Monument Healthcare and Nursing Center

Licensure Reference Number 175 NAC 12-006.02(H) State Statute 28-372 Based on record review and interview, the facility failed to submit an investigative report to the State Agency within 5 working days following a fall that resulted in significant injury for 1 (Resident 1) of 3 sampled residents. The facility identified a census of 88. Findings are: A record review of the facility's policy Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, with a last revised date of September 2022 revealed the facility would provide a follow-up investigative report of any allegation of abuse or incidents that resulted in serious bodily injury within 5 business days of the incident to the state agency. A record review of an admission Record revealed the facility admitted Resident 1 on 5/2/2025. Resident 1 had an admitting diagnosis of metabolic encephalopathy (problems with a person's metabolism that can cause brain dysfunction). A record review of an Un-witnessed Fall Report with a date of 6/28/2025 revealed Resident 1 had tripped and fallen. Resident 1 had bleeding…

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.

Licensure Reference Number 175 NAC 12.006.09 (I)(i)(1) Based on record review and interview, the facility failed to notify the resident and/or the residents' representative of a new medication for one (Resident 5) of three sampled residents. The facility identified a census of 89. Findings are: A record review of an undated Change in A Resident's Condition or Status Policy revealed the following: A significant change of condition is a major decline or improvement in the resident's status that will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions (is not self-limiting). Unless otherwise instructed by the resident, a nurse will notify the resident's representative when there is a significant change in the resident's physical, mental, or psychosocial status. A record review of Resident 5s' admission Summary revealed an admission date of 01/10/2025 from a short-term general hospital. The summary revealed Resident 5s' pertinent diagnoses include: -Wedge compression vertebral fracture T7-T8- (a bone fracture…

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.

Licensure Reference Number 175 NAC 12.006.09 (F) Based on observation, record review, and interviews, the facility failed to have resident specific interventions in place to address or minimize the behaviors of one (Resident 1) of three sampled residents. The facility identified a census of 89. Findings are: A record review of Resident 1's admission Summary revealed an admission date of 6/22/23. A record review of Resident 1's pertinent diagnoses revealed the following: -Dementia without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (a general term for a decline in mental ability, including memory, thinking, and reasoning, and is caused by damage to or changes in the brain). -Alzheimer's Disease (a progressive neurodegenerative disorder that primarily affects memory, thinking, and behavior). - Depression (a common and serious medical illness that negatively affects how you feel, think, and act. It's characterized by persistent sadness, loss of interest in activities). A record review of Resident 1's Quarterly Minimum Data Set (a federally mandated…

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.

Licensure Reference Number 175 NAC 12.006.09 Based on interviews and record review, the facility failed to perform wound care as ordered for one (Resident 6) of three sampled residents. The facility identified a census of 89. Findings are: A record review of an undated Pressure Ulcers/Skin Breakdown Clinical Protocol Policy revealed the physician will authorize pertinent orders related to wound treatments, including wound cleansing, debridement approaches, dressings, and application of topical agents, if indicated. A record review of Resident 6's care plan revealed that Resident 6 has a chronic surgical wound to their right shoulder. Interventions for that focus area revealed that staff are to follow treatment orders as provided by the wound nurse/wound clinic. A record review of Resident 6's provider orders revealed a wound care order with a start date of 8/18/24 and read as follows: Wound care to the right shoulder- cleanse with normal saline, wound cleanser, and gauze. Do not allow site to close, apply no sting barrier film to peri-wound, apply dermablue/equivalent over wound…

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.

Licensure Reference Number 175 NAC 12.006.09 (F) (i) (5) Based on observation, record review, and interviews, the facility failed to protect other residents from one (Resident 1) of three sampled residents who displayed adverse behaviors. The facility identified a census of 89. Findings are: A record review of Resident 1's admission Summary revealed an admission date of 6/22/23. A record review of Resident 1's pertinent diagnoses revealed the following: -Dementia without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (a general term for a decline in mental ability, including memory, thinking, and reasoning, and is caused by damage to or changes in the brain). -Alzheimer's Disease (a progressive neurodegenerative disorder that primarily affects memory, thinking, and behavior). - Depression (a common and serious medical illness that negatively affects how you feel, think, and act. It's characterized by persistent sadness, loss of interest in activities). A record review of Resident 1's Quarterly Minimum Data Set (a federally mandated assessment tool used…

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.

