Wapello Specialty Care

Inspectors wroteBased on observation, clinical record review, facility policy review and staff interview, the facility failed to use Enhanced Barrier Precautions (EBP) precautions during wound care in an effort to prevent the transfer of multidrug-resistant organisms (MDROs) for 1 of 1 residents (Resident #3) reviewed for EBP precautions. The facility reported a census of 41 residents.

Inspectors wroteBased on observations, staff interviews, Food Code review, and facility policy review the facility failed to ensure foods were appropriately labeled and dated and failed to ensure meal service conducted in a sanitary manner for all residents who received food from the kitchen. The facility reported a census of 44 residents.

Inspectors wroteBased on observations, clinical record review, facility policy review and staff interviews the facility failed to update care plans to address one residents wandering, and to address another resident taking the property of others while wandering in the building for 2 of 2 residents (Resident #39 and Resident #6) reviewed for wandering. The facility reported a census of 44 residents.

Inspectors wroteBased on observation, interview, clinical record review, and facility policy review the facility failed to ensure medication was available and administered per physician order for one of six residents reviewed for medications (Resident #18). The facility reported a census of 44 residents.

Inspectors wroteBased on clinical record review, facility policy review and staff interviews the facility failed to follow Care Plan fall risk interventions, leading to a fall for one of four residents (Resident #36) reviewed for falls. The facility reported a census of 44 residents.

Inspectors wroteBased on clinical record review, staff interview, and facility policy review the facility failed to ensure prompt treatment for a urinary tract infection (UTI) for one of two residents reviewed for UTI (Resident #30). The facility reported a census of 44 residents.

Inspectors wroteBased on interviews, record review, and the facility policy, the facility failed to prevent abuse from occurring between residents for 3 of 7 residents reviewed for abuse (Resident #1, Resident #2, and Resident #7). The facility reported a census of 33 residents.

Inspectors wroteBased on interview, record review, and the facility policy, the facility failed to report an allegation of abuse within 2 hours after the incident occurred for 3 of 7 residents reviewed for allegations of abuse (Resident #1, Resident #2, and Resident #7). The facility reported a census of 33 residents.

Inspectors wroteBased on interviews, record review, and the facility policy, the facility failed to adequately supervise a resident after an allegation of abuse with another resident. This resulted in another occurrence with a resident to resident allegation of abuse for 2 of 7 residents reviewed for allegation of abuse (Resident #1 and Resident #2). The facility reported a census of 33 residents.

Inspectors wroteBased on observation, interview, record review, and the facility policy review the facility failed to implement interventions to prevent worsening of a Stage II pressure ulcer on the right heel for 1 of 3 residents reviewed for pressure ulcers (Resident #17). The facility reported a census of 38.

Inspectors wroteBased on interviews, observations and record review the facility failed to transport a Resident safely in the shower chair and failed to determine the root cause analysis for two recent falls for 2 of 3 residents reviewed for accidents. (Resident #13 and Resident #34). The deficient practice resulted in a fractured fibula, increased pain and hospitalization. The facility reported a census of 38.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure prompt follow up on urinalysis and culture and sensitivity results, failed to document effectiveness of antibiotics, failed to ensure a catheter drainage bag remained positioned off of the floor, and failed to promptly address decreased urinary output for a resident who had a Foley catheter for three of four residents reviewed for catheter and/urinary tract infections (Resident #19, Resident #93, Resident #143). The facility reported a census of 38 residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure care plans were updated to reflect a resident's toe amputation surgery, discontinuation of as needed (PRN) Lorazepam medication, discontinuation of hospice services, discontinuation of a catheter, updated to include receipt of prophylactic antibiotic medication, and updated to include fall interventions for four of fourteen residents reviewed for care plans (Resident #1, Resident #24, Resident #25, Resident #34). The facility reported a census of 38 residents.

Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure Residents was treated in a dignified manner for 1 of 1 resident reviewed for dignity. (Resident #35). The facility reported a census of 38 residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident was assessed for self administration of medications prior to the resident's inhaler present at bedside for one of one resident reviewed for self administration (Resident #24). The facility reported a census of 38 residents.

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure that the consent was properly obtained when they required a resident with severe cognitive deficits, documented dementia and delusional disorder diagnoses, and history of suicidal ideation, to execute an Advanced Directive, instead of establishing a Power of Attorney (POA) as mandated by the resident's Level II PASARR requirements (Pre admission Screening and Resident Review), for 1 of 4 residents reviewed with Level II PASARR's (Resident #34). The facility reported a census of 39 residents.

