Wisconsin Dells Health Services

Inspectors wroteBased on observation, interview, and record review, the facility did not maintain a safe and sanitary environment in which food is prepared, stored, and distributed. This has the potential to affect all 9 residents who reside on the memory care unit at the facility. Surveyor observed the microwave and refrigerator in the kitchenette to be unkept. The microwave had food splatters all over the inside of the microwave. The refrigerator had crumbs and food spilled on the inside of the refrigerator. Evidenced by:The facility policy, Microwave Oven, dated, 7/21/22, states in part;.The microwave oven will be kept clean, sanitized, and odor free. The microwave oven interior should be cleaned after each use as needed, and at a minimum, after each meal service. The facility policy, Cleaning Instructions: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that residents advanced directive was signed by the resident or resident representative for 1 (R28) of 12 residents reviewed for advance directives. R28 did not have an advanced directive signed by their Power of Attorney. Evidenced by:The facility policy, Obtaining and Communicating Code Status, dated, [DATE], states in part;.It is the policy of this facility to adhere to residents rights to direct their code status. In accordance to these rights, this facility will implement procedures to communicate a resident's code status to those individuals who need to know this information. R28 was admitted to the facility on [DATE] and R28 has an activated power of attorney in place. R28's Cardiopulmonary Resuscitation/Do Not Resuscitate (CPR/DNR) Preference Form indicates, R28 wishes to be DNR. [...]

Inspectors wroteBased on observation, interview, and record review the facility did not ensure proper use of bed rails for 1 (R5) of 1 Residents reviewed for bed rails. R5 is care planned for side rails up with cares only. R5 was observed in bed, with side rails raised and no staff present. Evidenced by:The facility's Proper Use of Side Rails policy, dated 9/23/22, states, in part: It is the policy of this facility to utilize a person-centered approach when determining the use of side rails, also known as bed rails. If used, the facility ensures correct installation, use, and maintenance of the rails.5. The use of side rails will be specified in the resident's plan of care.c. Parameters for use shall be clearly defined, such as quarter rails or at certain times. 6. [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to have an effective pest control program in place to prevent pests and rodents from entering the building through damaged exterior doors which lead into the kitchen. This has the potential to affect the census of 52.

Inspectors wroteBased on observation, interview and record review the facility did not maintain a safe and sanitary environment in which food is prepared, stored and distributed. This has the potential to affect all 44 residents who reside in the facility. Surveyor observed the facility's freezer to have frozen condensation attached to the ceiling and fallen pieces of frozen condensation on top of and inside of boxes of unsealed food causing potential for contamination. Surveyor observed a mixer to be stored covered and unclean. Supplements in the medication rooms were not dated. Evidenced by: Example 1 Facility policy, titled Food Storage: Cold Foods, undated, includes: . All . foods, frozen and refrigerated, will be appropriately stored in accordance with guidelines of FDA (Food and Drug Administration) Food Code . [...]

Inspectors wroteBased on observation, interview and record review the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infection, this has the potential to affect the census (44), 1 of 4 residents (R10) wound care observations with hand hygiene concerns, and 1 of 3 residents (R37) medication pass observations with hand hygiene concerns. The facility is not monitoring the temperature of 2 of their 3 water heaters as part of their control measures for Water Management Program. The facilities Policy and Procedure for Pneumococcal Vaccine is not up to date. The facility did not identify an outbreak on the date it started. [...]

Inspectors wroteBased on observation, interview, and record review, the facility did not ensure that the residents environment remained free of accidents and hazards for 1 of 3 (R25) reviewed for falls and 1 of 1 (R7) reviewed for accidents and hazards. R25 did not have fall interventions in place after 2 falls. Surveyor observed R7's motorized wheelchair charging in the hallway and not behind a fire safe door. This is evidenced by: The facility's policy titled Fall Prevention and Management Guidelines, revised 7/18/24, states in part: Each resident will be assessed for fall risk and will receive care and services in accordance with their individualized plan of care to minimize the likelihood of falls or reduce the possibility/severity of injury. Provide interventions that address unique risk factors measured by the risk assessment tool. [...]