Licensure Reference Number 175 NAC 12.006.09 (H) Based on record review and interview, the facility failed to have a diagnosis in place to support the use of an antipsychotic medication and failed to ensure an as needed antipsychotic medication order was limited to 14 days as required. This affected 1 (Resident 5) of 3 sampled residents. The facility census was 89. Findings are: A record review of an undated Psychotropic Medication Use Policy revealed: Residents who have not used psychotropic medications are not prescribed or given these medications unless the medication is determined to be necessary to treat a specific condition that is diagnosed and documented in the medical record. Consideration of the use of any psychotropic medication is based on comprehensive review of the resident. This includes evaluation of the resident's signs and symptoms in order to identify underlying causes. Psychotropic medications are not prescribed or given on an as needed basis (PRN) unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical…

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 Licensure Reference Number 175 NAC 12-006.09 Based on observation, interview, and record review; the facility failed to perform wound care according to the provider's order for 1 (Resident 7) of 3 sampled residents. The facility census was 83. Findings Are: A record review of Resident 7's admission record revealed the resident was admitted to the facility on [DATE] and had a diagnosis of an open wound to their right shoulder which was added on 4/18/2022. A record review of Resident 7's physician's order revealed the following wound care order with a start date of 8/18/24: -Wound care to right shoulder: cleanse with Normal Saline (NS)/wound cleanser and gauze, do not allow site to close, apply No-Sting barrier film to peri-wound, apply Dermablue/equivalent over wound opening, and cover with a silicone border dressing. The order was to be completed daily on the day shift and as needed for drainage or dislodgement. An observation on 12/16/24 at 12:32 PM revealed Registered Nurse (RN)-A preparing to perform wound…

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 Licensure Reference Number 175 NAC 12-006.18(D). Based on observation, interview, and record review; the facility failed to prevent the potential for cross contamination during wound care for 1 (Resident 7) of 3 sampled residents. The facility census was 83. Findings Are: A record review of facility policy Wound Care dated October 2010 revealed in the section Steps in the Procedure, staff were to use a disposable cloth to establish clean field on resident's overbed table and were to place all items to be used during procedure on the clean field. The policy stated staff were to wash and dry their hands after placing supplies on the overbed table, after removing the soiled dressing from the resident, and after the completion of performing the wound care. The policy also revealed staff were to wear sterile gloves when physically touching the wound or holding a moist surface over the wound. A record review of Resident 7's admission record revealed the resident was admitted to the facility on [DATE] and had 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 License Reference Number 175 NAC 12-006.19(A) Based on observations and interviews: the facility staff failed to ensure the facility dishwashing machine reached the required temperature to prevent to the potential for food borne illness. This had the potential to effect all residents who ate food from the kitchen. The facility staff identified a census of 75. Findings are: Observation on 08/01/24 at 10:00 AM of a Placard on the side of the [NAME] dishwasher indicated the minimum temperatures needed for the wash cycle was to 160 degrees Fahrenheit and the minimum for the rinse cycle was to be 180 degrees Fahrenheit. Observation on 8/01/2024 at 10:15 AM of the kitchen dishwasher revealed the wash cycle temperature was a 145 Degrees Fahrenheit (DF) and the rinse cycle was 163 DF. An interview was conducted on 8/01/2024 at 10:10 AM with Dietary Aide (DA) Q. During the interview DA-Q reported not knowing if the dishwasher was low or high temp and didn't know what temps needed to be reached to facilitate cleaning 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 Licensure Reference Number 175 NAC 12-006.04(A)(ii) Licensure Reference Number 175 NAC 1-005.06 (A)(D)(F) Based on record review and interview the facility failed to ensure that pre-employment health history screens were reviewed to prevent the potential for transmission of contagious disease for 5 of 5 staff; the facility failed to ensure multi-use equipment was sanitized between use and hand hygiene practices were followed between tray passes; and the facility failed to implement a facility water management plan for the prevention of waterborne illnesses. The facility census was 75. Findings are: A. Record review of the undated and untitled list of facility employees revealed that Medication Aide-E (MA-E) had a hire date of 5/9/24. Record review of the Employee Health Screening Post Conditional Offer dated 5/9/24 for MA-E revealed that it was signed by MA-E on 5/9/24. The line for the RN (Registered Nurse) Signature was blank. Interview on 8/1/24 at 8:56 AM with the facility Human Resources (HR) 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 License Reference Numbers 175 NAC 12-006.19, NAC 1-006.02 Based on record reviews, observations and interviews, the facility failed to provide a clean, home like environment and to ensure equipment and building fixtures were in good, working order. This had the potential to effect all of the residents residing in the facility. The facility stated census was 75. Findings are: In an observation on 07/29/2024 at 3:13 PM the following was observed in the hall of the 200 wing: -From room [ROOM NUMBER] to room [ROOM NUMBER] the base board trim was missing causing exposed unfinished flaking drywall from the floor up the wall approximately 4 inches spanning the length of the hall. -The trim was missing from the floor of the doorway of rooms [ROOM NUMBERS] with gray black buildup of substance visible in the crack that is present. -The tile floor of the 200 hall from room [ROOM NUMBER] to room [ROOM NUMBER] was visibly scuffed and stained with black gray marks to the floor and yellow brown buildup along the edges of 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 Licensure Reference Number 175 NAC 12-006.09(F)(i) Based on record review and interview the facility failed to ensure that a written summary of the baseline care plan (a written plan required to be developed within 48 hours of admission detailing the instructions needed to provide initial effective and person-centered quality care for a resident) was reviewed with the resident/resident representative and that the resident/resident representative was provided a copy of the written summary of the baseline care plan for 4 of 4 residents reviewed (Residents 22, 127, 23, and 13). This had the potential to prevent the resident/resident representative from identifying and communicating additional care required for the resident. The facility census was 75. Findings are: A. Record review of the facility policy titled Care Plans-Baseline dated March 2022 revealed that a baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within 48 hours of admission. The baseline…

