cms_ND
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 164 | D | 1 | 1 | ZMNB11 | > Based on observation, review of the facility's educational information on privacy, and staff interview, the facility failed to provide privacy for 1 of 4 sampled residents (Resident #4) observed during personal cares in the resident's bathroom. Failure to provide privacy is an infringement of the resident's rights and may lead to a loss of dignity. Findings include: On the afternoon of 05/10/17, an administrative nurse (#1) stated the facility did not have a privacy policy and provided information from the Clinical Services Portal. This information titled, Privacy and Confidentiality dated 12/2012, stated, . The resident has the right to personal privacy . 1. Personal privacy includes . personal care . Observation on 05/09/17 at 10:20 a.m., showed two certified nursing assistants (CNAs) (#2 and #3) toileting Resident #4 in the resident's bathroom. The CNA's failed to close the bathroom door or pull the privacy curtain allowing Resident #4's roommate to observe the cares provided. During an interview on 05/10/17 at 10:10 a.m., an administrative nurse (#1) stated she would expect staff to pull the roommate's privacy curtain when performing personal cares for Resident #4 in her bathroom. | 2020-09-01 |
| 2 | 2 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 309 | D | 1 | 1 | ZMNB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of professional literature, and staff interview, the facility failed to provide the care and services necessary to attain the highest degree of safety possible for 1 of 1 sampled residents (Resident #7) requiring staff assistance with meals. Failure to provide proper positioning during/following meals, failure to cut the meats into appropriate bite sized pieces, and failure to follow the 3 cough rule as outlined by therapy, placed Resident #7 at a greater risk for aspiration. Findings include: Swigert's The Source for Dysphagia, 3rd ed., Pro-Ed, Inc., Texas, 2007, pages 9, 15, 16, 125, and educational handouts, identified, . Signs and symptoms of dysphagia . coughing/choking . left hemisphere stroke indicative of oral dismotility . [MEDICAL CONDITION] . swallowing problems . often begin with reduced tongue based retraction and repetitive tongue rolling, followed by delayed initiation of the pharyngeal swallow . head and [MEDICAL CONDITION] . [MEDICAL CONDITION] therapy can have a significant impact on pharyngeal swallowing, sometimes years after the [MEDICAL CONDITION] therapy . During the oral intake of . liquids, it is optimal for a patient to be seated at a 90 degree angle . (when) in a chair . Even a slightly reclined position while eating greatly increases the risk of premature loss of food over the back of the tongue . Review of Resident #7's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The quarterly Minimum Data Set (MDS), dated [DATE], identified long and short term memory problems, extensive assistance with meals, and extensive assistance of two for bed mobility and transfers. A Speech Therapy progress note, dated 12/26/15, stated, . She requires 1:1 feeding. Pt (patient) should be upright for all meals at least 90 degrees, straws are ok, 3 cough rule-discontinue texture if more than 3 coughs are noted and notify SLP (speech language pathologist), encourage self-fe… | 2020-09-01 |
| 3 | 3 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 312 | D | 1 | 1 | ZMNB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of faility policy, staff interview, and resident interview, the facility failed to provide activities of daily living (ADL) assistance for 2 of 9 sampled residents (Resident #3 and #7) observed during personal cares. Failure to provide assistance with oral care (Resident #3) and incontinence care (Resident #7) may result in decreased intakes, urinary tract infections, and a loss of dignity and comfort. Findings include:- Review of Resident #3's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Resident #3's current Minimum Data Set (MDS), dated [DATE], identified intact cognition and supervision and set up help from staff for personal hygiene. The current care plan stated, . Assist resident with applying fixadent sealer to bottom dentures daily . A nurse's note, dated 11/23/16, stated, . Patient returned from dental appt. (appointment) with upper and lower dentures. Pt (patient) was told to come back if she needs ay (sic) adjustment. Pt needs to use Fixodent with the lower denture per (provider name) . Observations on the mornings of 05/09/17 and 05/10/17 showed staff assisted Resident #3 with morning cares, but failed to assist the resident with applying denture adhesive or cue the resident to apply it herself. Observations during these times showed the resident's dentures loose when she spoke. During an interview on 05/10/17 at 10:22 a.m., Resident #3 stated, The bottom ones (dentures) are loose. I knew that was going to happen, the gums have eroded. Review of facility policy titled INCONTINENCE CARE occurred on 05/08/17. This policy, revised (MONTH) 2014, stated, . if feces present, remove with toilet paper or disposable wipe by wiping from front of perineum toward rectum. Cleanse peri-area and buttocks with cleansing agent or disposable wipe wiping from front of perineum toward rectum. Use separate area of cloth or new disposable wipe for each stroke. Gently separate labia a… | 2020-09-01 |
| 4 | 4 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 314 | D | 1 | 1 | ZMNB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, and staff interviews, the facility failed to provide appropriate interventions and treatment to promote healing for 1 of 2 sampled residents (Resident #7) with a current pressure ulcer. Failure to provide timely and appropriate interventions and ensure staff consistently implemented those interventions resulted in further deterioration of Resident #7's existing pressure ulcer. Findings include: Review of Resident #7's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The quarterly Minimum Data Set (MDS), dated [DATE], identified severely impaired cognition, at risk for pressure ulcers, and extensive assistance of two or more persons for bed mobility. Resident #7's current care plan stated, . Focus At risk for alteration in skin integrity related to: . impaired mobility. Encourage to reposition as needed; use assistive devices as needed. Observe skin condition . report abnormalities. Focus deep purple tissue injury on left heel . Administer treatment per physician orders [REDACTED]. Resident #7's current certified nursing assistant (CNA) kardex stated, . SKIN CARE encourage and/or assist to reposition frequently. HEEL PROTECTOR-left foot. SUSPEND HEELS . The nurse practitioner progress note, dated 03/24/17, stated . CHIEF COMPLAINT: complaints of pain in left heel . OBSERVATIONS: . approximately 4 cm (centimeter) round purplish area on left heel that is not blanchable. Diagnosis: [REDACTED]. boots (heel protector) on, when she is in bed she will have her heels floated so nothing is touching them. We'll continue to follow closely. If wound worsens will send her to wound clinic. The progress notes identified the following: * 03/22/17, Deep purple area 4 x (by) 3 cm. Surrounding purple area is red, . * 03/24/17, Wound rounds: Deep purple and not blanchable measuring 4 x 3 cm. The progress's notes showed the nursing staff failed to notify the physician when the wound size increased. * 04/07… | 2020-09-01 |
| 5 | 5 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 322 | D | 1 | 1 | ZMNB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of facility policy, and staff interview, the facility failed to provide the appropriate treatment and services for 1 of 1 supplemental resident (Resident #18) observed receiving medications through a gastrostomy tube. Failure to administer the appropriate amount of fluid with administration of medications into a gastric tube and clean the syringe after administration may result in harm to the resident. Findings include: Review of the facility policy titled Enteral Tubes: Medication Administration occurred on 05/10/17. The policy, dated (MONTH) 2012, stated, . Procedure . dissolve medication in medicine cup using 10 to 30 ml (milliliters) of water . (before medication) Flush tube with a minimum of 30 ml of water . flush between each medication with a minimum of 5-10 ml of water . flush tube at end of medication administration with a minimum of 30 ml water . rinse reusable syringe, allow to air dry . - Review of Resident #18's medical record occurred on 05/09/17. The current physician order stated, Flush (gastric) tube with at least 30 ml of water before and after an external feeding and/or medication administration Observation on 05/09/17 at 3:42 p.m. showed a licensed nurse (#6) entered Resident #18's room to administer the contents of the [MEDICATION NAME] (nerve pain) medication capsule. The nurse (#6) checked placement of the tube, checked the stomach residual with a syringe, and flushed the syringe with 5 ml of water. The nurse (#6) administered the [MEDICATION NAME] powder with 5 ml of water into the gastric tube, flushed with 20 ml of water, clamped the gastric tube, and placed the used syringe in a bag to air dry. The licensed nurse (#6) confirmed she flushed the gastric tube with 5 ml of water, then gave the medication with 5 ml of water, and did a final flush with 20 ml of water. The nurse (#6) failed to flush the tube with 30 ml of water before and after medication administration, dissol… | 2020-09-01 |
| 6 | 6 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 328 | D | 1 | 1 | ZMNB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of professional reference, review of facility policy, and staff interview, the facility failed to provide the necessary care and services for 1 of 3 sampled residents (Resident #8) receiving oxygen therapy. Failure to follow the medical providers orders, and provide guidance to the facility staff on oxygen usage does not allow the facility or the health care provider to assess the effectiveness of the resident's oxygen therapy. Findings include: Berman and Snyder, S., Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice, 10th ed., Pearson Education, Inc., New Jersey, page 1259 states, . Like any medication, oxygen is not completely harmless to the client. Clients can receive an inadequate amount or an excessive amount of oxygen and both can lead to a decline in the client's condition. Review of the facility policy titled Respiratory: Oxygen Administration occurred on 05/10/17. This policy, dated (MONTH) (YEAR), stated, . Procedure: 1. Verify Physician's order . Review of Resident #8's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Current physician's orders stated, OXYGEN AT 3L (liter) PER NASAL CANNULA AT BEDTIME AND AS NEEDED FOR SOB (short of breath)/WHEEZIN[NAME] Resident #8's care plan identified the following Focus: Resistive/noncompliant with oxygen therapy related to: [MEDICAL CONDITION], belief that treatment is not needed/working . The certified nurse aide (CNA) kardex identified OXYGEN 2L continuous, neb (nebulizer) prn (as needed), patient will remove O2 (oxygen) at times. Observations of Resident #8 showed the following: * 05/08/17 at 4:26 p.m. sitting in her room in her wheelchair wearing a nasal cannula connected to an oxygen tank set at 2 liters per minute (LPM). * 05/09/17 at 8:51 a.m., self propelling her wheelchair in the hallway wearing a nasal cannula connected to an oxygen tank set at 2 LPM. * 05/09/17 at 12:27 p.m. self propelling her … | 2020-09-01 |
| 7 | 7 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 371 | E | 1 | 1 | ZMNB11 | > Based on observation, review of the facility's policies, manufacturer recommendations, and staff interview, the facility failed to store and/or prepare food in a safe and sanitary manner in 2 of 3 food service areas (kitchen & North nurses station). Failure to ensure sanitizing solutions are at the correct concentration and failure to store food appropriately in a refrigerator may result in a food borne illness that can affect all residents who eat food prepared and served in these areas. Findings include: Review of the facility policy titled Manual[NAME]Washing occurred on 05/09/17. This policy, revised (MONTH) (YEAR), stated, . Some items which cannot be washed in the dishwasher are washed manually in the three compartment sink. Fill the third sink with hot water. Add Oasis 146 (multi-quaternary sanitizer) to give a concentration of 200-400 ppm (parts per million). Test the concentration with the QT-40 (quaternary) test strip designed for Oasis 146 . Check the concentration of the sanitizing solution periodically and add sanitizer or replace solution if necessary . Review of the manufacturer wall chart titled Oasis 146 Multi-Quat Sanitizer occurred on 05/09/17. The undated wall chart, stated, . Sanitation range . should be between 150-400 ppm . Review of the facility policy titled Pantry/Nutrition Room Cleaning occurred on 05/09/17. This policy, revised 03/01/03, stated, . Housekeeping staff will clean and disinfect the Medication Room on a daily schedule. Clean and defrost refrigerator as needed . - An observation of the kitchen on 05/09/17 at 2:00 p.m. showed a cook (#8) washed soiled dishes in a three compartment sink. The cook (#8) washed pots, ladles, and steam table buckets in the three compartment sink and set them out to dry. Using a QT-40 test strip, the dietary manager (#9) obtained a reading of 150 ppm in the third compartment sink containing Oasis 146 sanitizing solution. Observation also showed a quaternary wash bucket sitting on a counter. The dietary manager (#9) obtained a reading of 0 ppm in … | 2020-09-01 |
| 8 | 8 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2017-05-10 | 441 | D | 1 | 1 | ZMNB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of the facility policies, review of professional literature, and staff interview, the facility failed to follow infection control practices for 2 of 9 sampled residents (Resident #4 and #7) observed during personal cares and/or foley catheter cares. Failure to follow infection control practices of hand hygiene following perineal cares (Resident #4 and #7) and foley catheter cares (Resident #7) has the potential to spread infection to other personnel, residents, and visitors. Findings include: Review of the facility policy titled, Hand Hygiene occurred on 05/10/17. This policy, dated 12/2009, stated, . When to wash hands or use an alcohol-based hand rub: * Before applying and after removing gloves . *After contact with body fluids and excretions . Review of facility policy titled, INCONTINENCE CARE occurred on 05/10/17. This policy, revised (MONTH) 2014, stated, . if feces present, remove with toilet paper or disposable wipe . Discard soiled materials and gloves. Perform hand hygiene . Dry peri-area and buttocks . Remove and discard gloves. Perform hand hygiene. Reposition for comfort . provide additional care needs . - During observation on 05/09/17 at 10:20 a.m., two certified nursing assistants (CNAs) (#2 and #3) provided perineal cares for Resident #4 after using the toilet. A CNA (#2) completed the cares, including the cleansing of a smear of bowel movement (BM). Following the incontinence care and assisting Resident #4 into the wheelchair, the CNA (#2) removed her gloves, failed to perform hand hygiene, and donned a new pair of gloves. The CNA then proceeded to complete other tasks of pushing Resident #4 out of the bathroom and applying leg rests to the wheelchair. During an interview on 05/10/17 at 10:10 am, an administrative nurse (#1) stated she would expect staff to perform hand hygiene after removing gloves, and before doing other tasks. Berman and Snyder, Kozier & Erb's Fundamentals of … | 2020-09-01 |
| 9 | 9 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 574 | C | 1 | 1 | FA2L11 | > Based on interview with the resident council, observation, review of the admission packet, and staff interview, the facility failed to provide residents, in writing, with a complete and/or accurate list of names, addresses (mailing and email), and/or telephone numbers of all the pertinent State regulatory, advocacy, and informational agencies. Failure to provide this written information to residents has the potential to limit residents' and their families' access to these agencies and has the potential to impact all residents. Findings include: During the resident council interview conducted on 05/14/19 at 2:38 p.m., the residents stated they were not clear about how to contact the pertinent State regulatory, advocacy, and/or informational agencies. Observation on (MONTH) 14-16, 2019, showed a wall mounted enclosed glass case and a binder located near the entrance hallway, that contained written information for the residents and public to view. The wall mounted enclosed glass case contained a list with names and telephone numbers, the binder contained a list with some names, mailing addresses, and telephone numbers, such as the State Ombudsman program, the State Survey Agency, etc. However, the lists contained some inaccurate information (i.e. names, addresses, etc.) and failed to include all the pertinent required agencies. In addition, the lists lacked a statement informing residents that they may file a complaint with the State Survey Agency concerning any suspected violation of nursing facility regulations, non-compliance with the advance directives requirements, and requests for information regarding returning to the community. On the morning of 05/16/19, review of the facility's admission packet of written information/material provided to the residents contained the same inaccurate information as in the above-stated binder. During an interview on the afternoon of 05/16/19, two administrative staff members (#1 and #4) verified the facility failed to provide residents, in writing, with a complete and/or acc… | 2020-09-01 |
