Northwood Hills Care Center

Inspectors wroteBased on interview and record review, the facility failed to provide care per standards of practice when staff failed to document monitoring after a fall for three residents (Resident #2, #3, and #4) and failed to inform management of a fall for one resident (Resident #2) who was later found to have a fracture due to the fall. The facility census was 82. Review of the facility's policy, Incident and Reportable Event Management, revised 02/24/26, showed the following:-A fall refers to unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force (example, resident pushes another resident). An episode where a resident lost his/her balance and would have fallen, if not for another person or if he or she had not caught him/herself, is considered a fall. A fall without injury is still a fall. [...]

Inspectors wroteBased on interview and record review, the facility failed to appropriately bill the resident's appropriate Medicare plan during their stay resulting in an overpayment and failed to reimburse the resident 30 days after discharge for the over payment for one resident (Resident #5). The facility census was 82. Review of the facility's policy, Credit Balance and Refund Policy, revised 02/06/26, showed the following:-The purpose of the policy was to provide guidance on managing credit balances efficiently and to ensure accounts with credit balances due to overpayments are refunded in a timely manner and as required by law. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to maintain effective and complete an infection prevention and control program when staff failed to follow appropriate Enhanced Barrier Precautions (EBP - an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDRO - bacteria or fungi that have developed resistance to multiple classes of drugs, like antibiotics) that employs targeted gown and glove use during high contact resident care activities) for one resident (Resident #1) with an indwelling catheter (tubing placed to drain the bladder to outside the body), a nephrostomy tube (tubing placed to drain the kidney to the outside the body) and with two wounds present. The facility census was 82. [...]

Inspectors wroteBased on interview and record review, the facility failed to report all allegations of potential abuse immediately to facility management and to the State Survey Agency (Department of Health and Senior Services - DHSS) within two hours when staff did not report an allegation of employee to resident verbal abuse towards one resident (Resident #1) in a timely fashion as required. The facility census was 94. Review of the facility policy, titled Area of Focus: Abuse and Neglect, review date of 11/24, showed the following: -Each resident had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation of any type by anyone; -Residents must not be subjected to abuse by anyone, including staff; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure three nurse aides (NA) (NA I, NA P, and NA Q) completed a certified nurse aide (CNA) training program and obtained certification within four months of employment at the facility as a nurse aide. The facility census was 90. Review of the facility policy titled Nurse Aide Requirements, undated, showed the following: -The facility needed to ensure the nurse aides meet the training requirements to work within a facility including a state approved training and competency program; -The facility must not use any individual working in the facility as a nurse aide for more than four months, on a full-time basis unless that individual is competent to provide nursing and nursing related services and has completed a training and competency evaluation program; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was stored, prepared, and served in a manner to protect the food from possible contamination when staff failed to keep the ice machine vents, air vents, and a standing fan free of lint, debris, and grime; when staff failed to label and date refrigerated food and failed to dispose of outdated refrigerated food; and when staff failed to ensure the dishwasher rinsed the dishes at the recommended temperature and failed to ensure the chemical solution was tested properly. This had the potential to affect all residents who consumed food from the facility kitchen. The facility had a census of 90 residents. 1. Review of the 2013 Missouri Food Code showed food shall be protected from contamination by storing the food in a clean, dry location where it is not exposed to splash, dust, or other contamination. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a clean and homelike environment when staff failed to maintain the shower wall and floor tiles and mop areas in four facility shower rooms; failed to maintain the wall and grab bar integrity in one shower room; failed to maintain the wall and mop board area in the 200/400 hall sitting area; failed to adequately clean resident and make free of odors bathroom toilet area for two resident (Resident #20 and Resident #33); and failed to adequately clean and maintain the resident room sinks faucets and mirrors for four residents (Resident #20, Resident #33, Resident #36 and Resident #71). The facility census was 90. Review of a facility's policy entitled Plant Operations, reviewed 06/12/24, showed the following: [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure each resident or resident's representative was notified in writing of each transfer when staff failed to provide a written notice of transfer to a hospital, including the reasons for the transfer, for four residents (Residents #81, #67, #45, and #12). The facility census was 90. Review of the facility's policy titled, Transfers and Discharges, dated 09/05/24, showed the facility will provide transfer/discharge notice to the resident/responsible party in accordance with federal regulations. 1. Review of Resident #81's face sheet (a document that gives a resident's information at a quick glance) showed an admission date of 02/20/24. [...]

