Good Samaritan Society Augusta Place A Prospera Co

Based on observation, review of manufacturer's instructions and staff interview, the facility failed to sanitize surfaces in 1 of 1 facility kitchen. Failure to ensure the concentration of quaternary (quat) sanitizing solution is within manufacturer's guidelines may result in an incorrect solution concentration. Inadequate sanitization of the kitchen surfaces places residents at risk for foodborne illness. Findings include: Review of the manufacturer's instructions for Ecolab's Oasis 146 Multi-Quat Sanitizer occurred on 01/29/25. This information identified a concentration of 150- 400 ppm (parts per million) for effective sanitizing. Observation during the initial kitchen tour on 01/27/25 at 10 a.m., showed a dietary staff member (#11) wiped a food-prep counter in the kitchen with a cloth from a bucket of solution. The dietary staff (#10) identified the solution in the bucket as the quat disinfecting solution she obtained from the main kitchen earlier that morning. Upon request, the dietary staff member (#10) tested the solution twice using expired Hydrion QT 40 test strips. 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.

Based on observation, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 5 of 13 sampled residents (Resident #20, #30, #36, #38 and #200) and one supplemental resident (Resident #2) observed during cares and medication pass. Failure to practice infection control standards related to enhanced barrier precautions (EBP), droplet precautions, and hand hygiene, has the potential to spread infection throughout the facility. Findings include: Review of the facility policy titled Hand Hygiene occurred on 01/28/25. This policy, revised on 03/29/22, stated, . Policy: . All employees in patient cares areas . will adhere to . Hand Hygiene . 3 After bodily Fluid/Glove Removal . according to standard precautions . 2. Hand hygiene should be performed after glove removal . Procedure: HCW [Health Care Workers] will use waterless alcohol-based hand sanitizer or soap and water to clean their hands: . After removing gloves regardless of task completed . After contact with a patient's excretions . When moving from contaminated…

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 staff interview, the facility failed to review and revise care plans to reflect the residents' current status for 2 of 13 sampled residents (Resident #33 and #39). Failure to update care plans limited the staffs' ability to communicate needs and ensure continuity of care. Findings include: - Review of Resident #33's medical record occurred on all days of survey. A physician's order, dated 07/16/24, stated, Hiprex [antibiotic/antibacterial medication] Oral Tablet 1 GM [gram] . Give 1 tablet by mouth two times a day for prevent uti [urinary tract infection]. The current care plan stated, . Monitor/document for s/s [sign/symptoms of] UTI . The facility failed to update Resident #33 care plan to include a medication to prevent UTIs. - Review of Resident #39's medical record occurred on all days of survey. A physician's order, dated 09/23/24, stated, Hiprex Oral Tablet 1 GM . Give 1 tablet by mouth two times a day for Recurrent [sic] UTIs. The current care plan stated, . Monitor/document for s/s UTI . The facility failed to update Resident #39's care plan 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.

Based on observation, review of facility policy, review of manufacturer's instructions, and staff interview, the facility failed to ensure staff followed standards of practice for 1 of 2 residents (Resident #33) observed for insulin preparation and administration. Failure to properly prime an insulin pen and administer insulin correctly may result in residents receiving an inaccurate dose of insulin. Findings include: Review of the facility policy titled Insulin Administration, Insulin Pens, Insulin Pumps occurred on 01/30/25. This policy, revised 09/05/24, stated, . Insulin Pen. Turn the dosage knob to '2' units to prime the pen. 10.) Holding the pen with the needle pointing upwards, press the button until at least a drop of insulin appears. 11.) Dial in the ordered dose of units. Inject the dose into the chosen site. Be sure to wait 6 seconds to ensure that the full dose has been delivered. Review of manufacturer's Instructions For Use of Lantus occurred on 01/30/25 and stated, . Injecting your Lantus Dose: Place your thumb on the injection button. Then press all the way in 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 observation, review of facility policy, review of food temperature logs, review of resident council meeting minutes, and resident, family, and staff interviews, the facility failed to serve hot foods at palatable temperatures on 3 of 3 units (Pine Ride, [NAME] Hills, and Eagle Bend). Failure to serve foods at a temperature acceptable to residents may result in decreased intake, weight loss, and inadequate nutrition. Findings include: Review of the facility policy titled Food Temperature Monitoring - Food and Nutrition Services occurred on 01/18/24. This policy, revised 12/21/23, stated, . Proper holding temperature - Temperature required for food safety ( . hot food > [greater than] 135 degrees Fahrenheit) . Proper serving temperature - A temperature that is . appetizing to the resident . Food is cooked, reheated or cooled to ensure proper holding temperatures . Food temperatures are taken and recorded before each meal service. Periodically, temperatures are taken at other times during or at the end 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 THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 01/19/23 Based on record review, review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.18.11), and staff interview, the facility failed to ensure accurate coding of the Minimum Data Set (MDS) for 2 of 12 sampled residents (Resident #29 and #44) and one supplemental resident (Resident #12). Failure to accurately complete the MDS does not allow each resident's assessment to reflect their current status/needs and may affect the accurate development of a comprehensive care plan and the care provided to the residents. Findings include: SECTION E: BEHAVIORS The Long-Term Care Facility RAI User's Manual, revised October 2023, page E-1, stated, Intent: The items in this section identify behavioral symptoms in the last seven days that may cause distress to the resident, or may be distressing or disruptive to facility residents, staff members or the care environment. These behaviors may place the resident at risk for…

