Riverbend Heights Health & Rehabilitation

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to provide adequate protective oversight for one sampled resident (Resident #1) when the resident obtained access to a sharps container on the medication cart, found the tip/needle portion of an insulin pen and poked his/her finger out of ten sampled residents. The facility census was 94 residents. Review of the facility policy for Sharps Disposal revised January 2021 showed: -The facility staff was to discard contaminated sharps into designated containers immediately or as soon as feasible, into designated containers. -All containers used for discarding contaminated sharps were to be closable, puncture resistant, leakproof on sides and bottom, labeled or color-coded in accordance with the established labeling system and impermeable and capable of maintaining impermeability through final waste disposal. -During use, containers for contaminated sharps were to be handled by: --Designated individuals will ensure that the containers were easily…

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 interview and record review, the facility failed to ensure facility staff received training to maintain the highest practicable physical, mental, and psychosocial well-being, for four sampled residents (Resident #3, #4, #5 and #6) out of nine sampled residents. The facility census was 102 residents. Review of the Facility Behavioral Health Services Policy dated 2/19 showed: -Policy: -The facility will provide and residents will receive behavioral health services as needed to attain or maintain the highest practicable physical, mental and psychosocial well-being in accordance with the comprehensive assessment and plan of care. -Staff training regarding behavioral health services includes, but is not limited to: --Recognizing changes in behavior that indicated psychological distress. --Implementing care plan interventions that are relevant to the resident's diagnosis and appropriate to his or her needs. --Monitoring care plan interventions and reporting changes in conditions. --Protocols and guidelines…

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 interview and record review, the facility failed to notify two sampled residents (Resident #3 and #4) representatives of the injuries sustained as result of an altercation on 9/29/23 out of nine sampled residents. The facility census was 102 residents. 1. Review of Resident #3's admission Record showed the resident was admitted on [DATE], readmitted on [DATE] with the diagnoses antisocial personality disorder (a condition characterized by repetitive behavioral patterns that are contrary to usual moral and ethical standards and cause a person to experience continuous conflict with society), dementia (a progressive organic mental disorder characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses), schizoaffective disorder (a mental condition that causes loss of contact with reality and mood problems), bipolar disorder (mood disorders characterized usually by…

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 interview and record review, the facility failed to provide appropriate interventions necessary to prevent a resident to resident altercation for two sampled residents (Resident's #1 and #2) out of three sampled residents. The facility census was 101 residents. Review of the facility Abuse Prevention Program dated 12/16 showed: -Policy: -Our residents have the right to be free from abuse. -As part of the resident abuse prevention the administration will: --Protect our residents from abuse by anyone. --Require staff training and orientation programs that include such topics as abuse prevention, identification and reporting abuse, stress management, and handling verbally and physically aggressive resident behavior. Review of the facility policy Recognizing Signs and Symptoms of Abuse and Neglect dated 1/11 showed: -Our facility will not condone any form of abuse or neglect. -Abuse is defined as will infliction of injury, intimidation, or punishment resulting in harm, pain, or mental anguish. Review 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure facility staff received training to maintain the highest practicable physical, mental, and psychosocial well-being, for two sampled residents (Resident #1 and #2) out of three sampled residents. The facility census was 101 residents. Review of the Facility Assessment Tool dated 9/12/22 showed: -The facility served residents with the following: Psychiatric/Mood, Psychosis (Hallucinations, Delusions, etc.), Impaired Cognition, Mental Disorder, Depression, Bipolar Disorder (i.e., Mania/Depression), Schizophrenia, Post-Traumatic Stress Disorder, Anxiety Disorder, Behavior that Needs Interventions. -The facility had 154 licensed beds, with an average daily census of 97-103. -The facility had 22 residents with behavioral health needs. -The facility had one dementia unit. - Services and care offered based on resident needs: Manage the medical conditions and medication-related issues causing psychiatric symptoms and behavior; identified and implemented…