Inspectors wroteBased on interview and record review, the facility failed ensure each resident received a bed-hold notice upon transfer when staff did not provide a bed-hold notice to four residents (Residents #81, #67, #45, and #12) when they transferred/discharged to the hospital. The facility census was 90. Review of the facility's policy titled, Bed Hold Policy, revised 11/17/22, showed the following: -The bed hold policy should be given upon admission, upon transfer to the hospital, or if the resident goes on therapeutic leave of absence; -Before the facility transfers a resident to hospital, the nursing facility must provide written information to the resident or representative the specifies duration of state bed hold policy during which the resident is permitted to return and resume residence in the facility; the reserve bed payment policy in the state plan; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow approved menus to ensure the nutritional needs of all residents were met when staff failed to provide the approved serving sizes for meals and failed to prepare pureed diets per approved recipes. The facility census was 90. Review showed the facility did not provide a policy related to pureed meals or portions sizes for meal service. 1. Review of the facility's menu spread sheet showed on 11/12/24 residents should have received two-fifths of a cup of mechanically altered and pureed ham and one-half cup of pureed vegetables. Observation on 11/12/24, at 11:55 A.M., showed the following: -Dietary [NAME] (DC) X placed one third cup scoops in the pureed ham, mechanical ham, and pureed vegetables; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was served was palatable and at temperatures that were appetizing for resident including four residents (Resident #36, #71, #72, ad #45) who often ate in their rooms. The facility census was 90. Review of the facility policy titled, Food Temperature Control, revised 06/28/24, showed the following: -Food temperatures are maintained during mealtimes to ensure residents received safe food served at acceptable temperatures; -Hot foods are held at a minimum of 135 degrees Fahrenheit (F) per state requirements; -Cold foods are held at or below 41 degrees per federal guidelines, unless the state requirements are more stringent; -Food should not be placed on the steam table more than 30 minutes before meal service begins; -Maximum length of time food is held on the steam table is four hours; [...]

Inspectors wroteBased on observation, record review, and interviews, the facility to maintain an effective infection control program when the facility failed to screen all staff for tuberculosis (a contagious infection that usually attacks the lungs) as required when the facility failed to ensure the first step of the two-step Tuberculin (TB) skin test was completed prior resident contact for four staff member (Registered Nurse (RN) D, Licensed Practical Nurse (LPN) E, Speech Therapist (ST) F, and RN G) of 10 sampled staff members; and when staff counted resident cigarettes eight times per day by touching the cigarettes with their bare hands for eight residents (Resident #13, #18, #22, #23, #41, #52, #59, #79) out of fifteen sampled residents that were on the smoking list. The facility had a census of 90. 1. [...]

