Pioneer Lodge

Inspectors wroteThe facility reported a census of 23 residents. Based on observation, interview and record review, the facility failed to provide Registered Nurse (RN) coverage for at least eight continuous hours daily.

Inspectors wroteThe facility reported a census of 23 residents, and one main kitchen. Based on observation, record review and interview the facility failed to prepare and serve food under sanitary conditions to prevent the potential for food borne bacteria. This placed the residents at risk for food borne illnesses.

Inspectors wroteThe facility reported a census of 23 residents. Five Certified Nurse Aide (CNA) staff who worked in the facility for more than 12 months were reviewed for the required in-service training. Based on interview and record review, the facility failed to develop, implement, and permanently maintain an in-service training program for CNA staff with the required topics and no less than 12 hours per year.

Inspectors wroteThe facility reported a census of 23 residents; the sample included 14 residents. Based on interview and record review, the facility failed to inform Resident (R) 18, R6, R9, R5 and R15 and/or their representative regarding the risks related to psychotropic (alters mood or thoughts) medications.

Inspectors wroteThe facility reported a census of 23 residents. Based on observation, and interview, the facility failed to ensure that meals were served at safe and appetizing temperature. This was evident of a one of one meal observation.

Inspectors wroteThe facility reported a census of 23 residents; the sample included 14 with two residents reviewed for positioning and mobility. Based on observation, interview, and record review, the facility failed to provide a footboard or footrests for Resident (R) 3 and R9.

Inspectors wroteThe facility reported a census of 23 residents; 14 residents were sampled for advanced directives (a written document, which indicates the medical decisions for health care professionals when the person could not make their own decisions). Based on interview and record review, the facility failed to ensure two resident's advanced directives were accurately reflected when Resident (R) 2 had a Do Not Resuscitate (DNR- or no code, a legal document or order that means the person does not desire resuscitative measures) form completed but had an order for a full code. Additionally, R3's DNR lacked a resident/responsible party and witness signature. R14 declined a DNR in 2016, and the facility had a DNR order.

Inspectors wroteThe facility had a census of 23 residents. The sample included 14 residents with one resident reviewed for nutrition. Based on observation, record review, and interview, the facility failed to notify the representative of changes in weight for Resident (R) 1.

Inspectors wroteThe facility reported a census of 23 residents. The sample included 14 residents with one resident reviewed for hospitalization. Based on interview and record review, the facility failed to provide Resident (R) 1 a written notification of transfer to the resident and/or his representative as soon as practicable.

Inspectors wroteThe facility reported a census of 23 residents; the sample included three residents reviewed for accidents. Based on observation, interview, and record review, the facility failed to implement interventions to prevent further falls after a fall for Resident (R) 7 and 14.

Inspectors wroteThe facility reported a census of 23 residents. The sample included 14 residents. Based on observation, interview and record review, the facility failed to use adequate hand hygiene when caring for residents. Additionally, staff failed to disinfect the mechanical lift after use.

Inspectors wroteThe facility reported a census of 23 residents; the sample included 14. Based on interview and record review the facility failed to ensure staff adhered to the principles of antibiotic stewardship through monitoring for the appropriate use of antibiotics prescribed for Resident (R) 2 to prevent antibiotic resistance and spread of multidrug resistant organisms within the facility.

Inspectors wroteThe facility reported a census of 23 residents. Based on observation, interview, and record review, the facility failed to ensure the daily staff posting included the actual hours worked by the nursing staff as required.

Inspectors wroteThe facility reported a census of 23 residents. Based on interview and record review, the facility failed to electronically submit accurate staffing information through Payroll-Based Journaling (PBJ).

Inspectors wroteThe facility reported a census of 23 residents. The facility identified one central kitchen with one dining area. Based on observation, interview, and record review, the facility failed to provide proper sanitary food storage to prevent the spread of food born illness to the residents of the facility.

Inspectors wroteThe facility reported a census of 23 residents. Based on interview and record review, the facility failed to electronically submit to Centers for Medicare and Medicaid Services (CMS), complete and accurate staffing information to the federal regulatory agency through Payroll Based Journaling (PBJ), related to licensed nursing staff coverage 24 hours a day.

Inspectors wroteThe facility reported a census of 23 residents with 12 residents sampled. Based on observation, interview, and record review, the facility failed to maintain an effective infection control program with the failure of staff to follow infection control standards when delivering laundry to resident rooms, failure to place distilled water jugs on a surface other than the floor and failure of staff to appropriately clean nebulizers (a device which changes liquid medication into a mist easily inhaled into the lungs) after use. This deficient practice has the potential to lead to cross contamination between residents, and to place the residents receiving oxygen and nebulized medications at increased for respiratory infections.

Inspectors wroteThe facility census totaled 23 residents. Based on interview and record review, the facility failed to maintain an in-service training program for nurses' aides that was appropriate and effective to ensure the continuing competence of nurse aides. The facility identified three Certified Nurse Assistants (CNA's) had been employed over one year. Three of three CNAs lacked the required 12 hours of in-service training to include dementia and abuse training, to ensure the continuing competence of nurse aides and appropriate care and services to all the residents of the facility.

Inspectors wroteThe facility reported a census of 23 residents with 12 residents included in the sample. Based on observation, interview, and record review, the facility failed to develop a comprehensive care plan for Resident (R) 10 related to the use of oxygen (O2) therapy, R 4 related to nebulizer treatments, and for R 16, related to no diabetic interventions on the care plan.

Inspectors wroteThe facility reported a census of 23 residents with 12 residents sampled. Based on observation, interview, and record review, the facility failed to review and revise the person-centered care plan for three residents, Resident (R) 21 regarding ambulating (walking) independently without a gait belt (a belt used to help transfer a person from one place to another, also used as an ambulation safety aid) and R13 and R24 regarding interventions related to oxygen use and nebulized (a device which changes liquid medication into a mist that is easily inhaled into the lungs) breathing treatment use. This placed the residents at risk to not receive appropriate cares and treatments.

Inspectors wroteThe facility census totaled 23 residents with 12 residents reviewed for unnecessary medications. Based on observation, interview, and record review, the facility failed to administer R22's antidepressant medication as ordered by the physician.

Inspectors wroteThe facility reported a census of 23 residents with 12 sampled, including one for hospitalization. Based on observation, interview, and record review the facility failed to send a copy of the facility-initiated hospitalization transfer/discharge notice to the representative of the Office of the State Long-Term Care Ombudsman for Resident (R) 5. Findings Include: - Review of R5's Minimum Data Set (MDS) tracking form documented the resident discharged to the hospital on [DATE] and returned to the facility on [DATE]. Review of R5's Medical Record lacked evidence of written notification of the facility-initiated hospitalization transfer/discharge and bed hold to R5's Office of the State Long-Term Care Ombudsman. Observation on 01/25/22 at 08:20 AM revealed R5 sat in the dining room eating. [...]

Inspectors wroteThe facility reported a census of 23 residents with 12 sampled including one for hospitalization. Based on observation, interview, and record review the facility failed to provide a copy of the facility bed hold policy to Residents (R) 5 or his representative for his facility-initiated hospitalization. Findings Include: - Review of R5's Minimum Data Set (MDS) tracking form documented the resident discharged to the hospital on [DATE] and returned to the facility on [DATE]. Review of R5's Medical Record lacked evidence of written notification of the facility-initiated hospitalization transfer and bed hold to R5 or his representative. Observation on 01/25/22 at 08:20 AM revealed R5 sat in the dining room eating. On 01/27/22 at 10:05 AM Licensed Nurse (LN) C stated she did not send a bed-hold policy with the resident when they discharged to the hospital. [...]