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 keep the Dry Storage room, walk-in refrigerator, and walk-in freezer floors clean; to maintain sanitary utensils and food preparation equipment; to maintain plastic cutting boards and utensils in good condition to avoid food safety hazards; to separate damaged foodstuff; and to ensure the proper refrigeration and/or disposal of foodstuffs, in accordance with professional standards for food service safety. These deficient practices had the potential to affect all residents, visitors, volunteers, or staff who ate food from the kitchen. The facility's census was 95 residents with a licensed capacity for 160 residents at the time of the survey. 1. Observations during the initial kitchen inspection on 9/18/22 between 2:06 P.M. and 3:33 P.M. showed the following: -In the Dry Storage walk-in freezer there was a zip-lock bag of 4 hamburger patties dated 10-28-21, numerous pieces of paper, wadded up plastic, and four pieces of broccoli under the storage racks. -In the Dry Storage walk-in refrigerator there was…

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 properly contain waste and refuse in kitchen garbage cans and outdoor dumpster's, to prevent the harboring and/or feeding of pests. This deficient practice potentially affected all residents, visitors, volunteers, and staff who resided, visited, used, or worked in the facility and/or ate food from the kitchen. This facility had a capacity of 160 residents with a census of 95 residents at the time of the survey. 1. Observations during the initial kitchen inspection on 9/18/22 between 2:06 P.M. and 3:21 P.M. showed an unlidded large garbage can by the west exit door was approximately (appx.) 3/4 full and another unlidded large garbage can by the ice machine was appx. 2/3 full; no lids were seen in the immediate vicinity of either. Observations during the facility inspection on 9/18/22 at 3:58 P.M. showed two dumpster's in the lot outside the Service Hall had their lids all propped open appx. 1 foot (ft.) to 2 ft. by the overabundance of trash bags inside. Observations during the follow-up kitchen inspection on…

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 ensure one staff member that was Cardiopulmonary Resuscitation/Basic Life Support (CPR/BLS an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function) certified was on duty at all times; to ensure the Staffing Coordinator knew to schedule one CPR certified staff member on each shift; to keep accurate staffing files to ensure they knew who was CPR certified and when CPR certification would expire; and to ensure the facility van driver was CPR certified when he/she had transported nine supplemental residents on 11 different trips (Residents #15, #39, #58, #5, #48, #342, #18, #67, and #33). This deficient practice had the possibility of affecting all resident's who had a full code status (if a person's heart stopped beating and/or they stopped breathing, all resuscitation procedures will be provided to keep them alive.) The facility census was 95…

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 3. Record review of Resident #27's face sheet, dated 9/26/22, showed: -The resident was admitted to the facility on [DATE]. -The diagnoses included: schizophrenic disorder, altered mental status, Alzheimer's disease (progressive mental worsening due to generalized degeneration of the brain). Record review of the resident's Consultant Pharmacist Recommendation to Physician, dated 9/3/21, showed: -The resident was taking Haloperidol (an antidepressant drug used to treat psychotic conditions), 2 mg daily, 15 mg at bedtime since July 2020 without a Gradual Dose Reduction (GDR). -Recommendation from the pharmacist was to attempt a reduction to 1 mg daily, 15 mg at bed time. -There was no physician response. Record review of the facility's Consultant Pharmacist Recommendation: DON/Medical Director, dated 10/26/21, showed: -Recommendation to discontinue (as needed) PRN use of lorazepam or reorder for a specific number of days per federal guidelines: (psychotropic drugs PRN orders for psychotropic drugs are limited to…

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 3. Record review of Resident #1's face sheet, undated, showed he/she was admitted to the facility on [DATE] with the following diagnoses: -Major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest). -Anxiety disorder (anticipation of impending danger and dread accompanied by restlessness, tension, fast heart rate, and breathing difficulty not associated with an apparent stimulus). -Paranoid schizophrenia (a form of schizophrenia [a chronic mental illness that interferes with a person's ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others] characterized by persistent preoccupation with illogical, absurd, and changeable delusions, usually of a persecutory, grandiose, or jealous nature, accompanied by related hallucinations). Record review of the resident's Consultant Pharmacist Recommendation to Physician, dated 11/21/21, showed: -He/she was ordered Risperdal Consta (an antipsychotic-type…