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure each resident was treated with dignity and respect when staff spoke to one resident (Resident #72) in a threatening manner. The facility had a census of 90. Review of the facility policy titled Resident Rights, dated 09/10/24, showed the following: -The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility; -A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his/her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident; -The resident has the right to be treated with dignity and respect. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide trauma-informed care in accordance with standards of practice when staff failed to identify, assess, care plan, and provide supportive interventions for two residents (Resident #72 and #6) 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 two sampled residents. The facility's census was 90. Review showed the facility did not provide a policy related to Trauma Informed Care (a model of care that acknowledges the impact of trauma on people's lives and aims to provide effective services). Review of the facility's policy titled Resident Rights, dated 09/10/24, showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care per standards of practice when the facility failed to complete timely assessments/reassessments of side rail use, failed to obtain physician's orders for side rail use prior to side rail use, and failed to obtain full informed consent prior to side rail use for two residents (Resident #77 and #70). The facility also failed to care plan the use of side rails and failed to document risk/benefits and alternatives attempted prior to side rail use for one resident (Resident #77). The facility census was 90. Review of the facility policy titled Bed Rails - Safe and Effective Use of Bed Rails, dated 11/16/21, showed the following: -The facility must attempt to use appropriate alternatives prior to installing a side or bed rail; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide all residents food that accommodated each residents' allergies, intolerances, and preferences, when staff served one resident (Resident #36) food items containing an ingredient identified as an allergen/dislike on the resident's meal ticket and when staff served one resident (Resident #38) food items the guardian had requested not be served to the resident. The facility census was 90. Review of the facility policy titled, Food Allergies and Intolerances, revised 04/25/23, showed the following: -The Director of Food and Nutrition Services obtains food preferences, including any food allergies and intolerances upon admission; -Each resident receives, and the facility provides food that accommodates resident allergies, intolerances, and preferences; [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain an effective system of records and disposition of controlled medication when staff could not locate three cards of controlled medications and documented administration of the medication when it was not available for administration one resident (Resident #1). The facility census was 81. Review of the facility policy titled, Administration of Medication, last revised 02/23/23, showed the following: -The facility will ensure medications are administered safety and appropriately per physician order to address resident's diagnoses and signs and symptoms; -Medication administration is the responsibility of those individuals who through certification and licensure are authorized in their state to administer medications in a skilled nursing facility; [...]

Inspectors wroteBased on interview, observation, and record review, the facility failed ensure all food was protected from possible contamination during storage, preparation, and distribution when staff stored dented cans with other cans of food to be used in food service; stored dishes in a manner that trapped moisture; had unpasteurized eggs purchased and in the cooler for use; and failed to keep food free of contaminates when foil was stirred into noodle. The facility had a census of 88. 1. Record review of the 2017 Food Code, issued by the Food and Drug Administration, showed the following information: - Food packages should be in good condition and protect the integrity of the contents so the food is not exposed to potential contamination; - Food held for credit, such as damaged products, should be segregated and held in an area separate from other food storage. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure a clean and homelike environment when staff failed to adequately clean resident bathroom floors for ten residents (Resident #5, #8, #19, #21, #29, #37, #45, #47, #48, and #51); failed to adequately clean resident bathroom ceiling for two residents (Resident #5 and #51); failed to adequately clean and maintain the resident room sinks for five residents (Resident #8, #21, #29, #37, and #47); failed to maintain toilets in good working order for three residents (Resident #49, #63, and #69); failed to maintain the shower floor tile in one facility shower room; and failed to maintain the tiles and mop board areas for five residents (Resident #8, #19, #29, #37, and #48). The facility census was 88. Record review of the facility policy titled Housekeeping Services, dated 8/9/22, showed the following information: [...]

Inspectors wroteBased on interview and record review, the facility failed to complete the required Preadmission Screening and Resident Review (PASARR - a two level tool used to screen each resident in a nursing facility for a mental disorder or intellectual disability prior to admission) for two residents (Resident #28 and #51) and failed to complete a level two screening for one resident (Resident #68), prior to or upon admission to the facility, to ensure the resident received appropriate care and service. The facility census was 88. Record review showed the facility did not provide a policy regarding PASARRs. 1. Record review of Resident #28's face sheet (brief information sheet about the resident) showed the following information: -admission date of 3/20/2018; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a medication error rate of less than 5% when staff made seven errors out of 25 opportunities, resulting in an error rate of 28%, when staff failed to hold insulin injectable pens in place for for the recommended time following administration for two residents (Residents #73 and #67), failed to administer medication with orange juice for one resident (Resident #29), and failed to crush medications for one resident (Resident #61). The facility census was 88. Record review of a facility policy entitled Insulin Pen Administration, dated 8/10/2022, showed the following: -The facility will ensure residents with orders for insulin administration through the use of a pen delivery device is performed in accordance with current standards of practice and manufacturer's guidance; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow acceptable standards of practice for infection control when staff did not perform appropriate hand washing before, during, or after incontinent care for four residents (Resident #6, #40, #48, and #51) and when staff failed to properly clean and disinfect glucometers (machine used to test blood glucose levels) between use for four residents (Residents #8, #29, #67 and #73). The facility had a census of 88. 1. Record review of the facility policy, Perineal (the skin in between the genitals (external reproductive organ) and anus (opening through which solid waste leaves the body)) Care of the Female Patient, dated 8/22/2022, showed the following information: -After cleaning the perineum, perform hand hygiene, apply new gloves, and apply moisture-barrier skin protectant as needed; [...]

