Pioneer Skilled Nursing Center

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the range hood was free of a buildup of grease and debris, failed to ensure food items were closed/sealed, discarded when expired, and stored according to the manufacturer's label; failed to ensure the wall behind the fryer was free of a buildup of grease; and failed to ensure one refrigerator in the kitchen was equipped with a thermometer. The facility census was 47. 1. Review of the undated facility policy, Kitchen Hood Inspection and Cleaning, showed the following: -A safe and healthful work environment will be provided for all employees, residents and visitors. Pursuant to this end, the kitchen hood exhaust system will be properly cleaned and maintained in order to support the functioning of the kitchen hood fire suppression system; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to use appropriate infection control procedures for hand hygiene to prevent the spread of bacteria or other infectious causing contaminates for two residents (Resident #39 and Resident #300) in a review of 14 sampled residents and failed to utilize the appropriate personal protective equipment (PPE), including gowns, when providing care for residents who required Enhanced Barrier Precautions (EBP) (an infection control intervention designed to reduce transmission of multi-drug-resistant organisms (MDROs) that employs targeted gown and glove use during high contact resident care activities) for one sampled resident (Resident #39). [...]

Inspectors wroteBased on interview and record review, the facility failed to convey the remaining resident balance to the state or the probate jurisdiction administering the resident's estate within 30 days of death for eight residents (Residents #109, #103, #100, #102, #107, #106, #108, and #101), and failed to return resident funds to two discharged residents (Residents #105 and #104), within five days following discharge. The facility failed to send an accounting of the funds for Resident #109, who received Medicaid payment for his/her stay, to the state and planned to apply the remaining balance to the outstanding balance owed to the facility. The facility census was 47. Review of the facility's undated policy, Conveyance of Resident Funds Upon Discharge, Eviction, or Death, showed the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the pneumococcal vaccine (a vaccine that can protect against pneumococcal disease), as indicated by the current Centers for Disease Control and Prevention (CDC) guidelines and recommendations for three residents (Residents #37, #3 and #21), in a review of 14 sampled residents. The facility census was 47. Review of the facility policy, Pneumococcal Vaccine, dated October 2024, showed the following: -It is our policy to offer residents and staff immunization against pneumococcal disease in accordance with current CDC guidelines and recommendations; -Each resident will be offered a pneumococcal immunization unless it is medically contraindicated or the resident has already been immunized. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the current fall interventions for one resident (Resident #21), in a review of 14 sampled residents, had been reviewed for effectiveness or that his/her care plan was updated with additional interventions after falls. The facility also failed to ensure their Fall Prevention Program policy was followed. The facility census was 47. Review of the facility policy, Fall Prevention Program, last revised August 2024, showed the following: -Each resident will be assessed for fall risk and will receive care and services in accordance with their individualized level of risk to minimize the likelihood of falls; -The facility utilizes a standardized risk assessment for determining a resident's fall risk; -The risk assessment categorizes residents according to low, moderate, or high risk; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain acceptable parameters of weight for one resident (Resident #39), in a review of 14 sampled residents. The facility failed to consistently provide/offer lunch for the resident to take while away from the facility on dialysis (a treatment for kidney failure, or end-stage kidney disease, that filters waste and excess fluid from the blood when the kidneys can no longer do so) days or after he/she returned, failed to document meal intake per their policy and failed to re-assess food preferences to improve intake. The facility census was 47. Review of the facility policy titled, Nutritional Management, dated 2024, showed the following: [...]

