Seiling Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, and interview, the facility failed to ensure licensed nursing staff were working with a current valid license for 1 (LPN #1) of 4 employees files who required a licenses or certification. The administrator identified 20 residents resided in the facility. Findings:An undated policy titled Nursing Services Staffing, read in part, Shall have and maintain an organized nursing services for its residents which is under the direction of a professional licensed nurse.To provide adequate and properly supervised nursing services for each resident for 24 hours, 7 days a week.Review of the personnel file for LPN #1 did not show any current license verification.On [DATE] at 8:16 a.m., the Oklahoma Board of Nursing website was used to verify the license for LPN #1. LPN #1's license showed an expiration date of [DATE].A review of the clinical staff schedules from [DATE] through [DATE] showed 18 dates LPN #1 worked with an expired license on [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE],…

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 RN coverage for eight consecutive hours seven days per week.The administrator identified 20 residents resided in the facility.Findings:A PBJ Staffing Data Report, dated 07/01/25 through 09/30/25, showed the metric was suppressed as the PBJ had not been submitted for the required quarter.A review of the direct care staff schedule was conducted from 07/01/25 to 01/21/26. On the schedule the administrator documented on the paper what the letters and colors meant on the schedule:a. A - 6a-6p,b. N - 6p - 6a,c. red ink - request off, andd. highlights red - call out.There were seven days without 8 hours of RN coverage: 10/19/25, 11/08/25, 11/09/25, 11/29/25, 11/30/25, 01/17/26, and 01/18/26. On 01/21/26 at 10:58 a.m., the administrator stated the DON was salary and was not counted on the schedule. On 01/21/26 at 12:08 p.m., the DON stated, Call ins were handled by the nurse trying to get their shift covered, then if not they call and let me know. If the nurse does not find someone, then I find someone, and if not find…

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 the required PBJ staffing data was submitted to CMS within the mandated timeframe for the FY Quarter 4 2025. The administrator identified 20 residents resided in the facility. Findings:A PBJ Staffing Data Report, dated FY Quarter 4 2025 (07/01/25 through 09/30/25), showed the facility had not provided staffing data to CMS for the PBJ staffing data report for FY Quarter 2 2025. On 01/21/26 at 11:30 a.m., the administrator stated the PBJ was not submitted. They stated they attempted to submit it on the 16th of January, and it was not accepted. The administrator stated it showed it was late and was due on the 15th. They stated customer service was contacted, and the facility was told they missed the deadline and to try next month.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure a resident receiving dialysis services had pre-assessments, post assessments, and ongoing communication with the dialysis center for 1 (#12) of 1 sampled resident reviewed for dialysis. The administrator identified 20 residents resided in the facility and one resident received dialysis. Findings:A review of the facility policy book contained no policy for dialysis services. Undated dialysis center forms, Your Medication List and Nutrition and Blood Test Results showed the facility received a copy of Resident #12's tests results and medication from the dialysis center on 01/15/26 via fax. A baseline care plan, dated 01/15/26, showed Resident #12 was admitted to the facility on [DATE] and received dialysis services Tuesdays, Thursdays, and Saturdays.Nursing progress notes, dated 01/17/26, 01/20/26, and 01/22/26, showed Resident #12 was transported to and from dialysis via public transport. There was no documentation in Resident #12's 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.

Based on observation and interview, the facility failed to post nurse staffing information included all the required components. The administrator identified 17 residents resided in the facility. Findings: On 06/13/23 at 12:20 p.m., a staffing board was observed in the hallway, outside the med room. It was not observed to contain the facility name, total number and actual hours worked by following the categories of licensed and unlicensed nursing staff, or the resident census. On 06/13/24 at 12:25 p.m., the DON reported she was not aware of all the components required.

Based on record review and interview, the facility failed to monitor for side effects related to the use of Xarelto for two (#2 and #8) of five sampled residents reviewed unnecessary medications. The DON identified five residents received anticoagulants. Findings: An Unnecessary Drugs policy, dated 06/01/17, documented an unnecessary drug was any drug used without adequate monitoring. 1. Resident #2 had diagnoses which included paroxysmal atrial fibrillation. A Physician's order, dated 01/25/24, documented the resident received Xarelto twice a day. There was no documentation in the resident's clinical record the resident had been monitored for side effects of Xarelto. 2. Resident #8 had diagnoses which included unspecified atrial fibrillation. A Physician's order, dated 07/07/21, documented the resident received Xarelto once a day. There was no documentation in the resident's clinical record the resident had been monitored for side effects of Xarelto. On 06/13/24 at 12:22 p.m., the DON stated side effect monitoring was completed on the TAR. She stated they weren't aware they should…

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 and interview, the facility failed to ensure the ice machine was clean. The administrator identified 17 residents who resided at the facility. Findings: A weekly cleaning schedule, undated, documented the ice machine was to be cleaned. There was no documentation the ice and water dispenser was cleaned. A blank cleaning schedule, dated June 2024, documented the ice machine (outside and tray) was to be cleaned daily. There was no documentation the ice and water dispenser was cleaned. On 06/10/24 at 9:10 a.m., the ice machine was observed in the dining room. It was observed to have a separate ice and water dispenser. A paper towel was wiped on the inside water dispenser. Black residue was observed on the paper towel. A paper towel was wiped on the inside of the water dispenser. Orange/pink residue was observed on the paper towel. On 06/15/24 at 9:12 a.m., the CDM stated the ice and water dispensers were cleaned weekly. She was unable to provide documentation.

