SRMC Long Term Care, LLC dba Pole Creek Estates

Licensure Reference Number 175 NAC 12-006.18(B)Licensure Reference Number 175 NAC 12-006.18(D) Based on record reviews, observations, and interviews; the facility failed to ensure staff followed proper glove use practices by changing gloves when contaminated or between tasks in accordance with facility policy and Center for Disease Control (CDC) guidelines during meal service to prevent the potential for cross-contamination. This had the potential to affect all 15 residents who reside within the Memory Care Unit (MCU). The facility identified a census of 60.Findings are: A review of the facility policy titled Hand Hygiene last revised 4/21/2025 revealed staff are required to perform hand hygiene after each resident contact, before and after glove use, and that glove use does not replace hand hygiene. A CDC guideline titled Clinical Safety: Hand Hygiene for Healthcare Workers dated 2/27/2024 revealed gloves are to be changed between tasks and after contact with potentially contaminated surfaces or residents. A continuous observation on 7/16/2025 from 11:55 AM through 12:20 PM…

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 record review, observation, and interview, the facility failed to identify and address potential adverse side effects of psychotropic (drug that affects brain activities associated with mental processes and behavior) medications for 1 (Resident 7) of 5 sampled residents. The facility identified a census of 60.Findings are: A record review of the facility's policy Psychotropic Drug Use with a last revised date of 4/21/2025 revealed the effects of psychotropic medications on a resident's physical, mental, and psychosocial well-being will be evaluated on an ongoing basis upon physician evaluation routinely and as needed, during the pharmacist's monthly medication regimen review, during Minimum Data Set (MDS, a federally mandated comprehensive assessment tool used to determine a resident's functional capabilities and helps nursing home staff identify health problems) quarterly, annually, and with any significant change, and in accordance with nursing…

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(C)(ii) Based on record reviews and interviews, the facility failed to complete a Significant Change in Status Assessment (SCSA) Minimum Data Set (MDS, a federally mandated assessment tool used to determine a resident's functional capabilities and helps nursing home staff identify health problems) within 14 days of determining there had been a significant change (major decline in a resident's status that will usually not resolve) in the condition for 1 (Resident 7) of 1 sample resident. The facility identified a census of 60.Findings are: A record review of the facility's policy Resident Assessment last revised 6/17/2025, revealed the MDS Coordinator would be responsible for ensuring a comprehensive resident assessment was completed within 14 days of the facility determining there had been a significant change in the resident's status in accordance with the Resident Assessment Instruction (RAI) guidelines. A record review of the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual (RAI Manual, a document published 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 Licensure Reference Number 175 NAC 12-006.09(H)(v)Based on record review, observation, and interview, the facility failed to provide care, treatment, and ensure services were obtained for a hand contracture (a condition where the fingers bend towards the palm and cannot be straightened due to tightened tissues in the hand) for 1 (Resident 40) of 2 sampled residents. The facility identified a census of 60. Findings are: A record review of [NAME] Healthcare's Contracture Management dated 11/1/2014, revealed limited mobility and the need for supportive therapies should be evaluated for on admission and at least quarterly. Treatment considerations were as follows:- Frequent, simple stretching, noting that even a few degrees of movement can help.- Consider positioning devices for long-term use such as splints. Positioning devices can ensure prolonged contracture management and limit further tone development.- Educate all staff and encourage to provide daily range of motion (ROM) stretching outside of therapy…

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)(vi) and 175 NAC 12-006.14Based on record review, observation, and interview, the facility failed to provide assistance with eating and administration of medications that was consistent with the needs of an individual with a diagnosis of dementia for (a progressive disorder that primarily affects cognition, memory, and behaviors that includes agitation) 1 (Resident 40) of 4 sampled residents. The facility identified a census of 60.Findings are: A record review of the facility's undated policy, Dementia Care revealed the purpose of the policy was to provide appropriate treatment and services to those with dementia to meet their highest practicable well-being. This goal would be met by developing a care plan for the resident that was individualized to their symptoms and implementing interventions that were effective in enhancing the resident's well-being. A record review of Resident 40's Problem List (as of 7/16/2025) revealed Resident 40 had a diagnosis of severe Alzheimer's dementia with agitation. A record review of Resident 40's Care…

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 12-006.11E Based on observations, interviews, and record review; the facility failed to a) ensure food products were disposed of prior to expiration dates, b) utilize handwashing as required to prevent potential food contamination during food preparation, and c) ensure food temperatures were maintained at least 135 degrees on the steam table as required during serving of meals. This had the potential to affect all residents who resided at the facility. The facility census was 43. Findings are: A. A record review of the facility policy General Requirements Food Supply with a last reviewed date of 2/6/2023 revealed food was to be stored in accordance with professional standards for food service safety. An initial observation 5/21/2024 at 8:55 AM of the kitchen's reach-in refrigerator revealed an opened container of Heavy Whipped Cream with an expiration date of 5/16/2024 and two opened containers of Hiland's Cottage Cheese with expiration dates of 5/19/2024. An interview on 5/21/2024 at 9:10 AM with the Certified Dietary Manager (CDM) confirmed the container 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.

