Quapaw Care and Rehabilitation Center LLC

Inspectors wroteBased on observation, record review, interview and facility policy review, the facility failed to ensure meals were prepared and served according to the planned written menus to meet the nutritional needs of the residents for one of one meal observed. Based on observation, record review, interview and facility policy review, the facility failed to ensure meals were prepared and served according to the planned written menus to meet the nutritional needs of the residents for one of one meal observed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure meals were served in a method that maintained appearance, nutritive value, taste and that pureed foods were acceptable to the residents to improve palatability and encourage good nutritional intake during one of one meal observed. Based on observation, record review, and interview, the facility failed to ensure meals were served in a method that maintained appearance, nutritive value, taste and that pureed foods were acceptable to the residents to improve palatability and encourage good nutritional intake during one of one meal observed.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure that food items stored in the refrigerator, freezer, and dry storage areas were covered or sealed, expired food items were promptly removed or discarded on or before the expiration or use by date, to prevent the growth of bacteria, that dietary staff washed their hands between dirty and clean equipment, and hot food items were maintained at required temperature for one of one meal observed. [...]

Inspectors wroteBased on observations, record reviews, and interviews, it was found that the facility did not ensure the resident received treatment in accordance with the facility's Comprehensive Resident Centered Care Plan for one (Resident #60) of one resident investigated for skin concerns. Based on observations, record reviews, and interviews, it was found that the facility did not ensure the resident received treatment in accordance with the facility’s Comprehensive Resident Centered Care Plan for one (Resident #60) of one resident investigated for skin concerns.

Inspectors wroteBased on observations, record review, interviews, and facility policy review, it was discovered that the facility did not ensure there was an intervention implemented to increase range of motion (ROM) and mobility or to prevent further contracture for one (Resident #56) of one resident. Based on observations, record review, interviews, and facility policy review, it was discovered that the facility did not ensure there was an intervention implemented to increase range of motion (ROM) and mobility or to prevent further contracture for one (Resident #56) of one resident.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure cold food items were not maintained at the required temperatures on the pans of ice by the steam table while awaiting service to prevent potential food borne illness for the residents who received meals from 1 of 1 kitchen, failed to ensure 1 of 2 ice machines was maintained in a clean and sanitary condition to prevent potential contamination of residents' beverages for residents who received ice from the therapy room on the 500- hall. These failed practices had the potential to affect 87 residents who resided in the facility.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure odor eliminators were not at the bedside for 1 (Resident 18) to prevent hazardous chemicals from being ingested by residents. This failed practice had the potential to affect 4 (Residents #1, #18, #52, and #87) of 15 sampled residents that ambulate and/or self-propel on 300 Hall, to ensure the mechanical lift was used to lift with legs in the open position for stability to prevent injury for 1 (Resident #18) of 3 sampled residents, and to ensure that the housekeeping cart was kept closed and locked on the floor to prevent residents having access to harmful chemicals.

Inspectors wroteBased on observation, record review and interview the facility failed to provide peri care in a timely manner for 1 (Resident #18) to prevent skin breakdown, infection, and to promote dignity. This failed practice had the potential to affect 4 sampled residents and the potential to affect 13 residents on 300 hall requiring perineal care assistance. The facility failed to ensure that catheter was secured in a way to not drag the floor while 1 (Resident #38) was being transported to the dining area. This failed practice had the potential to cause trauma and induce infection in the resident.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure meals were served in a method that maintained the appearance of cold product and at temperatures that were acceptable to the residents to improve palatability and encourage good nutritional intake during 1 of 2 meals observed. This failed practice had the potential to affect 16 residents who receive meal trays in their rooms on the 100- Hall, 10 residents who receive meal trays on the 200- hall, 12 residents who receive meal trays in their room on the 300- hall, 9 residents who receive meal trays on the 400- hall, 9 residents who receive meal trays on the 500- hall, and 4 residents who receive meal trays on the 600- hall.

Inspectors wroteBased on observation, record review and interview the facility failed to provide appropriate hand hygiene during perineal care for 1 (Resident #71) sampled resident which had the potential to affect all 16 residents living in the Dementia Unit and failed to use proper hand hygiene during medication pass. This failed practice had the potential to affect all residents in the building.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure portable nasal cannula tubing for 1 (Resident 52) was dated to ensure tubing was changed every 7 days to prevent respiratory infections. This failed practice had the potential to affect 2 residents on 300 hall receiving oxygen therapy.

Inspectors wroteBased on observations and interviews the facility failed to ensure that a medication was stored in a secured manner to prevent potential misappropriation of the Resident's medications from other Residents, staff and/or visitors. This failed practice had the potential to affect any Resident residing the facility.

Inspectors wroteBased on observation, record review, and interview the facility failed to obtain informed consent for 1 (Resident #1) prior to administering immunizations. This failed practice had the potential to affect all 87 residents in the facility.

