Osage Rehab and Health Care Center

Inspectors wroteBased on record review, observation, and staff interview, the facility failed to provide a private space for residents to make telephone calls for 2 sampled residents (Resident #6 and Resident #15). Specifically, the facility lacked a designated private area for calls during non-business hours, forcing residents to use the phone at the nursing station in the presence of other residents and staff. The facility reported a census of 28 residents.

Inspectors wroteBased on record review, staff interviews and policy review the facility failed to revise the comprehensive, person-centered care plan that addressed a resident's wandering behaviors for 1 of 1 sampled residents (Resident #2). Specifically, despite clinical documentation showing the resident frequently wandered into other residents' rooms, the facility didn't update the care plan with interventions to manage this behavior or protect the privacy and safety of others. The facility reported a census of 27 residents.

Inspectors wroteBased on clinical record review, resident interviews, staff interviews, and facility's policy review, the facility failed to ensure residents received scheduled bathing and failed to maintain accurate documentation of hygiene services for 2 of 6 sampled residents (Resident #11 and Resident #14). One resident missed scheduled baths over a three-month period, while another reported feeling dirty and odorous due to infrequent showering. The facility reported a census of 28 residents.

Inspectors wroteBased on record review, policy review and staff interviews, the facility failed to transcript admission orders after a resident admitted to the facility for the facility staff to implement the orders for 1 of 3 residents reviewed (Resident #3). The facility reported a census of 26 residents.

Inspectors wroteBased on facility documents, schedule review, and staff interviews, the facility failed to provide a Registered Nurse (RN) in the facility for eight (8) consecutive hours per day as required by the Federal Regulations. In addition, the facility failed to have a full time Director of Nursing. The facility reported a census of 25 residents.

Inspectors wroteBased on record review, staff interview, and policy review, the facility failed to notify the Resident or the resident's representative in advance of the risks verses benefits for psychotropic medication, the treatment alternatives or other options the representative preferred for 1 of 4 residents reviewed (Resident #1). The facility reported a census of 25 residents.

Inspectors wroteBased on record review, staff interview, and policy review, the facility failed to document the release of a seat belt every 2 hours, failed to obtain an informed consent for the use of a seat belt in a wheel chair from the resident's representative in advance of potential risks and benefits of all options under consideration including using a restraint, not using a restraint, and alternatives to restraint use for 1 of 1 residents reviewed (Resident #8). The facility reported a census of 25 residents.

Inspectors wroteBased on record review and staff interviews the facility failed to complete Minimum Data Set (MDS) assessment and Care Area Assessment (CAA) worksheet for pressure ulcers for 1 of 1 resident reviewed (Resident #4). In addition, the facility failed to complete 1 of 2 residents CAA worksheet for Nutrition (Resident #24). The facility reported a census of 25 residents.

Inspectors wroteBased on clinical record review, staff interview, and Preadmission Screening and Resident Review (PASRR) manual, the facility failed to accurately code the PASRR Level ll on the Minimum Data Set (MDS) assessment for 1 of 2 residents with a PASRR Level II (Resident #2). In addition, the facility failed to accurately code pressure ulcers were not acquired at the facility for 1 of 1 resident with pressure ulcers (Resident #4). The facility reported a census of 25.

Inspectors wroteBased on clinical record review, policy and staff interview, policy review, the facility failed to incorporate the recommendation from the PASARR level ll determination and the evaluation report into the resident's assessment and care planning for 1 of 2 residents with new mental health diagnoses (Resident #2). Pre-admission Screening and Resident Review (PASRR) Level II (a in-depth federal assessment for individuals applying to or residing in Medicaid-certified nursing facilities, determining if they have a Serious Mental Illness or Intellectual Disability/Related Condition and need specialized services, this ensures they aren't inappropriately placed and receive care in the most integrated setting possible, involving comprehensive evaluations by mental health/disability experts). The facility reported a census of 25.

Inspectors wroteBased on record review, staff interview and policy review the facility failed to implement interventions for 1 of 1 resident with unstageable pressure ulcers. The facility reported a census of 25 residents.

Inspectors wroteBased on observations, facility document review and staff interviews, the facility failed to post the daily staff posting with the census and facility name. The facility reported a census of 25 residents.