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 Licensure Reference Number 175 NAC 12-006.09(H) Based on observation, record review, and interview the facility failed to ensure that staff performed blood glucose testing (determining the amount of blood sugar in your blood) in a manner consistent with current professional standards to prevent errors for 5 of 7 residents (Residents 47, 40, 48, 21, and 1). The facility census was 75. Findings are: A. Record review of the facility procedure titled Measuring A Blood Glucose Using A Handheld Glucometer (a medical device used to measure and display the amount of sugar in the blood for residents with diabetes) dated 7/11/24 revealed the steps included: wipe the site with an antiseptic wipe. Insert the test strip into the machine (glucometer). Perform a capillary puncture (a skin prick) using a lancet (a small sterile blade used to obtain a small amount of blood for testing). Discard lancet immediately in a sharp's container. Wipe away the first drop of blood. Touch the drop of blood to the reagent (test) strip,…

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 Licensure Reference Number 175 NAC 12-006.04(B)(ii)2 Based on observation, record review, and interview the facility failed to ensure that staff received training and assessments of competency for obtaining resident blood glucose (a measurement of the amount of blood sugar in your blood) and for use of the insulin pen (an injection device that allows you to deliver preloaded insulin-a medication used to reduce the amount of blood sugar in the blood of residents with diabetes) for 3 of 3 staff observed. This caused the residents to experience potential inaccurate blood sugar readings and incorrect insulin doses. The facility census was 75. Findings are: A. Record review of the Facility assessment dated [DATE] revealed the purpose is to determine what resources are necessary to care for residents competently. The section labeled Services and Care We Offer Based on our Resident's Needs revealed general care for medications with required specific Cares or Practices including administration of medications 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 Licensure Reference Number 175 NAC 12-006.10(D) Based on observation, record review, and interview the facility failed to maintain a medication error rate of less than 5% with an observed medication error rate of 16% (25 medications administered with 4 errors). The facility census was 75. Findings are: A. Record review of the undated facility Insulin Administration for Qualified Medication Aide (QMA) (a Medication Aide) Competency Checklist revealed that the QMA must perform the procedure with 100% accuracy for competency. The steps for preparing an insulin pen and administering insulin revealed the staff is to check the Medication Administration Record (MAR) for the insulin order. Remove the (insulin) pen cap. Wipe the pen tip with an alcohol wipe. Remove the protective seal from a new needle and screw the needle in place. Dial a dose of 2 units to prime the pen. Hold the pen with the needle pointing straight up and tap lightly so the bubbles will rise to the top. Press the injection button 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 Licensure Reference Number 175 NAC 12-006.05 (E) Based on interviews and record reviews, the facility failed to provide bathing preferences for 1 (Resident 27) of 1 sampled resident. The facility census was 75. Findings are: A. Record review of Resident 27's admission Record dated 07/29/2024 revealed that Resident 27 originally admitted to the facility on [DATE]. Record review of Resident 27's Minimum Data Set (MDS -a comprehensive assessment of each resident's functional capabilities used to develop a resident's plan of care) dated 05/27/2024 revealed a Brief Interview for Mental Status (BIMS-a test used to get a quick snapshot of a resident's cognitive function, scored from 0-15, the higher the score, the higher the cognitive function) of 15, which indicated the resident had no mental status impairment. An interview on 07/29/2024 at 11:15 AM with Resident 27 indicated the staff would not allow a bed bath as a choice. A review of Resident 27's Care Plan revealed no reference for choice about bathing…

