cms_NE
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 101 | 101 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 657 | D | 1 | 1 | XOYL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C1c Based on record review and interview the facility staff failed to revise the CCP (Comprehensive Care Plan) to reflect current status of smoking for 1 (Resident 27) of 2 sampled residents. Facility staff identified a census of 126. The findings are: Record review of Smoking assessment dated [DATE] for Resident 27 revealed that Resident 27 was unsafe to smoke independently and propel self to designated area safely. Patient required supervision to complete smoking task. Record review of behavior note dated 7/19/2018 revealed that Resident 27 was let out of the building by another resident and staff found Resident 27 outside smoking with 2 other residents. Record review of behavior note dated 9/11/2018 revealed that Resident 27 was in the courtyard smoking by self. Record Review of the CCP dated 8/31/2017 revealed that Resident 27 desired to smoke while at a smoke free campus. The goal was that Resident 27 would demonstrate compliance with non-smoking campus policies. There were no updates to the CCP reflecting Resident 27's non-compliance with the smoking policy. Interview with the Director of Nursing on 09/13/2018 at 02:45 PM confirmed that the CCP had not been updated to reflect Resident 27's non-compliance with the smoking policy. | 2020-09-01 |
| 102 | 102 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 686 | D | 1 | 1 | XOYL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175 NAC 12-006.09D2b Based on observation, record review and interview: the facility failed to obtain treatment orders at the time of admission to promote healing of a pressure ulcer (a localized injury to the skin/underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with shear and /or friction) for 1 (Resident 105) of 5 residents reviewed with pressure ulcers. The facility census was 126. Findings are: Record review of a facility Policy and Procedure for Skin and Wound Management standard dated revised (MONTH) (YEAR) revealed the following policies: - A resident having pressure sores receives necessary treatment and services to promote healing and prevent infection: Pressure Ulcer Skin Condition: - Initial identification of a new pressure ulcer will include an assessment and measurement of the wound. Documentation of findings, assessment results and notification of the physician and family will be made in the residents clinical record. Treatment: - The treatment plan will be specific for each individual resident as directed by the physician. Appropriate treatment will address length, width, depth, odor, drainage, pain, wound bed and surrounding skin. Evidence of slough (full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough and /or eschar), necrotic tissue or infection should be communicated to the physician and treated accordingly. Record review of Resident 105's Admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 8/9/18 revealed that Resident 105 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident 105's MDS identified the presence of 1 unhealed pressure sore that was unstageable due to coverage of the wound bed by slough and/or eschar (thick, leathery, frequently black or brown in color, necrotic (dead) or devitalized tissues that has lost its usual physical properties and biolo… | 2020-09-01 |
| 103 | 103 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 689 | D | 0 | 1 | XOYL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7a Based on record review, observation, and interview; the facility staff failed to provide assistance and supervision for residents identified at risk for smoking and failed to ensure accuracy of assessments for smoking ability for 2 (Resident 75 and 27) of 2 sampled residents. The facility staff identified census of 126. Findings are: Review of facility smoking policy dated 2/2018 revealed: a purpose to maintain the highest level of safety for all residents To uphold a non-smoking facility. All residents must be off ground when smoking A smoking assessment will be completed on all residents desiring to smoke and will identify resident's level of independence and ability to smoke safely. [NAME] Observation on 09/12/2018 at 08:35 AM revealed Resident 75 was smoking in the facility parking lot. Observation on 09/12/2018 at 03:00 PM revealed Resident 75 was sitting in the driveway of the facility smoking. Record review of Smoking assessment dated [DATE] for Resident 75 revealed that Resident 75 requires physical assist to smoking area destination due to uneven terrain and low vision (pt legally blind). Interview with Resident 75 on 09/10/2018 at 02:36 PM revealed that Resident 75 is a smoker and knows that the policy is to leave the premises to smoke, but it is difficult due to being legally blind. An interview conducted with the Assistant Director of Nursing (ADON) G on 09/12/2018 at 03:00 PM confirmed that Resident 75 was in the facility parking lot smoking and that the policy is for the residents to leave the premises to smoke. An interview conducted on 09/12/2018 at 10:30 AM with the Director of Nursing (DON) revealed that the facility is a non-smoking facility and if a resident smokes the resident is required to leave the premises. DON confirmed that the residents were smoking in the facility parking lot. B. Record review of Smoking assessment dated [DATE] for Resident 27 revealed that Resident … | 2020-09-01 |
| 104 | 104 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 758 | D | 0 | 1 | XOYL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure 1 of 5 residents reviewed (Resident 94) did not receive an as needed psychoactive medication for more than 14 days without a physician rationale. Findings are: Review of Resident 94's Physician orders [REDACTED]. Review of Resident 94's Physician orders [REDACTED]. Review of the monthly Pharmacy Review notes revealed in (MONTH) (YEAR) the Pharmacist documented a letter was not back from the physician regarding Resident 94 being on two as needed medications for Anxiety and the prescribed time for discontinuing the medication being over 14 days. Review of Resident 94's Electronic Medical Record revealed no documentation from Resident 94's healthcare provider regarding the rationale for use of the medications for over 14 days or the need for two medications for the same [DIAGNOSES REDACTED]. Interview on 09/17/18 at 10:01 AM with Assistant Director of Nursing (ADON)-F revealed ADON-F was unable to locate letter regarding [MEDICATION NAME] and [MEDICATION NAME] in Resident 94's medical record. | 2020-09-01 |
| 105 | 105 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 759 | D | 0 | 1 | XOYL11 | **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 staff failed to ensure a medication error rate of less than 5%. Observation of 25 medication administered revealed 4 errors for 3 Residents ( 4, 21 and 79) resulting in an error rate of 16%. The facility staff identified a census of 126. Findings are: [NAME] Record review of Resident 4's Medication Administration Record [REDACTED]. Observation on 9-11-18 at 3:50 PM revealed Licensed Practical Nurse (LPN) A administered the [MEDICATION NAME] and Potassium chloride with water and no food. On 9-11-18 3:57 PM a interview was conducted with LPN [NAME] During the interview LPN A confirmed the [MEDICATION NAME] was given late and the potassium Chloride was not given with food as ordered. B. Record review of a Order Summary Report sheet printed on 9-12-18 revealed Resident 21 had ordered for medications that included Breo Ellipta (medication to help with breathing) , 1 inhalation in the morning. According to the directions Resident 21 was to rinse the mouth after taking the Breo Ellipta. Observation on 9-12-18 at 9:22 AM revealed LPN B administered medications to Resident 21 that included the Breo Ellipta. LPN B instructed Resident 21 to swish with water and swallow. According to www.breo.com instructions for use of Breo Ellipta is to rinse the mouth with water without swallowing after using BREO ELLIPT[NAME] On 9-12-18 at 9:28 AM an interview was conducted with LPN B. During the interview, LPN B confirmed Resident 21 was instructed to rinse the mouth and swallow. C. Record review of a Order Summary Report sheet printed on 9-12-18 revealed Resident 79 had orders for medications that included Potassium Chloride 20 meq to be give 2 times a day. Observation on 9-12-18 at 9:30 AM revealed LPN B prepared Resident 79's medications that included the Potassium Chloride. LPN was observed to crush all of Resident 79's medication. Further observations r… | 2020-09-01 |
| 106 | 106 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 804 | F | 0 | 1 | XOYL11 | LICENSURE REFERENCE NUMBER 174 NAC 12-006.11D Based on observation and interview the facility failed to ensure food temperatures were maintained to prevent the potential for food borne illness and ensue the palatability of the food. This had the potential to effect 125 of 126 residents who ate food from the kitchen. The facility staff identified a census of 126. Observation on 8-12-18 at 8:56 am revealed the facility nursing staff had completed serving the last resident room tray. The Dietary Services Manager (DSM) removed a test food tray for evaluation. Following is the temperatures and tasting of the test tray food obtained by the DSM: - Regular oatmeal was 118.6 degrees, the oat meal was pasty tasting and stuck to the teeth. -The regular egg and cheese Omelet temperature was 123.1 degrees, was chewy and bland. -Pureed oat meal temperature was 103.9 degrees was pasty and bland. -Pureed eggs, temperature was 113.2 degrees, bland and grainy tasting. -Pureed bread temperature was 102.9 degrees, thick pasty that stuck to the roof of the mouth and teeth. On 9-12-18 at 8:56 AM the DSM confirmed the food was cold, bland, with some food items sticking to the teeth and roof of the mouth. | 2020-09-01 |
| 107 | 107 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 812 | D | 0 | 1 | XOYL11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.11E Based on observation, record review and interview; the facility failed to obtained food temperatures before and after meal services and failed to date food items prepared in the facility for resident use to prevent potential food borne illness. The had the potential to effect 125 of 126 resident who ate food from the kitchen. The facility staff identified a census of 126. Findings are: [NAME] Observations on 8-12-18 at 1:35 PM with the Dietary Services Manager (DSM) revealed 11 ham and cheese sandwiches that were undated, 4 peanut butter and jelly sandwiches that were undated and a container of cucumber salad with cream like dressing that was undated. B. Record review of of the facility Service Line Checklist sheets provided by the facility DSM revealed the following information: -9-2-18 revealed breakfast and lunch food temperatures were not obtained and recorded. -9-3-18 revealed breakfast and lunch services food temperatures were not obtained and recorded. -9-4-18 revealed breakfast and lunch service food temperatures were not obtained and recorded. -9-8-18 revealed breakfast and lunch service food temperature was not obtained and recorded. -9-9-18 revealed breakfast and lunch service food temperature was not obtained and recorded. -9-11-18 revealed breakfast and lunch service food tempts was not obtained and recorded. On 9-12-18 at 1:35 PM an interview was conducted with the DSM. During the interview the DSM confirmed the ham and cheese sandwiches were not dated when prepared and the peanut and jelly sandwiches were not dated when prepared. The DSM further confirmed food temperatures were not obtained and recorded and should have been. 09/12/18 7:25 AM [NAME] DSM, is certified, Easter D RN also is an employee at facility. Steam table not functional. Kitchen staff using 2 portable type steam tables, and using crock pot to try and keep food temps up. Crock pots have hot liquid, however, unable to submurge 3 containers in hot waters. Omelet 178.Oat Meal 164.3, folded… | 2020-09-01 |
| 108 | 108 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 880 | E | 0 | 1 | XOYL11 | Licensure Reference Number: 175 NAC 12-006.17D Based on observation, record review and interviews, the facility to failed to ensure hand hygiene was completed when changing gloves, failed to utilize a clean barrier for supplies during pressure ulcer treatments for 4 of 4 residents( 94,90,97,105), and failed to complete hand hygiene during personal cares for resident 22. The facility census was 126. Findings are: [NAME] Observation on 9/11/2018 at 8:23 AM of the wound nurse completing Resident 97's treatment to his pressure sore. The wound nurse performed hand hygiene on entering Resident 97's room and donned gloves. Assisted Resident 97 to expose the wound. The wound nurse then removed the old dressing and picked up the bottle of wound cleaner and sprayed wound cleaner on Resident 97's wound and wiped with a gauze pad removed from the dresser. No clean barrier was placed on the table under supplies to ensure a clean surface. Wound Nurse removed gloves and applied new gloves without performing hand hygiene. Clean dressing was retrieved from bare bedside table top and placed on Resident 97's wound. Review of the facility policy dated 10/2010 titled Wound Care revealed the following steps in the procedure: -Use disposable cloth to establish a clean field on resident's over bed table. -Place items to be used during procedure on the clean field. -Put on gloves. -Loosen tape and remove dressing. -Pull gloves over dressing and discard into appropriate receptacle. -Wash and dry hands thoroughly. -Put on gloves. -Apply clean dressing as ordered. -Discard Disposable items. -Wash and dry hands thoroughly. -Wipe over bed table. -Clean reusable supplies with alcohol and return to the treatment cart. -Disposable supplies cannot be returned to the cart. B. Interview on 9/11/2018 at 8:40 AM with the Wound Nurse revealed Resident 90 had large pressure wound with a large amount of drainage. Observation on 9/11/2018 at 8:45 AM of wound care revealed the Wound nurse entered Resident 90's room and placed the dressing supplies on bare… | 2020-09-01 |
| 109 | 109 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2018-09-17 | 921 | E | 1 | 1 | XOYL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.18A(1) Based on observation and interview, the facility staff failed to ensure that walls were free of gouges and holes, concrete sidewalks and parking area were free from large cracks and holes and failed to ensure the ventilation system was not dirty in resident rooms. Findings are: Observation during the Environmental tour on 09/13/2018 between 02:55 PM and 03:24 PM with the Maintenance Director (MD) revealed the following: room [ROOM NUMBER]B had a large hole in the wall behind the bed room [ROOM NUMBER] had gouges in the wall behind the bed room [ROOM NUMBER]A had gouges on exterior bathroom door and vent in bathroom was dirty room [ROOM NUMBER]B had paint chipped wall behind the toilet and no threshold room [ROOM NUMBER]B vent in bathroom was dirty with lint room [ROOM NUMBER]A vent in bathroom was dirty room [ROOM NUMBER]B vent in bathroom was dirty room [ROOM NUMBER]B vent in bathroom was dirty Large chunks of concrete missing from the edge of the side walk Large holes in the parking lot Interview with the MD on 09/13/2018 at 03:24 PM confirmed the areas of concern had not been identified prior to environmental tour and needed to be repaired. | 2020-09-01 |
| 110 | 110 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-09-23 | 609 | D | 1 | 0 | IVTR11 | > LICENSURE REFERENCE NUMBER 175 NACC 12-006.02(8) Based on record review and interviews the facility staff failed to report an allegation of abuse with 2 hours for 1 (Resident 1) of 3 sampled residents. The facility staff identified a census of 139. The findings are: Review of the only witness statement signed by the Life Enrichment Director and dated (MONTH) 29, 2019 revealed at approximately 1615 PM the Life Enrichment Director entered the memory support area and saw Resident 1 attempting to put a female residents hand down the front of Resident 1's pants. No contact was made due to Life Enrichment Director intervening and separating the residents. Review of the facility reported investigations revealed no evidence the observed incident was reported to the required state agency Interview with the Life Enrichment Director conducted on 09/23/2019 at 01:30 PM revealed the Life Enrichment Director was assisting residents back to the Memory support area and saw Resident 1 attempt to put a female residents hand down the front of Resident 1's pants. Life Enrichment Director separated the residents and no contact was made. She reported the incident to the Director of Nursing. Interview with the Director of Nursing on 09/23/2019 at 03:09PM confirmed the incident had not been reported to the required State Agency. | 2020-09-01 |
| 111 | 111 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 584 | E | 0 | 1 | WIY511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.18A(1) Based on observation and interview; the facility failed to ensure that residents dining experience was homelike as evidenced by meals served on trays to the 12 Residents who eat their meals in the Memory Unit Dining Room and failed to ensure the environment was maintained in a clean, safe and comfortable manner. The facility staff identified a census of 134. The findings are: [NAME] Dining An observation on 12/04/19 at 08:07 AM of residents eating in the dining room on the Memory Unit revealed residents were served their breakfast plates on serving trays. An observation on 12/04/19 at 12:16 PM of residents eating in the dining room on the Memory Unit revealed residents were served their lunch plates on serving trays and the plates were not removed from the trays. An observation on 12/05/19 at 07:50 AM of residents eating in the dining room on the Memory Unit revealed breakfast plates were left on serving trays. An interview conducted on 12/05/19 at 07:55 AM with Certified Medication Aide K revealed there is no reason for leaving the plates on the trays and confirmed that it was not homelike. An interview conducted on 12/05/19 at 08:00 AM with the Director of Nursing confirmed there was no reason for the plates being left on the serving trays and that it was not homelike. B. On 12/10/19 between 7:47 AM and 8:50 AM a tour of the facility with the Maintenance Man and the Infection Control Nurse revealed the following infomation: -The wheel chair by room [ROOM NUMBER] was scuffed on the arms and had food debris on the wheelchair. -Near room [ROOM NUMBER] a wheelchair was scuffed and had food debris on it. -The resident lifts near 509 were covered in debris and rust. -The lift near the Physicial therapy office was dirty and had chipped paint, - A wheel chair near room [ROOM NUMBER] was visibly soiled. - A lift near room [ROOM NUMBER] was visibly soiled with debris and had chipped paint. - Walls are … | 2020-09-01 |
| 112 | 112 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 656 | D | 0 | 1 | WIY511 | Licensure Reference Number 175 NAC 12-006.09C Based on interview and record review, the facility failed to notify the physician of abnormal blood pressure readings for 1 (Resident 23) of 5 residents reviewed. The facility had a census of 134. The findings are: A review of Resident 23's (MONTH) and (MONTH) 2019 Medication Administration Records revealed the following high blood pressure readings: 161/117, 156/99, 170/92, 160/91, 156/96, 173/82, 166/104, 166/104, 166/104, 174/104, 178/92, 156/93, 186/90. A review of Resident 23's Progress Notes revealed no documentation Resident 23's physician was updated regarding high blood pressure readings. A review of Resident 23's Comprehensive Care Plan (a document outlining how to care for a resident) dated 8/6/2019 revealed an intervention to notify physician of any abnormal vital sign (VS) readings. In an interview on 12/11/19 at 8:33 AM, the Director of Nursing confirmed Resident 23's physician was not notified of any high blood pressure readings. | 2020-09-01 |
| 113 | 113 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 676 | D | 0 | 1 | WIY511 | Licensure Reference Number 175 NAC 12-006.09D1 Based on interview and record review, the facility failed to provide restorative services for 1 (Resident 56) of 27 sampled residents. The facility had a census of 134. The findings are: A review of a discharge summary from Physical Therapy for Resident 56 dated 11/29/19 revealed a discharge recommendation of Restorative Nursing/Maintenance Program. A review of a document titled Therapy Communication Restorative Nursing Program revealed instructions for Resident 56's Restorative Program were written by physical therapy on 11/30/19. A review of the Facility Assessment updated on 7/20/19 revealed a staffing plan of two restorative nurse aides on day shift, 7 days a week. In an interview on 12/04/19 at 9:52 AM, Resident 56 reported being told Resident 56 would be receiving restorative services, but had not started yet. In an interview on 12/10/19 at 11:49 AM, Restorative Aide (RA)-H reported Resident 56 hadn't started restorative services yet. RA-H reported the reason restorative services were not getting done with Resident 56 was because RA-H gets moved to working the floor when there is a CNA (Certified Nursing Assistant) call-in. RA-H stated that the goal was to do restorative services with Resident 56 three times a week, but RA-H was only working as a Restorative Aide approximately one day a week due to the facility being short-staffed. RA-H reported making an appointment to start restorative services with Resident 56 the following day (12/11/19) at 10:00 AM. In an interview on 12/10/19 at 11:55 AM, Resident 56 reported still not receiving restorative services, but Restorative Aide H had scheduled an appointment for restorative services the following day (12/11/19) at 10:00 AM. In an interview on 12/11/19 at 11:03 AM, Resident 56 reported RA-H came to Resident 56's room that morning and informed Resident 56 that RA-H could not do restorative services with Resident 56 due to getting pulled to work on the floor. In an interview on 12/11/19 at 1:39 PM, RA-H confirmed R… | 2020-09-01 |
