Portageville Health Care Center

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of a transfer or discharge to a hospital, including the statement of appeal rights or the name, address, or telephone number of the Office of the State Long Term Care Ombudsman (advocates for the residents in nursing facilities) within the transfer and discharge notices for six residents (Residents #11, #16, #18, #50, #52 and #60) out of eight sampled residents and two residents (Residents #24 and #58) outside the sample. The facility's census was 56. Review of the facility's policy titled, Resident Transfer/Discharge, Immediate Discharge, and Therapeutic Leave, revised 05/14/24, showed: - Before any resident is transferred or discharged under a facility-initiated transfer or discharge, the facility must: 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff) for one resident (Resident #14) out of 14 sampled residents. The facility census was 56. Review of the facility's policy titled, MDS 3.0, Care Assessment Summary and Individualized Care Plans, revised 11/06/23, showed: - To understand the changes presented by Centers for Medicare and Medicaid (CMS) for the MDS 3.0, to define the intent of each section of the MDS 3.0 and to ensure that MDS 3.0 sections are completed accurately and in a timely manner by the assigned responsible parties; - Section N is to be completed by Nursing Staff. This section focuses on the medications the resident has received in the last seven days or since admission or re-entry if less than seven days; [...]

Inspectors wroteBased on interview and record review, the facility failed to implement a care plan with specific interventions to meet individual needs for three residents (Residents #6, #18, and #43) out of 14 sampled residents. The facility census was 56. Review of the facility's policy titled, Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff) 3.0, Care Assessment Summary and Individualized Care Plans, revision date 11/06/23, showed: - The Care Area Assessment (CAA's) drives the development of the individualized care plan; - The Care Area Trigger (CAT) alerts the assessor that interventions must be in place to address the care concern in the plan of care for the individual resident; - All Care Area Assessment Summary Triggers must be addressed in the individualized plan of care of the resident; - The Plan of Care should then address these factors: a. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure training was provided, competence was assessed, and a physician's order was received for tracheostomy (trach - incision in the windpipe to relieve an obstruction to breathing) care to be completed independently and to have all of the needed trach care supplies easily accessible for immediate emergency care per the facility's policy for one resident (Resident #39) out of one sampled resident with a trach. The facility census was 56. Review of the facility's policy titled, Tracheostomy Care, revised May 2024, showed: - The facility will ensure that residents who need respiratory care, including tracheostomy care and tracheal suctioning, is provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and resident goals and preferences; [...]

Inspectors wroteBased on interview and record review, the facility failed to identify, assess, and provide supportive interventions for two residents (Residents #27 and #162) out of six sampled residents and two residents (Residents #21 and #22) outside the sample with a diagnosis of post traumatic stress disorder (PTSD - a mental health condition triggered by a terrifying event - either experiencing it or witnessing it; symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event). The facility's census was 56. Review of the facility's policy titled, Behavioral Health Services, revision date 10/31/24, showed: - It is the policy of this facility to ensure all residents receive necessary behavioral health services to assist them in reaching and maintaining their highest level of mental and psychosocial functioning; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement procedures to ensure medications were accurately administered, documented, disposed of, and reconciled for one resident (Resident #45) outside 14 sampled residents. This practice had the potential to affect all residents. The facility census was 56. Review of the facility's policy titled, Controlled Substance Administration and Accountability, revised May 2024, showed: - The purpose of this policy is to have safeguards in place in order to prevent loss, diversion, or accidental exposure; - All controlled substances obtained from a non-automated medication cart or cabinet are recorded on the designated usage form. Written documentation must be clearly legible with all applicable information provided; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an error rate of less than five percent (%) when medications were given. There were 42 opportunities with three errors made, for an error rate of 7.14%. This affected two residents (Residents #23 and #42) out of six sampled residents and had the potential to affect all residents. The facility census was 56. Review of the facility's policy titled, Medication Administration Policy, revised June 2024, showed: - Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. It is the policy of this facility to ensure the safe and effective administration of all medications by utilizing best practice guidelines; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain proper infection control practices during wound care for one resident (Resident #23) out of one sampled resident. This practice has the potential to affect all residents. The facility census was 57. Review of the facility's policy titled, Wound Treatment Management Policy, revised May 2024, showed: - The purpose of this policy is to promote wound healing of various types of wounds, it is the policy of this facility to provide evidence-based treatments in accordance with current standards of practice and physician orders; - Wound treatments will be provided in accordance with physician orders, including the cleansing method, type of dressing, and frequency of dressing change. Review of the facility's policy titled, Hand Hygiene, revised June 2024, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide and document that residents received or declined appropriate immunizations and failed to provide and document pertinent education to the residents or resident's representative regarding benefits, side effects, or warnings of of those immunizations for three residents (Residents #18, #22, and #53) out of five sampled residents. The facility's census was 56. Review of the facility's policy titled, Infection Prevention and Control Programs, revised June 2024, showed: - Residents will be offered the influenza vaccine each year between October 1 and March 31, unless contraindicated or received the vaccine elsewhere during that time; - Education will be provided to the residents and/or representatives regarding the benefit and potential side effects of the immunizations prior to offering vaccines; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean and comfortable homelike environment. This deficient practice had the potential to affect all residents in the facility. The facility census was 59. Review of the facility's policy titled, Safe and Homelike Environment Policy, revised 06/05/2024, showed: - In accordance with residents' rights, the facility will provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. This includes ensuring that the resident can receive and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff treated residents with dignity and in a respectful manner by leaving one resident (Resident #41) out of 15 sampled residents exposed during care. The facility census was 59. Review of the facility's policy titled, Dignity and Respect, revised, 06/29/2023, showed: -Every resident has a right to be treated with dignity and respect; 1. Review of Resident #41's medical record showed: -admission date of 11/23/21; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the baseline care plan (initial plan for delivering of care and services) included specific interventions and the resident and/or guardian received a written summary of the baseline care plan for two residents (Resident #105 and #155) out of two sampled residents. The facility was census was 59. Review of the facility's policy titled, Baseline Care Plan Policy, revised 05/18/2024, showed: - The facility will develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. - The baseline care plan will be developed within 48 hours of a resident's admission; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to implement a care plan with specific interventions to meet individual needs of four residents (Residents #16, #50, #53, and #105, ) out of 15 sampled residents. The facility census was 59. Review of the facility's policy titled, Comprehensive Care Plans, revised 01/19/2022, showed: - The purpose of this policy is ensure that the facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. [...]