Inspectors wroteBased on interview, observation, and record review, the facility failed to maintain a sanitary environment when staff failed to maintain vents and non-food contact surfaces clean and free of debris. The facility census was 88. Record review of the Food and Drug Administration (FDA) 2013 Food Code showed the following information: -Non-food contact surfaces shall be kept free of an accumulation of dust, dirt, food residue, or other debris. 1. Observation of the kitchen on 2/26/2023, at 9:30 A.M., showed the following: -The ice machine filter, which covered a vent on the front of the machine, was covered in a black, fuzzy substance; -In some places the black, fuzzy substance was moving with any motion of air. Observation of the kitchen on 2/26/2023, at 9:35 A.M., showed the following: -Four ceiling vents above the doors to enter the kitchen and the ice machine; [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to treat each resident with dignity and respect when staff incorrectly spelled one resident's name (Resident #8) on the room name tag causing him/her to be called by the wrong name. The facility census was 88. Record review of the facility policy entitled Area of Focus: Resident Rights, dated 11/21/22, showed the following information: -A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. 1. Record review of Resident #8's face sheet (brief information sheet about the resident) showed the following information: -Most recent admission date of 3/4/22; -The resident's name spelled correctly on the face sheet. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an environment as free from accident hazards possible, when staff attempted to place one resident (Resident #5) on a scale in a unsafe manner. The facility census was 88. Record review of the facility policy titled Weight Monitoring, Long-Term Care, dated 8/19/22, showed the following: - Staff should gather equipment including a scale (a type that is appropriate for the resident's condition, such as standing, wheelchair, lift, or bed), gloves, and facility-approved disinfectant; -Staff should follow the facility guidelines for obtaining weight measurements (for example, time of day, before meals, with or without shoes) to ensure consistency among staff members; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure residents were free of significant medication errors when staff administered insulin to two residents (Residents #67 and #73) without holding the insulin pen in place the recommended time after injection. The facility census was 88. Record review of a facility policy entitled Insulin Pen Administration, dated 8/10/2022, showed the following: -The facility will ensure residents with orders for insulin administration through the use of a pen delivery device is performed in accordance with current standards of practice and manufacturer's guidance; -To verify that all insulin is injected, keep the pen needle in the subcutaneous fat layer for six to ten seconds after the injection with the thumb on the push button plunger. [...]

Inspectors wroteBased on record review, observation and interview, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards when staff failed ensure the range hood and range hood extinguishing system located over the stove where staff prepared and cooked resident food did not have a buildup of grease and lint; failed to ensure the sides, legs, and bottom shelves of prep tables and steam table did not have a buildup of grease and lint; and failed to protect food from possible contamination when staff failed to follow proper handling of dishes while serving food items. The facility census was 96. Record review of the 2013 Food and Drug Administration (FDA) Food Code showed: -Non-contact food surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris; [...]

Inspectors wroteBased on observation and interview, the facility staff failed to provide privacy, dignity, and respect for all residents when staff performed blood glucose testing on two residents (Resident #28 and #78) and an insulin injection on one resident (Resident #28) in the main dining room with random residents observing the procedures and when staff completed catheter (a sterile tube inserted into the bladder to drain urine) care with the room door open and privacy curtain not closed for one resident (Resident #71). A sample of 21 residents was selected and the facility census was 96. 1. Record review of Resident # 78's face sheet (general resident information) in the medical record showed the following: -admission dated of 3/9/16; -Diagnosis of diabetes mellitus (a disease that affects how a person's body handles insulin and glucose levels in the blood). [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure a clean and homelike environment when staff failed to clean shower rooms and a clean shower chair, failed to ensure one shower room was in good repair, failed to ensure one shower room door was free of scuff marks, and failed to ensure the kitchen floor was kept clean. The facility census was 96. 1. Observation on 11/05/19, at 3:21 P.M., of the shower room on the special care unit (SCU) showed black grime along the base of the tile and wall to the shower. The surveyor used a paper towel and the black grime came off the wall when wiped with a paper towel. The black grime appeared to be mold-like. The shower chair in the SCU shower had a build up of orange substance on the back of the chair and on various parts of the chair. The shower chair had a black substance on the chair between the back rest and the seat of the chair. [...]