| 114 | 114 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 686 | D | 0 | 1 | WIY511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D2 Based on record review and interview the facility failed to document a weekly assessment of wounds on toes for 1(Resident 237) of 1 sampled resident. The facility staff identified a census of 134. The findings are: Record review of admission/readmission assessment dated [DATE] for Resident 237 revealed the following: Right Ankle eschar (dead tissue found in a full thickness wound), Right heel eschar, Right toes eschar, Sacrum pressure, and Right Lower Extremity. Review of the (MONTH) TAR and (MONTH) TAR for Resident 237 revealed no documentation of treatment to right toes eschar. Review of the weekly skin alteration form dated 8/31/19 for Resident 237 revealed no documentation of the wounds to the toes. Review of the weekly skin alateration form dated 9/7/19 for resident 237 revealed no documentation of any wounds. On 12/10/19 at 07:06 AM an interview was conducted with the DON (Director of Nursing) which confirmed that the resident was re-admitted to the facility on [DATE] with areas to her toes. The DON further confirmed that the resident did not return with orders to treat toes and there was no further documentation on the weekly skin alterations of the areas to the toes. | 2020-09-01 |
| 115 | 115 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 695 | D | 0 | 1 | WIY511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09D6 Based on observation, interview, and record review, the facility failed to provide oxygen in accordance with physician orders [REDACTED]. The facility had a census of 134. The findings are: A review of Resident 36's physician's orders [REDACTED]. An observation on 12/10/19 at 10:48 AM revealed Resident 36 wearing a nasal cannula hooked to an oxygen concentrator delivering oxygen at 3.5 liters per minute. In an interview on 12/10/19 at 11:44 AM Registered Nurse (RN)-L confirmed Resident 36's oxygen was set at 3.5 liters per minute. RN-L checked Resident 36's oxygen order and confirmed the oxygen was supposed to be set at 2.5 liters per minute. | 2020-09-01 |
| 116 | 116 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 725 | E | 0 | 1 | WIY511 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.04C Based on record review and interview; the facility failed to ensure sufficient staff were available for a restorative program. The facility staff identified 27 residents receiving restorative care. The findings are: Record review of the Facility Assessment updated on 7/20/19 revealed a staffing plan as follows: Licensed Nurses providing direct Care 12 (6 Days, 6 Nights) Nurse Aids (2 restorative, 2 bath aides day shifts 7 days a week) 35 (14Days, 12Evenings, 7Nights) Other nursing personel (Infection, Wound, 2 Assistant Director of Nursing, Director of Nursing. Review of daily staffing schedule as worked for 30 days revealed that 2 restorative aides were not scheduled daily. 1 restorative aide was scheduled 13 times in 30 days. On 12/11/19 at 11:22 AM an interview with ADON A/ Restorative Coordinator confirmed that if an aide is needed for transportation or there is a staffing crisis, the restorative aide is assigned were needed and that restorative care does not get completed when the restorative aide is re-assigned or not scheduled. | 2020-09-01 |
| 117 | 117 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 757 | D | 0 | 1 | WIY511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09 Based on interview and record review, the facility failed to ensure vital signs were obtained in accordance with physician orders [REDACTED]. The facility had a census of 134. The findings are: A review of Resident 23's (MONTH) and (MONTH) 2019 Medication Administration Record [REDACTED]. A review of Resident 23's (MONTH) and (MONTH) 2019 MAR indicated [REDACTED] 11/3 (evening dose), 11/5 (evening dose), 11/7 (morning dose), 11/8 (morning and evening dose), 11/16 (evening dose), 11/17 (morning and evening dose), 11/18 (morning dose), 11/19 (evening dose), 11/21 (morning and evening dose), 11/30 (evening dose), 12/1 (evening dose), 12/3 (evening dose), 12/5 (morning and evening dose), 12/6 (morning and evening dose). In an interview on 12/11/19 at 7:50 AM, Registered Nurse G confirmed a blood pressure and pulse were not recorded as ordered by Resident 23's physician on the dates listed above. | 2020-09-01 |
| 118 | 118 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 758 | D | 0 | 1 | WIY511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a stop date was obtained for a PRN (as needed) [MEDICAL CONDITION] medication for 1 (Resident 118) of 5 residents reviewed. The facility had a census of 134. The findings are: A review of Resident 118's (MONTH) and (MONTH) 2019 MAR (Medication Administration Record) revealed a PRN order for [MEDICATION NAME] (an anti-anxiety medication) with a start date of 10/3/19. There was no stop date listed on the order. A review of Resident 118's (MONTH) and (MONTH) 2019 MAR indicated [REDACTED]. A review of Resident 118's Electronic Health Record revealed no documentation from the prescriber of a rationale for continued use of PRN [MEDICATION NAME]. In an interview on 12/11/19 at 12:01 PM, the DON (Director of Nursing) confirmed no stop date was listed for the PRN [MEDICATION NAME] order for Resident 118 nor was there a documented rationale for continuation of the PRN [MEDICATION NAME] past 14 days in Resident 118's medical record prior to 12/11/19. The DON stated documentation for continued use was obtained from the prescriber on 12/11/19. | 2020-09-01 |
| 119 | 119 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 759 | D | 0 | 1 | WIY511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.10D Based on observation, interview, and record review, the facility failed to ensure a medication error rate of less than 5%. The medication error rate was 8%. There were 2 medication errors out of 25 medications observed. This practice affected 2 (Residents 37 and 54) of 13 residents observed receiving medications. The facility had a census of 134. The findings are: [NAME] A review of Resident 54's (MONTH) 2019 MAR (Medication Administration Record) revealed an order for [REDACTED]. An observation on 12/11/19 at 9:36 AM of medication administration by Licensed Practical Nurse (LPN)-J to Resident 54 revealed LPN-J pouring [MEDICATION NAME] Liquid into a medication cup while holding the cup in the air at eye level. Further observation on 12/11/19 at 9:38 AM revealed an amount over 15mL (approximately 17mL) of [MEDICATION NAME] Liquid had been poured into the medication cup for Resident 54. An observation and interview on 12/11/19 at 9:38 AM with LPN-J confirmed too much [MEDICATION NAME] Liquid had been poured into the medication cup for Resident 54. B. A review of Resident 37's (MONTH) 2019 MAR indicated [REDACTED]. Further instruction on the order indicated to, use with toothbrush during oral cares. An observation on 12/11/19 at 9:47 AM of medication administration by LPN-J to Resident 37 revealed LPN-J instructed Resident 37 to swish with the [MEDICATION NAME] and handed it to Resident 37. Resident 37 put [MEDICATION NAME] in mouth and then swallowed it. In an interview on 12/11/19 at 3:00 PM, the Director of Nursing confirmed the [MEDICATION NAME] Solution should have been applied to Resident 37's toothbrush and that LPN-J made an error. | 2020-09-01 |
| 120 | 120 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 761 | D | 0 | 1 | WIY511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.12E3 & 12-006.12E7 Based on observation, interview, and record review, the facility failed to ensure medications were stored in the original pharmacy containers for 3 (Residents 79, 116, and 385) of 3 sampled residents and failed to ensure insulin pens were dated when opened for 4 (Residents 14, 69, 113, and 131) of 4 sampled residents. The facility had a census of 134. The findings are: [NAME] An observation on 12/11/19 at 9:17 AM revealed Licensed Practical Nurse (LPN)-I administering medications to Resident 385 from the top drawer of the medication cart that were already in a medication cup. An observation on 12/11/19 at 9:19 AM of the 100 Hall medication cart revealed 2 medication cups of medications in the top drawer of the medication cart for Residents 79 and 116. In an interview on 12/11/19 at 11:09 AM, Registered Nurse (RN)-G, confirmed medications should be prepared just prior to administration and staff should not be removing medications from original containers ahead of time. A review of an udated facility policy titled, Storage of Medication, revealed the following: -The provider pharmacy dispenses medications in containers that meet legal requirements, including requirements of good manufacturing practices established by the United States Pharmacopeia. Medications are kept in these containers in a controlled environment. B. An observation on 12/11/19 at 1:41 PM with RN-F of 400 Hall medication cart revealed a [MEDICATION NAME] Pen with no open date belonging to Resident 14, a Humalog Insulin Pen with no open date belonging to Resident 131, and a Tresiba Insulin Pen win no open date belonging to Resident 69. RN-F confirmed the insulin pens had been used and did not have an open date. C. On 12/11/19 at 01:47 PM an observation of Medication Cart 1 with the DON (Director of Nursing) revealed a [MEDICATION NAME] Insulin Pen belonging to Resident 113 had no open date. The DON confirmed the pen … | 2020-09-01 |
| 121 | 121 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 812 | F | 0 | 1 | WIY511 | Liscensure Reference number 12- C Based on observation and interview the faility failed to ensure that a thermometer was in place in the refrigerator and failed to ensure one staff member had adequate coverage of facilal hair. This had the potential to affect 133 residents that eat food in the facility . The facility census was 134 Findings are: Kitchen 12/04/19 07:04 AM Observation with Assistant Dietician manager B . One,Refrigerator in kitchen did not have a thermometer in it to determine the temperatures. all other Refrigerators did have thermometers. temps were at 41 F. Staff member B confirmed that the refrigerator did not have a thermometer inside to check temperature. Staff member B did have facial hair that was exposed, it was confirmed that he should have facial hair covered while working in the kitchen 12/5/19 Interview with Dietician : Dietian is in building 2 to 3 times per week. She confirmed that Staff member B needs to have facial hair covered and that themometer needs to be in place to check temperatures daily. | 2020-09-01 |
| 122 | 122 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 908 | F | 0 | 1 | WIY511 | Licensure Reference Number 175 NAC 12_006.18B Based on observation and interview, the facility failed to ensure that equipment was serviceable. The staff identified a census of 134. Findings are: An observation of the facility boiler room on 12/10/19 between 7:47 AM and 8:50 AM revealed a pool of water next to the boiler. An interview on 12/10/19 between 7:47 AM and 8:50 AM with the Maintenance Director confirmed that the boiler was not operational. | 2020-09-01 |
| 123 | 123 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2017-12-28 | 609 | D | 1 | 0 | S8MH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175 NAC 12-006.02 (8) Based on record reviews and interviews, the facility failed to report allegations of abuse for 1 resident (Resident 2) of 4 residents sampled. The facility staff identified the census at 129. The findings are: An interview conducted on 12-28-17 at 9:08 AM with Licensed Practical Nurse A revealed that Resident 2 was struck by Resident 4 in the head a couple months ago. A review of Resident 2's Admission Record dated 12-28-17 revealed that Resident 2 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A review of Resident 4's Admission Record dated 12-28-16 revealed that Resident 4 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. A review of Resident 2's progress note dated 10-18-17 revealed that Resident 2 was hit in the head by Resident 4. The family, doctor, and administrator were notified of the altercation. An interview conducted on 12-28-17 at 12:41 PM with the Director of Nursing (DON) confirmed that Resident 2 was hit by Resident 4 on 10-18-17 and that an investigation was completed regarding the incident, but the incident was not called to the state reporting agency because the facility did not believe it was abuse because Resident 4 was confused and had not hit anyone before. An interview conducted on 12-28-17 at 1:05 PM with the DON confirmed that Resident 4 did not accidentally hit Resident 2. The DON confirmed that Resident 4 did willfully strike Resident 2. The facility staff moved Resident 4 to another room in order to keep Resident 2 safe. A review of the facility's Abuse and Neglect Policy and Procedure dated 12-6-16 revealed the following Definitions of Abuse, Neglect and Abuse Coordinator: Abuse: Abuse is willful infliction of mistreatment, injury, unreasonable confinement, intimidation, or punishment. Types of Abuse and Examples: Physical: Any person in a position of power or authority may potentially cause harm to a resident. Potential agg… | 2020-09-01 |
| 124 | 124 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2018-03-20 | 880 | E | 0 | 1 | 9P1R11 | Licensure Reference Number 12-006.17D Based on observation, interviews, and record review; the facility failed to ensure that staff washed their hands according to facility policy to prevent cross contamination. This had the potential to affect 7 residents (Residents; 9, 19, 5, 18, 20, 1, and 228) on the 200 hall. Findings are: On 03/14/18 at 2:19 PM an observation of NA (Nurse Aide) A, who was assigned to the 200 hall, revealed NA A was completing pericare (a procedure that cleans the resident's perineal area after going to the bathroom) on Resident 5. Following the care, NA A removed gloves and washed and dried hands for 8 seconds. NA A turned the faucet off with bare hands. On 3/19/18 at 1:00 PM observation of NA B, who was assigned to the 200 hall, doing catheter care revealed NA B donned gloves and wet 4 washcloths. NA B placed the washcloths at the bedside and opened up 2 plastic bags for soiled items. NA B transferred Resident 9 into bed and did pericare. NA B opened the bedside drawer and reached in and pulled out an ointment for Resident 9's buttocks, with gloves remaining on. NA B applied the ointment to the resident and placed the ointment back in the drawer. NA B then removed gloves, picked up the soiled linens and trash bag and went out of the room to the bath house. NA B put the code in the door touching the keypad and opened the door and placed the soiled linens and trash into the barrels, lifting the lid of each container. NA B then went across the hall to the clean linen supply, opened the door and got a pad to place under Resident 9. NA B returned to the room, then donned gloves, without washing hands and placed the pad under Resident 9. NA B removed the soiled pad, placed it in a plastic bag, removed gloves and took the soiled linen to the bath house, put the code in the door while touching the keypad and placed the soiled linen in the linen barrel. NA B then washed hands for 10 seconds, dried hands and turned the faucet off with a paper towel. On 3/19/18 at 1:30 PM an interview with NA B confi… | 2020-09-01 |
| 125 | 125 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 558 | D | 0 | 1 | SIVO11 | License Reference Number 175 NAC 12.007.03I (7) Based on observation, record review and interview, the facility failed to ensure residents had call light in reach. This had the potential to affect 1 (Resident 3) from a sample size of 33. The facility census was 37. Findings Are: [NAME] Observation on 07/01/19 at 4:48 PM revealed Resident 3 was lying on right side with pillows behind back. The bed was moved away from the wall/ window. The call light was dangling next to the resident's bed not in reach. An observation on 07/02/19 at 6:22AM revealed Resident 3 lying in bed on back. The call light was dangling from the resident's bedside rail, not in reach of the resident. A observation on 07/02/19 at 9:18 [NAME]M revealed Resident 3 in wheelchair. The call light was not with in resident's reach. The call light was on bed. The resident was in wheelchair in the middle of room. A observation on 07/02/19 at 1:19 P.M revealed resident lying in bed on right side with pillows behind back on left side. The call light was wrapped around bedrail on left side of bed, not in reach of resident. Record Review of Care Plan (A document that explains how to care for a resident) dated 06/25/19 identified that Resident 3 had the potential for pressure ulcer development and falls r/t (related to) Immobility. Interventions included: Call light within reach and encourage to use it to call for assistance as needed. A interview on 07/03/19 at 10:00[NAME]M with the DON (Director of Nursing) confirmed that call lights need to be in residents reach when residents are in their rooms. | 2020-09-01 |
| 126 | 126 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 580 | D | 0 | 1 | SIVO11 | License Reference Number 175 NAC 12-006.04C3a(6) Based on observation, interview and record review, the facility failed to notify Resident 3's family of change in resident's skin condition. This had the potential to affect 1 (Resident 3) of 4 residents reviewed for skin condition. The facility census was 37. Findings Are: A observation on 07/01/19 at 10:00 AM revealed Resident 3 was in wheelchair and had a healed skin tear to the left hand. A phone Interview on 07/01/19 at 11:26 AM with Resident 3's family revealed they had not been notified of skin tears and were only informed by aides when they came to visit. Record Review of Progress Note dated 5/25/2019 at 09:54 AM revealed Resident 3 was being bathed, right elbow was bumped against tub. Skin tear measured 0. 5 cm. length and jagged. Edges approximated and secured with steri strips (sterile pieces of tape used to close wounds) x 6. There was no documentation of notification of the family. Record Review of Progress Note dated 2/28/2019 at 16:24 revealed a skin tear to right elbow area with steri strips; probably caused from slumping in wheel chair and scraped on arm of chair. There was no documentation of notification of the family. A interview on 07/02/19 at 3:30 P.M with MDS nurse (A MDS nurse is a nurse that is in-charge with the delivery of care for patients that are confined in long-term care medical centers and facilities) confirmed if any incidents occured a resident's family member was to be contacted and documented in Nursing Progress Notes. A interview on 07/03/19 at 7:54 AM with the Director of Nursing (DON) confirmed any change in Residents condition was to be documented in progress notes and family notified. | 2020-09-01 |
| 127 | 127 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 583 | F | 0 | 1 | SIVO11 | Licensure Reference Number 175 NAC 12,-006.16C2, 12-006.05(21) Based on observation, interview, and record review, the facility failed to A)ensure that EMR (Electronic Medical Records) were not visible to non-staff members on the medication cart in the halls of the facility. This had the potential to affect all current and former residents in the facility. B) The facility also failed to provide privacy for 1 resident (Resident 23) of 1 sampled resident, during the application of ointment. The facility census was 37. FINDINGS ARE: [NAME] An observation on 07/01/19 at 04:40 PM the medication EMR was open and accessible to the public. The name at the top of the computer was the DON (Director of Nurses) This Medication cart was for the Residents on the South hall. An interview on 07/01/19 at 04:45PM with the DON confirmed; the electronic medical records should not have been accessible to the public. An Observation on 07/02/19 at 10:08 AM of the medication EMR was open and accessible to the public. The name at the top of the computer was the DON (Director of Nurses) An observation on 07/02/19 at 10:11with the Administrator and the DON of the open medication EMR for the North Medication Cart. An interview on 07/02/19 at 10:14 AM with the DON confirmed they were aware the screen should be shut down when not in use. The DON reported they had closed the program when they left the computer. Record review of the facility Access Control Policy dated 1/2/19 revealed; access to information and computing resources is granted in a manner that balances restrictions designed to prevent unauthorized access against the need to provide access to information for performance of job responsibilities. Access will be limited to authorized persons whose job responsibilities require it. B. An observation on 07/02/19 at 07:17 AM of the DON (Director of Nurses) with Resident 23 in the hallway by the Nurses station. The DON asked what Resident 23's pain level was and Resident 23 responded 5. The DON pulled Resident 23's right pant leg up above… | 2020-09-01 |
