White County Rehab and Nursing

Inspectors wroteBased on observation and interview, the facility failed to maintain resident rooms in a clean, odor free manner for 3 (R1, R2, and R3) of 3 residents reviewed for safe/clean environment in the sample of 12.

Inspectors wroteBased on observation and interview the facility failed to ensure the air conditioning unit was in working order in the kitchen to provide dietary staff a comfortable working environment. This failure has the potential to affect all 44 residents residing in the facility.

Inspectors wroteBased on interview and record review the facility failed to ensure they had sufficient staff to meet the needs of the residents timely for 4 of 5 (R6, R16, R18, and R19) residents reviewed for sufficient staff in the sample of 34. This failure has the potential to affect all 54 residents currently residing at the facility. Findings Include: The facility Midnight Census Report dated 2/22/25 documents 54 residents reside at the facility. 1. R19's admission Record with a print date of 2/27/25 documents R19 was admitted to the facility on [DATE] with diagnoses that include diabetes. R19's MDS (Minimum Data Set) dated 1/2/25 documents a BIMS (Brief Interview for Mental Status) score of 08, which indicates a moderate cognitive deficit. R19's current Care Plan documents a Focus area of (R19) has a dx (diagnosis) of Diabetes Mellitus. Date Initiated: 07/14/2016. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure hot water was available for resident use for 5 of 5 (R3, R6, R15, R16, and R40) residents reviewed for hot water in the sample of 34. Findings Include: 1. R6's admission Record with a print date of 2/27/25 documents R6 was admitted to the facility on [DATE] with diagnoses that include cerebral palsy, morbid obesity, diabetes, lack of coordination, and urinary incontinence. R6's MDS (Minimum Data Set) dated 1/2/25 documents a BIMS (Brief Interview for Mental Status) score of 15, indicating R6 is cognitively intact. This same MDS documents R6 is frequently incontinent of bowel and bladder and is dependent on staff for toilet hygiene. On 2/23/25 at 2:17 PM, R6 was lying in bed and there was a strong odor of urine. [...]

Inspectors wroteBased on interview and record review the facility failed to provide showers for residents needing assistance for 4 of 5 (R6, R16, R18, and R40) residents reviewed for activities of daily living (ADL's) in the sample of 34. Findings Include: 1. R6's admission Record with a print date of 2/27/25 documents R6 was admitted to the facility on [DATE] with diagnoses that include cerebral palsy, morbid obesity, diabetes, lack of coordination, and urinary incontinence. R6's MDS (Minimum Data Set) dated 1/2/25 documents a BIMS (Brief Interview for Mental Status) score of 15, indicating R6 is cognitively intact. This same MDS documents R6 is dependent on staff for bathing. R6's current Care Plan documents a Focus area of (R6) has an ADL self-care performance deficit r/t (related to) Limited ROM (range of motion), Limited Mobility, impaired balance. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure restorative programs were administered for 3 of 4 (R4, R6, and R21) residents reviewed for restorative programs in the sample of 34. Findings Include: 1. R6's admission Record with a print date of 2/27/25 documents R6 was admitted to the facility on [DATE] with diagnoses that include cerebral palsy, morbid obesity, diabetes, lack of coordination, and urinary incontinence. R6's MDS (Minimum Data Set) dated 1/2/25 documents a BIMS (Brief Interview for Mental Status) score of 15, indicating R6 is cognitively intact. This same MDS documents no passive or active range of motion was performed in the last 7 calendar days. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure incontinence care was provided per current standards of practice for 2 of 3 (R6 and R18) residents reviewed for incontinence care in the sample of 34. Findings Include: 1. R6's admission Record with a print date of 2/27/25 documents R6 was admitted to the facility on [DATE] with diagnoses that include cerebral palsy, morbid obesity, diabetes, lack of coordination, and urinary incontinence. R6's MDS (Minimum Data Set) dated 1/2/25 documents a BIMS (Brief Interview for Mental Status) score of 15, indicating R6 is cognitively intact. This same MDS documents R6 is frequently incontinent of bowel and bladder and is dependent on staff for toilet hygiene. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents received nutritional supplementation as recommended by the dietitian to prevent weight loss for 3 of 6 (R22, R31, R48) residents reviewed for nutrition in the sample of 34. Findings Include: 1. R31's admission Record with a print date of 2/27/25 documents R31 was admitted to the facility on [DATE] with diagnoses that include muscle wasting and atrophy. R31's MDS (Minimum Data Set) dated 1/7/25 documents R31 has a severe cognitive impairment. R31's current Care plan documents a Focus area of, (R31's) diet is (Regular diet, mechanical soft texture, Regular thin liquids). Resident is at a (Moderate) nutritional risk d/t (due to) dysphagia. Date Initiated: 7/02/2019. Interventions for this same Focus area include, Discuss food likes and dislikes. Date Initiated: [...]