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.

Licensure Reference Number 175 NAC 12-006.09(I)(i)(1) Based on observation, record review and interview the facility failed to investigate falls for causative factors and implement interventions by causative factors to prevent falls with injury for 1 Resident, (Resident #24) of 2 sampled residents. Facility stated census of 75. Findings are: Review of a facility policy titled Falls Management dated 05/2017 revealed the interdisciplinary team identifies and implements appropriate interventions to reduce the risk of falls or injuries while maximizing dignity and independence. A review of an admission Record dated 07/30/2024 revealed the facility admitted Resident #24 on 01/12/2024 with diagnoses that included Multiple Sclerosis (a disease of the central nervous system), generalized muscle weakness, seizure disorder (when nerve cells don't signal properly causing seizures), and dementia (an impaired ability to remember, think, or make decisions that interferes with doing everyday activities). Review of a facility supplied document titled with the facility name and Incidents by Incident…

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.

Licensure Reference Number 175 NAC 12-006.12(A)(vi) Based on record review and interview the facility failed to ensure a monthly medication review (MRR) (a monthly review of a resident's medications by a licensed pharmacist to minimize or prevent adverse consequences or to prevent residents from receiving unnecessary drugs) was performed for 1 resident (Resident 37) of 5 residents reviewed. This had the potential for significant medication irregularities to go unidentified. The facility census was 75. Findings are: Record review of the admission Record for Resident 37 dated 7/30/24 revealed that Resident 37 admitted into the facility on 5/14/20. Diagnoses included Diabetes, hypertension (high blood pressure), and major depressive disorder. Record review of the Care Plan dated 7/30/24 for Resident 37 revealed that Resident 37 is on diuretic therapy (treatment with medicines that help reduce fluid buildup in the body. They are sometimes called water pills). The Care Plan revealed that the diuretic therapy may cause dizziness, hypotension (low blood pressure), fatigue, and increased…

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.

Licensure Reference Number 175 NAC 12-006.09(H) Based on record review and interview the facility failed to ensure as needed antipsychotic medications were limited to 14 days of use and residents and or their representatives were informed of risks, benefits, purpose, and potential adverse consequences of antipsychotic medication use. This effected 1 of 2 sampled residents, Resident #24. Facility stated census of 75. Findings are: A review of a facility policy titled Antipsychotic Medication Use and dated 07/2022 revealed: -Residents and or resident representatives will be informed of the recommendation, risks, benefits, purpose, and potential adverse consequence of antipsychotic medication use. -As needed orders for antipsychotic medications will not be renewed beyond 14 days. The duration of the as needed order will be indicated in the order for the medication. A review of an admission Record dated 07/30/2024 revealed the facility admitted Resident #24 on 01/12/2024 with diagnoses of Multiple Sclerosis (a disease of the central nervous system), generalized muscle weakness, seizure…

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 Licensure Reference Number 175 NAC 12-006.10D Based on observation, record review, and interview the facility failed to ensure that staff provided the ordered dose of insulin (a medication used to reduce the amount of blood sugar in the blood of residents with diabetes) to residents to prevent significant medication errors for 3 of 4 residents observed (Residents 40, 48, and 16). The facility census was 75. Findings are: A. Record review of the undated facility Insulin Administration for Qualified Medication Aide (QMA) (a Medication Aide) Competency Checklist revealed that the QMA must perform the procedure with 100% accuracy for competency. The steps for preparing an insulin pen and administering insulin revealed the staff is to check the Medication Administration Record (MAR) for the insulin order. Remove the (insulin) pen cap. Wipe the pen tip with an alcohol wipe. Remove the protective seal from a new needle and screw the needle in place. Dial a dose of 2 units to prime the pen. Hold the pen with the needle…