Inspectors wroteBased on observation, and interview, the facility failed to ensure refrigerated narcotic medications were stored in a permanently affixed compartment permitting only authorized personnel to have access. This failed practice had the ability to affect 44 residents who resided on the 400, 500 and 600 Halls who received medications from the Medication Room as documented on a list provided by the Administrator on 05/05/23 at 8:42 AM.

Inspectors wroteBased on observation, and interview, the facility failed to ensure food items stored in the refrigerator were covered and sealed; kitchen appliances (deep fryer, ovens, ceiling tiles and the shelf below the deep fryer) were cleaned and free of stains and spills; kitchen dietary staff washed their hands before handling clean equipment or food items to prevent potential for cross contamination for residents who received meals from 1 of 1 kitchen; expired food items were promptly removed /discarded by the expiration or use by dates; walls and door frames were clean, free of debris and stains, to provide a sanitary area for food preparation and prevent potential food borne illness for residents who received meals from 1 of 1 kitchen; and 1 of 2 ice machines were maintained in a clean and sanitary condition to prevent potential contamination of residents' beverages. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to treat 7 (Residents #3, #64, #73, #78, #84, #86 and #347) of 17 (Residents #3, #17, #32, #34, #64, #66, #69, #70, #73, #78, #81, #83, #84, #86, #346, #347 and #348) sampled residents on the Memory Care Unit with dignity by not providing meals to all residents seated at a table at the same time; failed to treat 2 (Residents #30 and #50) of 3 (Residents #30, #50 and #76) sampled residents who received Hospice care with dignity by not providing privacy during a nursing assessment and failed to treat 1 (Resident #36) of 3 (Residents #28, #36 and #346) sampled residents with indwelling catheters with dignity by not providing a privacy bag.

Inspectors wroteBased on observation, record review and interview, the facility failed to develop and implement a comprehensive person-centered Care Plan for 1 (Resident #44 28) of 13 (Residents #1, #2, #10, #12, #19, #23, #28, #30, #40, #44, #74, #76 and #146) sampled residents who required oxygen therapy; 1 (Resident #74) of 1 sampled resident who had a Physician's Order for a Lap Buddy (restraint) and 1 (Resident #76) of 3 (Residents #76, #30 and #50) sampled residents who received Hospice Services. This failed practice had the potential to affect all 104 residents who resided in the facility as documented on the Resident Census and Conditions of Residents provided by the Administrator on 05/01/23 at 11:20 AM.

Inspectors wroteBased on observation, and interview, the facility failed to ensure pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meals observed. The failed practice had the potential to affect 6 residents who received pureed diets as documented on a list provided by the Dietary Supervisor on 05/04/23 at 1:54 PM.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an accurate medical record by inaccurately documenting dates oxygen (O2) tubing was changed for 3 (Residents #19, #28 and #44) of 7 (Residents #10, #23, #28, #40, #44, #76 and #146) sampled residents who received O2 therapy.

Inspectors wroteBased on interview, and record review, the facility failed to act promptly and provide resolution to a grievance for 1 (Resident #23) of 1 sampled resident who was reviewed for grievances.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the comprehensive assessment was accurately coded for 2 (Residents #28 and #74) of 19 (Residents #3, #19, #23, #28, #30, #36, #, #40, #44, #50, #59, #64, #73, #74, #76, #78, #84, #86, #346 and #347) sampled residents whose Care Plans were reviewed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a Physicians Order was obtained prior to provision of treatment for 1 (Resident #36) of 7 (Residents #3, #36, #40, #44, #53, #74 and #80) sampled residents who received treatments as documented on a list of treatments provided by the Administrator on 05/05/23 at 10:10 AM. This failed practice had the potential to affect all 104 residents who resided in the facility, as documented on the Resident Census and Conditions of Residents provided by the Administrator on 05/01/23 at 11:20 AM.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident alarm box was attached to the sensor pad or could be found in the room to prevent the potential for accidents for 1 (Resident #59) of 6 (Residents #31, #50, #59, #64, #73, and #76) sampled residents. This failed practice had the potential to affect 14 residents who required an alarm as documented on a list provided by the Director of Nursing (DON) on 05/03/23 at 9:06 AM.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure Physician Orders were followed for changing nasal cannulas and humidified water to prevent the potential for infection for 2 (Residents #28 and #44) of 7 (Residents #10, #23, #28, #40, #44, #76 and #146) sampled residents who received oxygen therapy as documented on a list provided by the Director of Nursing (DON) on 05/04/23 at 1:55 PM.

Inspectors wroteBased on observation, and interview, the facility failed to ensure Enhanced Barrier Precaution (EBP) signage was posted on a resident ' s door to notify staff of increased precautions and Personal Protective Equipment (PPE) were required during resident care for 1 (Resident #346) of 1 sampled resident who was on transmission-based precautions.