Okeena Health and Rehabilitation Center LLC

Inspectors wroteBased on policy review, record review, job description review, and interview, the facility failed to ensure comprehensive nutritional assessments were completed timely by a dietitian for 2 of 3 (Resident #256 and Resident #259) residents reviewed for new admissions.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure food was stored, prepared, and served under sanitary conditions as evidenced by a dirty ice machine. The facility had a census of 88 residents.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infections when 1 of 14 staff (Certified Nursing Assistants (CNA) G) failed to properly remove their personal protective equipment (PPE) during dining services, when 2 of 15 staff (CNA F and Certified Occupational Therapist Assistant (COTA) BB) failed to properly disinfect reusable resident equipment before exiting an isolation room, and when 2 of 14 staff (CNA H and CNA I) failed to perform hand hygiene during dining.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to treat residents with respect and dignity when 1 of 13 (Certified Nursing Assistant (CNA) G) staff members stood over a resident (Resident #66) to assist with the meal, and when 2 of 13 (CNA M, CNA H) staff members observed during dining failed to use courtesy titles when addressing two residents (Resident #22, #26, and #83).

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to ensure a clean, safe, and sanitary environment in 7 of 64 (Resident #2, #12, #13, #30, #36, #51, #53, #54, #57, #62, #72, #73, #78, and #79) resident shared bathrooms when personal hygiene items were found unlabeled and uncontained.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to revise care plans for 4 of 18 (Resident #12, #38, #80, and #92) resident care plans reviewed for Pressure Ulcers, COVID, Transmission Based Precautions (TBP), and Influenza.

Inspectors wroteBased on policy review, medical record review, observation, and interview the facility failed to stage pressure wounds correctly for 1 of 2 (Resident #12) sampled residents reviewed for pressure ulcers.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure an environment free of accident hazards when sharps and hazardous personal items were found in 2 of 66 (Resident #2 and Resident #71) resident occupied rooms.

Inspectors wroteBased on document review and interview, the facility failed to post the scheduled total number of full-time employees (FTEs) scheduled to work a shift, and their total FTEs hours for 31 of 31 sampled days and failed to post the total actual hours worked by the licensed and unlicensed staff responsible for resident care on the facility's Today's Staffing form for 31 of 31 sampled days.

Inspectors wroteBased on policy review, review of the Pharmacy Products and Services Agreement, medical record review, review of facility drug destruction documentation, and interview, the facility failed to properly document narcotic medications signed in error or wasted, failed to document administration of narcotics on the Medication Administration Record (MAR), failed to identify and report discrepancies for the narcotic count, and failed to ensure drug destruction sheets were signed by a licensed pharmacist for 3 of 4 months ([DATE], [DATE], and [DATE]) of drug destruction documentation reviewed.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure medications were properly stored and secured when 1 of 1 staff member (Wound Nurse) left the treatment cart unlocked, unattended, and out of sight.

Inspectors wroteBased on policy review, United States Drug Administration (USDA) Refrigeration & Food Safety Chart review, observation, and interview, the facility failed to ensure food was stored, prepared, and served under sanitary conditions as evidenced by dust particles on the wall near the steam table and over a tray of dietary bowls, rust and dust particles on the vents over the steam table, when food items were stored opened and undated in the walk-in cooler, walk-in freezer and the reach-in refrigerator, when food was stored past the open dates in the walk-in refrigerator, when 1 of 3 dietary staff (Dietary Staff #1) touched food with her bare hands, and when 1 of 18 staff members (Certified Nursing Assistants (CNA) #1) were observed touching a resident's food. The facility had a census of 87, with 83 of those residents receiving a meal tray from the kitchen.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to maintain or enhance resident dignity and respect when 5 of 17 staff members (Certified Nursing Assistant (CNA) #3, #4, #5, and #6 and Licensed Practical Nurse (LPN) #1) did not use courtesy titles to address Resident #38, #50, #61, #70, #71, and #339 during dining, and 1 of 4 nurses (LPN #2) failed to provide dignity for Resident #33 during medication administration.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to deliver meal trays to residents in a timely manner resulting in delayed mealtimes on the 400 Hall. This had the potential to affect 37 of the 89 residents who had received a meal tray.

Inspectors wroteBased on review of the Centers for Medicare and Medicaid Services (CMS) COVID-19 Long-Term Care Facility Guidance, medical record review, observation, and interview, the facility failed to ensure measures to prevent the potential spread of infection were followed when an indwelling urinary catheter bag was on the floor for 1 of 1 sampled resident (Resident #27) reviewed with an indwelling urinary catheter, and the Activity Director and Certified Nursing Assistant (CNA) #8 entered the front door of the facility and walked throughout the facility prior to being screened.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to maintain privacy and confidentiality of resident medical records for 3 of 5 sampled residents (Resident #33, #70, and #339) observed during medication administration.

Inspectors wroteBased on review of Nursing Home Transfers and Discharges Frequently Asked Questions (FAQ), medical record review, and interview, the facility failed to notify the Ombudsman of emergency transfers for 2 of 4 sampled residents (Resident #59 and #61) reviewed for hospitalizations.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure Care Plan interventions were implemented and followed for 2 of 6 sampled residents (Resident #26 and #65) reviewed for activities of daily living (ADLs).

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to revise a Care Plan related to dialysis for 1 of 1 sampled resident (Resident #44) reviewed for dialysis care and services.

Inspectors wroteBased on observation and interview, the facility failed to properly store and maintain medications safely and securely when 1 of 7 medication storage areas (400 Hall Medication Cart) had a large hole in the third drawer from the top of the cart.