Communities Of Wildwood Ranch

Based on record review and interview, the facility failed to ensure all residents were free from unnecessary medications when staff administered blood pressure medication to one resident (Resident #22) when the resident's blood pressure was outside for the physician ordered parameters for administration. Review of the facility's policy titled Clinical Administering Medications, with a revised date of April 2019, showed the following: -Medications are administered in a safe and timely manner, and as prescribed; -Medications are administered in accordance with prescriber orders; -If a dosage is believed to be inappropriate or excessive for a resident, or a medication has been identified as having potential adverse consequences for the resident or is suspected of being associated with adverse consequences, the person preparing or administering the medication will contact the prescriber, the resident's attending physician, or the facility's medical director to discuss the concerns. 1. Review of Resident #22's admission Record, located in the Profile tab of the electronic medical record…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review, the facility failed to ensure all residents were as free from accident hazards as possible when staff completed a slide transfer for one resident (Resident #1) without ensuring the area was free from potential hazards prior to completing transfer resulting in the resident's leg getting caught in a blanket while being transferred resulting in pain. The facility had a census of 109. Review of a facility policy titled, Safe Lifting and Movement of Residents, revised July 2017, showed the following information: -Nursing staff in conjunction with rehabilitation staff shall assess resident needs for transfer assistance and will document the resident transfer and lift needs in the care plan; -Manual lifting of residents shall be eliminated when feasible. Review of a facility policy titled, Lifting Safety Precautions, revised March 2005, showed the following information: -When lifting or moving residents staff are to ensure equipment is secure; -If there are mechanical devices available to assist in moving residents more safety staff are to utilize…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review, the facility staff failed to implement policies and procedures to help prevent abuse when staff failed to ensure the required criminal background checks (CBC - check that searches for criminal misconduct) for three staff members (Registered Nurse (RN) B, Licensed Practical Nurse (LPN) D, and Social Services (SS) A); employee disqualification list (EDL - list maintained by the Department of Health and Senior Services of individuals who have been determined to have: abused or neglected a resident; misappropriated funds or property belonging to a resident) checks for four staff members (RN B, Office Staff C, LPN D, and Certified Occupation Therapy Assistant (COTA) F); and the CNA registry (Certified Nurse Aide - list of all nursing assistants who meet the requirements to practice under that title within their state) check for three staff members (RN B, COTA A and CNA E) were completed prior to staff beginning employment at the facility. The facility census was 103. Review of the facility provided policy titled, New Hire Checklist, dated February…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY 2. Review of Resident #8's face sheet showed the following: -admission date of 06/29/23; -Diagnoses included dependence on acute respiratory failure and pneumothorax (the presence of air or gas in the cavity between the lungs and chest wall, causing collapse of the lung). Review of the resident's discharge MDS, dated [DATE], showed the resident discharged with return anticipated. Review of the resident's progress notes dated 07/24/23, at 1:41 A.M., showed the following: -Night shift 07/23/23 - The resident was sent to the hospital for evaluation due to shortness of breath, diminished lung sounds, edema (swelling), rapid weight gain with history of kidney disease, cardiac disease, and respiratory failure. Staff notified family. Staff notified administrator and physician notified via electronic system. Review of the resident's medical record showed staff did documentation regarding the facility's bed-hold policy being provided to the resident or resident's representative related to the transfer to the hospital. A…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide protective oversight to all residents to prevent possible accidents/elopements when the staff did not complete checks of wander guards (wander/elopement alarm/devices) as ordered; when the facility failed to ensure the wander guard device alarms alarmed at all panels and pagers; and when staff failed to follow policy to ensure residents were accounted after one resident (Resident #14) exited the building causing the wander guard alarm to sound. The facility had a census of 103. Review of the facility's policy titled, Elopement Precautions/Missing Resident, undated, showed the following: -The facility does not have a special care unit; -In this facility, all exit doors are alarmed; -Any resident who is an elopement risk shall have a personal electronic monitoring device placed on their wrist, ankle or assistive device; -The doors that are activated by the electronic monitoring system include all dining room doors located in each…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, facility staff failed to complete a quarterly Minimum Data Set (MDS, a federally mandated comprehensive assessment instrument, completed by facility staff) assessment for four residents (Resident #2, #3, #9, and #24) out of 19 sampled residents, within 14 days from the assessment reference date (ARD). The facility had a census