| 10 | 10 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 580 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, review of facility policy, family interview, and staff interview, the facility failed to notify residents' representatives or physicians promptly of a change in condition for 2 of 20 sampled residents (Resident #31 and #49). Failure to update resident representatives promptly on injuries of unknown origin and new treatment orders (Resident #31 and #49) and failure to update the physician promptly on a deterioration in skin condition (Resident #31) may delay treatment and is a violation of residents' rights. Findings include: Review of the facility policy titled Change in a Resident's Condition or Status occurred on 05/16/19. This undated policy stated, . Our facility shall promptly notify the resident, his or her Attending Physician, and representative (sponsor) of changes in the resident's medical/mental condition and/or status (e.g., changes in level of care, billing/payments, resident rights, etc.). The nurse will notify the resident's Attending Physician or physician on call when there has been a(an): . discovery of injuries of an unknown source . need to alter the resident's medical treatment significantly . Unless otherwise noted by the resident, a nurse will notify the resident's representative when: . The resident is involved in any accident or incident that results in an injury including injuries of an unknown source . there is a significant change in the resident's physical, mental, or psychosocial status . - Review of Resident #31 medical record occurred on all days of survey. Progress notes stated the following: * 04/18/19 at 11:00 p.m. to 11:26 p.m.: . resident left dorsal foot area has open area, due to [MEDICAL CONDITION], skin cleaned and dressing applied . measurement on left dorsal foot 2 x 1.5 cm (centimeter) . resident left foot has pitted [MEDICAL CONDITION] +2, wear ACE wrap in AM and off at HS (hour of sleep) . has some redness around the wound . will continue to monitor. * 04/24/19 at 5:43 p.m… | 2020-09-01 |
| 11 | 11 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 607 | D | 0 | 1 | FA2L12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility policy, and staff interview, the facility failed to implement abuse investigation policies regarding injuries of unknown origin for 1 of 13 sampled residents (Resident #9) reviewed during the on-site revisit. Failure to assess, monitor, and investigate injuries of unknown origin placed Resident #9 at risk for abuse/neglect. Findings include: Review of the facility policy titled Abuse Investigation and Reporting occurred on 06/18/19. This undated policy stated, . All reports of resident abuse, neglect, exploitation, misappropriation of resident property, mistreatment and/or injuries of unknown source (abuse) shall be promptly reported to local, state and federal agencies (as defined by current regulations) and thoroughly investigated by facility management. Findings of abuse investigations will also be reported. Review of Resident #9's medical record occurred on (MONTH) 17-18, 2019. [DIAGNOSES REDACTED]. At risk for alteration in skin integrity related to: impaired mobility, spending more time in bed, decrease in appetite, wheel self around and often scratch self on walls or on objects in room and bathroom . Interventions . Observe skin condition with ADL (activities of daily living) care daily; report abnormalities . Current physician's orders included geri sleeves (long sleeves ok) on in AM (morning) off at HS (bedtime). A weekly skin assessment, dated 06/15/19, identified no skin issues. Observation on 06/17/19 at 12:41 p.m. showed Resident #9 had bruising/swelling and a skin tear covered with a Band-Aid to her left hand, bruising to her right forearm and shin, and wearing a short-sleeved shirt without geri sleeves in place. The certified nursing assistant (CNA) (#1) stated she did not know how the injuries occurred. Observation on 06/17/19 5:10 p.m. showed Resident #9's left hand covered with a [MEDICATION NAME] dressing and no geri sleeves in place. Review of Resident #9's treatment … | 2020-09-01 |
| 12 | 12 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 640 | E | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.16), the facility failed to ensure timely electronic data submission of required Minimum Data Sets (MDS) assessments for 9 of 20 sampled residents (Resident #1, #12, #13, #16, #20, #35, #38, #40, and #54) and 2 of 3 closed resident records reviewed (Resident #64 and #65). Failure to follow the MDS data submission specifications does not meet the intended regulatory requirements. Findings include: Review of Resident #1, #12, #13, #16, #20, #35, #38, #40, and #54's medical records occurred on all days of survey. Review of Resident #64 and #65's medical records occurred on 05/16/19. The MDSs showed the following: ENTRY TRACKING: The Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.16), page 2-36 stated, the entry tracking record, . Must be completed within 7 days after the admission/reentry. Must be submitted no later than the 14th calendar day after the entry (entry date (A1600) + 14 calendar days). Review of Resident #20's medical record identified an admission date of [DATE]. The entry tracking record was submitted to the Centers for Medicare and Medicaid Services (CMS) on 02/04/19, 10 days late. ADMISSION: The Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.16), page 2-21 regarding completion dates stated, . The MDS completion date (Item Z0500B) must be no later than day 14 (the admitted counts as day one). This date may be earlier than or the same as the CAA(s) (Care Area Assessment Summary) completion date, but not later . The CAA(s) completion date (Item V0200B2) must be no later than day 14 (the admitted counts as day one). -Review of Resident #12's medical record identified an admission date of [DATE]. The admission MDS, dated [DATE], showed the facility dated items V0200B2 and Z0500B 12/18/18, 15 days late. -Review of Resid… | 2020-09-01 |
| 13 | 13 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 641 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.16), and staff interview, the facility failed to ensure accurate coding of the Minimum Data Sets (MDSs) for 2 of 20 sampled residents (Resident #12 and #54). Failure to accurately complete Section A (Identification Information) and Section P (Restraints and Alarms) of the MDS does not allow each resident's assessment to reflect their current status/needs, and may affect the accurate development of a comprehensive care plan and the care provided to the residents. Findings include: SECTION A: IDENTIFICATION INFORMATION The Long-Term Care Facility RAI Manual, revised (MONTH) (YEAR), page A-19 to A-20, stated, . Section A1500: Preadmission Screening and Resident Review (PASRR) . Coding Instructions: Code 0, no: and skip to A1550, Conditions Related to ID/DD Status, if any of the following apply: PASRR Level I screening did not result in a referral for Level II screening, or Level II screening determined that the resident does not have a serious mental illness . Code 1, yes: if PASRR Level II screening determined that the resident has a serious mental illness and/or ID/DD or related condition, and continue to A1510, Level II Preadmission Screening and Resident Review (PASRR) Conditions. Coding instructions: Code A, Serious mental illness: if resident has been diagnosed with [REDACTED]. - Review of Resident #12's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The record showed a completed PASRR Level I and Level II screen for an indicated serious mental illness prior to Resident #12's admission to the facility on [DATE]. Review of the admission MDS, dated [DATE], showed section A1500 coded No which resulted in a skipped coding pattern and staff failed to code section A1510 [NAME] Serious mental illness. SECTION P: RESTRAINTS AND ALARMS The Long-Term Care Facility RAI Manual, revised (MONTH) (YEAR), … | 2020-09-01 |
| 14 | 14 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 656 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and review of facility policy, the facility failed to develop and implement a comprehensive care plan for 1 of 3 sampled residents (Resident #16) receiving [MEDICAL TREATMENT]. Failure to comprehensively assess [MEDICAL TREATMENT] care and implement interventions related to access sites/monitoring of residents may result in complications, including bleeding, loss of access sites, or [MEDICAL CONDITION]. Findings include: Review of the facility policy titled [MEDICAL CONDITION], Care of a Resident with occurred on 05/16/19. This undated policy stated, Education and training of staff, may include the following as applicable: . The type of assessment data that is to be gathered about the resident's condition on a daily or per shift basis . Signs and symptoms of worsening condition and/or complications of [MEDICAL CONDITIONS] . The care of grafts and fistulas . The resident's comprehensive care plan will reflect the resident's needs related to [MEDICAL CONDITION]/[MEDICAL TREATMENT] care . Resident #16's current care plan stated, . Focus . I have a potential for complication related to [MEDICAL TREATMENT] for [DIAGNOSES REDACTED]. Date Initiated: 02/21/2019 . Goal . I will not develop complications related to [MEDICAL TREATMENT] through next 30 days. Interventions . I will attend ([MEDICAL TREATMENT] center name) three days per week . Resident #16's [MEDICAL TREATMENT] care plan failed to identify access sites and interventions related to the assessment and care of sites and monitoring of Resident #16 for complications related to [MEDICAL TREATMENT]. | 2020-09-01 |
| 15 | 15 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 657 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM THE SURVEYS COMPLETED ON 06/28/18. Based on observation, record review, and staff interview, the facility failed to review/revise the comprehensive care plans to reflect the current status for 2 of 20 sampled residents (Resident #17 and #54). Failure to revise the care plan limited staff's ability to communicate care needs and ensure continuity of care for each resident. Findings include: - Review of Resident #54's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The skilled therapy notes showed physical therapy services discontinued on 12/31/18 and occupational therapy services discontinued on 01/11/19. The most recent quarterly Minimum Data Set ((MDS) dated [DATE], identified Resident #54 to be cognitively intact. The progress notes showed the following: * 02/07/19 at 3:02 p.m., . Continues to refuse to get up despite being offered multiple times, . * 04/18/19 at 10:30 p.m., . Order signed by MD (physician) for D/C (discontinue) of Ensure [MEDICATION NAME] this date. * 04/24/19 at 11:10 p.m., . Bed mobility: . prefers to stay in bed . Toileting: Is incontinent of b & b (bowel and bladder). Check et (and) change as needed . Resident #54's current care plan stated, . Interventions: Remind resident to wear gripper socks when up . Get up every morning at 11:00 AM for therapy . OT (Occupational Therapy) ADL (Activities of Daily Living) training/adaptive equipment to improve self-care, home management training, meal preparation, safety procedures and/or instructions in use of assistive devices and/or technology . Get up and be ready for therapy by 10:30 AM and go to therapy by 11:00 AM . Adjust toileting times to meet patient needs . Provide assistance with toileting . Supplements: 8 oz (ounces) Ensure [MEDICATION NAME] PM and HS (hour of sleep) . Assist with dentures as needed . Refer to dentist/hygienist for evaluation/recommendations re: denture realignment, new fitting . Fistula to right … | 2020-09-01 |
| 16 | 16 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 658 | E | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, record review, review of facility policy, review of professional reference, family and staff interview, the facility failed to follow professional standards of nursing practice for 5 of 20 sampled residents (Resident #30, #35, #43, #49, and #61). Failure to carry out a physician's order (Resident #35), failure to follow facility policy when priming insulin pens (Resident #43 and #61), and failure to ensure residents received follow up care as ordered (Resident #30 and #49) may result in adverse health effects. Findings include: PHYSICIAN'S ORDERS Kozier & Erb's Fundamentals of Nursing, Concepts, Process and Practice, 10th Edition, (YEAR), Pearson, Boston, Massachusetts, page 68, stated, . Carrying Out a Physician' Orders . If the order is neither ambiguous not apparently erroneous, the nurse is responsible for carrying it out. - Review of Resident #35's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. A cardiology progress note, dated 04/08/19, identified an order for [REDACTED].#35 on 9 of the past 37 days. During an interview on the morning of 05/16/19, an administrative nurse (#1) confirmed she expects nurses to follow physician orders and that the weights were missed. - Review of Resident #30's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The record identified a hospital stay from (MONTH) 3-7, 2019 for a [DIAGNOSES REDACTED]. Discharge instructions identified a follow up appointment at the urology clinic on 03/18/19. The medical record lacked evidence the resident went to this appointment. During an interview on the afternoon of 05/16/19, an administrative nurse (#1) confirmed Resident #30 did not go to the urology appointment. - During an interview on the afternoon of 05/13/19, a family member stated she was upset because Resident #49 missed a neurology appointment in (MONTH) which was previously scheduled. The resident was then unable to see the neurologist until June.… | 2020-09-01 |
| 17 | 17 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 677 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of facility policy, and staff interview, the facility failed to provide activities of daily living (ADL) assistance to 1 of 11 sampled residents (Resident #45) who required staff assistance for toileting. Failure to provide appropriate assistance to residents who cannot independently carry out ADLs may result in avoidable incontinence, poor grooming/hygiene, decreased self esteem, and an avoidable decline in ADL ability. Findings include: Review of the facility policy titled Activities of Daily Living (ADLs), Supporting occurred on 05/16/19. This undated policy stated, . Residents will (be) provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal and oral hygiene. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. Hygiene (bathing, dressing, grooming, and oral care); b. Mobility (transfer and ambulation, including walking); c. Elimination (toileting) . Review of Resident #45's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Focus . ADL Self care deficit related to physical limitations . Interventions . hands on staff assist with bed mobility, transfers, w/c (wheelchair) locomotion on and off unit, dressing, toileting, personal hygiene, eating and bathing. Staff anticipate needs as ADL's do fluctuate . Transfer: extensive assistance of one with gait belt and pivot . Focus . At risk for falls due to impaired balance/poor coordination . Interventions . assist to bathroom after meals as needed . check on resident and offer toileting regularly . Don't… | 2020-09-01 |
| 18 | 18 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 684 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, and review of professional reference, the facility failed to provide care and services to ensure safe positioning for meals for 1 of 4 sampled residents (Resident #30) observed eating in bed. Failure to ensure proper mealtime positioning placed Resident #30 at risk for aspiration. Findings include: Swigert's The Source for Dysphagia, 3rd ed., Pro-Ed, Inc., Texas, 2007, pages 9, 10, 125, and educational handouts, identified, . Signs and Symptoms of Dysphagia . coughing . during a meal . Some patients cough and choke when they aspirate . During the oral intake of . food and/or liquids, it is optimal for a patient to be seated at a 90 degree angle, whether in bed or in a chair. Even a slightly reclined position while eating greatly increases the risk of premature loss of food over the back of the tongue. Review of Resident #30's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Nurses' notes identified the following: *03/10/19 at 7:26 p.m.: . ProMod Liquid (a protein supplement) . Patient unable to swallow medication without coughing . *03/10/19 at 7:30 p.m.: . Juven Packet (a nutritional supplement) . Patient choking on liquids will update NP (nurse practitioner) . *03/10/19 at 10:42 p.m.: . Writer went into residents (sic) room where he was sitting up eating in bed. Writer gave him his 3 o'clock medication and patient began to cough. Patient face dark red in color. Patient was able to stop coughing after couple min. (minutes) . On call was called and writer was instructed to leave progress note . for NP. Observation on 05/14/19 at 12:48 p.m. showed Resident #30 eating lunch in bed. The head of the bed was at a 45 degree angle. Observation showed the resident coughed while eating. At 1:00 p.m., observation showed Resident #30 coughed and choked on his food, expelling pieces from his mouth while his eyes watered. The surveyor entered the room and asked if he needed to sit up. The resident… | 2020-09-01 |
| 19 | 19 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 686 | G | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 06/28/18. Based on observation, record review, review of facility policy, and family and staff interview, the facility failed to provide appropriate treatment and services to prevent the development and/or deterioration of pressure ulcers for 3 of 5 sampled residents (Resident #17, #30 and #31) with pressure ulcers. Failure to consistently implement interventions, ensure adequate monitoring/assessment, and complete wound care as ordered resulted in the deterioration of Resident #30's pressure ulcer, and delayed treatment/deterioration of pressure ulcers for Resident #17 and #31. Findings include: Review of the facility policy titled Pressure Ulcers/Skin Breakdown - Clinical Protocol occurred on 05/16/19. This undated policy stated, . In addition, the nurse shall describe and document/report the following, as applicable: a. Full assessment of pressure sore including location, stage, length, width and depth, presence of exudates or necrotic tissue . The physician may guide the care plan as appropriate, especially when wounds are not healing as anticipated or new wounds develop despite existing interventions. Review of the facility policy titled Repositioning occurred on 05/16/19. This undated policy stated, . The purpose of this procedure is to provide guidelines . to promote comfort for all bed- or chair-bound residents and to prevent skin breakdown, promote circulation and provide pressure relief for residents. Repositioning is a common, effective intervention for preventing skin breakdown, promoting circulation, and providing pressure relief. Positioning the resident on an existing pressure ulcer should be avoided since it puts additional pressure on tissue that is already compromised and may impede healing. - Review of Resident #30's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current Minimum Data Set (MDS), dated [DATE], identified no rejection of cares… | 2020-09-01 |
