Wisner Care Center

Licensure Reference Number 175 NAC 12-006.18 Based on observations, interview and record review; the facility failed to implement enhanced barrier precautions for Resident 15. The sample size was 15 with a census of 33. A. Review of the facility policy Enhanced Barrier Precautions implemented on 5/17/24 revealed the following: -Enhanced Barrier Precautions (EBP) refers to an infection control intervention designed to reduce transmission of Multi-Drug-Resistant Organisms (MDRO) that utilizes gown and glove use during high contact resident care activities, -an order for EBP would be obtained for residents with wounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO, or had an infection or colonization with a Centers for Disease Control (CDC)-targeted MDRO, -Personal Protective Equipment (PPE) for EBP was only necessary when performing high-contact care activities, -the infection preventionist would incorporate periodic monitoring and assessment of adherence to determine the need for additional training, -High-contact resident…

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 observation, record review, and interview, the facility failed to: 1) complete hand hygiene and change gloves to prevent possible cross contamination during the provision of incontinence cares for Resident 14; 2) ensure Transmission Based Precautions (TBP-additional control measures used to prevent the transmission of colonized infectious agents) were implemented for Resident 23; and 3) implement measures to prevent the growth of Legionella (severe type of pneumonia/lung infection caused by bacteria which can be found in water) and/or waterborne pathogens in the facility. The facility census was 25. Findings are: A. Review of the facility policy Hand Washing with a reviewed date of 2/1/23 revealed hand washing and sanitizing were the most important means of preventing infections. Hand washing was to be completed: -whenever hands were visibly soiled, -after touching inanimate sources that are likely to be contaminated, -after prolonged contact with a resident, -after contact with mucous membranes, blood, body fluids, excretions,…

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 an allegation of potential staff to resident abuse for 1 (Resident 11) of 1 sampled resident to the required state agency. The facility census was 25. Findings are: A. Review of the facility Abuse, Neglect or Misappropriation of Property policy (reviewed 3/18/21) revealed the facility was to ensure all alleged violations involving mistreatment, neglect or abuse and misappropriation of resident property were reported immediately to the Administrator/Director of Nursing (DON) and to other officials in accordance with State Law. The following procedure was identified for suspected staff to resident abuse or neglect: -staff to immediately intervene and take steps to protect the resident. -allegation to be reported to the state survey agency within 2 hours if serious bodily injury/abuse or within 24 hours for all other cases. -employee suspected of abuse was to be immediately reassigned or suspended until findings of the allegation had been reviewed. -investigate 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 12-006.09C Based on record review and interview, the facility failed to develop comprehensive care plans to reflect the current status for 2 of 16 sampled residents (Resident 13's antipsychotic medication [a type of psychoactive medication which alters chemicals in the brain to affect changes in behavior, mood, and emotion] and Resident 16's self-administration of medication. The facility census was 25. Findings are: A. Review of Resident 13's Minimum Data Set [MDS- a federally mandated comprehensive assessment tool used to develop resident care plans] dated 12/30/23 revealed diagnoses of: cancer, stroke, Urinary Tract Infection (UTI) last 30 days, left sided weakness, Post Traumatic Stress Disorder (PTSD), dementia and depression. The assessment further indicated the resident was taking antipsychotic, anti-anxiety, and antidepressant medications. Review of Resident 13's Care Plan with a printed date of 2/8/24 revealed the resident was taking an antipsychotic (Seroquel), 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.

Licensure Reference Number 175 NAC 12-006.10A2 Based on observation, record review and interview; the facility failed to ensure 1 (Resident 5) of 1 sampled resident's insulin was prepared and administered according to standards of practice. The facility census was 25. Findings are: During an observation on 2/12/24 at 7:20 AM, Licensed Practical Nurse (LPN-M) removed an insulin pen from the medication cart, removed the cap from the insulin pen, wiped the rubber seal with an alcohol wipe and screwed a needle cap onto the pen. LPN-M then turned the dial on the pen to the ordered dose of 60 units of Basaglar Kwikpen Insulin. LPN-M applied gloves to both hands, cleansed Resident 5's site of injection and administered the insulin. LPN-M then returned to the medication cart and disposed of the needle, removed gloves, sanitized hands and documented the insulin administration in the resident's Medication Administration Record (MAR). Record review of the facility policy Insulin Administration dated 10/2017 revealed the purpose of the policy was to provide guidelines for the safe…