Inspectors wroteBased on interview and record review, the facility failed to attempt a gradual dose reduction (GDR) for one resident (Resident #37) out of 15 sampled residents. This failure had the potential to keep any resident on a psychoactive medication from receiving the lowest possible dosage of medication due to not monitoring if a medication is treating the target symptom. The facility census was 59. Review of the facility's policy titled, Monthly Drug Regimen Review, revised 07/05/22, showed: -The consultant pharmacist will review the drug regimen of each Resident at least monthly and report, in writing, any irregularities; -The consultant pharmacist will provide to the director of nursing each month a written report with a statement about each resident and any irregularities found. If no irregularities were noted this shall be so noted; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an error rate of less than five percent (%) when medications were given. There were 28 opportunities with three errors made, for an error rate of 9.09%. This affected two residents (Resident #37 and #52) and had the potential to affect all residents. The facility census was 59. Review of the facility's policy titled, Medication Administration and Monitoring, revised 09/20/2023, showed: -Medications are to be given per doctors' orders; -All medications are recorded in the Electronic Medication Administration Record (EMR) immediately after the resident has taken the medications. The nurse of Certified Medication Technician (CMT) will check each medication to the EMR noting correct name of medication, correct resident name, correct dose, correct time and correct route of administration; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain proper infection control practices during incontinent care for one resident (Resident #38) out of four sampled residents and one resident (Resident #44) outside the sample. The facility failed to maintain proper infection control practices during a wound care treatment for one resident (Resident #26) out of two sampled residents. The facility census was 59. Review of the facility's policy titled, Handwashing/Hand Hygiene, dated 06/29/23, showed: - The use of gloves does not replace handwashing; - Hands are to be washed before and after gloving; - A waterless antiseptic solution may be used as an adjunct to routine handwashing; - Appropriate ten to fifteen second handwashing must be performed under the following conditions: -whenever hands are obviously soiled; -before performing invasive procedures; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and distribute food under sanitary conditions, increasing the risk of cross-contamination and food-borne illness. This potentially affected all residents. The facility census was 57. Record review of the facility's Dietary Equipment Operations, Infection Control, and Sanitation policy, revised 1/19/22, showed: - The Dietary staff shall maintain the sanitation of the Dietary Department through compliance with written, comprehensive cleaning schedules developed for the facility by the Dietary Manager; - Clean the dish machine interior and exterior with de-liming solution weekly; - Scrub pots and pans using scouring pad or an appropriate cleaning tool; - Any dish or utensil with debris will not be used. 1. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to follow their policy and procedure to complete a Criminal Background Check (CBC) for two out of six sampled staff prior to hire. The facility census was 57. Record review of the facility's Applicant Screening policy, revised 5/9/22, showed: - Human Resources (HR) department will conduct pre-employment screens on applicants to determine whether the applicant has committed a disqualifying crime, is an excluded provider of any Federal or State healthcare programs, is eligible to work in the United States, and, if applicable, is duly licensed or certified to perform the duties of the position for which they applied; - HR staff will conduct the following screens on potential employees prior to hire: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain infection control practices for four residents (Residents #10, #19, #44, and #52) out of four sampled residents when facility staff failed to clean/disinfect the glucometer (a device used to measure and display the amount of sugar in a person's blood) between each resident's use, and failed to practice proper isolation precautions for one resident (Resident #52) out of one sampled resident. The facility's census was 57. Record review of the facility's Cross Contamination of Equipment policy, revised 7/5/22, showed: - The policy will define procedures to prevent the spread of infection/diseases when utilizing multiple use equipment; - Examples of multiple use equipment include the accucheck machine (glucometer); [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to document a complete and accurate Minimum Data Set (MDS), a federally mandated assessment completed by the facility staff, assessments for three residents (Resident #10, #14 and #44) out of 15 sampled residents. The facility census was 57. Record review of the facility's MDS 3.0, Care Assessment Summary and Individualized Care Plans policy, dated 2/26/21 showed: - To understand the changes presented by Centers for Medicare Services (CMS) for the MDS 3.0, to define the intent of each section of the MDS 3.0 and to ensure that MDS 3.0 sections completed accurately and in a timely manner by the assigned responsible parties; - Section H will be completed by the nursing staff. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement a care plan with specific interventions tailored to meet individual needs of three residents (Resident #10, #14, and #39) out of 15 sampled residents and one resident (Resident #29) outside the sample. The facility census was 57. Record review of the facility's Comprehensive Care Plans and Baseline Care Plans policy, revised 1/19/22, showed: - The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental and psychosocial needs identified in the comprehensive assessment; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain new orders for one resident (Resident #10) for suprapubic catheter (a hollow flexible tube used to drain urine from the bladder through a cut in the lower abdomen) care when he/she was readmitted from the hospital, and failed to obtain physician orders and monitor a wanderguard bracelet (a bracelet with sensors that alert caregivers when a resident wearing one approaches a monitored door) for one resident (Resident #52) out of 15 sampled residents and one resident (Resident #41) outside the sample. The facility census was 57. Record review of the facility's Transcription of Orders/Following Physician's Orders policy, revised 7/9/21, showed: [...]