| 20 | 20 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 689 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of facility policy, and staff interview, the facility failed to provide enough supervision and/or assistive devices for 3 of 10 sampled residents (Resident #35, #45, and #62) observed transferred with staff assistance. Failure to use assistive devices per policy and/or manufacture guidance to transfer a resident safely places residents at risk of accidents with/without injury. Findings include: GAIT BELTS Review of the facility policy/procedure titled Safe Lifting and Movement of Residents occurred on 05/16/19. This undated policy, stated, . 4. Staff responsible for direct care will be trained in the use of manual (gait/transfer belts, lateral boards) and mechanical lifting devices. - Review of Resident #62's medical record occurred on (MONTH) 13-16, 2019. An admission Minimum Data Set (MDS), dated [DATE], identified extensive assistance two or more staff for transfers and toilet use. Resident #62's current care plan identified Transfers: 1 assist, FWW (front wheeled walker). Observation on 05/14/19 at 11:49 a.m., showed the certified nurse aide (CNA) (#12) lifted Resident #62 under her left arm to transfer from the wheelchair to the toilet. After the CNA (#12) provided person cares, the CNA (#12) again lifted under Resident #62's left arm to transfer from the toilet to the wheelchair. The CNA (#12) failed to utilize a gait belt to assist with Resident #62's transfers. - Review of Resident #45's medical record occured on (MONTH) 14-16, 2019. The resident's current care plan stated, . Focus . ADL (activities of daily living) Self care deficit related to physical limitations . Interventions . Transfer: extensive assistance of one with gait belt and pivot . Date Initiated: 05/02/2018 . Observation on 05/14/19 at 10:44 a.m. showed two CNAs (#8 and #13) placed a gait belt around Resident #45's waist and assisted her to transfer to bed. Observation showed the gait belt was loose and slid up the resident… | 2020-09-01 |
| 21 | 21 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 690 | G | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, the facility failed to ensure appropriate treatment and services to treat a urinary tract infection [MEDICAL CONDITION] for 1 of 4 sampled residents (Resident #30) with an indwelling urinary catheter. Failure to adequately monitor and promptly treat Resident #30's UTI resulted in an admission to the hospital for [MEDICAL CONDITION] work up, including continuous bladder irrigation (CBI) and treatment with intravenous (IV) antibiotics. Findings include: Review of Resident #30's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Nurses' notes identified the following: *02/22/19 at 10:48 p.m.: . New order from (nurse practitioner) on call for (primary medical doctor) ordered a UA/UC (urinalysis/urine culture) for blood in urine and low grade temp (temperature) of 99.9 this shift. Foley changed. Foley was clogged with dried blood and urine was bright red. New foley inserted and N[NAME] (night) nurse was updated and will collect UA/UC. *02/23/19 at 2:29 a.m.: . Resident noted to have cherry red returns from catheter bag. This writer adjusted tubing and noted the urinary returns lighten up to pink. last shift had replaced catheter and noted hematuria. *02/23/19 at 4:30 a.m.: . Resident noted to have cherry colored urine in foley bag. Specimen was sent to lab. Last nurse had noted clots after removing old catheter. *02/24/19 at 12:16 a.m.: . Urine in Foley bag continues to be reddish colored. No clots noted. *02/24/19 at 10:29 p.m.: . Resident continues to have reddish brown urine. *02/25/19 at 12:12 a.m.: . Urine in Foley bag less red tonight. *02/25/19 at 3:30 p.m.: . resident continues to have blood in urine and (physician's assistant) called and update order to do CBC (complete blood count) and BMP (basic metabolic panel) note sent ton (sic) the lab. *03/02/19 at 9:32 p.m.: . Tylenol Tablet 325 mg (milligrams) Give 2 tablet by mouth every 4 hours as needed for pain/fever . Per request back et leg pain r… | 2020-09-01 |
| 22 | 22 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 695 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, staff interview, and family interview, the facility failed to provide necessary respiratory care and services for 1 of 2 sampled residents receiving scheduled nebulizer medications (Resident #49). Failure to ensure the availability of medications may result in worsening respiratory symptoms and/or respiratory distress. Findings include: During an interview on the afternoon of 05/13/19, a family member stated she was upset as Resident #49 had been without one of her nebulizers going on three weeks now. Review of Resident #49's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Current medications included [MEDICATION NAME] nebulizer (used to treat shortness of breath) twice per day, started on 11/30/2018. Nurses' notes identified the following: *05/01/19 at 7:34 a.m.: . [MEDICATION NAME] Nebulization Solution . Medication awaiting Prior Authorization per MD (medical doctor) at this time . *05/01/19 at 7:49 p.m.: . [MEDICATION NAME] Nebulization Solution . Product not available. Requires prior auth (authorization) . *05/02/19 at 7:04 p.m.: . [MEDICATION NAME] Nebulization Solution . not available . *05/03/19 at 7:09 a.m.: . [MEDICATION NAME] Nebulization Solution . no supply available at this time . *05/03/19 at 3:20 p.m.: . This writer contacted pharmacy at the beginning of this shift regarding [MEDICATION NAME] which has not been available for sometime now. This writer spoke with (pharmacy technician) who told this writer that they have contacted the prescribing physician for prior authorization and that they are awaiting approval. Will follow up. *05/03/19 at 7:52 p.m.: . [MEDICATION NAME] Nebulization Solution . Product not available. MD and pharmacy aware . *05/13/19 at 11:47 p.m.: . This writer contacted pharmacy and (clinic name) pulmonology department regarding pending prior authorization for [MEDICATION NAME]. Told by pharmacist (name) that they have email (sic) the provider and that they are… | 2020-09-01 |
| 23 | 23 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 698 | D | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 06/28/18. Based on observation, record review, review of facility policy, and resident interview, the facility failed to provide care and services for the provision of [MEDICAL TREATMENT] consistent with professional standards of practice for 1 of 3 sampled residents (Resident #16) receiving [MEDICAL TREATMENT]. Failure to assess and monitor the resident's condition and access site after [MEDICAL TREATMENT] and provide ongoing care/monitoring of [MEDICAL TREATMENT] may result in bleeding, loss of access site, or other complications. Findings include: Review of the facility policy titled [MEDICAL CONDITION], Care of a Resident with occurred on 05/16/19. This undated policy stated, Education and training of staff, may include the following as applicable: . The type of assessment data that is to be gathered about the resident's condition on a daily or per shift basis . Signs and symptoms of worsening condition and/or complications of [MEDICAL CONDITIONS] . The care of grafts and fistulas . The resident's comprehensive care plan will reflect the resident's needs related to [MEDICAL CONDITION]/[MEDICAL TREATMENT] care . Review of the facility policy titled [MEDICAL TREATMENT] Access Care occurred on 05/16/19. This undated policy stated, . Care of AVFs and AVGs (Arterio-Venous Fistula and Arterio-Venous Graft) . To prevent infection and/or clotting: a. Keep the access site clean at all times. Check for signs of infection (warmth, redness, tenderness, or [MEDICAL CONDITION]) at the access site when performing routine care and at regular intervals. Do not use the access arm to take blood pressure. Check the color and temperature of the fingers, and the radial pulse of the access arm when performing routine care and at regular intervals. Check the patency of the site at regular intervals. Palpate the site to feel the thrill, or use a stethoscope to hear the whoosh or bruit of blood flow throug… | 2020-09-01 |
| 24 | 24 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 725 | E | 1 | 1 | FA2L11 | > Based on information provided by the complainant, observation, resident and family interviews, and group interview, the facility failed to ensure the availability of sufficient nursing staff to promptly respond to residents' needs for 5 of 10 confidential resident interviews (Resident A, B, C, F, and J). Failure to provide sufficient staffing for assistance may result in residents experiencing falls and/or incontinence and may negatively affect the residents physical, mental, and psychosocial well-being. Findings include: Observations and interviews included the following: - During an interview on 05/13/19 at 11:21 a.m., Resident B stated, I wait a long time for my call light to get answered, I've had to wait 50-60 minutes several times, weekends are the worst by far. They come in and turn the light off and say they will go get someone and no one comes back. - During an interview on 05/13/19 at 12:29 p.m., Resident A stated, They are slow answering lights, I don't make it on time to the bathroom and then I wet my pants. - An interview occurred on 05/13/19 at 4:11 p.m. Resident C and his/her family member. Resident C stated, I wait long periods of time for my call light to be answered, usually at least 25 minutes. Evenings and weekends are the worst times. Resident C's family member stated he/she had to make the bed (Resident C's bed) at 5:00 p.m. and the day before, staff failed to removed the noon meal tray until 3:00 p.m. - Observation on on 05/14/19 at 12:57 p.m. showed Resident B's call light on. At 1:01 p.m., a nurse (#2) entered Resident #40's room, did not turn call light off, and assisted the resident with cares while this surveyor observed. At 1:23 p.m., the staff nurse finished cares and exited Resident B's room with call light still on. No other staff members came to answer the call light. - During the Resident Council meeting held the afternoon of 05/14/19. Two of the nine residents stated they have experienced long wait times for call lights to be answered. Resident B stated he/she has reported cal… | 2020-09-01 |
| 25 | 25 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 790 | D | 1 | 1 | FA2L11 | > Based on record review, family interview, and staff interview the facility failed to assist in obtaining dental care to meet the needs of 1 of 1 sampled resident (Resident #49) who requested a dental appointment. Failure to assist the resident in making an appointment and/or arranging transport may result in delayed dental care and/or dental complications. Findings include: During an interview on the afternoon of 05/13/19, a family member stated she has asked staff to make Resident #49 a dental appointment, but they have not done it. The family member stated Resident #49 has been to the dentist one time in eight years and nothing changes or gets done. Review of Resident #49's medical record occurred on all days of survey. A nurses' note, dated 01/29/19, stated, . Care Conference . Also requested dental appointment, will f/u (follow up) and update mother and resident when appointments made. The record lacked evidence staff made a dental appointment for Resident #49. During an interview on the morning of 05/16/19, a supervisory nurse (#7) confirmed Resident #49 had no scheduled dental appointment prior to 05/16/19. | 2020-09-01 |
| 26 | 26 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 803 | E | 1 | 1 | FA2L11 | > Based on observation, resident interview, review of menu's, review of resident council minutes, group interview, and staff interview, the facility failed to ensure staff consistently followed dietary menus for all residents for 4 of 8 residents with food concerns (Resident #D, #G, #39 and #47). Failure to offer the residents all the menu items listed, does not allow for residents' personal food choices or follow nutritional guidelines for a balanced meal. Findings include: - During a confidential interview, on 05/13/19 at 3:31 p.m., Resident D reported the facility has run out of hotdogs five times since she/he moved into the facility. Resident D reports the facility has also run out of hamburgers and bananas. - Observation on 05/13/19 at 6:21 p.m., showed Resident #39 requested tomato juice from a certified nursing assistant (CNA). The CNA left the dining room and returned a short time later. She stated to Resident #39, We don't have tomato juice, do you want something else? and identified they were out. - Review of the Weekly Menu for (MONTH) 12-18, 2019 and Always Available Menu occurred on (MONTH) 14-16, 2019. The weekly menu showed one main entree, vegetable, fruit and/or dessert at each noon and evening meal. The Always Available Menu showed the following: hamburger or cheeseburger on a bun, hot dog on a bun, deli meat sandwich with cheese on white or wheat, grilled cheese sandwich on white or wheat, egg salad sandwich on white or wheat, chef salad, side salad, cottage cheese, yogurt, tomato soup, chicken noodle soup, vegetable beef soup, mashed potatoes and gravy. - Review of the Resident Council Meeting Minutes occurred on 05/14/19. The meeting minutes dated 04/24/19, stated, . Dietary: Compliments, comments, concerns: New menu changes going well, but don't always have everything on anytime menu per (name of resident) states there were no hamburgers one day . - During the resident council meeting, held the afternoon of 05/14/19, four of the nine residents stated the facility runs out of food items such … | 2020-09-01 |
| 27 | 27 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 804 | E | 1 | 1 | FA2L11 | > THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 06/28/18 Based on information received from the complainant, observation, review of facility policy, resident interview, and group interview, the facility failed to ensure residents received food and beverages that were palatable, attractive and at the proper temperatures for 5 confidential residents interviews (Resident A, C, D, H, and I) and 3 of 9 residents who attended the group interview (Resident B, F, and G). Failure to ensure residents receive food and beverages that are palatable, attractive and at proper temperature, places residents at risk of weight loss and nutritional decline. Findings include: Information received from the complainant identified concerns with food palatability. Review of the facility policy titled Food and Nutrition Services occurred on 05/16/19. This undated policy stated, Each resident is provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident. Food and nutrition services staff will inspect food trays to ensure . the food appears palatable and attractive, and it is served at a safe and appetizing temperature. Review of the facility policy titled Preventing Foodborne Illness - Food Handling occurred on 05/16/19. This undated policy stated, . Federal standards require that refrigerated food be stored below 41 (degrees) F (Fahrenheit) . - During an interview on 05/13/19 at 11:19 a.m., Resident A stated, The milk is always warm, it's never cold anymore. Turkey they served yesterday was consistency of jello. You would not even serve the food to your dog. - During a confidential interview on 05/13/19 at 3:31 p.m., Resident D reported residents can wait 30 minutes for meals to be served, then the food is cold. Resident D reported meals were consistently cold until she/he changed dining rooms. - During an interview on 05/13/19 at 5:47 p.m. Resident H stated he/she likes fried eggs for breakfast, but the … | 2020-09-01 |
| 28 | 28 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 880 | D | 1 | 1 | FA2L11 | > Based on observation, review of facility policy, and staff interview, the facility failed to follow infection control practices for 3 of 9 sampled residents (Resident #31, #36, and #45) observed during personal cares. Failure to follow infection control practices of hand hygiene during personal cares has the potential to spread infection to other residents, personnel, and visitors. Findings include: Review of the facility policy titled Handwashing/Hand Hygiene occurred on 05/16/19. This undated policy stated, . This facility considers hand hygiene the primary means to prevent the spread of infections. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-microbial) and water for the following situations: . Before and after direct contact with residents; . Before moving from a contaminated body site to a clean body site during resident care; . After removing gloves; . - Observation on 05/14/19 at 9:35 a.m. showed a certified nurse assistant (CNA) (#15) applied gloves and washed Resident #36's face, upper body and dressed the resident's upper body. The CNA (#15) removed the resident's brief and provided incontinence care for bowel and bladder. The CNA applied barrier cream to the resident's perineal area and continued to wash, dry, and lotion the resident's legs and feet, and dressed the resident's lower body. The CNA (#15) poured mouthwash into a cup, dipped a toothette swab into the mouthwash and completed Resident #36's oral cares. The CNA placed the resident's blanket at the foot of the bed, placed the call light and overbed table next to the resident before removing gloves and performing hand hygiene. - Observation on 05/14/19 at 11:38 a.m. showed two CNAs (#13 and #15) provide incontinent care for Resident #31 after a bowel movement (BM). The CNA (#15) changed gloves and, without performing hand hygiene… | 2020-09-01 |
