Ranchwood Nursing Center

Inspectors wroteBased on record review and interview, the facility failed to ensure the physician and family were notified when a resident had a change of condition for 1 (#6) of 3 sampled residents reviewed for a change of condition which resulted in death. Resident #1 had low blood pressure of 73/47, 81/59 and a pulse of 41 without notification to the physician of the change. The MDS coordinator identified 105 residents resided in the facility. On 04/10/26, an IJ situation was determined to exist related to the facility's failure to notify the physician and family of a change in condition for Resident #6 who was reported to have a low blood pressure and pulse which resulted in death. On 04/10/26 at 11:55 a.m., the Oklahoma State Department of Health was notified and verified the existence of the IJ situation. [...]

Inspectors wroteBased on record review and interview, the facility failed to promptly assess, identify, and intervene when a resident experienced an acute emergent change in condition for 1 (#6) of 3 sampled residents reviewed for changes in conditions when facility staff failed to notify the medical provider of critical emergent vital signs/symptoms and identify hypoglycemia on a resident with known history of diabetes and known recent history and hospitalizations for hypoglycemia resulting in transfer to the acute care hospital and subsequent death. Specifically, the facility failed to:a. Identify, monitor, intervene, and provide continuing assessments for Resident #6 who was admitted with a known history of diabetes and hypoglycemia experiencing signs and symptoms of hypoglycemia.b. [...]

Inspectors wroteBased on record review and interview, the facility failed to develop a care plan:a. for a resident who had a diagnosis of diabetes mellitus type 2 and acute kidney injury for 1 (#6) of 3 sampled residents reviewed for care plans. Resident #1 had no care plan for glucose levels and showed the resident's cause of death was protein calorie malnutrition, cognitive impairment disorder, and acute kidney failure. The Certificate of Death showed a significant condition contributing to Resident #6's death was diabetes mellitus.b.to include interventions for weight loss for 1 (#1) of 3 sampled residents reviewed for weight loss. The MDS coordinator identified 105 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to provide sufficient staff to ensure the highest practicable well-being of each resident. The director of nurses reported 98 residents resided in the facility. The Quality of Care Monthly Report dated December 2025 showed 3 days with insufficient direct care staff for the reported resident census. The Quality of Care Monthly Report dated January 2026 showed 5 days with insufficient direct care staff for the reported resident census. The Quality of Care Monthly Report dated February 2026 showed 1 day with insufficient direct care staff for the reported resident census. A Bath List provided by the facility showed Res. #1 in room [ROOM NUMBER]A was to have baths on Monday and Thursday every week. Facility provided Bath Sheet documents showed Resident #1 had baths on 03/05/26, 03/19/26, and 03/24/26. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure medication was available for administration as ordered for 1 (#1) of 3 sampled residents reviewed for medication administration. The administrator identified 105 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the hall 8 computer on top of the treatment cart was locked and secured to prevent the exposure of resident medical records for 1 of 1 treatment cart observed. The administrator identified 105 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure timely incontinent care was provided for 1 (#3) of 2 sampleds resident observed for incontinent care. The administrator identified 105 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the treatment cart for hall 8 was secure when staff were not in attendance for 1 of 1 treatment cart observed. The administrator identified 105 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure hand hygiene practices were maintained during the provision of perineal care for 1 (#4) of 2 sampled residents observed for incontinent care. The administrator identified 105 residents resided in the facility.