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 12-006.09D3(1) Based on observation, record review and interview; the facility failed to provide care and services according to standards of practice, for the prevention of urinary tract infections for 1 (Resident 13) of 1 sampled resident who had an indwelling urinary catheter [a flexible plastic tube inserted into the bladder that remains in place to provide continuous urinary drainage]. The facility census was 25. Findings are: Review of the facility Policy Catheter Care, Urinary dated 11/12/23 revealed the purpose of the policy was to prevent catheter-associated urinary tract infections. The procedure included the following: 1. Place clean equipment/supplies so they can be reached easily. 2. Wash and dry your hands thoroughly. 3. Have a package of wipes within easy reach. 4. Position the resident on his/her back. 5. Put gloves on. 6. Place a bed protector under the resident. 7. Wash the resident's genitalia and perineum [area located between the genitals and anus] thoroughly with wipes. 8. Dispose of soiled wipes into trash receptacle. 9.…

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 to ensure residents received trauma informed care related to diagnosis of Post Traumatic Stress Disorder (PTSD) and to identify potential triggers as well as resident preferences to prevent and/or mitigate re-traumatization for 1 (Resident 17) of 2 sampled residents. The facility census was 25. Findings include: A. Review of the facility policy Trauma Informed Care with an implemented date of 5/9/23 revealed it was the policy of the facility to provide care and services which met professional standards using culturally competent approaches which accounted for experiences and preferences. The facility was to use a multi-pronged approach to identify a resident's history of trauma and cultural preferences. This was to include asking the resident about potential triggers or stressors regarding a previous traumatic event. These approaches were to be used to address the needs of a trauma survivor and to minimize potential triggers and/or re-traumatization. The following guidelines were identified: - ensuring residents have a sense 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 12-006.09D Based on record review and interview; the facility failed to have indications for continued use of an antibiotic medication for 1 (Resident 14) of 6 sampled residents. The facility staff identified a census of 25. Findings are: Record review of the facility policy Antibiotic Stewardship Program with a reviewed date of 9/26/22 revealed the following: -The goal of the Antibiotic Stewardship Program (ASP) was to promote the appropriate use of antibiotics, to maximize treatment outcomes and minimize unintended consequences of antibiotic therapy. The ASP aimed to improve antibiotic prescribing practices through the development and implementation of antibiotic use protocols and a system to monitor antibiotic use. -The antibiotic Stewardship Committee had been established to provide support and oversee activities of the Antibiotic Stewardship Plan. The committee and the ASP would be part of the Infection Prevention and Control Program, and outcomes would be reported to the Quality Assurance Performance Improvement (QAPI) committee, and in turn…

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 12-006.09D Based on record review and interview, the facility failed to ensure psychotropic medications [a type of psychoactive medication which alters chemicals in the brain to affect changes in behavior, mood, and emotion] had the required diagnosis or documentation of specific behaviors for 1 (Resident 13) of 5 sampled residents. The facility census was 25. Findings are: Review of the facility's Psychotropic Drug Policy last reviewed 9/1/22 revealed antipsychotic medication therapy shall be used only when necessary to treat a specific condition. Psychoactive drugs are prescribed to control and improve mood, mental status and/or behaviors. These medications fall into the following categories: -Anti-anxiety and hypnotic drugs are used for relief of anxiety and to treat insomnia. -Antipsychotics are used to treat mental illness such as schizophrenia, psychotic depression and manic disorders. -Anti-depressant drugs. Targeted behaviors will be monitored weekly with resident reviews and with care plan meetings on residents who are receiving…

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 12-006.10A4 Based on record review and interview; the facility failed to ensure medications were safely administered and secured according to standards of practice for 1 (Resident 16) of 11 sampled residents. The facility census was 25. Findings are: Record review of the facility policy Medication Administration dated 12/13/24 revealed, the administration of medications to residents would be completed by a licensed healthcare professional and the nurse administering the medication shall stay with the resident until the medication is administered, unless otherwise care planned. A resident may self-administer a medication per self-administration of medication. Ability to self-administer a medication must be assessed and documented in the resident Electronic Medical Record (EMR) and care planned. Medications left in the resident's room must be secured in a red medication box for the resident's personal use. Self-administered medications must be monitored by the charge nurse 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.

