Ozark Rehabilitation & Health Care Center

Inspectors wroteBased on observation and interview, facility staff failed to maintain a clean, comfortable, homelike environment when staff failed to maintain the interior of building. Facility staff failed to remove trash from the exterior and maintain the exterior of the premises. The facility census was 40. 1. Observation on 05/12/25 between 12:00 P.M and 12:45 P.M., showed: -The bathroom door in resident room [ROOM NUMBER] contained a dark brown patch on the lighter stained door, and a marred area at the top with a layer of plywood dug out; -The bathroom door in resident room [ROOM NUMBER] patched with a dark brown patch in the middle of the lighter stained door; -The bathroom door in resident room [ROOM NUMBER] had a hole near the middle of the door; -The hallway ceiling tile near resident rooms #23 and #26 had yellow-brown stains; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to change and store oxygen tubing for one resident (Resident #18 ) of two sampled residents; failed to to use appropriate hand hygiene infection control practices during perineal and catheter care, for four residents (Resident's #12, #14, #24, and #37) of five sampled residents; failed to follow Enhanced Barrier Precautions (EBP), (the wearing of gown and gloves during high contact patient care activities to prevent the spread of multi-resistant organisms), for two residents (Resident #12 and #24) of five sampled residents. The facility census was 40. 1. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to ensure two residents (Resident #18 and #37) had orders for oxygen and failed to ensure oxygen tubing was dated per facility policy. The facility census was 40. 1. Review of the facility's policy titled, Oxygen Therapy, March 2019, showed staff are directed to: -Verify the physician's order; -Adjust the delivery rate per the physician's order; -Change oxygen tubing/mask/cannuala and/or tracheostomy mask weekly; -Date tubing changes. 2. Review of Resident #18's admission Minimum Data Set (MDS), a federally mandated assessment tool, dated 04/18/25, showed staff assessed the resident as: -admitted on [DATE]; -Cognitively intact; -Dependent on staff for upper body dressing and personal hygiene; -Required oxygen. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to document collaboration of care with hospice providers for development and implementation of a coordinated plan of care, communication between the facility and hospice providers and did not have physician orders for hospice for two residents (Resident #27 and #36) of three residents. The facility census was 40. 1. Review of facility Hospice Services policy, undated, showed the facility provides continuity of care to provide residents who are terminally ill with the opportunity to receive comprehensive, interdiscipinary care that recognizes the spirtiual needs, and to assist residents, family members and friends to live as fully and completely as possible with meaing and diginity. An interdisciplinary care plan which integrates the care and services provided by the faciity and the hospice provider including. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to post the required nurse staffing information, which included the resident census, and the total number of staff and the actual hours worked, by both licensed and unlicensed nursing staff directly responsible for resident care, per shift, on a daily basis. The facility census was 40. 1. Review of the facility's policies did not contain a policy for posting required nurse staffing information. 2. Observation on 05/12/25 at 12:43 P.M., showed the nurse staff posting did not include the total number of staff and the actual hours worked by both licensed and unlicensed nursing staff directly responsible for resident care per shift. [...]

Inspectors wroteBased on interview and record review, facility staff failed to properly stretch one resident (Resident #1) leg for range of motion, in a safe manner which resulted in an injury to his/her leg that required surgical intervention. The facility census was 40. 1. Review of the Restorative Program - range of motion policy, revised 02/03/22, showed the policy is to provide the resident with limited range of motion appropriate treatment and services to increase or prevent further decrease in range of motion. Staff are instructed to provide resident with repetitions as per residents tolerance and care plan and never continue past the point of resistance or pain. 2. Review of Resident #1's Annual minimum data set (MDS) a federally mandated assessment tool, dated 09/17/24, showed staff assessed the resident as follows: -Cognitively intact; -Totally dependent with two plus staff to assist; [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure one resident (Resident #1) remained free from sexual abuse when Resident #2 touched Resident #1's chest inappropriately. The facility census was 40. 1. Review of the facility's Abuse Prevention Program, undated, showed the facility affirms the right of their residents to be free from abuse, neglect, misappropriation of resident property, corporal punishment, and involuntary seclusion. This facility therefore prohibits mistreatment, neglect, or abuse of its residents. Review showed: -Abuse is defined as any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means in a facility; - Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment resulting in physical harm, pain, or mental anguish; [...]

Inspectors wroteBased on interview and record review, facility staff failed to meet professional standards when staff failed to document they administered medications and failed to document the reason they did not administer the medications for two residents (Resident #1 and #2) out of four sampled residents. The facility census was 43. 1. Review of the facility's Medication Administration policy, revised 11/18/17, showed: -Drug administration shall be defined as an act in which a single dose of a prescribed drug or biological is given to a resident by an authorized person in accordance with all laws and regulations governing such acts; -The complete act of administration entails removing an individual dose from a previously dispensed, properly labeled container, verifying it with the physician's orders, giving the individual dose to the proper resident, and promptly recording the time and dose given; [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide the services of a Registered Nurse (RN), for at least eight consecutive hours per day, seven days a week. The facility census was 45. 1. Review of the facility's policies showed the facility did not provide a policy for RN coverage. 2. Review of the facility's RN staff schedule, dated July 2023, showed the facility did not have an RN in the building the following dates: -Tuesday 07/01/23; -Thursday 07/13/23; -Thursday 07/20/23; -Monday 07/24/23; -Thursday 07/27/23; -Saturday 07/28/23. 3. Review of the facility's RN staff schedule, dated August 2023, showed the facility did not have an RN in the building the following dates: -Tuesday 08/01/23; -Thursday 08/03/23; -Saturday 08/05/23; -Tuesday 08/08/23; -Saturday 08/12/23; -Tuesday 08/15/23; -Thursday 08/17/23; -Saturday 08/19/23; -Tuesday 08/22/23; -Thursday 08/24/23; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to ensure three Nurse Aide's ((NA) NA L, NA M and NA N) completed the nurse aide training program within four months of his/her employment in the facility. The census was 45. 1. Review of the facility's policies showed the facility did not provide a policy for NA qualifications. 2. Review of Certified Nurse Aide (CNA) training report showed NA L's hire date as 11/24/23. Review showed the NA's file did not contain documentation the NA completed a nurse aide training program. During an interview on 2/29/24 at 11:56 A.M., the Director on Nursing (DON) said NA L has not started the nurse aide training program yet. 3. Review of the CNA training report showed NA M's hire date as 1/16/23. Review showed the NA's file did not contain documentation the NA completed a nurse aide training program. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to designate a person to serve as the Director of Food and Nutrition Services with the appropriate qualifications, when the facility did not employ a qualified dietitian or other clinically qualified nutrition professional full-time. The census was 45. 1. Review of facility's In-service Training policy, dated 06/06, showed the Food Service Manager or Registered Dietician plans and/or conducts regularly scheduled in-service training and education to develop the skills and knowledge required for satisfactory job performance. The policy did not contain guidance related to the qualifications of the dietary manager. Review of the dietary manager's (DM) personnel record showed he/she hired to the DM position on 09/01/22. Review showed the record did not contain documentation of prior dietary experience or related education. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to ensure dietary staff had the appropriate competencies and skills to safely and effectively carry out the functions of food and nutrition services. Facility staff failed to provide effective training to dietary staff related to handwashing. Facility staff also failed to provide effective training to dietary staff related to kitchen ware washing/sanitation. The facility census was 45. 1. Review of facility's In-service Training policy, dated 6/06, showed the Food Service Manager or Registered Dietician plans and/or conducts regularly scheduled in-service training and education to develop the skills and knowledge required for satisfactory job performance. Review of the facility's Hand Washing policy, revised 10/09, showed hand washing is to be done using soap and water for at least 20 seconds: [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to store food in a manner to prevent potential contamination and outdated use. The facility staff failed to maintain the kitchen floors and appliances in a clean manner to prevent the growth and harborage of bacteria. Facility staff failed to properly sanitize kitchen wares, food preparation surfaces and resident dining tables to prevent potential cross contamination. The facility staff failed to maintain the dining room ice machine in a clean and sanitary manner to prevent cross contamination and inhibit the growth water-borne pathogens. The facility census was 45. 1. Review of the facility policy Storage, Revised 6/06, showed kitchen staff are directed to: -Date items upon receipt; -Store left overs in covered, labeled and dated containers under refrigeration or frozen; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to designate one or more individuals with specialized training in Infection Prevention and Control (IPC) as the Infection Preventionist (IP) for the facility's infection prevention and control program. The census was 45. 1. Review of he facility's policies showed staff did not provide a policy in regard to the qualifications of the Infection Preventionist. During an interview on 02/28/24 at 2:15 P.M., the Director of Nursing (DON) said he/she had mistaken a different Center for Medicare and Medicaid Services (CMS) course with the Infection Preventionist (IP) Course, so he/she was not certified as an IP. [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure three residents (Resident #14, #15 and #19) had appropriate access to their trust fund account which included evenings and weekends. The facility census was 45. 1. Review of the facility's policies showed the facility did not provide a policy for availability of funds. 2. Review of Resident #14's Quarterly Minimum Data Set (MDS), a federally mandated assessment tool, dated 10/18/23, showed staff assessed the resident as cognitively intact. During an interview on 02/26/24 at 3:30 P.M., the resident said we cannot get money on the weekends, you have to get it on Fridays if we want it for the weekend, or your're just out of luck and have to wait. 3. Review of Resident #15's Quarterly MDS, dated [DATE], showed staff assessed the resident as mildly cognitive impaired. [...]

Inspectors wroteBased on interview and record review, facility staff failed to document two residents (Resident #7 and #8) code status as Do Not Resuscitate (DNR) or Full Code (Resuscitate refers to cardiopulmonary resuscitation-CPR). The facility census was 45. 1. Review of the facility's policy titled, Advanced Directive, dated [DATE], showed each resident has the right to make their own decisions, and to formulate advance directives to serve as decisions when the individual is incapacitated. It is the policy of this facility to honor resident's wishes as expressed in advanced directives regarding medically indicated treatments whenever possible. Review showed the facility shall take all steps necessary to comply with state and federal legislation relating to advanced directives. [...]

Inspectors wroteBased on interview and record review, facility staff failed to give appropriate Center for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advance Beneficiary Notices (SNFABN) for two resident (Resident # 12 and #45) of three sampled residents the facility initiated discharge from Medicare Part A Services when benefit days were not exhausted. The facility census was 45. 1. Review of the facility's policies showed staff did not provide a policy on SNFABN Notices. 2. Review of Resident #12's Skilled Nursing Facility (SNF) Beneficiary Protection Notification Review form showed staff documented: -Medicare Part A Skilled Services started on 12/19/23; -Last covered day of Medicare Part A Skilled Services on 01/06/24; -The resident wanted to go home. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to provide a clean, homelike and comfortable environment when staff failed maintain resident rooms, common areas, medical device equipment and the exterior of the building clean and in good repair. Facility census was 45. 1. Review of the facility's policy titled, Physical Plant and Environmental Policy and Guidelines, undated, showed staff were directed to do the following: -It is of the utmost importance to provide a safe, hospitable, clean and organized facility and grounds to ensure an environment that is conducive to providing the best care, comfort and home-like surroundings for residents; [...]

Inspectors wroteBased on interview and record review, facility staff failed to screen six new employee (Dietary E, Dietary F, Dietary G, Certified nurse aide (CNA) H, Licensed Practical Nurse (LPN) I, and housekeeping J) out of ten new employees prior to employment to determine if any employees had a federal indicator with the Employee Disqualification List (EDL) and/or the Family Care Safety Registry (FCSR). Facility staff failed to develop a written policy to notify the Department of Health and Senior Services (DHSS) of any allegation of abuse within the required two hour timeframe. The facility census was 45. 1. Review of the Facility's Abuse Prevention Program Facility Policy, not dated, showed the purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of mistreatment, neglect or abuse of our residents. [...]

Inspectors wroteBased on interview and record review, facility staff failed to notify the Ombudsman (a resident advocate who provides support and assistance with problems and/or complaints regarding the facility) of resident transfers to the hospital for five sampled residents (Resident #14, #19, #24, #49, and #50). The facility census was 45. 1. Review of the facility's Transfer and Discharge Policy and Procedure, undated , showed the policy did not include direction for staff to notify the ombudsman of resident discharge or transfer. 2. Review of an email from the Regional Ombudsman Program Director, dated 02/22/24 at 1:42 P.M., showed did not send the Ombudsamn Director the monthly notifications of discharged or transferred residents. 3. Review of Resident #14's medical record, showed the resident transferred to the hospital on [DATE] and readmitted to the facility on [DATE]. [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide written information to the resident and/or the resident's representative of the bed hold policy at the time of transfer to the hospital for three (Resident #14, #19, and #24) out of three sampled residents. The facility's census was 45. 1. Review of the facility's Bed Hold Guarantee Policy, revised 08/01/17, showed, the resident, resident family or legal representative will be given the appropriate Notice of Bed Hold Policy at the time of discharge or therapeutic leave, if possible, but notice will be given no longer than 24 hours after discharge or initiation of leave. 2. Review of Resident's #14's Quarterly Minimum Data Set (MDS), a federally mandated assessment, dated 10/18/23, showed staff assessed the resident as cognitively intact. Review of the resident's medical record showed : [...]

Inspectors wroteBased on record review and interview, facility staff failed to ensure they assessed residents using the quarterly Minimum Data Set (MDS), a federally mandated assessment completed by staff, no less frequently than once every 92 days as directed by the Resident Assessment Instrument (RAI) manual for six residents (Resident #10, #16, #22, #37, #38, #46). The facility census was 45. 1. Review of the Resident Assessment Manual (RAI), dated 10/1/17, showed the Quarterly assessment is an Omnibus Budget Reconciliation Act of 1987 (OBRA) non-comprehensive assessment for a resident that must be completed at least every 92 days following the previous OBRA assessment of any type. It is used to track a resident's status between comprehensive assessments to ensure critical indicators of gradual change in a resident's status are monitored. As such, not all MDS items appear on the Quarterly assessment. [...]

Inspectors wroteBased on staff interview and record review, facility staff failed to provide person-centered, measurable time frames to meet the residents' individual needs and goals identified in the comprehensive care plans for four (Resident #3, #7, #20, and #31) sampled residents. The facility census was 45. 1. Review of the Facility's Comprehensive Care Planning Policy, revised 11/01/17, showed it is the policy of the facility to comprehensively assess and periodically reassess each resident admitted to this facility. The results of this resident assessment shall serve as the basis for determining each resident's strengths, needs, goals, life history and preferences to develop a person-centered comprehensive plan of care for each resident that will describe the services that are to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being. [...]

Inspectors wroteBased on interview and record review, the facility staff, failed to review and revise care plan after falls for two residents (#8 and #47). Staff failed to hold care conference for three residents (#14, #15, and #24). The facility census was 45. 1. Review of the facility's Comprehensive Care Planning Policy, revised 11/01/17, showed: Components of the CPC may include: -Care Plan- Plan of care describing a need/problem, and indicating approaches/interventions to be instituted to assist the Resident in maintaining/receiving care in relation to the need/problem; -The following procedures shall be utilized in the development and maintenance of care plans: Participants of the Interdisciplinary Team in the development/revision of the CCP should include: [...]

Inspectors wroteBased on interviews and record review, staff failed to maintain a professional standard of care for two residents (Resident #3 and 16) when staff did document they completed weekly skin assessments. Staff failed to get one resident (Resident #14) physician order to to self-administer insulin. The facility census was 45. 1. Review of the facility's policies showed staff did not provide a policy for following physician treatment orders. 2. Review of the Resident #3's Quarterly Minimum Data Set (MDS), a federally mandated assessment, dated 11/03/23, showed staff assessed the resident as follows: -Cognitively intact; -Risk of pressure ulcers; -One venous and arterial ulcer present; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide assistance with grooming and bathing for four sampled residents (Resident #15, #29, #45, and #47). The facility census was 45. 1. Review of the facility's Bath/Shower policy, undated, directs staff to ensure adequate hygiene needs are met. Review showed a bath/shower is scheduled for all residents in the facility at least weekly. 2. Review of Resident #15's quarterly Minimum Data Set (MDS), a federally mandated assessment tool used to plan care, dated 12/05/23, showed facility staff assessed the resident as: -Moderate cognitive impairment; -Rejected care four out of the six days during the look back period; -Required substantial assistance from staff for personal hygiene. Review of the resident's care plan, dated, showed 10/05/23, showed: [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide an ongoing program of activities designed to meet the residents' interest on the weekends and when the Activity Director (AD) was not in the facility for four residents' (#7, #15, #20 and #31). The facility census was 45. 1. Review of the facility's policy titled, Activity Program, dated 07/11/06, showed the facility will provide a program of activities which includes a combination of large and small group, one-to-one and self-directed activities; and a system that supports the development, implementation, and evaluation of the activities provided to the residents in the facility. Review showed: -All residents shall be offered the opportunity, and encouraged to participate in activities, but shall not be required to participate; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to ensure the resident environment remained as free of accident hazards as is possible, when staff failed to provide safe mechanical lift transfers for two residents (Residents #31 and #37), failed to properly propel four resident's (unidentifed resident, #31, #6 and #15) in a manner to prevent accidents, failed to store sharps and toxic chemicals in a manner not accessible to residents, and failed to maintain the hot water temperature of plumbing fixtures accessible to residents on Hall two. The facility census was 45. 1. Review of the facility's policy titled, Limited Lift Resident Handling- Policy and Procedures, undated, showed staff were directed to do the following: [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to remove soiled gloves and/or properly wash hands and provide an environment to prevent the spread of bacteria and other infection causing contaminants during the provision of wound care for one resident (Residents #31). Staff failed to remove soiled gloves and/or properly wash hands during incontinence care for two resident's (Resident #7 and #8). The facility census was 45. 1. Review of the facility's policy titled, Aseptic Wound and Skin Treatment Procedure, revised 01/2018, showed staff were directed to -Establish clean and dirty fields. Remember the dirty field should be the farthest away from your clean field. (Place the plastic bag at the end or foot of the bed to receive soiled dressings). -Wash your hands; -Put on clean gloves; -Clean the wound as ordered. [...]

Inspectors wroteBased on record review and interviews, facility staff failed to ensure residents were allowed to make choices about aspects of their lives while in the facility, when facility staff failed to allow one resident (Resident #24) to sign out of the facility as a consequence for his/her behavior and is his/her own responsible person. The facility census was 45. 1. Review of the facility's policies showed the facility did not provide a policy for Resident Rights. Review of the Resident #24's Quarterly Minimum Data Set (MDS), a federally mandated assessment, dated 11/29/23, showed the staff assessed the resident as follows: -Cognitively intact; -No behaviors exhibited by the resident. Review of the resident's care plan, dated 3/24/23, showed the record did not contain direction on the residents ability to leave the facility. [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure one (Resident #39) received care and services for the provision of hemodialysis (the clinical purification of blood by dialysis, as a substitute for the normal function of the kidney) consistent with professional standards of practice when staff failed to provide orders, ongoing assessments of the resident's condition, and monitoring for complications after dialysis treatments. The facility census was 45. 1. Review of the facility's Long Term Care Facility Dialysis Services Agreement between the facility and the dialysis clinic , dated 09/19/05, showed the: Responsibilities of the dialysis clinic: -Dialysis Clinic (DC) shall provide relevant information regarding the patient's(s') dialysis treatment which may require follow-up care or observation by the long-term care facility (LTCF) staff; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide protective oversight for one resident (Resident #1) with cognitive impairment and a history of wandering, when on 12/13/2023 the resident exited the facility without staff knowledge and was found lying in the street, less than one mile away from the facility, in the early morning hours by a passerby, who notified the police and the emergency medical services (EMS). The outside air temperature was 31 degrees Fahrenheit (F). The resident was found in only a shirt and undergarments with his/her body temperature at 90.2 degrees F. The facility census was 48. The Administrator was notified on 12/13/23 at 6:30 P.M., of an Immediate Jeopardy (IJ) which began on 12/13/23. The IJ was removed on 12/15/23 as confirmed by surveyor onsite verification. [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure three Nurse Aides (NAs) (NA A, NA B, and NA C) completed the nurse aide training program within four months of employment in the facility. The facility census was 48. Review of the facility's Certified Nurse's Aide Policy, undated, showed staff are directed that completion of the Certified Nurses Aide course or be enrolled in a Competency Training Program leading to certification in less than 120 days from the date of employment. 1. Review of NA A's personnel file showed a hire date of 05/01/22. The NA's file did not contain documentation the NA completed a nurse aide training program. During an interview on 12/22/23 at 3:00 P.M., NA A said it had been a struggle with the facility to get into the classes to get certified. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to store food in a manner to protect from potential contamination and out-dated use. Facility staff failed to perform hand hygiene as often as necessary using approved techniques to prevent cross-contamination. Facility staff failed to allow sanitized dishes to air dry prior to stacking in storage, to prevent the growth of food-borne pathogens. Facility staff failed to touch resident-use utensils only by the handles to prevent cross-contamination. Facility staff failed to ensure the bulbs for two kitchen light fixtures were covered to prevent the potential for physical contamination by broken glass. The facility census was 46. 1. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to develop and implement policies and procedures for the inspection, testing, and maintenance of the facility water systems to inhibit the growth of waterborne pathogens and reduce the risk of an outbreak of Legionnaire's Disease (LD). The facility census was 46. 1. Review of the Centers for Medicare and Medicaid Services (CMS) Survey and Certification (S&C) letter 17-30, dated 06/02/17 and revised on 06/09/17; showed: -The bacterium Legionella can cause a serious type of pneumonia called LD in persons at risk. Those at risk include persons who are at least [AGE] years old, smokers, or those with underlying medical conditions such as chronic lung disease or immunosuppression. [...]

Inspectors wroteBased on observation and interview, facility staff failed to post, in a form and manner accessible to the residents; a list of names, addresses, and phone numbers for the Long-Term Care Ombudsman information. The facility census was 46. 1. Review of the facility policy's showed staff did not provide a policy on required postings. Observation on 11/15/22 at 9:54 A.M., showed the Ombudsman information was not posted in the facility. Observation on 11/16/22 at 8:30 A.M., showed the Ombudsman information was not posted in the facility. Observation on 11/17/22 at 9:00 A.M., showed the Ombudsman information was not posted in the facility. Observation on 11/18/22 at 11:29 A.M., showed the Ombudsman information was not posted in the facility. [...]