cms_NE
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36 rows where "inspection_date" is on date 2015-08-13
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| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5992 | 5992 | ROSE LANE HOME | 285228 | RR 2 BOX 46, 1005 NORTH 8TH STREET | LOUP CITY | NE | 68853 | 2015-08-13 | 329 | D | 0 | 1 | 3NYH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview; the facility failed to monitor the effects of a medication given for mood stabilization for one resident (Resident 26). The facility census was 49. Findings are: A review of the Medication Administration Record [REDACTED]. [DIAGNOSES REDACTED]. There was no documentation indicating Resident 26 had a [DIAGNOSES REDACTED]. A review of Davis's Drug Guide for Nurses, Fourteenth Edition, revealed [MEDICATION NAME] had therapeutic classifications of anticonvulsant (anti-[MEDICAL CONDITION]) and mood stabilizer. A review of a Psychoactive Medication (chemical substances that affect the brain functioning, causing changes in behavior, mood and consciousness) Review form for Resident 26, dated 4/21/14-5/28/15, revealed no documentation related to the use of [MEDICATION NAME] for mood stabilization. During an interview on 08/13/2015 at 1:19 PM, the Director of Nursing (DON) revealed [MEDICATION NAME] was not one of the medications the facility had been monitoring related to behavioral concerns for Resident 26. | 2019-07-01 |
| 5993 | 5993 | ROSE LANE HOME | 285228 | RR 2 BOX 46, 1005 NORTH 8TH STREET | LOUP CITY | NE | 68853 | 2015-08-13 | 428 | D | 0 | 1 | 3NYH11 | Licensure Reference Number 175 NAC 12-006.12B Based on record review and interview; the facility failed to ensure monthly pharmacy reviews included documentation related to duplicate medication (more than one medication used to treat the same condition) and possible medication interactions for two residents (Residents 6 and 26). The facility census was 49. Findings are: A. A review of the Medication Administration Record [REDACTED]. A review of the medical record for Resident 6 revealed no documentation indicating monthly pharmacy reviews were completed. B. A review of the MAR for Resident 26 dated (MONTH) (YEAR), indicated the resident received the following meds: Namenda 10 mg twice daily for Alzheimer's Disease, and an Exelon Patch 9.5 mg/24 hours for Alzheimer's Disease. Further review of the medical record for Resident 26 revealed no documentation indicating monthly pharmacy reviews were completed. C. During an interview on 08/13/2015 at 3:04 PM, the Director of Nursing (DON) revealed the Pharmacist signed off on the past months MAR indicated [REDACTED]. | 2019-07-01 |
| 5994 | 5994 | ROSE LANE HOME | 285228 | RR 2 BOX 46, 1005 NORTH 8TH STREET | LOUP CITY | NE | 68853 | 2015-08-13 | 467 | E | 0 | 1 | 3NYH11 | Based on observation, interview, and review; the facility failed to provide functioning vent fans in two resident restrooms, in Rooms 102 and 306. This had the potential to affect 4 residents (Residents 39, 44, 56 and 68). The facility census was 49. Findings are: On 08/12/2015 at 8:54 AM during an Environmental Tour with the Maintenance Director, it was observed that vent fans in resident restrooms for Rooms 102 and 306 were no functioning. On 08/12/2015 at 8:54 AM, an interview with the Maintenance Director revealed, the vent fans in the restrooms for Rooms 102 and 306 were not functioning. The roof fans for the restroom vent fans were checked every three months, with the last check being in (MONTH) (YEAR). The facility used the TELS Maintenance system (TELS is a Senior Living building management system) for routine preventative maintenance. The individual vents in the resident restrooms were checked randomly. No documentation was available to verify any vent fan maintenance checks had been completed. Record review revealed no documentation of routine maintenance checks of the resident restroom vent fans had been completed. | 2019-07-01 |
| 6462 | 6462 | COLONIAL HAVEN | 285204 | 424 HARRISON | BEEMER | NE | 68716 | 2015-08-13 | 157 | D | 0 | 1 | GHXN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC ,[DATE].04C3a(6) Based on record review and interviews, the facility failed to notify a physician of significant weight changes while on Diuretic (water pills) medications for Resident 5. The facility census was 32. Findings are: A closed record review of Resident 5's face sheet revealed an admission date of [DATE] and a [DIAGNOSES REDACTED]. Review of Resident MARS (Medication Administration Records) for (MONTH) (YEAR) revealed the resident received: -[MEDICATION NAME] (diuretic) 40mg (milligrams) daily ,[DATE] to [DATE] -[MEDICATION NAME] 80mg daily [DATE] to [DATE] -[MEDICATION NAME] (diuretic) 5mg daily [DATE] to [DATE]. Review of the weight log for Resident 5 revealed: -[DATE] on admission, weight (wt) 244 pounds (lbs) -[DATE] wt was 250 lbs -[DATE] wt was 252 lbs -[DATE] wt was 258 lbs -[DATE] wt was 249 lbs -[DATE] wt was 241 lbs A progress note dated [DATE] at 1:56 am stated Resident 5 was unresponsive, 911 was called, CPR (cardiopulmonary resuscitation) initiated and resident was transferred to the hospital. A review of the progress notes revealed no physician notification Resident 5's increased wt gain on [DATE], [DATE] or [DATE], nor of the weight loss on [DATE] or [DATE]. An interview conducted with the Director of Nursing (DON) on [DATE] at 11:40 am confirmed that the physician was not notified of Resident 5's weight changes. The DON stated, Yes, the physician is expected to be informed, as they may want to change orders, especially with these weight changes. | 2019-02-01 |
| 6463 | 6463 | COLONIAL HAVEN | 285204 | 424 HARRISON | BEEMER | NE | 68716 | 2015-08-13 | 332 | E | 0 | 1 | GHXN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.10D Based on observation, record review, and interview, the facility failed to ensure a medication error rate below 5 % related to [MEDICATION NAME] (laxative) administration for Residents 14 and 30 and [MEDICATION NAME] (acid reducer) administration for Resident 11. The facility error rate was 12%. Facility census was 32. Findings are: A. Observation on 08/12/2015 at 8:33 AM of medication administration revealed Registered Nurse (RN)-A administered [MEDICATION NAME] (laxative) to Resident 14 . [MEDICATION NAME] was mixed in a small plastic cup . Review of Physicians orders dated (MONTH) (YEAR) for Resident 14 revealed the order revealed the direction of mix in 8 oz of water or juice. Observation on 08/12/2015 at 8:35 AM of medication administration revealed RN-A administered [MEDICATION NAME] to Resident 30. [MEDICATION NAME] was mixed in a small plastic cup . Review of Physicians orders dated (MONTH) (YEAR) for Resident 30 revealed the order revealed the direction to mix in 8 oz of water or juice. Interview on 08/12/2015 at 10:49 AM with RN-A revealed the plastic drinking cups on the medication cart are used to mix the residents [MEDICATION NAME] in and they hold 4 oz of liquid. B. Observation on 8/12/15 at 8:40 AM of medication administration for Resident 11 revealed RN-A administered Omeprazol to Resident 11 after Resident 11 had began to eat breakfast. Review of Resident 11's Physician order [REDACTED]. Review of Resident 11's Medication Administration Record [REDACTED]. 08/12/2015 11:37:25 AM Interview with the DON (Director of Nursing) revealed that the [MEDICATION NAME] order should be scheduled prior to the meal being served. | 2019-02-01 |
