Wakefield Health Care Center

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G)Based on record review and interview; the facility failed to ensure Residents 5, 6 and 13's drug regimens were free from unnecessary medications as the facility failed to attempt Gradual Dose Reductions (GDR)s for Residents 13 and 6's antipsychotic (drugs that affect the mind, emotions, and behavior) medications and to ensure Resident 5's as needed antipsychotic medication was limited to 14 days. The sample size was 5 and the facility census was 31.

Inspectors wroteS483.45(g) Labeling of Drugs and Biologicals Drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable. This requirement is not met as evidenced by:LICENSURE REFERENCE NUMBER 175 NAC 12-006.12(D)(i):Based on observation, record review and interview; the facility failed to provide safe storage of drugs as: 1) Medications were left on top of the medication cart and unattended, 2) The medication cart was left unlocked with no staff in attendance, 3) The keys were in the narcotic lock box with no nurse within visualization and 4) Medications were administered to resident's without staff supervision. The total sample size was 19 and the facility census was 31.

Inspectors wroteLicensure Reference Number NAC 12-006.09Based on record reviews and interviews; the facility failed to complete neurological assessments to assess for potential injury after unwitnessed falls for Residents 2 and 5. The sample size was 2 and the facility census was 31.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on record review and interview; the facility failed to ensure Residents 6 and 13's drug regimens were free from unnecessary medications as the facility failed to attempt Gradual Dose Reductions (GDR)s for the residents psychoactive (drugs which affect mental processes such as perception, consciousness, cognition, mood and emotions) medications. The sample size was 5 and the facility census was 31.

Inspectors wroteD. Review of Resident 12's MDS dated [DATE] revealed the following: -diagnoses of dementia, diabetes, arthritis, anxiety, and depression, -severe cognitive impairment, -behaviors towards other people and not towards other people, -the resident was dependent with toileting, dressing, personal hygiene, bed mobility, and transfers, and -the resident received antipsychotic, antianxiety, and antidepressant medications. Review of Resident 12's Care Plan last revised 6/24/24 revealed the following: -staff were to administer psychotropic medications as ordered by the Physician and monitor side effects and effectiveness, -consult with pharmacy and the Physician to consider dose reductions when clinically appropriate, -discuss the need for ongoing need for use of medications with the physician. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18 (B) Licensure Reference Number 175 NAC 12-006.18(D) Based on observations, record review and interview; the facility failed to implement enhanced barrier precautions (EBP-an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDRO's) when providing assistance with high-contact care activities for Resident 4, to wash hands and change gloves at indicated intervals during the provision of cares for Resident 12, to transport soiled linens and to clean re-useable care equipment to prevent the potential for cross contamination. The total sample was size 17 and the facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(B) Based on record review and interviews; the facility failed to provide 2 (Resident 5 and 18) of 3 sampled residents/representatives with the cost of continuing to receive skilled Medicare Services, a choice of whether to appeal the facilities Medicare determination to discontinue services, or the reason for the discharge from skilled Medicare services. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(9) Based on record review and interview; the facility failed to protect residents 2 and 5 from potential abuse related to an allegation of staff to resident abuse. This had the potential to affect all facility residents. The facility census was 33.

Inspectors wroteBased on record review and interview; the facility failed to complete and submit an investigation of a fall with injury for Resident 25 and to submit an investigation of an elopement for Resident 1 within the required time frames. The sample size was 5 and the facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on record review and interview; the facility failed to ensure residents were free from unnecessary medications related to long term use of an antibiotic for 1 (Resident 18) of 5 sampled residents as there was no specified duration or supporting documentation for clinical use based on laboratory results. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10D Based on observations, record review and interviews; the facility failed to ensure a medication error rate of less than 5%. Observations of 28 medications administered revealed 2 errors resulting in a medication error rate of 7.14%. The errors affected 2 (Residents 4 and 23) of 4 sampled residents. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(D)(vi) Based on observations, record review and interview the facility failed to ensure an insulin medication was labeled correctly for 1 (Resident 23) of 4 sampled residents. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(A)(iii)(2) Based on record review and interview; the facility failed to complete the required state Nurse Aide registry checks for 2 of 5 sampled employees to prevent potential abuse/neglect of residents. This had the potential to affect all residents. The facility census was 33.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.02(8) Based on record review and interviews; the facility staff failed to thoroughly investigate resident to resident altercations and to assure interventions were put into place to prevent further altercations for 2 (Residents 5 and 81) of 2 sampled residents. The facility staff identified a census of 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09B Based on record review and interview; the facility failed to ensure Resident 19's Pre-admission Screening and Resident Review (PASARR-federally mandated evaluation used to identify Mental Disorders (MD), Intellectual Disability (ID), or Related Disorders (RD) and to ensure appropriate facility placement with appropriate services), accurately reflected a potential MD. The sample size was 1 and the facility census was 30.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09D2b Based on observation, record review and interview the facility failed to: 1) provide ongoing monitoring and assessment; 2) implement assessed interventions; and 3) obtain changes in treatment when the condition of the pressure ulcer declined for 1 (Resident 17) of 1 sampled resident. The facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on observation, record review and interviews, the facility failed to ensure 2 residents (Resident 16 and 27) were tested for Covid-19 when symptoms were identified and failed to prevent potential cross contamination when staff did not wear a face mask while testing Residents 16 and 27 for Covid-19. The sample size was 18 and the facility census was 30.