| 29 | 29 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 576 | C | 0 | 1 | ROZG11 | Based on policy review, resident group interview and staff interview, the facility failed to provide mail delivery on Saturday for 7 of 7 interviewed residents (Resident A, B, C, D, E, F, and G). Failure to provide mail delivery on Saturdays infringes on the residents' rights. Findings include: Review of policy titled Mail Distribution occurred on 06/27/18. This policy, dated (MONTH) 2013, stated, . delivers mail to the patient within 24 hours of receipt to the center. The resident group interview occurred on 06/26/18 at 10:37 a.m The residents stated they did not receive mail on Saturday. During an interview on 06/27/18 at 1:45 p.m., an administrative staff member (#1) confirmed the expectation is for mail to be delivered on Saturday. She reported staff are responsible for passing out mail on Saturday. | 2020-09-01 |
| 30 | 30 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 644 | D | 0 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the North Dakota Provider Manual for Preadmission Screening and Resident Review (PASARR) and Level of Care Screening Procedures For Long Term Care Services, and staff interview, the facility failed to complete a status change assessment for 1 of 1 sampled resident (Resident #23) with a newly diagnosed mental illness since the facility completed the initial PASARR on admission. Failure to complete a change in status assessment may result in the delivery of care and services that are inconsistent with resident's needs. Findings include: The North Dakota PASARR Provider Manual page 13 states, . Change in Status Process . Whenever the following events occur, nursing facility staff must contact Ascend (name of contracted service provider for screening process) to update the Level I screen for determination of whether a first time or updated Level II evaluation must be performed. These situations suggest that a significant change in status has occurred: . If an individual with MI, ID, and/or RC (mental illness, intellectual disability, and conditions related to intellectual disability (referred to in regulatory language as related conditions or RC)) was not identified at the Level I screen process, and that condition later emerged or was discovered. Review of Resident #23's medical record occurred on all days of survey. The record showed an initial PASARR completed on 03/12/12 and identified dementia and no mental illness. The screening stated, . The Level I Screen conducted for the above named individual determined that there was not evidence to suggest presence or known conditions of mental illness . Resident #23's medical record identified [DIAGNOSES REDACTED]. The record lacked evidence the facility completed a Level II assessment following the new [DIAGNOSES REDACTED]. During an interview on 06/28/18 at 8:40 a.m., a supervisory social service staff member (#3) confirmed the facility failed to submit a PASARR f… | 2020-09-01 |
| 31 | 31 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 657 | D | 0 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility policy and staff interview, the facility failed to review and revise comprehensive care plans to reflect the resident's current status for 2 of 18 sampled residents (Resident #2 and #71). Failure to review/revise the care plan to reflect each resident's current status limited the staff's ability to communicate needs and ensure continuity of care for the residents. Findings include: Review of the policy titled, Interdisciplinary Care Planning occurred on 06/27/18. This policy, updated (MONTH) (YEAR) stated, . The patient's care plan is a communication tool that guides members of the interdisciplinary healthcare team in how to meet each individual patient's needs. It also identifies the types and methods of care that the patient should receive . The care plan should include patient-specific measurable objectives . identifying risk versus benefits of the current interventions . incorporate the patient's personal and cultural preferences. - Review of Resident #2's record occurred on all days of the survey. The Quarterly Minimum Data Set (MDS), dated [DATE], identified Resident #2 as requiring the assistance of two staff for transfers and toileting, assistance of one staff for dressing and eating and only set up help with personal hygiene. The current care plan stated, . activities of daily living (ADL) self care deficit . Assist with daily hygiene, grooming, dressing, oral care and eating as needed. The certified nursing assistant (CNA) care card showed, . ADL assist-usually 2 person with minimum (min) level of assist . provide assistance with toileting. Observation on 06/26/18 at 9:00 a.m., showed a CNA (#14) assisted Resident #2 from her wheelchair (WC) to her bed using a gait belt and a pivot transfer. Observation on 06/27/18 at 8:08 a.m., showed an unidentified CNA transferred Resident #2 from the toilet to her WC with a gait belt and pivot transfer. During an interview on 06/28/18 at 11… | 2020-09-01 |
| 32 | 32 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 658 | D | 0 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, review of professional reference, and staff interview, the facility failed to administer medications in accordance with acceptable standards of practice for 1 of 1 resident (Resident #16) with a physician's orders [REDACTED]. Failure to follow acceptable standards of practice for medication administration has the potential to result in medication errors and/or adverse reactions for the resident. Findings include: Kozier & Erb's Fundamentals of Nursing, Concepts, Process and Practice, 10th Edition, (YEAR), Pearson, Boston, Massachusetts, page 776, states . Administering Oral Medications . Preparation: . 2. Check the MAR (medication administration record). Check for the drug name, dosage, frequency, route of administration, . If the MAR is unclear or pertinent information is missing, compare the MAR with the prescriber's most recent written order. Performance. 3. Obtain the appropriate medication. Read the MAR and take the appropriate medication . Compare the label of the medication container or unit-dose package against the order on the MAR . 4. Prepare the medication. While preparing the medication, recheck each prepared drug and container with the MAR again. Rationale: this second safety check reduces the chance of error. During an interview on 06/26/18 at 9:37 a.m., Resident #16 stated her digestive system problems cause some of her pills to pass through without even dissolving, so the doctor said to crush those pills. Resident #16 stated some nurses crush the pills, and others don't. It says it right on the record, but I have to keep telling staff. Review of Resident #16's medical record occurred on all days of survey. The physician's orders [REDACTED]. and recommend crushing this med. Review of the (MONTH) MAR on 06/27/18, identified the following: 6/20/18 [MEDICATION NAME] 30 mg (milligrams) po (by mouth) BID (two times a day) Crush. Observation of medication pass occurred on 06/28/18 at 7:54 a.m… | 2020-09-01 |
| 33 | 33 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 686 | D | 1 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 05/10/17 Based on information provided by the complainant, observation, record review, resident and family interview, and staff interview, the facility failed to provide the necessary care and services to prevent the development of pressure ulcers and promote healing, for 1 of 4 sampled residents (Resident #22) with pressure ulcers. Failure to evaluate risk factors that may impact the development/healing of a pressure ulcer, implement, monitor and modify interventions to reduce those risk factors, resulted in Resident #22 developing avoidable, facility acquired pressure ulcers and may result in the development of new ulcers. Findings include: The complainant identified Resident #22 was admitted to the hospital on [DATE] with multiple areas of skin breakdown. Review of Resident #22's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. During an observation on 06/26/18 at 9:45 a.m. two certified nursing assistants (CNAs), (8# and #9) assisted Resident #22 with perineal cares. While staff performed cares, Resident #22 called out in pain and moaned. His buttocks, peri area, and scrotum were excoriated, his penis reddened and ulceration noted to the foreskin. He had an indwelling foley catheter. Current physician orders [REDACTED]. A quarterly MDS (Minimum Data Set), dated 05/28/18 identified frequent incontinence of bowel and bladder, extensive assistance of two persons for bed mobility, toileting and total dependence for transfers. The current care plan stated, . Self care deficit as evidenced . hands on staff assist with bed mobility, transfers, toileting . Skin care: . At risk for alteration . related to incontinence . barrier cream to peri area, buttocks . observe skin condition with ADL(Activities of Daily Living) care daily - report abnormality . Although Resident #22 was identified as frequently incontinent of bowel and bladder, his care plan failed to address his … | 2020-09-01 |
| 34 | 34 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 692 | D | 1 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on facility policy review, record review, observation and staff interview, the facility failed to provide sufficient fluid intake to maintain proper hydration and health for 1 of 1 sampled resident (Resident #22) hospitalized for [REDACTED]. Failure to frequently offer fluids placed residents at risk for dehydration, UTI, and fluid/electrolyte imbalances. Findings include: Review of the facility's Hydration Practice Guide Flowchart, dated 2012, stated: Prompting patients to consume fluids and hydrate themselves is the single most effective approach in maintaining fluid balance . prompting to drink fluids is paired with toileting activities. Review of Resident # 22's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Current physician orders [REDACTED]. Current medications included [MEDICATION NAME] (diuretic) 20 milligram (mg) 1 tablet daily by mouth. The resident's care plan identified, . Risk for alteration in hydration related to diuretics, disease process/conditions, . times of pain, times of dry mouth, states he doesn't drink enough water, . dysphagia with thickened liquids at meals and thin liquids between meals per physician/mid-level order, . offer encourage and assist patient with fluids and between meals as needed. Observation on 06/26/18 at 9:45 a.m. showed two certified nursing assistants (CNAs) (#8 and #9) assisted Resident #22 with perineal cares, however, failed to offer fluids upon completion of cares. Observation on 06/27/18 at 11:39 a.m. showed two CNAs (8# and #7) assisted Resident #22 with perineal cares, however, failed to offer fluids upon completion of cares. During an interview on 06/28/18 at 4:00 p.m., an administrative nurse (#2) stated the staff are to offer fluids with cares and throughout the day. | 2020-09-01 |
| 35 | 35 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 698 | D | 0 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility policy and procedure, resident interview, and staff interview, the facility failed to ensure residents received the care and services consistent with professional standards of practice for 1 of 2 sampled residents (Resident #63) receiving [MEDICAL TREATMENT] outside the facility. Failure to assess the [MEDICAL TREATMENT] vascular access site (central venous catheter) can result in complications with access function, infection, and possible loss of the access site. Findings include: Review of the facility policy/procedure titled [MEDICAL TREATMENT] Guidelines occurred on 06/28/18. This policy, dated (MONTH) (YEAR), stated, . Guidelines: . A coordinated comprehensive care plan for [MEDICAL TREATMENT] treatments is developed with input from both the interdisciplinary team (IDT) and [MEDICAL TREATMENT] facility staff. Both the center and the [MEDICAL TREATMENT] facility are responsible for shared communication regarding patients receiving [MEDICAL TREATMENT] served, either onsite or offsite. Collaborative communication includes information regarding: . [MEDICAL TREATMENT] adverse reactions/complications and/or recommendations for follow up observations and monitoring including those related to the vascular access site . During an interview on 06/25/18 at 4:04 p.m., Resident #63 stated he/she has a [MEDICAL TREATMENT] catheter (a tube placed in a large central vein in the chest) and a fistula (an artery and a vein connected together under the skin to provide access to the blood) in his/her arm for [MEDICAL TREATMENT]. Observation showed a central venous catheter (CVC) with a dressing on Resident #63's upper right chest and a dressing over his/her left arm fistula. Review of Resident #63's medical record occurred on all days of survey. Resident #63's medical conditions are such that he/she requires treatment for [REDACTED].#63's current care plan failed to identify his/her central venous cathe… | 2020-09-01 |
| 36 | 36 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 757 | D | 1 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, and staff interview, the facility failed to ensure each resident's medication regimen was free of unnecessary drugs for 1 of 14 sampled residents (Resident #9) identified as having severe/moderate pain. Failure to ensure adequate indications for increasing the dosage of the drug limited Resident #9's ability to reach or maintain her highest practicable mental, physical, and psychosocial well-being. Findings include: Observation on 06/25/18 at 3:22 p.m. and 06/26/18 at 4:22 p.m. showed Resident #9 sleeping in her bed. Observation on 06/27/18 at 11:15 a.m. showed resident sleeping in her wheelchair with her head down. Observation on 06/26/18 at 12:25 p.m., showed Resident #9 in the dining room slowly eating independently. The resident fell asleep numerous times throughout the meal. Observation on 06/27/18 at 8:37 a.m. and 06/27/18 at 12:31 p.m. showed the resident asleep with food in front of her at the dining table. Observation on 06/27/18 at 11:17 a.m., showed two certified nursing assistants (CNAs) (#10 and #11) attempted to wake Resident #9, who was asleep in her wheelchair in her room. The CNAs were unable to fully wake the resident. The resident did not open her eyes or lift her head. Resident #9 responded with groans when asked if she wanted to transfer to the toilet. A CNA (#10) stated, Recently, she is hard to wake up sometimes. If she does not wake up, instead of transferring her to the toilet, we check and change her in the bed. The CNAs transferred the resident to the bed and provided cares. The resident did not open her eyes or respond verbally while cares were done. The resident followed commands and groaned. Review of Resident #9's medical record on 06/27/18 showed a daily pain assessment documented as 0 for all of (MONTH) 1-31, (YEAR). Pain/Pain Assessment in Advanced Dementia Evaluation, entered on 05/09/18, indicated pain level of 0. The quarterly Minimum Data Set, dated dated [DATE], ide… | 2020-09-01 |
| 37 | 37 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 804 | E | 0 | 1 | ROZG11 | Based on observation, review of facility policy, group interview, resident interview, and staff interview, the facility failed to serve food at palatable and appetizing temperatures for 7 of 7 residents attending the group interview (Resident A, B, C, D, E, F, and G) and 4 of 11 sampled residents (Resident #16, #25, #35, and #65) interviewed. Failure to serve foods at a temperature acceptable to residents may result in decreased intake, weight loss, and inadequate nutrition. Findings include: Review of the facility policy titled Food Temperatures at Point of Service occurred on 06/28/18. This policy, dated (MONTH) 2014, stated, The regulation that addresses food temperatures at point of service to the patient . 'each patient receives and the facility provides: (1) Food prepared by methods that conserve nutritive value, flavor, and appearance; (2) Food that is palatable, attractive, and at the proper temperature.' The intent . states that 'Food should be palatable, attractive and at the proper temperature as determined by the type of food to ensure patient's satisfaction.' . A temperature or range of temperatures at point of service is not defined in the regulation or Guidance to Surveyors. Patient acceptance is used as a guide and consideration is given to the time the food sits at temperatures between 135 (degrees) Fahrenheit (F) and 41 degrees F. The resident group interview occurred on 06/26/18 at 10:37 a.m. The residents who attended group reported the food is always at least 30 minutes late, can be as late as 90 minutes, and the food is always cold. - During an interview, the morning of 06/25/18, Resident #65 stated that his food is sometimes cold because his tray will come without silverware or condiments, and by the time they bring the items to him, the food is cold. - During an interview on 06/26/18 at 9:47 a.m., Resident #16 stated she is the last person to get served her meal tray and the food is cold when I get it. - During an interview on 6/26/18 at 10:55 a.m., Resident #25 stated the food is not serv… | 2020-09-01 |
| 38 | 38 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 809 | E | 0 | 1 | ROZG11 | Based on observation, review of facility policy, resident interview, resident group interview, and staff interview, the facility failed to provide meals in a timely manner according to resident needs, preferences, and requests for 5 of 11 sampled residents interviewed (Resident #6, #16, #25, #31, and #35) and for 7 of 7 residents attending the resident group interview (Resident A, B, C, D, E, G, and F). Failure to provide timely meal service and snacks can negatively impact the dining experience and has the potential to cause adverse reactions for residents receiving medications such as short acting insulin. Findings include: Review of the facility policy titled Meal Schedules, occurred on 06/28/18. This policy, dated (MONTH) 2014, stated, . Guidelines: 1. Requests for different meal times for individual patients are reviewed and accommodated as possible. 6. According to the Investigative Protocol for Dining and Food Service from the Survey Procedures for Long Term Care Facilities, meals should arrive no later than 30 minutes past the scheduled meal time. The facility meal times for Dakota Dining were as follows: * Breakfast at 8:00 a.m. * Lunch at 12:00 p.m. * Dinner at 6:00 p.m. Observation of the noon meal in the Dakota Dining room occurred on 06/25/18 between 12:00 p.m. and 1:10 p.m. and showed numerous residents commenting about the food being late. Meal service started 45 minutes after the scheduled 12:00 p.m. meal time. During an interview on 06/25/18 at 4:06 p.m., Resident #6 reported he missed lunch today due to an appointment, and he returned to the facility at 2:30 p.m. Resident #6 was currently eating ice cream for an afternoon snack, but stated staff did not offer him a meal. Resident #6 stated this is not the first time this has happened. Observation on 6/26/18 at 8:24 a.m. showed Resident #31 in his room waiting for his breakfast tray, and 8:50 a.m. he received his breakfast tray. The resident group interview occurred on 06/26/18 at 10:37 a.m. All residents who attended group reported the food is a… | 2020-09-01 |
