Wildflower Court

Inspectors wroteBased on observation, record review, and interview, the facility failed to store, prepare, and maintain food and food-contact sanitation in accordance with food safety standards. Specifically, the facility failed to ensure: 1) Sanitizer solutions used for food-contact surfaces were maintained at the manufacturer-recommended concentration; and 2) Food items available for resident use were labeled with required use-by dates and/or removed when expired; and 3) Culinary staff followed hand hygiene and glove-use practices to prevent cross-contamination during food preparation. These failed practices had the potential to cause cross contamination during food preparation and to allow contaminated and/or expired food to be served to 54 residents who received food from the kitchen, out of a total of 55 residents, placing these residents at risk for foodborne illness.

Inspectors wroteBased on record review and interview, the facility failed to ensure: 1. The Centers for Medicare & Medicaid Services (CMS) Notice of Medicare Non-Coverage (NOMNC), Form CMS-10123, was completed with the required Quality Improvement Organization (QIO) name and toll-free telephone number before issuance for 3 residents (#18, #58, and #62), out of 3 residents who were reviewed for beneficiary notifications; and 2. The Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN), Form CMS-10055, was provided when required for 1 resident (#18), out of 3 residents who were reviewed. Instead, the facility issued an expired Advance Beneficiary Notice of Non-Coverage (ABN), Form CMS-R-131, which was retired from use by CMS on [DATE]. [...]

Inspectors wroteBased on record review, interview, and observation, the facility failed to provide adequate supervision and effective use of assistive fall-prevention devices for 2 residents (#17 and #37), out of 4 residents reviewed for fall precautions. Specifically, the facility failed to: 1) Ensure adequate supervision and effective use of an assistive fall-prevention device for resident #37, who was found on the floor following an unwitnessed fall; and2) Ensure the Smart Caregiver sensor pad monitoring system used for Residents #17 and #37 were functioning properly and set at an audible volume to alert staff. These failures resulted in Resident #37 experiencing an unwitnessed fall and placed both residents at risk for delayed staff response, falls, and fall-related injury.

Inspectors wroteBased on record review, interview, and observation, the facility failed to ensure staff treated 1 resident (#39), of 14 sampled residents, with dignity and respect by honoring the resident's expressed preference for how staff announced themselves before entering the resident's room. Specifically, staff knocked on Resident #39's door despite the resident's known request that staff ring the mounted doorbell instead of knocking due to knocking being a trigger related to the resident's history of trauma and post-traumatic stress disorder (PTSD - a mental health condition that's caused by an extremely stressful or terrifying event). This failed practice had the potential to cause psychosocial harm by triggering trauma related symptoms, decreasing the resident's sense of safety, diminishing dignity, and reducing quality of life.

Inspectors wroteBased on record review, observation, and interview, the facility failed to complete all sections of the Resident Assessment Instrument 3.0 Minimum Data Set (MDS, a federally required nursing assessment for long term care residents) required to accurately make a comprehensive assessment for 1 Resident (#33), of 14 sampled residents. Specifically, the facility failed to complete Sections D (Mood), and E (Behavior) on both an annual and a quarterly MDS assessment, despite documentation in the medical record identifying mood concerns, refusal behaviors, and resident preferences. This failed practice had the potential to result in an inaccurate assessment of the resident's mood, behavioral, psychosocial, and care needs, placing the resident at risk for inconsistent or unmet care.

Inspectors wroteBased on record review and interview, the facility failed to follow the Preadmission Screening and Resident Review (PASRR) Level I determination and failed to notify the State of Alaska Division of Senior and Disability Services (SDS) when 1 resident (#61), out of 2 residents reviewed for PASRRs, compliance remained in the facility beyond the time-limited 90-day convalescent stay. This failed practice resulted in Resident #61 remaining in the facility without the required updated PASRR review and/or Level II evaluation to determine whether the resident required specialized services, which had the potential to adversely affect the resident's ability to attain or maintain his/her highest practicable physical, mental, and psychosocial well-being.

Inspectors wroteBased on record review, observation, and interview, the facility failed to develop, implement, and revise the comprehensive person-centered care plan for 1 resident (#39) out of 14 sampled residents. Specifically, the facility failed to: 1) implement the care-planned fall prevention intervention of placing floor mats at the resident's bedside; and 2) include interventions for multiple high risk medications with fall-related side effects. These failed practices placed Resident #39 at risk for falls and fall-related injury, with the potential to negatively affect the resident's ability to attain or maintain his/her highest practicable physical, mental, and psychosocial well-being.

