Sheridan County Hospital Ltcu

Inspectors wroteThe facility had a census of 27 residents. The sample included 12 residents. Based on interviews and record review, the facility failed to provide Registered Nurse (RN) coverage for eight consecutive hours a day, seven days a week.

Inspectors wroteThe facility had a census of 27 residents. The sample included 12 residents, with seven reviewed for unnecessary drugs. Based on observation, interview, and record review, the facility failed to ensure Resident (R) 25 was free from antipsychotic (a class of medications used to treat major mental conditions that cause a break from reality) medication use without an appropriate indication for use.

Inspectors wroteThe facility had a census of 27 residents. The sample included 12 residents. Based on observation, interview, and record review, the facility failed to develop a comprehensive care plan for two residents, Resident (R) 11 and R27, who received prophylactic antibiotics for urinary tract infections (UTI- an infection in any part of the urinary system).

Inspectors wroteThe facility had a census of 27 residents. The sample included 12 residents, with seven reviewed for unnecessary medications. Based on observation, interview, and record review, the facility's Consultant Pharmacist (CP) failed to address with the facility the ongoing prophylactic (a medicine or course of action used to prevent disease) antibiotic (a class of medications used to treat infections) use for Resident (R) 11 and R27.

Inspectors wroteThe facility had a census of 27 residents. The sample included 12 residents, with one reviewed for Hospice (specialized end-of-life) services. Based on observation, interview, and record review, the facility failed to provide thorough care planning instruction for Resident (R) 7, who received Hospice services.

Inspectors wroteThe facility had a census of 27 residents. The sample included 12 residents, with seven reviewed for unnecessary medications. Based on observation, interview, and record review, the facility failed to implement antibiotic use protocols to avoid unnecessary and/or inappropriate antibiotic use to reduce the risk of adverse effects, including antibiotic resistance, when the facility failed to monitor effectiveness and evaluate appropriateness for the extended administration of prophylactic (preventative in nature) antibiotics for Residents (R) 11 and R27.

Inspectors wroteThe facility had a census of 27 residents. Based on observation, interview, and record review, the facility failed to submit complete and accurate staffing information through Payroll Based Journaling (PBJ- a required detail of staffing information submitted by nursing homes, provided by the Centers for Medicare and Medicaid Services (CMS)).

Inspectors wroteThe facility identified a census of 26 residents, with three residents reviewed for falls and accidents. Based on record review, observation, and interview, the facility failed to transfer Resident (R) 1 safely with a gait belt, and in the process of the transfer staff lifted R1 by both of her arms and R1 sustained a broken left humerus (upper arm bone). This deficient practice placed R1 at risk for injury, pain, and delayed healing.

Inspectors wroteThe facility had a census of 23 residents. The sample included 13 residents with eight reviewed for falls. Based on observation, record review, and interview the facility failed to ensure an environment free from accidents when staff placed Resident (R) 4's electric lift chair remote in reach, despite a safety evaluation which indicated it was not safe. As a result, R4 fell and required sutures to her head laceration. The facility continued to leave the lift control within R4's reach, which placed her at continued risk for falls, injuries, and associated pain.

Inspectors wroteThe facility had a census of 23 residents. The sample included 13 residents. Based on observation, record review, and interview the facility failed to implement a water management program for the Legionella disease (Legionella is a bacterium spread through mist, such as from air-conditioning units for large buildings. Adults over the age of 50 and people with weak immune systems, chronic lung disease, or heavy tobacco use are most at risk of developing pneumonia caused by legionella) and other waterborne pathogens. The facility staff failed to change gloves while providing incontinent care for R23. This placed the residents in the facility at risk for infectious disease. Findings Included: [...]

Inspectors wroteThe facility had a census of 23 residents. The sample included 13 residents with one reviewed for dignity. Based on observation, record review, and interviews, the facility staff failed to treat Resident (R) 17 with dignity when staff failed to close the window curtain during personal care of a gastrostomy tube (G-tube: tube surgically placed through an artificial opening into the stomach). This placed the resident at risk for an undignified experience and embarrassment.

Inspectors wroteThe facility had a census of 23 residents. The sample included 13 residents, of which five were reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure Resident (R) 9's as needed (PRN) Xanax (an antianxiety medication that calms and relaxes people with excessive restlessness, nervousness, and tension) had a 14-day stop date and or a rationale for extended use with a specified stop date. This placed R9 at risk of receiving unnecessary psychotropic medications (medications that affect the chemical makeup of the brain).

Inspectors wroteThe facility identified a census of 29 residents with three reviewed for accidents. Based on record review, observation, and interview, the facility failed to update Resident (R) 1's Care Plan to include staff using a gait belt to assist R1 when standing from a seated to a standing position after Certified Nurse's Aide (CNA) M did not use a gait belt causing bruises and pain. This deficient practice placed R1 at risk for unsafe transfers due to uncommunicated care needs.

Inspectors wroteThe facility identified a census of 29 residents with three reviewed for accidents. Based on record review, observation, and interview, the facility failed to provide Resident (R) 1 a safe environment when Certified Nurse's Aide (CNA) M did not use a gait belt and pulled on R1's left arm causing bruises and pain. This deficient practice placed R1 at risk for pain, bruising, altered skin integrity, and falls.

Inspectors wroteThe facility had a census of 28 residents. The sample included 12 residents with one resident reviewed for foot care. Based on observation, record review, and interview the facility staff failed to provide appropriate foot care in accordance with professional standards of practice, to prevent complications from conditions such as diabetes, when a Certified Nurse Aide (CNA) filed Resident (R) 15's callous on her right big toe, which caused a wound. As a result. R15's wound became infected, required medical treatment including antibiotics, and continued to cause R15 pain.

Inspectors wroteThe facility had a census of 28 residents. The sample included 12 residents. Based on record review and interview, the facility Quality Assessment and Assurance Committee (QA&A) failed to include the Medical Director's (Consultant GG) presence at the quarterly meetings. This placed the residents at risk for lack of input from Consultant GG towards issues discussed in quarterly QA&A meetings.

Inspectors wroteThe facility had a census of 28 residents. The sample included 12 residents with no residents positive for Covid-19 (potentially fatal, highly contagious respiratory virus). The facility was located in a county with substantial county trasmission. Based on observation, record review, and interview the facility failed to monitor and adhere to the use of facial masks as directed in the core principles of infection control to mitigate the spread of Covid-19. This placed the residents at increased risk for Covid-19 infection.