Smithville Western Care Center

Inspectors wroteBased on record review, staff interview, and review of the facility policy, the facility failed to ensure and maintain accurate and complete drug records for the residents. This affected four (Residents #38, #84, #95 and #99) of four residents reviewed for pharmacy services. The facility census was 89.

Inspectors wroteBased on resident and staff interview, review of the Almanac Weather History, medical record review, and review of the facility policy, the facility failed to ensure a resident's room maintained a comfortable temperature for Resident #97. This affected one (Resident #97) of three residents reviewed for safe environment. The facility census was 89.

Inspectors wroteBased on interview, record review and review of the facility policy the facility failed to ensure Resident #86 directed his own medical care. This affected one resident (Resident #86) out of three residents reviewed for resident rights. The facility census was 85.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on interview, record review, Self-Reported Incident (SRI) review, and review of facility policy the facility failed to ensure Resident #88's privacy was maintained. This affected one resident (Resident #88) out of three residents reviewed for privacy. The facility census was 88. Findings Include: Review of Resident #88's medical record revealed an admission date of 01/27/23, a re-entry date of 05/01/23 and a discharge date of 11/05/24. Diagnoses included paraplegia, type two diabetes mellitus with diabetic neuropathy, morbid obesity, bipolar disorder and anxiety disorder. Review of Resident #88's Quarterly Minimum Data Set assessment dated [DATE] revealed Resident #88 was cognitively intact. [...]

Inspectors wroteBased on observation, interview, record review, and review of the facility policy the facility failed to ensure Resident #81's physician's orders were followed to ensure proper diabetic insulin management, and failed to ensure Resident #86's open area to his abdominal fold was evaluated and treated. This affected two resident's (Resident #81 and Resident #86) out of three residents reviewed for quality of care. The facility census was 85.

Inspectors wrote2. Review of the medical record for Resident #25 revealed an admission date of 06/23/22 with diagnoses including diabetes mellitus, pressure ulcer to the sacral region and hypertension. Review of the physician's orders revealed Resident #25 had an order dated 10/16/24 for an appointment at the wound center on 10/21/24 at 9:00 A.M. He was to go via his wheelchair by facility transportation. Interview and observation on 10/21/24 at 8:50 A.M. with Resident #25 revealed he was waiting for transportation to an appointment with the wound care center which had been rescheduled numerous times. He stated when he returned from the wound care center he would provide additional information. Interview on 10/21/24 at 10:04 A.M. with the Director of Nursing (DON) revealed Resident #25 was unable to go to his wound care center appointment on 10/21/24 due to a mix-up with their transportation. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure residents were seen by their physician once at least every 30 days for the first 90 days after an admission. This affected four residents ( #9, #10, #78 and #84) of seven residents reviewed for physician visits. The facility census was 77.

Inspectors wroteBased on closed medical record, interview, and policy review, the facility failed to notify the physician and/or nurse practitioner of abnormal lab results for Resident #78. This affected one resident (#78) of 17 residents reviewed for abnormal lab results. The census was 77.

Inspectors wroteBased on observations, staff interview and review of facility policy, the facility failed to maintain a clean and sanitary kitchen area and ensure foods were properly stored. This had the potential to affect all 90 residents who received meals from the kitchen. The facility census was 90.

Inspectors wroteBased on observation, staff interview and review of facility policy, the facility failed to ensure garbage was properly disposed of. This had the potential to affect all 90 residents of the facility. The facility census was 90.

Inspectors wroteBased on observation, staff interview, review of pest control reports and review of facility policy, the facility failed to maintain a kitchen area free of pests. This had the potential to affect all 90 residents who received meals from the kitchen. The facility census was 90.