Inspectors wroteOn 09/16/25 at 2:02 p.m., the Oklahoma State Department of Health was notified and verified the existence of an IJ situation related to the facility's failure to assess and identify a wound for Resident #128. This likely resulted in an infected diabetic foot ulcer which caused the resident to be admitted to the hospital and resulted in a right below-knee amputation. On 09/16/25 at 2:15 p.m., regional director was notified of the IJ and provided the IJ template. On 09/17/25 at 8:25 a.m., an acceptable plan of removal was approved by the Oklahoma State Department of Health. The plan of removal, read in part,Plan Of Removal 09/16/2025:What measures will be put into place or what systemic changes will be made to ensure that the deficient practice does not occur. Resident #128 was discharged . Skin assessment for current residents in house will be completed by 09/16/25 at 11:59 p.m. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure a discharge summary was completed for 1 (#129) of 5 sampled residents reviewed for discharge from the facility. The administrator identified 109 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to accurately assess a resident for smoking safety/privileges for 1 (#32) of 2 sampled residents reviewed for smoking assessments. The administrator identified 15 residents who smoked.

Inspectors wroteBased on record review, and interview, the facility failed to develop and implement a comprehensive care plan for a. anxiety disorder for 1 (#70) of 5 sampled residents reviewed for unnecessary medication, and b. smoking for 1 (#16) of 3 sampled residents reviewed for smoking. The DON identified 15 residents in the facility were smokers. The DON reported 109 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to: a. revise and update the care plan for Resident #32 when their smoking privileges were suspended, andb. include the resident's legal guardian in the development and review of the care plan for Resident #76. The administrator identified 109 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to: a. ensure incontinent care was provided for 1 (#100), and b. ensure showers were provided for 1 (#127) of sampled 8 residents reviewed for activities of daily living. The DON identified 109 residents resided in the facility.

Inspectors wroteStatement of Deficiency:Based on record review and interview, the facility failed to notify the resident's legal guardian of a change in the resident's condition and treatment for 1 (#76) of 1 sampled resident reviewed for notification. The administrator identified 109 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to develop and implement a baseline care plan to provide effective and person-centered care for 1 (#126) of 1 sampled resident reviewed for baseline care plans. The administrator identified nine residents admitted to the facility in the previous 30 days.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure care plan interventions were implemented to promote the healing of a pressure ulcer for 1 (#100) of 7 sampled residents reviewed for pressure ulcers. The DON identified 13 residents in the facility had pressure ulcers.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure residents were bathed as scheduled for 3 (#1, 2, and #3) of 3 sampled residents reviewed for assistance with activities of daily living. The administrator identified 115 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure medications were administered according to physician orders for 3 (#1, 2, and #3) of 3 residents sampled for timely administration of medications. The administrator identified 115 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a resident's representative was notified when the resident experienced a fall requiring transport to the hospital for 1 (#2) of 3 sampled residents reviewed for accidents. The administrator identified 115 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to maintain an infection control program for EBPs and ensure staff followed infection control guidelines to prevent the potential spread of disease during wound care for 1 (#7) of 3 sampled residents reviewed for wound care. The DON identified 30 residents with wounds and 33 residents on enhanced barrier precautions.

Inspectors wroteBased on record review and interview, the facility failed to ensure bathing was provided for 1 (#2) of 3 sampled residents reviewed for bathing. The assistant director of nursing identified 117 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to conduct a thorough investigation after receiving an allegation of missing doses of medication for one (#8) of three sampled residents reviewed for medications being administered as ordered. The administrator reported there were 112 residents residing in the facility.

Inspectors wroteBased on record review and interview, the facility failed to complete a comprehensive MDS assessment within the required time frame for one (#6) of eleven sampled residents reviewed for MDS assessment completion. The DON identified 112 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident did not receive the wrong medications for one (#3) of three sampled residents reviewed for medication being administered as ordered. The administrator identified 112 residents resided in the facility. Findings A Medication Administration- General Guidelines policy, dated 01/2024, read in parts, Residents are identified before medication is administered using at least two resident identifiers .the resident's room number or physical location is not used as an identifier Resident #3 had diagnoses which included pneumonia and deep vein thrombosis. An incident report, dated 12/25/24 at 8:02 a.m., documented CMA #2 had given Resident #3 medications that belonged to another resident. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to maintain a home like environment during two of two observations by ensuring: a. carpets were in good repair and clean, b. walls were in good repair and not damaged, c. outlets and exposed wires were covered, d. tiles were in good repair and not torn or missing e. walls and ceilings were clean and free of debris and stains, and f. strong odors of urine were prevented. The DON identified 102 residents resided in the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure safe food handling practices of covering food in a sanitary condition when on the tray line. The DON stated 101 residents received nutritional meals from the kitchen

