Shattuck Nursing Center

Based on record review and interview, the facility failed to ensure resident assessments were completed and submitted to CMS for nine (#13, 17, 21, 23, 25, 37, 40, 42, and #45) of 13 sampled residents who were reviewed for resident assessments. The DON identified 45 residents resided in the facility. Findings: 1. Resident #21's Annual Assessment, dated 09/15/24, documented the ARD was 09/15/24. Sections B, C, D, F, GG, J, L, M, N, P, and Q did not contain any data. Section Z0400 did not contain any signatures documenting the assessment had been completed. On 10/24/24 at 5:34 p.m., MDS #1 stated Resident #21's assessment was not completed. 2. Resident #13's Quarterly Assessment, dated 08/29/24, documented the ARD was 08/29/24. Section Z0500 documented the DON signed the assessment 09/12/24. A MDS Final Validation Report, dated 10/22/24, documented Resident #13's assessment was submitted late (more than 14 days after section Z0500.) On 10/24/24 at 5:30 p.m., MDS #1 stated Resident #13's assessment was not submitted timely. 3. Resident #17's Quarterly Assessment, dated 09/07/24,…

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.

Based on record review and interview, the facility failed to ensure resident assessments were accurate for two (#15 and #30) of 13 sampled residents whose resident assessments were reviewed for accuracy. The DON identified 45 residents who resided in the facility. Findings: The Long-Term Care Facility Resident Assessment Instrument, dated October 2023, documented alternative medicine products were considered as a dietary supplement. It documented medications such as melatonin should not be counted as a medication. 1. Resident #15 had diagnoses which included insomnia. An Order Summary Report, dated 04/20/24, documented Resident #15 received melatonin at bedtime for insomnia. Resident #15's quarterly assessment, dated 08/10/24, documented the resident received a hypnotic. 2. Resident #30 had diagnoses which included insomnia. An Order Summary Report, dated 03/20/24, documented Resident #30 received melatonin at bedtime for insomnia. Resident #30's quarterly assessment, dated 06/30/24, documented the resident received a hypnotic. On 10/25/24 at 4:40 p.m., MDS #1 was asked how…

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 resident assessments were not back dated for three (#23, 37 and #45) of 13 sampled residents who were reviewed for resident assessments. The DON identified 45 residents resided in the facility. Findings: 1. Resident #23's Quarterly Assessment, dated 08/25/24, documented the ARD was 08/25/24. Section Z0500 documented the DON signed the assessment was completed on 09/08/24. Section Z0400 documented MDS #1 completed sections A-E, GG, and H-Q on 10/03/24. 2. Resident #37's Quarterly Assessment, dated 09/05/24, documented the ARD was 09/05/24. Section Z0500 documented the DON signed the assessment was completed on 09/19/24. Section Z0400 documented the DON completed sections A-E, GG, and H-Q on 10/22/24. 3. Resident #45's Quarterly Assessment, dated 08/29/24, documented the ARD was 08/29/24. Section Z0500 documented the DON signed the assessment was completed on 09/12/24. Section Z0400 documented the DON completed sections A-E, GG, and H-Q on 10/03/24. On 10/24/24 at 4:36 p.m., the DON and MDS #1 were asked how…

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 care plans were updated for use of alarms for one (#3) and failed to ensure the care plan specified what behaviors were being treated with psychotropic medications for one (#30) of eight sampled residents whose care plans were reviewed for behaviors and alarms. The DON identified 45 residents resided in the facility. Findings: 1. Resident #3 had diagnoses which included senile degeneration of the brain. An Order Summary Report, dated 05/23/24, documented the resident had an order for a fall alert monitor device. Resident #3's quarterly assessment, dated 07/20/24, documented the resident's cognition was severely impaired. It documented a bed and chair alarm were used. A Care Plan, dated 10/03/24, did not document an alarm was utilized. On 10/24/24 at 3:55 p.m., the DON stated the care plan did not address the alarms. 2. Resident #30 had diagnoses which included psychosis. An Order Summary Report, dated 03/20/24, documented the resident received Seroquel (antipsychotic medication). Resident #30's quarterly assessment,…