Based on observation, record review, and interview, the facility failed to ensure a resident was assessed for the use of bed rails, an order had been obtained, or the care plan had been updated prior to installation for one (#5) of one sampled resident reviewed for bed rails. The DON identified two residents with bedrails. Findings: Resident #5 had diagnoses which included repeated falls and dementia A significant change assessment, dated 03/08/24, documented Resident #5 had severely impaired cognition. It documented Resident #5 required substantial and total assistance for position changes. On 06/10/24 at 10:29 a.m., Resident # 5 was observed resting in bed with half bed rails in up position on either side of the bed. On 06/13/24 at 9:48 a.m., the DON stated Resident #5's bed rails were for positioning. The DON stated during a care plan in March, it was decided bed rails would assist with the resident during care. The DON stated there was no documentation of an assessment, order, nor the care plan had been updated.

Based on record review and interview, the facility failed to ensure side effects were monitored for an antidepressant for one (#2) of five sampled residents reviewed for unnecessary medications The DON identified nine residents received antidepressants. Findings: Resident #2 had diagnoses which included depression. A Physician's order, dated 07/11/23, documented the resident was to receive citalopram once a day. The resident's clinical record did not contain side effect monitoring for citalopram. On 06/13/24 at 12:22 p.m., the DON stated side effect monitoring was documented on the TAR. She stated she didn't know why Resident #2 didn't have it on their TAR.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to ensure an insulin pen was discarded and not used after 28 days for one (#14) of one sampled resident observed for insulin administration. The DON identified two resident received insulin. Findings: An Insulin Pens policy, dated [DATE], documented the facility shall ensure insulin pens were used in accordance with manufacture instructions. TheHumalog manufacture instructions, dated 08/2023, documented to discard the Humalog pen after using for 28 days even if insulin is left in the pen. On [DATE] at 11:20 a.m., LPN #1 was observed to prepare the Humalog insulin pen for administration for Resident #2. There was a 5/5 written on the label of the insulin pen. LPN #1 stated that was the date they first started using the pen. LPN #1 clarified it was 5/5 of 2024. LPN #1 was observed to administer six units of the insulin to Resident #2. LPN #1 stated the look at the use by date on the insulin pen to determine when the insulin was expired. LPN #1…

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 interviews, the facility failed to ensure enhanced barrier precautions were implemented for a resident with an indwelling catheter for one (#1) of one sampled resident reviewed for infection control with a catheter. The DON identified one resident had an indwelling with a catheter. Findings: Resident #1 had diagnoses which included retention of urine. A Physician's order, dated 09/29/23, documented foley catheter to bedside drainage. A Quarterly assessment, dated 05/25/24, documented Resident #1 had moderately impaired cognition. It documented the resident had a urinary catheter. Resident #1's care plan did not contain documentation of enhanced barrier precautions. On 06/10/24 and 06/12/24 Resident #1 was observed with a catheter bag attached to their wheelchair. There was no signage observed on Resident #1's door indicating the resident was on enhanced barrier precautions. On 6/12/24 at 11:02 a.m., CNA #1 and CNA #4 was observed providing catheter care to Resident #1. They were not observed to wear any PPE other than gloves. Staff were asked…

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 interviews, the facility failed to ensure: a. staff sanitized hands between dependent residents when feeding and meal assistance was provided for five (#5, 7, 10, 11, and #17) of six residents observed for meal assistance; and b. a water management program was in place to prevent water born illnesses for 17 residents that resided in the facility. The Resident Census and Condition of Residents, dated 06/20/23, documented one resident was dependent for eating and three residents required meal assistance. The census was 17. The DON identified six residents require cues and assistance for meals. Findings: 1. On 06/22/23 at 4:59 p.m., the Administrator was asked if the facility had a water management program in place that included policies and testing water for potential water born illnesses. The administrator stated they did not know about the requirement and did not have a water management program in place. 2. Resident #5 had diagnosis of dementia. An Annual Assessment, dated 04/05/23, documented Resident #5 had severe cognitive impairment 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.

Based on observation and interview, the facility failed to ensure lidocaine multiple dose bottles were labeled and dated. The Resident Census and Conditions of Residents report, dated 06/20/23, documented 17 residents resided in the facility. Findings: A Multiple Dose Vials policy, dated 06/01/17, read in part, .Once a multiple dose vial has been punctured, the staff member shall assign a beyond-use date to the vial and place this date on the vial's label . A facility policy titled, Unusable and Outdated Drugs, dated 06/01/17, read in parts, .All discontinued resident drugs .or missing labels shall be returned to the pharmacy for proper disposal .these drugs shall be stored in an isolated area in the pharmacy or other area that has been designated for the storage of such unusable drugs . On 06/22/23 at 8:25 a.m., a medication cart was observed. There were three 1% lidocaine bottles in the medication cart. All three bottles were opened, unlabeled, and undated. On 06/22/23 at 8:35 a.m., the DON stated the lidocaine bottles should have been labeled and dated when opened. They stated…

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 interviews, the facility failed to provide personal privacy to ensure dignity of a dependent resident for one (#17) of one sample resident reviewed for dignity. The Resident Census and Condition of Residents report, dated 06/20/23, documented seven residents were dependent for dressing and the census was 17. Findings: Resident #17 had diagnoses to include dementia, and personality disorder with behaviors. An Annual Assessment, dated 04/12/23, documented Resident #17 had severe cognitive impairment, was inattentive with disorganized thinking which fluctuated, and required extensive assistance with dressing. On 06/20/23 at 2:15 p.m., Resident #17 was observed in bed and restless. Resident #17 had removed the top linens, was naked from the waist down, and exposed the lower half of their body and legs to the hallway. On 06/22/23 at 8:53 a.m., Resident #17 was observed in bed and had placed their feet over the left side/edge of the bed. Resident #17 had removed their gown and linens, which exposed their upper body to the hall. On 06/22/23 at 8:56…

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.