| 128 | 128 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 644 | D | 0 | 1 | SIVO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview; the facility failed to ensure that a required Preadmission Screening and Resident Review (PASRR) (an evaluation used to identify the presence of mental illness) level 2 evaluation was requested for a new medical [DIAGNOSES REDACTED]. This had the potential for the facility to fail to identify specialized services needed by the resident. The facility census was 37. Findings are: Record review of Resident 27's Nebraska Level 1 Form Preadmission Screening and Resident Review (PASRR) dated 5/12/17 revealed no serious mental illness, mental disorders, or [DIAGNOSES REDACTED]. Record review of Resident 27's Consultant Pharmacist MD Communication (a form used to provide communication from the pharmacist to the medical doctor) dated 9/7/18 revealed a new [DIAGNOSES REDACTED]. Record review of Resident 27's MDS (a mandatory comprehensive assessment tool used for care planning) dated 6/4/19 revealed that Resident 27 has not been evaluated by level 2 PASSR and not determined to have a serious mental illness and/or mental [MEDICAL CONDITION] or another related condition. 07/03/19 11:02 AM Interview with the DON confirmed that a request for a PASSR level 2 evaluation should occur for a new [DIAGNOSES REDACTED]. | 2020-09-01 |
| 129 | 129 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 657 | D | 0 | 1 | SIVO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175NAC 12-006.09C1c Based on record review and interview the facility failed to review and revise the comprehensive care plan according to the root cause for falls for 1 Resident (Resident 10) of 12 sampled residents. The facility census was 37. Findings are: The facility failed to review and revise and implement interventions to prevent further falls for 1 Resident (Resident 13) Record review of Fall Investigation dated 4/8/19 Predisposing physiological factors were; Incontinence confused, gait imbalance, and impaired memory. The Predisposing Situation Factors were; Exit seeking, wanderer, ambulation without assist, and using a wheeled walker. Record review of Verification of Investigation of Alleged Violations Involving Mistreatment, Neglect, Abuse, Injuries of Unknown Source and Misappropriation of Resident Property document dated 4/8/19 revealed; the cause was gait imbalance and cognitive ability to remember to call for help or push call light button. No corrective action was documented on the form. Record review of Care Plan for falls dated 4/8/19 revealed; an intervention dated 4/10/19 Physician reviewing medication due to increased agitation, and aggression. Record review of Fall Investigation form dated 4/19/19- Predisposing physiological factors were; confused and impaired memory. The Predisposing Situation Factors were; wanderer, ambulation without assist, and recent room change. Record review of Verification of Investigation of Alleged Violations Involving Mistreatment, Neglect, Abuse, Injuries of Unknown Source and Misappropriation of Resident Property document dated 4/19/19 revealed; there was no documentation of the conclusion of the fall and the corrective action to prevent future accidents. Record review of the care planned intervention for the fall dated 4/19/19 revealed; no care planned intervention to prevent further falls. Record review of Fall Investigation dated 5/29/19 revealed; Predisposing p… | 2020-09-01 |
| 130 | 130 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 756 | D | 0 | 1 | SIVO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.12B Based on Record review and interview, the facility Consultant Pharmacist failed to identify duplicate antidepressant medication use as an irregularity and contact the Physician for a rationale for the continued use of duplicate antidepressant medication for 1 (Resident 31) of 5 residents reviewed. The facility census was 37. Findings are: Record Review of a facility policy and procedure entitled [MEDICAL CONDITION] Drug Use revealed: - The definition of Excessive Dose means the total amount of any medication (including duplicate therapy) given at one time or over a period of time that is greater than the amount recommended by the manufacturer's label, package insert, and accepted standards of practice for a resident's age and condition. - The definition of Duplicate Therapy refers to multiple medications of the same pharmacological class/category or any medication therapy that substantially duplicates a particular effect of another medication that the individual is taking. Procedure step 6 states that upon initial comprehensive assessment, the Social Services designee shall review new admissions for any psychiatric, mood or behavior disorders, mental and psychosocial difficulties, and/or physician's orders [REDACTED]. a. [MEDICAL CONDITION] medication was prescribed to treat a specific diagnosed condition, as documented in the clinical record; b. Not in excessive dosage Record review of Resident 31's Admission Face Sheet dated 6/28/19 revealed that Resident 31 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Record review of Resident 31's admission Physician order [REDACTED]. Record review of Resident 31's admission Medication Regimen Review dated 5/14/19 identified the use of Trazadone and [MEDICATION NAME] but did not identify duplicate orders for Therapeutically similar medications. Record review of Resident 31's monthly Medication Regimen review dated 6/8/19 did not identify d… | 2020-09-01 |
| 131 | 131 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 758 | D | 0 | 1 | SIVO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.12B Based on record review and interview, the facility failed to obtain a 14 day stop date for a PRN (as needed) [MEDICAL CONDITION] ( medications used to treat behavioral conditions) medication for 2 residents (Resident 31 and 29) of 5 residents reviewed for unnecessary medications, failed to ensure duplicate antidepressant medication was not used (Resident 31) and failed to complete a sleep study to ensure that a Hypnotic medication was necessary for Resident 31. The facility census was 37. Findings are: [NAME] Record review of a policy / procedure entitled [MEDICAL CONDITION] Drug Use dated 08/2017 revealed the following: - The definition of Excessive Dose means the total amount of any medication (including duplicate therapy) given at one time or over a period of time that is greater than the amount recommended by the manufacturer's label, package insert, and accepted standards of practice for a resident's age and condition. - The definition of Duplicate Therapy refers to multiple medications of the same pharmacological class/category or any medication therapy that substantially duplicates a particular effect of another medication that the individual is taking. Procedure step 6 states that upon initial comprehensive assessment, the Social Services designee shall review new admissions for any psychiatric, mood or behavior disorders, mental and psychosocial difficulties, and/or physician's orders [REDACTED]. a. [MEDICAL CONDITION] medication was prescribed to treat a specific diagnosed condition, as documented in the clinical record; b. Not in excessive dosage d. Monitoring for adverse consequences and effectiveness of medications are in place; e. PRN medications are within guidelines. Policy step 3 states PRN orders for [MEDICAL CONDITION] drugs are limited to 14 days. Except for PRN orders for anti-psychotic medications, if the attending physician or prescribing practitioner believes that is approp… | 2020-09-01 |
| 132 | 132 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 759 | D | 0 | 1 | SIVO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** License Reference Number 175 NAC 12.006.10D Based on observation, record review and interviews, the facility failed to maintain a medication administration error rate of 5% or less for 2 (Residents 4, 29) of 8 residents observed. The medication administration error rate was 7.69%. The facility census was 37. Findings are: An Observation on 07/02/19 at 4:22PM revealed LPN-A administering [MEDICATION NAME] (An antibiotic) HCL 100mg tablet to Resident 29 without a meal. Record Review of Physician Orders dated 05/24/19 confirms [MEDICATION NAME] HCI tablet 100mg, Give 1 tablets by mouth two times a day for UTI give with meals. Interview on 07/03/19 at 2:30PM with DON confirmed all Physician Orders are to be followed as written. B. Record review of the facility policy/procedure titled Six Rights of Medication Administration dated 05/2017 revealed step 3 that states medications are checked against the order before they are given. Record review of the facility policy/procedure titled Administration of Drugs dated 05/2007 revealed: It is the policy of this facility that medications shall be administered as prescribed by the attending physician. Record review of Resident 4's Order Summary Report of active orders dated 7/3/19 revealed an order for [REDACTED]. Observation of medication administration on 7/3/19 at 6:51 AM revealed that Registered Nurse (RN) C crushed the [MEDICATION NAME] XL tablet prior to administration for Resident 4 even though the order specified that the [MEDICATION NAME] XL was not to be crushed. Interview with the DON on 7/3/19 at 10:56 AM confirmed that medications labeled as Do Not Crush are not to be crushed. | 2020-09-01 |
| 133 | 133 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2019-07-04 | 880 | E | 0 | 1 | SIVO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** License Reference Number 175 NAC 12-006.17B and 12-006.17D Based on observation, record review and interview the facility failed to disinfect the glucometer after patient use to prevent the potential for cross contamination, this affected 2 residents Resident 28 and 29 of 7 residents that received ACCU checks (the use of a glucometer to test a patient's blood sugar levels), failed ensure hand hygiene was performed prior to catheter cares for 1 resident (Resident 29) of 2 residents with catheters and failed to ensure hand hygiene was performed prior to medication administration for 1 resident (Resident 4) of 8 resident observed to prevent the potential for cross contamination. The facility census was 37. Findings Are: [NAME] An observation on 07/02/19 at 4:30 P.M revealed LPN- B placed a glucometer (a medical device used to determine blood sugar levels) on the medication cart used disposable germicidal surface wiped glucometer for 6 seconds and left on top of medication cart, LPN -B was wearing gloves during this time. An observation 0n 07/02/19 at 5:00 PM revealed LPN- B placed a glucometer on the medication cart, did not apply gloves, and removed a germicidal surface wipe from container. Glucometer was wiped off for 3 seconds and placed on top of wipe lying on medication cart. Record Review of glucometer cleaning and disinfecting policy that was not dated revealed the following steps: Cleaning Step 1: Wear appropriate protective gear such as disposable gloves. Step 2: Open the towelette container and pull out 1 towelette and close the lid. Step 3. Wipe the entire surface of the meter 3 times horizontally and 3 times vertically using 1 towelette to clean blood and other body fluids. Step 4: Dispose of the used towelette in a trash bin. - Note No actual drying of the meter is necessary before starting the disinfecting procedure. Disinfecting (the meter should be cleaned prior to disinfection) Step 5: Open the towelette container and pull out 1… | 2020-09-01 |
| 134 | 134 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-04-11 | 689 | D | 1 | 0 | XK2D11 | > Based on observations, record reviews and interview; the facility failed to ensure that residents identified at risk for elopement were unable to exit through the 1st floor kitchen from 1 LifeQuest for one sampled resident (Resident 2). The facility census was 146 with 3 sampled residents. Findings are: Observations were conducted of residents wearing Wanderguard (alarm device) revealed that the alarm would sound alerting the staff if they were close to an exit in the facility including the elevators. Interview with the Administrator on 4/11/19 at 3:25 PM confirmed that Resident 2 had exited the facility through the 1st floor kitchen from 1 LifeQuest. The 1st floor kitchen from 1 LifeQuest did not have a Wanderguard to alert staff if residents were seeking to leave the facility. The Administrator confirmed that the door did not have an alarm and was not secured in the event of a resident seeking to leave the facility. Resident 2 wore a Wanderguard and was at risk for potential elopement due to occasional wandering in the facility. | 2020-09-01 |
| 135 | 135 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2018-06-28 | 584 | E | 0 | 1 | QLOG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.18B3 Based on observation and interview, the facility failed to ensure vents were in working order for 3 resident rooms. (rooms [ROOM NUMBER]) and two of four service galley kitchens. (200 and 300 Life Quest Wings) This had the potential to affect 52 residents. Facility Census was 168. Findings are: Observation on 06/25/18 at 03:10 PM revealed vents in bathrooms in rooms [ROOM NUMBER] were not working. Environmental tour on 06/26/18 at 03:17 PM with the head of maintenance confirmed the vents in rooms [ROOM NUMBER] were not working. Observation on 06/25/18 at 02:10 PM revealed vents in galley kitchens on the 200 and 300 Life Quest Wings were rusty and had a gray matter inside of them. Interview on 06/26/18 03:49 PM with the Administrator confirmed that there was rust and gray matter in the vents in the kitchen galley on the 200 and 300 Life Quest Wings. | 2020-09-01 |
| 136 | 136 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2018-06-28 | 690 | D | 0 | 1 | QLOG11 | Licensure Reference Number 175 NAC 12.006.09D3(1) Based on observation, interview and record review; the facility failed to ensure catheter care was provided in a manner to prevent urinary tract infections for 1 resident (Resident 101) out of 1 sampled resident. Findings are: A telephone interview with Resident 101's family on 6/25/18 at 10:54 AM revealed Resident 101 had a catheter and does have occasional urinary tract infections. An observation of catheter care and transfer with the lift on 6/26/18 at 11:10 AM revealed NA (Nurses Aide) A and NA B transferring Resident 101 to the toilet. NA B removed the catheter bag from under the w/c and lifted the bag above Resident 101's bladder as NA B stood to attach the bag to the w/c. An observation of morning cares on 6/27/18 at 8:00 AM revealed NA B and NA C assisted Resident 101 with cares. As NA C dressed the lower half of the resident, NA C raised the catheter above the Resident 101's bladder as NA C placed the catheter bag through the pants leg. On 06/27/18 at 08:18 AM Interview with future DON (Director of Nursing) revealed that the future DON went and educated the staff concerning not to raise the catheters above the bladder level of residents. A record review on 6/27/18 of Policy and Procedure Manual dated 1/20/14 revealed Avoid raising the drainage bag above bladder level. This prevents reflux (backflow) of urine, which may contain bacteria. | 2020-09-01 |
| 137 | 137 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2018-06-28 | 759 | D | 0 | 1 | QLOG11 | Licensure Reference Number 175 NAC 12.006.10D Based on observation, record review, and interview; the facility failed to ensure medication error rate was below 5%. The facility had 2 medication errors out of 22 medication administration opportunities, which resulted in a 9% medication error rate. These errors had the potential to effect 2 residents, Residents 131 and 137. The facility census was 169. Findings are: An observation on 06/21/18 at 11:40 AM revealed a short acting insulin given to Resident 137 and lunch was served to Resident 137 at 12:17 PM. An observation on 06/25/18 at 11:25 AM revealed a short acting insulin given to Resident 131, and lunch was served to Resident 131 at 12:10 PM. An interview on 06/27/18 at 3:11 PM with the DON (Director of Nursing) confirmed that according to the pharmacy a short acting insulin should be given as per manufacturer's instructions. A review of the manufacturer's recommendations, dated (MONTH) (YEAR), revealed that a meal should be eaten within 5 to 10 minutes after taking the insulin. | 2020-09-01 |
| 138 | 138 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2018-06-28 | 760 | D | 0 | 1 | QLOG11 | Licensure Reference Number NAC 12.006.10D Based on observation, interview and record review, the facility failed to ensure residents who received a short acting insulin received nourishment within the manufacturers time frames in order to prevent a drop in the resident's blood glucose levels which was a potential for a significant medication administration error. This had the potential to affect 2 residents (Resident 137 and Resident 131). 22 medication administration opportunities were observed. The facility census was 169. Findings are: An observation on 06/21/18 at 11:40 AM revealed LPN D (Licensed Practical Nujrse) gave 10 Units of short acting insulin to Resident 137. Resident 137 received lunch at 12:17 PM. An observation on 06/25/18 at 11:25 AM revealed LPN D gave Resident 131 short acting insulin 6 Units, and lunch was served to Resident 131 at 12:10 PM. On 06/27/18 at 03:11 PM an interview with the DON (Director of Nursing) confirmed that according to the pharmacy insulin was to be given according to manufacturer's suggested timing. On 6/27/18 a record review of Tabitha on Spot Education Sheet dated 5/25/16 revealed LPN D was educated concerning insulin administration. A review of the manufacturer's recommendations, dated (MONTH) (YEAR), revealed that a meal should be eaten within 5 to 10 minutes after taking the insulin. | 2020-09-01 |
| 139 | 139 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2018-06-28 | 812 | E | 0 | 1 | QLOG11 | Licensure Reference Number 175 NAC 12.006.11D Based observation, interview, and record review, the facility failed to ensure food was served at temperatures in order to prevent potential foodborne illness. This failure had the potential to affect 49 Residents being served meals on 3 Life Quest. The facility census was 169. Findings are An observation on 6/25/18 at 12:10 PM, of food being served to residents residing on 3 Life Quest, revealed a Dietary Staff Member (DSM)-E assessing food temperatures. The hot items to be served included fish, diced potatoes, smothered pork chops, and soup. Pre-service temperatures were revealed the fish at 140 degrees Fahrenheit (F), and all of the other hot items were at 160 degrees F. A sample tray was requested to be dished up and served after the last room tray was delivered to residents. Continued observation revealed plates of food were dished up in a Galley area by Dietary Staff, and the Nursing Staff served the plates immediately to individual residents. An interview on 6/25/18 at 12:40 PM with the DSM indicated all of the residents on 3 Life Quest had been served. The DSM checked and confirmed the post service food temperatures were as follows: fish=108 degrees F, diced potatoes=110 degrees F, smothered pork chop=105 degrees F, and soup=130 degrees F. The food items on the requested sample tray, dished up at 12:40 PM, were noted to be slightly warm when tasted, but not hot. An interview on 6/25/18 at 12:50 PM with Chef-F confirmed the food temperatures were below the recommendations to prevent foodborne illness and revealed the steam table (device used to maintain hot food) had not been turned up all the way, and it needed to be in order to ensure foods were served within recommended temperatures. | 2020-09-01 |
| 140 | 140 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2018-06-28 | 925 | E | 0 | 1 | QLOG11 | Licensure Reference Number 175 NAC 12-006.18A(4) Based on observation and interview, the facility failed to ensure the light fixtures in 2 of 4 food service galleys were free from evidence of dead insects. This had the potential to affect 52 residents that were served meals on 200 Life Quest and 300 Life Quest Wings of the main facility. Facility Census was 168. Findings are: Observation on 06/21/18 at 03:11 PM revealed the galley kitchens on the 200 and 300 Life Quest Wings had dead insects in the lights in the ceiling. Observation on 06/25/18 at 02:11 PM revealed the galley kitchens on the 200 and 300 Life Quest Wings had dead insects in the lights in the ceiling. Interview on 06/26/18 at 10:12 AM with the Dietary Manager and the Aministrator confirmed that there were dead insects in the lights in the Gally Kitchens on the 200 and 300 Life Quest Wings. | 2020-09-01 |
| 141 | 141 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2017-07-12 | 242 | D | 1 | 1 | LXOF11 | > Licensure Reference Number: 175 NAC 12-006.05 (4) Based on interview and record review, the facility failed to honor one resident's (Resident 253) preferences regarding schedule for awakening in the morning. The facility census was 177 and the sample size was 29. Findings are: Review of Resident 253's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 5/15/17 revealed Resident 253 required staff assistance with transferring, dressing and hygiene. Review of an undated Personal Preferences form revealed Resident 258 preferred to wake up between 8:30 and 10:30 AM. Interview with Resident 253's Family Member on 7/06/2017 at 10:13 AM revealed Resident 253 complained to the Family Member that staff got resident up too early. The Family Member reported Resident 253's usual routine was to get up around 9 am. Observation and Interview with Resident 253 on 07/11/2017 at 8:11 AM revealed Resident 253 was up and in a wheelchair and had already eaten most of breakfast. Resident 253 stated staff sometimes wake (Resident 253) up as early as 4:30 or 5:30 AM and often before 7 AM. Resident 253 reported it must be a rule to get up by breakfast. Interview with Nursing Assistant (NA) A 07/12/2017 at 8:35 AM reported Resident 253 was assisted up between 7 am and 8 am depending on who was working. NA A reported Resident 253 doesn't like to get up and would stay in bed all day if you let (Resident 253). NA A reported that they do not ask Resident 253 if Resident 253 is ready to get up but just tell Resident 253 that it is time to get up for breakfast otherwise Resident 253 would just stay in bed all day. | 2020-09-01 |