Inspectors wroteBased on interview and closed record review, the facility failed to ensure a discharge planning process was in place which addressed goals and needs and involved the resident and/or the resident's legal guardian and the interdisciplinary team (IDT) (a group of health care professionals from diverse fields who work in a coordinated effort toward a common goal for a resident) in developing a discharge plan for one resident (Resident #57) out of two sampled discharged residents. The facility census was 57. 1. Record review of Resident #57's closed medical record showed: - admission date of 10/6/22; - Diagnoses of traumatic subdural hemorrhage (a head injury) and schizophrenia disorder (a long term mental disorder that affects a person's ability to think, feel, or behave clearly, sometimes including delusions or hallucinations); - Family member as the legal guardian; [...]

Inspectors wroteBased on interview and closed record review, the facility failed to complete a comprehensive discharge summary for one resident (Resident #57) out of two sampled discharged residents. The facility census was 57. Record review of the facility's Resident Transfer, Discharge, Immediate Discharge, and Therapeutic Leave policy, revised 7/12/22, showed: - A resident must have a discharge summary that includes a recapitulation (describes the course of treatment while residing in a facility) when the facility anticipates a discharge; - The intent will ensure appropriate discharge planning and communication of necessary information to the continuing care provider. 1. Record review of Resident #57's closed medical record showed: - The resident discharged to another facility on 10/19/22; - No documentation of a comprehensive discharge summary. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff maintained proper positioning and placement of catheter tubing and the drainage bag for an indwelling urinary catheter (a tube inserted into the bladder to drain the urine) on one resident (#52) out of three sampled residents. The facility census was 57. Record review of the facility's Catheter Care policy and procedure, revised on 2/26/21, showed: - The facility will ensure any resident with a urinary catheter will be maintained to prevent infection; - Staff will make sure urine flows out of the the catheter into the drainage bag; - Staff to keep the urinary drainage bag below the level of the bladder to prevent back flow of the urine; - Staff to make sure the urinary drainage bag and catheter tubing does not touch the floor; [...]