Inspectors wroteBased on record review and interview, the facility failed to ensure nursing staff have the specific competencies and skills set necessary to care for residents' needs. Specifically, the facility failed to ensure: 1) 6 Licensed Nurses (LN #'s 1, 2, 3, 4, 5, and 6), out of 15 LN personnel files reviewed, had current training for safe oxygen handling; and 2) 1 Certified Nurse Aide (CNA #1), out of 3 CNA personnel files reviewed, had a valid Cardiopulmonary resuscitation (CPR) certificate. This failed practice had the potential to place all residents (based on a census of 53) at risk of not receiving the necessary treatment and care and immediate assistance during an emergency.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and prepare food in accordance with professional standards for food service safety. Specifically, the facility failed to ensure: 1) expired food was discarded; and 2) the temperature of cooked potentially hazardous food was recorded after cooking. These failed practices had the potential of causing or spreading foodborne illness to all residents, based on a census of 53, who received food from the affected kitchens.

Inspectors wroteBased on record review and interview, the facility failed to ensure that residents who received opioid pain medications (a class of strong pain-relieving medications that act on the nervous system, with potential for dependence, overdose, and serious side effects) were re-evaluated for pain for 11 residents (#1, #2, #6, #12, #20, #24, #26, #37, #49, #51, and #259), out of 53 residents reviewed for pain management. Specifically, the facility failed to re-evaluate the residents' pain level within 30 to 60 minutes following opioid administration. This failed practice had the potential to result in unrelieved pain, delayed identification of medication ineffectiveness, or overmedication.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure 1 resident (#49), out of 5 residents observed for medication administration, was appropriately assessed for safe self-administration of medications. This failed practice placed the resident at risk of medication errors and adverse outcomes.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure the care plan was implemented for 1 resident (#40), out of 14 sampled residents. Specifically, a Certified Nurse Aide (CNA #2) failed to follow Resident #40's care plan for basic care needs while assisting the resident out of bed to the toilet. This failed practice had the potential to injure the resident and negatively impact the resident's physical well-being.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure 1 resident (#40), out of 14 sampled residents received quality care. Specifically,1) a Certified Nurse Aide (CNA #2) failed to follow 2 person assist during a transfer and toileting as specified in the comprehensive care plan; 2) CNA #2 did not safely handle the resident during transfer; and 3) the internal doorway to Resident #40's room was obstructed. This failed practice had the potential to place the resident at risk of injury and negatively impact the resident's physical health and well-being.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure residents' environment remains free of accident hazards. Specifically, the facility failed to ensure: 1) resident's room internal entryway was not obstructed for 1 resident (#40), out of 14 sampled residents; and 2) 1 exit door, out of 11 possible exit doors, was secured to prevent elopement of 6 residents (#'s 9, 1, 14, 20, 34, and 41), out of 53 residents (total census) who were at risk of wandering. This failed practice: 1) placed the resident at risk of delay in timely assistance in his/her room in emergency situations; and 2) placed residents who wandered at risk for unsafe situations if they eloped from the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure the medication error rate was below 5%. The medication error rate was 36%. 9 medication administration errors were identified, out of 25 opportunities, during medication administration observations. This failed practice placed the resident at risk for adverse medication effects.

Inspectors wroteBased on record review and interview, the facility failed to ensure 1 Certified Nurse Aide (CNA #1), out of 3 CNAs personnel file reviewed, had Cardiopulmonary Resuscitation (CPR) certificate before providing direct patient care. This failed practice had the potential to place all residents (based on a census of 53) at risk of not receiving CPR immediately during an emergency.

Inspectors wroteBased on record review, observation, and interview, the facility's pharmacy services failed to meet the obligations of its contract agreement. Specifically, pharmacy services failed to: 1) provide accurate pharmaceutical services to assure the accurate dispensing of drugs; and 2) provide consultation on aspects of the provision of pharmacy services in the facility. These failed practices placed all residents (based on a census of 48) at risk for receiving improper pharmaceutical services and the potential for medication errors and/or adverse reactions.

Inspectors wroteBased on record review and interview, the facility's pharmacy services failed to: 1) complete monthly drug regimen reviews (DRRs), from November 2023 to January 2024, by a licensed pharmacist for all residents (based on a census of 48); and 2) complete accurate DRRs for 2 residents (#'s 2 and 35), out of 14 sampled residents. This failed practice placed all residents (based on a census of 48) at risk for unnecessary medications, medication errors, and/or adverse reactions.

