Puxico Nursing and Rehabilitation Center

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 had the potential to affect all residents. The facility census was 40. Review of the facility's policy titled, Food Preparation and Service, dated November 2022, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement proper infection control practices when staff performed incontinent care for three residents (Residents #3, #14, and #35) out of three sampled residents, catheter (a flexible tube inserted into the bladder to drain urine) care for two residents (Residents #3 and #35) out of two sampled residents, wound care for two residents (Residents #3 and #12) out of two sampled residents, and during glucose monitoring and insulin administration for four residents (Residents #5, #26, #28, and #36) out of four sampled residents. The facility also failed to ensure the laundry building remained in good condition to promote infection control. The facility census was 40. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a urinary indwelling catheter (a tube inserted into the bladder to drain urine) drainage bag was maintained in the proper position for two residents (Residents #3 and #35) out of two sampled residents. The facility census was 40. Review of the facility's policy titled, Urinary Catheter Care, dated August 2022, showed:- Be sure the catheter tubing and drainage bag are kept off the floor;- Keep the drainage bag lower than the bladder at all times to prevent urine from flowing back into the urinary bladder. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician's orders for three residents (Resident #21, #23 and #33) out of 12 sampled residents. The facility's census was 31. Review of the facility's policy titled, Administering Medications, revised April 2019, showed: - Medications are administered in a safe and timely manner, and as prescribed; - Medications are administered in accordance with prescriber orders; - Medication errors are documented, reported, and reviewed by the Quality Assurance Performance Improvement (QAPI) committee to inform process changes and or the need for additional staff training. 1. Review of Resident #21's medical record showed: - Diagnoses of type 1 diabetes mellitus (an autoimmune disease that leads to the destruction of insulin-producing pancreatic beta cells); [...]

Inspectors wroteBased on interview and record review, the facility failed to provide documentation of ongoing assessment and monitoring for one (Resident #21) out of one sampled resident receiving dialysis (process for removal of waste and excess water from the blood due to kidney failure) after returning from treatments. The facility census was 31. Review of the facility's policy titled, Hemodialysis Catheters-Access and Care of, last revised 2001, showed: Care of arteriovenous fistula (a surgical connection made between an artery and a vein for dialysis access) and arteriovenous graft (a type of access used for hemodialysis): - Check for signs of infection (warmth, redness, tenderness, or edema) at the access site when performing routine care and at regular intervals; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure two nurse aides (NA) completed a nurse aide training program within four months of his/her employment in the facility. This deficient practice had the potential to affect all residents in the facility. The facility census was 31. Review of the facility's policy titled, Nurse Aide Qualification and Training Requirements, revised August 2022, showed: - The facility will employ any individual as a nurse aide for more that four months full-time, temporary, per diem, or otherwise, unless: that individual is competent to provide designated nursing care and nursing related services; and that individual has completed a training program and competency evaluation program, or a competency evaluation program approved by the state; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure staff reconciled narcotics (a process that allows one staff to reconcile the exact narcotic inventory on hand with another staff) at each shift change for one out of two medication carts. This practice had the potential to affect all residents. The facility census was 31. Review of the facility's policy titled, Controlled Substances, last revised November 2022, showed: - The facility complies with all laws, regulations, and other requirements related to handling, storage, disposal, and documentation of controlled medications; - Controlled substances inventory is monitored and reconciled to identify loss or potential diversion in a manner that minimizes the time between loss/diversion and detection/follow up; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an error rate of less than five percent (%) when medications were administered. There were 26 opportunities with two errors made, for an error rate of 7.69%. This practice affected two residents (Resident #30 and #23) of five sampled residents. The facility census was 31. Review of the facility's policy titled, Administering Medications, last revised April 2019, showed: - Medications are administered in accordance with prescriber orders; - Medication errors are documented, reported, and reviewed by the Quality Assurance Performance Improvement (QAPI) committee to inform process changes and or the need for additional staff training; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure two vials of Aplisol (a solution used during a tuberculosis (a serious bacterial infection that mainly affects the lungs) test were dated when opened. This had the potential to affect all residents. The facility's census was 31. Review of the facility's policy titled, Medication Labeling and Storage, revised February 2023, showed multi-dose vials that have been opened or accessed are dated and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the open vial. Review of the manufacturer's recommendations for Aplisol, revised November 2013, showed the medication will be discarded 30 days after date opened. Observation on 07/23/24 at 9:10 A.M., of the locked refrigerator in the medication room showed two opened vials of Aplisol solution not dated. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to distribute food under sanitary conditions, increasing the risk of cross-contamination and food-borne illness. These practices had the potential to affect all residents. The facility census was 36. Record review of the facility's Food Preparation and Service policy, dated 11/2022, showed: - Food and nutrition service employees prepare, distribute and serve food in a manner that complies with safe food handling practices; - When meals are assembled in the kitchen and then delivered to residents' rooms or dining areas to be distributed, covering foods is appropriate, either individually or in a mobile food cart; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete comprehensive Minimum Data Set (MDS) (a federally mandated assessment tool completed by the facility staff) assessments within the required time frames for one resident (Resident #18) out of 12 sampled residents and five residents (Resident #131, #132, #133, #181, and #184) outside of the sample. The facility census was 36. Record review of the facility's Resident Assessments policy, revised March 2022, showed: - The resident assessment coordinator is responsible for ensuring the appropriate resident assessments and reviews are completed; - The Resident Assessment Instrument (RAI) (the manual used to help staff gather definitive information on the resident's strengths and needs which must be addressed in the MDS and care plans) provides detailed information on timing and submission of the assessments. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by the facility staff, within the required timeframe for two residents (Resident #16 and #23) of 12 sampled residents and 15 residents (Resident #1, #8, #11, #17, #22, #81, #82, #83, #84, #85, #86, #133, #181, #184, and #185 ) outside the sampled residents. The facility's census was 36. Record review of the facility's Resident Assessments policy, Revised March 2022, showed: - The resident assessment coordinator is responsible for ensuring that the appropriate resident assessments and reviews are completed; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain a safe, clean, comfortable, and homelike environment. The facility's census was 36. Record review of the facility's Maintenance Service policy, revised December 2009, showed: - Maintenance service shall be provided to all areas of the building, grounds, and equipment; - The Maintenance Department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times; - Functions of maintenance personnel include, but are not limited to: maintaining the building in compliance with current federal, state, and local laws, regulations, and guidelines; maintaining the building in good repair and free from hazards; maintaining the fire alarm system and emergency generator system in good working order; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a significant change Minimum Data Set (MDS) (a federally mandated assessment tool completed by the facility), assessment for three residents (Resident #18, #19, and #23) out of 12 sampled residents. The facility's census was 36. Record review of the facility's Resident Assessments policy, Revised March 2022, showed: - The resident assessment coordinator is responsible for ensuring that the appropriate resident assessments and reviews are completed; - The Resident Assessment Instrument (RAI) (the manual used to help staff gather definitive information on the resident's strengths and needs which must be addressed on the MDS and care plans) provides detailed information on timing and submission of the MDS assessments. 1. Record review of the Resident #18's medical record showed: - An admission date of 2/4/21; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to update and revise care plans with specific interventions tailored to meet individual needs for three residents, (Resident #15, #19, #134) or include the resident and/or the guardian for four residents (Resident #15, #18, #19, and #134) and the interdisciplinary care team (IDT) (a group of health care professionals from diverse fields who work in a coordinated effort toward a common goal for a resident) for two residents (Resident #15 and #134) out of 12 sampled residents. The facility census was 36. Record review of the facility's Care Plans, Comprehensive Person- Centered policy, revised March 2022, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide documentation of ongoing assessments, monitoring, and communication between the facility and the dialysis (a process for removing waste and excess water from the blood) center for one resident (Resident #15) out of one sampled resident. The facility's census was 36. Record review of the facility's End-Stage Renal Disease (ESRD), Care of a Resident With policy, revised September 2010, showed: - Staff caring for residents with ESRD, including residents receiving dialysis care outside the facility, shall be trained in the care of these resident; - Education and training of staff includes the type of assessment data that is to be gathered about the resident's condition; [...]