Inspectors wroteBased on interview and record review, staff failed to follow facility policy for required components for dialysis treatments (a process of cleaning the blood by a special machine necessary when the kidneys are not able to filter the blood) and failed to perform and document assessments for one of one resident sampled (Resident #39) who received dialysis. The facility also failed to provide Resident #39 with services consistent with professional standards of practice by failing to assess the resident's dialysis access site for signs and symptoms of infection before and after dialysis treatments. The facility census was 47. Review of the facility policy titled Hemodialysis, dated 2024 showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff provided four residents (Resident #1, #2, #3, and #7), of seven sampled residents, that were unable to complete their own activities of daily living, the necessary care and services to maintain good personal hygiene and staff failed to assist and provide nail care. The facility census was 60. Review of the facility's policy titled, Nail Care, dated 2024, showed the following: -The purpose of this procedure is to provide guidelines for the provision of care to a resident's nails for good grooming and health; -Routine cleaning and inspection of the nails will be provided during activities of daily living (ADL) care on an ongoing basis; -Routine nail care, to include trimming and filing, will be provided on a regular schedule (such as weekly on 3-11 shift). [...]

Inspectors wroteBased on interview and record review, the facility failed to report allegations of misappropriation of property as required for one resident (Resident #7) in a review of seven sampled residents. The facility census was 60. Review of the facility's policy titled, Abuse Neglect and Exploitation, undated, showed the following: -It is the policy of this facility to provide protections for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation, and misappropriation of resident property; -Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary, or permanent, use of a resident's belongings or money without the resident's consent; [...]

Inspectors wroteBased on interview and record review, the facility failed to thoroughly investigate allegations of misappropriation made by one resident (Resident #7) in a review of seven sampled residents. The facility census was 60. Review of the facility's policy titled, Abuse Neglect and Exploitation, undated, showed the following: -It is the policy of this facility to provide protections for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation, and misappropriation of resident property; -Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary, or permanent, us of a resident's belongings or money without the resident's consent; [...]

Inspectors wroteBased on interview and a closed record review for six residents, the facility failed to notify one resident's physician (Resident #55) timely when the resident had continued diarrhea after the implementation of medication to stop diarrhea, incontinence and vomiting with stomach pain. In addition, the facility failed to notify the resident's physician timely of abnormal laboratory results, faxing rather than calling the physician. The physician did not see the laboratory results for review for two days (faxed on [DATE], a weekend, and not reviewed until [DATE]). The resident had repeatedly requested to be sent to the hospital for treatment over a period of twelve days. The resident's physician was not aware of these repeated requests. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store food in accordance with professional standards for food service safety when it failed to refrigerate opened containers of food as specified by the manufacturer, discard food that was expired or showed visible signs of deterioration, appropriately store and handle food products to maintain quality and free from potential contaminants, and label and date opened food and beverage items. The facility also failed to ensure the range hood baffle filters were free of an accumulation of grease, vent covers and dish storage areas were free of dust and debris, and condensation from vents was not allowed to drip onto food surface areas. The facility census was 50. 1. Review of the facility's policy, implemented January 2023, Food Safety Requirements, showed the following: [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain the environment in the facility to ensure the interior and exterior of the facility were in good repair. The facility census was 50. 1. Observation on 5/16/23, at 8:04 A.M. and 8:52 A.M., showed the following: -One of three lights, located in the dishwashing area of the kitchen, was not working; -One of five lights, located in the food preparation and cooking area of the kitchen, was not working; -One of six lights, located above the steam table and coffee/tea maker area of the kitchen, was not working; -Two of the six light covers for the lights, located above the steam table and coffee/tea maker area of the kitchen, were damaged. One cover had two 6 inch cracks and the other cover had a 2 inch by 2 inch hole; -One of two lights, located in the dry storage room adjacent to the kitchen, had no light cover. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure nursing staff performed acceptable infection control practices to prevent contamination when staff failed to protect nebulizer masks while not in use for three residents (Resident #5, Resident #39 and Resident #44), according to the facility policy, and failed to change and document the change of oxygen and nebulizer tubing according to facility policy for four residents (Resident #5, Resident #34, Resident #39 and Resident #44) in a review of 13 sampled residents. The facility census was 50. Review of the facility's policy, Cleaning of Oxygen Tubing, dated 2022, showed the following: -Purpose: to prevent the spread of infection; -Oxygen tubing will be changed every Saturday on night shift; -The tubing must be labeled with the date and stored in a zip lock bag when not in use. [...]

