Rex Rehab & Nursing Care Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, facility failed to have accurate advanced directive documentation throughout the medical record for 1 of 5 residents reviewed for advanced directives (Residents #25). The findings included: Resident #25 was admitted to the facility on [DATE] with diagnoses that included chronic kidney disease and hypertension.Her admission Minimum Data Set assessment dated [DATE] revealed Resident #25 was cognitively intact.The electronic medical record profile indicated Resident #25's code status as do not resuscitate. Review of the advanced care planning notes, which are progress notes, in Resident #25's medical record indicated she did not have an advanced directive.A Medical Orders for Scope of Treatment (MOST) form dated [DATE] for Resident #25 stated attempt CPR (cardio-pulmonary resuscitation) and full scope of treatment.Review of Resident #25's physician's orders revealed there was no order addressing code status.An interview was conducted on [DATE] at 3:34 PM with the Social…

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 staff interviews the facility failed to complete a recapitulation of stay for 2 of 2 residents reviewed for a planned discharge from the facility to home (Resident #79 and Resident #146). Findings included: 1. Resident #79 was admitted to the facility on [DATE] and discharged home on 3/07/24. The discharge Minimum Data Set, dated [DATE] revealed Resident #79 was coded as cognitively intact. Review of Resident #79's electronic health record revealed a discharge summary completed by different disciplines dated 3/07/24. Further review of the discharge summary revealed that it did not include the required components of the recapitulation of stay and a final summary of the resident's status at discharge to include customary routine, cognitive patterns, communication, vision, mood and behavior patterns, psychosocial well-being, continence, skin conditions, dental status, physical function, and structural problems. An interview on 5/15/24 at 3:30 PM with the Social Worker (SW) revealed that…

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 observations, record review, staff and Nurse Practitioner interviews, the facility failed to obtain orders for the use of supplemental oxygen for 1 of 1 resident reviewed with oxygen (Resident #133). Findings included: Resident #133 was admitted to the facility on [DATE] with diagnoses which included shortness of breath and acute kidney failure. Resident #133's admission Minimum Data Set was in progress. Review of Resident #133's care plan last updated 5/14/24 revealed a problem for impaired gas exchange. The goal was that the resident maintained adequate gas exchange as evidenced by oxygen saturation within normal limits and absence of hypoxia through the next review. The interventions included monitoring for signs and symptoms of hypoxia and administer oxygen as ordered. Review of the physician orders revealed no order for supplemental oxygen use. An observation made on 5/13/24 at 2:25 PM revealed that Resident #133 wore oxygen via nasal cannula at 2 liters per minute. An observation made on 5/14/24…

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 observations and staff interviews the facility failed to secure resident medications stored in an unattended and unlocked medication cart (Wing D) for 1 of 5 medication carts. The findings included: A continuous observation was conducted of the Wing D medication cart on 5/16/24 at 9:50 AM through 9:56 AM. The cart was parked midway down the hall with the drawers of the cart facing out. The medication cart was observed with the lock not engaged as evidenced by the red dot on the lock being visible. There was no staff member with the medication cart. Four staff members, one resident, and 2 visitors were observed walking past the unlocked medication cart. Nurse #2 came out of a resident room and returned to the medication cart at 9:56 AM. Nurse #2 was asked to open the top drawer and realized she had left the medication cart unlocked. Nurse #2 stated she usually locked her cart and revealed it should be locked any time she was not using it. An interview with the Director of Nursing (DON) on 05/16/24 09:59 AM was completed. The DON stated the medication cart should have been…

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 and staff interview, the facility's Quality Assessment and Assurance (QAA) Committee failed to maintain implemented procedures and monitor the interventions that the committee put into place following the 3/23/23 recertification and complaint survey in the area of Medication Storage (F761). This deficiency weas cited again on the current recertification and complaint survey of 5/17/24. The continued failure of the facility during 2 federal surveys of record show a pattern of the facility's inability to sustain an effective Quality Assessment and Assurance program. The findings included: This tag is cross referenced to: 1. 761: Based on observations and staff interviews the facility failed to secure resident medications stored in an unattended and unlocked medication cart (Wing D) for 1 of 5 medication carts. During the recertification and complaint investigation survey of 3/23/23 the facility was cited for failing to keep medications secure. An interview was conducted with the Administrator on 5/17/24 at 12:14 PM. The Administrator stated constant rounds 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 record review, observation and staff interviews, the facility failed to date food items opened and placed in the walk-in refrigerator and discard expired food items stored for use in 1 of 1 walk-in refrigerator. These practices had the potential to affect food served to residents. The facility also failed to date leftover food items and discard expired food items stored for use in 1 of 3 resident nourishment refrigerators located in the recreation center of the facility. Finding included: 1. On 3/20/2023 at 10:04 a.m. during the initial tour of the kitchen with the Dietary Supervisor, the following food items were observed in the walk-in refrigerator: * Small sandwich size ham slices wrapped in clear plastic wrap dated 3/16/2023. The slice of ham on top was observed with a light tan discoloration to one half of the slice while the other half was observed with a pale pink color. The Dietary Supervisor stated the ham was sliced for sandwiches and was good for 3 days once open from the original package and…

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 observations, resident representative and staff interviews, and record review, the facility failed to assist Resident #55 and their representative in locating missing hearing aids, as well as in making appointments, and arranging for transportation to replace the lost devices. This occurred for 1 of 1 sampled resident (Resident #55) reviewed for hearing/vision. The findings included: Resident #55 was admitted to the facility on [DATE] with diagnoses including confusion, dehydration, and hypertension. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #55 revealed he had adequate hearing with hearing aids. He was coded as moderately cognitively impaired without any rejection of care behaviors. Review of Resident #55's active care plan (dated 12/10/21) revealed he had impaired verbal communication defined by word finding difficulty related to neuromuscular development. Interventions included: use appropriate adaptive equipment and provide tools necessary to communicate. An…

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 and staff interviews the facility failed to keep medications secured by storing over-the-counter medications in an unoccupied storage room that had the door propped open with boxes for 1 of 6 storage rooms inspected (the main hall storage room). Findings included: On 03/21/23 at 1:30 PM the main hallway storage room door was observed to have the door propped open with boxes. There were 12 unopened bottles of Zinc 50 Milligram tablets and 3 unopened bottles of ResaQuad capsules stored on a shelf. These items were visible from the hallway and the storage room was unoccupied. In an interview with the Central Supply Aide on 03/21/23 at 1:55 PM she stated she understood propping the door open to the storage room could lead to a resident or a staff person taking items out of the room, specifically the over-the-counter medications. She verbalized understanding that all medications were to be stored in a locked room. She stated she usually kept the storage room door locked but she was busy and it was easier to leave the door open because she was coming back to unpack…

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.