NHC Healthcare - Garden City

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the facility policy, observations and interviews, the facility failed to ensure medications and biologicals were properly stored in 3 of 7 medication carts. Findings include: Review of the facility policy titled, Medication Storage In the Facility documented, Policy: Medications and biological's are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. I. Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are removed from inventory, disposed of according to procedures for medication disposal. J. Medication storage areas are kept clean, well lit, and free of clutter and extreme temperatures and humidity. K. Medication storage conditions are monitored on a quarterly basis by the consultant pharmacist or 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review, the facility failed to provide respiratory care consistent with professional standards of practice for 1 of 1 residents reviewed for respiratory care, Resident (R)70. Findings include: The facility did not provide a policy related to Oxygen Administration. Review of R70's Face Sheet revealed R70 was admitted to the facility on [DATE], with diagnoses including but not limited to: unspecified dementia, moderate, with mood disturbance Note: SEE PSYCH NOTES, solitary pulmonary nodule, basal cell carcinoma of skin of nose, hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease, chronic kidney disease, stage 3b, hyperlipidemia, hypothyroidism, unspecified osteoarthritis, major depressive disorder, recurrent, anxiety disorder, dysphagia, oropharyngeal phase, insomnia, chronic respiratory failure, unspecified protein-calorie malnutrition, syncope and collapse, and dependence on supplemental…

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 review of facility policy, observations, record review and interviews, the facility failed to ensure a medication administration error rate of less than 5 percent. The facility additionally failed to ensure an ordered medication for Resident (R)526 was administered timely. The medication administration error rate was 12.12 percent. Findings include: Review of the facility policy titled Specific Medication Administration Procedures revised on 01/01/19, documented, Purpose: To administer oral medications in a safe, accurate, and effective manner. Review and confirm medication orders for each individual resident on the Medication Administration Record PRIOR to administering medications to each resident. Pour correct number of tablets or capsules into the medication cup, taking care to avoid touching the tablet or capsule, unless wearing gloves. During an observation of medication pass on 01/08/25 at 7:44 AM, revealed Registered Nurse (RN)1 dropped a pill on the medication cart and picked the pill up with the medication wrapper and put it in the medication cup. The pill was…

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, interview, and review of manufacturer guidelines, the facility failed to ensure no significant medication errors for Resident (R)85 and R86. Specifically, R85's insulin pen was not primed prior to administering and an extended release medication for R86 was crushed and placed in applesauce with all the other medications for 2 of 4 residents reviewed. Findings include: Review of the Manufacturer's Recommendations titled, Insulin Administration Using an Insulin Pen, documents, How to Use . 7. Wipe the tip of the pen where the needle will attach with an alcohol swab or cotton ball moistened with alcohol. 8. Remove the protective pull tab from the needle and screw it onto the pen until snug (but not too tight.) 9. Removed the plastic outer cap and inner needle cap. 10. Look at the dose window and turn the dosage knob to 2 units. 11. Holding the pen with the needle pointing upwards, press the button until at least a drop of insulin appears. this will prime the needle and remove any air from the needle. Repeat this step if needed until a drop appears.…

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, interview, record review, review of Resident Council meeting minutes, facility recipe review, and facility policy review, the facility failed to have sufficient dietary staff to assure resident meals were served as scheduled and standardized recipes were followed to provide properly cooked, well-seasoned and hot food to residents. The facility's failure to have sufficient dietary staff to prepare and serve meals had the potential to affect 127 residents who received meals that were prepared in the kitchen. Findings include: Review of the facility's policy titled, Meal Service & Patient Meal Delivery, with a revised date of 11/2020, revealed Meals will be planned and served at regular times comparable to normal mealtimes in the community and/or based on patient's needs and preferences . Guidelines 1. Mealtimes will be planned and posted in areas which are accessible to patients and families. Review of the facility's Meal Service Distribution and Time Sheet, updated on 10/10/18, revealed 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 Based on observations, interviews, record review, and facility policy review, the facility failed to ensure one (Resident (R)55) out of 29 sampled residents, was provided personal privacy. This had the potential for the risk of R55 not being provided dignity and the potential for psychological harm. Findings include: Review of the facility policy titled, Privacy in the Patient Rights (undated) provided by the Administrator revealed .we provide you with privacy so that you may maintain a dignified existence .In your accommodations you will be afforded at least visual privacy . Review of R55's undated admission Record located on the Electronic Medical Record (EMR) revealed he was initially admitted to the facility on [DATE] and readmitted on [DATE]. Review of R55's quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/13/23 and located in his EMR under the MDS tab, revealed a Brief Interview for Mental Status (BIMS) with a score of 13 out of 15 indicating the resident was cognitively…