| 39 | 39 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-06-28 | 880 | D | 0 | 1 | ROZG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, record review, observation, and staff interview, the facility failed to ensure staff followed appropriate infection control practices for 1 of 3 sampled residents (Resident #6) on contact precautions. Failure to follow appropriate infection control practice related to disinfecting equipment may result in the spread of infection within the facility. Findings include: Review of the policy titled Transmission Based Precautions occurred on 06/28/18. This policy, dated (MONTH) 2013, stated, . Patient Care Equipment . Clean and disinfect equipment between patients. Review of Resident #6's medical record on 06/26/18 indicated the resident was on contact precautions due to [MEDICAL CONDITION]-resistant Staphylococcus aureus in the resident's abdominal wound. Observation on 06/26/18 at 2:10 p.m. showed two Certified Nursing Assistants (CNAs) (#4 and #5) removed a Hoyer Lift from Resident #6's room and placed it across the hall in the equipment room. The CNAs failed to disinfect the lift prior to the next use. During an interview on 06/26/18 at 2:15 p.m. with two CNAs (#4 and #5), they stated staff disinfect lifts daily. During an interview on 06/28/18 at 3:20 p.m., an administrative nurse (#6) stated she expected staff to disinfect lifts after every use when used on a resident on contact precautions. | 2020-09-01 |
| 40 | 40 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-12-06 | 565 | E | 1 | 0 | PNS511 | > Based on information provided by the complainant, observations, review of monthly Resident Council meeting minutes, and resident, family, and staff interviews, the facility failed to actively seek a resolution to resident grievances related to delayed responses to call lights expressed by 9 of 10 sampled residents (Residents #1, #2, #3, #4, #6, #7, #8, #9, and #10). Failure to act upon the resident/family grievances regarding staff response time to call light resulted in continued dissatisfaction. Findings include: The facility failed to provide a copy of their policies addressing call lights and resident and/or family/representative grievances upon request. Information provided by the complainants indicated they had been contacted by residents who expressed frustration waiting for staff to respond to their call lights and/or who experienced pain/discomfort related to skin breakdown due to incontinence. Observations showed the following: * On the morning of 12/06/18, a bathroom call light remained unanswered from 8:02 a.m. until 8:24 a.m. (22 minutes). * 12/06/18 at 8:25 a.m., Resident #3 lying in bed. His call light, hanging over the top of the night stand, and not within reach. * 12/06/18 at 10:35 a.m., Resident #3 lying in bed. His call light, hanging over the top of the night stand, and not within reach. Resident reached for his call light and was unable to access it. A sign, posted on the wall, stated, Please keep call light clipped to the sheet and within reach. Review of Resident Council Meeting minutes, dated June-November (YEAR), occurred on 12/06/18. The meeting minutes identified residents voiced the following concerns : * August, . certified nursing assistants (CNAs) . make roommate wait. Roommate can't use (his/her) call light. CNA refused to help another pt (patient) . * September, . CNAs don't answer call lights timely in the a.m. * October, . (Resident) - slow call lights concern form filled (out). Resident and Family/Representative interviews identified the following: * 12/05/18 at 5:05 p.m., R… | 2020-09-01 |
| 41 | 41 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-12-06 | 657 | D | 1 | 0 | PNS511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 06/28/18. Based on observation, record review, review of facility policy, and staff interview, the facility failed to review and revise comprehensive care plans to reflect the resident's current status for 1 of 10 sampled residents (Resident #10). Failure to review/revise care plans to reflect each resident's current status limited the staffs' ability to communicate needs and ensure continuity of care for the residents. Findings include: The facility failed to provide a copy of their policy addressing resident care plans upon request. Review of the facility's policy titled Weight Assessment and Intervention occurred on 12/06/18. This policy, dated (YEAR), stated, . (Careplanned) Interventions for undesirable weight loss shall be based on careful consideration of . Resident choice and preferences . The use of supplementation . Review of Resident #10's medical record occurred on all days of survey. The record identified a [DIAGNOSES REDACTED]. - Resident #10's bathing record identified an initial bath on 11/26/18 (eight days post admission to the facility). The current care plan stated, . Focus: Resident has a potential for self care deficits . Interventions: . Assist resident with activities he/she is unable to perform independently. Encourage patient to perform minimal oral-facial hygiene as soon after rising as possible. Assist with brushing teeth and shaving, as needed. Resident #10's current care plan failed to address her bathing needs. - Resident #10's physician's orders [REDACTED]. Apply to rectum topically BID (twice daily). Donut cushion to minimize perineal discomfort with sitting. The current care plan stated, . Focus: Skin integrity impaired: redness to perineum area secondary to diarrhea r/t (related/to) [MEDICAL CONDITION] . Interventions: Maintaining clean, dry skin provides a barrier to infection. [NAME]ng skin dry instead of rubbing reduces risk of dermal trauma to fra… | 2020-09-01 |
| 42 | 42 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-12-06 | 677 | D | 1 | 0 | PNS511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information provided by the complainants, record review, review of facility policy, and staff interview, the facility failed to assist with activities of daily living (ADLs) for 1 of 10 sampled residents (Resident #10) who required staff assistance for bathing. Failure to provide assistance to residents who cannot perform the bathing task independently may result in poor personal-hygiene and decreased self-esteem. Findings include: Information provided by the complainants indicated residents are not bathed regularly, and are observed with greasy hair. Review of the facility policy titled Activities of Daily Living (ADLs) occurred on 12/06/18. This policy, dated (YEAR), stated, . Appropriate care and services will be provided for resident who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with . Hygiene (bathing, dressing, grooming, and oral care) . - Review of Resident #10's medical record occurred on all days of survey. The record identified a [DIAGNOSES REDACTED]. The current care plan stated, . Focus: Resident has a potential for self care deficits . Interventions: . Assist resident with activities he/she is unable to perform independently. Encourage patient to perform minimal oral-facial hygiene as soon after rising as possible. Assist with brushing teeth and shaving, as needed. Resident #10's current care plan failed to address her bathing needs. Resident #10's bathing record identified an initial bath on 11/26/18 (eight days post admission to the facility). Staff documented not applicable and/or resident not available on four occasions during the time period between admission and her first bath. During an interview on 12/06/18 at 1:30 p.m., when asked questions pertaining to Resident #10's bathing schedule, an administrative nurse (#1) confirmed staff failed to bathe Resident #10 during the initial eight days of… | 2020-09-01 |
| 43 | 43 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-12-06 | 684 | G | 1 | 0 | PNS511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information provided by the complainants, observation, record review, review of professional reference, and resident/staff interviews, the facility failed to provide the necessary care/services to treat 1 of 10 sampled residents (Resident #10) with skin breakdown and pain/discomfort. Failure to monitor Resident #10's skin condition and provide physician-prescribed interventions in a timely manner contributed to her existing skin breakdown and resulted in her experiencing avoidable pain/discomfort. Findings include: Information provided by the complainants indicated facility staff failed to identify possible risk factors contributing to residents' skin conditions and failed to provide the care/services necessary to prevent further skin breakdown. The complainants reported having been contacted by residents who were frustrated waiting for staff to respond to their call lights and/or who experienced pain/discomfort secondary to skin breakdown/being soiled. The facility failed to provide a copy of their policy addressing skin conditions/pressure ulcers upon request. Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice, 10th ed., Pearson Education, Inc., New Jersey, pages 828 and 862, states, . Many medications increase (skin) sensitivity . [MEDICAL CONDITION] drugs [MEDICAL CONDITION] . Several factor increase the risk for the development of pressure ulcers: immobility and inactivity, inadequate nutrition, fecal and urinary incontinence . and certain chronic medical conditions. Nursing interventions to prevent the formation of pressure ulcers include conducting ongoing assessment of risk factors and skin status, providing skin care to maintain skin integrity, ensuring adequate nutrition and hydration . providing supportive devices . - Review of Resident #10's medical record occurred on all days of survey. The record identified [DIAGNOSES REDACTED]. The current physician's orders [REDACTED]. * 11/26/18, [MEDICATION NA… | 2020-09-01 |
| 44 | 44 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-12-06 | 692 | D | 1 | 0 | PNS511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information provided by the complainants, observation, record review, review of the professional references, review of facility's policy, and resident/staff interviews, the facility failed to address the needs and monitor weight for 1 of 1 sampled resident (Resident #10) already experiencing impaired nutrition. Failure to develop and implement interventions in a timely manner may result in Resident #10 experiencing impaired wound healing, a decline in function, and/or unplanned weight loss. Findings include: Information provided by the complainants indicated facility staff failed to provide snacks and/or supplements to residents at high risk for weight loss. The complainant also reported families/representatives were directed to purchase snacks for residents. Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice, 10th ed., Pearson Education, Inc., New Jersey, page 862, states, . Several factor increase the risk for the development of pressure ulcers: . inadequate nutrition . Nursing interventions to prevent the formation of pressure ulcers include . ensuring adequate nutrition and hydration . Review of the facility's policy titled Weight Assessment and Intervention occurred on 12/06/18. This policy, dated (YEAR), stated, . The nursing staff will measure resident weights on admission, and monitor until no weight concerns noted. The . multidisciplinary team may identify conditions . that may be . increasing the risk of weight loss. For example . Increased need for calories and/or protein . (Careplanned) Interventions for undesirable weight loss shall be based on careful consideration of . Resident choice and preferences . The use of supplementation . Review of Resident #10's medical record occurred on all days of survey. The record identified [DIAGNOSES REDACTED]. The current physician's orders [REDACTED]. * 11/19/18, [MEDICATION NAME] (an appetite stimulant) 40 mg/ml (milligrams/milliliters) suspension take 10 ml (… | 2020-09-01 |
| 45 | 45 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-12-06 | 697 | D | 1 | 0 | PNS511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information provided by the complainants, observation, record review, review of facility policy, and resident/staff interviews, the facility failed provide treatment and services in a manner that maintained the highest practicable physical well-being for 1 of 10 sampled residents (Resident #10) observed experiencing pain during cares. Failure to carry out physician's orders [REDACTED].#10 experiencing avoidable pain/discomfort. Findings include: Information provided by the complainants indicated residents contacted family members/representatives when they experienced pain/discomfort secondary to skin breakdown/being soiled. Review of the facility's policy titled medication orders [REDACTED]. This undated policy stated, . The prescriber is contacted for direction when delivery of a medication will be delayed or the medication is not or will not be available. - Review of Resident #10's medical record occurred on all days of survey. The record identified [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. Apply to rectum topically BID. The progress notes identified the following: * 11/19/18, . Patient was admitted from (hospital) with a [DIAGNOSES REDACTED]. * 11/22/18, . Patient is incontinent of B/B (bowel/bladder) . * 11/25/18, Weekly skin assessment done, noted redness to her bottom and continuing with feces d/t (due/to) her illness. * 11/26/18, Patient returned from (cancer center) with new orders to discontinue ammonium [MEDICATION NAME]. Start [MEDICATION NAME] to apply to gluteal/perianal and the vulvar areas three times a day. monitor skin for breakdown every shift. * 11/27/18, . Her coccyx area is excoriated from frequent diarrhea. Lac-Hydrine cream is burning her, so it will be d/c (discontinued) and [MEDICATION NAME] started. * 11/28/18, . Receiving [MEDICAL CONDITION] therapy and continuous chemo infusion for [MEDICAL CONDITION]. * 11/29/18, . Incontinent of B/B (bowel/bladder) . * 12/02/18, . redness to the perirectal… | 2020-09-01 |
| 46 | 46 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2018-12-06 | 761 | D | 1 | 0 | PNS511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of facility policy, and staff interview, the facility failed to ensure accurate labeling of medications for 1 of 10 residents (Resident #6) observed during medication pass. Failure to have undamaged and legible medication labels may result in residents receiving the wrong medication and dose. Findings include: Review of the facility policy titled, Medication 0rdering and Receiving from Pharmacy; Medication Labels occurred on 12/06/18. This undated policy stated, . medication containers having damaged, incomplete, illegible, confusing labels are returned to the dispensing pharmacy for relabeling . in accordance with the medication destruction policy . medication labels are not altered or marked in anyway by nursing personnel . Review of resident #6's medical record occurred on all days of survey. The current physician orders included [MEDICATION NAME], inject 2-12 units subcutaneous three times a day with meals per sliding scale, and Tresiba insulin injection 10 units subcutaneous every morning. Observation on 12/06/18 at 8:18 a.m. showed a nurse (#2) administered insulin to Resident #6 with an insulin pen with the label rubbed off. The label failed to show the medication dose, open date, ordering physician, and expiration date. An interview with an administrative nurse (#1) in the afternoon of 12/06/18, agreed the necessary information on the insulin pen was illegible, and for medication error prevention, illegible insulin pen labels should be replaced per policy. | 2020-09-01 |
| 47 | 47 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 550 | E | 1 | 0 | HFFF11 | > THIS IS A REPEAT DEFICIENCY FROM SURVEYS COMPLETED ON 08/16/18. Based on information received from the complainants, observation, review of facility policy, and staff interview, the facility failed to provide care for 3 of 16 sampled residents (Resident #4, #13, and #15) and 2 supplemental residents (Resident #20 and #21) in a manner and environment that maintained, enhanced, and respected each resident's dignity and individuality. Failure to knock on doors, announce themselves, and wait for permission prior to entering residents' rooms, identify/honor resident preferences, and provide dining assistance/feed residents in a dignified manner does not preserve the residents' personal dignity or enhance their quality of life and places them at risk of embarrassment and/or emotional harm. Findings include: Information provided by the complainants indicated nursing staff failed to assist residents leaving them in soiled clothing and/or a dirty environment. Review of facility policy titled Quality of Life - Dignity occurred on 06/10/19. This policy, revised (MONTH) 2009, stated, . Each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality. Staff will knock and request permission before entering residents' rooms . - Observations showed the following: * 06/04/19 at 10:37 a.m., Resident #21 utilized the bathroom with the bedroom and bathroom doors open, and unclothed/exposed to the hallway. Staff were not present in the room to assist her with transfer/toileting. * 06/04/19 at 2:51 p.m., Resident #21 utilized the bathroom with the bedroom and bathroom doors open, and unclothed/exposed to the hallway. An unidentified nurse attempted to close the bathroom door. The unidentified nurse left the room after Resident #21 refused to allow her to close the door. Review of Resident #21's medical record occurred on 06/04/19. The current care plan stated, . self care deficit . Break . tasks into sub-task for easier patient performance . Cares in Pairs . Transfer with o… | 2020-09-01 |
