Ada Care Center

Based on observation, record review, and interview, the facility failed to ensure adequate safety for smokers for two (#2 and #43) of two residents sampled for smoking safety. The administrator identified 20 residents who smoked. Findings: An undated Smoking Policy, read in parts, Purpose: to provide maximum safety to all residents at all times .Smoking will be allowed in smoking areas ONLY .Any restrictions will be noted in the resident's record .Smoking privileges will be addressed in the Care Plan .Smoking materials will be kept in a designated area accessible only by staff .Residents assessed as likely to drop ashes on their clothing or self will wear a smoking apron provided by the Center. 1. Resident #43 had diagnoses which included diabetes, seasonal allergies, anxiety, and chronic pain. A Smoking Assessment, dated 11/22/24, documented Resident #43 could smoke independently and the facility did not need to store their lighter and cigarettes. An MDS assessment for Resident #43, dated 11/23/24, documented the resident was cognitively intact. A Care Plan for Resident #43, dated…

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

Based on observation, record review, and interview, the facility failed to ensure food was completely covered while being served. The administrator reported 57 residents received meals from the kitchen. Findings: A Preventing Foodborne Illness-Food Handling policy, dated July 2014, read in part, Food will be stored, prepared, handled and served so that the risk of foodborne illness is minimized. On 02/02/25 at 11:40 a.m., residents were observed during the noon meal. Dessert was observed to be served on a saucer with a plastic lid sitting on top of the dessert. The plastic lid did not completely cover the cake being served for dessert. On 02/03/25 at 8:17 a.m., cook #2 was asked about serving the desserts on an uncovered saucer the previous day. The cook stated they were out of bowls and the plastic wrap was not the proper size. On 02/03/25 at 8:19 a.m., the dietary manager was asked about the cake that was served uncovered the previous day. They stated the administrator had ordered some dessert dishes and they were waiting on them to come in.

Based on observation, record review, and interview, the facility failed to: a. ensure proper disposal of the lancet and blood contaminated glucometer strip for one (#105) of two sampled residents reviewed for blood glucose monitoring; b. to properly dispose of soiled PPE supplies for two (#2 and #204); and c. failed to use proper PPE for enhanced barrier precautions for one (#2) of five sampled residents reviewed for infection control. The administrator reported 59 residents resided in the facility. The DON reported 12 residents with blood glucose monitoring. Findings: A Obtaining a Fingerstick Glucose level policy, dated October 2011, read in part, Dispose of lancet in the sharps disposal container, Discard disposable supplies in the designated containers. A Enhanced Barrier Precautions policy, dated 04/01/24, read in part, EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities. Position a trash can inside the resident room and near the exit for discarding PPE after removal, prior to…

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

Based on observation, record review, and interview, the facility failed to revise care plans related to smoking interventions for two (#2 and #43) of two residents sampled for smoking safety. The administrator identified 20 residents who smoked. Findings: An undated Smoking Policy, read in parts, Purpose: to provide maximum safety to all residents at all times .Smoking will be allowed in smoking areas ONLY .Any restrictions will be noted in the resident's record .Smoking privileges will be addressed in the Care Plan .Smoking materials will be kept in a designated area accessible only by staff .Residents assessed as likely to drop ashes on their clothing or self will wear a smoking apron provided by the Center. A Care Plans, Comprehensive Person-Centered policy, dated March 2022, read in parts, The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment .Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. 1. Resident #43 had…

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 ensure an as needed (PRN) medication for anxiety had a documented rational for continued use beyond 14 days for one (#11) of five residents sampled for unnecessary medications. The DON reported 14 residents received anti-anxiety medications. Findings: A Psychotropic Medication Use policy, dated July 2022, read in part, Psychotropic medications are not prescribed or given on a PRN basis unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record. a. PRN orders for psychotropic medications are limited to 14 days. (1) For psychotropic medications that are NOT antipsychotic's: If the prescriber or attending physician believes it is appropriate to extend the PRN order beyond 14 days, [they] will document the rational for extending the use and include the duration for the PRN order. Resident #11 had diagnoses which included heart failure, hypertension, and anxiety/depression. A care plan, dated 03/18/22, documented the resident received anti-anxiety medications r/t…

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 have a registered nurse on duty eight hours a day and/or seven days a week. The administrator reported 55 residents resided in the facility. Findings: A Oklahoma Health Care Authority Report documented three days on the weekends in August 2023, five days on the weekends in September 2023, and two days on the weekends in October 2023 had less than the required staff per resident ratio. The nursing schedules from August 2023 through October 2023 were reviewed and revealed the facility failed to have consistent RN coverage for the weekends. The facility failed to have RN Coverage: Five of eight opportunities in August 2023 Eight of nine opportunities in September 2023 Four out of seven opportunities in October 2023. On 11/16/23 at 10:49 a.m., the administrator and DON both reported the facility had one RN who worked one weekend a month. On 11/27/23 at 2:43 p.m., the DON reviewed the schedules and stated there had not been an RN who had worked on all the weekend shifts.