| 6464 | 6464 | COLONIAL HAVEN | 285204 | 424 HARRISON | BEEMER | NE | 68716 | 2015-08-13 | 441 | E | 0 | 1 | GHXN11 | Licensure Reference Number 175 NAC 12-006.17D Based on observation, record review, and interview; the facility failed to ensure hand washing was completed during insulin administration for Residents 20 and 26, and failed to disinfect the glucometer after obtaining a blood sample for Resident 24 to prevent the potential for cross-contamination. Facility census was 32. Findings are: A. Observation on 08/12/2015 at 7:15 AM during medication pass revealed RN (Registered Nurse)-A was preparing to administer Insulin (diabetes medication) to Resident 20. RN-A entered the room and donned gloves without washing hands and administered the insulin. Observation on 08/12/2015 7:20 AM of insulin administration for Resident 26 revealed RN-A entered the resident's room holding the two insulin pens and placed them on the resident's bed. RN-A then entered bathroom and washed hands for 10 seconds. Review of the facility policy dated 2/9/2012 titled Handwashing/Hand Hygiene revealed the following: Employees must wash their hands for at least twenty seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: -Before and after direct resident contact, - before and after performing any invasive procedure, Interview on 08/12/2015 at 11:31 AM with the DON (Director of Nursing) revealed that hand washing should be completed prior to donning gloves and should have been done for at least 20 seconds. B. Observation on 08/12/2015 at 7:45 AM revealed Medication Aide (MA)-B completing a blood sugar monitoring for Resident 24. MA-B entered Resident 34's room and put on gloves without performing and washing. After completing the glucometer (machine for testing blood sugar) check, MA-B removed the gloves and handled the glucometer machine with bare hands. MA-B returned the glucometer back to the medication cart and placed it on the top of the clean medication cart with no barrier. MA-B used sanitizing hand wipe to wipe hands then picked up the unsanitized glucometer from medication cart with bare hands and wiped… | 2019-02-01 |
| 6649 | 6649 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2015-08-13 | 157 | D | 0 | 1 | 1MDI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.04Ca Based on record review and interview, the facility staff failed to notify the responsible party for 1 resident (Resident 311) of changes in orders. The facility staff identified a census of 121. Findings are: Record review of an Admission Record sheet dated 1-2-2015 revealed Resident 311 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Record review of Physician Orders/Progress Notes dated 10-14-2013 revealed orders that instructed Resident 311's blood sugar level be tested 4 times a day. Record review of a physician's orders [REDACTED]. to continue [MEDICATION NAME] 100 u/ml (milliliter) sliding scale insulin Record review of a physician's orders [REDACTED]. Record review of Resident 311's record did not contain evidence Resident 311's Responsible Party/Family member was notified of the change in insulin orders for Resident 311. On 8-17-2015 at 11:23 AM a phone interview was conducted with the facility Administrator. During the interview the Administrator reported not able to locate evidence Resident 311's Responsible/Family had been notified in the change in insulin orders. | 2018-11-01 |
| 6650 | 6650 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2015-08-13 | 280 | D | 0 | 1 | 1MDI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.09C1c Based on record review and interviews; the facility failed to review and revise care plans for the use of psychoactive medications for 2 residents (Resident 127 and 290). The facility staff identified a census of 121. A. Record review of Resident 290's Admission Record revealed Resident 290 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of an Electronic Physician order [REDACTED]. Record review of Resident 290's Comprehensive Care Plan (CCP) dated 07/02/2015 revealed Resident 290 was taking an antidepressant medication for [DIAGNOSES REDACTED]. - Administer [MEDICAL CONDITION] medication as ordered by physician. Monitor for behaviors of _____ and ____ if behavior seen. - Administer antidepressant medication as ordered by physician. Monitor for behaviors of ____ and ____ if behavior seen. - Administer anti-anxiety medications as ordered by physician. Monitor for behaviors of ____ and ____ if behavior seen. - Name of the interventions on the CCP contained nonpharmacological interventions or targeted behaviors. Interview with the Director of Nursing (DON) on 08/13/2015 at 7:16 AM revealed, the DON confirmed that Resident 290's CCP care plan did not contain nonpharmacological interventions or targeted behaviors for the antidepressant, antipsychotic and the antianxiety medication for Resident 290. The DON also confirmed that the blanks on the care plan were to be filled in and not left blank. B Record review of a pharmacy Consultation Report signed on 7-13-2015 revealed Resident 127 was on Quetipine for depression. The Consultation report had identified that depression was indicated for this medication and gave Resident 127's physician some options for a diagnoses. Resident 127's physician identified the medication was being used for behavioral or psychological symptoms of dementia. The symptom criteria was identified as hallucination and paranoia. Record review of Resident 127's C… | 2018-11-01 |
| 6651 | 6651 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2015-08-13 | 323 | D | 0 | 1 | 1MDI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09D7a Based on observation, interview, and record review; the facility failed to evaluate side rail safety for 2 residents (Resident 134 and 30). The facility had a total census of 121 residents. Findings are: Resident 30 was admitted to the facility on [DATE] and had a [DIAGNOSES REDACTED]. Observations on 8/12/15 at 7:52 AM, 8/12/15 at 2:02 PM and 8/13/15 at 7:51 AM revealed a half side rail raised on the side of the bed next to the wall. Observations revealed the side rail was loose. In an interview on 8/13/15 at 7:51 AM, Registered Nurse B confirmed the side rail was loose. A review of the Side Rail Rationale Screen dated 3/17/15 revealed the following: Resident 30 demonstrated poor bed mobility or difficulty moving to a sitting position on the side of the bed. Resident 30 expressed a desire to have side rails raised while in bed. Resident 30 was currently using side rails for positioning or support and Resident 30 needed/requested side rails for turning and positioning. The screen included decision options regarding the need for side rails which were not completed for Resident 30. Documentation on the side Rail Rationale Screen stated the side rail rational screen was to be completed upon admission, re-admission, quarterly, and as needed with resident condition changes. A review of Resident 30's Interdisciplinary Team Assessment and Progress Note dated 7/27/15 did not identify Resident 30's side rail under safety devices section and the comment section under review of safety risk and devices was not completed. In an interview on 8/13/15 at 3:12 PM, Registered Nurse B confirmed that the side rail safety evaluation was not completed on the 7/27/15 Interdisciplinary Team Assessment and Progress Note. A review of the facility Procedure titled Side-Rails, Use and Safety of dated 2008 revealed bed-rails shall be checked for loosening or bowing of the rail, gaps between the rail and the mattress, or la… | 2018-11-01 |
| 6652 | 6652 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2015-08-13 | 329 | D | 0 | 1 | 1MDI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D Based on record review and interview; the facility staff failed to have the clinical indications for use and failed to identify specific target behaviors for 3 residents ( Resident 80, 127 and 290) who received psychoactive medications and failed to implement non-pharmacological interventions prior to administering an anti-anxiety medication for 1 resident ( Resident 290). The facility staff identified a census of 121. Findings are: A. Record review of Resident 80's Medication Administration Record [REDACTED]. Record review of Resident 80's Behavior monitoring from 7-15-2015 through 8-12-2015 revealed there were no specific behaviors being monitored for the use of the anti-psychotic medication. An interview was conducted with the facility Director of Nursing (DON) on 8-13-2015 at 10:53 AM. During the interview, Resident 80's use of the Quetipine was reviewed with the DON. The DON confirmed there were no specific behaviors being monitored for the use of the medication and further confirmed the indication for the use of the antipsychotic medication was not correct. B. Record review of a pharmacy Consultation Report signed on 7-13-2015 revealed Resident 127 was on Quetipine for depression. The Consultation reported had identified that depression was indicated for this medication and gave Resident 127's physician some options for a diagnoses. Resident 127's physician identified the medication was being used for behavioral or psychological symptoms of dementia. The symptom criteria was identified as hallucination and paranoia. Review of Resident 127's behavior monitoring sheet from (MONTH) 30th through (MONTH) 12 revealed there were no specific behaviors being monitored related to hallucinations or paranoia. An interview was conducted with the facility Director of Nursing (DON) on 8-13-2015 at 10:54 AM. During the interview, Resident 127's use of the Quetipine was reviewed with the DON. The DON confirm… | 2018-11-01 |