| 142 | 142 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2017-07-12 | 371 | E | 0 | 1 | LXOF11 | Licensure Reference Number 175 NAC 12-006.11E Based on observation and interview, the facility failed to ensure the cleanliness and condition of equipment and walls in accordance with the Nebraska Food Code as evidenced by a buildup of burned liquid in the stove in Greenhouse 2, stains and liquid particles inside the refrigerators, paint scraped walls and paint chipped exterior of the air conditioner (AC) units and liquid stained and spattered on the backsplash above the steam tables on the 2 North unit and the 3 Life quest Unit of the facility. This had the potential to affect 67 residents that resided on those units and ate food served from the satellite kitchens. The facility census was 177. Findings are: Observation on 07/11/2017 between 7:30 AM and 9:00 AM with the Interim Dietary Manager and the Regional Support Manager revealed sanitation concerns in the following satellite kitchens of the facility: - Greenhouse 2: The interior of the stove was soiled with baked on foods and liquids. - 2 North and 3 Life quest areas: The interior of the refrigerator had liquid spills and stains, paint scrapes were present on the exterior of the AC unit in the unit kitchen, the backsplash above the steam tables had dried liquid stains present and the paint was chipped in places on the walls around the satellite kitchens. Interview on 07/11/2017 at 9:00 AM with the Interim Dietary Manager confirmed the equipment, stove, walls, back splash and air conditioner units in those resident areas needed to be cleaned and the issues of concern addressed. Record review of a list of residents that resided on 2 North, 3 Life Quest and Greenhouse 2 revealed a total of total 67 residents ate foods served from those facility satellite kitchens. | 2020-09-01 |
| 143 | 143 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 561 | D | 0 | 1 | J64C11 | Licensure Reference Number: 175 NAC 12-006.05 (4) Based on interviews and record review, the facility failed to provide bathing for one sample resident (Resident 118) per resident preferences. Sample size was 32 residents. Facility census was 162. Record review of Resident 118's MDS (Minimum Data Set, a federally mandated comprehensive assessment tool utilized to develop resident care plans) records revealed the resident on admission required extensive assistance with bathing. Interview with Resident 118 on 10/17/17 at 11:15 a.m. revealed the resident preferred to bathe two times per week with assistance from staff. The resident stated that the staff were not providing the two baths per week. Record review of Resident 118's care plan for personal preferences with an initiation date of 10/1/19 revealed the resident preferred an a.m. shower and wash hair 2 x/week. Record review of Resident 118's bath charting revealed baths were performed 10/2/19 and 10/14/19. Resident 118 had received two baths between 10/1/19 and 10/17/19. Interview with RN/House Supervisor (Registered Nurse) W on 10/17/19 9:08 a.m. verified that requested bathing two times per week was not being done for Resident 118 based on the documentation in the bathing record. Interview with RN X on on 10/17/19 9:09 a.m. verified that requested bathing two times per week was not being done for Resident 118 based on the documentation in the bathing record. Record review of an undated Tabitha Health Care Services Policy and Procedure Manual Whirlpool bathing Procedure revealed the following. Each client will receive a bed bath, shower, or whirlpool bath at least weekly or according to the client's preferences. The policy was provided 10/17/19. | 2020-09-01 |
| 144 | 144 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 623 | D | 0 | 1 | J64C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.05(5) Based on record review and interview, the facility failed to provide in writing to resident and resident's representative the reason for transfer to the hospital for 2 residents (Residents 37 and 38) out of 2 residents reviewed. The facility census was 162. Findings are: Review of progress notes dated 8/22/2019 at 07:13 PM stated Resident 37 was transferred to local emergency room for evaluation of nausea and vomiting. Review of progress notes dated 8/23/19 at 01:00 PM stated staff talked to nurse at local hospital and was informed that Resident 37 had been admitted to local hospital with [DIAGNOSES REDACTED]. Review of progress notes dated 08/07/10 stated that after sustaining a laceration to the head from a fall, Resident 38 was transferred at 08:58 AM to local hospital. Review of progress note dated 8/7/19 at 2:14 PM stated that Resident 38 was admitted to the local hospital. Interview with SSD on 10/22/19 at 01:40 PM confirmed that no written documentation of reason for hospital transfer was provided to Residents 37 and 38 or Resident 37 and 38's Representatives. | 2020-09-01 |
| 145 | 145 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 644 | D | 0 | 1 | J64C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, observations, and interviews, the facility failed to identify pertinent MI (Mental Illness) [DIAGNOSES REDACTED]. Facility census was 162. Findings are: [NAME] Record review of Resident 86's MDS (Minimum Data Set, a federally mandated comprehensive assessment tool utilized to develop resident care plans) completed 9/17/19 revealed the resident was diagnosed with [REDACTED]. Record review of Resident 86's current care plan revealed the resident could be aggressive and combative during cares and had poor impulse control. The resident chose to remain in bed most of the time and would not allow staff to toilet. Targeted behaviors identified on the current care plan included yelling, screaming and anger. Record review of Resident 86's PASSR assessment completed 7/4/13 recorded the following: - The resident was not diagnosed with [REDACTED]. - The resident was not diagnosed with [REDACTED]. - The resident was identified as not having exhibited any interpersonal symptoms or behaviors in the last six months to include; frequently isolated or avoided others or serious difficulty interacting with others. Interview with LPN (Licensed Practical Nurse) AA on 10/17/19 R 2:28 PM revealed Resident 86 had behaviors of cussing at staff, was rude to staff, often refused to get out of bed, and was care planned to just get out of bed for bathing. The resident had only been out of bed a couple of times this month besides bath day. Resident's Daughter will not allow any psychiatric medications. The resident gets angry and turns the volume up on the TV. Interview with NA BB (Nursing Assistant) on 10/17/19 at 2:33 PM Resident 86 frequently yelled from the room. Numerous other residents had asked what all the yelling was about. Observations of Resident 86 throughout the afternoon of 10/17/19 revealed the resident spent time in the room. The resident was not observed to socialize with other residents. The resident did not leave the room for the… | 2020-09-01 |
| 146 | 146 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 657 | D | 0 | 1 | J64C11 | Licensure Reference Number 175NAC 12-006.09C1c Based on observation, record review, and interview the facility failed to ensure that the resident care plan was updated to reflect the current dentition (the condition of the teeth) for 1 resident (Resident 90) of 1 resident observed. The facility census was 162. Findings are: Record review of the care plan (a written interdisciplinary comprehensive plan detailing how to provide quality care for a resident) for Resident 90 revealed that the resident is at nutritional risk and contained the intervention of dentures with all meals and snacks. Record review of the nutrition/dietary note on 9/6/18 at 4:17 PM for Resident 90 noted that the resident's weight was down 13.7 pounds over the last 30 days and confirmed that the resident is edentulous (lacking teeth). Observation on 10/17/19 at 8:28 AM in the unit 2 North dining room revealed that Resident 90 was seated in a wheelchair at a table in middle of dining room. The resident used a spoon to take a bite of yogurt and no teeth were observed in the resident's mouth. Interview with Certified Nursing Assistant (CNA) [NAME] on 10/17/19 at 2:49 PM confirmed that Resident 90 does not have dentures. Interview with Licensed Practical Nurse (LPN) C on 10/17/19 at 2:57 PM confirmed that Resident 90 no longer has dentures. LPN C confirmed that the resident's dentures disappeared and that it was likely that the resident threw them in the trash. LPN C revealed that the family did not want them replaced. Interview on 10/22/19 at 2:00 PM with the Licensed Practical Nurse (LPN) Manager D in the 2 North Unit manager office confirmed that the care plan for Resident 90 contained an intervention for nutrition for dentures with all meals and snacks. LPN Manager D confirmed that the care plan was not updated as the resident no longer has dentures. | 2020-09-01 |
| 147 | 147 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 661 | D | 0 | 1 | J64C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 661 Based on record review and interview the facility failed to ensure a recapitulation of stay was completed for 1 resident (Resident 125) of 1 resident reviewed for discharge to Long-term Care. The facility census was 162. Findings are: The facility failed to ensure a recapitulation of stay was completed for one resident (Resident 125). Record review of the Recapitulation of stay IDT summary revealed; that the document was not completed. Information on the IDT summary included; 1. Resident 125 had a fall with right hip repair, 2. The admission dx was fracture of unspecified part of neck of right femur. 3. The discharge date was 9 to a SNF (Skilled Nursing Facility). 4. Resident 125 had no complications during stay, 5. The equipment that would be needed was a manual wheelchair and Resident 125 had no teeth. 6. Resident 125'sCognition had not been completed 7. Resident 125's Communication was documented that (gender) was able to make needs known. 8. Resident 125's Dietary needs had not been completed 9. Resident 125's Activity needs had not been completed. 10. Resident 125's vitals had been recorded. 11. Resident 125's ambulation, Transfer, ADL(Activities of Daily Living) status had not been completed. 12. Resident 125's Skin integrity had not been completed. 13. Resident 125 was continent of bowel and bladder. 14. Resident 125's Medications were on the order summary report. 15. Resident 125's Post Discharge Plan of Care revealed; follow up physician appointments. Record review of Lab Corp revealed an order dated 9 for IV [MEDICATION NAME] for 7 days and had been diagnosed with [REDACTED]. Record review of 14 day MDS dated 9 revealed; 1. Section C Cognition revealed Resident 125 had a BIMS (Brief Interview for Mental Status an interview to determine memory loss) score was 12 indicated moderately impaired cognition. 2. Section G revealed; Resident 125 required extensive assist of 2 person with the following ADL's bed mobility, transfers, toile… | 2020-09-01 |
| 148 | 148 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 759 | D | 0 | 1 | J64C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC ,[DATE].10D Based on observation, interview, and record review; the facility failed to maintain a medication error rate of less than 5%, which affected 1 resident (Resident 69) of 8 residents reviewed. The medication error rate was 6.25%. The facility census was 162. Findings are: Observation of medication administration on [DATE] at 04:31 PM by RN U to Resident 69. When the medication were prepared and the five rights were administered it was noted that the computer field was red in color for medications: [REDACTED] 1. [MEDICATION NAME] 200MG 2 TABS TID (three times a day) 2. [MEDICATION NAME] 0.5mg 1 tablet TID 3. [MEDICATION NAME] 800MG TID PRN (as needed) was requested for Pain and had been documented at 4:23PM on [DATE]. Resident 69 had requested and received antiemetic after (gender) had taken the above medications. RN U had administered a dose antiemetic, 4. [MEDICATION NAME] 8 mg (milligrams) every 8 hours PRN and the documented time for the [MEDICATION NAME] was [DATE] at 4:26PM. Record review of MAR (Medication Administration Record) dated (MONTH) of 2019 revealed; Resident 69 had the following medications ordered for 3:00PM; [MEDICATION NAME] 0.5mg 1 tablet TID, and [MEDICATION NAME] Tablet 200mg 2 tablet TID. An interview with the DON (Director of Nurses) on [DATE] at 08:52 AM confirmed; if medications were given outside the window it is a medication error, unless the resident requested the medication to be later. Record review of the Medication Error Policy not dated revealed; Medication errors were as follows: Wrong medication was administered Wrong dose/amount of medication was administered Wrong form of medication was administered Wrong time Wrong route Wrong resident given the medications/unauthorized medication Omission of medication ordered Use of outdated medications Failure to document a medication An interview on [DATE] at 03:33 PM with the NM (Nurse Manager) V confirmed; that when the … | 2020-09-01 |
| 149 | 149 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 761 | E | 0 | 1 | J64C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 12-006.12E7 The facility failed to ensure that multi-dose stock medication labels were not faded and were legible to prevent the possibility of medication errors. This had the potential to affect 5 residents (Resident 1, 14, 53, 60, and 326) and the facility failed to ensure a medication card was labeled accurately for 1 resident (Resident 51). The facility census was 162. Findings are: [NAME] An observation on 10/21/19 at 08:30 AM of the Medication cart at the Journey House revealed; A facility stock bottle of Tylenol 325mg label was faded and difficult to read. A facility stock bottle of Tylenol 500mg the label was faded and difficult to read. An interview on 10/21/19 at 08:32 AM with the UM (Unit Manager) V confirmed; that the Tylenol bottles had faded labels and were difficult to read. Record review of Medication Labeling Policy not dated revealed; Medications having soiled, damaged, incomplete or illegible labels are returned to the pharmacy provider for re-labeling or disposed of in accordance with LTC (Long-term Care) facility policy. Record review of Resident 1's MAR (Medication Administration Record) revealed; [MEDICATION NAME] 325mg give 2 tablets as needed by mouth for pain/fever related to pain. Record review of Resident 14's MAR revealed [MEDICATION NAME] 500mg give 1 tablet orally every 6 hours as needed for Elevated Temperature. Record review of Resident 53's MAR revealed; [MEDICATION NAME] 325mg 2 tablets orally as needed for pain/fever related to pain. Record review of Resident 60's MAR revealed; [MEDICATION NAME] 325mg 1 tablet orally every 4 hours as needed for pain. Record review of Resident 326's MAR revealed; [MEDICATION NAME] 325mg 1 tablet every 4 hours as needed for pain. B. Observation on 10/22/19 at 09:31 AM of Resident 51's Carvedilol card revealed the order to give one 3.125 mg tablet twice per day with food. The medication label also included the directive to hold the medication if hear… | 2020-09-01 |
| 150 | 150 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 812 | E | 0 | 1 | J64C11 | Licensure Reference Number 175 NAC 12.006.11E Based on observation, record review and interview; the facility failed to ensure all staff entering the Good, Elizabeth and Martha House kitchens wore hairnets or that hairnets worn by staff enclosed all hair to prevent potential food borne illness. This had the potential to affect all residents who eat food prepared in these houses. The facility census was 162. Findings are: Observation on 10/16/19 from 12:08 PM-12:40PM in the Martha House dining room and kitchen revealed Cook H to be plating food from the steam table with hairnet in place that did not fully contain hair in back or on sides, Nursing Assistant (NA) L to be going in and out of the kitchen serving plated food to residents wearing hairnet that did not fully cover all hair strands in back and NA M to enter the kitchen during food service without a hairnet on and then after leaving the kitchen, put on a hairnet with stands of hair exposed in the back and on the sides and proceed to serve plated food to residents. Observation on 10/17/19 at 10:55 AM in the Martha House revealed that Cook H was in kitchen preparing food with hairnet in place that did not fully cover hair in back and on sides, NA L was noted to be standing in the kitchen without a hairnet on and NA N entering and leaving the kitchen with a hairnet on that did not fully contain hair in the back and on the sides. Observation on 10/17/19 from 11:35 AM-12:10 PM in the Good House kitchen and dining room revealed food was being plated and served by Culinary Manager K. NA O was wearing a hairnet with hair exposed in the back and sides, NA P was wearing a hairnet with hair on the sides exposed and RN Q was wearing a hairnet with hair not completely covered in the back and were observed going in and out of the kitchen during this time while food was being served. Observation on 10/21/19 at 08:40 AM in the Martha House revealed that NA R was standing in the kitchen and did not have a hair restraint on. Observation on 10/21/19 at 08:51 AM revealed that … | 2020-09-01 |
| 151 | 151 | TABITHA NURSING HOME | 285057 | 4720 RANDOLPH STREET | LINCOLN | NE | 68510 | 2019-10-22 | 880 | E | 0 | 1 | J64C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 12-006.17, 12-006.17D Based on observation, record review, and interview: the facility failed to ensure staff cleaned a sit to stand lift (a mechanical lift used to assist resident from a sitting to standing position)prior to making the lift available for other resident use. This had the potential to affect 8 residents (Residents 98, 16, 84, 85, 106, 40, 105, and 104) who used the sit to stand lift on the unit. The facility failed to ensure staff performed hand hygiene between glove changes while providing [MEDICAL CONDITION] (a surgically created opening in the abdomen in which a piece of the large intestine is diverted outside the abdominal wall) care for 1 resident (Resident 30) of 1 resident observed. The facility failed to ensure staff washed hands after removing gloves during wound care for 1 resident (Resident 71) of 4 residents observed. The facility failed to ensure staff washed hands after removing gloves during catheter (a thin tube placed into the bladder to drain urine) care for 1 resident (Resident 108) of 1 resident observed. The facility failed to ensure the catheter bag (urine collection bag connected to the catheter) was not on the floor for 1 resident (Resident 108) of 1 resident observed. The facility failed to ensure staff performed hand washing for the required 15-20 seconds during wound care for 2 residents (Resident 85 and 90) of 4 residents observed. The facility failed to ensure staff wet hands prior to applying soap during the hand washing procedure for 1 resident (Resident 90) of 2 residents observed. The facility failed to ensure staff scrubbed hands prior to putting hands under running water during hand washing for 1 resident (Resident 90) of 2 residents observed. The facility failed to ensure hand hygiene was performed between contaminated and clean procedure during wound care for 1 resident (Resident 73) of 4 residents observed. Facility census was 162 Findings are: A) Observation… | 2020-09-01 |
| 152 | 152 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-03-07 | 580 | D | 1 | 0 | IWUO11 | > LICENSURE REFERENCE NUMBER 175 NAC 12-006.04C3a(6) Based on record review and interview; the facility staff failed to notify the physician of blood sugars over 400 for 1 (Resident 20) of 10 residents reviewed. The facility staff identified a census of 93. Findings are: Record review of Resident 20's Medication Administration Record [REDACTED]. Record review of a admission orders [REDACTED]. Further review of the admission orders [REDACTED]. Record review of Resident 20's MAR for (MONTH) (YEAR) revealed on 2-14-2018 Resident 20's BS was 414 at bed time and on 2-15-2018 Resident 20's BS at bed time was 434. Review of Resident 20's medical record revealed there was no evidence the facility staff had notified Resident 20's physician of the BS results. On 3-06-2018 at 3:01 Pm an interview was conducted with Licensed Practical Nurse (LPN) C. During the interview LPN C confirmed Resident 20's physician had not been notified of the BS results and should have been. | 2020-09-01 |
