Smith Medical Nursing Care Ctr

Inspectors wroteBased on observation, resident and staff interviews, and review of the facility's policy titled Grievance Policy, the facility failed to ensure information about the grievance process was posted and made available in visible areas of the facility. In addition, the facility failed to ensure three of 20 sampled residents (R) (R1, R38, and R3) were informed of the grievance process. The deficient practices had the potential to place the 44 residents residing in the facility at risk of not having the knowledge to file a grievance.

Inspectors wroteBased on staff interviews and record review, the facility failed to ensure 14 of 14 Certified Nurse Aides (CNA) reviewed received an annual performance evaluation. This deficient practice had the potential to place the 44 residents residing in the facility at risk of receiving care from incompetent staff.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure expired medications and medical supplies were not stored in the medication storage room. This deficient practice had the potential to place the 44 residents residing in the facility at risk of receiving expired medications or having expired medical supplies being used for them. Findings Include:Observation of the medication storage room on 8/6/2025 at 10:45 am with the Office Manager and Licensed Practical Nurse (LPN) JJ revealed the room contained supplies sitting on the floor and included: One box of 10 cubic centimeters (cc) syringes with expiration date 11/03/2024. Three boxes of skin prep with expiration date 4/1/2025. Two bottles of bisacodyl 5 milligram (mg) with expiration date of 8/2024. Bisacodyl suppositories with an expiration date of 6/2025. One box of Metamucil with an expiration date of 1/2025. [...]

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure kitchen equipment was stored in a sanitary manner and failed to ensure the ice machine was clean and free from residue. These deficient practices had the potential to place the 44 residents who received hydration from the kitchen at increased risk of illness.

Inspectors wroteBased on observations, staff interviews, and review of the facility's policy titled Smoking Policy, the facility failed to ensure proper and effective ventilation, specifically in the indoor designated smoking area and hallways near the area. This deficient practice had the potential to place the 44 residents residing in the facility at risk of medical complications related to exposure to poor air quality.

Inspectors wroteBased on staff and resident interviews, record review, and review of the facility's policy titled Medication Administration General Guidelines, the facility failed to ensure a significant medication error did not occur for one of 20 sampled residents (R) (R32). This deficient practice had the potential to place R32 at risk of medical complications and a reduced quality of life.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled [Facility's Name] Fall Management Guide, the facility failed to identify a fall, investigate the fall to determine a root cause, and implement interventions to ensure protection from future potential falls for one of four residents (R) (R3) reviewed for falls.

Inspectors wroteBased on observations, staff interviews, and a review of the dietary menu cycle and recipes, the facility failed to ensure staff followed food recipes for preparing pureed foods for eight of eight residents who received a puree diet. This failure had the potential to compromise the nutritive value of the pureed meal served to eight of the eight residents who received a pureed diet.

Inspectors wroteBased on observation, staff interviews, and review of the facility policy titled Food Labeling Policy, the facility failed to ensure items in the reach-in freezer, reach-in cooler, and dry food storage area were labeled and dated, food items in dry storage were not expired, and the proper use of the three-compartment sink. The deficient practices had the potential to place 36 of 38 residents who received an oral diet from the kitchen at risk of contracting a foodborne illness.

Inspectors wroteBased on staff interviews, record review, and review of the PBJ (Payroll Based Journal) [NAME] Report for the First Quarter (Q1) of Fiscal Year 2024, the facility failed to accurately report direct care staffing data to the Centers for Medicare and Medicaid (CMS). The facility census was 38 residents.

Inspectors wroteBased on observations, resident interview, staff interviews, and a review of the facility policy titled Preventive Maintenance, the facility failed to ensure that it maintained a safe, clean, and comfortable home-like environment in 10 of 29 resident rooms related to dust and grime build-up and vegetation growth on resident room air conditioner/heater units, grime buildup on medical equipment in resident rooms, dusty ceiling vents in resident bathroom, rusty equipment and furniture in resident rooms, and missing paint in a resident room. These failures placed the residents at risk from the use of unsanitary equipment and the potential for a diminished quality of life.

Inspectors wroteBased on record review, staff interviews, and review of the facility policies titled Completion of Minimum Data Set (MDS) and Comprehensive Care Plan, and Patient's Plan of Care, the facility failed to develop a care plan for one resident (R) (R28) with a diagnosis of Post Traumatic Stress Disorder (PTSD). This failure had the potential for R28 to not receive treatment and/or care according to their needs and place the resident at risk for adverse consequences. The sample size was 22.

Inspectors wroteBased on observations, staff interviews, record review, and review of the policy titled Falls Management, the facility failed to complete neuro checks for one resident (R) (R22) after a fall and failed to complete fall risk assessments for two residents (R22 and R20) of 22 sampled residents. These failures had the potential for residents to not receive treatment and/or care according to their needs and placed R22 and R20 at risk for adverse consequences.

Inspectors wroteBased on observations, resident interviews, and staff interviews, the facility failed to ensure one resident (R) (R26) of 22 sampled residents received a meal tray timely to prevent food from being cold. This deficient practice had the potential to cause R26 to have a decreased nutritional intake and the potential for weight loss.

Inspectors wrote2. A review of R26's admission MDS dated [DATE] revealed Section GG (Functional Abilities and Goals) documented that R26 was dependent on staff for all ADLs. Section H (Bowel and Bladder) documented that R26 had an indwelling urinary catheter. Section I (Active Diagnoses) documented diagnoses including, but not limited to, neurogenic bladder, and a urinary tract infection in the last 30 days. During an observation on 3/22/2024 at 12:52 pm R26 was observed sitting in her geriatric chair in her room with her catheter bag on the floor. During an observation on 3/23/2024 at 8:08 am R26's catheter bag was observed lying on the base of the overbed table. During an observation on 3/23/2024 at 4:15 pm R26's catheter bag was observed lying on the floor. [...]

Inspectors wroteBased on record review, review of the facility's policy Code Blue 911 Call, and staff interviews, the facility failed to activate Emergency Medical Services (EMS) and continue Cardio-Pulmonary Resuscitation (CPR) until more aggressive life sustaining treatment could be initiated for two residents (R#30 and R#232) of four residents reviewed for code status. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused or had the likelihood to cause, serious injury, harm, impairment, or death to residents. The facility's Administrator and Director of Nursing Services (DON) were informed of the Immediate Jeopardy (IJ) on [DATE] at 9:22 a.m. The noncompliance related to the IJ was identified to have existed on [DATE]. An Acceptable Removal Plan was received on [DATE]. [...]

Inspectors wroteBased on record review, staff interviews and review of the Administrator and Director of Nursing Job Description, Administration failed to ensure that staff were following appropriate procedure when providing Cardiopulmonary Resuscitation (CPR) for two residents (R) (R#30 and R#232) of four residents reviewed for code status. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused or had the likelihood to cause, serious injury, harm, impairment, or death to residents. The facility's Administrator and Director of Nursing Services (DON) were informed of the Immediate Jeopardy (IJ) on [DATE] at 9:22 a.m. The noncompliance related to the IJ was identified to have existed on [DATE]. An Acceptable Removal Plan was received on [DATE]. [...]

Inspectors wroteBased on observation and staff interviews, the facility failed to maintain a clean and sanitary kitchen and failed to ensure all opened items in the reach in cooler and reach in freezer was labeled with an open dated and labeled with a used by date. The deficient practice had the potential to affect 29 of 31 residents receiving an oral diet.

Inspectors wroteBased on staff interviews and review of the facility policy titled, Infection Prevention and Control Program, the facility failed to have a qualified Infection Preventionist who had completed the required specialized training in infection prevention and control. This failure placed all residents at risk for the potential transmission of infections and communicable diseases. The facility census was 31 residents.

Inspectors wroteBased on record review, staff interviews and review of the facility policy, the facility failed to offer and/or administer the pneumonia and influenza vaccine to four residents (R) (R#133, R#28, R#132 and R#26) of five residents reviewed for the vaccines.

Inspectors wroteBased on record review and staff interviews, the facility failed to offer and/or administer the COVID-19 vaccine to four residents (R) (R#133, R#28, R#132 and R#26) of five residents reviewed for the vaccines.

Inspectors wroteBased on observation and interviews, the facility failed to ensure that the environment was safe, clean, and comfortable for residents, staff, and visitors related to disrepair of the main lobby, front and back halls, dining room, and shower rooms. The facility census was 31.

Inspectors wroteBased on record review, interviews, policy review, and review of Centers for Medicare and Medicaid Services (CMS) Guidelines, the facility failed to ensure family members of non-hospice residents were allowed to visit at a time of the residents'/families' choosing without needing to schedule their visits with the facility in advance for one of 20 sampled residents (R) (R#21).

Inspectors wroteBased on record review and staff interviews, the facility failed to provide one of one resident (R) (R#134) with the required Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (Form CMS-10055) who was discharged from Medicare Part A services in the last six months.

Inspectors wroteBased on observation, interviews and record review, the facility failed to ensure that one of 20 sampled residents (R) (R#12) comprehensive Minimum Data Set (MDS) assessment was accurate related to dental needs/concerns.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that a resident with a serious mental diagnosis was referred for a Level II PASARR (Pre-admission Screen and Resident Review) evaluation for one of 20 sampled residents (R) (R#7).

Inspectors wroteBased on observation, record review, staff interview, and review of facility's policy, the facility failed to develop a care plan related to bilateral hand contractures for one of 20 sampled residents (R#13).

Inspectors wroteBased on observation, interviews and record review, the facility failed to provide Activities of Daily Living (ADL) care related to showers and shaving for three of 20 sampled residents (R#132, R#12, and R#6).

Inspectors wroteBased on observation, record review, staff interview and facility policy review, the facility failed to provide care and services related to contracture management and range of motion (ROM) for one of two residents (R) (R#13) reviewed for mobility.

Inspectors wroteBased on observation, interviews and record review, the facility failed to ensure that one of 20 sampled residents (R) (R#12) was provided with routine dental services.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to develop a water management policy and implement a procedure to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in the building water system; and failed to maintain an effective Infection Control Program to prevent the spread of infections by not ensuring staff practiced appropriate techniques related to cleaning lint trap of dryer resulting with large accumulation of lint buildup. This had had the potential to affect 31 residents who resided in the facility.

Inspectors wroteBased on observations and interviews, the facility failed to provide a working system that allows residents to call for staff assistance through a communication system that relays the call directly to a staff member for one resident room (158A). The facility census was 31 residents.