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 Licensure Reference Number 175 NAC 12-009.04 Based on observation and interview the facility failed to maintain a pest free environment. This had the potential to effect all of the residents residing in the facility. The facility stated a census of 75. Findings are: Review of a facility policy labeled Maintenance Service dated 12/2009 revealed maintenance service shall be provided to all areas of the building, grounds, and equipment. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. In an observation on 07/29/2024 at 3:04 PM flying insects were observed to be gathering in the corner of a window located in the courtyard across the hall from room [ROOM NUMBER] and 122. A resident was observed to be sitting in their wheelchair in the gazebo in the courtyard area. A wasp nest was present to the upper right-hand corner of the window frame approximately the size of a soft ball with multiple wasps visibly crawling on the nest 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.

Licensure Reference Number 175 NAC 12-006.02 (8) Based on record review and interview; the facility failed to report to the State Agency (SA) a fall that resulted in an injury for one (Resident 4) resident within the required timeframes, and failed to thoroughly investigate allegations of residents' reporting missing funds for two (Resident 1 and Residnet 2) of three sampled residents. The facility identified a census of 87 residents at the time of the survey. Findings include: A. A record review of Resident 4's, admission Record with a printed date of 11/15/2023 revealed the resident had a diagnosis of unsteadiness on feet, generalized muscle weakness, and unspecified dementia, unspecified severity, without other behavioral disturbance. A record review of the facility's, Accidents/Unusual Occurrence report with a date of 9/20/2023 revealed Resident 4 had an unwitnessed fall that had occurred on 9/3/2023 at 3:00 PM. The report revealed at the time of the fall, Resident 4 had a Brief Interview Mental Status (BIMs- a tool utilized to evaluate a resident's cognitive status) score of 5…

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.

License Reference Number NAC 175 12-006.11E Based on observations, interviews, and record review, the facility staff failed to ensure the food services areas were maintained in a clean manor and in good repair, failed to utilize handwashing and gloving techniques during food preparation services to prevent the potential for food borne illness. This had the potential to affect 86 out of 87 residents who resided at the facility. The facility identified a census of 87 residents at the time of the survey. Findings are: Observations on the initial tour of the kitchen on 7/9/2023 at 1:54 PM revealed the following: A. -grease and dust buildup on the pipes and outlet connected to the stove (the pipes hover over the left, back burner. Dust was dangling down toward the stove top/burners from the outlet). -dust and grease buildup covering the white pipe/tubing that ran along the back wall/backsplash of the stove and double ovens. -build-up of grease and dust covering the white gas tank and its connections which were directly above a stainless-steel counter (to the right of the boiling AccuTemp…

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 LICENSURE REFERENCE NUMBER 175 NAC 12-006.16E Based on interview and record review, the facility staff failed to covey the resident's personal funds within 30 days of discharge. This affected 1(Resident 188) of 3 discharged financial record reviewed. The facility identified a census of 87 at the time of survey. Findings are: Record Review of the facility document Trust-Current Account Balance as of 7/12/23 by Posting Date revealed Resident 188 had money in the trust account of $1606.00 and no longer resided in the facility. The discharge date was verified on the MDS Discharge Tracking (Minimum Data Set-an assessment tool used to track a resident's discharge from the facility) records. Interview with Ombudsman on 7/12/23 at 9:07 AM revealed Resident 188 discharged [DATE] and did not have the Trust -Current Account Balance paid out. Interview with the ADM (Administrator) on 7/12/23 at 09:44 AM revealed Resident 188 was discharged to another facility; and no return was anticipated. Revealed monies should be paid 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 record review and interview, the facility failed to provide advance notifications of changes in coverage for Residents 3 and 11 on discharge from Medicare A services. This affected 2 of 3 residents sampled for Beneficiary Notification Review. The facility census was 87. Findings are: A. A review of the SNF (Skilled Nursing Facility) Beneficiary Protection Notification Review form provided by the facility for Resident 3 revealed that the resident's Last Covered Day for Medicare Part A services was 2-20-23. The facility initiated the discharge from Medicare part A services when benefit days were not exhausted. A further review of the form revealed the facility did not provide a SNF Advance Beneficiary Notice (SNF ABN-a form that lists the items or services that the facility expects Medicare will not pay for, along with an estimate of the costs for the items and services and the reasons why Medicare may not pay) or a Notice of Medicare Non-Coverage (NOMNC-a form that gives the last day that Medicare will cover costs and provides instructions for appealing that decision) 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.

