Piketon Nursing Center

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure a resident with Post Traumatic Stress Disorder (PTSD) was appropriately assessed to identify the cause of the residents PTSD and minimize triggers and/or re-traumatization. This affected two residents (#7 and #18) out of two residents identified by the facility as having PTSD/trauma. The facility census was 43.

Inspectors wroteBased on record reviews and staff interviews, the facility failed to ensure an order for the administration of as needed Ativan (an anti-anxiety medication) contained a stop date of 14 days or less. This affected one resident (#31) out of the five residents reviewed for unnecessary medications. The facility census was 43.

Inspectors wroteBased on observations, interviews, record reviews, and review of facility policy, the facility failed to ensure a medication was administered according to physicians order. This affected one resident (#31) out of the five residents reviewed for unnecessary medications. The facility census was 43.

Inspectors wroteBased on record reviews and staff interview, the facility failed to ensure spend down notices were provided timely and appropriately. This affected four residents (#17, #24, #28, and #31) out of the five residents whose facility fund accounts were reviewed during the annual survey. The facility census was 40.

Inspectors wroteBased on interviews, record reviews and facility policy, the facility failed to identify target behaviors with documentation and/or provide an appropriate diagnosis for psychotropic medications for five (Resident #2, #11, #28, #30 and #41) of the eight residents reviewed. The facility census was 40.

Inspectors wroteBased on observation and interview the facility failed to maintain a clean and sanitary kitchen. This had the potential to affect 39 residents who received meals from the kitchen. The facility census was 40.

Inspectors wroteBased on record review, review of facility daily staffing sheets, and staff interviews, the facility failed to ensure resident medical records were maintained in an accurate manner and failed to ensure staff did not document the administration of medications using another staff members name and credentials. This affected the four residents (#2, #10, #28, and #295) reviewed for accurate documentation of medication and treatments. The facility census was 40.

Inspectors wroteBased on record reviews and staff interview, the facility failed to ensure arbitration agreements provided to residents included written notice of the residents right to rescind the agreement within 30 days of signing. This affected the ten residents (#7, #8, #18, #21, #26, #30, #31, #34, #37, and #41) who the facility identified as having signed arbitration agreements. The facility census was 40.

Inspectors wroteBased on staff interview and observation the facility failed to provide a safe comfortable environment for residents when the wall was scratched in room [ROOM NUMBER] and 20. The toilet seat was soiled in room [ROOM NUMBER], and there was cracked floor tiles in room [ROOM NUMBER]. This affected seven residents (#10, #11, #17, #20, #23, #37, and #95) living in those rooms. The facility census was 40.

Inspectors wroteBased on record reviews and staff interview, the facility failed to ensure a Notice of Medicare Non-Coverage (NOMNC) and Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNFABN) specified the type of skilled services being discontinued. This affected one resident (#33) out of the three residents reviewed for NOMNC and SNFABN notices during the annual survey. The facility census was 40.

Inspectors wroteBased on record reviews, staff interviews and facility policy, the facility failed to develop resident centered care plans for behavioral interventions for three (Residents #2, #28 and #30) of the eight residents reviewed. The facility census was 40.

Inspectors wroteBased on facility interviews, record reviews and Medscape, the facility failed to obtain orders, and/or create care plans, conduct assessments and conduct communications for the appropriate care for three (Resident #25, #37, and # 295) out of twenty five residents reviewed. The facility census was 40.

Inspectors wroteBased on observation, staff interview, and record review the facility failed to ensure medication error rates were not greater than five percent when Resident #95 did not receive their dose of Eliquis (an anticoagulant blood thinner medication) and gave Resident #37 the wrong dose amount of Vitamin D3. This affected two (Resident #37, and #95) of four residents reviewed for medication administration. The facility had two errors out of 25 opportunities for a medication error rate of eight percent. The facility census was 40.

Inspectors wroteBased on observation, staff interview, record review, and policy review the facility failed to to provide a sanitary environment to prevent the spread and development of communicable disease and infections when they did not cleanse blood glucose monitoring machines appropriately after resident use for Resident #95. The facility identified three Residents (#5, #9, #11) on the 19-27 hallway who received blood glucose monitoring checks. The facility census was 40.

Inspectors wroteBased on medical record review, contract review, and staff interview the facility failed to provide necessary treatment and services to treat constipation, and hospice services. This affected three of three residents (Residents #15, #20, and #22) reviewed for constipation, one of one residents (Resident #15) reviewed for hospice services. Actual harm occurred to Resident #20 when the resident did not receive timely treatment for constipation that resulted in hospitalization of a bowel obstruction.

Inspectors wroteBased on staff interview, review of time punch cards, and review of direct care staff schedule revealed the facility failed to ensure the facility had Registered Nurse (RN) coverage for a consecutive eight hours. This had the potential to affect all 34 residents.