Inspectors wroteBased on observation, interview, and record review, the facility did not ensure residents who are fed and receive medication by G-tube (Gastrostomy tube, a thin flexible tube inserted through a small incision in the abdomen and into the stomach, used to provide nutrition and fluids) receive the appropriate treatment and services. This affects 1 of 2 residents (R22) reviewed for tube feedings. The facility did not properly check placement of R22's G-tube prior to administering tube feeding. This is evidenced by: The facility's policy titled Verifying Placement of Tube Feeding, revised 8/10/22, states in part: It is the practice of this facility to ensure proper placement of feeding tubes prior to beginning a feeding, flushing the tube, or before administering medications via feeding tube. [...]

Inspectors wroteBased on observation, interview, and record review the facility did not ensure that a resident who needs respiratory care is provided such care consistent with professional standards of practice for 1 of 2 residents (R39) reviewed for oxygen. R39 did not have oxygen tubing changed on a weekly basis. Evidenced by: R39 admitted to the facility on [DATE] and has diagnoses that include, in part: pneumonia due to other specified infectious organisms (infection that causes inflammation of the lungs); chronic obstructive pulmonary disease (a group of lung diseases that cause ongoing breathing problems); acute on chronic systolic congestive heart failure (a condition that causes the heart to pump less effectively causing shortness of breath, weakness and fatigue. [...]

Inspectors wroteBased on observation, interview, and record review the facility did not ensure that a resident who requires dialysis receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 2 of 2 residents (R39 and R33) reviewed for dialysis. R39 is receiving dialysis services. R39's care plan does not indicate how to handle an emergency situation with R 39's dialysis port and staff were not able to appropriately verbalize how to handle an emergency situation. R33 is receiving dialysis services. R33's care plan does not indicate how to handle an emergency situation with R33's dialysis port and staff were not able to appropriately verbalize how to handle an emergency situation. Evidenced by: The facility's Hemodialysis policy, dated 9/10/23, states, in part: [...]

Inspectors wroteBased on interview and record review, the facility did not ensure the effective monitoring of psychotropic medications for 1 of 5 residents (R35) reviewed for unnecessary medications. R35 was started on Trazadone (antidepressant) for sleep. R35's comprehensive care plan and medical record does not contain sleep monitoring or tracking to assess the effectiveness of this medication. This is evidenced by: The facility policy entitled, Psychotropic Medications, dated 10/24/2022, states in part: .4. The indications for use of any psychotropic drug will be documented in the medical record .b. For Psychotropic drugs that are initiated after admission to the facility, documentation shall include the specific condition as diagnosed by the physician .ii. Non-pharmacological interventions that have been attempted, and target symptoms for monitoring shall be included in the documentation .13. [...]

Inspectors wroteBased on observation and interview the facility did not ensure drugs and biologicals are labeled in accordance with currently accepted professional standards 1 of 1 medication carts observed. The medication cart on the 400 hall had two tubes of open and used medicated ointment with no resident names. Evidenced by: Surveyor observed an open, used tube of muscle rub and an open, used tube of hydrocortisone acetate 1% cream in the drawer of the 400 hall medication cart. Surveyor asked LPN G if the tubes were both open and used. LPN G stated yes. Surveyor asked LPN G what resident the tubes were for. LPN G stated no idea, the tubes are not labeled. On 3/11/25 at 10:35 AM, Surveyor interviewed DON/IP B (Director of Nursing/Infection Preventionist) Surveyor asked how long nutritional supplements are good after being opened. DON/IP B stated 3 days. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure staff were following the plan of care, failed to complete a root cause analysis, and failed to ensure fall interventions were functioning properly for 1 of 3 residents (R3) reviewed for falls. R3 has severe cognitive impairment. R3's care plan states R3 is assist of 1 for transfer resident was observed transferring and ambulating independently. Staff were not aware R3 required assistance with transfer and ambulation and did not know a fall intervention was not functioning. Evidenced by: The Facility Fall Prevention and Management Guidelines revised 7/18/24, includes, in part: each resident will be assessed for fall risk and will receive care and services in accordance with their individualized plan of care to minimize the likelihood of falls or reduce the possibility/severity of injury. 3. [...]