Inspectors wroteBased on facility record review, staff interview and policy review, the facility failed to have the minimum required members at the Quality Assessment and Assurance (QAA) meetings to identify issues with respect to which quality assessment and assurance activities are necessary. The facility reported a census of 25 residents.

Inspectors wroteBased on observation, staff interviews, record review, and policy review the facility failed to use enhanced barrier precautions (EBP infection control measures, requiring healthcare workers to wear gowns and gloves for high-contact care) when providing routine catheter care for 1 of 1 resident reviewed (Resident #9). The facility reported a census of 25 residents.

Inspectors wroteBased on facility policy and staff interviews, the facility failed to have a qualified Infection Preventionist to monitor and provide oversight to the facility's infection prevention program. The facility reported a census of 25 residents.

Inspectors wroteBased on record review, policy review and staff interviews, the facility failed to provide pneumococcal vaccine as requested for 2 of 5 residents reviewed (Resident #4 and #15). The facility reported a census of 25 residents.

Inspectors wroteBased on clinical record review, staff and family interview, the facility failed to provide transportation for a resident from a physician's appointment for which resulted in the family member transporting the resident back to the facility for 1 of 4 resident reviewed. (Resident #1) The facility identified a census of 26 residents.

Inspectors wroteBased on record review, observation, photos taken during observation, resident, and staff interview, the facility failed to ensure all residents who resided on the East end of the building resided in a clean, sanitary, and homelike atmosphere. The facility identified a census of 28 residents.

Inspectors wroteBased on resident interview, staff interview, Alarm Response Report forms, and facility policy review, the facility failed to answer resident call lights in a timely manner and within the regulated 15-minute time frame for 2 residents reviewed (Residents #6 and #1). The facility identified a census of 28 residents.

Inspectors wroteBased on observation, clinical record review, staff interview and resident interview, the facility staff failed to maintain appropriate nursing supervision to prevent a cat bite which resulted in a wound infection for one (1) resident reviewed. (Resident #3) The facility identified a census of 31 residents.

Inspectors wroteBased on resident interview, staff interview, Alarm Response Report forms, and facility policy review, the facility failed to answer a resident's call light in a timely manner and within the regulated 15-minute time-frame for 1 of 3 residents reviewed (Resident #6). The facility identified a census of 31 residents.

Inspectors wroteBased on clinical record review, staff interview and policy review the facility failed to implement Care Plans for one (1) resident reviewed (Resident #6) The facility reported a census of 31 residents.

Inspectors wroteBased on clinical record review, staff interview and facility policy review the facility staff failed to follow Physician Orders for 1 of 3 residents reviewed (Resident #3). The facility identified a census of 31 residents.

Inspectors wroteBased on record review, policy review, and staff interview the facility failed to provide the resident or the resident's legal representative with a Skilled Nursing Advance Beneficiary Notice of Non-Coverage (SNF/ABN) and Notice of Medicare Non-Coverage (NOMNC) to document an appeal decision and the date of notification of Medicare non-coverage for 1 of 3 residents (Resident #10) sampled. The facility identified a census of 27 residents.

Inspectors wroteBased on interview and staff files review, the facility failed to do a background check on 1 of 5 staff reviewed. The employee file for Staff A, Certified Medication Aide (CMA) lacked a criminal background check. The facility reported a census of 27 residents.

Inspectors wroteBased on clinical record review, policy review and staff interviews, the facility failed to complete a baseline care plan for 1 of 2 residents reviewed (Resident #27). The facility reported a census of 27 residents.

Inspectors wroteBased on clinical record review, resident interview, staff interviews and policy review, the facility failed to ensure residents had at least 2 baths/showers per week for 2 of 3 residents reviewed for bathing (Resident #4 and #6). The facility reported a census of 27 residents.

Inspectors wroteBased on clinical record review, resident interview and staff interview, the facility failed to ensure completion of physician ordered treatments for 1 of 2 residents (Resident #6). The facility reported a census of 27 residents.

Inspectors wroteBased on interviews, observations, and record review, the facility failed to do pre and post dialysis assessments for 1 of 1 resident who received hemodialysis (use of a machine to filter waste out of the kidneys) (Resident #24). The facility reported a census of 27 residents.