| 48 | 48 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 580 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information received from the complainants, record review and staff interview, the facility failed to notify the resident's physician and/or family member of a change in condition for 2 of 16 sampled residents (Resident #3 and #16) and 2 discharged residents (Resident #17 and #18) reviewed during the complaint survey. Failure to notify the physician of a resident's change in condition may result in complications to the resident and prevented the physician from evaluating the effectiveness of the current treatment plan. Findings include: Information provided by the complainants indicated facility staff failed to consistently notify them of changes in their family members' condition. Upon request, the facility failed to provide a copy of their policy addressing physician and/or family notification of a change in the resident's condition. - Review of Resident #3's medical record occurred on all days of survey. The current care plan stated, Diagnosis . unspecified dementia without behavioral disturbance . muscle weakness . repeated falls . At risk for falls due to: history of falls . Review of progress notes showed the following: * 02/28/19 at 2:20 p.m., Resident found on floor . Family has been notified . Will update MD (medical doctor) at this time . * 03/13/19 at 1:50 p.m., Will update MD and family. Resident had a missed fall . * 05/28/10 at 2:05 p.m., Late entry. Will update MD and family. Resident had a witnessed fall . - Review of Resident #16's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Medications included, [MEDICATION NAME] (insulin) 20 units two times a day and [MEDICATION NAME] (insulin) 10 units three times a day. A physician's orders [REDACTED]. [MEDICATION NAME] . Inject as per sliding scale . 426+ = 7 units Call MD for blood glucose less than 50 and greater than 426 . Review of the blood sugars showed a blood sugar reading of 426 on 02/08/19 and 430 on 02/09/19. The facility failed to notify Re… | 2020-09-01 |
| 49 | 49 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 584 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information received from the complainants, and observations, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly and comfortable interior on 1 of 2 floors (first floor). Failure to maintain a clean and sanitary environment does not provide a comfortable living area for residents. Findings include: Information provided by the complainants indicated facility staff failed to provide a clean, comfortable environment for the residents to live in. Upon request, the facility failed to provide a copy of their policy addressing a clean, comfortable and homelike environment. - Observations on the morning of 06/05/19 of the resident living area on first floor showed the following: * room [ROOM NUMBER]: torn wallpaper border near ceiling, glove laying on the sink, shirt laying on top of a dresser * room [ROOM NUMBER]: breakfast tray on bedside table at 11:00 a.m., clean brief laying on the bed, used towel on the sink, clothing on the floor (bra, socks, shirt), closet door open, shirt on the floor in closet * room [ROOM NUMBER]: cereal, popcorn, and soda can boxes on the floor, clothes and open popcorn bag on the bed, dirty plate on the bedside table, a used towel on the sink * room [ROOM NUMBER]: closet doors open, used towel on the sink, sink dripping * room [ROOM NUMBER]: unopened package of Procare wipes on the floor underneath the sink, opened package of Procare wipes on the floor behind the door, urinal tipped over behind the door * room [ROOM NUMBER]: pants and shirt draped over the back of a recliner, strong urine odor in the room * room [ROOM NUMBER]: dirty wheelchair foot pedals, uneaten breakfast tray on the sink at 11:20 a.m. * room [ROOM NUMBER]: torn wallpaper above the bed, tooth brush laying on a towel on the sink, sink dripping, paper towel on the floor by a wastebasket * room [ROOM NUMBER]: used washcloth laying in the sink | 2020-09-01 |
| 50 | 50 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 585 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information provided by the complainant, observations, review of Resident Council Meeting minutes, review of facility policy, and resident interviews, the facility failed to provide reasonable accommodation of needs regarding call lights for 6 of 16 confidential and/or sampled residents (Resident A, B, C, #5, #6, and #7). Failure to place call lights within the residents' reach and/or respond to the call lights in a timely manner does not allow residents to request/obtain assistance and may result in avoidable incontinence/falls, increased behaviors, and/or a decreased quality of life. Findings include: Information provided by the complainants indicated nursing staff failed to respond to call lights in a timely manner (waiting up to 55 minutes) resulting in residents and/or family members searching the halls for staff and indicated they found call lights that were not functioning properly. Review of the facility policy titled Call Light, Use of occurred on 06/10/19. This policy, dated (MONTH) (YEAR), stated, . Answer ALL call lights promptly whether or not you are assigned to the resident . Never make the resident feel you are too busy to give assistance. Offer further assistance before you leave the room. When providing care to resident, be sure to position the call light conveniently for the resident to use. Be sure all call lights are placed on the bed at all times, never on the floor or bedside stand. Review of Resident Council Meeting minutes, dated (MONTH) 22-May 23, 2019, occurred on 06/07/19. The meeting minutes identified the following concerns were discussed with the facility: * 03/22/19, . Call lights taking long to be answered . * 04/25/19, . Call lights around meal times taking a long time . * 05/23/19, . Call light times in general . Random interviews identified the following: * 06/05/19 at 12:05 p.m., resident (A) stated, I've had to wait up to 45 minutes for someone to answer my light. * 06/05/19 at 1:30 p.m., resid… | 2020-09-01 |
| 51 | 51 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 657 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM SURVEY COMPLETED ON 08/16/18. Based on observation, record review, review of facility policy, and staff interview, the facility failed to review and revise the comprehensive care plan to reflect the current status for 4 of 16 sampled residents (Resident #1, #5, #13, #14) and 1 discharged resident (Resident #17). Failure to revise the care plan limited the ability of staff to communicate care needs and ensure continuity of care for each resident. Findings include: Review of the facility policy titled Care Plans - Comprehensive occurred on 06/10/19. This undated policy stated, . develops and maintains a comprehensive care plan for each resident that identifies the highest level of functioning the resident may be expected to attain . Incorporate identified problem areas . Incorporate risk factors associated with identified problems . Identifying problem areas and their causes, and developing interventions that are targeted and meaningful to the resident . care plans are revised as information about the resident and the resident's condition change . - Review of Resident #1's medical record occurred on all days of survey. The current physician order stated, Oxygen at 2 L/M (liters per minute) to maintain O2 (oxygen) saturations > (less than) 90%. Check each shift. Observations on 06/04/19 at 11:05 a.m. and 06/05/19 at 10:08 a.m., showed Resident #1 wearing a nasal cannula attached to an oxygen concentrator set at 1 liter per minute. The facility failed to review/revise the care plan to reflect Resident #1's respiratory status. During an interview on 06/06/19 at 9:05 a.m., an administrative nurse (#5) stated he/she would expect staff to address O2 use/interventions on the careplan. - Review of Resident #5's medical record occurred on all days of the survey. The current care plan stated, ADL (activities of daily living) self care deficit as evidenced by unsteady gait related to lumbar L2 fracture. Transfer with ext… | 2020-09-01 |
| 52 | 52 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 658 | D | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM SURVEYS COMPLETED ON 08/16/18. MEDICATION ADMINISTRATION 1. Based on information received from the complainants, observation, review of facility policy, and staff interview, the facility failed to ensure staff followed professional standards of practice for 2 of 2 sampled residents (Resident #1 and #2) on insulin and 1 supplemental resident (Resident #20) observed during medication administration. Failure to follow physician's orders for Resident #1 and #2 and failure to ensure Resident #20 consumed his/her medication may result in adverse health consequences. Findings include: Information provided by the complainants indicated family members questioned nursing staff regarding changes in the residents' medication/treatment regimen. Review of facility policy titled Administering Medications occurred on 06/10/19. This policy, revised (MONTH) 2012, stated, Medications must be administered in accordance with the orders . If a dosage is believed to be inappropriate or excessive for a resident . contact the resident's Attending Physician . If a drug is withheld . update physician and family . Residents may self-administer their own medications only if the Attending Physician, in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision-making capacity to do so safely. Review of facility policy titled Administering Oral Medications occurred on 06/10/19. This policy, revised (MONTH) 2010, stated, . Remain with the resident until all medication have been taken . - Review of Resident #1 occurred on all days of survey. Review of Resident #1's Medication Administration Record [REDACTED] * 04/14/19 at 7:36 a.m.: [MEDICATION NAME] Flex Pen . Inject 3 units . BS (blood sugar) 90, held per nursing judgement. * 04/22/19 at 7:16 a.m.: [MEDICATION NAME] Flex Pen . Inject 3 units . held BS 99, per nursing judgement. * 04/27/19 at 9:53 a.m.: [MEDICATION NAME] Flex Pen . Inject 3 units … | 2020-09-01 |
| 53 | 53 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 677 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM SURVEYS COMPLETED ON 08/16/18. Based on information received from the complainants, observation, record review, and staff interview, the facility failed to provide dining assistance for 2 of 16 sampled residents (Resident #1 and #14) and 3 supplemental resident (Resident #22, #23, and #24) observed during meals. Failure to reposition, cue, and/or assist dependent residents may result in decreased intake and/or unwanted weight loss. Findings include: Information provided by the complainants indicated nursing staff failed to provide cues/assistance for residents with vision and/or mobility deficits. Upon request, the facility failed to provide a copy of their policy addressing dining assistance. Staff indicated they provide standard of practice based on resident's individualized needs. - Review of Resident #1's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current care plan stated, . self care deficit . requires assistance related to: disease process, physical limitation, [MEDICAL CONDITION] . Assist with daily . grooming . oral care . and eating as needed . Upper and lower dentures. Observation on 06/05/19 at 8:35 a.m., showed Resident #1 sitting in bed holding a piece of toast with a breakfast tray in front of her. Resident #1's eyes had yellowish crusty matter around the eye lids. The resident stated, my eyes are blurry. Resident #1 asked for assistance obtaining her dentures. Resident #1's dentures were located on the sink. During an interview on 06/05/19 at 8:40 a.m., a certified nursing assistant (CNA) (#4) stated the CNA's try to do morning cares before the residents eat, but will try again after breakfast if they refuse. The CNA (#4) acknowledged she set-up Resident #1's breakfast tray. The CNA (#4) failed to give Resident #1 her dentures prior to providing tray set-up. - Review of Resident #14's medical record occurred on all days of survey. The current care plan identified,… | 2020-09-01 |
| 54 | 54 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 684 | D | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM SURVEYS COMPLETED ON 08/16/18. AREAS OF SKIN BREAKDOWN 1. Based on information received from the complainants, record review, review of facility policy, and staff interview, the facility failed to provide the necessary care and services to prevent the development and promote healing of skin breakdown for 2 of 4 sampled residents (Resident #13 and #15) and 1 discharged resident (Resident #18) at risk of developing or with known abrasions, skin tears, and burns. Failure to reassess and/or consistently utilize interventions contributed to Resident #13, #15, and #18 developing new wounds and/or healing of their various areas of skin breakdown. Findings include: Information provided by the complainants indicated nursing staff failed to consistently utilize physician ordered interventions to prevent and/or heal areas of skin breakdown. Review of the facility policy titled Skin Management System occurred on 06/10/19. This undated policy stated, . Pressure Ulcers, Venous Ulcers, and Arterial Ulcers, and surgical sites will be documented on . form or EMR (electronic medical record). Use one form per wound. Wound progress is to be documented each week with measurement and wound descriptions. Daily treatments are also documented on the same form. Skin issues such as skin tears, bruises, rashes, abrasions,[MEDICAL CONDITION]. will be documented . - Review of Resident #13's medical record occurred on all days of survey. The current physicians order stated the following: * Started 05/21/19, . Clean area to right clavicle with NS (normal saline), apply triple antibiotic cream and cover with [MEDICATION NAME] every day shift . * Started 05/25/19, . Clean large skin tear to RFA (right forearm) with NS and applied antibiotic ointment and xeroform gauze, cover with boarder foam gauze. Clean small skin tear to RFA with NS and apply paper tape. Change Q (every) 3 days until healed . A progress note, dated 05/23/19 at 3:30 p.m., … | 2020-09-01 |
| 55 | 55 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 686 | G | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information received from the complainants, observation, record review, and staff interview, the facility failed to provide the necessary care and services to prevent the development and promote healing of pressure ulcers for 2 of 2 sampled residents (Resident #3 and #14) and 1 discharged resident (Resident #17) at risk of developing and/or with known ulcers. Failure to implement, monitor, and modify interventions to reduce risk factors and consistently provide treatment to prevent the development of new pressure ulcers and/or heal current pressure ulcers resulted in Resident #14 and #17 developing avoidable facility-acquired pressure ulcers and had the potential to result in other residents (Resident #3) developing skin breakdown. Findings include: Information provided by the complainants indicated nursing staff failed to consistently utilize physician ordered interventions in a timely manner to prevent and/or heal ulcers. Review of the facility policy titled Skin Management System occurred on 06/10/19. This undated policy stated, . Pressure Ulcers, Venous Ulcers, and Arterial Ulcers, and surgical sites will be documented on . form or EMR (electronic medical record). Use one form per wound. Wound progress is to be documented each week with measurement and wound descriptions. Daily treatments are also documented on the same form. Skin issues such as skin tears, bruises, rashes, abrasions,[MEDICAL CONDITION]. will be documented . - Review of Resident #14's medical record occurred on all days of survey. The Significant Change Minimum Data Set (MDS), dated [DATE], identified extensive assistance from two or more people for bed mobility, one Stage II pressure ulcer, and one venous and arterial ulcer. Right Lower Leg Resident #14's current physician order stated, .Wound to right lower extremity: Apply santyl ointment to dark eschar tissue. Apply hydrogel gauze over santyl (not on good tissue). Cover with non-adherent dressing. Wrap with… | 2020-09-01 |
| 56 | 56 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 689 | D | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM SURVEYS COMPLETED ON 07/26/17 and 08/16/18. GAIT BELT USE 1. Based on observation, record review, review of facility policy, review of a professional reference, and staff interview, the facility failed to provide adequate supervision and assistive devices necessary to prevent accidents for 3 of 4 (Resident #3, #14, and #15) observed during a gait belt transfer. Failure to properly use a gait belt during transfers placed the resident at risk of accidents and injury. Findings include: Review of the facility Gait Belt Skill Checklist occurred on 06/10/19. This list stated, . properly position gait belt low on resident waist . Properly grasp belt for effective use . Assist resident from a sit to stand position grasping gait belt properly. - Observation on 06/04/19 at 10:59 a.m. showed two certified nursing assistant (CNAs) (#9 and #10) placed a gait belt around Resident #14's waist and assisted her to transfer from her chair to bed. The CNAs (#9 and #10) held the gait belt with one hand and lifted under the resident's arm axilla with the other hand. The resident did not fully bear weight, and her knees bent to an almost 90 degree angle. - Observation on 06/05/19 at 9:55 a.m. showed two CNAs (#3 and #4) transferred Resident #3 from the wheelchair to bed with assist of two and a gait belt. CNA (#4) failed to properly use the gait belt during transfer and lifted Resident #3 under her right arm pit. - Observation on 06/05/19 at 1:55 p.m. showed a CNA (#6) transferred Resident #15 from the wheelchair to the toilet with assist of one with a gait belt. Review of Resident #15's medical record occurred on all days of survey. The current care plan stated, . Transfer with two staff assist with gait belt . During an interview on 06/06/19 at 9:05 a.m., a managerial nurse (#5) stated, if the resident requires assistance from two staff members, he expected one staff member to stand on each side of the resident with one hand on… | 2020-09-01 |
