Wapakoneta Manor

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, staff interview, and policy review, the facility failed to complete adequate wound assessments and failed to ensure pressure-reducing interventions were in place as ordered. This affected one (#11) of three residents reviewed for pressure ulcers. The facility census was 58. Findings include: Review of the medical record for Resident #11 revealed admission date of 04/24/24. The resident was admitted with diagnoses including congestive heart failure, type two diabetes mellitus, and depression. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition. Resident #11 required required moderate assistance for transfers, maximum assistance for bed mobility, was dependent for toileting hygiene, and required supervision for eating. Resident #11 was assessed at risk for pressure ulcers, but none were observed at the time of the assessment. Review of a progress note by Licensed Practical Nurse (LPN) #108 dated 05/23/24…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, staff interviews, and policy review, the facility failed to ensure Resident #210's catheter bag was covered to promote dignity. This affected one (Resident #210) of one residents reviewed for dignity. The facility census was 62. Findings include: Review of Resident #210's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including acute kidney failure and benign prostatic hyperplasia without lower urinary tract symptoms. Review of Resident #210's physician's orders revealed an order dated 05/13/24 to use privacy bag for catheter bag every shift. Observation on 05/13/24 at 9:50 A.M. revealed Resident #210's Foley catheter bag, with urine present, hanging on the bed side dresser visible from the hallway. There was no privacy bag present. Observation on 05/14/24 at 9:40 A.M. revealed Resident #210 resting in bed with the Foley catheter bag, with urine present, hanging on bedframe on the right side of bed without a Foley privacy bag,…

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 medical record review, staff interview, and review of facility policy, the facility failed to ensure resident comprehensive care plans had interventions for psychiatric disorders. This affected one (Resident #18) of two reviewed for care planning. The census was 62. Findings Include: Review of Resident #18's medical record revealed an admission date of 03/06/24. Diagnoses listed included Post-Traumatic Stress Disorder (PTSD), major depressive disorder, anxiety disorder, and type two diabetes mellitus. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #18 was cognitively intact with a diagnoses of PTSD. Interview with Resident #18 on 05/13/24 at 2:33 P.M. revealed she had not had a care conference since admission. Review of Resident #18's comprehensive care plan revealed PTSD was not listed and no interventions were in place. Interview with Corporate Registered Nurse (CRN) #361 on 05/14/24 at 3:50 P.M. confirmed a PTSD diagnosis and interventions were not listed on…

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 medical record review and staff interview, the facility failed to hold care conferences with residents. This affected (Residents #07 and #18) of two residents reviewed for care conferences. Additionally, the facility also failed to implement fall interventions and update the care plan after falls. This affected one (Resident #209) of three reviewed for falls care planning. The census was 62. Findings Include: 1. Review of Resident #07's medical record revealed an admission date of 06/04/23. Diagnoses listed included type II diabetes mellitus, congestive heart failure, skin cancer, obesity, major depressive disorder, and stage four pressure ulcer of left heel. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #07 had a stage four pressure ulcer, lower extremity impairment to both sides, and was cognitively intact. Interview with Resident #07 on 05/14/24 at 8:28 A.M. revealed he had not had any recent care conferences. Further review of Resident #07's medical record revealed 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 Based on review of contract with dialysis center, review of facility policy, observation of care, interview with resident, and interview with staff, the facility failed to ensure Enhanced Barrier Precautions (EBP) were implemented. This affected two (Residents #51 and #52) of three residents reviewed for EBP. The current census is 62. Findings include: 1. Review of the medical record for Resident #52 revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #52 included peritonitis, diabetes type two, chronic kidney disease, dependence on peritoneal dialysis, and hypotension. Review of the Minimum Data Set (MDS) comprehensive assessment dated [DATE] revealed the resident had no brief interview for mental status coded as no interview due to resident never understood. Per the assessment the resident was receiving peritoneal dialysis. Review of Resident #52's care plan dated 01/20/24 revealed a focus for receiving Peritoneal (PD) dialysis services through Fresenius. Interventions included…

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 resident record review and staff interview; the facility failed to ensure minimum data set (MDS) assessments were accurate. This affected four (#18, #22, #41, and #45) of 14 residents reviewed for accuracy of the MDS assessment. The census was 44. Findings include: 1. Review of the medical record of Resident #18 revealed an admission date of 12/22/20. Diagnoses include lumbosacral spinal stenosis, anxiety disorder and unspecified visual disturbance. Review of the quarterly MDS assessments dated 06/10/22 and 07/15/22 revealed no brief interview of mental status (BIMS) nor mood assessment being completed as required. Interview on 09/01/22 at 8:57 A.M. with Director of Clinical Support #174 provided verification of the MDS assessment incompleteness. 2. Review of Medical Record for Resident #22 admitted [DATE] with diagnoses that included, but are not limited to, depression, chronic pain, spinal stenosis, mild cognitive impairment, delusional disorders, anxiety, and brief psychotic disorder. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observations and staff interview, the facility failed to maintain a safe environment when medications were left unattended by staff. This directly affected one resident (#31) and had the possibility to affect seven residents (#2, #3, #13, #34, #36, #39, and #43) identified by the facility as being independently mobile and cognitively impaired, residing in the D hall. The facility census was 44. Findings include: Review of the medical record of Resident #31 revealed an admission date of 11/22/20. Diagnoses include atherosclerotic heart disease of native coronary artery with other forms of angina pectoris, chronic atrial fibrillation, hypertensive heart disease with heart failure, acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity, presence of cardiac pacemaker, history of alcohol dependence, uninhibited neuropathic bladder, gastro-esophageal reflux disease, benign prostatic hyperplasia with lower urinary tract symptoms, feeling of incomplete…