| 153 | 153 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-03-07 | 609 | D | 1 | 0 | IWUO11 | > LICENSURE REFERENCE NUMBER 175 NAC 12-006.02(8) Based on record review and interview; the facility staff failed to report to the state agency and submit their investigation within 5 working days for 1 (Resident 22) of 6 investigations reviewed. The facility staff identified a census of 93. Findings are: [NAME] Record review of a Verification of Incident Investigation/Administrative Summary (VIIAS) sheet with a incident date of 1-19-2018 with the type of incident identified as an allegation of Neglect revealed a family member of Resident 22 had reported to the facility staff that Resident 22 had to wait for staff to assist Resident 22 to the bathroom resulting in Resident 22 becoming incontinent. Further review of the VIIAS dated 1-19-2018 revealed there was no evidence the facility had reported within 2 hours and submitted their investigation to the required state agency within 5 working days. On 3-7-2018 at 8:35 AM an interview was conducted the facility Administrator. During the interview, the facility Administrator confirmed there was no evidence the facility had reported the allegation and that the facility investigation had been submitted to the required state agency within the 5 working days. | 2020-09-01 |
| 154 | 154 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-03-07 | 688 | D | 1 | 0 | IWUO11 | > LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D4 Based on record review and interview; the facility staff failed to implement a Restorative Nursing Program (RNP) for 1 (Resident 22) 1 sampled resident for a RNP. The facility staff identified a census of 93. Findings are: Record review of Resident 22's Minimal Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 2-19-2019 revealed the facility staff assessed the following: - Brief Interview for Mental Status (BIMS) was a 15. According to the MDS Manuel, a score of 13 to 15 indicates intact cognition. -Required extensive assistance with bed mobility, transfers, dressing, toilet use and personal hygiene and no RNP. On 3-06-2018 at 6:40 AM and again on [PHONE NUMBER] at 12:07 PM Resident 22 reported (gender) was not receiving any RNP and should have been. Record review of a Physical Therapy Plan of Care note dated 12-20-2017 revealed Resident 22 was on therapy for lower extremities strengthen, pain management and a decrease mobility and range of Motion (ROM). The discharge plan for Resident 22 was to remain in the facility with a RNP. Review of Resident 22's record revealed there was no evidence the facility had developed a RNP for Resident 22. On 3-07-2018 at 8:35 AM an interview was conducted with the facility Administrator. During the interview, the Administrator confirmed Resident 22 did not have a RNP. | 2020-09-01 |
| 155 | 155 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-03-07 | 689 | D | 1 | 0 | IWUO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.18E1 Based on observation and interview; the facility staff failed to implement interventions to prevent potential falls for 1 (Resident 23) of 3 sampled Residents. The facility staff identified a census of 93. Findings are: Record review of Resident 23's Minimal Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) signed as completed on 9-18-2018 revealed the facility staff assessed the following about the resident: - Brief Interview for Mental Status score of 15. According to the MDS Manuel a score of 13 to 15 indicates a resident is cognitively intact. -Required extensive assistance with bed mobility, transfers, dressing and toilet use. -had a history of [REDACTED]. Record review of a Fall Report of Incident sheet dated 11-28-2017 revealed Resident 23 had a fall with a resulting laceration to the left side of the head. Record review of Resident 23's Comprehensive Care Plan (CCP) dated 12-14-2017 revealed there was not an identified area for fall prevention with interventions. Observation on 3-05-2018 at 10:40 AM revealed Resident 23 was seated in a wheelchair waiting for a bath. Resident 23's bed was positioned above the waist area. Observation on 3-06-2018 at 9:12 AM of a resident self-transfer revealed Resident 23 locked the wheelchair brakes, removed the foot pedals to the wheel chair and kicked of slipped Resident 23 had been wearing. Further observation revealed Resident 23 had socks on that were not non-skid type. Resident 23 stood up, slowly and with some shakiness held onto the wheelchair arm resident and slowly transferred to the bed that was at Resident 23's waist line. Observation on 3-06-2018 at 12:04 PM revealed Resident 23 was in the room having lunch. Further observation revealed Resident 23's bed was not in the low position. On 3-06-2018 at 4:20 PM an interview was conducted with Registered Nurse (RN) [NAME] During the interview, review of Resi… | 2020-09-01 |
| 156 | 156 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-03-07 | 759 | D | 1 | 0 | IWUO11 | **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 staff failed to ensure it was free of a medication error rate of 5% or greater. Observations of 39 medications administered revealed 3 errors resulting in a medication error rate of 7.69%. The medication errors affect 2 (Resident 27 and 28) of 7 residents. The facility staff identified a census of 93. Findings are: [NAME] Observation on 3-06-2018 at 7:05 AM revealed Licensed Practical Nurse (LPN) D prepared medications For Resident 28 that included [MEDICATION NAME] ( [MEDICATION NAME] medication, also used for treatment of [REDACTED]. Further observation revealed LPN D using a plastic measuring cup prepared 25 milliliters (ml) of the [MEDICATION NAME] medication. Review of the label on the [MEDICATION NAME] bottle revealed 20 ml's would provide the 25 mg's as ordered. On 3-06-2018 at 7:10 AM am interview was conducted with LPN D. During the interview, LPN D confirmed the measured dose of the [MEDICATION NAME] was going to be given to Resident 28. Further review with LPN D of the prepared dose of the [MEDICATION NAME] was completed. LPN D confirmed the dose of [MEDICATION NAME] was not correct. B. Record review of a Self-Administration Assessment (SAA) sheet for medications dated 2-20-2018 revealed the facility had evaluated Resident 28's ability to self-medicate. Further review of the SAA sheet revealed Resident 28 was able to self-administer medications with supervision. Observation on 3-06-2018 at 7:05 AM revealed Licensed Practical Nurse (LPN) D prepared medications for Resident 28 that included [MEDICATION NAME] ([MEDICATION NAME] medication, also used for treatment of [REDACTED]. Staff were to give 7.5 ml per tube every 4 hours as needed. Further observation with LPN C revealed LPN D placed the 3 containers of medication onto Resident 28's tray table. LPN D obtained a container and went into resident 28's bath room to obtain w… | 2020-09-01 |
| 157 | 157 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-03-07 | 760 | D | 1 | 0 | IWUO11 | **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 staff failed to ensure 1 (Resident 27) of 7 reviewed were free of significant medications errors. The facility staff identified a census of 93. Findings are: Record review of an Order Summary Report printed on 3-06-2018 revealed Resident 27 had medications that included 9 units of [MEDICATION NAME]to be given every AM with breakfast, [MEDICATION NAME]2 units in the AM and [MEDICATION NAME]insulin to be administered based upon Resident 27's blood sugar levels Observation on 3-06-2018 at 8:00 AM with the Director of Nursing (DON) revealed LPN [NAME] using an insulin syringe withdrew insulin from the [MEDICATION NAME] bottle. Observation of the dose of [MEDICATION NAME]prepared by LPN [NAME] revealed 7 units were in the insulin syringe. On 3-06-2018 at 8:05 AM during an interview LPN [NAME] confirmed the syringe of [MEDICATION NAME]was going to be given to Resident 27. On 3-07-2018 at 8:25 AM a follow up interview was conducted with LPN E. During the interview when asked how much [MEDICATION NAME]was in the syringe, LPN [NAME] reported 8 units. Upon request LPN [NAME] observed the dose of [MEDICATION NAME]in the syringe and reported 7 units. LPN [NAME] confirmed the incorrect does was going to be given to Resident 27. On 3-07-2018 at 8:10 AM an interview was conducted with the DON. During the interview, the DON confirmed the incorrect dose of [MEDICATION NAME]was a significant medication error. | 2020-09-01 |
| 158 | 158 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 156 | E | 0 | 1 | 0ROU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide notices of non-coverage of Medicare services for 3 (12,165, 16) and failed to provide a list of services not covered by Medicaid for 2 residents (Resident 122 and 47). Findings are: The facility Policy and Procedure titled When to Deliver the Notice of Medicare Non-Coverage CMS (NOMNC), undated, revealed that: A Medicare provider or health plan must deliver a completed copy of the Notice of Medicare Non-Coverage to beneficiaries/enrollees receiving covered skilled nursing. The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily. Providers must deliver the NOMNC to all beneficiaries eligible for the expedited determination process. A NOMNC must be delivered even if the beneficiary agrees with the termination of services. The Provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice and understands that the termination decision can be disputed. A) Record review of Admission Record for Resident 12 revealed that, Resident 12 was admitted to the facility on [DATE] with Medicare services. Record review of Resident 12's Electronic Medical Record revealed that Resident 12 services changed from Medicare to Private pay. Record review revealed the facility did not have documentation of NOMNC or SNF Denial Letter for services. Interview with facility Business Office Manager (BOM) on 7/11/17 at 2:23 PM confirmed that the facility failed to provide Resident 12 with NOMNC and Denial Letter. The BOM confirmed that there was no documentation of Resident 12 being provided notice of when Medicare Services would end. B) Record review of Admission Record for Resident 16 revealed that Resident 16 was admitted to the facility on [DATE] with Medicare services provided Record review of NOMNC,… | 2020-09-01 |
| 159 | 159 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 157 | D | 1 | 1 | 0ROU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175 NAC 12-006.04C3a(6) Based on record review and interview, the facility failed to notify the physician of medications not being administer for one of 11 residents sampled, (Resident 48). The facility census was 71. Record review of Admission Record for Resident 48 revealed that Resident 48 was admitted to the facility on [DATE]. The Admission Record revealed Resident 48 [DIAGNOSES REDACTED]. Record review of Resident 48's Brief Interview of Mental Status (BIMS)( According to the RAI Manual Version 3.0 The BIMS of 13-15 indicates Cognitively Intact, 8-12 indicates moderately impaired cognition, 0-7 indicates severe cognitive impairment.) on Resident 48's Minimum Data Set ( MDS, a federally mandated assessment tool used for care planning) signed 6/29/17, Resident 48 was 14. Record review of Resident 48's Physicians order dated 5/18/17, revealed Carvedilol tablet 6.25 mg po( heart medication used for Hypertension) , to be administered every morning and at bedtime for Hypertension and Hold the medication if Heart rate is less than 50 or systolic blood pressure (BP) (top number) is less than 95. Record review of Resident 48's Plan of Care revealed that Resident 48 had a altered cardiovascular status related to [DIAGNOSES REDACTED]. The Resident related goal was to be free from complications of cardiac problems. Interventions included Medications as prescribed, monitor for adverse reactions, monitor vital signs as ordered and notify MD of significant abnormalities. Record review of Resident 48's MAR revealed the following -May (YEAR): B/P and pulse were not documented and medication was not given on 5/2, 5/4, 5/12, 5/13, 5/14, 5/16. -On 5/17/17 Resident b/p was below parameters, 84/58, medication was held, no documentation of physician notification was found. -May 19th thru the 29th, there is no b/p or pulse documented on the MAR, medication is documented as administered excluding 5/20 and 5/29 where it was documente… | 2020-09-01 |
| 160 | 160 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 223 | D | 1 | 1 | 0ROU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175 NAC 12-006.05 (9) Based on observations, interviews, and record reviews; the facility failed to ensure 1 resident (Resident 85) of 35 sampled residents was protected from abuse. The facility identified the resident census as 71. A review of Resident 85's Admission Record dated 7/5/17 revealed Resident 85 had been admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. A review of Resident 85's Minimum Data Set (MDS: A federally mandated comprehensive assessment tool used for care planning) dated 5/1/17 revealed a Brief Interview for Mental Status (BIMS) score of 14/15 which is considered cognitively intact. An interview conducted on 7/5/17 at 12:53 PM with Resident 85 revealed that Resident 85 was having issues with their roommate making messes in the room, pushing their belongings over onto Resident 85's side of the room, and not keeping the curtain pulled between them. An observation conducted on 7/5/17 at 12:53 PM during the interview with Resident 85 revealed Resident 85's roommate entered the room and stopped at the end of Resident 85's bed and told Resident 85 not to talk to the state people. Resident 85's roommate then began talking over Resident 85 when the resident would attempt to answer interview questions. When the roommate was asked to give Resident 85 some privacy in order to finish the interview, the roommate refused to allow the interview to continue with Resident 85. The roommate reported that they go and talk to Resident 85's spouse about the resident and how difficult Resident 85 was and that Resident 85 will listen to their spouse, but will not listen to them. The interview was ended at this time. An interview conducted on 7/5/17 at 1:29 PM with Resident 85 revealed that Resident 85's roommate will sit and just stare at Resident 85. Resident 85 reported that when they turn on their call light to go to the bathroom, their roommate will quickly go into the bathroom and when staff an… | 2020-09-01 |
| 161 | 161 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 225 | D | 1 | 1 | 0ROU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, and interviews; the facility failed to report and investigate allegations of potential abuse for 5 of 5 residents reviewed Residents 48, 53, 148, 117, and 50. The facility census was 72. [NAME] Review of Resident 117's progress notes revealed on 7/8/2017 friends of Resident 117 voiced concern Resident 117 was being abused. The Assistant Director of Nursing (ADON) was notified. Interview on 7/10/2017 at 11:09 AM with the ADON revealed the staff had reported the allegation of abuse to the ADON on 7/8/2017, however, no report was called to the state agency and an investigation was not started for 2 days. Review of the facility policy titled Abuse Prevention, Intervention, Investigation and crime reporting policy dated (MONTH) (YEAR), revealed all allegations of abuse are to be reported to the state agency immediately but not later than 2 hours after the allegation is made. Interview on 7/11/2017 at 8:53 AM with the Director of Nursing (DON) revealed the facility should have reported the allegation of abuse in the regulatory timeframe. B. A review of Resident 50's Admission Record dated 7/11/17 revealed Resident 50 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. A review of Resident 50's medical record revealed a progress note dated 6/9/17 that revealed Resident 50 had yelled at a resident from another unit that they did not belong on Resident 50's unit and to leave. The author of the note documented that Resident 50 became agitated and continued yelling and that the other resident felt threatened and chose to leave. When the other resident got up to leave, Resident 50 walked towards the other resident calling them profane names. An interview conducted on 7/11/17 at 10:35 AM with the Director of Nursing revealed that the incident should have been investigated as suspected abuse and reported to the state agency. C) Interview with Resident 48 on 7/5/17 at 9:30 AM revealed that there was a… | 2020-09-01 |
| 162 | 162 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 241 | D | 1 | 1 | 0ROU11 | > Licensure Reference Number: 175 NAC 12-006.05 Based on observation, and interview, the facility failed to ensure residents were treated with dignity related to staff performing tasks on residents without communicating to the resident what was being performed for 1one of 8 sampled residents (Resident 59). The facility census was 71. Findings are: Observation on 7/10/17 at 10:47 AM, Resident 59 being was being provided cares, by NA N and NA O, with the Director of Nursing (DON) present in room. The observation revealed that NA N, and NA O initiated, performed and completed cares without communicating to the resident verbally or nonverbally what they were going to do before they did it. Observation revealed NA O moving Resident 59's hand 3 times without communicating where he should place his hand during a lift to stand mechanical lift being used to assist to the toilet. Interview with DON on 7/10/17 at 14:34 confirmed that NA N and NA O had not provided communication with Resident 59. DON did confirm that speaking to Resident 59, providing instruction and engaging Resident 59 in cares was more dignified for the resident than providing cares without communicating to the resident. | 2020-09-01 |
| 163 | 163 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 253 | E | 0 | 1 | 0ROU11 | Licensure Reference Number: 175 NAC 12-006.18B Based on observation and interview, the facility failed to ensure walls, doors, tub covering and tub fixtures were maintained in a clean condition and in good repair for rooms 404, 406,408, 416, 424, 429, and 436. 7/10/2017 10:30 AM Observation during environmental rounds with the Maintenance Director, Maintenance Assistant, and the Interim Administrator was completed and revealed the following: - Painted plywood board located on top of unused tubs in resident bathrooms that are marred and present a non-cleanable surface in rooms 408, 424, 436, 429, 406. - Water dripping and water stain in the unused bathtub in room 404. - Gouges in walls and doors in rooms 416, 404, 429, 406. - Multiple screws in the wall that have not been removed and holes patched in room 404. Interview on 7/11/2017 at 11:00 AM with the administrator revealed the identified environmental issues need to be addressed and a maintenance schedule developed to maintain the condition of the environment. | 2020-09-01 |
| 164 | 164 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 309 | D | 0 | 1 | 0ROU11 | Licensure Reference Number 175 NAC 12-006.09D Based on record review and interview the facility failed to ensure Resident 48 received ongoing evaluation of pain level, blood sugar monitoring,medications and Resident 116 failed to have monitoring of bruising 2 of 42 sampled residents. The facility census was 71. Observation on 7-05-2017 at 1:01 PM revealed Resident 116 was in bed awake. Resident 116 had a night gown on with the arms exposed revealed bruising to the upper and lower left arm. Record review of Resident 116's Nursing Summary sheet dated 7-10-2017 revealed the facility staff had identified bruising to both arms. The areas of bruising was not identified or the size of the bruising. On 7-11-2017 at 2:15 PM an interview was conducted with the Director of Nursing (DON). During the interview, the DON confirmed the bruising should have been identified earlier and that the location of the bruising should have been identified and was not. | 2020-09-01 |
| 165 | 165 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 325 | D | 0 | 1 | 0ROU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D8b Based on record review and interview, the facility staff failed to implement nutritional interventions for 2 (Resident 96 and 156) of 3 residents reviewed. The facility staff identified a census of 71. Findings are: Record review of a Instructions for after Discharge sheet dated 2-23-2017 from the hospital for Resident 156 revealed the diet section of the discharge orders was Resident 156 was to continue to drink your supplement (Ensure [MEDICATION NAME]) twice a day for 30 days. Record review of a Nutritional Assessment with an effective date of 3-01-2017 revealed the facility Registered Dietician (RD) evaluated Resident 156's nutritional requirements and identified that Ensure Plus would be given to Resident 156 twice a day. Record review of Resident 156 record that included Medication Administration (MARS) and Treatment Administration Record (TARS) for (MONTH) and (MONTH) (YEAR) revealed the ensure was not started until 3-23-2016, 27 days after the original order. On 7-11-2017 at 2:10 PM an interview was conducted with the Director of Nursing (DON). During the interview, review of the Instructions for Discharge orders were reviewed with the DON. The DON confirmed during the interview that Resident 156 should have been started on the Ensure supplement on admission and was not. B. A review of Resident 96's Admission Record dated 7/11/17 revealed was initially admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. A review of Resident 96's weights from 1/17/17 to 3/1/17 revealed the following: - 1/17/17 126.8 pounds - 1/19/17 117.8 pounds - 2/16/17 111.0 pounds - 3/1/17 110.4 pounds A review of Resident 96's nutritional assessment dated [DATE] revealed that Resident 96 had experienced a significant weight loss and the plan was to start the resident on a Magic Cup (sherbet style nutritional supplement) twice a day. A review of Resident 96's nutritional assessment dated [DATE] revealed … | 2020-09-01 |