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 follow their protocol and the resident's care plan by not completing weekly wound assessments for one (#15) of two sampled residents reviewed for pressure ulcer care. The Resident Matrix, dated 10/22/24, documented two residents had pressure ulcers. Findings: An undated Wound Care Protocol, documented wounds would be drawn and documented on the pressure ulcer chart and documented in the skin assessment book every Saturday. Resident #15 had diagnoses which included pressure ulcer. Resident #15's Care Plan, dated 05/29/24, documented to follow the facility's protocol, assess, record, and monitor wound healing weekly. A Weekly Observation Tool, dated 09/11/24, documented the resident had a stage three pressure ulcer to their right hip and a stage two pressure ulcer to their left hip. This was the last documented weekly wound assessment. On 10/24/24 at 9:55 a.m., Resident #15's skin was observed with LPN #1. LPN #1 stated they completed skin assessments weekly. They stated they are behind on them. They stated they were…

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 physician was notified when a medication was unavailable for one (#44) of five sampled residents reviewed for medications. The DON stated 45 residents resided in the facility. Findings: Resident #44 had diagnoses which included Huntington's disease. An Order Summary Report, dated 03/25/24, documented to give Austredo (VMAT2 inhibitor medication) 24 mg daily, and another order, dated 04/08/24, documented to give Austredo 6 mg daily. Both medications were to treat Huntington's disease. Resident #44's quarterly assessment, dated 08/21/24, documented the resident had moderate cognitive impairment. A CMA Medications report, dated September 2024, documented the resident did not receive either one of the Austredo medications for 18 out of 30 days. A CMA Medications report, dated October 2024, documented the resident did not receive either one of the Austredo medications for 22 out of 23 days. On 10/24/24 at 12:46 p.m., CMA #1 was asked what they knew about Resident #44's Austredo medication. They stated the pharmacy…

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 a medication was available for one (#44) of five sampled residents reviewed for medications. The DON stated 45 residents resided in the facility. Findings: Resident #44 had diagnoses which included Huntington's disease. An Order Summary Report, dated 03/25/24 documented to give Austredo (VMAT2 inhibitor medication) 24 mg daily, and another order, dated 04/08/24, documented to give Austredo 6 mg daily. Both medications were to treat Huntington's disease. Resident #44's quarterly assessment, dated 08/21/24, documented the resident had moderate cognitive impairment. A CMA Medications report, dated September 2024, documented the resident did not receive either one of the Austredo medications for 18 out of 30 days. A CMA Medications report, dated October 2024, documented the resident did not receive either one of the Austredo medications for 22 out of 23 days. On 10/24/24 at 12:46 p.m., CMA #1 was asked what they knew about Resident #44's Austredo medication. They stated the pharmacy could not fill it because insurance…

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 provide privacy for two (#11 and #13) of five sampled residents reviewed for privacy. The Resident Census and Conditions of Residents report, dated 08/01/23, documented 31 residents resided in the facility. Seven residents had seizure disorders. Findings: A Notice of Privacy Practices policy, dated 04/14/03, read in parts, .[Name of facility] may use your health information for purposes of providing you treatment .[Name of facility] has established a policy to guard against unnecessary disclosure of your health information . 1. Resident #11 had diagnoses which included epilepsy, and conversion disorder with seizures or convulsions. On 08/02/23 at 2:46 p.m., a Seizure Disorder sign was observed hanging on the wall above Resident #11's bed and was visible from the hallway door. 2. Resident #13 had diagnoses which included unspecified convulsions, persistent vegetative state, and aphasia. On 08/02/23 at 2:38 p.m., a Seizure Disorder sign was observed hanging on the wall above Resident #13's bed and was visible…

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: a. ensure staff were aware of the system used to identify CPR/DNR status, and b. ensure clinical health records correctly identified CPR/DNR status for three (#3, 17 and #19) of twelve sampled residents reviewed for advanced directives. The Resident Census and Condition of Residents report, dated [DATE], documented 31 residents resided in the facility. Five residents had advanced directives. Findings: A Life-Sustaining Treatment Decisions policy, dated [DATE], read in parts, .Do Not Resuscitate Orders . A Resident's request to have a DNR Order entered on the chart is to be noted in the medical record .The DNR order should be communicated to all relevant healthcare providers and documented in the Resident's Care Plan .If the Resident or family consent, a DNR wristband could be used to assist identifying the Resident who has a current DNR order. If a DNR wristband is not allowed, a sticker on the resident's chart will be used to identify…