| 6653 | 6653 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2015-08-13 | 333 | D | 0 | 1 | 1MDI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09D3 Based on observation, record review and interview; the facility staff failed to ensure 1 resident ( Resident 125) was free of a significant medication error. The facility staff identified a census of 121. Findings are: Record review of Resident 125's Comprehensive Care Plan (CCP) dated 8-10-2015 revealed Resident 125's admitted on the CCP was identified as 8-01-2015 with the [DIAGNOSES REDACTED]. Record review of a physician's orders [REDACTED]. Record review of Resident 125's Medication Administration Record [REDACTED]. The amount of insulin ( also know as sliding scale insulin) to be administered was based on result of Resident 125's blood sugar level. Observation on 8-12-2015 at 2:15 PM revealed Licensed Practical Nurse (LPN) C had obtained Resident 125's blood sugar level of 344. According to the practitioners orders the sliding scale of insulin was 8 units of additional [MEDICATION NAME] insulin. LPN C drew up the 12 units of scheduled [MEDICATION NAME]and the 8 additional units of sliding scale [MEDICATION NAME]and administered the insulin to resident 125. An interview was conducted with LPN C on 8-12-2015 at 2:18 PM. During the interview LPN C confirmed the insulin was to have been given at meals. LPN C confirmed Resident 125 had eaten lunch and giving the insulin after lunch was an error. An interview with the Director Of Nursing (DON) was conducted on 8-12-2015 at 2:20 PM. During the interview, when asked if administering the insulin late was a significant error, the DON stated yes. | 2018-11-01 |
| 6654 | 6654 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2015-08-13 | 371 | F | 0 | 1 | 1MDI11 | Licensure Reference: 175 NAC 12-006.11E Based on observation, interview, and record review; the facility failed to ensure outdated food was not available for consumption, failed to label and date leftover food, failed to ensure food was stored to prevent potential contamination, and failed to ensure nonfood contact surfaces were maintained in a clean manner. The facility practice had the potential to affect all 113 residents who eat meals prepared at the facility. The facility had a total census of 121 residents. Findings are: Observation during a tour of the kitchen and dry storage area on 8/10/15 between 9:22 AM-9:40 AM revealed the following: -A container of heavy sour cream with an expiration date of 7/12/15; -One large steam table pan and one small steam table pan containing gravy that was not labeled or dated. -A box containing Instant Food Thickener located on the floor in the dry food storage area. The plastic bag inside the box was not closed exposing the Instant Food Thickener to potential contamination. Observations on 8/12/15 between 10:32-11 AM and 8/13/15 1:01 PM revealed the following nonfood contact surfaces were soiled with an accumulation of dust and/or dried on food spills: -Louvered doors to the heating/air conditioning unit -Sides and base of the plate warmer -Sides of the sugar and flour bins -Outside of the deep fat fryer -Based and sides of the large mixer -Outside of the convection oven In an interview on 8/13/15 at 1:01 PM, the Dietary Department Director confirmed nonfood contact surfaces were in need of cleaning and were on the cleaning schedule to be completed daily. The Dietary Department Director confirmed all left over foods need to be labeled and dated and Instant Food Thickener should be stored on the self and sealed up. The Dietary Department reported the expired sour cream was an over site. Review of the 3/8/2012 version of the Food Code, based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practice… | 2018-11-01 |
| 6655 | 6655 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2015-08-13 | 441 | D | 0 | 1 | 1MDI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.17D Based on observation and interview; the facility staff failed to utilize handwashing and gloving techniques to prevent potential cross contamination during treatments for 1 resident (Resident 262). The facility staff identified a census of 121. Findings are: Record review of Resident 262's Comprehensive Care Plan (CCP) dated 8-11-2015 revealed an admission date of [DATE] with [DIAGNOSES REDACTED]. Further review of Resident 262's CCP revealed Resident 262 was tube fed and had a tracheotomy. Observation on 8-12-2015 at 8:27 AM of treatments to the tube feeding insertion site and tracheotomy care revealed Registered Nurse (RN) G completed hand washing and donned gloves. RN G obtained the required supplies. RN G removed the gloves after opening a container with the sterile supplies for tracheotomy care and applied the sterile gloves. Observation of Resident 262 revealed there was sputum on the tracheotomy mask. RN G unfastened the tracheotomy mask with the left gloved hand. RN G using the right hand suctioned Resident 262. Observations at this time revealed RN G was holding part of the suction tubing in the left hand with the soiled glove. RN G removed the soiled gloves and completed handwashing. RN G removed a pulse oximeter from (gender) pocked and placed it onto a finger on Resident 262's right hand. RN G completed handwashing, donned gloves, obtained the needed supplies for the feeding tube insertion site cares. RN G removed the soiled dressing around the tube and completed cleaning the insertion site. RN G without changing the soiled gloves applied a new dressing around the tube insertion site. RN G completed the treatments for Resident 262 and removed the pulseoximeter and placed it around (gender) neck. The pulseoximeter was not cleaned after removing it from the resident. An interview was conducted on 8-12-2015 at 9:03 AM. During the interview, RN G confirmed the suction tube and pulseoxcimet… | 2018-11-01 |
| 6903 | 6903 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 241 | D | 0 | 1 | HIRN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.05 (20) AND 12-006.05 (21) Based on observation, interview, and record review; the facility failed to treat 2 residents (Resident 66 and Resident 120) in a dignified manner by dressing them in hospital type gowns during the day, failing to knock and wait for permission before entering one resident's room (Resident 22), and by posting confidential medical information in an area visible to the public for 1 resident (Resident 120). The facility census at the time of survey was 129. Findings are: A. Observation of Resident 66's room on 8/11/2015 at 11:16 AM revealed a sign on the armoire door in Resident 66's room that stated family does not want teeth put in until sores heal. The sign was visible to Resident 66's roommate and anyone else that entered the Resident 66's room. Observation of Resident 66 on 8/11/2015 at 11:16 AM revealed Resident 66 dressed in a hospital type gown. Observation of Resident 66 on 8/12/2015 at 3:59 PM revealed Resident 66 dressed in a hospital type gown. Observation of Resident 66 on 8/12/2015 at 4:58 PM revealed Resident 66 dressed in a hospital type gown. Review of Resident 66's care plan dated 3/28/2011 revealed that Resident 66 required extensive assistance with dressing due to weakness on the left side of the body due to a stroke. There was no documentation on Resident 66's care plan that Resident 66 was to be dressed in a hospital type gown during the day. Review of Resident 66's annual MDS (a comprehensive resident assessment tool used in care planning) dated 6/12/2015 revealed an admission date of [DATE]. Resident 66 had a BIMS (Brief Interview for Mental Status) score of 10 indicating moderately impaired cognitive function. Resident 66's functional status revealed that Resident 66 required extensive assistance from 2 staff persons for bed mobility and dressing and Resident 66 was totally dependent on staff for locomotion, eating, tilting, personal hygiene, and bathing.… | 2018-08-01 |