Licensure Reference Number 175 NAC 12-006.17D Based on observations, interviews, and record review the facility failed to implement hand hygiene as required while passing water pitchers to resident rooms, during medication administration, and during dining room services. This had the potential to affect all residents who resided within the facility. The facility census was 43. The Findings Are: A. An observation on 5/23/24 at 10:55 AM revealed Domestic Aide (DA)-H collecting old water pitchers and passing out new water pitchers to resident rooms. DA-H went into Resident 31's room and carried a water pitcher out of the room, sat it on the lower shelf of a rolling cart, and wrote down the total amount drank on a piece of paper. DA-H then carried a new water pitcher that had been setting on the top shelf of the rolling cart into Resident 18's room, came back out of the room with a different water pitcher, sat the pitcher on the lower shelf of the rolling cart and wrote the total amount drank on the paper. DA-H performed hand hygiene (HH) via Alcohol Based Hand Rub (ABHR). DA-H then…

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 12-006.09C Based on observations, record reviews and interviews the facility failed to develop and implement a comprehensive care plan for 2 (Residents 29, and 30) of 12 sampled residents. The facility census was 43. The Findings Are: A. A record review of facility policy Care Plan dated 5/15/24 revealed that the comprehensive care plan would describe the services that were being furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. The policy also revealed the comprehensive care plan would describe care provided related to high-risk medications including, but not limited to psychotropics, anticoagulants, and antibiotics. The policy also revealed that care plans were to be updated with acute conditions or any unexplained change in the resident's condition (i.e., weight change, new diagnosis, change in pain), and with medication changes such as antibiotics, diuretics, and/or psychotropic or medications prescribed for sleep psychotropic benefit. A record review of Resident 29's diagnosis…

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 observation, interviews, and record review the facility failed to provide ongoing care and services to address 1 (Resident 42) of 1 sampled resident's lower extremity edema (swelling). The facility census was 43. Findings Are: A record review of Resident 42's Minimum Data Set (MDS), a federally mandated comprehensive assessment tool used for care planning, dated 3/4/2024 revealed in Section C a Brief Interview for Mental Status (BIMS) score of 2/15, which indicated the resident had severe cognitive impairment. Section I revealed the resident had a diagnosis of non-Alzheimer's dementia, and Section K revealed the resident had not had any significant weight changes in the prior 6 months. An observation on 5/21/24 at 12:23 PM revealed Resident 42 sitting in a chair in the dining room with their lower legs visible. Resident 42 had edema to both of their lower legs and was wearing TED Hose (compression stockings) on both legs. The TED Hose on the resident's right leg was rolled down, causing a moderate indentation approximately 3…

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 interviews and record reviews, the facility failed to ensure residents were free from unnecessary antibiotic use for 2 (Resident 1 and 29) of 3 sampled residents. The facility census was 43. Findings are: A. A record review of Center for Disease Control's (CDC) document The Core Elements of Antibiotic Stewardship for Nursing Homes APPENDIX A: Policy and Practice Actions to Improve Antibiotic Use revealed Surveys of antibiotic use have shown that (Urinary Tract Infection) UTI prophylaxis accounts for a significant proportion of antibiotic prescriptions. Very few studies support antibiotic use for UTI prophylaxis, especially in older adults, and many studies have shown this antibiotic exposure increases risk of side effects and resistant organisms. Therefore, efforts to educate providers on the potential harm of antibiotics for UTI prophylaxis could reduce unnecessary antibiotic exposure and improve resident outcomes. A record review of a Resident Master Information indicated the facility admitted Resident 1 on 7/1/2019. A record review of Resident 1's quarterly Minimum Data…

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 12-006.10D Based on observations, interviews, and record reviews; the facility failed to administer medications at the right time for 2 (Resident 6 and 33) out of 9 sampled residents and ensure the medication error rate was less than 5%. There were 25 medication opportunities observed and there were 2 errors, this resulted in a medication errors rate of 8%. The facility census was 43. Findings are: A record review of the facility's Medication Administration policy with a last reviewed date of 2/15/2024 revealed to note directions in the comment section of the medication on the medication administration record during the first check. An observation on 5/23/2024 at 7:54 AM revealed Medication Aide (MA) - E had administered levothyroxine to Resident 33. Resident 33 had been in the dining room eating breakfast at the time of administration. A record review of Resident 33's levothyroxine order revealed administration instructions of administer at least 30 minutes before food. An observation on 5/23/2024 at 8:00 AM revealed MA-E had administered levothyroxine…

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 12-006.09D Based on observation, interview, and record review, the facility failed to obtain a supporting diagnosis for the use of an antipsychotic medication (a medication utilized in the control of hallucinations, delusions, and disordered thinking) for one current sampled resident (Resident #33) out of 12 sampled Residents. The facility census was 44. Findings are: Record review of the Resident Master Information form for Resident #33 revealed the resident was admitted on [DATE]. A review of the Problem list for Resident #33 revealed the resident had no qualifying diagnosis or identified problem that is listed as an approved treatment for Abilify (an antipsychotic medication). The problem list for Resident #33 revealed the following diagnoses; diabetes; hypertension; hypothyroidism; diabetic peripheral neuropathy; hyperlipidemia; glaucoma; osteoarthritis; atherosclerosis of both carotid arteries; falls; blind R eye; lung nodule; edema of leg; vasomotor rhinitis; humeral head…

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.