Platte County Legacy Home

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, review of manufacturer's instructions, and policy and procedure review, the facility failed to label medications with the date medications were opened and/or expired in 1 of 2 medication storage areas (south medication room). The census was 42. The findings were:1.Observation of the south medication storage room on [DATE] at 8:45 AM showed the general stock for PPD Tubersol vial had been opened, partially used, and no use by date had been written on vial. Further observation showed the general over the counter stock supply of acetaminophen suppositories had expired on 1/2026, and were still available for use.2. Interview with RN #1 on [DATE] at 8:45 am confirmed the Tubersol vial was in use and should have been labeled with a use by date. Further interview confirmed the acetaminophen suppositories were expired and available for use by residents and revealed they should have been discarded.3. Review of facility policy titled Storage of Medication dated [DATE] showed .4. 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 medical record review, staff interview, and policy review, the facility failed to ensure adequate monitoring of psychotropic medications for 2 of 5 sample residents (#2, #10) reviewed for unnecessary medications. The findings were: 1. Review of the quarterly MDS assessment dated [DATE] showed resident #10 had short-term and long-term memory impairment and diagnoses which included non-Alzheimer's dementia. The MDS assessment showed the resident had physical and verbal behaviors directed towards others and other behavioral symptoms not directed towards other on 1 to 3 days during the look-back period. Further review showed resident received antipsychotic and antidepressant medications. Review of the current physician orders showed the resident was receiving lorazepam (antianxiety) 0.5 milligrams (mg) by mouth for pain and agitation daily. The following concerns were identified:a. Review of the medical record showed no evidence the facility had identified resident specific or medication specific target…

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 medical record review and staff interview, the facility failed to ensure a bed-hold policy was provided in writing at the time of transfer for 1 of 3 sample residents reviewed (#46) for transfer and discharge. The findings were:1. Review of a progress note dated 12/10/25 and timed 11:03 PM showed resident #46 had small amounts of emesis at beginning of shift and the facility received an order to transport the resident to the emergency department for evaluation and treatment. Review of a progress note dated 12/11/25 and timed 2 AM showed the resident was admitted to the hospital related to a small bowel obstruction, gastrointestinal bleed, sepsis, and supraventricular tachycardia. Review of a Nursing Home Transfer and Discharge Notice dated 12/10/25 showed the resident was provided the transfer notice related to an immediate transfer or discharge required by the residents' urgent medical needs, which cannot be met in the facility. Further review showed the bed-hold policy was marked as attached to the notice; however, no bed-hold policy was attached. Review of the medical…

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 medical record review and staff interview, the facility failed to ensure preadmission screening was performed and was accurate for 1 of 5 sample residents (#3) with qualifying diagnoses. The findings were: 1. Review of the quarterly MDS assessment dated [DATE] showed resident #3 had diagnoses which included post-traumatic stress disorder. The following concerns were identified:a. Review of a PASRR Level I completed on 7/30/23 showed no primary psychiatric diagnosis listed and the decision indicated a PASRR level II was not indicated due to no evidence of mental illness or intellectual disability. b. Interview with the social services director on 2/20/26 at 9:24 AM revealed the resident's diagnosis of post-traumatic stress disorder was identified after admission and a significant change was not completed. He confirmed a new PASRR should have been completed after the diagnosis was received.

Based on Payroll Base Journal (PBJ) review and staff interview, the facility failed to ensure the quarterly PBJ data was submitted timely for 1 of 4 quarters (4th quarter of 2023). The findings were: 1. Review of the four quarters showed the facility failed to submit the July 1, 2023 through September 30, 2023 (4th quarter of 2023) data. 2. Interview with the business office manager on 7/24/24 at 5:08 PM revealed she began submitting the PBJ in January and the facility had another staff member entering the data to PBJ prior to that. Further interview confirmed the 4th quarter of 2023 did not have data submitted.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, policy and procedure review, and manufacturer's recommendation review, the facility failed to ensure medication was labeled with an open date for 1 of 2 medication carts (300 - 400 medication cart). The findings were: 1. Observation on [DATE] at 3:24 PM of the 300 - 400 medication cart with RN #1 showed one Novolog flex pen 100 unit/milliliter with no date, and one Lantus Solostar 100 unit/milliliter with no date. Interview at that time with RN #1 revealed the medication was for resident use, and confirmed the insulins were not dated. She stated they were considered expired. 2. Interview with the administrator on [DATE] at 4:13 PM revealed insulin should have a date on it when it is taken out of the refrigerator. Further interview revealed if the insulin was not dated, staff should dispose of it. 3. Review of the policy and procedure Insulin Administration showed .Steps in the Procedure (Insulin Injections via Syringe) .4. Check expiration date, if drawing from an opened…