| 57 | 57 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 690 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > INCONTINENCE 1. Based on information received from the complainants, record review, and review of the facility policy, the facility failed to assess the residents' bowel and bladder patterns to maintain continence for 2 of 16 sampled residents reviewed (Resident #11 and #14) and 2 discharged residents (Resident #17 and #19). Failure to assess bowel and bladder patterns and implement routine toileting consistent with these patterns may result in avoidable incontinence, urinary tract infections (UTIs), and/or falls and does not allow residents to attain/maintain their highest practicable physical and psychosocial well-being. Findings include: Information provided by the complainants indicated nursing staff failed to toilet residents on a frequent basis resulting in residents' observed in soiled clothing/bedding. Review of the facility policy titled Incontinence Prevention Program occurred on 06/11/19. This undated policy stated, . Based upon the results of the Evaluation of Continence . Prompted voiding is a scheduled toileting program . Residents are offered toileting assistance at regular intervals while awake and as needed at night. Habit training is a scheduled bladder management program designed according to the patient's/resident's individual voiding pattern. Routine Toileting . A scheduled bladder management program will be designed to toilet an incontinent patient/resident when a voiding pattern cannot be established or for a patient/resident who is unable to communicate the need to void . - Review of Resident #11's medical record occurred on all days of survey. The current care plan identified, . Urinary incontinence r/t (related to) Disease process (dementia), functional incontinence, [MEDICAL CONDITIONS] . Provide assistance with toileting every two hours at minimum. At risk for falls due to: history of falls, impaired balance/poor coordination. Increased toileting during nighttime hours (every 2-3 hours) . Review of toileting docu… | 2020-09-01 |
| 58 | 58 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 692 | D | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > HYDRATION 1. Based on information provided by the complainants, observation, review of facility policy, record review, and staff interviews, the facility failed to offer fluids 3 of 16 sampled residents (Resident #6, #15 and #16) who required staff assistance for fluid intake and were at risk for dehydration. Failure to provide assistance with fluid intake may result in dehydration, constipation, and urinary tract infections (UTIs). Findings include: Information provided by the complainants indicated nursing staff failed to provide dependent residents assistance with fluid intake. Review of facility policy titled, Hydration Policy occured on 06/11/19. This policy, dated 01/2017, stated, . each resident receives adequate fluids to maintain proper hydration . - Review of Resident #6's medical record occurred on all days of the survey. [DIAGNOSES REDACTED]. The current care plan stated, . Encourage and assist as needed to consume foods and/or supplements and fluids offered . Observation on 06/04/19 at 11:15 a.m., showed a CNA (#13) provided cares for Resident #6 and exited the room. The CNA failed to offer the resident fluids. - Review of Resident #15's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current care plan stated, . Encourage and assist as needed to consume foods and/or supplements and fluids offered . Observation on 06/05/19 at 1:55 p.m. showed a certified nursing assistant (CNA) (#6) provided cares for Resident #15 and exited the room. The CNA failed to offer the resident fluids. - Review of Resident #16's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The care plan stated, . Encourage as needed to consume foods and/or supplements and fluids offered . Observation on 06/04/19 at 3:42 p.m. showed two CNA (#7 and #8) provided cares for Resident #16 and exited the room. The CNAs failed to offer the resident fluids. During an interview on 06/06/19 at 10:00 a.m., an administrative nurse (#… | 2020-09-01 |
| 59 | 59 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 695 | D | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information provided by the complainants, observation, record review, review of professional reference, and staff interview, the facility failed to provide the necessary care and services for 2 of 3 residents (Resident #1 and #13) receiving oxygen. Failure to provide oxygen as ordered has the potential for residents to experience complications related to inadequate oxygen saturation levels. Findings include: Information provided by the complainants indicated nursing staff failed to ensure oxygen was administered per physician's order. Review of the facility policy titled Oxygen Administration occurred on 06/10/19. This policy, revised (MONTH) (YEAR), stated, . Validate physician orders for oxygen and set liter flow according to physician order. Berman and Synder, S., Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice, 9th ed., Pearson Education, Inc., New Jersey, page 1397, stated, OXYGEN THERAPY . Like any medication, oxygen is not completely harmless to the client. Clients receive an inadequate amount or an excessive amount of oxygen and both can lead to a decline in the client's condition. An inadequate amount of oxygen ([MEDICAL CONDITION]) will lead to cell death, and if left untreated can ultimately lead to death. - Review of Residents #1's medical record occurred on all days of survey. A physician's order stated, . Oxygen at 2 L/M (liters per minute) to maintain O2 (oxygen) sats (saturations) >90%. Check each shift. Observation on 06/04/19 at 11:05 a.m., and 06/05/19 at 10:08 a.m., showed Resident #1 wearing a nasal cannula attached to an oxygen concentrator set at 1 liter per minute. The facility failed to consistently provide Resident #1 oxygen at the ordered concentration per nasal cannula. - Review of Resident #13's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. A current physician's order stated, Oxygen at 2L (liters) to keep sats greater than 90% prn as needed . Review of Resid… | 2020-09-01 |
| 60 | 60 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 712 | D | 1 | 0 | HFFF11 | > Based on record review, the facility failed to ensure the physician visits the resident at least once every 30 days for the first 90 days after admision, and at least once every 60 thereafter for 1 of 1 sampled resident (Resident #15). Failure to ensure residents receive the required phsyician visits may result in negative outcome and delay treatment. Findings include: Review of Resident #15's medical record occurred on all days of survey. Resident was admitted on (MONTH) 2019 and the medical record lacked evidence the resident received the required physician visits per the regulations. | 2020-09-01 |
| 61 | 61 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 760 | D | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and review of facility policy, the facility failed to ensure residents remained free of significant medication errors for 1 of 1 resident discharged from the facility (Resident #17) with a significant medication error. Failure to administer an antibiotic as stated in the physician's orders may result in a negative outcome for the resident. Findings include: Review of the facility policy titled Administering Medication occurred on 06/10/19. This policy, revised (MONTH) 2012, stated, . Medications must be administered in accordance with the orders, including any required time frames. - Review of Resident #18's medical record occurred on all days of survey, and identified [DIAGNOSES REDACTED]. The Medication Administration Record [REDACTED]. [MEDICATION NAME] 500 mg (milligrams) PO (by mouth) every 24 hrs (hours) for 10 days. The progress notes identified the following: * 10/09/18 at 10:30 p.m., Resident started first dose of [MEDICATION NAME] tonight. Wound to right lower leg has yellow slough present in wound bed. Wound has purulent yellow drainage that is soaked onto the kerlix covering her legs. Wound has an odor to it. * 10/16/18 at 9:10 p.m., . transport to . (another facility out of state) . The facility failed to administer the medication for the first time twenty-four hours after receiving the order and only administered six of nine recommended doses of the antibiotic. (The tenth dose was due the day after she was discharged from the facility.) The facility failed to administer Resident #18's antibiotic per the physician's order. | 2020-09-01 |
| 62 | 62 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 801 | D | 1 | 0 | HFFF11 | > Based on staff interview, the facility failed to ensure the dietary manager received the necessary education to obtain the required qualifications to hold the director of food and nutrition for 1 of 1 dietary manager (#2). Failure to ensure qualified staff with the appropriate competencies and skill sets to carry out the functions of the food and nutrition services has the potential to result in adverse consequences for resident. During an interview on 06/05/19 at 4:25 p.m., a dietary manager (#2) stated, I have started the process of getting my CDM (certified dietary manager). Upon request, on 06/05/19, the facility failed to provide evidence of staff member (#2) completing the required education of CDM, certified food service manager, or a national certification for food service management and safety from a national certifying body. The facility failed to provide the necessary training in food and nutrition services to carry out daily operation duties. | 2020-09-01 |
| 63 | 63 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 880 | E | 1 | 0 | HFFF11 | > THIS IS A REPEAT DEFICIENCY FROM SURVEYS COMPLETED ON 08/16/18. Based on observation, review of facility policy, and staff interview, the facility failed to follow infection control practices for 6 of 16 sampled residents (Resident #1, #3, #4, #13, #14, and #16) observed during personal cares. Failure to follow infection control practices of hand hygiene during toileting/personal cares has the potential to spread infection to other residents, personnel, and visitors. Findings include: Review of the facility policy titled Handwashing/Hand Hygiene occurred on 06/10/19. This undated policy stated, . Before and after direct resident contact (for which hand hygiene is indicated by acceptable professional practice) . Before and after assisting a resident with toileting (hand washing with soap and water) . The use of gloves does not replace handwashing/hand hygiene . Review of the facility policy titled Infection Prevention and Control Manual Standard Precautions occurred on 06/10/19. This undated policy stated, . Sterile gloves and examinations gloves are removed . As soon as practical when contaminated . Between resident contacts . Before touching uncontaminated surfaces or other areas of the same resident's body that may be contaminated . Observations showed the following: * 06/04/19 at 10:59 a.m., two certified nursing assistants (CNAs) (#9 and #10) applied gloves and provided incontinent cares for Resident #14 after a bowel movement (BM). The CNA (#10) changed gloves and, without performing hand hygiene, placed a clean brief, removed his/her gloves, and then both CNAs positioned the resident into his/her wheelchair. The CNA (#10) failed to remove gloves and perform hand hygiene after incontinent cares. * 06/04/19 at 3:42 p.m., two CNAs (#7 and #8) applied gloves and provided incontinent cares for Resident #16 after a BM. The CNA (#8) failed to remove gloves or perform hand hygiene before placing a clean brief, and then both CNAs positioned the resident into his/her wheelchair. * 06/05/19 at 9:55 a.m., two CNAs (#… | 2020-09-01 |
| 64 | 64 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 157 | D | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure notification of the health care provider for 1 of 1 sampled resident (Resident #7) regarding medication held for numerous days. Failure to notify the resident's health care provider when holding [MEDICATION NAME] (fluid medication) for numerous days limited the physician's ability to make an informed decision regarding the resident's care. Findings include: Review of Resident #7's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Review of Resident #7's Medication Administration Record [REDACTED]. The medical record failed to identify staff notified the resident's physician. During an interview on 07/26/17 at 11:00 a.m. an administrative nurse (#3) stated she would expect staff to notify the physician when holding medication that frequently. | 2020-09-01 |
| 65 | 65 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 274 | D | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual, and staff interview, the facility failed to complete a significant change in status assessment (SCSA) for 1 of 13 sampled residents (Resident #3) reviewed. Failure to determine the need for and complete a SCSA in response to the resident's decline limited the facility's ability to accurately assess the resident's status, and identity and implement appropriate care approaches. Findings include: The Long-Term Care Facility RAI 3.0 User's Manual (Version 1.14), dated (MONTH) (YEAR), page 2-22 stated, . A significant change is a decline or improvement in a resident's status that: 1. Will not normally resolve itself without staff intervention . 2. Impacts more than one area of the resident's health status; and 3. Requires interdisciplinary review and/or revision of the care plan. and page 2-25 stated, A SCSA is appropriate if there are either two or more areas of decline or two or more areas of improvement. Review of Resident #3's medical record occurred on all days of survey. The quarterly Minimum Data Set (MDS), dated [DATE], identified: * walking in room did not occur * extensive assistance with locomotion on the unit * extensive assistance with locomotion off the unit * frequently incontinent of bowel * one unstageable pressure ulcer The admission MDS, dated [DATE], identified the following changes: * limited assistance with walking in room * supervision with locomotion on the unit * supervision with locomotion off the unit * occasionally incontinent of bowel * no pressure ulcers The facility failed to complete a SCSA following Resident #3's decline in four areas, plus the development of a pressure ulcer. | 2020-09-01 |
| 66 | 66 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 280 | E | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 01/12/17. Based on observation, record review, and staff interview, the facility failed to review and revise the comprehensive care plan to reflect the current status for 4 of 13 sampled residents (Resident #2, #3, #4, and #13). Failure to revise the care plan limited the ability of staff to communicate care needs and ensure continuity of care for each resident. Findings include: - Review of Resident #2's medical record occurred on all days of survey. The record included a fax from the physician, dated 06/22/17, which stated, . Thank you for the update. Please advance diet to regular textured diet . The record also included a fax to the physician, dated 07/05/17, which requested the use of Prevalon (pressure-reducing) boots at night. The physician responded, yes, agree (with) above. Review of Resident #2's care plan on 07/24/17 identified a mechanical soft diet and failed to include the use of Prevalon boots. Observations throughout the survey showed staff served Resident #2 a regular textured diet. - Review of Resident #3's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. physician's orders [REDACTED]. Medications included [MEDICATION NAME] and [MEDICATION NAME] at bedtime to facilitate sleep. Nurses' notes, reviewed from 01/12/17 to 07/25/17, stated Resident #3 failed to sleep well on multiple occasions. A nurse's note, dated 05/03/17, stated, . not slept . Dr (doctor) increased the [MEDICATION NAME] from 5 to 10 mg (milligrams). Dr wants psych evaluation for anxiety and [MEDICAL CONDITION]. The current care plan stated, . Focus: Resistive/noncompliant with treatments/cares. On Honey Thickened liquids. Focus: At risk for nutritional status change . Nectar thick liquids . Observation throughout the survey showed Resident #3 wore bilateral hearing aids and received oxygen at 2 liters per minute (L/min) per nasal cannula. During an interview on the afternoon of 07/26/… | 2020-09-01 |
| 67 | 67 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 281 | D | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** MEDICATION VIA GASTROSTOMY TUBE 1. Based on observation, record review, review of facility policy, and staff interview, facility staff failed to provide care and services according to professional standards for 1 of 1 sampled resident (Resident #8) observed receiving medications via gastrostomy ([DEVICE]). Failure to flush the [DEVICE] between medications may affect the efficacy of the medications. Findings include: Review of the facility policy titled, Administering Medications through an Enteral Tube occurred on 07/26/17. This policy, not dated, stated, . Equipment and Supplies . 26. If administering more than one medication, flush with 15 ml (milliliters) (or prescribed amount) warm sterile or purified water between medications. Review of Resident #8's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Liquid medications included [MEDICATION NAME] (laxative) and UTI (Urinary Tract Infection) Heal (cranberry supplement). Observation on 07/25/17 at 9:20 a.m. showed a licensed staff nurse (#7) checked placement of Resident #8's [DEVICE] and administered [MEDICATION NAME] mixed in 120 cubic centimeters (cc) of water, and without flushing the [DEVICE] with water, the nurse administered the UTI Heal mixed in 120 cc of water. During an interview on 07/26/17 at 11:00 a.m., an administrative nurse (#3) stated she would expect staff to flush the [DEVICE] with water between medications. INSULIN ADMINISTRATION 2. Based on observation and review of professional reference, the facility failed to follow professional standards of practice regarding insulin administration for 1 of 3 residents (Resident #7) observed receiving rapid-acting insulin. Failure to ensure food is offered within the recommended time frame after insulin administration may result in [DIAGNOSES REDACTED] (low blood sugar). Findings include: The Nursing (YEAR) Drug Handbook, 37th Edition, Wolters Kluwer, Pennsylvania, pages 789-790 stated, . [MEDICATION NAME] . (5 to … | 2020-09-01 |