Inspectors wroteBased on interview, record review, and facility policy the facility failed to notify the provider with a low blood pressure for 1 of 1 residents reviewed for notification to providers (Resident #17). The facility reported a census of 38.

Inspectors wroteBased on clinical record review, staff interview, and facility policy review the facility failed to ensure thorough documentation in the clinical record for why resident was sent to the hospital for one of two residents reviewed for transfer/discharge (Resident #143). The facility reported a census of 38 residents.

Inspectors wroteBased on record review, staff interview, and facility policy review, the facility failed to ensure a significant change assessment completed following entry to hospice services and following discontinuation of hospice services for two of two residents reviewed for significant change assessments (Resident #12, Resident #24). The facility reported a census of 38 residents.

Inspectors wroteBased on record review, staff interview, and facility policy review the facility failed to ensure timely completion of Quarterly Minimum Data Set (MDS) assessments for two of 14 residents reviewed for quarterly MDS assessments (Resident #1, Resident#9, and Resident #25). The facility reported a census of 38 residents.

Inspectors wroteBased on interviews, record review and the facility policy the facility failed to complete the Minimum Data Set (MDS) for entry, discharge, and the end of (Prospective Payment System (PPS) Part A stay within a timely manner for 2 of 14 residents reviewed for MDS. (Resident #17, Resident #19). The facility reported a census of 38.

Inspectors wroteBased on interview and record review and the facility failed to update the care plan to reflect the Preadmission Screening and Resident Review (PASSAR) recommendations for specialized services for 1 of 2 residents reviewed for PASSAR (Resident #34). The facility reported a census of 38.

Inspectors wroteBased on interview and record review the facility failed to submit a Preadmission Screening and Resident Review (PASSAR) Level 2 in a timely manner for 1 of 2 residents reviewed for PASSAR (Resident #34). The facility reported a census of 38.

Inspectors wroteBased on observation, staff interview, and record review the facility failed to ensure completion of a resident's nursing assessment promptly post admission to the facility and failed to ensure a resident provided instruction to rinse their mouth following inhaler administration for one of fourteen residents reviewed for standards of practice (Resident #7, Resident #93). The facility reported a census of 38 residents.

Inspectors wroteBased on observation, interview, record review, and facility policy the facility failed to provide showers twice weekly and clean a resident's nails for 1 of 1 residents reviewed for Activities of Daily Living (ADL's) (Resident #19). The facility reported a census of 38. Findings Include: The admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #19 scored 12 out of 15 on a Brief Interview for Mental Status (BIMS) exam, which indicated cognition moderately impaired. The MDS documented the resident needed extensive assistance of two plus person physical assist with bed mobility and transfer. The MDS revealed the bathing self performance activity didn't occur and the bathing support provided ADL activity didn't occur over a 7 day period. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure consistent assessment of non-pressure wounds following a resident's amputation of the toes and failed to consistently assess a resident's finger infection for two of two residents reviewed for non-pressure skin (Resident #25, Resident #30).

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a licensed behavioral health professional to residents who required Specialized Services per Preadmission Screening and Resident Review (PASSAR) recommendations for 1 of 1 resident reviewed for Specialized Services. (Resident #34). The facility reported a census of 38.

Inspectors wrote2. The Quarterly MDS assessment dated [DATE] revealed Resident #1 didn't complete Brief Interview for Mental Status (BIMS) exam due to resident rarely understood. The MDS revealed an indwelling catheter and the resident needed extensive assistance with one person physical assist with toilet use. The MDS revealed the resident utilized a wheelchair. The MDS revealed medical diagnosis of obstructive uropathy and benign prostatic hyperplasia with lower urinary tract symptoms. The Care Plan revealed a focus area revised on 12/19/22 of self care deficit related to cognitive impaired associated with mental illness, urinary retention and need for indwelling catheter, occasional refusal of cares and bathing. The interventions dated 2/13/18 documented monitored for signs/symptoms (s/s) of urinary infection; [...]

Inspectors wroteBased on staff interview, review of CMS-2567 reports, and facility Quality Assurance and Performance Improvement(QAPI) Plan, the facility failed to ensure an effective Quality Assurance Performance Improvement (QAPI) process to address previously identified quality deficiencies, resulting in multiple repeat deficiencies identified on the facility's current recertification and complaint survey previously identified during surveys completed in the last twelve months. The facility reported a census of 38 residents.