Stigler Nursing & Rehab

Inspectors wroteBased on record review and interview, the facility failed to ensure a RN was in the facility 08/2025 through 09/2025 at least eight consecutive hours a day, seven days a week. The administrator identified 54 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents were provided with advance directive information for 2 (#5 and #10) of 24 sampled residents reviewed for advance directives. The administrator identified 54 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents who were discharged from Medicare Part A skilled services, had benefit days remaining, and remained in the facility were issued SNF ABN and NOMNC notices for 1 (#23) of 3 sampled residents reviewed for beneficiary notices. The MDS coordinator identified nine residents discharged from Medicare Part A skilled services with benefit days remaining in the past six months.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure staff served food in a manner that would reduce the risk of cross contamination during one of one kitchen observation. The DM identified 53 residents received meals prepared by the kitchen and one resident who received nutrition via peg tube.

Inspectors wroteBased on observation and interview, the facility failed to ensure walls were kept clean for 1 (room [ROOM NUMBER]) of 1 room observed for infection control concerns. The administrator identified 54 residents resided in the facility.

Inspectors wroteOn 07/31/24, an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to ensure Res #1, who was at risk for elopement, did not elope from the facility. Res #1 admitted to the facility on [DATE] with diagnoses including dementia. Res #1 eloped from the facility on 06/29/24 without staff knowledge and was returned to the facility by a community member. The facility did not complete one-on-one monitoring upon the Res #1's return or initiate environmental interventions for prevention. The care plan was not revised for the Res #1 and staff did not have a consistent plan to monitor and prevent elopement for the resident. On 07/31/24 at 3:00 p.m., the Oklahoma State Department of Health was notified and verified the existence of the IJ situation related to elopement for Res #1. On 07/31/24 at 3:12 p.m., the administrator was notified of the IJ situation. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure RN coverage eight consecutive hours seven days per week. The Resident List Report documented 54 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure a comprehensive care plan was developed for a resident with wounds for one (#1) of three sampled residents whose wound documentation was reviewed. LPN #2 identified ten residents who had wounds.

Inspectors wroteBased on record review and interview, the facility failed to ensure wound care assessments were accurate for a resident with wounds for one (#1) of three sampled residents whose wound documentation was reviewed. LPN #2 identified ten residents who had wounds.

Inspectors wroteBased on observation, record review, and interview the facility failed to update the comprehensive person-centered care plans to reflect the residents' current needs for four (#2, 19, 30, and #46) of 15 sampled residents whose care plans were reviewed. The administrator identified 58 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident was free from abuse for one (#1) of four residents sampled for abuse. On 08/06/23 CNA #1 sprayed Res #1 in the face for five seconds while the resident was screaming, yelled at the resident, and then sprayed her in the face again again per witness statement and interview. CNA #1 was terminated for abuse on 08/06/23 and rehired on 09/21/23. The administrator identified 58 residents residing in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure hot water was provided for the residents for approximately a month. The DON identified 58 residents resided in the facility.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure residents received bathing as scheduled for four (#1, 2, 3, and #4) of four residents sampled for ADLs. The DON identified 58 residents who resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure all allegations of abuse were reported within two hours and a final report with five days for one (Res #1) of four residents sampled for abuse. The DON identified 58 residents residing in the facility.

Inspectors wroteOn [DATE] an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to ensure staff were available 24 hours a day who had current certification in CPR for Healthcare Providers (training to include hands-on practice and in-person skills) and maintain their certifications to be able to provide CPR until emergency medical services arrived. The facility failed to have a CPR policy and ensure staff were familiar with facility policies related to CPR. Three of the facility's 15 nurses had CPR certification, one night shift nurse who worked three shifts a week, one weekend nurse, who worked the day shift, and the administrator/RN, who was not on the schedule. No CMAs or CNAs had evidence of CPR certification. On [DATE] at 3:35 p.m., the Oklahoma State Department of Health verified the existence of the IJ situation. [...]

Inspectors wroteOn 02/28/23, an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to ensure residents who had fallen had interventions put in place to prevent the recurrence of falls; monitor and evaluate the effectiveness of the interventions; modify the care plan with each fall; conduct a root cause analyses for each fall; and communicate the interventions with all staff. Res #41 had 16 falls in four months with one fall resulting in a fractured hip. Res #41 had sustained a broken hip after six falls and only two falls had steps to prevent recurrence. Res #41 had nine falls after a hip fracture with only two of those falls having interventions to prevent recurrence. The last fall was 02/26/23. Res #24 had five falls in four months, with the forth fall resulting in a fractured hip. [...]

Inspectors wroteBased on record review, observation, and interview, the facility failed to have an effective administration to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The facility failed to: a. ensure residents who were discharged from Part A skilled services, had days remaining, and remained in the facility were issued NOMNC notices. b. ensure a significant change assessment was completed when residents experienced a change of status. c. update the comprehensive person centered care plan to reflect the residents' current needs. d. ensure the availability of staff present 24 hours a day who had current certification in CPR for Healthcare Providers, maintained their certifications, have a CPR policy, and ensure staff were familiar with facility policies related to CPR. e. [...]

Inspectors wrote3. Res #41 had diagnoses which included unspecified injury of left hip, Parkinson's disease, dementia, anxiety disorder due to known physiological condition, and pain. An annual MDS assessment, dated 10/25/22, documented the resident's cognition was severely impaired; was independent with most ADLs; had no impairment in ROM; used a walker and a wheelchair; and had one fall with no injury. The care plan, dated 11/02/21, documented the resident was at risk for falls. The interventions were documented as the following: a. Be sure resident's call light is within reach and encourage the resident to use it for assistance as needed. b. The resident needs prompt response to all requests for assistance. c. The resident needs a safe environment with floors free from spills and/or clutter; adequate, glare-free light; the bed in low position at night; [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure physician ordered lab tests were obtained for one (#34) of five residents whose labatory orders were reviewed. The Resident Census and Conditions of Residents form documented 47 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to follow their COVID-19 staff vaccination policy and failed to ensure staff received all the vaccinations in the primary series, had an exemption, or were temporarily delayed in completing their vaccinations. The Resident Census and Conditions of Residents form documented 47 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents who were discharged from Part A skilled services, had days remaining, and remained in the facility were issued NOMNC notices for two (#5 and #19) of three residents reviewed for beneficiary notices. The facility identified 21 residents who were discharged from part A skilled services with benefit days remaining in the previous six months.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure a significant change assessment was completed within 14 days after a resident experienced a change of status for two (#24 and #41) of 12 residents whose assessments were reviewed. The Resident Census and Conditions of Resident form documented 47 residents lived at the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure a physician provided an acceptable rational for not reducing a psychotropic medication and failed to monitor for side effects of the use of psychotropic medications for two (#24 and #34) of five residents reviewed for unnecessary medications. The Resident Census and Conditions of Residents form documented 22 residents received psychotropic medications.