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 cart was kept locked when not in direct observation of the staff; to ensure the medication room was in a sanitary condition; to ensure staff was checking the temperatures in the refrigerator used to store the resident's medications; to ensure the nursing staff had a key to unlock the medication refrigerator; to ensure other objects were stored with the resident's medications; and to ensure the resident's open medication bottles were kept in a sanitary condition. The facility census was 95 residents. Record review of the facility's policy, Storage of Medications, dated November 2020 showed: -The facility stored all drugs and biologicals in a safe, secure, and orderly manner. -Drugs and biologicals used in the facility were stored in locked compartments under proper temperature, light and humidity controls. -The nursing staff was responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. -Unlocked medication carts were not left unattended.…

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 ensure testing/screening for tuberculosis (TB-a communicable disease that affects especially the lungs, that is characterized by fever, cough, difficulty in breathing, abnormal lung tissue and function) was completed for one sampled resident (Resident #69) and four supplemental residents (Residents #63, #71, #80 and #342) out of five residents sampled for TB testing/screening and to follow infection control procedures by not for ensuring staff cleansed their hands while feeding one supplemental resident (Resident #18) out of 19 sampled residents. The facility census was 95 residents. Record review of the facility's TB policy, dated 2001, showed: -The facility screened all residents for TB. -The admitting nurse screened residents for admission and readmission for information regarding exposure to or symptoms of TB. -Screening of new admissions and readmissions for TB would be in compliance with state regulations. -The policy did not specify…

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 staff failed to ensure the resident was free from a merry walker (combination walker/chair ambulation device with tubular rectangular gated frame) restraint without an assessment, a physician's order including a medical symptom and without informed consent for the use of a merry walker restraint for one sampled resident (Resident #77) out of 19 sampled residents. No other residents had a restraint. The facility census was 95 residents. Record review of the facility's Unauthorized Physical Restraints policy dated April 2021 showed: -Residents were to be free from the use of any physical restraint not required to treat their medical condition. -A physical restraint was defined as any manual method, physical or mechanical device, equipment or material that meets all of the following criteria: --Is attached or adjacent to the resident's body; --Cannot be removed easily by the resident; and --Restricts the resident's freedom of movement or normal access…

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 interview and record review, the facility failed to ensure an accurate completion, submission and retention of a Level I Nursing Facility Pre-admission Screening for Mental Illness, Intellectual Disability or Related Condition (PASARR-a federally mandated screening process for individuals with serious mental illness and/or intellectual disability/developmental disability related diagnosis who apply or reside in Medicaid (program that helps with medical costs for some people with limited income and resources) certified beds in a nursing facility regardless of the source of payment. The screening assures appropriate placement of persons known or suspected of having a mental impairment(s) and also that the individual needs of mentally impaired persons could be and were being met in the appropriate placement environment) for one sampled resident (Resident #72) out of 19 sampled residents. The facility census was 95 residents. Record review of the facility's Behavioral assessment, intervention and monitoring…

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 interview and record review, the facility failed to do thorough weekly skin assessments and to document current skin issues for one sampled resident (Resident #37) who had several skin injuries out of 19 sampled residents. The facility census was 95 residents. Record review of the facility's policy, Wound Evaluations, dated September 2018 showed: -Evaluation of wounds would be performed on admission, weekly and on discovery. -Wound assessments would be completed by the facility Nursing staff or the designated wound care company. -Components of wound documentation should include: --Location, size, staged if a pressure injury (the breakdown of skin integrity due to pressure), type of wound if not a pressure wound (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction), onset date for pressure ulcers, wound bed (the base or floor of a wound) description, drainage, odor, tunneling/undermining…

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 the gastrostomy tube ( G-tube is a tube inserted through the belly that brings nutrition directly to the stomach) was securely fastened and to keep the feeding tube and surrounding skin clean for one sampled resident (Resident #8) out of 19 sampled residents. The facility census was 95 residents. Record review of the facility's policy, Maintaining Patency of a Feeding Tube, revision date 2018 showed: -Confirm placement of the tube. -Flush enteral feeding tubes with 30 Millimeters (ml) of warm water before and after intermittent feedings. -Verify that there was a physician's order for this procedure. -NOTE: There was no mention of how to secure the feeding tube to prevent pulling and possible dislodgement. -NOTE: There was no mention of how to clean or how often to clean the feeding tube and surrounding skin to prevent infection. 1. Record review of Resident #8's admission Minimum Data Set (MDS- a federally mandated assessment tool completed by the facility for care planning) dated 6/15/22 showed the…