| 166 | 166 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 329 | D | 0 | 1 | 0ROU11 | **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 monitor specific target behaviors for the use of an antipsychotic medication for 1 (Resident 122) of 5 residents. Findings are: Record review of Resident 122's Medication Administration Record [REDACTED]. Review of Resident 122's record revealed no evidence the facility staff were monitoring specific behaviors related to the use of the [MEDICATION NAME] medication. On 7/11/2017 9:43:25 AM an interview was conducted with the Director of nursing (DON). During the interview the DON confirmed there were not specific behaviors being monitored for Resident 122 related to the reason Resident 122 was on an antipsychotic medication. | 2020-09-01 |
| 167 | 167 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 333 | D | 1 | 1 | 0ROU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.10D Based on record review and interview; the facility staff failed to ensure 1 (Resident 127) of 11 residents was free of significant medication errors. The facility staff identified a census of 71. Findings are: Record review of an History and Physical (H&P) dated 6-5-2017 revealed Resident 127 had the [DIAGNOSES REDACTED]. Record review of Resident 127's Medication Administration Record [REDACTED]. Further review of Resident 127's (MONTH) MAR for 29th and 30 revealed the bed time [MEDICATION NAME] was not administered. On 7-11-2017 at 10:17 AM an interview was conducted with Registered Nurse (RN) D. During the interview, RN D confirmed the 35 units of [MEDICATION NAME]was not administered on (MONTH) 29 and (MONTH) 30th. When asked if this would be a significant medication error, RN D stated yes. | 2020-09-01 |
| 168 | 168 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 363 | E | 0 | 1 | 0ROU11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.11A1 Based on observation, record review and interview; the facility staff failed to provide the correct portion size for 6 (Resident 43, 113, 4,122, 6 and 45) of 6 residents who received mechanical altered diets. The facility staff identified a census of 71. Findings are: Record review of the menu for the lunch meal on 7-10-2017 revealed the facility resident were to have Lemon Baked Chicken 3 ounces (oz), sauce of choice, orzard pasta, California vegetable blend, bread and fruit cocktail. Observation of the lunch meal service with the Dietary Services Manager (DSM) on 7-10-2017 starting at 11:30 AM revealed Cook L began dishing up the residents food for lunch that included the 6 residents who have a mechanical altered diet. Observations revealed Cook L was using green handled scoop for the resident on a pureed diet and a gray handled scoop for those residents who received a mechanical (ground) diet for the chicken portion of the menu. An interview on 7-10-2017 at 12:32 PM was conducted with the DSM. When asked what the ounces were for the green handled scoop and gray handled scoop was, the DSM reported the scoops were a #12 or 2 ounces in size. The DSM confirmed the resident who received mechanical altered foods did not receive enough of the ground or pureed chicken. | 2020-09-01 |
| 169 | 169 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 371 | F | 0 | 1 | 0ROU11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.11E Based on observation, record review and interview; the facility staff failed to ensure the large mixer, utensil storage rack, ceilings and light fixtures were clean and in good repair. This had the potential to affect all residents who ate food from the kitchen. Findings are: Observation on the initial inspection on 7-05-2017 at 8:20 AM of the kitchen revealed the large mixer had dried on food debris. Observation on 7-10-2017 at 11:30 AM through 12:30 PM of the meal service revealed. The metal shelving unit that stored utensils, pots and pans next to the food prep area had a buildup of dust and grime. Light fixtures above the food prep areas and throughout the kitchen were broken, cracked, stained with the plastic covering sagging. The ceiling over the food preparation area was cracked and peeling with a large amount of brown stains. An interview on 7-10-2017 at 12:32 PM was conducted with the Dietary Services Manager (DSM). During the interview the DSM confirmed the issue that were identified. | 2020-09-01 |
| 170 | 170 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 412 | D | 0 | 1 | 0ROU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.14 Based on observation, record review and interview; the facility staff failed to ensure 3 (Resident 113, 116 and 131) of 3 residents reviewed received dental services as ordered. The facility staff identified a census of 71. Findings are: [NAME] Record review of a Nursing Summary sheet dated 7-10-2017 revealed Resident 116 was admitted to the facility on [DATE]. Observation on 7-05-2017 at 1:14 PM revealed Resident 116 had missing teeth. Record review of Resident 116's medical record revealed there was no evidence the facility had arranged dental services for Resident 116. B. Record review of Clinic sheet dated 4-25-2017 revealed Resident 113 had been seen by the Dentist. According to the Clinic sheet dated 4-25-2017, Resident 113 was being seen as a follow up to have the remaining teeth removed. The dentist documented for staff to wait 2 to 3 months for bone remodeling prior to dental fabrication. Review of Resident 113's record revealed there was no an indication the facility staff had followed with the dentist related to fabrication of dentures. On 7-11-2017 at 11:16 AM an interview was conducted with Registered Nurse (RN) K. During the interview RN K confirmed dental follow up was not completed for Resident 116 and 113. B. Observation on 7/6/2017 at 8:00 AM revealed Resident 131 had several missing teeth and Residents 131's teeth had brownish staining present. Review of Resident 131's Progress notes for the past 6 months revealed no documentation Resident 131 had been seen by a dentist or that Resident 131 had been offered an appointment to see the dentist. Interview on 07/11/2017 2:42 PM with the Health Information Manager (medical records) revealed the facility was unable to locate any documentation that Resident 131 had been seen by the dentist or offered dental services. | 2020-09-01 |
| 171 | 171 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 441 | D | 1 | 1 | 0ROU11 | > Licensure Reference Number: 175 NAC 12-006.17D Based on observation, interview and record review; the facility staff failed to perform hand hygiene while providing cares for 2 of 8 residents sampled (Residents 59 and 100). The facility census was 71. Findings are: A) The facility Infection Control Policy regarding Glove Use revealed toperform hand hygiene after removing gloves. Observation on 7/10/17 at 10:47 AM Resident 59 was being provided cares, in the bathroom, by Nursing Assistants (NA) N and O, also present in the room was the Director of Nursing (DON). Nursing assistant O was observed to leave the bathroom and enter the bed room area. NA O then removed gloves, without hand hygiene, NA O went to the night stand, removed items from draws, went to Resident 59's closet and removed items. NA O then returned to the bathroom and performed hand washing and applied a new pair of gloves. Interview with NA O on 7/10/17 at 10:54 AM confirmed that NA O had not performed hand hygiene upon removal of gloves, and did touch multiple items in different parts of the Resident 59's room, and belongings. Interview with DON on 7/10/17 at 10:54 AM confirmed that standard precautions and facility policy, hand washing was to be performed upon removal of gloves. DON confirmed that NA) did not perform handwashing after removal of gloves and did touch multiple area's in Resident 59's room. B. An observation conducted on 7/10/17 at 12:54 PM revealed Nursing Assistant (NA) F entered Resident 100's room and offered to take the resident to the bathroom without performing hand hygiene at entrance. NA F took Resident 100 into the bathroom and without performing hand hygiene put on gloves and assisted Resident 100 to the toilet. An observation conducted on 7/10/17 at 1:10 PM revealed NA F put on gloves and removed Resident 100's soiled brief and then put a clean brief in place and proceeded to gather wet washcloths to perform perineal hygiene. With the same gloves still on, NA F performed perineal hygiene following standard technique whic… | 2020-09-01 |
| 172 | 172 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 467 | E | 0 | 1 | 0ROU11 | Licensure Reference Number: 175 NAC 12-007.04D Based on observation and interview, the facility failed to maintain the ventilation system in working condition in rooms 404, 406, 408, 410, 412, 414, 416, 420 and 422. Observations of the ventilation system on 7/11/2017 at 10:30 AM revealed the exhaust ventilation system would not draw a 1 ply piece of toilet tissue. This effected 9 rooms on the fourth floor. Rooms 404, 406, 408, 410, 412, 414, 416, 420, 423. Interview on 7/11/2017 at 10:35 AM with the Maintenance assistant revealed that the system on the roof is checked twice weekly for operation but no documentation of these checks was completed and vents are not checked inside the building to assure a draw is present. Interview on 7/11/2017 at 10:35 AM with the administrator revealed a routine audit should be completed and documented to assure the ventilation system is working. Interview on 7/11/2017 at 4:00 PM with the administrator revealed the exhaust system required 3 motors to be replaced to make the system functional and the facility had no identified the units were not working. | 2020-09-01 |
| 173 | 173 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2017-07-12 | 520 | F | 0 | 1 | 0ROU11 | Licensure Reference Number: 175 NAC 12-006.07C Based on observation, record review, and interviews; the facility failed to maintain an effective Quality Assurance (QA) program as evidenced by repeat and additional citations. The facility census was 72. After observation, record review and interviews; the facility had 9 repeat deficiencies and 7 additional deficiency citation when compared to the facility performance report (Casper) for the past 3 surveys at the following areas: F156 - Resident Rights F157 - Notify of Changes F225 - Abuse Reporting F241 - Dignity and Respect F253 - Housekeeping and Maintenance F329 - Drug Regimen Review F333 - Significant Medication errors F371 - Food Sanitation F441 - Infection Control 07/11/2017 3:42 PM Interview with the Director of Nursing (DON) the Quality Assurance (QA) Committee discontinued monitoring Federal Tag F225 as of (MONTH) 30 (YEAR) as in the facility Plan of Correction Dated 5/15/2017 and no further monitoring was planned. Record review shows that the facility has repeat tags at F225 for not reporting or investigating episodes or allegations of abuse. 07/11/2017 3:42 PM Interview with the DON and Assistant Director of Nursing (ADON) revealed they are not monitoring any of the areas of the repeat tags. Interviews were completed on 7/11/2017 with 3 staff members, two of the three staff members were aware of the QA committee but Staff A was no aware what the committee was working on or how often they meet. NA B was not aware of how often the committee meets and what the function of the committee is. Interview on 7/11/2017 at 10:00 AM revealed the Interim Administrator was aware that compliance needed to be maintained with the use of the QA process. | 2020-09-01 |
| 174 | 174 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 565 | E | 0 | 1 | 7GF911 | Licensure Reference Number 175 NAC 12-006.06A Based on the group interview, staff interview, review of the facility's policy and review of the Resident Council meeting minutes, the facility failed to resolve grievances brought forth by the resident group for eight of eight residents, (Residents (R)7, R15, R34, R42, R49, R64, R66, and R72) who attended the resident group interview and who regularly attended the facility's Resident Council meetings. Findings include: Review of the facility's policy titled, Grievance Policy dated (MONTH) (YEAR), documented: . Resident Council . All grievances identified during the Resident Council meeting will be submitted immediately to the Grievance Official for investigation and resolution . Resolution . The Grievance Official will complete a written response . which includes . a summary of the grievance . investigation steps . findings . resolution outcome and actions taken . date decision was issued . On 09/10/19, during the resident group interview, the residents in attendance, R7, R15, R34, R42, R49, R64, R66, and R72, all identified themselves as regular attendees of the Resident Council meetings. The eight residents stated they often had grievances that came up in the Resident Council meetings; however, the facility did not respond, and did not resolve the grievances. The eight residents stated their primary concern for several months has been food palatability and variety of food, staffs' cell phone usage, overall staff professionalism, and slow call light response times. The eight residents stated they were not sure who in the facility handled their complaints and were not sure which staff was the designated Grievance Official. Review of the Resident Council Meeting Minutes for 06/21/19 documented complaints of Certified Nursing Assistants (CNAs) dressed inappropriately and playing music on their cell phones as they entered residents' rooms, staff not cleaning up after themselves and not cleaning up after the evening meal, staff smoking outside of designated smoking areas… | 2020-09-01 |
| 175 | 175 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 574 | C | 0 | 1 | 7GF911 | Based on observation and interview, it was determined the facility failed to ensure the contact information for the State Agency was posted in the facility, which impacted all 93 residents residing in the facility. Findings include: On 09/10/19 at 2:02 PM, all eight residents who attended the Resident Group meeting, Resident (R)7, R15, R34, R42, R49, R64, R66, and R72 stated they did not know where in the facility the State Survey Agency contact information was posted. The eight residents who attended the group stated they were not aware they could file grievances directly with the State Survey Agency but thought they could only contact the Ombudsman's office. On 09/12/19 at 3:53 PM, the Administrator stated that the facility did not have the contact information for the State Survey Agency posted and was not aware of the requirement. | 2020-09-01 |
| 176 | 176 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 623 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.05(5) Based on resident and staff interview, clinical record review, and facility policy review the facility failed to provide and send a written copy of Notice of Transfer/Discharge to the resident and the representative of the Office of the State Long-Term Care (LTC) Ombudsman (a public advocate official; one who is charged with representing the interests of the public by investigating and addressing complaints of maladministration or a violation of rights) for one of two sampled residents (Resident (R) 82), who had a non-emergent discharge to the hospital. Findings include: Review of R82's Demographic Sheet in the clinical record dated 09/12/19, revealed he was admitted to the facility on [DATE]. Review of R82's quarterly Minimum Data Set (MDS) resident assessment, dated 08/12/19, revealed he usually understood and usually able to make needs known. R82's Brief Interview for Mental Status score was 12, meaning he was mildly cognitively impaired. On 09/11/19 at 11:00 AM, in an interview with R82, he stated his name and where he was located. He stated during a discussion of his most recent hospital stay, he was not sure he had received any information in writing regarding his non-emergent visit to the hospital. He stated, he really couldn't remember, but he didn't think he or his spouse received anything. On 09/11/19 at 3:12 PM, the Administrator provided a copy of a log titled, Admit/Discharge To/From Report dated 06/01/19 to 08/31/19. The log detailed residents who had been discharged to home or to the hospital in the past three months. The Administrator stated that the log was faxed to the Office of Ombudsman to notify of which residents were transferred or discharged . The Administrator stated it was the Social Services Director (SSD) responsibility to notify the resident/responsible party and provide the Ombudsman's office with a copy of the Notice of Transfer/Discharge that was given to the resident/re… | 2020-09-01 |
| 177 | 177 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 641 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09B Based on interview, record review, and review of the Resident Assessment Instrument (RAI) Manual, the facility failed to ensure the accuracy of the Minimum Data Assessments (MDS) for two of 41 sampled residents, (Resident (R)45 and R188), reviewed for falls. Findings include: 1. R188's Admission Record located under the Profile tab of her Electronic Health Record (EHR) documented she was admitted to the facility on [DATE]. The [DIAGNOSES REDACTED]. Review of R188's Nurse's Notes dated 08/23/19 at 7:47 AM, located under the Progress Notes tab of her EHR, documented, fell on the way to the bathroom in the middle of her bedroom floor. R188's Admission MDS, with an Assessment Reference Date (ARD) of 08/29/19, documented under item J1800, that R188 had not fallen since her admission to the facility. During an interview on 09/11/19 at 05:21 PM, the MDS Coordinator reviewed R188's Nurse's Notes and the 08/29/19 MDS. The MDS Coordinator stated the MDS item, J1800, was coded incorrectly. 2. Interview on 09/10/19 at 1:00 PM, R45 stated that he had recently been hospitalized due to a fall. R45 further stated the fall occurred because the resident attempted to transfer from the wheelchair to the bed without assistance from staff. Review of R45's Admission Record with an original admission date of [DATE] and a most recent date of admission as 06/26/19, revealed R45 had a primary [DIAGNOSES REDACTED]. R45's Care Plan dated 05/14/19 indicated, The resident is at risk for falls related to gait/balance problems, unaware of safety needs and included documentation of five falls dated, 04/29/19, 05/01/19, 06/07/19, 06/15/19, and 06/19/19. R45's quarterly MDS, with an ARD of 07/30/19, indicated R45 had two recent falls. On 09/12/19 at 4:25 PM, Registered Nurse (RN) 28 stated R45's MDS dated [DATE] was incorrect and did not reflect accurate information related to R45's recent falls. Review of the Resident Assessment Instrumen… | 2020-09-01 |
| 178 | 178 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 656 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09C Based on interview, clinical record reviews, and facility policy review, the facility failed to develop and implement a plan of care for two (of five sampled residents, Resident R8 and R23), who were reviewed for the use of [MEDICAL CONDITION] medications; and failed to develop and implement a care plan for one of two sampled residents, (R22), reviewed for a known history of bedbugs with ongoing exposure in the community. Findings include: 1. A review of R8's Demographic sheet in the clinical record, indicated the resident was admitted to the facility on [DATE] with diagnoses of, but not limited to, unspecified dementia without behavioral disturbances, hypertensive [MEDICAL CONDITION], anxiety disorder, cognitive communication deficit, dizziness, and giddiness. A review of R8's quarterly Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 06/14/19, specified a Brief Interview for Mental Status (BIMS) (a test to determine resident cognition) was completed with a score of 14 out of 15, which indicated the resident was cognitively intact. R8 was assessed in section E: Behavior to exhibit no behaviors. In section G: Functional Status it was documented the resident required supervision to extensive assist of staff with activities of daily living (ADLs). A review of R8's Physician order [REDACTED]. R8 had an order for [REDACTED]. A review of R8's Care Plan(s) dated for the next review of 12/09/19, was completed. There was no care plan for the use of; nor for the monitoring of the medication, [MEDICATION NAME]. 2. R22's Admission Record located under the Profile tab of her EHR documented the resident was admitted to the facility on [DATE]. The resident diagnoses included left femoral neck fracture and [MEDICAL CONDITION] without behaviors. R22's quarterly MDS assessment with an ARD of 06/27/19, located under the MDS tab of the resident EHR documented a BIMS of 13 out of 15, which indica… | 2020-09-01 |