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, interview, record review, and facility policy review, the facility failed to determine if self-administration of a nasal spray was safe and clinically appropriate for one (Resident (R) 10) of 29 sampled residents. This failure placed the resident at risk for inappropriate and unsafe medication use. Findings include: Review of a facility policy titled, Self-Administration of Medication, dated 01/01/19, indicated, .residents who desire to self-administer medications are permitted to do so if the facility's interdisciplinary team has determined that the practice would be safe for the resident and other residents of the facility and there is a prescriber's order to self-administer . Review of R10's undated Face Sheet, located in the electronic medication record (EMR) under the Resident tab revealed the resident was admitted to the facility on [DATE]. Review of R10's quarterly Minimum Data Set (MDS) located in the resident's EMR under the RAI tab with an Assessment Reference Date (ARD) 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 observation, interview and record review, the facility failed to maintain a comfortable environment for one (Resident (R) 41) of 29 sampled residents. Specifically, R41's bed was not maintained in good condition and comfortable for the resident. Findings include: Review of R41's undated Face Sheet, located in the electronic medical record (EMR) under the Resident tab revealed the resident was admitted to the facility on [DATE] with diagnosis of Parkinson's disease. Review of R41's quarterly Minimum Data Set (MDS), located in the EMR under the RAI (Resident Assessment Instrument) tab with an Assessment Reference Date (ARD) of 04/04/23, revealed a Brief Interview for Mental Status (BIMS) score of five out of 15, indicating R41 was severely cognitively impaired. Review of a Maintenance Request, dated 03/23/23 provided by the Maintenance Partner (MP) from a shelf at the nurses' station, revealed the following request for R41's bed: Feet will not go up or down. This request was marked as completed 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 interview and record review, the facility failed to transmit discharge a Minimum Data Set (MDS) assessment within the required timeframe for one (Resident (R) 260) of three residents reviewed for MDS 3.0 Missing Omnibus Budget Reconciliation Act (OBRA) Assessment. Findings include: Review of MDS 3.0 Missing OBRA Assessment with a run date of 04/06/23, revealed three residents with potentially missing assessments. Review of R260's undated Face Sheet, located in the electronic medical record (EMR) under the Resident tab revealed the resident was admitted to the facility on [DATE] and was discharged from the facility on 07/18/22. Review of R260's discharge MDS, located in the resident's EMR under the RAI (Resident Assessment Instrument) tab with an Assessment Reference Date (ARD) of 07/18/22, revealed the MDS was in process. During an interview on 04/12/23 at 1:13 PM, the MDS Coordinator (MDSC) confirmed R260's discharge MDS had not been transmitted. MDSC further stated, That is a missed MDS.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, record review, and review of hospital documentation, the facility failed to ensure one (Resident (R)360) out of 29 sampled residents, was provided surgical wound treatment for his biliary tube (allows bile to flow out from a blocked bile duct) insertion/surgical site. This had the potential for the increased risk of biliary tube complications for R360. Findings include: The facility did not have a Biliary Tube policy for review. Review of R360's .Hospital Discharge Summary dated 02/28/23 located under the Documents tab in the Electronic Medical Record (EMR) revealed .Biliary and Gallbladder: Unchanged percutaneous biliary drainage stent tip terminating in the duodenum . Discharge Instructions Wound Care keep wound clean and dry . Review of R360's Face Sheet (undated) located in the EMR revealed R360 was initially admitted to the facility on [DATE] and readmitted on [DATE] and was discharged on 03/13/23. R360 had multiple diagnoses to include obstruction of bile duct, malignant neoplasm 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 observation, interview, record review, resident selective menu review, and facility policy review, the facility failed to serve foods that were selected and written on a selective menu for one (Resident (R) 89) of four sampled residents reviewed for menus being followed and adequate. Findings include: Review of the facility's policy titled, Menu Planning and Service, with a revised date of 11/2020, revealed Cycle menus, either selective or non-selective, are used, written and revised periodically . 9. Overall meal acceptability, therapeutic modifications and patient preferences, needs and allergies/intolerances will be monitored for accuracy by the Dietitian and/or FNS (Director of Food and Nutrition Services) Manager. Review of the admission Record located in R89's electronic medical record (EMR) under the Resident tab indicated she was admitted to the facility on [DATE]. Review of the resident's admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/05/23 located in the EMR…

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, interview, record review, recipe review, and facility policy review, the facility failed to serve food that was properly cooked and well-seasoned to three (Resident (R) 42, R98, and R89) of four sampled residents reviewed for food palatability. Findings include: Review of the facility's policy titled, Recipes, with a revised date of 11/2020, revealed Standardized recipes will be used for all menu items to ensure consistent quality food. Guidelines 1. Recipes will be provided for each menu cycle and will be used for all food preparation. Instructions will be provided on recipes for proper preparation in order to consistently yield attractive, nutritious, flavorful, and pleasurable foods. Each recipe will state the Critical Control Points (CCP) to ensure food safety is maintained throughout the food production process. 1. Review of R42's electronic medical record (EMR) revealed a quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 01/07/23 located under the RAI (Resident Assessment Instrument) tab revealed a Brief Interview for Mental…

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, interviews, and record review, the facility failed to provide thickened liquids in the prescribed consistency for one (Resident (R)105) of one sampled residents who had a diagnosis of dysphagia (difficulty with swallowing) and received thickened liquids. Findings include: Review of the admission Record located in R105's electronic medical record (EMR) under the Resident tab indicated she was admitted to the facility on [DATE] and had diagnoses including dysphagia and Alzheimer's disease. Review of R105's quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/05/23 located in the EMR under the RAI tab revealed R105 had a Brief Interview for Mental Status (BIMS) score of five out of 15, which indicated severe cognitive impairment. The MDS also indicated R105 experienced coughing or choking during meals or when swallowing medications, had complaints of difficulty or pain when swallowing and required limited assistance with one-person physical assistance with eating.…

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.