Inspectors wroteBased on interview, record review and observation the facility failed to maintain communication and collaboration with an offsite dialysis center for 1 (R22) of residents reviewed for dialysis in a sample of 34. The Findings Include: R22's admission profile sheet documents an admission date of 11/6/2023. This same document includes the following diagnoses: calculus of kidney and chronic kidney disease, stage 4 (severe) and unspecified hydronephrosis. R22's current month physician orders document a diet order for low concentrated sweets dysphasia advanced texture, regular consistency, no oranges/orange juice/bananas/fresh potatoes-limit milk to 1/2 cup per day, 1-ounce extra protein per meal and no added salt. This same document lists dialysis on Tuesday, Thursday, and Saturday three times a week. R22's care plan has a focus area of: [...]

Inspectors wroteBased on interview and record review the facility failed to ensure bedtime snacks were offered to 2 of 2 (R19 and R16) residents reviewed for snacks in the sample of 34. Findings Include: 1. R19's admission Record with a print date of 2/27/25 documents R19 was admitted to the facility on [DATE] with diagnoses that include diabetes. R19's MDS (Minimum Data Set) dated 1/2/25 documents a BIMS (Brief Interview for Mental Status) score of 08, which indicates a moderate cognitive deficit. R19's current Care Plan documents a Focus area of (R19) has a dx (diagnosis) of Diabetes Mellitus. Date Initiated: 07/14/2016. This Focus area includes the intervention of, Provide Diabetic snacks between meals and at bedtime per diet orders. On 2/24/25 at 1:42 PM, R19 stated they don't get snacks at night, and she is diabetic and is supposed to have a snack each night. 2. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure hand hygiene was performed per current standards of practice for 3 of 6 (R6, R18, and R31) residents reviewed for infection control in the sample of 34. Findings Include: 1. R6's admission Record with a print date of 2/27/25 documents R6 was admitted to the facility on [DATE] with diagnoses that include cerebral palsy, morbid obesity, diabetes, lack of coordination, and urinary incontinence. R6's MDS (Minimum Data Set) dated 1/2/25 documents a BIMS (Brief Interview for Mental Status) score of 15, indicating R6 is cognitively intact. This same MDS documents R6 is frequently incontinent of bowel and bladder and is dependent on staff for toilet hygiene. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide privacy during perineal, urinary catheter, and wound care for 1 (R1) of 3 residents reviewed for personal privacy in the sample of 3.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide perineal, urinary catheter, and wound care per standards of practice to prevent infections for 1 (R1) of 3 residents reviewed for infection control in a sample of 3.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from verbal abuse for 1 of 3 (R2) residents reviewed for abuse in the sample of 6. Findings Include: R2's admission Record documents an initial admission date of 11/21/2022. R2's admission Record documented the following diagnoses of down syndrome, unspecified, type 2 diabetes mellitus without complications. R2's Minimum Data Set (MDS) annual assessment dated [DATE], documented a Brief Interview for Mental Status Score of 15, indicating R2 is cognitively intact. R1's admission Record documents an initial admission date of 5/1/2022. R1's admission Record documented the following diagnoses of major depressive disorders, generalized anxiety disorder and delusional disorders. [...]

Inspectors wroteBased on interview and record review, the facility failed to timely initiate an investigate for an abuse allegation for 1 of 3 resident (R2) reviewed for abuse in a sample of 6. Findings Include: R2's admission Record documents an initial admission date of 11/21/2022. R2's admission Record documented the following diagnoses of down syndrome, unspecified, type 2 diabetes mellitus without complications. R2's Minimum Data Set (MDS) annual assessment dated [DATE], documented a Brief Interview for Mental Status Score of 15, indicating R2 is cognitively intact. R1's admission Record documents an initial admission date of 5/1/2022. R1's admission Record documented the following diagnoses of major depressive disorders, generalized anxiety disorder and delusional disorders. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure staff donned Personal Protective Equipment (PPE) in accordance with current Center for Disease Control (CDC) recommendations for infection control practices to prevent the spread of communicable disease. This has the potential to affect all 54 residents residing in the facility. Findings Include: 1. R1's admission Record documents an admission date of 4/12/2024 and included diagnoses of Metabolic Encephalopathy, Metabolic Acidosis, Chronic Kidney Disease, Congestive Heart Failure, and Epilepsy. R1's Minimum Data Set (MDS) assessment dated [DATE] included a Brief Interview for Mental Status (BIMS) score of 99, indicating severe cognitive impairment. R1's Care Plan documents R1 currently has a communication deficit related to language barrier. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to obtain scheduled medications from the pharmacy and secure emergency medications for 1 (R1) of 5 residents reviewed for medication administration in the sample of 8. This failure resulted in R1 abruptly stopping and missing his scheduled seizure medication resulting in R1 experiencing two seizures lasting approximately four minutes each. Additionally, this failure has the potential to result in prolonged, life-threatening seizures when abruptly stopping anti-seizure medication. This failure resulted in an Immediate Jeopardy, which was identified to have begun on 9/23/24 at approximately 8:00 PM when the facility was unable to provide R1's scheduled seizure medications. The facility did not administer R1's seizure medications again on 9/24/24 at 8:00 AM and 8:00 PM. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to implement procedures for timely acquisition of medications to administer as ordered for 4 (R1, R4, R5, and R7) out of 5 residents reviewed for pharmacy services in a sample of 8.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement current behavior interventions for a resident with inappropriate sexual behaviors and failed to re-assess and implement progressive individualized interventions for increased occurrences of unwanted sexual behaviors for 1 (R1) of 3 residents reviewed for behavioral health in the sample of 5.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from resident-to-resident abuse for 3 (R1, R2, and R4) of 5 residents reviewed for abuse out of a sample of 13.

