a total sample of 15. R7 has orders for scheduled Tylenol and Tramadol pain medication. R7 has pain in left knee and Polyosteoarthritis. Facility has not been assessing pain with scheduled pain medications to track effectiveness of medications. Evidenced by: The facility policy, entitled Pain Assessment and Monitoring, dated 4/1/24, states, in part: . Purpose: To provide care and services to attain or maintain optimal comfort and pain management from acute and/or chronic medical conditions. Procedure: 1. Evaluate the resident for signs/symptoms that may indicate the need for pain management . 3. Documentation will include, but not be limited to: [...]

Inspectors wroteBased on interviews and record reviews, and facility policy review, the facility failed to provide medically related social services for one of three residents (Resident (R) 36) related to his mental health diagnosis and physician recommendation upon admission of 15 sampled residents.

Inspectors wroteBased on interview and record review, the facility did not ensure that drug regimens are free of unnecessary psychotropic medications, and that a resident taking a psychotropic medication has a care plan that includes targeted behaviors and side effects for 2 of 5 residents (R32 and R36) reviewed for unnecessary medications. R32 was started on Clonazepam (sedative) for involuntary body movements and Citalopram (antidepressant) for Major Depressive Disorder. R32 does not have a diagnosis for Major Depressive Disorder and the care plan contained no mood or behavior monitoring to assess the effectiveness of these medications or any potential side effects. R36 did not have targeted behavior monitoring. Evidenced by: [...]

Inspectors wroteBased on record review and interview, the facility did not have evidence that residents or their responsible parties received timely Notice of Medicare Non-Coverage for 2 of 3 residents reviewed (R28 and R33). R28 and R33 did not sign the Notice of Medicare Non-Coverage. This is evidenced by: The facility policy titled, SNF Advanced Beneficiary Notice/Notice of Medicare Non-Coverage Policy, last reviewed 4/01/24, states in part . Purpose: To inform resident of their rights when being discharged from a Medicare Part A/Medicare Advantage covered stay, regardless of whether they remain in the facility or not. Medicare beneficiaries have specific rights and protections related to financial liability and the right to appeal a denial of Medicare services under the Medicare program. Procedure: 1. [...]

Inspectors wroteBased on interview and record review the facility must develop policies and procedures to ensure that residents and/or resident responsible party receives education regarding the benefits and potential side effects of the immunization prior to offering the immunization and documentation is noted in the medical record on whether the resident received or declined the immunization, this affected 4 of 5 residents (R28, R95, R31, R5) reviewed for influenza immunizations and 1 of 5 residents (R31) reviewed for pneumococcal immunizations of 12 sampled residents. R28 did not have the influenza immunization and no documentation. R95 did not have the influenza immunization and no documentation. R31 did not have the influenza and the pneumococcal immunization and no documentation. R5 did not have the influenza immunization and no documentation. [...]

Inspectors wroteBased on interview and record review the facility failed to consult with the physician related to a significant change of condition for 2 of 3 residents (R4 and R19) reviewed for physician notification. The facility did not consult with R4's physician nor notify her APOAHC (Activated Power of Attorney for Health Care) when R4 experienced a 7.48% decrease in her weight on 1/2/23, 6.03% decrease on 1/16/23, 10.67% on 1/24/23 and 9.7% decrease on 1/30/23. R19's provider was not updated timely of his weight loss and gain. This is evidenced by: The facility policy titled, Weights, dated 7/23/13 states, in part, as follows: Purpose: To identify and provide nutritional interventions to maintain control of weight loss or gain in residents. Weight will be monitored and assessed to prevent avoidable weight loss and/or weight gain. Significant Change is defined as: [...]

Inspectors wroteBased on interview, observation and record review, the facility did not ensure that a resident with limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion for 1 of 5 residents (R15) reviewed for range of motion, of a total sample of 15 residents. R15 did not regularly receive her restorative therapies and the facility did not reassess resident to ensure the program was effective and the resident did not experience a decline in range of motion.

Inspectors wroteBased on interview and record review the facility must develop policies and procedures to ensure that residents or their responsible party receive risk and benefits of COVID immunizations, are offered the immunization and documented in the medical record whether the immunization was received or declined, this affected 3 of 5 residents (R28, R95, and R31) reviewed for immunizations of 12 sampled residents. R28 did not have the COVID immunizations offered and no documentation. R95 did not have the COVID immunizations offered and no documentation. R31 did not have the COVID immunizations offered and no documentation. This is evidenced by: The facility did not provide a policy and procedure that speaks of COVID immunizations for the residents. Example 1 R28 was admitted to the facility on [DATE]. [...]