Inspectors wroteBased on interview and record review, the facility did not make prompt efforts to resolve resident grievances for 1 resident (R1) out of 3 sampled residents. R1's Activated Power of Attorney (APOA) informed the facility that R1 did not receive morning (AM) medications until noon. The facility failed to make prompt efforts to resolve the grievance. Evidenced by: The facility policy, Grievance Policy, dated 7/22, states, in part; Policy: The facility will seek to resolve concerns, complaints or grievances and provide residents, responsible parties, staff and others feedback and resolutions in a timely manner . R1 was admitted to the facility on [DATE] with diagnoses including dementia, weakness, obesity, fibromyalgia, depression, and anxiety. [...]

Inspectors wroteBased on interview and record review, the facility did not ensure the provision of pharmaceutical services (including procedures that assure that accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 2 out of 3 sampled residents (R1 and R3). On 5/19/24, R1 did not receive morning (AM) medications until noon. On 5/19/24, R3 did not receive scheduled 7:30 AM and 8:00 AM medications timely. This resulted in 20 medication timing errors. Evidenced by Facility policy, Medication Administration: General Guidelines, dated 1/23 states, in part; .Policy Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices and only by persons legally authorized to do so. [...]

Inspectors wroteBased on interview and record review, the facility did not ensure residents are free of significant medication errors for 1 of 3 total sampled residents (R3). The facility scheduled R3's Metoprolol Succinate ER to be administered at 7:30 AM and 7:30 PM. On 5/18 and 5/19/24, the facility administered R3's morning dose of Metoprolol late and administered the evening dose of Metropolol less than 12 hours after the morning dose. This resulted in four (4) timing errors. As evidenced by Facility policy, Medication Administration: General Guidelines, dated 1/23 states, in part; .Policy Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices and only by persons legally authorized to do so. Personnel authorized to administer medications do so only after they have familiarized themselves with the medication .1. [...]

Inspectors wroteBased on observation, interview, document review, and review of the United States (US) Food Code, Dietary Aide (DA) J failed to test a low temperature dish machine's final rinse chemical level properly. In addition, two drink items were not labeled and located in the dietary reach-in refrigerator. The deficient practice affected 46 out of 48 residents and could cause the potential spread of foodborne illness.

Inspectors wroteBased on observation, interview, and record review the facility did not maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment this has the potential to affect the census of 48 and 2 of 6 residents observed on EBP protocol. The facility did not have an up-to-date process to ensure all staff have been fit tested annually for use of N95 masks. Enhanced Barrier Precautions were not appropriately implemented and maintained for two residents R27 and R16. This is evidenced by: The Facilities Policy and Procedure entitled N95 Fit Testing dated 10/16/23, documents in part: All staff that work in direct resident care will have an initial and annual fit-test for respirator use in accordance with Occupational Safety Health Administration (OSHA) regulations .The initial fit test will occur prior to initial use of the respirator. [...]

Inspectors wroteBased on observation, interview, and record review, the facility did not ensure a resident with a catheter receives appropriate treatment and services to prevent urinary tract infections for 1 of 2 residents (R36) reviewed for catheter care out of total sample of 14. Staff did not perform appropriate hand hygiene while providing catheter care. There was no barrier placed under supplies on the bedside table during the catheter care. Staff reused a washcloth after cleansing with it by placing it back in the wash basin and using it for the second time on resident's peri area. Staff placed dirty wash cloths directly on bedside table and did not disinfect bedside table after use. Evidenced by: The facility policy entitled Hand Hygiene, dated 11/2/22, states, in part: . Policy: [...]

Inspectors wroteBased on interview and record review, the facility did not ensure that a resident who displays or is diagnosed with a mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder (PTSD), receives appropriate treatment and services to correct the assessed problem or attain the highest practical mental and psychosocial well-being for 1 of 1 residents reviewed for PTSD out of 14 sampled residents (R26). R26 was listed as having a diagnosis of PTSD and his care plan is not person centered, as it does not specify triggers, symptoms to monitor for or interventions to use to ensure R26 is reaching his highest practical mental and psychosocial well-being. This is evidenced by: [...]

Inspectors wroteBased on record review, observation and interview, the facility did not ensure that each resident receives adequate supervision and assistance devices to prevent accidents for 1 of 5 residents (R) R5.