| 179 | 179 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 657 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09C1c Based on observation, interview, record review, and review of facility policy, the facility failed to review and revise the care plan for one of 41 sampled residents, (Resident (R)43), to include changes in the resident's mood status. Findings include: The facility's Care Plan and Resident Conference Schedule policy, created 10-2018, documented, . The facility must review and revise the care plan at least quarterly or with change in condition or services provided. Review of the care plan must include an interdisciplinary evaluation of the resident's progress relative to the goals established. R43's Admission Record located in the Electronic Health Record (EHR) documented the resident was admitted to the facility on [DATE]. R43's [DIAGNOSES REDACTED]. R43's Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 06/18/19, located in the EHR, documented the resident had a Brief Interview of Mental Status (BIMS) score of 15, which indicated the resident was cognitively intact; and a PHQ-9 score of 4, indicated minimal depression. R43's care plan did not identify any concerns with the resident's mood state or the need for counseling services. No interventions were in place for R43's psychological/psychosocial well-being. On 08/01/19, a Nurse Practitioner (NP) progress note under the Misc tab of R43's EHR documented the resident had a history of [REDACTED]. On 08/16/19 at 10:40 AM, a Social Services (SS) entry in the Progress Notes tab of R43's EHR documented the resident had been screened for counseling services and deemed as an appropriate candidate for follow-up services. On 09/10/19 at 08:51 AM, R43 was interviewed. When asked about R43's interactions with the other residents, R43 paused and asked for a moment to collect (gender)self. R43's eyes were moist. R43 stated (gender) liked the other residents but had a history of [REDACTED]. R43 described (gender self) as guarded around the… | 2020-09-01 |
| 180 | 180 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 675 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09D2 Based on observation, interview, and record review, it was determined the facility failed to provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, for one of 41 sampled residents (Resident (R)22). R22 reported ongoing distress related to the facility's lack of attention to R22 concerns about bedbugs, even when insect bites were noted on R22 skin. Additionally, the facility failed to provide adequate showers, bed baths, or hygiene for R22. Findings include: The facility's Bed Bugs policy with a Creation Date of 10/2019, documented, . Infestation can cause psychosocial stress or 'psychogenic itching.' R22's Admission Record located under the Profile tab of her EHR documented the resident was admitted to the facility on [DATE]. R22 [DIAGNOSES REDACTED]. R22's Quarterly Minimum Data Set assessment dated [DATE] documented a Brief Interview for Mental Status (BIMS- a cognitive evaluation) of 13 out of 15, which indicated the resident was cognitively intact. The assessment did not indicate R22 had acute mental status changes, inattention, disorganized thinking, or altered level of consciousness. The MDS documented no hallucinations or delusions; and no rejections of care for R22. On 06/25/19 at 03:16 PM, a Social Services (SS) note, located in the Progress Notes tab of R22's EHR, documented, .It was reiterated that due to bed bug infestation at home it is important that all clothing and furniture be brought to staff for cleaning before allowing it to go to the resident room. (Son) voiced understanding and agreed. The next entry in R22's Progress Notes was a second SS note dated 07/18/19 at 04:04 PM. The note documented, Team met with (R22) and (gender) friends/family to discuss bed bug problem. It was requested that facility handle all laundry. It was decided any clothing brought into facility will be brought to a staff member to la… | 2020-09-01 |
| 181 | 181 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 677 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09D1c Based on observation, interview, and record review, the facility did not ensure a resident received bathing frequency per their preference for one of 41 sampled residents, (Resident (R)22). Findings include: Review of R22's Admission Record located under the Profile tab of R22'a Electronic Health Record (EHR) documented the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. R22's quarterly Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 06/27/19, located under the MDS tab of R22's EHR, documented a Brief Interview for Mental Status (BIMS) of 13 out of 15, indicating the resident was cognitively intact; had no rejection of care; and required physical assistance of one for bathing. Review of R22's care plan dated 07/12/18, located under the Care Plan tab of R22's EHR documented, Bathing/showering. The resident requires (ASSISTANCE) by staff with (SPECIFY CNA bathing/showering) per resident preference and as necessary. The care plan did not document how frequently the resident preferred bathing. On 09/10/19 at 10:00 AM, R22 was seated in a chair in the hallway outside the fourth-floor shower room. R22 stated the resident had an appointment to receive a shower at 10:00 AM. R22 stated the resident did not receive showers on a regular basis, and often felt dirty. Review of R22's bathing record, located under the Tasks tab of R22's EHRd documented the resident had not received a shower between 08/15/19 and 08/20/19, a period of five days. R22's bathing record documented the resident then received a shower on 08/22/19, but no further showers were documented until 09/09/19. Further record review revealed an entry under the Progress Notes tab of the resident EHR that documented a bath was provided on 09/02/19. The facility provided no documentation R22 received a bath during the 11-day period between 08/22/19 and 09/02/19. On 09/10/19 at 10:47 AM, Licensed Pra… | 2020-09-01 |
| 182 | 182 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 686 | D | 0 | 1 | 7GF912 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D2a Based on observation, record review and interview; the facility staff failed to implement assessed interventions to prevent a potential decline in pressure ulcer healing for 1 (Resident 505) of 3 sampled residents. The facility staff identified a census of 86. Findings are: Record review of a Skin Only Evaluation sheet dated 11-05-2019 revealed Resident 505 was identified as having a left heel blister like area. Record review of a Wound-Weekly Observation Tool (WWOT) dated 11-08-2019 revealed Resident 505 was evaluated as having a Pressure Ulcer to the left heel area. According to the information on the WWOT dated 11-08-2019 revealed the facility had obtained a treatment to the pressure ulcers and in addition staff were to float heels with Prevalon boots ( pressure reducing type of soft boots) at all times. Record review of a sheet titled Pressure Ulcer dated 11-08-2019 revealed the Prevalon boots were to be worn at all times. Record review of Resident 505's Comprehensive Care Plan (CCP) dated 7-17-2019 revealed Resident 505 was to wear Prevalon boots at all times. Record review of Resident 505's current practitioners orders printed on 11-22-2019 revealed Resident 505 was to wear heel lift boots to both feet at all times in a chair and bed. Observation on 11-20-2019 at 2:50 PM Resident 505 was in the dining room for an ice cream activity. Residents 505 did not have Prevalon boots on. Observation on 11-21-2019 at 12:05 PM revealed Resident 505 was seated in a wheelchair and did not have the Prevalon boots on. On 11-21-2019 at 12:07 PM an interview was conducted with Licensed Practical Nurse (LPN) C. During the interview LPN C confirmed Resident 505 was not wearing the Prevalon boots. Observation on 11-21-2019 at 1:05 PM revealed Resident 505 was in Resident 505's room, seated in a wheelchair without the Prevalon boots on. | 2020-09-01 |
| 183 | 183 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 688 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09D4 Based on observation, interview, record review and review of the facility's policy, the facility failed to implement restorative nursing programs recommended by Physical Therapy to ensure residents received Restorative Nursing Services (RNA) to maintain mobility and Range of Motion (ROM) for three of 41 sampled residents, (Resident R3, R9, and R67). Findings include: The facility's Restorative Nursing Program and Philosophy dated (MONTH) (YEAR) and identified by the facility's Wound Nurse, Licensed Practical Nurse (LPN)105, as the facility's policy for Restorative Nursing Services, documented: . Generally, restorative nursing programs are initiated when a resident is discharged from formalized occupational, physical or speech therapy . .Restorative nursing is an attitude, further defined by a dynamic interdisciplinary (IDT) approach and commitment by all associates to maintain the (facility name) residents at their optimal level of functioning . The Restorative Nursing Program employs trained staff to manage a specific caseload of residents to provide a continuum of rehabilitative care while active on therapy caseload and/or after the resident has been discharged and/or after the resident has been discharged from therapy services . .Restorative nursing is a service provided by (facility name) through the nursing department .Restorative nursing staff is supervised by the Director of Nursing (DON) . Restorative Nursing Program includes . therapy referrals are written on the Restorative Nursing Request form . the request would include training of restorative aides with the resident and the referring therapist . . Completion of required documentation . the Neighborhood Nurse will contact the resident's physician . Restorative Aide will indicate resident participation on a daily basis using the Restorative Nursing Flow Sheet . Restorative Nurse completes a monthly summary on all residents in the Restorative … | 2020-09-01 |
| 184 | 184 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 690 | D | 0 | 1 | 7GF912 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D3 Based on record review and interview; the facility staff failed to implement a toileting program for 1 (Resident 504) of 3 sampled residents. The facility staff identified a census of 86. Findings are: [NAME] On 11-20-2019 at 3:10 PM an interview was conducted with Resident 504. During the interview Resident 504 reported being incontinet of bladder at times and needs staff assistance. When asked if Resident 504 was on a toileting program, Resident 504 reported no. Record review of Resident 504's Minimal Data Set(MDS: a federally mandated comprehensive assessment tool used for care planning) sighed and dated 10-31-2019 revealed the facility staff assessed the following about the resident: -Brief Interview for Mental Status (BIMS) was a 9. According to the MDS Manuel, a score of 8 to 12 indicated moderately impaired cognition. -Required limited assistance, with one person physically assisting for bed mobility, transfers, dressing, toilet use and personal hygiene. -No trial of a toileting program, prompted voiding or bladder training had been completed and Resident 504 was occasionally incontinent of bladder. -Resident 504 was evaluated as occasionally incontinent of bowel and no toileting program had been implemented. Record review of a Bowel and Bladder Program Screener dated 10-21-2019 revealed Resident 504 was a candidate for a scheduled toileting. Record review of Resident 504's Comprehensive Care Plan (CCP) revised on 10-30-2019 revealed Resident 504 is occasionally incontinent of bowel and bladder. Further review of Resident 504's CCP revised on 10-30-2019 revealed Resident 504 required assistance's with transfers and on and off the toilet. On 11-26-2019 at 9:00 AM an interview was conducted with the Director of Nursing (DON). During the interview the DON confirmed Resident 504 was not on a toileting program and should have been. | 2020-09-01 |
| 185 | 185 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 695 | D | 0 | 1 | 7GF911 | LICENSURE REFERENCE 175 NAC 12-006.09D6 Based on observation, interview, record review, and review of facility policy, the facility failed to ensure that the oxygen tubing was changed and dated per the facility policy for one of 41 sampled residents (Resident (R) 84). Findings include: During a tour of the facility's fourth-floor unit on 09/09/19 at 4:48 PM, R84 was in bed receiving 02 (oxygen) therapy via a nasal cannula with the tubing attached to a concentrator. A label (made of white tape) on the tubing read,9/2/19. Review of R84's Physician Orders, dated 04/26/17, indicated, Change oxygen tubing every (two) weeks and PRN (as needed) every night shift every 14 day(s) and as needed when visibly soiled. This order was documented as being discontinued on 04/26/19. Review of R84's Physician Orders, dated 08/21/19, revealed that there was no order to change the oxygen tubing. Review of R84's Medication Administration Record (MAR) for (MONTH) and (MONTH) 2019 revealed no documentation to indicate the oxygen tubing had been, or was being, changed as per the facility's policy. During an interview with the Director of Nursing (DON) on 09/13/19 at 8:51 AM, the DON indicated that the facility's policy was that oxygen tubing is changed weekly and the staff should have a physician order. The DON stated that staff changing the tubing should be dating the tubing and documenting that procedure on either the MAR or the Treatment Administration Record (TAR). During an interview with the Assistant Director of Nursing (ADON) on 09/12/19 at 2:25 PM, the ADON stated she randomly checks the 02 tubings to be sure they are dated and changed. The ADON stated that some nurses document the change on the MAR and some document on the TAR. Observation on 09/12/19 at 2:30 PM. revealed R84's oxygen tubing still bore the date of 09/02/19. Review of R84's MAR and TAR indicated there was no documentation that the O2 tubing was changed, or which staff changed it. During an interview with Certified Medication Technician (CMT)22 on 09/12/19 at 2:4… | 2020-09-01 |
| 186 | 186 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 740 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the timely provision of counseling services for one of 41 sampled residents, (Resident R43) in that the facility did not follow up on a recommendation from the counselor for services for R43 for over one month after the resident was screened for services. Findings include: Review of R43's Admission Record located under the Profile tab of the resident's Electronic Health Record (EHR) documented the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The facility's policy titled, Mental Health and Rehabilitative Services effective (MONTH) (YEAR), documented, .Residents with mental illness . will receive all services necessary to maintain or achieve independence and self-determination . In conjunction with other disciplines, social services staff will ensure that interventions and approaches are developed to meet identified needs and are incorporated into the resident's interdisciplinary care plan . Services will be provided according to assessed needs. These services include . individual, group, and family psychological services . R43's quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 06/18/19, located under the MDS tab of the resident's EHR, documented the resident had a Brief Interview of Mental Status (BIMS) score of 15 out of 15, indicating the resident was cognitively intact; and a Patient Health Questionnaire (PHQ)-9 score of four, indicating minimal depression. R43's care plan, located under the Care Plan tab of the resident's EHR, did not document any difficulty with the resident mood state or the need for counseling services. Review of the Nurse Practitioner (NP) progress note dated 08/01/19 under the Misc tab of R43's EHR documented the resident had a history of [REDACTED]. Review of a Social Services (SS) entry dated 08/16/19 at 10:40 AM, in the Progress Notes tab of R43's EHR documented, . (Counseling S… | 2020-09-01 |
| 187 | 187 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 755 | E | 0 | 1 | 7GF911 | LICENSURE REFERENCE 175 NAC 12-006.12E1b Based on observation, interview, document review, and review of the facility's policy, the facility failed to follow their pharmacy policy that required the signatures of the on-coming and off-going staff who verified the narcotic count on each medication cart at the change of shift. Controlled Drug Receipt/Proof of Use/Disposition Forms for four of four medication carts (Second floor A and B, and Fourth floor A and B) lacked signatures of the on-coming and off-going nursing staff. Findings include: Review of the facility policy titled, Policy CO17, Controlled Substances and Prescription Drugs Diversion Prevention Policy, dated 05/18 indicated, Nurses must count controlled drugs every time the keys change hands, included in the exchange of keys narcotic count is the narcotic box number of cards/bottles/boxes count for each cart, the count is listed and includes how many individual items are in the drawer. Each box, bottle, syringe, and card should be included in this total count. The nurse going off duty verifies documentation in the narcotic count book on the proof of use sheets, the nurse coming on duty verifies the actual medication amount remaining, the count is done together, and if the count is correct, both nurses or medication aide and a nurse, sign the narcotic dose count and number of cards/bottles/boxes/syringes count log. Observation of the of the second floor A hall medication cart on 09/10/19 at 11:10 AM, revealed the staff used a record book to record controlled drug administration and change of shift counts. Review of the record book revealed it was missing the two signatures required to indicate that the controlled drug count had been done by two people and the count of the drugs was correct at each change of shift 6:00 AM and 6:00 PM, daily on multiple days for the nine residents receiving controlled medications on the A hall. Observation of the second floor B hall medication cart on 09/10/19 at 11:00 AM, revealed the record book used by staff to record c… | 2020-09-01 |
| 188 | 188 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 758 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.12B5 Based on interviews, record reviews, and facility policy review, the facility failed to ensure three of five residents reviewed for unnecessary [MEDICAL CONDITION] medication use (medications that alter a person's mind and/or mood) had proper indications/diagnoses for the use of [MEDICAL CONDITION] medications; failed to monitor for adverse effects of the medications; failed to identify and monitor for target behaviors; and failed to perform gradual dose reductions (GDRs) or clearly document a contraindication for a GDR attempt for the three residents, (Resident (R)8, R23, and R188). Findings include: 1. A review of R8's Demographic sheet in the clinical record, indicated the resident was admitted to the facility on [DATE] with diagnoses of, but not limited to, unspecified dementia without behavioral disturbances, hypertensive [MEDICAL CONDITION], anxiety disorder, cognitive communication deficit, dizziness and giddiness. The medical record review indicated there was no diagnoses to support the use of the antipsychotic medication, [MEDICATION NAME]. A review of R8's admission Minimum Data Set ((MDS) dated [DATE], specified a Brief Interview for Mental Status (BIMS) (a cognitive evaluation) was completed with a score of 14 out of 15, which indicated R8 was cognitively intact. In section G: Functional Status, it was documented R8 required supervision to extensive assist of staff with activities of daily living (ADL). In section E: Behavior, it was documented R8 had no hallucinations or delusions, and no behaviors during the assessment period. In section N Medications, it was documented R8 received no antipsychotic medications. A review of R8's quarterly MDS assessment dated [DATE], specified a BIMS was completed with a score of 14 out of 15. R8 was assessed in section [NAME] Behavior, to exhibit no behaviors. In section G Functional Status, it was documented R8 required supervision to extensive assist of … | 2020-09-01 |
| 189 | 189 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 759 | D | 0 | 1 | 7GF912 | **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 staff failed to ensure a medication error rate of less then 5%. Observations of 39 medications administered revealed 5 errors resulting in an error rate of 12.82%. The medication errors were related to 2 (Resident 507 and 62) of 4 residents. The facility staff identified census of 86. Findings are: [NAME] Record review of Resident 507's Medication Administration Record [REDACTED]. Observation on 11-25-2019 at 7:55 AM revealed Certified Medication Assistant (CMA) D prepared Resident 507's medications that included the [MEDICATION NAME]. CMA D gave Resident 507 the medications that were to be swallowed, then gave Resident 507 the [MEDICATION NAME]. Resident 507 inhaled the medication as instructed, CMA D did not have Resient 507 rinse the mouth after inhaling the [MEDICATION NAME]. On 11-25-2019 at 8:07 AM an interview was conducted with CMA D. During the interview CMA D confirmed Resident 507 was not instructed to rinse the mouth after taking the [MEDICATION NAME] medication. B. Record review of a Order Summary Sheet active as of 11-25-2019 revealed Resident 62's practitioner ordered medications that included the following: -Refresh ( similar to artificial tears). -[MEDICATION NAME] Aerosol inhaler for asthma, 2 puffs every 12 hours. -[MEDICATION NAME] once a day in the morning to prevent [MEDICATION NAME]. -[MEDICATION NAME] (antianxiety medication) 0.5 milligrams (mg), one time a day every Monday Wednesday and Fridays 30 minutes prior to [MEDICAL TREATMENT]. -[MEDICATION NAME] Aerosol inhalant as needed for [MEDICAL CONDITIONS]. Observation on 11-25-2019 at 8:15 AM revealed CMA [NAME] prepared Resident 62's medications that included the [MEDICATION NAME] and [MEDICATION NAME] and 2 vials of the [MEDICATION NAME] inhalant medication. CMA separated the [MEDICATION NAME] medication into a small clear plastic envelope and took the medica… | 2020-09-01 |
