Schleicher County Medical Center

Inspectors wroteBased on interviews and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 3 of 9 residents (Residents #1, #8, and #33) reviewed for advance directives. The facility failed to ensure Resident's #1, #8, and #33 Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) forms were completed correctly. This failure could place residents at risk of having their end of life wishes dishonored, and of having CPR performed against their wishes.

Inspectors wroteBased on interviews and record review, the facility failed to ensure in accordance with professional standards of practices, the medical records on each resident were accurately documented for 2 of 3 residents (Residents #33 and #34) reviewed for accurate medical records. The facility failed to accurately document the type of discharge for Residents #33 and #34. This failure could affect residents whose records are maintained by the facility and could place them at risk for errors in care and treatment.

Inspectors wroteBased on observation, interview and record review the facility failed to maintain an infection control program designed to prevent the development and transmission of infections for 1 of 4 (Resident #21) reviewed for infection control. The facility failed to ensure Resident #21's oxygen nasal cannula tube was bagged when not in use and CNA A touched the nasal cannula with her bare hands to place it on the resident's nose. This failure could place the residents at risk of infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food safety in the facility's only kitchen. The facility failed to ensure food items in the facility's only dry storage was sealed appropriately. These failures could place residents at risk for food-borne illness, and food contamination.

Inspectors wroteBased on interviews and record review, the facility failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 5 residents (Resident #16) reviewed for care plans. The facility failed to have a care plan in place to accurately address Resident #16's oxygen use. This failure could affect residents by placing them at risk of not receiving individualized care and services to meet their needs.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure drugs and biologicals were labeled in accordance with currently accepted professional principles for 1 of 1 medication rooms inspected for medication storage. The medication room had opened and undated vial of Tuberculin (TB) medication in the refrigerator. This failure could place residents at risk of receiving medications that were expired and not produce the therapeutic effect.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 1 (Resident #9) of 2 residents reviewed for infection control. CNA B failed to change her gloves when going from dirty to clean during peri-care for Resident #9. CNA C failed to wash her hands prior to putting gloves on and assisting Resident #9 with personal care. This failure could place residents at risk for cross contamination and the spread of infection.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the resident environment remained as free from accident hazards was possible and each resident received adequate supervision and assistive devices to prevent accidents for 1 of 4 residents (Resident #1) reviewed for accidents and supervision . 1. HA A failed to ensure Resident #1 was properly transferred by two persons using a Hoyer lift. 2. The facility failed to ensure HA A was properly trained before transferring Resident #1 by Hoyer lift . The noncompliance was identified as PNC. The noncompliance began on 8/29/23 and ended on 9/4/23. The facility had corrected the noncompliance before the investigation began. This failure could place residents at risk of severe injury.

Inspectors wroteBased on interview, and record review, the facility failed to ensure staff had the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 of 4 residents (Resident #1) reviewed for accidents and supervision . 1. HA A failed to ensure Resident #1 was properly transferred by two persons using a Hoyer lift. 2. The facility failed to ensure HA A was properly trained and able to demonstrate compentency in skills and techniques before transferring Resident #1 by Hoyer lift . The noncompliance was identified as PNC. The noncompliance began on 8/29/23 and ended on 9/4/23. The facility had corrected the noncompliance before the investigation began. This failure could place residents at risk of severe injury.

Inspectors wroteBased on observation, interview and record review the facility failed to provide pharmaceutical services, including procedures that ensure the accurate administering of all drugs to meet the needs of the residents, for 1 of 1 medication room and 1 of 1 treatment cart inspected for medication storage. The medication room had opened, undated and an expired vials of tuberculin in the medication refrigerator. The treatment cart contained insulin pens without open dates. This failure could place residents at risk of receiving medications that were expired and not produce the desired effect, and at risk of not receiving the therapeutic benefit of medications or adverse reactions to medications.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents with bed rails were assessed for the risk of entrapment from bed rails, failed to provide ongoing monitoring and supervision for the use of bed rails, and failed to have a care plan in place for bed rails for 1 of 1 resident (Resident #7) reviewed for the use of full (4) bed rails. 1. Resident # 7 had full side rails at her request without a developed care plan with measurable goals benefits and risks related to side rail use. 2. The facility failed to routinely assess Resident #7 for ongoing need for and risks of side rail use (including entrapment). 3. The facility failed to conduct and document routine monitoring of Resident #7 while full side rails were in use. This failure could affect residents by putting them at an increased and unnecessary risk of harm, entrapment, and injury.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for one (Resident #4) of one resident reviewed for infection control. LVN C failed to sanitize the bedside table and put down a barrier to prevent cross contamination. LVN C failed to sanitize scissors after they became contaminated prior to ostomy care for Resident #4. LVN C failed to wash her hands prior to donning gloves for resident care. This failure could place resident's risk for cross contamination and the spread of infection. Findings Included: [...]

Inspectors wroteBased on interview and record review, the facility failed to follow guidelines for mandatory submission of staffing information based on payroll data in a uniform format. Long-term care facilities must electronically submit to CMS complete and accurate direct care staffing information, including information for agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format according to specifications established by CMS. The facility failed to submit PBJ staffing information to CMS for the 2nd quarter of the fiscal year 2023. The facility's failure could place residents at risk for personal needs not being identified and met, decreased quality of care, decline in health status, and decreased feelings of well-being within their living environment.