Inspectors wroteBased on resident interviews, group resident interview, review of Resident Council Meeting Minutes, and a test tray the facility failed to serve food that was palatable and at an acceptable temperature. This had the potential to affect 33 of 34 resident (Resident #15 receives nothing from the kitchen) and specifically affected Residents #26, #10, #22, #15, #18, #23, #26, #28, #29, and #31.

Inspectors wroteBased on observation, resident interview, resident group interview, resident council meeting minutes, and staff interview the facility failed to ensure accommodation of resident food preferences and failed to offer a food substitute when a resident did not like the food served. This affected 33 of 34 residents (except Resident #15 who received nothing from the kitchen) and specifically affected Residents #7, #18, #23, #28, #29, #30, and #31 .

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain a sanitary kitchen and ensure safe storage of foods served to residents. This had the potential to affect 33 of the 34 residents (Resident #15 does not receive nutrition from the facility kitchen) and specifically affected Residents #29 and #30. Facility census was 34.

Inspectors wroteBased on observation, interview, policy review, and review of Centers for Disease Control information, and record reviews, the facility failed to implement transmission based precautions to prevent the spread of COVID-19. This had the potential to affect the 34 residents residing in the facility and specifically affected Resident #135. The facility census was 34.

Inspectors wroteBased on observation and interview, the facility failed to maintain the call light system in working order. This had the potential to affect the 34 residents residing in the facility. The facility census was 34.

Inspectors wroteBased on observation and interview, and review of facility policy, the facility failed to maintain tile flooring in a resident room in safe condition and to ensure residents and staff smoking area was free of fire hazards This had the potential to affect all 34 residents residing at the facility.

Inspectors wrote3. Record review for Resident #26 revealed this resident was admitted to the facility on [DATE] with diagnoses including non-displaced transverse fracture of right fibula, falls, muscle weakness, urinary tract infection, anxiety, morbid obesity, chronic pain, acute kidney failure, hypertension, bimalleolar fracture, and hyperlipidemia. This resident had no known drug allergies. Review of Resident #26's quarterly Minimum Data Set (MDS) assessment, dated 11/19/21, revealed this resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15. Resident #26 was admitted to the facility with a diagnosis of bilateral leg fractures and is currently in bed with a urinary catheter in place. [...]

Inspectors wroteBased on record review and interview the facility failed to ensure Witnessed Authorization Forms were completed and available for residents whose personal funds were being managed by the facility. This affected two (Resident #4, and #5) of the four residents reviewed for personal funds. The facility census was 34.

Inspectors wroteBased on record review and interview the facility failed to provide receipts and/or book keeping records for all personal account activity. This affected three (Resident #4, #5, and #11) of the (4) four residents reviewed for personal funds. The facility census was 34.

Inspectors wroteBased on observation, resident interview, group resident interview, staff interview, and policy review the facility failed to provide an adequate dining space that was clean, comfortable, and homelike. This affected 11 residents who routinely ate in the common area by the nurses station (Resident #6, Resident #8, Resident #18, Resident #23, Resident #31, Resident #24, Resident #29, Resident #13, Resident #7, Resident #3, and Resident #26) and one resident ( Resident #12) who was observed eating in the common area. The facility census was 34 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a therapeutic diet for three residents, (Residents #6, #12 and #30,) and accurately monitor weights for one resident (Resident #24), as ordered by the physician for 21 residents reviewed for nutritional status. The facility census was 34.

Inspectors wrote3. Review of Resident #24's medical record revealed she was admitted on [DATE] with diagnoses that included: seizures, dementia, diabetes, hypertension, schizoaffective disorder (10/26/2021). Review of Resident #24's significant change Minimum Data Set (MDS) dated [DATE] revealed the following. Resident #24 used oxygen and on hospice. Review of Resident #24's monthly physician orders for November 2021 revealed oxygen at two liters per minute as needed for dyspnea and to change the oxygen tubing every week and as needed. Review of Resident #24's treatment administration record for November 2021 revealed oxygen ordered at two liters for per minute and to change the tubing every week. There was no evidence Resident #24's oxygen tubing was changed. Observation on 11/21/21 at 9:48 A.M. of Resident #24's room revealed an oxygen concentrator with tubing next to Resident #24's bed. [...]

Inspectors wroteBased on observation, medical record review, staff interview, and personnel file review, the facility failed to ensure direct care staff were provided dementia education. This affected one resident (Resident #24) of 11 residents with a dementia diagnosis. The facility census was 34.

Inspectors wroteBased on record review, interview, and observation the facility failed to provide personal materials of the resident's choice as requested. This affected one resident(Resident #28) out of two residents reviewed for personal choices. The facility census was 34.

