The Nm Behavioral Health Institute at Las Vegas

Inspectors wroteBased on record review and interview, the facility failed to provide documentation confirming 2 (NA #1 and NA #3) of 5 (NA #1, NA #3, NA #4, and NA #5) Nurse Aides had completed a Nurse Aide Training and Competency Evaluation Program (NATCEP) or a Competency Evaluation Program (CEP) within four months of being employed at the facility. This deficient practice is likely to affect all 102 residents residing in the facility. Residents are likely to experience substandard care because of the use of untrained or unqualified aides providing direct care to residents.

Inspectors wroteBased on record review and interview, the facility's Administrator (ADM) and Director of Nursing (DON) failed to administer the facility when they knew/should have known and prevented the following deficient practices which occurred in the facility: 1. Not ensuring staff were trained and/or competent before providing care to residents. 2. Allowing untrained and uncertified nurse aides to train other nurse aides. These deficient practices are likely to affect all 102 residents residing in the facility according to the daily census provided by the Admissions Coordinator (AC) on [DATE] and could lead to residents not maintaining their highest practicable physical, mental, and social well-being.

Inspectors wroteBased on record review and interview, the facility failed to ensure staff revised the care plan for 1 (R #29) of 3 (R #1, R #29, and R #32) residents reviewed when staff failed to update a care plan after a resident was diagnosed with dementia. This deficient practice could result in residents' care and needs not being addressed.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure the annual performance review for the certified nursing assistants (CNAs) was completed for 1 (CNA #2) of 5 (CNA #1, CNA #2, CNA #3, CNA #4, and CNA #5) CNAs reviewed. This could lead to residents not receiving the care and services as described on the care plan.

Inspectors wroteBased on observation, and interviews, the facility failed to properly store medications in the facility by making sure:-Medications in bubble wraps are not compromised (not opened or punctured and secured in the original packaging from the pharmacy). -All medical supplies are not expired. These deficient practices are likely to result in expired medications and medical supplies being used in resident care resulting in residents being at risk of possible infections and not receiving the full benefits of medication.

Inspectors wroteBased on record review and interview, the facility failed to notify a resident's representative of a transfer or discharge and the reasons for the move in writing prior to the transfer or discharge for 1 (R #104) of 3 (R #29, R #104, and R #106) residents reviewed for transfers and discharges. This deficient practice could lead to residents' representatives being unaware of the residents' health status.

Inspectors wroteBased on record review, and interview, the facility failed to complete an accurate Minimum Data Set (MDS; a federally mandated assessment instrument completed by facility staff) assessment for 2 (R #19 and R #32) of 4 (R #8, R #15, R #19, and R #32) residents reviewed for assessments. This deficient practice could likely result in the residents' preferences and care needs not being met.

Inspectors wroteBased on record review and interview, the facility failed to create an accurate baseline care plan (minimum healthcare information necessary to properly care for a resident immediately upon their admission to the facility) within 48 hours of admission for 2 (R #1 and R #19) of 3 (R #1, R #19, and R #29) residents reviewed for baseline care plans. This deficient practice could likely result in residents not receiving the appropriate care and may place residents at risk of an adverse event (undesirable experience, preventable or non-preventable, that caused harm to a resident because of medical care or lack of medical care) or worsening of current condition after admission.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive care plan for 1 (R #32) of 1 (R #32) resident reviewed who was identified as having a hearing impairment and utilizing a hearing aid. This deficient practice could likely result in staff being unaware of the current and actual needs of the residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide quality care that meets professional standards for 1 (R #11) of 1 (R #11) resident when the staff failed to follow physician order for derma saver palm pillow (a pillow to keep fingernails from digging into palms) to R #11's right hand. This deficient practice is likely to result in residents not maintaining their optimal health as planned by their medical provider.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received proper treatment and assistive devices to maintain hearing abilities for 1 (R #32) of 1 (R #32) resident reviewed. This deficient practice had the potential to result in unmet hearing needs, miscommunication, and decreased participation in daily activities.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide food that accommodates resident allergies, intolerances, and preferences for 1 (R #8) of 1 (R #8) resident observed for food preferences. This deficient practice is likely to result in food intolerance and/or an allergic reaction to the food being served to the residents.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure resident records were accurate for 1 (R #15) of 3 (R #12, R #15, and R #77) residents reviewed for catheter care (proper cleaning and maintenance of a catheter). This deficient practice could likely cause staff confusion and residents to get care and services that are not needed.