Licensure Reference Number: 175 NAC 12-006.06 Based on interviews and record reviews; the facility failed to address and to resolve Resident Council concerns regarding call light response times and grievances by Resident 23 regarding the provision of baths. The total sample size was 18 and the census was 30. Findings are: A. Review of the facility policy Grievances/Complaints with a revision date of 10/27/19 revealed it was the policy of the facility to investigate all grievances and complaints reported to the facility and to come to a resolution with all involved parties. The following procedures were identified: -residents were to be notified of their rights to voice a grievance to the facility upon admission and at least monthly in Resident Council; -the person filing the grievance or complaint was to receive a written or verbal notification regarding the steps taken to resolve the grievance from the appropriate department head in a timely manner; -the person filing the grievance will be asked if they agree with the action taken and if they feel the issue is resolved. If they do…

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 12-006.09D1c Based on record review and interview; the facility failed to provide bathing assistance for 2 residents (Residents 23 and 24) who required assistance with activities of daily living. The facility census was 30 and the sample size was 18. Findings are: A. Review of Resident 23's current Care Plan dated 7/26/2022 revealed the resident required assistance with activities of daily living related to pain, weakness, recent weight loss and a diagnosis of Leukemia in remission. In addition, the resident was at risk for impaired skin integrity and required assistance with bathing 1-2 times a week. Review of Resident 23's medical record revealed the resident had not received a bath for more than 7 days between the following dates: -10/4/22 and 10/12/22, a total of 8 days; -10/28/22 and 11/10/22, a total of 13 days; -11/10/22 and 11/18/22, a total of 8 days; -11/23/22 and 12/1/22, a total of 8 days; and -12/20/22 and 12/29/22, a total of 9 days. During an interview with Registered Nurse (RN)-B on 12/29/22 at 11:25 a.m., RN-B confirmed residents…

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 12-006.09D7 Based on observations, record review and interviews; the facility failed to implement interventions and to revise and/or develop new interventions to prevent ongoing falls for Resident 24. The facility census was 30 and the sample size was 5. Findings are: A. Review of the facility Resident Fall policy with revision date 1/16/21 revealed all falls were to be documented on an Incident Report. Staff were to investigate the fall for probable cause and an immediate intervention was to be put into place to prevent a re-occurrence. B. Review of Resident 24's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 12/1/22 revealed diagnoses of anxiety, depression, Alzheimer's dementia, obsessive-compulsive disorder and cancer. The MDS identified the following regarding Resident 24: -moderately impaired cognition; -required extensive staff assistance with transfers, bed mobility, dressing and toilet use; -incontinent of bowel and bladder; and -frequent incidence of falling since the previous…

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 12-005.09D8b Based on interview and record review; the facility failed to provide/implement interventions to prevent ongoing weight loss for 1 (Resident 17) of 2 sampled residents. The facility census was 30. Findings are: Review of Resident 30's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 10/20/22 revealed diagnosis of ulcerative colitis, Crohn' disease, dementia, anxiety and depression. The assessment indicated the resident's cognitive was severely impaired, the resident had behaviors which included delusions and wandering, was independent with eating and drinking and had a weight of 137 pounds (lbs.). The resident was identified as having a weight loss of 5 percent (%) in 1 month or a loss of 10% or more in the last 6 months and was not on a physician prescribed weight loss regimen. Review of a report of the resident's weights revealed the following: -weight on 6/7/22 was 143 lbs. -weight on 7/7/22 was 136 lbs. (down 7 lbs. or a 5% loss 1 month). Review of the resident's current 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.