Shawano Health Services

Based on observation, staff interview, and record review, the facility did not ensure appropriate treatment to promote healing of a pressure injury was provided for 1 resident (R) (R6) of 1 sampled resident.R6 had a stage 2 pressure injury on the right heel which was present upon re-admission to the facility. During an observation of wound care, Registered Nurse (RN)-F used soiled scissors to cut a clean dressing that was applied to R6's right heel pressure injury. Findings include:The facility's Clean Dressing Change policy, revised 1/19/26, indicates: It is the policy of this facility to provide wound care in a manner to decrease potential for infection and/or cross contamination.From 2/15/26 to 2/17/26, Surveyor reviewed R6's medical record. R6 had diagnoses including a stage 2 pressure injury on the right heel, diabetes, Alzheimer's disease, and venous insufficiency. R6's Minimum Data Set (MDS) assessment, dated 12/13/25, had a Brief Interview for Mental Status (BIMS) score of 5 out of 15 which indicated R6's cognition was severely impaired.R6's medical record contained dressing…

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 record review, the facility did not ensure 1 resident (R) (R5) of 3 sampled residents received appropriate care and services to prevent urinary tract infections (UTIs).The facility did not provide catheter care for R5 in a manner that decreased R5's risk for infection. Findings include:The facility's Catheter Care policy, revised 3/15/23, indicates: It is the policy of this facility to ensure residents with indwelling catheters receive appropriate catheter care and maintain their dignity and privacy when indwelling catheters are in use .Privacy/dignity bags will be available and catheter drainage bags should be covered or shielded at all times while in use .On 2/15/26, Surveyor reviewed R5's medical record. R5 had diagnoses including benign prostatic hyperplasia (BPH) with lower urinary tract symptoms, other obstructive and reflux uropathy, and personal history of malignant neoplasm of bladder. R5's Minimum Data Set (MDS) assessment, dated 11/13/25, had a Brief Interview for Mental Status (BIMS) score of 0 out of 15 which indicated R5 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 observation, staff and resident interview, and record review, the facility did not provide pharmaceutical services to meet the needs of 3 residents (R) (R2, R42, and R1) of 7 sampled residents.R2 received a 750 milligram (mg) calcium carbonate chewable tablet during the 3:00 PM medication pass on 2/15/26. R2 should have received a 500 mg calcium carbonate chewable tablet.R42's polyethylene glycol 3350 was left at the bedside on 2/16/26. R42 did not have a self-administration of medication assessment or a physician's order that indicated R42 could safely and accurately self-administer the medication. R1 had an order for ipratropium-albuterol inhalation solution 0.5-2.5 mg inhaled via nebulizer four times daily for chronic obstructive pulmonary disease (COPD). On 2/15/26, R1 administered the nebulizer independently. R1 did not have a self-administration of medication assessment or a physician's order that indicated R1 could safely and accurately self-administer the medication. Findings include: The facility's Medication Administration General Guidelines policy, dated January…

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 record review, the facility did not ensure physician-ordered diets and menus were followed to meet nutritional needs for 3 residents (R) (R22, R14, and R5) of 3 sampled residents.R22, R14 and R5 had orders for a pureed diet. Staff did not ensure the required serving size of pureed items were served to meet R22, R14, and R5's nutritional needs.Findings inlcude:The facility's (contracted company's) Therapeutic Diets policy, revised 9/2017, indicates: All residents have a diet order, including regular, therapeutic, and texture modification, that is prescribed by the attending physician, physician extender, or credentialed practitioner in accordance with applicable regulatory guidelines .Diets are prepared in accordance with the guidelines in the approved diet manual and the individualized plan of care .On 2/16/26, Surveyor reviewed R22's medical record. R22 had diagnoses including dementia and type 2 diabetes mellitus. R22's Minimum Data Set (MDS) assessment, dated 2/26/26, had a Brief Interview for Mental Status (BIMS) score of 3 out of 3…

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 record review, the facility did not ensure food was stored and prepared in a sanitary manner. This practice had the potential to affect more than 4 of the 42 residents residing in the facility. (One resident received nutrition via tube feeding.) During multiple observations, Dietary Manager (DM)-C did not wear a beard net in the kitchen. Findings include: The facility's dining services' Staff Attire policy, revised 10/2023, indicates: All employees wear approved attire for the performance of their duties .1. All staff members will have their hair off the shoulders, confined in a hair net or cap, and facial hair properly restrained . During a continuous kitchen observation that began at 9:12 AM on 2/4/25, Surveyor observed DM-C in the kitchen assisting with kitchen prep. DM-C's beard was not covered with a beard net. During a continuous observation of lunch service that began at 11:43 AM on 2/4/25, Surveyor observed DM-C assist with lunch trays, weigh meat loaf prior to service at the steam table, and cut meatloaf into serving sizes without…

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 staff and resident interview and record review, the facility failed to implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act for 1 resident (R) (R1) of 4 sampled residents. On 10/19/24, the facility discovered missing doses of narcotic medication for R1 which raised concerns of potential drug diversion and possible exploitation. The facility did not report the suspected crime to the State Agency (SA) or local law enforcement. Findings include: The facility's Reporting Abuse to Facility Management policy, with a revision date of December 2013, indicates: It is the responsibility of our employees, facility consultants, attending physicians, family members, visitors, etc., to promptly report any incident or suspected incident of neglect or resident abuse, including injuries of unknown source, and theft or misappropriation of resident property to facility management .1. Our facility does not condone resident abuse by…