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, resident interview, and staff interview, the facility failed to serve meals in the dining room due to staffing issues. This potentially affected 40 residents (with exception of Residents #3, #13, #18, and #40 who preferred to eat in their rooms) who receive meals from the kitchen. The census was 44. Findings include: Observation of dining on 08/29/22 at 7:30 A.M. revealed no residents were eating in the dining room. Interview on 08/29/22 at 7:30 A.M. with State Tested Nursing Assistant/Medical Records (STNA #134) who was working as a cook stated all meal trays were being served on the nursing floors. STNA #134 stated that no residents were eating in the dining room due to being short staffed. Interview on 08/29/22 at 3:46 P.M. with Administrator stated they were not sure why residents were not eating in the dining room. Administrator stated they would find out what the protocol for the facility was. Interview on 08/31/22 at 11:24 A.M. with Dietary Aide #139 stated they were told that there was not enough staff to assist residents with eating in the dining room.…

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 interview, and record review the facility failed to ensure treatments were completed as ordered. This affected one (Resident #41) of two residents reviewed for wounds. The census was 44. Findings include: Review of Medical Record for Resident #41 admitted [DATE] with diagnoses that included, but not limited to, pressure ulcer stage four (deep wound that reaches the muscles, ligaments, or bone) in sacral region, noncompliance with other medical treatment and regimen, type two diabetes, morbid obesity, depression, insomnia, and renal dialysis. Review of Minimum Data Set (MDS) dated [DATE] for Resident #41 revealed resident is cognitively intact. Resident #41 required extensive assist of two for Activities of Daily Living (ADL's) and had a catheter and colostomy. MDS indicated Resident #41 did not have any unhealed pressure ulcers. Review of pharmacy delivery sheet revealed Acetic Acid 0.25 percent (%) solution (1000 milliliters) was delivered on 07/09/22, 07/23/22, 08/02/22, and 08/23/22. 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.

Based on observation, staff interview, and review of the facility policy, the facility failed to ensure opened food was dated when placed into storage. This had the potential to affect 80 resident who received food from the facility kitchen. The facility identified one resident (#19) who received no food from the kitchen. The facility census was 81. Findings include: Observation of the facility kitchen on 09/09/19 starting at 8:45 A.M. revealed the walk in refrigerator to have a bag of shredded lettuce and an open bag of parmesan cheese which were undated. The dry food storage had a bag of vanilla wafers and bag of cheese curls which were opened and undated. The reach in refrigerator had five bowls of lettuce covered with plastic wrap without dates. Interviews at the time of the observations with Staff Member #400 verified opened and undated foods observed during the kitchen tour. Review of the undated facility policy titled Storage of Perishable Foods revealed prepared or left-over foods should be stored tightly covers, clearly dated and used within three days or discarded.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of medication administration record, staff interview, and review of the facility policy, the facility failed to ensure medications were stored in a safe manner. This affected three residents (#10, #44, and #55) and had the potential to effect 11 residents (#5, #11, #23, #27, #29, #31, #32, #62, #67, #68 and #73), residing in the A and D Halls, who were independently mobile and confused. The facility census was 81. Findings include. Observation on 09/09/19 at 9:16 A.M. revealed Housekeeper #415 approached Registered Nurse (RN) #420 and handed her a white tablet, stating I found this on the floor in Resident #55's room. Interview on 09/09/19 at 9:20 A.M. with RN #420 revealed the tablet was bumetanide, a diuretic, 1 milligram. Review of the 09/19 medication administration record of Resident #55, with RN #420, revealed the bumetanide was administered at supper on 09/08/19 and upon rising on 09/09/19. Observation on 09/09/19 at 12:26 P.M. of Resident #10 and Resident #44's room, room…

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, staff interview, family interview, resident interview, medical record review, and facility policy review, the facility failed to have supporting documentation for the medical necessity for an indwelling urinary catheter for one (#181) of one resident reviewed for urinary catheters. The facility identified three residents with indwelling urinary catheters. The facility census was 81. Findings include: Review of the medical record of Resident #181 revealed an admission date of 08/28/19. Diagnoses included intrahepatic bile duct carcinoma, obstruction of bile duct and atherosclerotic heart disease. Review of the hospital discharge paperwork revealed Resident #181's daughter would like the urinary catheter to be placed for comfort reasons. Review of the physician orders for September 2019 contained no order for a urinary catheter. The record was silent for documentation on a valid diagnosis for a urinary catheter. Observation on 09/09/19 at 10:00 A.M. revealed Resident #181 with a urinary catheter hanging on the foot of the bed, in a privacy bag. Interview on…

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.