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 MDS assessments were accurate for two (#7 and #23) of 12 residents sampled for accuracy of MDS assessments. The Resident Census and Conditions of Residents report, dated 08/01/23, documented 31 residents resided in the facility. The DON identified nine residents used oxygen. Findings: 1. Resident #7 had diagnoses of atherosclerosis and heart failure. A Physician Order, dated 11/10/22, read in part, .02 at 0.5 L via n.c at HS . An Annual Assessment, dated 07/05/23, did not document oxygen therapy was used during the 14 day look back. On 08/02/23 at 4:01 p.m., the MDS Coordinator was asked about Resident # 7's respiratory orders. They stated Resident # 7 had orders for supplemental oxygen at night prescribed since 11/10/22. They were asked what the date was of most recent MDS. They stated it was on 07/05/23. They were asked if section O documented Oxygen therapy, They stated, No, it does not document oxygen by nursing on the TAR,so I did not…

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 maintain infection control during medication observation for two (#17, and #28) of four sampled residents reviewed during medication observation. The Resident Census and Conditions of Residents report, dated 08/01/23, documented 31 residents resided in the facility. 1. Resident #17 had diagnoses which included high blood pressure, chronic kidney disease, and abnormal coagulation profile. 2. Resident #28 had diagnoses which included high blood pressure, dementia, and anxiety. On 08/03/23 at 7:04 a.m., CMA #1 was observed to remove the b/p cuff from the top of the cart and obtained a blood pressure on Resident #17. CMA #1 was observed to return to the medication cart and placed the b/p cuff on top of the cart. CMA #1 was not observed to sanitize the b/p cuff. On 08/03/23 at 7:19 a.m., CMA #1 was observed to remove the b/p cuff from the top of the cart and obtained a blood pressure on Resident #28. CMA #1 was observed to return to the medication cart and placed the b/p cuff on top of the cart. CMA #1 was not…

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 administer a pneumococcal vaccination for one (#32) of five sampled residents reviewed for immunizations. The Resident Census and Conditions of Residents documented 31 residents resided in the facility and 21 residents had receive the pneumococcal vaccination. Findings: An undated, Influenza/Pneumonia Vaccines policy, read in parts, .It is the intent of [name of facility] to follow the guidelines of the CDC and ACIP (Advisory Committee on Immunization Practices) on the administration of the influenza and pneumococcal vaccines to their residents with written consent from the residents' POA, representative or the resident, upon admittance to the facility and annually as indicated . Findings: Resident #32 had diagnoses which included, dementia, thrombocytopenia, and high blood pressure. A [Name of Facility] vaccination consent form, dated 05/26/23, documented the Resident's power of attorney had signed for Resident #32 to be administered the pneumococcal vaccination. An admission Assessment, dated 06/05/23,…

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 interview and record review, the facility failed to ensure a facility risk assessment had been completed and updated. The DON identified 36 residents resided in the facility. Findings: On 06/24/22 at 8:20 a.m., the BOM was asked to provide the most currant facility assessment that had been completed. They provided two binders, an emergency management binder and a Facility Assessment Compliance Tool binder. The FACT book contained an assessment, dated 2017, last signed by the previous administrator. The BOM was asked if there was another date. They stated they would look for another book. On 06/24/22 at 8:32 a.m., the BOM returned and stated they did not find additional information.

Based on interview and record review, the facility failed to have a RN eight consecutive hours a day for three of 22 days in June 2022. The DON reported 36 residents resided in the facility. Findings: The nursing schedule from June 1st through June 22nd, 2022, did not document a RN on June 11th, 12th, and 19th. On 06/22/22 at 2:09 p.m., the BOM and DON were asked if there was a RN for eight consecutive hours a day, seven days a week. The BOM stated, There is a RN here almost all the time. They were asked to provide documentation of RN coverage for June 11th, 12th, and 19th. On 06/22/22 at 2:28 p.m., the BOM was not able to provide the documentation. They stated the administrator, who was also an RN, was here for seven hours on June 19th.