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a catheter bag was covered with a vanity bag to maintain residents dignity for one (#96) of three sampled resident reviewed for catheter bags covered to maintain a residents dignity during two of two observations. The DON identified 9 residents had catheters in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents were offered the choice to formulate an advanced directive for one (#4) of 32 sampled residents whose advanced directive acknowledgments were reviewed. The DON identified 102 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to document the alleged abuse for one (#44) of three sampled residents. The DON reported 101 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure quarterly assessments were completed within 92 days of the previous ARD for two(#1 and #75) of 32 sampled residents whose MDS assessments were reviewed. The DON identified 102 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure that Resident #102 MDS records accurately reflected the residents status of discharge. The DON stated 101 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the residents carpet was not torn and frayed causing a resident to fall for one (#45) of one resident sampled for accidents and hazards. The DON identified 102 residents resided in the facility

Inspectors wroteBased on record review and interview, the facility failed to ensure allegations of abuse were reported to OSDH for seven (#1, #3, #4, #7, #9, #10, and #11) of 11 residents reviewed for allegations of abuse reported to the OSDH. The facility census was 115.

Inspectors wroteBased on record review and interviews, the facility failed to fully investigate allegations of abuse for nine (#1, #2, #3, #4, #7, #9, #10, and #11) of eleven sampled residents reviewed for abuse. The facility census was 115.

Inspectors wroteBased on record review, observation, and interview, the facility failed to: a. remove discontinued medications from current medication supply for three (#5, 6, and #7), and b. use corresponding blister cards and controlled drug sheets when dispensing controlled medications for two (#8 and #9) of five sampled residents reviewed for medication administration. The Administrator identified 112 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure residents were safe to self-administer medication for two (#10 and #11) of two sampled residents reviewed for self-administering medications. The Administrator identified 112 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide care consistent with professional standards of practice for the administration of intravenous fluids for one (#4) of one sampled resident reviewed for intravenous fluid administration. The Administrator identified 112 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure resident's family was notified of a room change for one (#50) of three sampled residents reviewed for notification of change. Resident Census and Conditions of Residents report, dated 06/01/23, documented 109 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure a NOMNC and ABN was provided for a facility initiated discharge from Medicare Part A services with days remaining for one (#1) of three sampled residents reviewed for beneficiary notices. The Entrance Conference Worksheet, undated, documented 33 residents discharged from Medication Part A services with days remaining in the last six months.

Inspectors wroteBased on record review and interview, the facility failed to ensure care plans were reviewed and revised for one (#27) of 22 sampled residents reviewed for care plans. The Resident Census and Conditions of Residents report, dated 06/01/23, documented 109 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure bathing was provided as scheduled for one (#96) of seven sampled residents reviewed for ADL care. The Resident Census and Conditions of Residents report, dated 06/01/23, documented 97 residents required assistance for bathing.

Inspectors wroteBased on observation, record review, and interview, the facility failed to obtain wound measurements to fully assess pressure wounds for healing or worsening for one (#102) of two sampled residents reviewed for pressure ulcers. The Resident's Census and Conditions of Residents report, dated 06/01/23, documented seven residents with pressure ulcers and the census was 109.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure safe medication administration practices were followed for two (#78 and #88) of six sampled residents observed during medication administration. The Resident Census and Conditions of Residents report, dated 06/01/23, documented 109 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure soiled linen were not placed on the floor to prevent the spread of infection for one (#10) of three sampled residents observed for linen handling. The Resident Census and Condition of Residents report, dated 06/01/23, documented 109 residents resided in the facility.