| 6904 | 6904 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 242 | D | 0 | 1 | HIRN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 006.05 (4) Based on interview and record review, the facility failed to ask 1 resident (Resident 79) about bathing preference. The facility census at the time of survey was 129. Findings are: Interview with Resident 79 on 8/11/2015 at 3:38 PM revealed that the facility had not asked Resident 79 how many baths a week Resident 79 would desire. I only get one. I would like more, but they didn't ask. Review of Resident 79's care plan dated 7/17/2015 revealed no documentation of Resident 79's bathing preference. Review of Resident 79's bathing documentation revealed that the resident received 1 bath per week from 6/3/2015 to 8/3/2015. Review of Resident 79's significant change in status MDS (an assessment tool) dated 6/21/2015 revealed an admission date of [DATE]. Resident 79's BIMS (Brief Interview for Mental Status) score was 15 indicating resident was cognitively intact. Review of Resident 79's functional status revealed that Resident 79 required extensive assistance from one staff person for bathing. Interview with Resident 79 on 8/12/2015 at 4:53 PM confirmed that the facility had not asked Resident 79 about bathing preference. Interview with the DON (Director of Nursing) on 8/13/2015 at 9:57 AM confirmed that there was no documentation that the facility had asked Resident 79 about bathing preference. | 2018-08-01 |
| 6905 | 6905 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 253 | E | 0 | 1 | HIRN11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.18A Based on observation and interview; the facility failed to provide a clean and comfortable environment for 25 of the 129 residents (Residents 52, 134, 192, 120, 127, 69, 95, 43, 136, 123, 41, 134, 57, 79, 68, 90, 173, 38, 115, 16, 66, 76, 114 and 156) by not painting the door or door frames, not fixing the marred doors, not fixing the cracked caulking around the toilets, not securing the sinks in bathrooms, not cleaning or replacing stained linoleum in bathrooms, not ensuring ceiling vents worked and not cleaning ceiling vents. The facility census was 129 at the time of the survey. Findings are: A. Tour of the room occupied by Resident 136 on 8/11/15 at 8:36 AM revealed the ceiling vent in the bathroom was not functioning. B. Tour of the room occupied by Resident 69 on 8/11/15 at 9:24 AM revealed a gray stain on the floor with a brown stain around the toilet in the bathroom. C. Tour of the room occupied by Resident 95 on 8/11/15 at 10:20 AM revealed a gray stain on the floor with a brown stain around the toilet in the bathroom. D. Tour of the room occupied by Resident 90 on 8/11/15 at 10:31 AM revealed the ceiling vent was not functioning. E. Tour of the room occupied by Resident 192 on 8/11/15 at 10:37 AM revealed the ceiling vent in the bathroom was no functioning. F. Tour of the room occupied by Resident 120 on 8/11/15 at 10:37 AM revealed the ceiling vent in the bathroom was covered with a gray debris. The closet doors and room door were marred. G. Tour of the room occupied by Resident 66 on 8/11/15 at 11:15 AM revealed the ceiling vent in the bathroom was not functioning. The bathroom and room doors were marred. H. Tour of the room occupied by Resident 68 on 8/11/15 at 11:20 AM revealed the caulking was cracked around the bathroom toilet and the paint was chipped on the heater. I. Tour of the room occupied by Resident 79 on 8/11/15 at 11:22 AM revealed the sink in the bathroom was not secure. The ceiling vent fan in the bathroom was covered with a gray debris. T… | 2018-08-01 |
| 6906 | 6906 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 312 | E | 0 | 1 | HIRN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D1c Based on interviews and record review, the facility failed to provide bathing assistance to 3 residents (Resident 52, Resident 54, and Resident 127 ) that required assistance with bathing. The facility census was 129 at the time of survey. Findings are: A. Interview with Resident 52 on 8/12/2015 at 9:26 AM revealed that Resident 21 was scheduled to receive 2 baths a week but Resident 52 did not always receive a bath. I would like more baths but I don't get more because they don't have enough staff. The bath aide gets pulled to the floor a lot because they are short . I am not even getting the 2 baths a week they set up for me. Sometimes I don't get one. B. Review of Resident 52's annual MDS (an assessment tool) dated 12/5/2014 revealed a BIMS (Brief Interview for Mental Status) score of 15 indicating that Resident 52 was cognitively intact. Resident 52's functional status indicated that the resident required extensive assistance from 2 staff for bathing. Review of the facility bathing documentation revealed that there was no documentation that Resident 52 received a bath from 7/9/2015 to 7/20/2015 and from 8/1/2015 to 8/11/2015. Interview with the facility administrator on 8/13/2015 at 9:38 AM confirmed that there was no documentation that Resident 52 received a bath from from 7/9/2015 to 7/20/2015 and from 8/1/2015 to 8/11/2015. Interview with the DON (Director of Nursing) on 8/13/2015 at 9:57 AM confirmed that there was no documentation that Resident 52 received a bath from 7/5/2015 to 7/20/2015 and from 8/1/2015 to 8/11/2015. C. Interview with Resident 127 and the outside care giver on 8/12/2015 at 10:00 AM revealed the resident did not get bathed. Review of Resident 127's care plan revealed the resident was dependent on staff for cares Review of the MDS (a federally mandated comprehensive assessment tool used for care planning) dated 7/30/2015, revealed the ADL's (Activities of daily living … | 2018-08-01 |
| 6907 | 6907 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 323 | E | 1 | 1 | HIRN11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.18B3 Based on observation and interviews, the facility failed to ensure adaptive equipment was maintained for safe use by residents and failed to secure potentially hazardous chemicals. This had the potential to affect 20 residents in the facility that were using the adaptive equipment and 22 residents that resided in the area that had potential access to the hazardous chemicals. The facility census was 129 at the time of survey. Findings are: A. Observation of Resident 52's bathroom on 8/11/2015 at 5:18 PM revealed that the adaptive toilet riser in the bathroom was not secured to the toilet. Interview with Resident 52's roommate on 8/11/2015 at 5:30 PM revealed Resident 52's roommate had a fear of falling when using the toilet because the toilet riser was not secured to the toilet and tipped forward. B. Observation of Resident 173's bathroom on 8/11/2015 at 5:36 PM revealed that the adaptive toilet riser was not secured to the toilet. Interview with the facility Administrator on 8/12/2015 at 10:14:58 AM revealed that the facility did not have a plan in place to monitor the safety of the toilet risers. Interview with the facility Administrator on 8/12/2015 at 3:54 PM revealed that 20 toilet risers in the facility were not secured to the toilet and were deemed unsafe. LICENSURE REFERENCE NUMBER 175 NAC 12-006.18E4 Observed on 08-10-2015 at 3:52 PM, the door to the bath house on the 400 wing was not locked and the door opened. Upon investigation of the room found the following items: An unlocked cabinet with an opened 28 ounce container of Ajax cleansing powder without a lid approximately 3/4 full. (According to the MSDS-Material Safety Data Sheets, dated 9-21-2012, the hazards identified revealed: causes eye irritation on direct contact; may cause skin irritation upon prolonged contact; ingestion may be harmful if swallowed in large quantities). Sitting on the counter was a spray bottle of U-1+ Germicidal Cleaner Ready to Use. (According to the MSDS dated 10-29-2013, the h… | 2018-08-01 |