of 91. Record review of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, Chapter 2, Assessments for the RAI, showed the following information: -The quarterly assessment is an Omnibus Budget Reconciliation Act of 1987 (OBRA) non-comprehensive assessment for a resident that must be completed at least every 92 days following the previous OBRA assessment of any type; -The quarterly assessment is used to track a resident's status between comprehensive assessments to ensure critical indicators of gradual change in a resident's status are monitored; and -The ARD must be not more than 92 days after the ARD of the most recent OBRA assessment of any type. 1. Record review…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to transmit a Death in Facility Minimum Data Set (MDS, a federally mandated assessment instrument, required to be completed by facility staff for care planning) record within 14 days of a death in the facility for one resident (Resident #6). The facility had a census of 91. Record review of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, Chapter 2, Assessments for the RAI, showed the following information: -The Death in Facility Tracking Record consists of demographic and administrative items; it must be completed when the resident dies in the facility or when on leave of absence (LOA); -The record must be completed within seven days after the resident's death, and within 14 days after the resident's death, staff should electronically transmit encoded, accurate, and complete MDS data to the CMS System. 1. Record review of Resident #6's medical record showed the following information: -admitted…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to complete a side rail assessment to include a risk/benefit review and alternatives attempted prior to use, and failed to obtain informed consent for the use of side rails for four residents (Resident #29, #67, #95 and #101). The facility failed to complete bed rail measurements for one resident (Resident #95). A sample of 19 were reviewed. The facility census was 91. Record review of a facility policy entitled, Bed Safety (Revised December 2007), showed the following information: -Facility shall strive to provide a safe sleeping environment for the resident; -Resident's sleeping environment shall be assessed by the interdisciplinary team, considering the resident's safety, medical conditions, comfort, and freedom of movement, as well as input from the resident and family regarding previous sleeping habits and bed environment; -To try to prevent deaths/injuries from the beds and related equipment (including the frame, mattress, side rails,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, facility staff failed to complete an annual Minimum Data Set (MDS, a federally mandated comprehensive assessment instrument, completed by facility staff) assessment for three residents (Resident #3, #12 and #24) within the required 14 days from the assessment reference date (ARD). A sample of 19 residents was selected for review; the facility had a census of 91. Record review of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, Chapter 2, Assessments for the RAI, showed the following information: -The Annual assessment is an OBRA (Omnibus Budget Reconciliation Act of 1987) comprehensive assessment for a resident that must be completed on an annual basis (at least every 366 days) unless an SCSA (Significant Change in Status Assessment) or an SCPA (Significant Correction to Previous Assessment) has been completed since staff completed the most recent comprehensive assessment; -The Annual assessment ARD is the ARD of previous OBRA comprehensive assessment plus 366 calendar days, and ARD of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure staff cleaned and maintained a continuous positive airway pressure machine (CPAP - treatment for obstructive sleep apnea (breathing repeatedly stops and starts during sleep), with a hose and mask or nosepiece to deliver constant and steady air pressure) according to professional standards, failed to have a physician's order for a CPAP, failed to have a diagnosis for sleep apnea, and failed to address in the care plan the use of the CPAP for one resident (Resident #310); and failed to ensure staff changed oxygen equipment per professional standards, and failed to address in the care plan the use of oxygen for one resident (Resident #95), out of a sample of 19 residents. The facility had a census of 91. Record review of the facility's policy titled, CPAP Support, dated March 2015, showed the following information: -Used to improve arterial oxygenation in residents with respiratory insufficiency, obstructive sleep apnea, or restrictive lung disease; -Review the resident's medical record to determine…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure a medication error rate of less than 5% when the facility staff made two errors in 28 opportunities resulting in an error rate of 7.14%. Facility staff failed to administer the correct dose of one medication and failed to administer one inhaler per professional nursing standards and manufacturer's specifications for one resident (Resident #311). The facility census was 91. Record review of the Symbicort (name brand for Budesonide/Formoterol inhaler) manufacturer's website dated April 2019, showed the following information: -This product is used to control and prevent symptoms caused by asthma or chronic obstructive pulmonary disease, (COPD - a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible); -Symbicort should be administered as two inhalations twice daily (approximately 12 hours apart), every day by the orally inhaled route only. -After inhalation, the patient should rinse the mouth with water, spit out the water, do…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.