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 for seven residents (Resident #15, #61, #69, #71, #79, #90, and #242). A sample of 21 residents was selected out of a facility census of 96. Record review of the facility's policy titled Transfers and Discharges, dated 5/06/19, showed the following information: -The facility ensures systems are implemented to provide written notification to the resident and resident representative prior to transfer. This written notification is provided on the Notice of Transfer or Discharge form. This information will be presented in a language and manner that the resident/resident representative can understand; -Obtain physician's order for the transfer unless it is a 911 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 a transfer to the hospital for seven residents (Resident #15, #61, #69 #71, #79, #90, and #242). A sample of 21 residents was selected out of a facility census of 96. Record review of the facility's policy, titled Bedhold/Reservation of Room, dated 5/02/19, showed the following information: -The bed-hold policy should be given upon admission, upon transfer of a resident to the hospital (if in an emergency within 24 hours), or if the resident goes on therapeutic leave of absence; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow up and notify the physician of low blood sugar levels for three residents (Resident #27, #38, and #61) and failed to document interventions of and responses to the residents' abnormal blood sugar levels for two residents (Resident # 27 and # 38). A sample of 21 residents was selected for review out of a facility census of 96. Record review of the facility's Hypoglycemia (low blood sugar) Policy, dated 10/4/19, showed the following: -Decreased levels of blood glucose (sugar) to the brain can lead to seizures, coma, and death; -Follow hypoglycemia prevention and management protocol as directed; -Monitor blood glucose levels as ordered; -Recheck glucose levels within 15 minutes of treatment, and continue or monitor glucose as ordered; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to adhere to professional standards when staff 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 a diagnosis of diabetes mellitus (a disease that affects how a person's body handles insulin and glucose levels in the blood). This practice affected four residents, Resident # 65, # 78, # 241, and # 242. The facility failed to administer the two-step tuberculin (TB) test timely and failed to document results in millimeters three residents (Resident #70, #71, and #90). The facility census was 96. 1. Record review of the Centers for Disease Control and Prevention (CDC) website showed the following: -Blood glucometers approved for use for more than one person must be cleaned and disinfected. [...]

Inspectors wroteBased on observation, interview, and record review, the facility's licensed staff failed to ensure the Emergency Kit (E-Kit) and the pharmacy form titled Security Lock Register matched the lock tag number on the E-Kit. The facility census was 96. 1. Record review of the document from the pharmacy titled Security Lock Register showed the following information: -On 9/18/19, staff signed the register that lock number 6260356 was taken off and a new lock number 6500499 was put on the E-Kit; -On 10/8/19, staff signed the register that lock number 6228305 was taken off and a new lock number 6500637 was put on; -On 10/14/19, staff signed the register that lock number 6228618 was taken off and a new lock number 6500637 was put on; -On 10/15/19, staff signed the register that lock number 6500637 was taken off and a new lock number 6500633 was put on; [...]

Inspectors wroteBased on observation and interview, facility staff failed to post required nurse staffing information, and failed to include the resident census, in a prominent place readily accessible to residents and visitors on a daily basis at the beginning of each shift. The facility census was 96. 1. Observation on 10/30/19, at 10:16 A.M., showed the nurse staffing not posted at the 100/300 or the 200/400 nurse station. Observation on 10/30/19, at 3:59 P.M., showed the nurse staffing hours posted on the wall behind the 200/400 nurse station. The posting did not contact the resident census. Observation on 10/31/19, at 3:14 P.M., showed the nurse staffing hours posted on the wall behind the 200/400 nurse station. The posting did not contain the resident census. Observation on 11/1/19, at 2:29 P.M., showed the nurse staffing hours posted behind nurse station was dated 10/31/19. [...]