Inspectors wroteBased on medical record review and staff interview the facility failed to ensure residents who formulated an advance directive had the directive honored. This affected two of five sampled residents (Resident #15 and Resident #24) reviewed for advance directives.

Inspectors wroteBased on medical record review, interview, and facility policy review, the facility failed to ensure a resident being discharged from a Medicare covered Part A stay with benefit days remaining was provided a Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) form, and a Notice of Medicare Non-Coverage-Forms, Center for Medicare and Medicaid Services (CMS) 10123-(NOMNC) form. This affected one resident of the three residents reviewed for Beneficiary Notifications (Resident #13). The facility census was 34.

Inspectors wroteBased on medical record review, staff interview, and observation the facility failed to assess a resident's use of a specialty chair and failed to assure the resident's chair was not positioned to prevent the resident for getting out of the chair. This affected one of one residents (Resident #24) reviewed for restraints.

Inspectors wroteReview of resident medical record and staff interview, the facility failed to document a discharge for a resident returning to the community. This affected one (Resident #34) of the two residents reviewed for discharging from the facility. The facility census was 34.

Inspectors wroteBased on record review, observation, and interview the facility failed to provide appropriate dental and nutritional assessments to appropriately represent the residents health status. This affected two residents (Resident #4 and Resident #20) of 21 residents reviewed for accurate assessments. The facility census was 34.

Inspectors wroteBased on medical record review and staff interview the facility failed to refer a resident for a level II pre-admission screening and resident review (PASRR) when the resident was newly diagnosed with a mental illness. This affected one of three sampled residents (Resident #24) reviewed for PASRR.

Inspectors wroteBased on medical record review and staff interview the facility failed to notify the state mental health authority promptly after an significant change in a resident mental health, a resident with a newly diagnosed mental illness. This affected one of three sampled residents (Resident #24) reviewed for pre-admission screening and resident review (PASRR).

Inspectors wroteReview of resident medical record and staff interview, the facility failed to complete a discharge summary for a resident returning to the community. This affected one (Resident #34) of the two residents reviewed for discharge from the facility. The facility census was 34.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents were provided with the necessary assistance to help maintain abilities in the area of eating and ambulation. This affected four of 22 residents (#7, #8, #12, and #24) reviewed for meal assistance. The facility census was 34.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide Activities of Daily Living (ADL) assistance and care for one dependent resident (Residents #11) of 21 residents reviewed for ADL assistance. The facility census was 34.

Inspectors wroteBased on observation, medical record review, staff interview, resident group meeting, and resident council minute review the facility failed to provide residents with a meaningful, varied activity program, and ongoing activities program that was tailored to the wants and needs of the residents living in the facility. This affected three of three sampled residents (Resident #6, Resident #20, and Resident #24) and five of five residents (Resident #18, Resident #31, Resident #23, Resident #28, and Resident #29) who attended the resident group meeting.

Inspectors wroteBased on resident interview, medical record review, and staff interview the facility failed to assess and provide vision services and devices as needed. This affected one of one residents reviewed for vision (Resident #15).

Inspectors wroteBased on medical record review, staff interview, and policy review the facility failed to complete fall investigations and assessments of residents after falls with head injuries. This affected one of three residents reviewed for falls and after fall assessments (Resident #384). Findings Include: Review of the closed medical record for Resident #384 revealed an initial admission date of 10/09/13, re-entry date on 11/01/13, and a discharge date on 05/19/21. Diagnoses included difficulty in walking, unsteadiness on feet, repeated falls, muscle weakness, abnormal posture, stiffness of the knees, transient ischemic attack (TIA), concussion without loss of consciousness, injury of the head, and contusion of the scalp. [...]

Inspectors wroteBased on resident interview, medical record review, and staff interview the facility failed to assess and provide treatment and care to treat a resident's incontinence. This affected one of one residents reviewed for bladder function (Resident #15).

Inspectors wroteBased on medical record review, review of pharmacy recommendations, and staff interview the facility failed to review a resident's drug regimen and make recommendations regarding drug irregularities. This affected one of six sampled residents (Resident #24) reviewed for unnecessary medications.

Inspectors wroteBased on medical record review and staff interview the facility failed to ensure a resident did not receive an antipsychotic medication without an indication for its use. This affected one of six sampled residents (Resident #24) reviewed for unnecessary medications.

Inspectors wroteBased on record review, observation, and interview the facility failed to provide routine dental services for two residents. This affected two residents (Resident #4 and Resident #15) of four residents reviewed for routine dental services. The facility census was 34.

Inspectors wroteBased on medical record review, observation, and staff interview, the facility failed to ensure resident medical records reflected an accurate code status and enteral nutrition orders. This affected two residents (Resident #383, and #20) of the 23 resident records reviewed. The facility census was 34.