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, staff and resident interview, and record review, the facility did not ensure accurate and safe administration of pharmaceuticals for 3 residents (R) (R2, R1, and R3) of 4 sampled residents. On 11/4/24, multiple oral medications and an inhaler were left unattended by staff in R2's room. R2 was not assessed as able to self-administer medication. On 11/4/24, R1 indicated nurses sometimes left 2 Tylenol (used to treat mild to moderate pain) at R1's bedside for R1 to take if R1 had pain during the night. R1 was not assessed as able to self-administer medication. On 11/4/24, medication was left unattended by staff in R3's room for R3 to self-administer. R3 was not assessed as able to self-administer medication. Findings include: The facility's Medication Administration policy, dated 1/23, indicates: To administer oral medications in an organized, accurate, and safe manner .10. Administer medication and remain with the resident while medication is swallowed. Do not leave medication in a resident's…

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 staff interview and record review, the facility did not ensure the appropriate parameters for administering a bowel medication were met and did not document bowel movements or abnormal blood pressures for 1 Resident (R) (R1) of 14 sampled residents. R1 was given Miralax (a laxative used to treat constipation) on 8/9/24 after two documented episodes of diarrhea. In addition, R1 had episodes of diarrhea and low blood pressure that were not documented in R1's medical record. Findings include: On 8/28/24, Surveyor reviewed R1's medical record. R1 was admitted to the facility on [DATE] with diagnoses of post operative care for kidney/ureter/bladder removal, kidney disease, type 2 diabetes, hypertension, and chroic obstructive pulmonary disease (COPD). R1's most recent Minimum Data Set (MDS) assessment, dated 8/20/24, stated R1's Brief Interview for Mental Status (BIMS) score was 15 out of 15 which indicated R1 had intact cognition. R1 was R1's own decision maker and discharged home on 8/24/24. Surveyor…

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 staff interview and record review, the facility did not ensure 1 Resident (R) (R3) of 2 residents who had a Guardian received services to ensure court-ordered protective placement was obtained. R3 did not have court-ordered protective placement in the facility since admission. Findings include: On 12/18/23, Surveyor reviewed R3's medical record. R3 resided in the facility for multiple years with diagnoses including traumatic subdural hemorrhage, right sided hemiplegia (paralysis on one side of the body) and hemiparesis (weakness on one side of the body) of right dominant side, and mixed receptive-expressive language disorder. R3's most recent Minimum Data Set (MDS) assessment contained a Brief Interview for Mental Status (BIMS) score of 3 out of 15 which indicated R3 had severe cognitive impairment. R3's medical record included a court order appointing guardianship of R3 from 2007. R3's medical record did not include a court order for protective placement in the facility. On 12/19/23 at 8:16 AM, Surveyor interviewed Nursing Home Administrator (NHA)-A who verified R3 had 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 staff interview and record review, the facility did not ensure a physician was notified of a change in condition for 1 Resident (R) (R93) of 5 sampled residents. R93 had an order to notify the physician if R93's blood sugar level was less than 70 mg/dL (milligrams per deciliter) or greater than 400 mg/dL. The physician was not notified on 12/19/23 when R93's blood sugar level was 479 mg/dL. Findings include: The facility's Diabetes-Clinical Protocol Policy indicates: 3. The physician will order desired parameters for monitoring and reporting information related to diabetes or blood sugar management .A. The staff will incorporate such parameters into the Medication Administration Record and care plan .4. The staff will identify and report complications such as .hyper/hypoglycemia. On 12/20/23, Surveyor reviewed R93's medical record. R93 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus type 2 with hyperglycemia (high blood sugar), peripheral vascular disease (PVD), 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview and record review, the facility did not ensure a complete baseline care plan was developed or provided within 48 hours of admission for 2 Residents (R) (R20 and R93) of 2 sampled residents. R20's baseline care plan was not complete or provided to R20 within 48 hours of admission. R93's baseline care plan was not complete or provided to R93 within 48 hours of admission. Findings include: 1. On 12/20/23, Surveyor reviewed R20's medical record. R20 was admitted to the facility on [DATE] with diagnoses including unspecified dementia, retention of urine, sensorineural hearing loss bilateral, type 2 diabetes mellitus with other diabetic kidney complication, unspecified severe protein-calorie malnutrition, moderate persistent asthma uncomplicated, pain in right knee, anxiety disorder, obstructive sleep apnea, nonrheumatic pulmonary valve disorder, essential hypertension, gastro-esophogeal reflux disease (GERD), other abnormalities of gait and mobility, and cognitive communication deficit. R20's…

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 record review, the facility did not establish and maintain an infection control program designed to prevent the development and transmission of disease and infection for 2 Residents (R) (R15 and R25) of 3 residents observed receiving medication. Staff did not appropriately cleanse hands before preparing and administering medication to R15 and R25. Findings include: The facility's Hand Hygiene policy, dated 11/2/22, indicates: All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility. Hand hygiene is indicated and will be performed under the conditions listed in, but not limited to, the attached Hand Hygiene Table. The Hand Hygiene Table states: Before preparing or handling medications. On 12/19/23 at 8:45 AM, Surveyor observed Registered Nurse (RN)-E prepare medication for R15. Surveyor did not observe RN-E perform hand hygiene prior to preparing or administering R15's medication. When RN-E…

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.