Inspectors wroteBased on record review and interview, the facility failed to ensure the mandatory submission of staffing information based on payroll based journal (PBJ) data was submitted for the Fiscal Year (FY) Quarter 4 2023 (July 1 - September 30, 2023). This failed practice potentially denied residents and/or representatives (based on a census of 48), and the public, accurate staffing data when accessing the Nursing Home Compare website.

Inspectors wroteBased on record review and interview, the facility failed to ensure the resident's, or the resident representative's, right to be informed of the risks and benefits of proposed care of psychoactive medication (a medication that can alter perception, mood, or behavior) administration was documented for 2 residents (#'s 2 and 35), out of 14 sampled residents. This failed practice had the potential to violate the resident's, or resident representative's, right to be informed of treatment and treatment alternatives or treatment options and to choose the alternative or option he/she preferred.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN), form CMS-10055, and the Notice of Medicare Non-Coverage (NOMNC), form CMS-10123, were delivered to 2 Medicare part A residents (#s 44 and 66) or the resident representatives, out of 3 sampled Medicare Part A residents reviewed, in a timely manner. Specifically, the forms were delivered either the day of, or 1 day before, the end of Medicare Part A coverage. This failed practice denied the resident, or family, a timely opportunity to appeal a denial of Medicare coverage and placed the resident at risk for not receiving services.

Inspectors wroteBased on record review and interview, the facility failed to ensure a copy of the resident's (#6) transfer notice was sent to the Office of the State Long Term Care (LTC) Ombudsman. This failed practice had the potential to affect all residents, based on a census of 48, by: 1) denying residents the added protection from being inappropriately discharged ; 2) providing the residents with access to an advocate who can inform them of their options and rights; and 3) ensuring the Office of the State LTC Ombudsman was aware of facility practices and activities related to transfers and discharges.

Inspectors wroteBased on record review, observation, and interview, the facility failed to implement the comprehensive person-centered care plan for 1 resident (#4), out of 14 sampled residents, to repair eyeglasses and ensure the resident had regular eye exams, for proper and ongoing assessments of a known eye condition. This failed practice had the potential to delay treatments to improve eyesight by not scheduling follow up appointments, which could have affected the resident's ability to maintain his/her highest practicable physical, mental, and psychological well-being.

Inspectors wroteBased on record review, interview, and observation, the facility failed to ensure information about a new open area on the skin was communicated to the nurse for 1 resident (#34), out of 14 sampled residents. Specifically, the Certified Nursing Assistants (CNAs) failed to communicate to the nurse information about a new non-pressure related wound discovered on Resident #34's sacral area (area at the end of the spine in the pelvic region) during cares. This failed practice placed this resident at risk for further skin breakdown and infection.

Inspectors wroteBased on record review, interview, and observation, the facility failed to ensure the sole resident who smoked at the facility (Resident #4), followed his/her care plan and the smoking policy. Specifically, the facility failed to ensure the resident smoked in the one and only designated smoking area on campus, where appropriate safety measures were maintained. This failed practice had the potential to introduce avoidable fire accidents, which could affect all residents (based on a census of 48).

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure significant weight loss was reported to the physician for 1 resident (#39), out of 14 sampled residents. This failed practice had the potential to place the resident at risk for further weight loss and complications due to excessive weight loss.

Inspectors wroteBased on record review and interview, the facility failed to ensure the medication regimen for 1 resident (#35), out of 14 sampled residents, was free from an unnecessary medication. Specifically, the facility failed to ensure 4 different Morphine (a narcotic medication that helps control severe pain) as needed medication orders were written with specific parameters for each order. This failed practice placed the resident at risk of excessive medication administration, subtherapeutic (too low a dose to be effective) medication administration, and/or the potential for adverse reactions.

Inspectors wroteBased on interview, observation, and record review, the facility failed to ensure 2 residents (#'s 7 and 24) out of 14 sampled residents, were provided with their ordered diet. Specifically, no oversight was provided to the staff serving the resident's meals in the unit kitchens. This failed practice had the potential to place the residents at risk for poor health outcomes, inadequate nutritional intake, and risk for medical complications.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure staff performed hand hygiene according to accepted professional practices during provision of care and services for 1 resident (#148), out of 14 sampled residents. Specifically, hand hygiene was not performed when moving from a dirty to clean task during wound care. This failed practice had the potential to increase the risk for development and transmission of disease and infection in a vulnerable population.