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, review of the North Dakota Provider Manual Preadmission Screening and Resident Review (PASARR) and Level of Care Screening Procedures for Long Term Care Services, and staff interview, the facility failed to complete a status change assessment for 1 of 2 sampled residents (Resident #29) reviewed for PASARR. Failure to complete a change in status assessment with a newly diagnosed mental illness may result in the delivery of care and services inconsistent with the resident's needs. Findings include: The North Dakota PASARR Provider Manual, revised 12/29/20, page 13 states, . Change in Status Process . Whenever the following events occur, nursing facility staff must contact Maximus to update the Level I screen for determination of whether a first time or updated Level II evaluation must be performed. These situations suggest that a significant change in status has occurred: . If an individual with MI, ID, and/or RC (mental illness, intellectual disability, and conditions related to intellectual disability [referred to in regulatory language as related conditions…

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, record review, review of manufacturer's instructions, and staff interview, the facility failed to provide adequate supervision and assistive devices necessary to prevent accidents for 1 of 4 sampled residents (Resident #9) observed during a transfer utilizing a sit-to-stand mechanical lift transfer. Failure to ensure proper use of a stand lift during transfers placed the resident at risk for accidents and injury. Findings include: Review of the facility policy titled Safe Resident Handling, dated January 2023, stated, . enables caregivers to safely support residents who require partial or total assistance to ambulate, transfer and reposition . mobility equipment . refers to sit to stand lifts . slings a resident uses with mobility tasks . caregivers with perform am TIME OUT safety stop while the resident is in a sling or harness and still over the surface . to ensure all straps are secure before moving away from the surface . this is to be completed once the straps are taut, but before the resident leaves the surface . Review of Resident #9's 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 record review, review of facility policy, and staff interview, the facility failed to ensure the resident's medication regimen remained free of unnecessary medications for 1 of 3 sampled residents (Resident #44) reviewed for antipsychotic medications. Failure to consistently monitor residents while on the medication may result in the residents experiencing adverse consequences related to the antipsychotic medication. Findings include: Review of the facility policy titled Tardive Dyskinesia occurred on 01/18/24. This policy, reviewed 02/07/23, stated, . Tardive Dyskinesia (TD) is an involuntary movement disorder that may appear after use of neuroleptic medications [antipsychotics]. Upon initiation of antipsychotic medication therapy, a baseline assessment shall be completed . Positive screenings will be . considered in the continuation of drug therapy . The User-Defined Assessment (UDA) utilized by the facility for Abnormal Involuntary Movement Scale (AIMS) assessments, stated, . Abnormal Involuntary Movement Scale . Required at least every six months when resident is…

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, record review, review of facility policy, and staff interview, the facility failed to ensure appropriate labeling of medications for 1 of 6 residents (Resident #45) observed during medication administration. Failure to ensure medication cards contain the correct administration information may result in medication errors and adverse drug effects. Findings include: Review of the facility policy titled Medications: Acquisition Receiving Dispensing and Storage occurred on 01/18/24. This policy, revised 02/02/23, stated, . Licensed nursing employees are responsible for ordering from pharmacy . and checking all new orders of medications from the physician's orders . The medication orders/changes are communicated to the pharmacy. All medications . are packaged in accordance with . state pharmacy rules. Observation on 01/17/24 at 9:46 a.m. showed a nurse (#5) administered Resident #45's medications. The pharmacy labels on the cards identified Lorazepam 0.5 mg [milligrams] 1 tablet BID [two times a day] and every 6 hours PRN [as needed] and Oxycodone 5 mg 1 tablet BID…

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, review of facility policy, and staff interview, the facility failed to maintain sanitary food service in 1 of 3 kitchenettes (Eagle Bend). Failure to ensure safe transportation of foods to resident rooms and ensure utilization of sanitary food service equipment has the potential to result in contamination of food and spread illness to resident, staff, and visitors. Findings Include: Review of the facility policy titled Safe Meal Service occurred on 01/18/24. This policy, reviewed 01/11/23, stated, . Meals served in resident's rooms . need to be covered during transportation. Upon completion of the meal by the resident in their room, nursing will document the necessary detail of food consumption before placing the used tray into the enclosed 'dirty' cart in the kitchenette. The Nutrition and Food Services employees will retrieve the tray to bring back to the dish room for processing. Observation on 01/18/24 at 8:47 a.m. showed a certified nurse aide (CNA) (#9) transported a meal tray to Resident #8's room. The tray contained three uncovered cups of liquids. 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.