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 ensure infection control practices were maintained for oxygen tubing and a Continuous Positive Airway Pressure (CPAP a machine that uses mild air pressure to keep breathing airways open while you sleep) machine for two sampled residents (Resident #58 and #8) out of 19 sampled residents. The facility census was 95 residents. Record review of the facility's policy, Use of Oxygen and Nebulizer, revised July 2016 showed: -The oxygen tubing cannula or mask, nebulizer tubing would be changed weekly and as needed. -The tubing should be kept off of the floor and in a dated bag or container when not in use. -The oxygen equipment should be cleaned regularly. 1. Record review of Resident #58's face sheet showed he/she was re-admitted on [DATE] with the following diagnoses: -Acute respiratory failure with hypoxia (a serious condition when the lungs can not get enough oxygen into the lungs). -Chronic obstructive pulmonary disease (COPD - a chronic…

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 interview and record review, the facility failed to provide influenza (a highly contagious viral infection of the respiratory passages causing fever, severe aching, and catarrh, and often occurring in epidemic) and pneumococcal (lung inflammation caused by bacterial or viral infection) vaccines for two sampled residents (Resident #71 and #342) out of five residents sampled for immunizations. This practice had the potential to effect all residents. The census was 95 residents. Record review of the facility's Pneumococcal Vaccine Policy, dated March 2022, showed: -All residents were offered pneumococcal vaccines to aid in preventing pneumonia/pneumococcal infections. -Prior to or upon admission, residents were assessed for eligibility to receive the pneumococcal vaccine series, and when indicated were offered the vaccine series within thirty days of admission to the facility, unless medically contraindicated or the resident had already been vaccinated. -Assessments of pneumococcal vaccination status were…

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 interview and record review, the facility failed to provide COVID-19 (a respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) immunization education for one supplemental resident (Resident #342) out of five residents sampled for immunizations. This practice had the potential to effect all residents. The census was 95 residents. Record review of Centers for Medicare and Medicaid Services (CMS) memorandum QSO-21-19-NH, dated 5/11/21, showed: -Each facility must develop and implement policies and procedures that meet each resident's informational needs and provides vaccines to all residents that elect them. -All residents and or resident representatives must be educated on the COVID-19 vaccine they were offered. - Long Term Care (LTC) facilities must offer residents vaccination against COVID-19 when vaccine supplies were available to the facility. -Screening individuals prior to offering the vaccination for prior immunization, medical precautions and contraindications…

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 fully complete the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) (form CMS-10055) for two sampled residents (Resident #267 and #58) out of two sampled residents who were discharged from Medicare part A services and remained in the facility. The facility had three residents who discharged form Medicare Part A services in the last six months. The facility census was 66 residents. Record review of the Centers for Medicare and Medicaid Services Survey and Certification memo (S&C-09-20), dated 1/9/09 showed: -If the skilled nursing facility (SNF) believes on admission or during a resident's stay that Medicare will not pay for skilled nursing or specialized rehabilitative services and the provider believes that an otherwise covered item or service may be denied as not reasonable or necessary, the facility must inform the resident or his/her legal representative in writing why these specific services may not be covered and the beneficiary's potential liability for payment for the non-covered services. The SNF's…

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 assistance to residents totally or partially dependent upon staff for bathing/showering needs for three sampled residents (Residents #34, #24, and #46) out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's Bath, Shower/Tub procedure, revised February, 2018 showed: -The purpose of the procedure was to promote cleanliness, provide comfort to the resident and observe the condition of the resident's skin. -Documentation must include: --The date and time the shower/tub bath was given and the name and title of the person assisting the resident. --Certified Nurse Aide (CNA) assessment data obtained during the shower, including skin issues such as sores and reddened areas. --How well the resident tolerated the shower/bath or if the resident refused. If refused, the reason why, and the intervention implemented. -The supervisor will be notified if the resident refuses the shower/bath. 1. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to provide sufficient staffing to assist with bathing/showering needs for three sampled residents (Residents #34, #24, and #46) out of 17 sampled residents. The facility census was 66 residents. 1. Record review of Resident #34's Face sheet showed he/she was originally admitted to the facility on [DATE] with the following diagnoses: -Hemiplegia and Hemiparesis (muscle weakness or partial paralysis on one side of the body) Following Cerebral Infarction (brain tissue death resulting from blockage or narrowing of arteries supplying blood and oxygen to the brain). -Contractures (permanent shortening and tightening of muscles, tendons, ligaments and/or skin, making it difficult or impossible to move the nearby joints) of right and left shoulders and left elbow. -Foot Drop (difficulty lifting the front part of the foot), left foot. Record review of the resident's Skin Monitoring and CNA Shower Reviews (commonly referred to by staff as shower/bath…

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 interview and record review, the facility failed to ensure the Pre admission Screen and Resident Review (PASARR) Level I and if indicated, Level II was obtained for one sampled resident (Resident #57) having a mental condition, out of 17 sampled residents. The facility census was 66 residents. Record review of the Missouri Department of Health and Senior Services Division of Regulation and Licensure Initial Assessment - Social and Medical (DA-124A/B), dated 9/2017 showed: -When persons transfer from one skilled/intermediate nursing facility to another, the sending facility furnishes a copy of their DA-124A/B and C forms to the receiving facility. -The receiving facility then notifies their local Family Support Division (FSD, Department of Social Services - DSS). -When persons transfer from one skilled/intermediate nursing facility to another and application for Medicaid is not indicated, then the ORIGINAL DA-124C form must follow to the next facility. Record review of the Missouri Department of Health…

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 ensure restorative services were provided to maintain, improve, or prevent decline in Range of Motion (ROM - the range on which a joint can move) for one sampled resident (Resident #29) out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's Resident Mobility and ROM policy revised 7/2017 showed: -Residents with limited ROM will receive treatment and services to increase and/or prevent a further decrease in ROM. -As part of the resident's comprehensive assessment, the nurse will identify the resident's current ROM. -The care plan will include specific interventions, exercises and therapies to maintain, prevent avoidable decline in, and/or improve ROM. -Interventions may include therapies, the provision of necessary equipment, and/or exercises and will be based on professional standards of practice. 1. Record review of Resident #29's Face Sheet showed he/she was admitted to the facility on [DATE]…

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 ensure destruction of controlled medications when the medication was discontinued for one sampled resident (Resident #37) out of 17 sampled residents. The facility census was 66 residents. Record review of the facility Discarding and Destroying Medications policy dated October 2014 showed that disposal of controlled substances must take place immediately (no longer than three days) after discontinuation of use by the resident. 1. Record review of Resident #37's Face Sheet showed: -He/she was admitted to the facility on [DATE]. -Had diagnoses of Parkinson's disease (a progressive nervous system disorder that affects movement) and malignant neoplasm (cancerous tumor that can invade other areas of the body). Record review of the resident's Electronic Medical Record (EMR) showed: -He/she was admitted to hospice care (end of life care) on 11/29/19. -His/her physicians ordered Lorazepam (antianxiety medication) concentrate (liquid) 2 milligrams…

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 interview, and record review, the facility failed to ensure one sampled resident (Resident #34) was free of significant medication errors, out of 17 sampled residents. The facility census was 66 residents. Record review of the facility Insulin (a hormone that helps the glucose get into cells to give them energy) Administration policy, revised 09/2014 showed: -The four types of insulin and their characteristics (varies with manufacturer) included Rapid-acting insulin. -Rapid acting insulin's onset (how quickly the insulin reaches the bloodstream and begins to lower blood sugar) is 10 to 15 minutes. -Rapid acting insulin peaks (the time when the insulin is at its maximum effectiveness) in one half hour to three hour. -Rapid acting insulin has a duration (the length of time during which the insulin is effective) of three to six hours. Record review of https://www.novocare.com/novolog.html, dated 01/2020 showed: -NovoLog® is fast-acting. -Eat a meal within five to ten minutes after taking it. 1. 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.