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 medical record review, resident and staff interview, and policy and procedure review, the facility failed to ensure residents received services to maintain good personal hygiene for 2 of 3 residents (#11, #24) reviewed for bathing. The findings were: 1. Review of the quarterly MDS assessment dated [DATE] showed resident #11 had a BIMS score of 3 out of 15 (severely cognitive impaired). Review of section GG showed the resident had a range of motion (ROM) impairment of 1 side both upper and lower extremities. Review of the functional abilities showed s/he was dependent for oral hygiene, toileting, showers, upper body dress, lower body dress, personal hygiene, and putting on footwear. Review of the care plan last revised 6/5/24 showed .for transfers mechanical lift (sit to stand) as needed with (2) staff assistance for toileting. Specifically, when transferring for baths or showers, please use full-lift as of 11/24/23 due to decreased ability to support own weight in sit-to-stand . Further review showed…

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 medical record review, and resident and staff interview, the facility failed to ensure residents received services to increase range of motion for 1 of 2 residents (#11) reviewed for restorative services. The findings were: 1. Review of the quarterly MDS assessment dated [DATE] showed resident #11 had a BIMS score of 3 out of 15 (severely cognitive impaired). Review of the resident's range of motion (ROM) showed impairment of 1 side both upper and lower extremities. Review of the functional abilities showed s/he was dependent for oral hygiene, toileting, showers, upper body dress, lower body dress, personal hygiene, and putting on footwear. Further review showed the resident had diagnoses which included stroke, hemiplegia, affecting right dominant side, seizure, and cerebrovascular accident (CVA) and the resident's therapy ended on 3/25/22. Review of the care plan last initiated on 3/1/23 showed [resident name] has limited physical mobility related to CVA. NURSING REHAB/RESTORATIVE: PASSIVE ROM Program…

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 policy review, the facility failed to ensure hand hygiene was done during wound care for 1 of 2 sample residents (#35) who received wound care. The findings were: 1. Observation of wound care on 7/23/24 at 9:28 AM for resident #35 showed LPN #2 changed the dressing on the right upper shoulder without concern. The LPN then doffed her gloves after dating the dressing, and donned gloves and dressed the left lower arm with out hand hygiene in between. 2. Interview with LPN #2 on 7/23/24 at 9:46 AM revealed this was how she always done the dressing changed. She stated she thought she did hand hygiene between doffing and donning. 3. Interview with administrator on 7/23/24 at 3:07 PM revealed staff were expected to perform hand hygiene before donning and when doffing their gloves. 4. Review of policy and procedure Handwashing/Hand Hygiene showed .Applying and Removing Gloves. 1. Perform hand hygiene before applying non-sterile gloves. 3. When removing gloves, [talks about how to removed the gloves included in to 4. ] . 5. Perform hand hygiene.

Based on review of the dishwasher temperature log sheet, policy and procedure, the 2017 U.S. Public Health Service Food Code, and staff interview, the facility failed to ensure the water temperature of the dishwasher was at the proper temperature for sanitization to occur on 22 of 61 days reviewed. The census was 41. The findings were: 1. Review of the dishwasher temperature log sheet showed the temperature of the dishwasher was to be recorded in the morning and in the evening on each day of use. The following concerns were identified: a. Review of the March 2023 dishwasher temperature log sheet showed no temperature was recorded on 3/1, 3/2, 3/3, 3/4, 3/18, 3/26, 3/27, and 3/28. b. Review of the April 2023 dishwasher temperature log sheet showed no temperature was recorded on 4/2, 4/11, 4/14, 4/15, 4/16, 4/17, 4/18, 4/21, 4/22, 4/26, 4/27, 4/28, 4/29, and 4/30. 2. Interview with the certified dietary manager (CDM) on 5/4/23 at 8:42 AM revealed the facility used a dishwasher which required a high temperature of water to ensure the sanitizer was properly dissolved. The CDM stated 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.

Based on resident interview, staff interview, and review of the admission packet, the facility failed to ensure residents were given the required notices. The census was 41. The findings were: 1. Interview with 8 residents of the resident council on 5/2/23 at 10:30 AM revealed the facility had not made them aware of the contact information for, or their right to file a complaint with, the State Survey Agency. 2. Review of the admission packet showed it failed to include the address (email and mailing) and telephone number of the State Survey Agency. In addition, the admission packet failed to include a statement that a resident could file a complaint with the State Survey Agency. 3. Interview with the social worker on 5/2/23 at 10:54 AM confirmed the information in the admission packet did not include all of the required notices.

Based on medical record review, facility investigation review, State Survey Agency incident report log review, policy review, and staff interview, the facility failed to develop and/or 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 of 4 allegations of abuse reviewed (involving resident #145). The findings were: 1. Review of the facility's policy Abuse Prevention, last reviewed 8/6/20, showed PROCEDURE: 1. If abuse or suspicious injuries of unknown origin is suspected: The facility staff will immediately (including nights, weekends, and holidays) report all alleged violations involving mistreatment, neglect or abuse, including injuries of unknown source and misappropriation of property, to the Administrator or his or her designee. a. The Administrator/designee will make notification of reported allegation within 2 hours if the events that cause the suspicion result in serious injury 24 hours if the events that cause the allegation do not involve abuse and do not result in serious…

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.