Inspectors wroteThis deficiency is uncorrected. For previous examples, please refer to the Statement of Deficiencies dated 10/25/19. Based on observation, record review and interview, the facility failed to prepare food in a safe manner in accordance with professional standards for food service safety when they failed to follow their policy for food preparation and handling to discard foods that stand for several hours at room temperature when staff let raw chicken set uncovered on the counter with no way to ensure it did not fall into the danger zone (food temperatures between 41 degree Fahrenheit (F) and 135 degree F) from 9:25 A.M. to 12:20 P.M. The raw chicken's internal temperature reached 51 to 59 degrees F during the noon meal preparation before cooking the chicken to serve the residents. This practice affected all residents who consumed the fried chicken. The facility had a census of 45. 1. [...]

Inspectors wroteBased on observation and interview, the facility failed to assure staff kept residents' personal belongings, including a wallet with money and a watch, protected from loss or theft, which affected two of 13 sampled residents, (Residents #43 and #48). The facility census was 44. The facility did not provide a policy for how to account for residents' personal belongings. 1. Observation and interview on 10/2/19, at 4:32 A.M., in the locked cabinet in the East hall medication room showed: - A wallet with a white piece of paper with a rubber band around it. The piece of paper had Resident #43's name on it. Staff wrote 8/3/19, $65.00 in cash. On 9/7/19, the resident took $12.00 out; staff and the resident signed the piece of paper; - Licensed Practical Nurse (LPN) B said the resident keeps his/her wallet in the medication room so he/she can have money when he/she wanted it. 2. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure staff followed professional standards of care when staff failed to administer Flonase nasal spray (used to treat seasonal allergies), failed to administer Azopt eye drops (used to treat glaucoma, increased pressure within the eyeball causing gradual loss of sight) and failed to administer artificial tears (used for dry eyes) correctly for one of 13 sampled residents (Resident #24), failed to obtain an order to flush Resident #100's PEG tube (a tube placed in the stomach to provide a route to deliver nutrition) and failed to start antibiotics in a timely manner for Resident #34. The facility census was 44. 1. Review of the facility's undated Physician Orders and Administration Policy showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff transferred residents in a same manner to prevent accidents or potential for accidents when staff failed to follow manufacturer's guidelines during mechanical lift transfers for three of 13 sampled residents (Resident #17, #26 and #100). The facility census was 44. Review of the facility's undated Mechanical Lift Transfer Policy showed: - Provide maximum safety for both the residents residing in the facility and the staff working with residents; a no lift facility. - Residents unable to bear any weight will be transferred safely with the mechanical lift device which has been assessed to be the right lift for the needs of each resident. Review of the Drive Electric patient lift manufacturer's guidelines, dated 2015, showed: [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure staff administered medications with a medication error rate of less than five percent. Facility staff made four medication errors out of 29 opportunities for error which resulted in a medication error rate of 13.79%, which affected three of 13 sampled residents (Residents #24, #37 and #9). The facility census was 44. Review of the facility's undated Medication Administration Policy showed: - All medications will be administered as ordered by a physician in a safe and sanitary manner. - Administer medications as specified by the manufacturer. - Administer medications with adequate fluids as specified by the manufacturer including bulk laxatives. 1. Review of Resident #24's physician order sheet (POS), dated October 2019, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff properly stored and discarded stock medications in the medication room and disposed of loose pills in the medication cart; failed to label liquid morphine sulfate (narcotic pain medication) with an open date for one of 13 sampled residents (Resident #26). This had the potential to affect any resident who required the stock medication and multi-dose bottles of medication. The facility census was 44. Review of the facility's undated Medication Storage Policy showed: - All medications will be stored per manufacturer's recommendations. - Medication expiration dates will be checked prior to use. - Any medications noted to be expired will be destroyed per facility policy. 1. Observation and interview on 10/2/19, at 4:32 A.M., in the East hall medication room: [...]