| 6908 | 6908 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 334 | D | 0 | 1 | HIRN11 | Based on Interviews and Record Reviews, the facility failed to provide documentation of education or consent/refusal for the influenza immunization for 3 of 5 sampled residents (Resident 110, 125, and 41). The facility census at the time of the survey was 129. Findings are: A. Record review on 08/12/2015 revealed Resident 110 received an influenza immunization on 10/30/2014. Further review revealed no evidence of documentation of resident/personal representative education of potential risks and benefits or resident/personal representative consent/refusal for the influenza immunization. B. Record review revealed Resident 125 received an influenza immunization on 10/31/2014. Further review revealed no evidence of documentation of resident/personal representative education of potential risks and benefits or resident/personal representative consent/refusal for the influenza immunization. C. Record review revealed Resident 41 received an influenza immunization on 10/30/2014. Further review revealed no evidence of documentation of resident/personal representative education of potential risks and benefits or resident/personal representative consent/refusal for the influenza immunization. Review of the facility policy for immunizations titled Influenza/Pneumococcal Immunization Guideline with a Last Review Date of 12/01/2014 stated, The resident and/or responsible party will be required to sign the Immunization Consent & Declination Form. The Resident Annual Consent or Declination Form will be signed each year as proof that education of risk/benefits was provided on the influenza vaccine. Record review of the Facility Immunization Report, a list of residents/personal representatives who had received education about the risks and benefits of the influenza immunization and had given consent to receive the influenza immunization, did not contain Resident 125, Resident 110, and Resident 41. Interview with the DNS (Director of Nursing Services) and LPN-A (Licensed Practical Nurse) on 08/12/2015 at 4:33 PM revealed the Facilit… | 2018-08-01 |
| 6909 | 6909 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 367 | D | 0 | 1 | HIRN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.11A4 Based on observation, record review, and interviews; the facility failed to serve the modified texture diet to a resident as prescribed by the Physician to prevent choking for Resident 108. The facility census was 129. Findings are: Observed on 8-12-15 at 1:06 PM, Resident 108 eating lunch in the 400 unit kitchen dining room. Observed resident being served regular textured roast beef for the meal. Resident 108 independently fed self. A nurse aide asked Resident 108 if resident needed assistance, which Resident 108 denied and continued feeding self. At 1:29 PM, Resident 108 started coughing and choking resulting in his face turning dark red in color. A nurse aide responded to Resident 108's side and asked Resident 108 if (gender) was okay. Resident 108 shook head no. Another aide summoned the nurse while one aide stayed with Resident 108 and reassured Resident 108. The nurse arrived and assessed and continued to monitor Resident 108 until coughing lessoned and resolved. At 1:32 PM, Resident 108 started to feed self again. Interview on 8-12-15 at 1:32 PM with NA-F (nurse aide) confirmed resident had been served regular texture meat. Record review of physician orders [REDACTED]. Interview on 08-13-2015 at 8:26 AM with the RD (Registered Dietician) revealed a mechanical soft texture diet consists of the meat ground up. Review on 08-13-2015 at 8:15 AM of Diet Type Report revealed Resident 108 name with diet type as Regular, Diet texture as mechanical soft. Interview on 08-13-2015 at 8:15 AM with NA-E revealed staff have a list (titled Diet Type Report) with resident names and resident diet orders posted on the inside of a kitchen cabinet door in the kitchen dining room for reference. Interview with NA-E while serving breakfast in the activity dining room, across the hall, revealed staff reference back to the list in the cabinet in the kitchen dining room to know what textured diet to serve the residen… | 2018-08-01 |
| 6910 | 6910 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 371 | E | 0 | 1 | HIRN11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.11E Based on observation, interview, and record review; the facility staff failed to perform hand hygiene between tasks while serving food to residents in the dining room and the facility failed to monitor 2 unit refrigerator temperatures to assure food did not fall into the danger zone (temperatures above 41 degree F that allow the rapid growth of pathogenic microorganisms that can cause foodborne illness). The facility also failed to store dry foods to prevent potential contamination. This had the potential to affect the 128 residents who were served food from the facility kitchen. The facility census was 129 at the time of survey. Findings are: A. Observation of the east dining room on 8/10/2015 at 12:50:40 PM revealed NA-B touched NA-B's hair then touched a glass without performing hand hygiene and served it to a resident after filling it with chocolate milk. B. Observation of the east dining room on 8/10/2015 at 1:19 PM revealed LPN-C performed a 4 second hand scrub with hand sanitizer then served plates of food to residents and retrieved a glass of milk for a resident. Review of the facility policy Infection Control-Hand Washing dated 2/2/2015 revealed the following for when to wash hands: -upon entering the dining services department; -before handling food, clean equipment, utensils, dishes or service wear; -before any food handling, preparation or service; -after touching hair, beards or any piercing; -all staff will sanitize hands prior to serving a meal to a patient; -alcohol gel is not a substitute for hand washing with soap and water. Interview with the DON (Director of Nursing) on 8/13/2015 at 10:25 AM revealed that hand hygiene should be performed per facility policy. LICENSURE REFERENCE NUMBER 175 12-006.11E C. Record review on 08-11-2015 at 3:33 PM of the 400 unit kitchen refrigerator and freezer temperature log for the month of (MONTH) (YEAR) was incomplete. The form Temperature Log revealed temperatures were to be recorded at the beginning of the AM and … | 2018-08-01 |
| 6911 | 6911 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 431 | E | 0 | 1 | HIRN11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.12E4 Based on observation, interviews, and record review; the facility failed to remove outdated medications from the medication cart for potential use by residents. This had the potential to affect the residents from the 100 hall. Facility census was 129 at the time of survey. Findings are: Observation of the 100 hall medication cart on 8/13/2015 at 2:52 PM revealed the following outdated medications: [REDACTED] -Stool Softener-100 tablet bottle 1/4 full with an expiration date of 12/2014; -Arthritis pain reliever-50 tablet bottle 1/3 full with an expiration date of 3/2015; -Antacid 72 tablet bottle 1/2 full with an expiration date of 9/2014; -Thermotabs 100 tablet bottle 1/2 full with an expiration date of 4/2015; -Glucosamine sulfate 500 mg (milligram) 60 capsule bottle 3/4 full with an expiration date of 6/2015; -Vitamin D-400 IU (internation units) 100 tablet bottle 3/4 full with an expiration date of 2/2015; -Calcium 500 mg tablet 100 tablet bottle 3/4 full with an expiration date of 10/2014; - -Hawthorn Berries 535 mg full 180 tablet bottle with an expiration date of 7/2015; Observation of LPN-C administering medications on 8/11/2015 on 8:46 AM revealed LPN-C poured medications out of bulk medication supply bottles and administered them to residents. Interview with LPN-C on 8/11/2015 on 8:46:53 AM revealed that the facility administered over the counter medications out of bulk medication supply bottles for all residents. LPN-C confirmed that the bulk medication supply bottles were not labeled with the individual residents name and were used for all residents Interview with the DON (Director of Nursing) on 8/13/2015 on 2:52 PM confirmed that the medications were outdated and should not be on the medication cart for use by residents. Review of the policy Expiration Dating provided by the DON revealed that it is the responsibility of nurses who administer medications to monitor the expiration dates of the medications. All expired medications were to be disposed of per… | 2018-08-01 |