Based on observation, record review, and interview, the facility failed to ensure proper storage of dry goods. The administrator reported 55 residents received services from the kitchen. Findings: On 11/16/23 at 11:00 a.m., a kitchen tour was conducted. On 11/16/23 at 12:21 p.m., a 50 lb. bag of oats was observed sitting on the floor in dry storage room. Dietary Aide #1 reported the oats had been delivered to the facility last Thursday. They reported the oats were stored on the floor because all of our storage buckets were full. On 11/28/23 at 11:03 a.m., the dietary supervisor reported it was the facilities policy to not store food on the floor. They could not locate the food storage policy, but stated they would store it on a rack off of the floor, if the buckets were not available.

Based on record review and interview, the facility failed to ensure a quarterly assessment was completed within the required timeframe for one (#46) of 19 sampled residents' assessments reviewed. The administrator reported 55 residents resided in the facility. Findings: Res #46's medical record documented the last quarterly assessment was dated 07/13/23, and a quarterly assessment was due in October 2023. The resident's record did not contain a quarterly assessment, dated for October 2023. On 11/21/23 at 4:18 p.m., the corporate MDS coordinator reviewed and reported the system did not identify the missed quarterly assessment or a discharge assessment. They reported the MDS would be corrected and did not know why it did not show up in the system.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure accurate coding of MDS assessments for one (#22) related to falls and for one (#23) related to CPAP machine usage of 19 sampled residents whose MDS assessments were reviewed. The administrator reported 55 residents resided in the facility. Findings: Comprehensive Assessments policy, dated March 2022, read in part, .A significant error is an error in an assessment where .the resident's overall clinical status is not accurately represented (i.e., miscoded) .A significant error differs from a significant change because it reflects incorrect coding of the MDS and not an actual significant change in the resident's health status . 1. Res #22's physician order, dated 10/23/23, documented PT/OT/ST to evaluate and treat for Part A services. The care plan, dated 11/04/23, documented the resident had a fall next to their bed and their right elbow was red with no bruising or edema noted. A quarterly assessment, dated 11/10/23, documented diagnosis which…

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 record review and interview, the facility failed to ensure finger stick blood sugar checks and insulin administration was performed per the physician orders for three (#4, 20 and #40) of nine residents with orders for insulin medication. The Resident Census and Conditions of Residents documented 42 residents resided in the facility. Findings: A facility policy and procedure for glucose monitoring and insulin administration read in part .documentation: 1) the resident's blood glucose result .2) the dose and concentration of the insulin injection . 1. Resident (Res) #4 was admitted with diagnoses which included diabetes mellitus. The resident's Quarterly Assessment, dated 6/28/22, documented the resident was moderately impaired with cognition and received injections for a diagnosis of type two diabetes mellitus. The resident's Care Plan, dated 06/28/22, documented the resident had a diagnosis for diabetes mellitus. A Physician Order, dated Sept. 2022, documented: Lantus solution 100 unit/ml inject 15 unit…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to develop a comprehensive person-centered care plan for one (#38) of 17 residents whose care plans were reviewed. The Resident Census and Conditions of Residents, dated 09/26/22, documented 42 residents resided in the facility. Findings: Resident #38 was admitted on [DATE] with diagnoses which included right lung squamous cell carcinoma and chronic obstructive pulmonary disease. The resident's Physician Orders, dated 09/07/22, did not include an order for oxygen. The Care Plan, dated 09/08/22, did not include the resident's oxygen. An admission Assessment, dated 09/14/22, documented cognition intact and oxygen therapy while in the facility. A Nurse Note, dated 09/12/22 at 8:09 a.m., read in part, .Continues to wear O2 at 2-3 liters nasal cannula. A Nurse Note, dated 09/16/22 at 1:20 p.m., read in parts .Patient stated he is leaving today and will be back later this evening .Left with full oxygen tank and instructed not to use while smoking…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to obtain a physician's order for one (#38) of three residents reviewed for oxygen therapy. The Resident Census and Conditions of Residents, dated 09/26/22, documented six residents received respiratory treatment. Findings: The facility's Oxygen Administration policy, revised 10/2010, read in parts, .Verify that there is a physician's order for this procedure .Review the physician's orders or facility protocol for oxygen administration. Resident #38 was admitted on [DATE] with diagnoses which included right lung squamous cell carcinoma and chronic obstructive pulmonary disease. The resident's Physician Orders, dated 09/07/22, did not include an order for oxygen. The Care Plan, dated 09/08/22, did not include the resident's oxygen. An admission Assessment, dated 09/14/22, documented the resident's cognition was intact and used oxygen therapy while in the facility. A Nurse Note, dated 09/12/22 at 8:09 a.m., read in part, .Continues to wear O2…

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.