Inspectors wroteBased on interview and record review, the facility failed to ensure allegations of resident-to-resident abuse were reported in a timely manner to the administrator of the facility and to other officials including the State Agency for 3 (R1, R2 and R4) of 5 residents reviewed for abuse out of a sample of 13.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from abuse for 2 of 3 residents (R10, R12) reviewed for abuse in a sample of 13. This resulted in R10 experiencing feelings of fear and uncertainty for his safety in his home.

Inspectors wroteBased on interview and record review the facility failed to report an allegation of sexual abuse to the State Agency for 1 of 1 resident (R12) in the sample of 13.

Inspectors wroteBased on interview and record review the facility failed to identify an allegation of sexual abuse and then failed to complete a thorough investigation for an allegation of sexual abuse for 1 (R12) of 1 residents in a sample of 13.

Inspectors wroteBased on interview and record review the facility failed to accurately assessment a resident for 1 (R8) of 1 resident in a sample of 13.

Inspectors wroteBased on interview and record review the facility failed to ensure a resident's personal funds were not charged for service while receiving Medicaid benefits for 1 of 3 residents (R1) reviewed for billing in the sample of 6.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide supervision and assistance during outside medical appointments for a resident with physical limitations for 1 (R2) of 3 residents reviewed for risk of accidents and adequate supervision out of a sample 6.

Inspectors wroteBased on interview and record review the facility failed to complete a significant change Minimum Data Set (MDS) assessment after an admission to hospice care for 1 (R18) of 1 resident reviewed for hospice services in a sample of 31.

Inspectors wroteBased on interview and record review the facility failed to conduct a Level II PASARR (Pre-admission Screening/Resident Review) screening due to a mental health diagnosis for 1 (R4) of 1 resident reviewed for PASSAR screenings in the sample of 31.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement interventions to prevent falls for 2 of 4 (R6, R31) residents reviewed for falls in the sample of 31.

Inspectors wroteBased on interview and record review, the facility failed to attempt non-pharmacological interventions prior to administering a PRN (as Needed) anti-psychotic medication, failed to observe 14 day time frames for PRN anti-psychotic medication orders, and failed to ensure when the PRN anti-psychotic medication renewed that the prescribing physician evaluates the resident for continued appropriateness of the medication for 1 of 5 (R6) residents reviewed for unnecessary medications in a sample of 31.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident clothing is returned from the laundry in a timely manner or replaced for 3 of 10 residents (R6, R7, R10) reviewed for laundry in the sample of 10.

Inspectors wroteBased on interview and record review, the facility failed to operationalize its Abuse Policy by immediately initiating investigations into resident reports of staff to resident retaliation and misappropriation of property for 3 of 10 residents (R2 R3 R6) reviewed for abuse in the sample of 10.

Inspectors wroteBased on interview and record review, the facility failed to report to The State Agency and local law enforcement allegations of staff to resident abuse and misappropriation for 3 of 10 residents (R2 R3 R6) reviewed for abuse in the sample of 10.

Inspectors wroteBased on interview and record review, the facility failed to investigate resident reports of staff to resident retaliation and misappropriation of property for 3 of 10 residents (R2 R3 R6) for abuse in the sample of 10.

Inspectors wroteBased interview, and record review the facility failed to implement interventions to appropriately supervise a resident with a history of elopement for 1 (R1) of 3 residents reviewed for supervision in the sample of 4.

Inspectors wroteBased on record review and interview the facility failed to ensure quarterly assessments were completed in a timely manner for 8 of 8 residents (R3, R8, R12, R18, R23, R29, R31 and R36) reviewed for timely quarterly assessments in a sample of 30 . The Findings Include: 1. R3's admission record documents an admission date of 3/18/21. On 12/1/22 at 10:30 AM, V4 (Minimum Data Set Coordinator) confirmed that the most recent completed minimum data set (MDS) completed on 7/22/22 . V4 stated that a quarterly MDS was due on 10/20/22 and is not completed. 2. R8's admission record documents an admission date of 9/13/17. On 12/1/22 at 10:30 AM, V4 confirmed that the most recent MDS completed was on 7/22/22 with one in progress but not yet completed due on 10/21/22. 3. R12's admission record documents an admission date of 12/10/21. [...]