| 6912 | 6912 | SCOTTSBLUFF CARE AND REHABILITATION CENTER, LLC | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-08-13 | 520 | E | 0 | 1 | HIRN11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.07 Based on record review and interviews; the facility's Quality Assurance Committee (QA) failed to develop and implement plans of actions to correct issues of deficient practice relevant to resident care and services. The facility failed to implement effective plans of action to maintain correction for previously cited areas of deficient practice identified at F253 and 431. This had the potential to affect all residents that resided in the facility. The facility census was 129 at the time of the survey. Findings are: Record review of the facility Statement of Deficiencies for the annual survey completed on 7/31/2014 revealed the facility was cited at F253 on 4/20/12, 6/20/13, 7/31/2014. The facility was also cited at F431 on 4/20/12, 6/20/13, 7/31/2014. The facility was found to be deficient in areas of regulatory compliance after the tasks of the annual standard survey were completed on 8/13/2015. The facility failed to maintain corrections for the regulations identified as repeat deficiencies and failed to identify and develop plans of action to prevent deficient practice in the areas identified below. Please refer to the Tag citations for specific detailed findings: F253-Failed to maintain a clean and comfortable environment. F431-The facility failed to remove outdated medications from the medication cart for potential use by residents. Interview with the Administrator on 7/13/2015 at 2:30 PM revealed that the facility QA Committee did not have current programs in place to address the current deficient practices in these areas. | 2018-08-01 |
| 6952 | 6952 | SUNRISE COUNTRY MANOR | 285232 | PO BOX A, 610 224TH STREET | MILFORD | NE | 68405 | 2015-08-13 | 157 | G | 1 | 0 | HXM711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.04C3a (6) Based on interview and record review, the facility failed to notify one resident's (Resident 2) physician of a fall with injury in order to not delay treatment. The facility census was 67. Findings are: Review of Resident 2's History of Present Illness dated 8/24/14 revealed that the resident had increased weakness, multiple falls, and was not eating or drinking well. The resident was not caring for self at home with having physical decline in multiple areas. The resident's Discharge [DIAGNOSES REDACTED]. Review of Resident 2's Quarterly MDS (Minimum Data Set: a federally mandated comprehensive tool used for care plans) revealed that the resident had a BIMS (Brief Interview for Mental Status) of 9 (8-12 is moderately cognitively impaired). The resident's Total Severity Score for mood was 2 (1-4 is minimal depression). The resident had delusions and displayed other behaviors one to three days weekly. The resident required supervision with bed mobility and transfers. The resident was independent with ambulation and locomotion with the use of a walker. The resident required limited assistance with toileting. The resident had balance issues, but was able to correct on own. The resident was frequently incontinent of urine, but was not on a toilet plan. The resident had pain rated at a 7. The resident had shortness of breath with exertion, sitting, and lying down. The resident had two falls since the last MDS with no injury. The resident took antianxiety medication, antidepressants, and anticoagulants (blood thinners). The resident did not receive therapy or restorative services. Review of Resident 2's IDPN (Interdisciplinary Progress Notes) revealed: -On Saturday, 7/25/15 at 5 PM, the IDPN stated At 1135 Res (resident was witnessed by staff losing (resident) balance while trying to sit in (resident) chair at the DR (dining room) table. (Resident) leaned up against the wall and slid down it onto t… | 2018-08-01 |
| 6953 | 6953 | SUNRISE COUNTRY MANOR | 285232 | PO BOX A, 610 224TH STREET | MILFORD | NE | 68405 | 2015-08-13 | 280 | D | 1 | 0 | HXM711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 12-006.09C1c Based on observation, record review and staff interviews; the facility failed to implement a system for care planning to review and revise care plans for two residents with repeated falls. The facility also failed to provide information on the change of the resident's needs/condition to direct care staff for the resident's ongoing medical needs. This practice affected Resident 2 and 3. Facility census 67. Findings are: A. Review of Resident 3's medical record revealed the resident sustained [REDACTED]. Resident 3 was admitted to the facility in (MONTH) 2012. Resident [DIAGNOSES REDACTED]. Review of the facility fall log, facility fall investigations and fall tracking log for Resident 3 on 8/13/15 for June, (MONTH) and (MONTH) (YEAR) revealed the resident had experienced 9 falls with one emergency room encounter for a head injury and one hospitalization for a fractured femur requiring surgical repair. On 7/31/15, the resident was provided with a tilt in space wheelchair for positioning needs. Interview with Nursing Assistants P and K on 8/13/15 at 2:38 pm revealed that a care sheets notebook was kept at the nursing station to refer to residents current interventions and needs. A copy of this care sheet provided on 8/13/15 revealed the date of 4/28/15 as the last time the report was reviewed/updated. Observation of a transfer for Resident 3 on 8/13/15 at 1:47 pm with the Assistant Director of Nursing and Nursing Assistant T, revealed the resident had an abductor pillow between knees and lower legs. The resident was transferred with two staff using a gait belt and residents feet were placed on a pivot disc on floor. Resident was laid in bed and the abductor/immobilizer pillow was placed on the resident. Review of the Care sheets noted Resident 3's transfer/ambulation/ mobility as one Assist, independent in wheelchair. There was no information about the resident's current fracture/use of abductor pillow or … | 2018-08-01 |
| 6954 | 6954 | SUNRISE COUNTRY MANOR | 285232 | PO BOX A, 610 224TH STREET | MILFORD | NE | 68405 | 2015-08-13 | 323 | G | 1 | 0 | HXM711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 12-006.09D7b Based on observations, record review and staff interview; the facility failed to conduct assessments of repeated falls and failed to identify and implement interventions to prevent resident injuries incurred after falls for two of four sampled residents (Resident 2 and 3). Facility census 67. Findings are: A. Review of Resident 3's medical record revealed the resident sustained [REDACTED]. Resident 3 was admitted to the facility in (MONTH) 2012. Resident 3's [DIAGNOSES REDACTED]. Review of the facility fall log, facility fall investigations and fall tracking log for Resident 3 on 8/13/15 for June, (MONTH) and (MONTH) (YEAR) revealed the resident had experienced 9 falls with one emergency room encounter for head injury and one hospitalization for a fractured femur: - Fall on 6/1/15 at 10:40 am - resident trying to toilet - alarm sounding. Care Plan reviewed no new interventions. Reminded staff to assist to toilet every 2 hours and prn ( as needed). - Fall on 6/5/15 at 12:30 am - resident self transferring to restroom, had bowel movement noted in toilet. All intervention appropriate. Continues to ambulate in room unattended. Bed alarm is working. On the evening of 6/5/15 resident was witnessed to stand at 7:30 pm, lost balance and fell in room by television. No apparent injuries. - Fall on 6/29/15 at 6:30 am - resident incontinent of bowel and urine. Attempted to self transfer to wheelchair which was by closet lost balance and fell hitting head. Care plan reviewed all interventions appropriate. No recent changes. - Fall on 7/3/15 at 1:45 am - resident had been in bed was found on the floor by bathroom. Assessed by nurse on duty assisted off of floor toileted and put back in bed. All interventions in place. Resident needed to use bathroom. - Fall on 7/4/15 at 2:45 am - resident was walking from bed to bathroom. All interventions in place. No current changes. Self transferring. - Fall on 7/7/15 at 9:10 pm -… | 2018-08-01 |