Inspectors wroteBased on observation, medical record review, staff interview and review of the facility policy, the facility failed to store medications in a safe manner. This affected one (#79) resident, with the potential to affect nine additional residents (#14, #28, #41, #52, #54, #62, #89, #197, and #198) who were identified by the facility as being independently mobile and cognitively impaired residing on the memory care unit. The facility census was 90.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure residents rooms were maintained in a clean/sanitary manner and were in good repair. This affected 10 (#16, #17, #20, #21, #23, #33, #36, #39, #66, and #85) of 10 residents reviewed for physical environment. The facility census was 90.

Inspectors wroteBased on medical record review, review of resident fund records and staff interview, the facility failed to ensure resident funds were conveyed timely upon resident discharge from the facility. This affected one (#148) of one resident reviewed for funds conveyance. The facility census was 90.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure residents and/or resident representatives received written transfer notices when transferring to the hospital. This affected two residents (#11 and #51) of three residents reviewed for hospitalization. The facility census was 90.

Inspectors wroteBased on medical record review, observation and staff interview, the facility failed to ensure dependent residents received nail care. This affected one resident (#89) of three residents reviewed for podiatry care. The facility census was 90.

Inspectors wroteBased on observation, medical record review, review of hospital records, staff interview and review of facility policy, the facility failed to ensure all fall interventions were implemented. This affected two (#41 and #45) of three residents reviewed for falls. In addition, the facility failed to follow procedures following a fall to prevent further injury. This affected one (#41) of three residents reviewed for falls. The facility census was 90.

Inspectors wroteBased on medical record review, resident interview and staff interview, the facility failed to ensure residents were free of unnecessary medication increases. This affected one (#74) of six residents reviewed for unnecessary medications. The facility census was 90.

Inspectors wrote2. Review of the medical record for Resident #79 revealed an admission date of 01/02/24. Diagnoses included, but not limited to, altered mental status, depression and anxiety disorder. Review of the comprehensive MDS assessment dated [DATE] revealed Resident #79 had severe impaired cognition and required moderate assistance with activities of daily living (ADLs). Review of the care plan meeting documentation, completed by Social Services Designee (SSD) #900 with an effective date of 01/29/24 at 4:19 P.M., revealed a care conference meeting was held on 01/29/24 at 12:00 A.M. and the resident and resident representative attended. Review of the care plan meeting documentation, completed by Social Services Designee (SSD) #611 with an effective date of 04/29/24 at 10:32 P.M., revealed a care conference meeting was held on 01/29/24 at 12:00 A.M. [...]

Inspectors wroteBased on record review, staff interview, review of the Centers for Medicare and Medicaid Services (CMS) guidelines, and review of the Notice of Medicare Non-Coverage (NOMNC), the facility failed to ensure proper liability notices were received timely. This affected one resident (#104) of three residents reviewed for liability notices. The facility census was 101. Findings Include: Review of the closed medical record for Resident #104 revealed an admission date of 01/04/24 with diagnoses including Alzheimer's disease, dementia, and COVID-19. Review of the medical record revealed Resident #104 was discharged on 02/23/24. Review of the NOMNC revealed Resident #104 received notification that his skilled services would end effective 02/19/24 with the option to appeal no later than noon of the day before the effective date. [...]

Inspectors wroteBased on medical record review, interview, and facility policy review the facility failed to ensure Minimum Data Set (MDS) assessments were accurate regarding resident vaccination status. This affected three residents (#28, #38, and #99) out of five residents reviewed for vaccinations. The facility census was 107. Findings Include: 1. Medical record review revealed Resident #28 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus, encephalopathy, anxiety disorder, and hypertension. Review of the quarterly MDS assessment dated [DATE] revealed Resident #28 was not offered the influenza vaccine. Further review of Resident #28's medical record revealed that she was offered and received the influenza vaccine on 10/17/23. Interview on 02/08/24 at 2:42 P.M. with MDS Licensed Practical Nurse (LPN) #313 verified that Resident #28's quarterly MDS was coded incorrectly. [...]

Inspectors wroteBased on observations, interviews, record review, and policy review the facility failed to ensure the dishwasher provided sufficient sanitizer, all food was labeled, dated, and stored properly and food was prepared in a sanitary manner. This had the potential to affect all residents of the facility. The facility also failed to ensure all food in each of the three-unit resident refrigerators was covered and dated. This had the potential to affect all residents. The census was 93.