| 190 | 190 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 761 | D | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.12E4 Based on observation and interview, the facility failed to ensure that stock medications stored in medication storage rooms on the second and fourth floors of the facility were not expired. Findings include: An inspection of the second-floor medication storage room on 09/12/19 at 3:30 PM revealed the following expired medications were included with the stock medications: [REDACTED] -One bottle of [MEDICATION NAME] 220 milligram tablets with an expiration date of 04/(20)19; -One bottle of Multivitamin tablets with an expiration date of 06/(20)19; -One bottle of Mineral Oil laxative with an expiration date of 03/(20)19; -One bottle of Tylenol 500 milligram tablets with an expiration date of 12/(20)18; -One bottle of [MEDICATION NAME] 50 milligram tablets with an expiration date of 04/(20)19; -One bottle of liquid Multivitamins with an expiration date of 07/(20)19. The expiration dates of the above medications were verified by Registered Nurse (RN)14 on 09/12/19 at 3:50 PM. An inspection of the fourth-floor medication storage room on 09/12/19 at 3:00 PM revealed the following expired medications were included with the stock medications: [REDACTED] -One bottle of Sodium chloride tablets, one gram each, with an expiration date of 03/(20)19; -One bottle of Multivitamin tablets with an expiration date of 03/(20)19; -One Nicotine patch 21 micrograms with an expiration date of 07/(20)19; -One bottle of Vitamin B1 100 milligram tablets with an expiration date of 02/(20)19; -One box of Glucose control strips with an expiration date of 07/31/18; -One box of Hemoccult test slides with an expiration date of 11/(20)18. The expiration dates of the above medications were verified by Certified Medication Technician (CMT)22 and Licensed Practical Nurse (LPN)21 on 09/12/19 at 3:15 PM. During an interview with the Director of Nursing (DON) on 09/13/19 at 8:35 AM, the DON stated that stock medications were ordered through th… | 2020-09-01 |
| 191 | 191 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 804 | E | 0 | 1 | 7GF911 | LICENSURE REFERENCE 175 NAC 12-006.11D Based on resident interviews, record review and review of the facility's policy, the facility's staff failed to provide each resident with a palatable diet. This deficient practice had the potential to affect the 90 residents of the facility capable of oral intake out a total census of 93 residents on the first day of the survey. Findings include: On 09/09/19 at 9:53 AM, R67 was observed eating his breakfast in his room. R67 had mechanical soft ham and scrambled eggs on his plate. R67 took a bite of his ham, coughed, and spit it into a cup. R67 stated, It's terrible. Nothing but gristle. R67 then took a bite of his eggs and stated, They're dry, with no flavor at all. R67 added salt to his eggs, took another bite and stated, Still no flavor. R67 stated, I've complained so many times, I stopped complaining about every bad meal. They're all bad. An interview with R62 on 09/10/19 at 2:23 PM, R62 stated the food served in the facility was always nasty and cold. During an interview with R34 on 09/10/19 at 12:08 PM, R34 stated the food served at the facility does not taste good. Review of the facility's Resident Council Meeting Minutes, dated 06/21/19, documented multiple complaints about the food. The minutes documented eggs were served piled in a bowl; condiments were not being provided with meals; and the residents did not like the taste of the regular bread used by the facility. Review of the facility's Resident Council Meeting Minutes, dated 08/02/19, documented meals were served cold, particularly breakfast. On 09/09/19 at 2:00 PM, during the Group Meeting, the eight residents that attended the meeting, Resident (R)7, R15, R34, R42, R49, R64, R66, and R72, all stated the food in the facility, has gone from bad to worse. Specifically, the residents stated, Sometimes a hotdog is on a soggy bun; food was not served hot; the food was cold enough when served in the dining rooms but became even colder when the carts were taken down the halls to deliver the trays to residents who at… | 2020-09-01 |
| 192 | 192 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 812 | L | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC ,[DATE].11E Based on observations, interviews, review of facility documents, and review of facility policies and procedures, the facility failed to ensure the staff used non-expired test strips to test the sanitizer level of the dishwashing machine, and failed to ensure the water temperature of the dishwashing machine was maintained within an acceptable range for the effective sanitization of kitchen and food-service dishware and utensils. This deficient practice created a likelihood for the occurrence of serious injury, harm, impairment, or death from foodborne illness and placed the 90 residents capable of oral intake in immediate jeopardy. The facility had a census of 93 residents on the first day of the survey. Findings include: During the initial tour of the kitchen, accompanied by the facility's Dietary Manager (DM), on [DATE] beginning at 8:38 AM, observation revealed, and the DM confirmed, that the facility used a low-temp dishwashing machine to clean and sanitize the facility's kitchen ware and food-service ware. At 8:40 AM, observation revealed Dietary Aide (DA)17 checked the water temperature of the dishwashing machine by visualizing the water temperature gauge on the front of the machine below a built-in water reservoir. DA17 reported the water temperature registered 115 degrees Fahrenheit (F). During the observation, the DM confirmed that the water temperature was below the acceptable range of 120 degrees F at the time the temperature was tested . DA17 then tested the level of sanitizer in the water by dipping a test strip into the sanitizing solution collected in the built-in water reservoir on the front of the machine. DA17 reported the sanitizer level as 100 parts per million. At that time, observation of the container of test strips just used by DA17 to test the sanitizer level, revealed the test strips had an expiration date of [DATE]. During an interview at that same time, both DA17 and the DM st… | 2020-09-01 |
| 193 | 193 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 880 | F | 0 | 1 | 7GF911 | LICENSURE REFERENCE 175 NAC 12-006.17A Based on interview and facility policies reviewed, the facility failed to maintain and implement an effective infection prevention and control program (IPCP) regarding waterborne pathogens, specifically (legionella) known as Legionnaire's disease. This had the potential to affect all residents residing in the facility. The survey census was 93. Findings include: Interview on 09/10/19 at 10:00 AM, the Maintenance Director revealed he had not had any training or education on Legionnaire's disease or waterborne pathogens as related to IPCP and the facility's water management. Review of the facility's Infection Prevention and Control Program (IPCP) and policies and procedures dated 08/2019, revealed they had not implemented an effective program to prevent, detect and control waterborne contaminants including legionella, known as Legionnaire's disease. The Director of Nursing (DON), who was responsible for the IPCP stated in an interview on 09/10/19 at 10:48 AM, to her knowledge, the facility had not completed education and training on Legionnaire's disease or waterborne pathogens, nor could she provide for any of the facility staff, evidence of education and training in the past. An interview on 09/10/19 at 11:00 AM the Administrator stated, that she was familiar with the infection control requirement for facility education and training on Legionnaire's disease and waterborne pathogens, however, could not recall if or when the last time the facility had been educated or trained. An interview on 09/12/19 05:55 PM, the Assistant Director of Nursing (ADON), who was partially responsible for staff education and development, stated that waterborne pathogens was not one of the components of the facility's mandatory infection control education and training provided. Review of the facility's policy titled, Infection Prevention and Control Program dated 08/2019 revealed the policy statement, .A policy of this facility to establish and maintain an infection prevention and control program … | 2020-09-01 |
| 194 | 194 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2019-09-12 | 925 | E | 0 | 1 | 7GF911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.18A4 Based on observations, resident and staff interviews, facility policy review, and review of exterminator invoices the facility failed to prevent and/or reduce the recurrence of bed bug infestation. This failure affected two of four floors in the facility, and for one of 41 sampled residents, (Resident (R)22). Findings include: The facility's Bed Bugs policy with a Creation Date of 10/2019, documented, Staff will employ infection control strategies to prevent and manage infestation of bed bugs . The General Guidelines section of the policy documented, .4. They feed primarily at night. Each feeding 'session' lasts for approximately 5 minutes, after which the bugs return to their hiding places - under mattresses, in linens or rugs, or on clothing .7. Lifespan of bed bugs can be up to two years with a food source and up to a year without . The Steps in the Procedure area of the policy documented, .Identifying and eradicating bed bug infestation is a multi-disciplinary task, involving nursing, infection control, administration, and housekeeping .Monitoring .2. Thoroughly screen newly admitted residents, as well as those returning from a stay away from the facility .4. Ask the resident if they have been exposed to bed bugs or have experienced pruritis .6. Pay particular attention to unusual developments in skin appearance in any resident. 7. Remain alert to complaints of pruritis .Identification .2. Inspect adjacent areas in the facility for signs of infestation. a. Check resident rooms at night when bed bugs are active. Use a flashlight to check linens, mattresses, etc., for signs of bed bug activity .Eradication of Infestation. 1. Remove and/or treat all infected materials using non-chemical methods, including: a. Washing and drying bedding, linens, and clothing at high temperatures; b. Vacuuming or steam cleaning floors, mattresses, and any porous surfaces that cannot be machine-washed; c. Steaming or heat… | 2020-09-01 |
| 195 | 195 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-09-25 | 561 | D | 0 | 1 | A8U811 | LISENSURE REFERENCE NUMBER 175 NAC 12-006.05(4) Based on interviews and record reviews, the facility failed to ensure resident's bathing choices related to the number of baths the resident requested weekly were assessed for 1 sampled resident (Resident 43). The sample size was 53. The facility census was 87. Findings are: Interview on 9/18/18 at 12:12 PM with Resident 43 and Staff Member C who was acting as the resident's interpreter, revealed that bathing had been 2 days a week. Resident 43 confirmed that the resident wanted to bath 3 times a week related to an increase in sweating and itching. Resident 43 confirmed that the resident preferred to be bathed on Monday, Wednesday and Friday. Interview on 9/24/18 at 09:56 AM with the Activity Director revealed that the bathing preferences were documented by the Activity Aide, after the nurse aides had gotten the information. The Activity Director confirmed that during the assessments an interpreter was not used. Interview on 9/24/18 at 10:00 AM with the DON (Director of Nurses) confirmed that after the initial bathing preference questions were asked, there was no follow up on bathing preferences. Record review of Resident 43's Care Plan dated 8/17/18 revealed a focus of Activities of Daily Living. Resident 43 had a Bathing preference for a shower during the day 2 times per week on Monday and Friday. | 2020-09-01 |
| 196 | 196 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-09-25 | 584 | E | 1 | 1 | A8U811 | > Licensure Reference Number: 175 NAC 12-006.18A(1) Based on observation and interview the facility failed to ensure dining room was free from a scrapped up wall, discolored ceiling tile and foul odors in the hallway of the 400 wing. Sample size was 53. Facility census was 87 Findings are: Observation on 09/17/18 at 3:11 PM revealed the Dining Room on the 400 wing had a wall that was scraped up and the ceiling tiles had light brown stains in places. Observation on 09/19/18 at 2:36 PM revealed the Dining room on the 400 wing had a wall that was scraped up and the ceiling tiles had light brown stains in places. Interview with the Administrator on 09/20/18 at 10:55 AM confirmed that the wall on the 400 wing dining room was scraped up and the ceiling tiles had light brown stains in places. B. Observation on 9/17/18 at 9:30AM revealed a strong foul odor on 4th floor. Observation on 9/18/18 at 9:30 AM revealed a strong foul odor on 4th floor. Observation on 9/19/18 at 08:25PM soiled wheelchair with dark color stain noted in hall. Interview on 9/17/18 at 10:52 Am with Resident 85 confirmed that there were times when the area is odorous. Interview on 9/19/18 at 2:05PM with Resident 60 confirmed that there was a foul odor on 4th floor, Resident 60 reported that it is not as clean as it should be. Interview on 9/19/18 at 825PM interview with Administrator confirmed the odor was strong related to incontinence. | 2020-09-01 |
| 197 | 197 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-09-25 | 641 | D | 1 | 1 | A8U811 | > Licensure Reference Number 175 NAC 12.006.09B Based on interviews, observations, and record reviews; the facility failed to document the preferred Language and need for interpretive services on the comprehensive MDS for 1 resident (Resident 43) of 53 sampled residents. The facility census was 87. Findings are: Record review of Resident 43's MDS Annual Assessment, dated 12/19/17 revealed the resident was Hispanic or Latino and the resident did not need interpretive services and had no response for the preferred language of the resident. Observation on 9/18/18 at 2:40PM of Resident 43 in an Activity, in which the residents were talking about hunting and fishing, directed by Activity Aide B revealed Resident 43 was at a table and was observed for 15 minutes with no verbal communication with Activity Aide B and the other residents. Activity Aide B asked Resident 43 How long did it take you to catch your first fish? Resident 43 did not respond. Resident 36 who attended the activity, interpreted the question in Spanish and Resident 43 answered the question with 3 hours. Interview on 09/23/18 at 07:56 PM with Resident 43 revealed when the resident was asked, are you able to make choices in how many baths you would like per week the resident was slow to respond. When asked if the resident would like an interpreter Resident 43 responded with yes. Staff Member C, in Spanish, asked the question of are you able to make choices in how many baths you would like per week and Resident 43 answered the question in Spanish. Staff Member C revealed that Resident 43 would like to have 3 baths per week and was only getting 2 baths per week. Interview on 09/24/18 at 09:45 AM with Social Services confirmed that an interpreter was used at times when needed for communicating with Resident 43. | 2020-09-01 |
| 198 | 198 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-09-25 | 656 | D | 0 | 1 | A8U811 | Licensure Reference Number 175 NAC 12-006.043a (5) Based on record review, observation and interviews; the facility failed to develop a care plan to address language barriers and bathing preferences for 1 resident (Resident 43) of 53 sampled residents. The facility census was 87. Findings are: Record review for the Care Plan of Resident 43 with a revision date of 8/27/18 revealed the language barrier/preference and the need for interpretive services was not located in the care plan. Resident 43's preferences related to bathing were documented as 2 days per week. Observation on 9/18/18 at 2:40PM of Resident 43 in an Activity, in which the residents were talking about hunting and fishing, directed by Activity Aide B revealed Resident 43 was at a table and was observed for 15 minutes with no verbal communication with Activity Aide B and the other residents. Activity Aide B asked Resident 43 How long did it take you to catch your first fish? Resident 43 did not respond. Resident 36 who attended the activity, interpreted the question in Spanish and Resident 43 answered the question with 3 hours. Interview on 09/23/18 at 07:56 PM with Resident 43 revealed when the resident was asked, are you able to make choices in how many baths you would like per week the resident was slow to respond. When asked if the resident would like an interpreter Resident 43 responded with yes. Staff Member C, in Spanish, asked the question of are you able to make choices in how many baths you would like per week and Resident 43 answered the question in Spanish. Staff Member C revealed that Resident 43 would like to have 3 baths per week and was only getting 2 baths per week . Interview on 09/24/18 at 09:45 AM with the MDS (Minimal Data Set: a comprehensive assessment used to complete a person centered plan of care) Coordinator confirmed the Language barrier/language preference had not been addressed in the care plan. Record review for the care plan of Resident 43 with a revision date of 8/27/18 revealed the language barrier and the need for i… | 2020-09-01 |
| 199 | 199 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-09-25 | 756 | D | 0 | 1 | A8U811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.12B (5) Based on record review the facility failed to provide pharmacy reviews that recognized a potential irregularity related to the indication for use for a medication. This had the potential to affect two residents. (Residents 61 and 69) out of 53 sampled residents. Findings are: [NAME] Resident 61's record review revealed the MDS (Minimum Data Set which is a comprehensive assessment for long term care residents ) dated 9/6/18 revealed a BIMs (Brief Interview for Mental Status) score of 15, (a score of 13-15 the person is intact cognitively) [DIAGNOSES REDACTED]. Record review of the physician orders [REDACTED]. Record review of electronic and paper documentation revealed no documentation of indications for use, why the resident received the [MEDICATION NAME], [MEDICATION NAME], Tylenol Extra Strength, [MEDICATION NAME] and [MEDICATION NAME]. Record review of (MONTH) MAR (Medication Administration Record) revealed resident received the following medications on a daily basis from (MONTH) 1st through (MONTH) 23rd, [MEDICATION NAME] two times daily, [MEDICATION NAME] two times daily, [MEDICATION NAME] three times daily. The following medications were given for pain from (MONTH) 1st through (MONTH) 23rd, Tylenol Extra Strength two tablets two times daily, [MEDICATION NAME] 22 doses, [MEDICATION NAME] 52 doses, [MEDICATION NAME] 9 doses, and [MEDICATION NAME] 18 doses. On 9/25/18 at 3:15 PM, an interview with the DON (Director of Nursing) confirmed there was no documentation as to why Resident 61 had been prescribed and no pharmacy review related to these medications. B. Resident 69's record review revealed the MDS dated [DATE] revealed a BIMS score of 9 (a score of 8-12 points the person is moderately impaired), [DIAGNOSES REDACTED]. Record review of the physician orders [REDACTED]. Record review of electronic and paper documentation revealed no documentation of indications for use, why the resident r… | 2020-09-01 |
| 200 | 200 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2018-09-25 | 758 | E | 0 | 1 | A8U811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.12B Based on record review and interview, the facility failed to provide a clinical rationale for the use of an antipsychotic medication for three residents (Residents 22, 23, and 61). The sample size was 53 and the facility census was 87. Findings are: [NAME] Review of Resident 61's Physician orders [REDACTED]. Review of the resident's medical report did not identify that the resident had a [DIAGNOSES REDACTED]. A review of the resident's MDS (Minimal Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 8/31/18 identified that the resident was on an antidepressant medication on a routine basis. B. Review of Resident 22's Physician orders [REDACTED]. Review of the resident's medical report did not identify that the resident had a [DIAGNOSES REDACTED]. A review of the resident's MDS (Minimal Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 7/18/18 identified that the resident was on an antidepressant medication on a routine basis. Interview on 09/25/18 at 3:08 PM with the Director of Nursing confirmed that Resident 22 was taking a medication for depression and did not have a [DIAGNOSES REDACTED]. C. Review of Resident 23's Physician orders [REDACTED]. Review of the resident's medical report did not identify that the resident had a [DIAGNOSES REDACTED]. A review of the resident's MDS (Minimal Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 7/19/18 identified that the resident was on an antidepressant medication on a routine basis. Interview on 09/25/18 at 3:08 PM with the Director of Nursing confirmed that Resident 23 was taking a medication for depression and did not have a [DIAGNOSES REDACTED]. | 2020-09-01 |
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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 );