| 7093 | 7093 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 241 | D | 0 | 1 | 5JK911 | Licensure Reference Number 175 NAC 12-006.05(21) Based on observations and interviews, the facility failed to ensure that signs with specific resident cares were not posted in the rooms of 2 sampled resident (Resident 6 and 39). Facility census was 31. Findings are: Observations on 8/11/15 at 1:30 PM and 8/12/15 at 9:00 AM of signs posted with specific resident cares on the walls in the rooms of Residents (6 and 39). Further observation revealed that the signs were visible from the hallway. Interview with the Administrator and the Director of Nursing on 8/13/15 at 10:35 AM verified that signage should not have been posted in Resident (6 and 39's) rooms with specific resident cares. Further interview verified that the signs should not have been visible from the hallway. | 2018-07-01 |
| 7094 | 7094 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 253 | E | 0 | 1 | 5JK911 | Licensure Reference Number 175 NAC 12-006.18A(1) Based on observations and interviews, the facility failed to ensure that the carpeting throughout the facility was clean and in good repair. Facility census was 31. Findings are: Observations on 8/11/15 at 9:00 AM and 8/13/15 at 9:00 AM of several dark stains in the carpeting in the hallways of 400, 300, and 200. Further observation revealed a white stain in front of the nurse's station in the carpeting. Observations on 8/11/15 at 12:00 AM and 8/13/15 at 9:00 AM of the carpet in the dining room wet and sticky. Also noted black appearing stains throughout the carpeting in the dining room. Interview on 8/13/15 at 10:30 AM with the Administrator and the Director of Nursing verified that the carpeting throughout the building to include the hallways, the dining room and in front of the nurse's station was soiled and dirty and should have been cleaned or replaced. | 2018-07-01 |
| 7095 | 7095 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 272 | D | 0 | 1 | 5JK911 | Licensure Reference Number 175 NAC 12-006.09B Based on record reviews and interview, the facility failed to evaluate a decline in activities of daily living, identify potential causal factors, and develop a plan to potentially restore function for one sampled resident (Resident 31). The facility census was 31. Findings are: Review of Resident 31's MDS (Minimum Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 7/30/15, revealed that the resident required increased assistance with bed mobility, ambulation, and eating since the last assessment which was completed on 4/30/15. Further review revealed no documentation that the staff evaluated the decline in activities of daily living, identified the potential causal factors related to the decline, or developed a plan to potentially restore function. Interview on 8/13/15 at 10:15 AM with RN (Registered Nurse) - D, MDS Coordinator, confirmed that the staff did not evaluate the resident's decline in activities of daily living, identify the potential causal factors related to the decline, or develop a plan to restore function. | 2018-07-01 |
| 7096 | 7096 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 278 | D | 0 | 1 | 5JK911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09C (1) Based on record review and interview, the facility failed to identify the use of an antidepressant medication on an MDS (Minimum Data Set, a comprehensive assessment tool utilized to develop resident care plans) assessment for one sampled resident (Resident 36). Facility census was 31. Findings are: Record review of Resident 36's Admissions Face Sheet dated 6/3/14 revealed the resident was admitted to the facility on [DATE]. A [DIAGNOSES REDACTED]. Record review of Resident 36's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Further review of the form revealed the resident was administered [MEDICATION NAME] every day in (MONTH) of (YEAR). Record review of Resident 36's MDS assessments revealed a Significant Change in Status MDS was completed on 6/4/15. Review of the medication section of this MDS revealed the resident was assessed as not having received an antidepressant medication during the reference period (5/29/15 through 6/4/15). Record review of the facility's Long-Term Care Facility Resident Assessment Instrument User's Manual (an authoritative manual with instructions on how to accurately record assessment items in the MDS) Version 3.0 revised on (MONTH) 2014 revealed the following instructions related to assessing the Medications section of the MDS: - With regard to Antidepressants the manual instructed to Record the number of days an antidepressant medication was received by the resident at any time during the 7-day look-back period . - An additional instruction regarding medication coding instructed staff to Code medications according to the medication's therapeutic classification, not how it is used . Interview with the MDS Coordinator and the Director of Nursing on 8/13/15 at 10:34 a.m. confirmed Resident 36's MDS on 6/4/15 had not captured the resident's use of a daily antidepressant medication ([MEDICATION NAME]) on the resident's MDS assessment. | 2018-07-01 |
| 7097 | 7097 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 323 | E | 0 | 1 | 5JK911 | Licensure Reference Number: 175 NAC 12-006.18E4 Based on observations, interviews and record reviews; the facility failed to ensure that potentially hazardous chemicals were secured for 3 sampled wandering/confused resident's (Resident 32, 9, and 25) safety. Facility census was 31. Findings are: Observations on 8/11/13 at 8:00 AM and 8/11/13 at 10:00 AM revealed that a can of Drop Dead II bug spray was on the counter in the dirty laundry room. Further observations revealed that the can did have a Caution warning on the label. Review of the Material Safely Data Sheet for the Drop Dead II Aerosol dated as issued 2/12/2001 revealed that the effects of over exposure for short term were: Prolonged skin contact may cause irritation seen as itching and redness. Eye contact: may cause irritation seen as tearing and redness. Inhalation: at low levels, no harmful effects are expected. At high vapor concentrations, inhalation causes headache, dizziness, sneezing, drowsiness, weakness, coughing, nausea, peripheral numbness(numbness of the hands and feet), pulmonary irritation( irritation of the lungs), cardiac arrhythmia(heart rate irregular) with possible anesthetic effects from central nervous system depression (intoxication) and possible death may occur . Interview on 8/11/15 at 8:00 AM with (Nursing Assistant) NA - B and NA - C revealed that the bug spray was used by housekeeping to spray for insects. Further interview revealed that the facility did have some residents that were confused and had wandering behaviors. Interview on 8/11/15 at 10:00 AM with the Administrator and the Director of Nursing verified that the Drop Dead II Aerosol did have a Caution warning on the can. Further interview confirmed that the Drop Dead II Aerosol should have been locked in the cupboard in the dirty laundry room. Continued interview verified that the facility did have 3 sampled residents (Resident 32, 9, and 25) that potentially could have gotten into the unlocked dirty laundry room and into the Drop Dead II bug spray. | 2018-07-01 |