Licensure Reference Number: 175NAC 12-006.06A Based on interview and record review, the facility staff failed to display the process for submitting grievances in the facility and educating the residents how to file grievances. This had the potential to affect all of the facility residents. The facility identified a census of 87 at the time of surrey. Findings are: An interview with Resident 60, on 7/12/23 at 10:04 AM revealed during the Resident (RC) meeting, the residents did not know the process for filing a grievance in the facility. Observation of the facility 7/10/23 during the survey revealed there was no information posted on how to file a grievance with the facility, or whom to talk with. Review of the RC meeting minutes for the past year from July 14th, 2022 thru June 8th,2023 revealed there was no documentation that the staff of the facility had educated the resident about the how to file a grievance with the facility. Record review of RC notes dated 7-12-2023 and 7-23-2023 revealed the RC expressed concerns about the facility ggrievance process. Interview with the SSD…

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.

Licensure Reference 175 NAC 12-006.09B1(2) Based on record review and interview, the facility failed to complete a Significant Change of Status Minimum Data Set (MDS-a comprehensive assessment of each resident's functional capabilities) for Resident 5 after admission to hospice services. This affected 1 of 1 resident sampled for hospice services. The facility census was 87. Findings are: A review of Resident 5's Progress Notes revealed that the resident was transferred to the hospital 4/9/23 and admitted for pneumonia. A Progress Note from 4/15/23 revealed the resident returned to the facility 4/15/23 on comfort cares/Hospice care. Hospice will be at the facility on 4/16/23 to admit the resident. A review of Resident 5's Hospice Medicaid Benefit Election Statement revealed an Effective Date of 4/16/23. A review of the list of MDS dates revealed no Significant Change in Status MDS opened within 14 days of Resident 5's admission to hospice services. An interview with the MDS Coordinator on 07/12/23 at 4:18 PM confirmed that a Significant Change of Status MDS should have been done…

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 Licensure Reference 175 NAC 12-006.09B Based on record reviews and interview, the facility failed to ensure the accuracy of the Minimum Data Set (MDS-a comprehensive assessment of each resident's functional capabilities) regarding a Pressure Injury for Resident 4, and a Pre-admission Screening and Resident Review [PASARR-a federal requirement to help ensure that residents are not inappropriately placed in nursing homes for long term care. Level II screening is triggered by evidence of a serious mental illness (MI), Intellectual or Developmental Disabilities (IDD) or condition related to IDD (RC) as defined by state or federal guidelines] for Resident 12. This affected 2 of 21 residents reviewed for MDS accuracy. The facility census was 87. Findings are: A. A review of Resident 4's admission Record revealed a current admission date of 5/31/07 and a diagnosis of a Stage III Pressure Injury to the sacral region (tailbone) with an onset of 9/22/22. A review of the resident's Progress Notes revealed a Nutrition Note…

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.

LICENSURE REFERENCE NUMBER 12-006.14 Based on observation, interview and record review: the facility failed to provide dental services for 1 (Resident 15) of 1 sampled resident. The facility staff identified a census of 87 at the time of the survey. Findings are: Record Review of Dietary Nutrition note dated 7/18/2022 revealed Resident 15 reported having difficulties chewing due to ill fitting dentures. On 7/11/23 at 9:55 AM an interview was conducted with Nursing Assistant (NA) U. During the interview NA U reported Resident 15 had been complaining of dentures not fitting correctly. On 7/11/23 at 10:43 AM an interview was conducted with Resident 15. During the interview Resident 15 reported Resident 15's dentures did not fit and needed to see dentist. On 7/12/23 at 8:30 AM observation of Resident 15 eating revealed Resident 15 was eating without dentures. Observation on 7/12/23 at 1:13 PM revealed Resident 15 putting dentures in. The dentures were loose with Resident 15 reporting the dentures rub on the gums and further the dentures did not fit to facility staff. Record 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.