Inspectors wroteBased on record review and interview, the facility failed to prevent abuse for 1 (R #79) of 1 (R #79) resident reviewed when the facility staff failed to recognize the difference between horseplay and unwanted touching and harassment between a staff and resident. This deficient practice likely resulted in R #79 increase of isolation and fear of further abuse.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to maintain the kitchen in a sanitary manner when staff failed to: - Perform hand hygiene and to change gloves as often as necessary to avoid cross contamination, - Store open food protected and with labels and dates to prevent cross contamination and outdated usage, - Utilize hair restraints and beard guards in a manner which restrained all hair while in the kitchen, - Use the sanitizing solution according to manufacturer's instructions, - Protect clean disposable wares (includes dishware, drinkware, and flatware such as spoons, forks, and knives) to prevent contamination, These failures had the potential to result in cross contamination and foodborne which could affect all residents who ate food from the kitchens.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents received the necessary treatment and services to prevent the development and worsening of pressure wounds (also called a pressure injury; skin damage which results from unrelieved pressure on the body) for 1 (R #16) of 1 (R #16) residents reviewed when staff failed to update wound care treatment orders according to R #16's care plan and in relation to R #16's pressure ulcer becoming worse. This deficient practice is also likely to lead to residents developing more/other pressure ulcers and wounds worsening.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that 1 (R #16) of 1 (R #16) residents reviewed was free from accidents and hazards. Facility was using a call light attached to R #16's clothing to alert staff when resident attempts to transfer on her own. Call light would detach from the wall and ring and staff would be alerted that resident was attempting to transfer self. This deficient practice is likely to put residents at risk of unsafe situations.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to have recipes for all menu items and to ensure staff followed nutritionally calculated recipes for pureed diets. This failure had the potential for food not to meet the nutritional requirements of all residents who ate pureed foods.

Inspectors wroteBased on record review, and interview, the facility failed to provide food that accommodated resident preferences for 2 (R #9 and R #69) of 2 (R #9 and R #69) residents reviewed for food preferences. This deficient practice is likely to result in weight loss due to the residents not eating or an allergic reaction to the food being served to the residents.

Inspectors wroteBased on record review and interview, the facility failed to meet professional standards of care for 3 (R #8, #42, and #52) of 3 (R #'s #8, #42, and #52) residents reviewed by not providing restorative nursing services (a type of rehabilitation that helps residents regain or maintain their independence and physical abilities) as ordered by a physician. This deficient practice is likely to result in the resident experiencing psychosocial harm (harm to someone's mental health) and despair.

Inspectors wroteBased on record review and interview, the facility failed to ensure Certified Nurse Aides (CNAs) received the required in-service training of no less than 12 hours per year for 2 (CNAs #1 and #2) of 5 (CNAs #1, #2, #3, #4, and #5) CNAs randomly reviewed for required in-service training. This deficient practice is likely to result in the nurses aides not receiving the necessary training to meet the care needs of the residents.

Inspectors wroteBased on record review and interview, the staff failed to immediately report a witnessed incident of abuse to a supervisor and the facility failed to report an incident of abuse to the state survey agency within 2 hours for 1 (R #79) of 1 (R# 79) resident reviewed for incidents/accidents. If the facility fails to report incidents of abuse to the State Agency, then the implementation of measures to prevent further abuse is delayed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to maintain oxygen equipment according to professional standards for 2 (R #8 and R #17) of 3 (R #8, R #17, and R #53) residents reviewed for respiratory care by not ensuring the posting of caution and safety signs indicating the use of oxygen in the resident's room and This deficient practice could likely result in: Staff not recognizing that oxygen is being used in a residents room, this could result in a dangerous (able or likely to cause harm or injury), firehazard (material, substance, or action that increases the likelihood of an accidental fire occurring). A. Record review of the facility policy, Medical Oxygen Handling and Storage, last revised 07/13/20, revealed, Procedures. IV. All rooms with oxygen tanks/concentrators will be labeled with O2 (oxygen) precautions. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that 1 (R #21) out of 1 (R #21) resident was safely transferred from bed to wheelchair using two staff members. This deficient practice has the potential to cause an accident when two staff members aren't used to transfer a resident who requires a mechanical lift (a lift that helps residents move from bed to wheelchair etc .).

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that residents are free of any significant medication errors for 1 (R #22) of 1 (R #22) resident reviewed for medication administration, when they failed to administer medication without regard to manufacturer's instructions for administration. Residents may likely not experience the maximum benefit intended and fail to achieve their highest level of well-being. This deficient practice could likely lead to the resident having adverse (unwanted, harmful, or abnormal result) side effects, or not receiving the desired therapeutic effect of the medication due to it not being administered as prescribed.

Inspectors wroteBased on interview, observation, and record review, the facility failed to provide proper infection control practices by not performing hand hygiene between resident care for 4 (R #12, R #22 R #47, and R #76) out of 4 (R #12, R #22, R #47, and R #76) residents. This deficient practice could likely result in the spread of infectious agents (viruses and bacteria) between residents and/or staff.