| 7098 | 7098 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 364 | E | 0 | 1 | 5JK911 | Reference Licensure Number: 175 NAC 12-006.11D Based on observation and staff interview; the facility failed to 1) ensure that the juice and water were served with the meal to maintain a palatable temperature and 2) that the nutritive value of food items (jello, egg beaters, cake mix) was compromised due to expired serving dates. Facility census was 31. A) Observation 08/12/2015 8:47:52 AM before breakfast, beverages (juice and water) were placed on the dining tables for all residents prior to residents being seated at the tables for meals. Interview with Cook-A on 08/12/2015 at 8:50:18 AM revealed the beverages which consist of water, and juice were placed on the dining tables 30 minutes prior to the mealtime which is 7:15 to 8:30 AM. At 8:30 AM it was requested that the cook to take the temperature of the juice which was still sitting at a table where a resident had not arrived. The temperature taken by the cooks thermometer was 62.6 degrees. Cook - A confirmed the temperature was 62.6. This had the potential to affect 31 residents. Interview with Dietary Manager confirmed beverages are set out 30 minutes prior to the beginning of the meals being served to the residents. Reference: Review of the 3/8/2012 version of the Food Code based on the United States Food and Drug Administration Food code and used as an authoritative reference for food service sanitation practices, revealed the following: Regarding 3-202.11(A) Potentially Hazardous food (time/temperature control for safety food) shall be at a temperature of 41 degrees Fahrenheit or below when received. B) Initial tour of the kitchen 8/11/2015 at 8:30 AM revealed expired lemon jello and cake mix and refrigerated egg beaters. Interview with the Dietary Manager (DM) 5/11/2015 at 8:45 AM confirmed that the jello and cake mix were expired. Further interview revealed the egg beaters had been frozen and then thawed and served. The DM confirmed awareness of the expired egg beaters, comprising the flavor and nutritive value of the product. | 2018-07-01 |
| 7099 | 7099 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 371 | F | 0 | 1 | 5JK911 | Reference Licensure Number: 175 NAC 12-006.11E Based on observation, staff interview and record review; the facility failed to 1) assure cleanliness of 1 cupboard containing spices; 2) 3 freezers located in a dry storage area were free from crumbs and food residue; 3) shelves in the kitchen area were free from grease buildup, and 4) utensils were stored in a location free of crumbs and food residue. This had the potential to affect all residents. Facility census was 31. Findings are: A) Observation on 8/11/2015 at 8:30 AM and 8/13/ at 10:30 AM revealed 1 cupboard located in the kitchen area was unclean with dust and spice spillage on the shelves. B) Observations on 8/11/2015 at 8:30 AM and 8/13/ 10:30 AM revealed three freezers located in a dry storage area of the kitchen contained crumbs and food debris and residue on the bottom shelves. Crumbs and food residue included ground beef, crumbs, and other un-identifiable debris. C) Observations on 8/11/2015 at 8:30 AM and 8/13/ 10:30 AM revealed the shelves located above and near the stove/oven area were sticky with a greasy residue. D) Observations on 8/11/2015 at 8:30 AM and 8/13/ 10:30 AM revealed that drawers containing utensils had food residue and dust. Interview with the Dietary Manager 8/13/2015 10:30 AM confirmed there there was spice spillage and dust within the cupboard storing the spices as well as the three identified freezers did have food crumbs and debris on the bottom shelve. The DM also confirmed the shelves above and around the stove area were unclean with a greasy/sticky residue and that the drawers storing the utensils contained food particles and dust. The DM confirmed the existence of a cleaning schedule and that it was not posted or filled out and could not confirm kitchen staff followed the schedule. Record review of the kitchen cleaning schedule revealed that it was not posted, filled in pertaining to specifics of cleaning assignments. No documentation existed to confirm the task had been completed. The potential of cross contamination and f… | 2018-07-01 |
| 7100 | 7100 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 431 | D | 0 | 1 | 5JK911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.12E7 Based on observation, record review, and interview, the facility failed to identify a discrepancy between an eye drop medication's label instructions and the physician's orders [REDACTED]. Facility census was 31. Findings are: Observation on 8/11/15 at 11:04 a.m. revealed LPN (Licensed Practical Nurse)-E was administering a Systane eye drop to Resident 20. Further observation of the procedure revealed the resident's (MONTH) Medication Administration Record [REDACTED]. Comparison to the medication label affixed to the Systane eye drop container revealed instructions to administer one drop to each eye TID (Three times daily). Further review of the observation revealed the medication's container bottle had been opened and used. Record review of Resident 20's physician orders [REDACTED]. Interview with LPN-E on 8/11/15 at 11:04 a.m. verified Resident 20 received Systane eye drops four times daily and the medication label was incorrect reading to administer the medication three times daily. LPN-E verified the eye drops had been used without the label being questioned or corrected. | 2018-07-01 |
| 7101 | 7101 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 469 | D | 0 | 1 | 5JK911 | Licensure Reference Number 175 NAC 12-006.18A(4) Based on observations and interviews, the facility failed to ensure that one sampled resident's (Resident 13) overhead bathroom light fixture was free of insects. Facility census was 31. Findings are: Observations on 8/12/15 at 12:00 PM and 8/13/15 at 10:30 AM of dead insects and debris in the overhead bathroom light fixture in the bathroom of Resident 13. Interview with the Maintenance Supervisor and the Administrator on 8/13/15 at 10:30 AM verified the presence of the bugs in the over head light fixture in Resident 13's bathroom. Further interview confirmed that all fixtures and resident areas should have been free of insects. | 2018-07-01 |
| 7102 | 7102 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 514 | D | 0 | 1 | 5JK911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.16B (1) Based on record reviews and interviews, the facility failed to: 1) Clarify and correct the medical record containing a conflicting medication order for one sampled resident (Resident 31); and 2) record the administration of medications on the Medication Administration Record [REDACTED]. Facility census was 31. Findings are: A. Record review of Resident 31's Admissions Face Sheet revealed the resident was admitted to the facility on [DATE]. [MEDICAL CONDITION] was listed among the resident's medical [DIAGNOSES REDACTED]. Record review of Resident 31's Recertification medication order formed signed by the physician on 8/5/15 revealed an order for [REDACTED]. Interview with the DON (Director of Nursing) on 8/13/15 at 10:41 a.m. verified Resident 31's medical record had conflicting orders signed on the same day (8/5/15) for artificial tear administration. The DON confirmed the orders had not been clarified to determine the correct dosage for Resident 31's artificial tear medication administration. B. Record review of Resident 1's Admissions Face Sheet revealed the resident was admitted to the facility on [DATE]. Record review of Resident 1's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Interview with the DON on 8/13/15 at 10:41 a.m. verified Resident 1's bedtime doses of [MEDICATION NAME] ER, [MEDICATION NAME], and [MEDICATION NAME] were not recorded on the resident's Medication Administration Record [REDACTED]. | 2018-07-01 |
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CREATE TABLE [cms_NE] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );