Pahrump Health and Rehabilitation

Inspectors wroteBased on observation, interview, record review and document review the facility failed to ensure the physician ordered dressing changes for a midline catheter (a small flexible tube inserted into a vein of the upper arm) for 1 of 33 sampled residents (Resident 84). The deficient practice had the potential for the midline catheter to become infected due to the dressing not being changed.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure 1) a smoking safety evaluation was completed to determine whether a resident was safe to smoke independently or required supervision for 1 of 33 sampled residents (Resident 39); and 2) and prevent residents or staff from smoking in the facility enclosed courtyard. The deficient practice had the potential to place residents, staff, and visitors at risk of injury related to smoking.

Inspectors wroteBased on interview, record review, and document review the facility failed to communicate to the dialysis center, the need for contact precautions related to infectious dermatitis for 1 of 33 sampled residents (Resident 11). The deficient practice had the potential to place others at risk for transmission of infection.

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure medication was not left unattended on top of a medication cart. The deficient practice had the potential for placing residents at risk for improper use of medication.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure 1) the use of protective personal equipment (PPE) for 1 of 33 sampled residents (Resident 18) and 2 unsampled residents (Resident 16 and 115) on contact precautions and enhanced barrier precautions and 2) report an outbreak of infectious dermatitis to the state health authority. The deficient practice had the potential for the spread of infectious organisms.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to 1) monitor and report a decline in function for 1 of 19 residents (Resident 65) and 2) identify and report a resident's increase in pain related to worsening contractures for 1 of 19 unsampled residents (Resident 14). The deficient practice placed the residents at risk for diminished function and potentially an impact on the physical, mental and psychosocial well-being of the residents.

Inspectors wroteBased on interviews and document review, the facility failed to ensure food concerns raised by the resident group were acted on, followed through and facility's actions (if any) were communicated back to the resident group. The deficient practice had the potential to have negative psycho-social outcomes to the residents.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure 1) kitchen staff were wearing appropriate facial coverings during food preparation and 2) molded strawberries were not being prepped for service. The deficient practice placed residents at risk for food related illnesses from ingesting contaminated food.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to develop a baseline care plan for a resident who was admitted with a condom catheter for 1 of 19 sampled residents (Resident 140). The deficient practice had the potential to place the resident at risk for not receiving appropriate care related to the condom catheter which included perineal care and site monitoring.

Inspectors wroteBased on interview, record review and document review, the facility failed to ensure 1) a physician's PRN order for an anti-anxiety medication had a stop date for 1 of 19 sampled residents (Resident 70) and 2) a gradual dose reduction was attempted for a psychotropic medication for 2 of 19 sampled residents (Residents 23 and 70). The deficient practice placed the residents at risk for receiving unnecessary medications.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure outdated and expired vaccine vials were discarded in accordance with the facility's policy. Specifically, two opened vials of Influenza vaccine (formula Year 2023-2024) were found inside the medication refrigerator. The deficient practice placed residents at risk for receiving outdated and expired Influenza vaccine during flu season 2024-2025.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure 1) a hospice physician's order to get resident out of bed daily was followed and, 2) hospice aides reported a loosened pressure ulcer dressing to the facility nurse for 1 of 19 sampled residents (Resident 15). The deficient practice had the potential to negatively impact quality of life by depriving the resident of environmental stimulation and social interaction and placed the resident at risk for wound complications.

Inspectors wroteBased on interview, record review and document review, the facility failed to ensure a resident with a full code status was provided basic life support (BLS) after having been found unresponsive for 1 of 9 sampled residents (Resident 1). The deficient practice deprived the resident of life-saving measures, specifically cardiopulmonary resuscitation (CPR) which may have potentially increased the resident's chances of recovery and survival.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure 1) the emergency crash cart was free of expired supplies, 2) staff were trained on the suction equipment, oral airway device and automated external defibrillator (AED) and 3) mock code drills were conducted quarterly once per shift in accordance with facility policy. The deficient practice placed residents' safety at risk as a result of poor-quality response to an emergency such as aspiration, choking and cardiopulmonary arrest. Emergency Crash Cart On [DATE] at 9:23 AM, a Registered Nurse (RN) and the Resident Care Manager (RCM) were present for an inspection of the emergency crash cart located in the 500-Hall and 600-Hall nurse's station. The crash cart checklist for [DATE] and [DATE] reflected the emergency crash cart was checked daily with no missed entries. [...]

Inspectors wroteBased on interviews, record review, and document review, the facility failed to complete or document the status of the orthopedic follow-up consultation for fractured bilateral feet for 1 of 4 sampled residents (Resident 2). This deficient practice had the potential to delay the necessary medical intervention and exacerbate the resident's pain and complications.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to ensure a resident's room was in good repair and free of debris on the floor for one of four residents (Resident (R)41) rooms observed for a clean, homelike environment out of a sample of 18 residents.

Inspectors wroteBased on observation, interview, record review, and review of the RAI [Resident Assessment Instrument] Manual, the facility failed to ensure Minimum Data Set (MDS) assessments were accurate for three out of 18 sampled residents (Residents (R)21, R28, and R64).

Inspectors wroteBased on observation, interview, record review and review of the RAI [Resident Assessment Instrument] Manual, the facility failed to develop comprehensive care plans for two of 18 sampled residents (Residents (R)21 and R62). Specifically, R21 did not have a care plan to address R21's deteriorated dental condition, and R62 did not have a care plan to address oxygen use. This had the potential for the residents to have unmet care needs.

Inspectors wroteBased on observation, interview, review of CNA [Certified Nursing Assistant] Competency Oral Hygiene document, and record review, the facility failed to ensure one out of three dependent residents reviewed for activities of daily living (Resident (R)21), out of a sample of 18 residents, was provided with adequate oral hygiene.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure two of two sampled residents (Resident (R)21 and R28) who were bedridden were offered activities of their interest. This deficient practice had the potential for the residents to not have their psychosocial well-being met.

Inspectors wroteBased on observation, interview, and competency review, the facility failed to ensure the nurse providing wound care followed physician orders for one of two wound care observations for (Resident (R) 21). This failure had the potential to cause wounds to become more complex requiring more extensive and/or intrusive treatments.

Inspectors wroteBased on observation, interview, record review, review of manufacturer's guidelines, and facility policy review, the facility failed to ensure appropriate respiratory services for two of three sampled residents (Resident (R)28 and R64) by failing to ensure a filter was in the Bilevel Positive Airway Pressure (BIPAP) machine, masks and tubing were cleaned and stored when not in use for a BIPAP machine and nebulizer machine, and a physician order was in place for a resident on oxygen (O2). This had the potential for possible respiratory issues and/or infections.

Inspectors wroteBased on observation, interview, review of the Centers for Disease Control (CDC) guidelines, and policy review, the facility failed to ensure hand hygiene was performed between glove changes and clean gloves were used during wound care for one Resident (R) 21 of two residents observed for wound care. This failure had the potential to create a higher bacterial load and/or wound infection causing a wound not to heal.