Inspectors wroteBased on observation, interviews, and record review the facility failed to maintain the air temperature above 71 degrees in Resident #49's room. This affected one (Resident #49) of 31 residents on the 500-hall. Facility census was 93.

Inspectors wroteBased on record review and interview the facility failed to ensure Resident's #28 and #34 had a comprehensive care plan for smoking. This affected two of 21 residents reviewed for care plans. The facility census was 93.

Inspectors wroteBased on observation, taste test, and recipe review the facility failed to prepare pureed foods at a consistency appropriate for safe swallowing. This had the potential to affect eight residents (Resident's #6, #12, #20, #31, #47, #72, #74 and #386) who were prescribed a pureed diet and consumed meals from the facility's kitchen. The facility census was 93.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure fortified soup was of honey thick consistency for Resident #6. This affected one (Resident #6) of two residents (Resident's #6 and #30) who received honey thick liquids and fortified foods. The facility census was 93.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure Resident #40 received assistive devices for meals. This affected one of three residents (Residents #15, #40 and #72) reviewed for nutrition. The facility census was 93.

Inspectors wroteBased on observations, medical record review, policy review, and interview, the facility failed to ensure a resident exhibiting symptoms of new onset shortness of breath, cough, and decreased oxygen saturation levels was tested to rule out COVID-19. This affected one (Resident #69) of 24 residents reviewed for infections. The facility census was 93.

Inspectors wroteBased on observation and interviews the facility failed to provide a safe and homelike environment. This affected three (Resident's #35, #66, and #77) of 24 residents reviewed for environment. The facility census was 93.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the operation of the kitchen was maintained in a sanitary manner related to the dish machine, cleaning of the thermometers and monitoring appropriate food temperatures prior to service in the north dining room. This had the potential to affect the 102 residents who received meals from the facility and the 15 residents (Residents #40, #55, #94, #3, #104, #102, #15, #67, #71, #69, #97, #41, #75, #43 and #7) who received meals from the north dining room.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents were afforded dignified dining experiences in the north dining room including receiving timely meals, adequate supplies of service ware such as silverware, plates, cups, bowls, and ordered/requested food items. This had the potential to affect the 15 residents (Residents #40, #55, #94, #3, #104, #102, #15, #67, #71, #69, #97, #41, #75, #43 and #7) who received meals from the north dining room and one of one resident reviewed for food concerns (Resident #3).

Inspectors wroteBased on observation, interview and record review the facility failed to ensure resident's code status were clearly and/or easily identified. This affected two of two residents reviewed for accuracy of code status (Residents #57 and #71).

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a resident was comprehensively assessed, care planned and had a physicians order for the use of a seatbelt while in his electric wheelchair. This affected one of one residents reviewed for restraints (Resident #57).

Inspectors wroteBased on record review and interviews, the facility failed to re-evaluate a resident via a Pre-admission Screening and Resident Review (PASARR) after being newly diagnosed with psychosis. This affected one (Resident #6) of one resident reviewed for PASARR assessments.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a comprehensive care conference for a resident to ensure all concerns were addressed. This affected one of one residents reviewed for care conferences (Resident #3).

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a resident had a comprehensive bladder program in place when the resident needed assistance of staff for toileting to ensure the resident was able to maintain as much continence as possible. This affected one of one residents reviewed for bladder incontinence (Resident #12).

Inspectors wroteBased on medical record review and staff interview, the facility failed to provide timely and effective pain management for Resident #60's continued pain following a fall. This affected one (Resident #60) of three residents reviewed for falls. The facility census was 102 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure coordination of care for a resident who received hemodialysis from an outside facility. This affected one of one residents reviewed for dialysis (Resident #57) and affected four of four residents on fluid restrictions (Resident's #96, #2, #10 and #57) .