Inspectors wroteBased on clinical record review, staff interview, Physician interview, Emergency Medical Service (EMS) interview, and facility policy review, the facility failed to provide adequate care and services to maintain the highest functional status for 1 of 2 residents with gastronomy tube (GT) (Resident #2). Resident #2 had an order to have his head of bed elevated while receiving his feeding. As the nurse gave Resident #2 his feeding, they had the head of bed lowered. When Resident #2 started to vomit, the nurse stopped the feeding, but failed to elevate Resident #2's head of the bed. When the certified nurse aides attempted to assist the nurse, the nurse told them to have him lay flat. Resident #2 suffered from aspiration pneumonia and septic shock. [...]

Inspectors wroteBased on clinical record review, staff interview and facility policy review, the facility failed to follow the Care Plan for 1 of 3 residents reviewed (Resident #2). The facility identified a census of 33 residents.

Inspectors wroteBased on clinical record review, staff interview, and facility policy review, the facility failed to complete thorough assessments and interventions for a 2 of 3 residents following a condition change (Residents #1 and #2). The facility identified a census of 33 residents.

Inspectors wroteBased on personnel file reviews, facility policy review and staff interview, the facility failed to assure 2 of 6 staff met the requirements for Dependent Adult Abuse Training (Staff A and Staff B). The facility reported a census of 33 residents.

Inspectors wroteBased on observation, policy review, and staff interview, the facility failed to serve food under sanitary conditions, in order to reduce the risk of contamination and food borne illness. The facility reported a census of 33 residents.

Inspectors wroteBased on resident interviews, staff interviews and policy reviews, the facility failed to ensure staff treated residents with dignity and respect for 1 of 5 residents reviewed (Resident #5). The Facility reported a census of 33 residents.

Inspectors wroteBased on observation and staff interviews the facility failed to maintain a clean and safe homelike environment when the flooring in the dinning room showed multiple areas where the vinyl had been ripped. The facility also failed to ensure the carpet in multiple hallways throughout the facility was in good condition without stains or frays. The facility reported a census of 33 residents.

Inspectors wroteBased on record review and staff interviews the facility failed to Care Plan 1 of 2 residents Specialized Services that were instructed to be care planned on his Preadmission Screening Resident Review (PASRR) Level II document (Resident #31). The facility reported a census of 33 residents.

Inspectors wroteBased on record review and staff interview the facility failed to code a resident admitted on an anti-coagulant (blood thinner) medication and a diuretic (removes excess water in the body) medication for 1 of 5 residents reviewed for medications (Resident #19). The facility also failed to develop a comprehensive Care Plan within 7 days of the completion date of the Minimum Data Set (MDS) for 1 of 1 new admissions reviewed (Resident #32). The facility reported a census of 33 residents.

Inspectors wroteBased on observation, clinical record review, and staff interview the facility failed to update the Care Plan for 1 of 1 resident reviewed for mood and behaviors (Resident #2). The facility reported a census of 33 residents.

Inspectors wroteBased on observation, clinical record review and staff interview the facility failed to follow physician orders for a gastrostomy tube (g-tube) (a g-tube is an opening into the stomach from the abdominal wall, made surgically for a tube for the introduction of food via a feeding tube) feeding for 1 of 1 resident reviewed for care of a g-tube (Resident #13). The facility reported a census of 33 residents.

Inspectors wroteBased on record review, staff interviews, and policy review the facility failed to ensure 1 of 2 residents reviewed for hospitalizations (Resident #11) was provided with standard nursing assessment and intervention when a known decline was occurring and the facility failed to assess, document, or update the doctor if changes were occurring for greater than 36 hours. The facility reported a census of 33 residents.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure the treatment cart was locked for 2 of 2 treatment carts on the initial walk through of the building and the Nurse and Certified Medication Aide (CMA) responsible for the cart were not in sight. The facility reported a census of 33 residents.

Inspectors wroteBased on record review and staff interviews the facility failed to ensure the Minimum Data Set (MDS) was accurately coded for 1 of 2 residents reviewed for Preadmission Screening and Resident Review (PASRR) (Resident #19). The facility reported a census of 33 residents.

Inspectors wroteBased on record review and staff interviews the facility failed to accurately submit to the Payroll Based Journal (PBJ)(The Centers of Medicare and Medicaid Services (CMS) tracking system of daily nursing coverage in facilities) licensed nursing coverage for 20 days from January 1, 2023 to March 31, 2023. The facility reported a census of 33 residents.