| 68 | 68 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 323 | D | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to ensure adequate supervision and assistive devices to prevent accidents for 1 of 2 sampled residents (Resident #4) who required extensive assistance with transfers using a mechanical lift. Failure to use the proper transfer lift sling and provide adequate supervision with transfers/cares placed the resident at risk for sustaining a fall or injury. Findings include: Review of Resident #4's medical record occurred on all days of survey. Medical [DIAGNOSES REDACTED]. The significant change Minimum Data Set (MDS), dated [DATE], identified severely impaired cognition and extensive assistance of two for transfers. Review of the physical therapy plan of care, dated 06/29/17, identified, . Transfers, Bed/Chair . total assist (100%) . The current care plan identified, . Pathological fracture right . femur . NWB (nonweight bearing) to right leg . Transfer with full body sling and full mechanical lift and two staff. Use care with moving right leg. Immobilizer to remain in place at all times . Review of the certified nursing assistants (CNA's) kardex, dated 07/26/17, identified, . transfer with full body sling and full mechanical lift and two staff. Use care with moving right leg. Immobilizer to remain in place at all times. Observation on 07/24/17 at 3:10 p.m., showed two CNAs (#8 and #9) entered Resident #4's room, completed cares and placed a partial lift sling underneath her. The CNA (#9) pulled Resident #4's right leg outward to the side while she lay in bed. The resident yelled out, ouch ouch, when the CNA (#9) pulled the transfer sling straps up between her legs. The CNA (#8) raised Resident #4 up off the bed with the mechanical lift. Resident #4's right leg hung down with the immobilizer on it and she yelled out, ouch ouch, as the CNA (#9) lowered her down into the wheel chair/recliner. The facility staff failed to transfer Resident #4 with the full body sling and sup… | 2020-09-01 |
| 69 | 69 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 325 | D | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to maintain acceptable nutritional status for 1 of 3 residents (Resident #2) identified with weight loss. Failure to consistently implement weight loss interventions may result in poor nutrition and avoidable weight loss. Findings include:Review of Resident #2's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current Minimum Data Set (MDS), dated [DATE], identified extensive assistance from one person for eating. Resident #2's care plan stated, . At risk for nutritional status change r/t (related to) wt. (weight) loss. Intakes less than estimated need . Interventions . assist to consume foods and/or supplements and fluids offered . A dietary assessment, dated 05/09/17, stated, . Visited with (Resident #2) and spouse about preferences. Her UBW (usual body weight) 150#. She dislikes; all potato but French fries, all vegetables except green beans and corn . Dietary progress notes stated the following: *05/23/17 at 1:58 p.m.: . Fortified cereal daily and fortified soup at supper. Staff set up and assist her at meals. *06/04/17 at 10:49 a.m.: . receiving fortified items at meals for additional nutrition and finger foods offered as much as possible. Recent weight loss is noted. Review weight 140, will add high calorie snacks at 10 am and 3 pm. Will continue to provide a fruit cup at hs (bedtime) per her request. *07/11/17 at 10:01 a.m.: . Fortified pudding at 10 AM provides approx. (approximately) 250 calories and 6 gms (grams) pro. (protein) Ice cream at 3 PM and fruit cup at HS per her request. *07/11/17 at 3:03 p.m.: . Current wt. 133.6# 3% loss in 1 month. Continues to lose wt. Continue fortified items and supplements. Try fortified mashed potato. Resident #2's dietary assessment, dated 05/09/17, identified the resident did not like potatoes. *07/25/17 at 11:33 a.m.: . receiving fortified items at meals for additional nutrition and high calori… | 2020-09-01 |
| 70 | 70 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 328 | D | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of professional reference, review of facility policy, and staff interview, the facility failed to provide the necessary care and services for 2 of 5 sampled residents (Resident #4 and #13) receiving oxygen therapy. Failure to follow the physician's orders and provide guidance to facility staff on oxygen usage does not allow the facility or the health care provider to assess the effectiveness of the resident's oxygen therapy. Findings include: Berman and Snyder, S., Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice, 10th ed., Pearson Education, Inc., New Jersey, page 1259 states, . Like any medication oxygen is not completely harmless to the client. Clients can receive an inadequate amount or an excessive amount of oxygen and both can lead to a decline in the client's condition. Review of the facility policy titled Oxygen Administration occurred on 07/26/17. This policy, dated (MONTH) 2010, stated, . Review the physician's orders or facility protocol for oxygen administration. Adjust the oxygen delivery device so that . the proper flow of oxygen is being administered. - Review of Resident #4's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The significant change Minimum Data Set (MDS), dated [DATE], identified severely impaired cognition and oxygen use. The current care plan identified, . O2 (oxygen) on at 2L/min (liters per minute) via nasal cannula to keep sats (oxygen saturation) > (greater than) 90%. Monitor O2 SATS q (every) shift. respiratory impairment related to: history of hospitalization for pneumonia, [MEDICAL CONDITIONS] . evaluate lung sounds and VS (vital signs) . A current physician order, dated 06/29/17, identified, oxygen @ 2L/MIN via NC (nasal cannula) to keep O2 SATS > 90%. Monitor SATS every shift. A progress note, dated 07/18/17, stated, . admitted to hospital . [MEDICAL CONDITION] . left sided pleural effusion . The Treatment Administra… | 2020-09-01 |
| 71 | 71 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2017-07-26 | 431 | E | 0 | 1 | GH6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, facility record review, and staff interview, the facility failed to ensure proper labeling and storage/disposal of medications on 3 of 3 days of survey (July 24-26, (YEAR)). Failure to ensure correct labeling of insulin pens (4 observations), lock an unattended medication cart (North Cart Second Floor), and properly dispose of a fentanyl patch (narcotic pain patch) may result in medication errors and allow access of unauthorized personnel, visitors, and/or residents to medications. Findings Include: LABELING OF MEDICATION Review of the facility policy titled Labeling of Medication Containers occurred on 07/26/17. This policy, dated (MONTH) 2007, stated, . 9. The nursing staff must inform the pharmacy of any changes in physician orders for a medication. - Observation during a medication pass on 07/24/17 at 5:25 p.m. showed a licensed staff nurse (#7) administered Novolog 4 units, as stated on the Medication Administration Record [REDACTED]. The current physician orders, dated 07/06/17, stated, decrease Novolog to 4 units three times daily with meals. The facility failed to update the medication label to coincide with the physician's order. - Observation on 07/25/17 at 8 a.m. showed a licensed staff nurse (#7) administered 20 units of Levemir insulin, as stated on the MAR, to Resident #7. The medication label stated, inject 30 units subcutaneously. The current physician order dated 07/08/17, stated, decrease Levemir to 20 units. The facility failed to update the medication label to coincide with the physician order. An interview occurred on 07/24/17 during the medication pass; a licensed nurse (#7) stated when an insulin dose changes pharmacy does not change the label. - Observation during a medication pass on 07/25/17 at 8:46 a.m. showed a staff nurse (#1) administered Levemir insulin 15 units, as stated on the MAR, to Resident #16. The medication label stated inject 10 units subcutaneously at bedtime. The current physici… | 2020-09-01 |
| 72 | 72 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 550 | E | 0 | 1 | B0I611 | Based on observation and staff interview, the facility failed to provide care for 6 of 18 sampled residents (Resident #6, #8, #14, #15, #35, and #46) in a manner and environment that maintained, enhanced, and respected each resident's dignity and individuality. Failure to speak respectfully, knock on doors/announce themselves, and wait for permission prior to entering residents' rooms, does not preserve the residents' personal dignity or enhance their quality of life and placed them at risk of embarrassment and/or emotional harm. Findings include: The facility failed to provide a policy regarding dignity per request. Observations on 08/14/18 showed the following: * At 9:52 a.m., two certified nursing assistants (CNAs) (#8 and #9) entered Resident #35's room to provide personal cares. A third unidentified CNA entered the room without knocking, and addressed the other two CNAs before exiting the room. The staff member failed to knock /announce herself and/or wait for permission to enter. * At 11:40 a.m., an unidentified CNA assisted Resident #14 to the bathroom. The CNA left the bathroom door wide open and failed to pull the privacy curtain between the bathroom and Resident #6's side of the room while she sat in the wheelchair facing bathroom. The CNA assisted Resident #14 with cares, then opened door for Resident #6 to leave the room while Resident #14 remained in bathroom. * At 4:20 p.m., observation showed Resident #46 seated in a wheel chair beside her bed with her call light sounding. Observation revealed a large brown stain approximately 6 by 8 inches on a white sheet covering the center of the bed. A CNA (#23) responded to call light, transferred the resident to her bed onto the soiled sheet, changed her brief, and left the room. A second CNA (#11) entered and transferred the resident back to her wheel chair, then changed the soiled sheet. During an interview on 08/15/28 at 2:30 p.m. two administrative nurses (#16 and #17) confirmed staff should have changed the sheet on Resident #46's bed at the time it bec… | 2020-09-01 |
| 73 | 73 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 578 | D | 0 | 1 | B0I611 | Based on record review, facility policy, and staff interview, the facility failed to ensure the medical record for 1 of 16 sampled residents (Resident #38) accurately reflected the resident's Advanced Directive regarding code status. Failure to ensure the resident's medical record accurately reflected her wishes may prevent emergency personnel from knowing the resident's choices in the event of a medical emergency. Findings include: Review of the facility policy titled Code Status occurred on 08/16/18. This undated policy, stated, . Every resident or responsible party signs a consent for full code or no code upon admission . Red sheet of paper with DNR (do not resuscitate)/No Code is placed in the front of the chart with consent choice sheet signed right behind it. Green sheet of paper with Full Code is placed in the front of the chart with the consent choice sheet signed right behind it. The full code or no code order is noted on physician orders. Review of Resident #38's medical record occurred all days of survey. A Living Will form signed and dated on 06/25/14 by Resident #38, indicated DNR status. A physician's order, dated 10/04/17, indicated Full Code status. A green sheet of paper for Full Code was placed in the front of Resident #38's medical record with a copy of the signed physician's order attached. During an interview on the morning of 08/16/18, an administrative staff member (#16) indicated nursing staff asks the resident on admission and/or readmission what he/she would like their code to be. The facility failed to ensure the code level status was consistent in all areas of the medical record and accurately reflected the residents' current wishes. | 2020-09-01 |
| 74 | 74 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 622 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide written notification for 2 of 7 sampled residents (Resident #24 and #38) transferred to the hospital. Failure to provide the resident and/or resident's family member/legal representative, in writing of a transfer, including the destination and reason for the transfer, and the resident's right to appeal the action, did not allow the resident or family member/legal representative to make an informed decision. Findings include: - Review of Resident #24's medical record occurred on all days of survey, and identified the facility transferred the resident to the hospital on [DATE] and 06/23/18. The medical record lacked evidence the facility provided the resident and/or their family member/legal representative written notice of the transfers, including the reason for the transfers, the effective date of the transfers, the location to which they transferred the residents, and the right to appeal the actions. During an interview on 08/16/18 at 9:21 a.m., a medical records staff member (#2) stated staff failed to complete Transfer Notices for Resident #24's hospital stays on 06/08/18 and 06/23/18. - Review of Resident #38's medical record occurred on all days of survey, and identified the facility transferred the resident to the hospital on [DATE] and 06/26/18. The medical record lacked evidence the facility provided the resident and/or their family member/legal representative written notice of the transfers, including the reason for the transfers, the effective date of the transfers, the location to which they transferred the residents, and the right to appeal the actions. During an interview on the morning of 08/15/18, a medical records staff member (#2) stated staff failed to complete Transfer Notices for Resident #38's hospital stays 06/23/18 and 06/26/18. | 2020-09-01 |
| 75 | 75 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 623 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide the Office of the State Long Term Care (LTC) Ombudsman a written notice of transfer, including the destination, the reason for transfer, and the resident's right to appeal the action for 2 of 7 residents (Resident #24 and #38) transferred to the hospital. Failure to provide a notice of transfer or discharge does not allow the Ombudsman to keep informed of all transfers/discharges. Findings include: - Review of Resident #24's medical record occurred on all days of survey. Progress notes identified Resident #24 was hospitalized [DATE] and 06/23/18. The record lacked evidence the facility provided the State LTC Ombudsman written notice of transfer for these hospitalization s. During an interview on 08/16/18 at 9:21 a.m., a medical records staff member (#2) confirmed staff failed to complete Transfer Notices or Bed Hold for Resident #24's hospital stays on 06/08/18 and 06/23/18, and failed to notify the ombudsman of either hospital transfer. - Review of Resident #38's medical record occurred on all days of survey, and identified the facility transferred the resident to the hospital on [DATE] and 06/26/18. The medical record lacked evidence the facility provided the State LTC Ombudsman written notice of transfer for the hospitalization . During an interview on the morning of 08/15/18, a medical records staff member (#2) stated confirmed staff failed to complete a Transfer Notice for Resident #24's hospital stay on 06/23/18, and failed to notify the ombudsman. | 2020-09-01 |
| 76 | 76 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 625 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide a bed-hold notice upon transfer to the hospital for 3 of 7 sampled residents (Resident #23, #24, and #38) transferred to the hospital. Failure to provide the facility's bed-hold policy does not allow residents or their legal representatives to make informed choices regarding their readmission rights. Findings include: - Review of Resident #23's medical record occurred on all days of survey, and identified the facility transferred the resident to the hospital on [DATE]. The medical record lacked evidence the facility staff provided Resident #23 and/or their family member/legal representative written notice of the bed-hold policy upon transfer to the hospital. During an interview on 08/15/18 at 10:58 a.m., a business office manager (#3) stated facility staff failed to provide the bed-hold notice. - Review of Resident #24's medical record occurred on all days of survey, and identified the facility transferred the resident to the hospital on [DATE] and 06/23/18. The medical record lacked evidence the facility provided Resident #24 and/or their family member/legal representative written notice of the the bed-hold policy upon transfers to the hospital. During an interview on 08/16/18 at 9:21 a.m., a medical records staff member (#2) stated facility staff failed to provide the bed-hold notice. - Review of Resident #38's medical record occurred on all days of survey, and identified the facility transferred the resident to the hospital on [DATE] and 06/26/18. The medical record lacked evidence the facility provided Resident #38 and/or their family member/legal representative written notice of the the bed-hold policy upon transfers to the hospital. During an interview on the morning of 08/15/18, a medical records staff member (#2) agreed the facility failed to provide the bed-hold notice. | 2020-09-01 |
| 77 | 77 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 641 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.15), and staff interview, the facility failed to ensure accurate coding of Minimum Data Sets (MDSs) for 2 of 18 sampled residents (Resident #6 and #46). Failure to accurately complete Section N (Medications) and Section O (Special Treatments, Procedures,and Programs) of the MDS does not allow each resident's assessment to reflect their current status/needs, and may affect the accurate development of a comprehensive care plan and the care provided to the residents. Findings include: SECTION N: Medication The Long-Term Care Facility RAI Manual, page N12 - N13, stated, . Coding Instructions for N0450A: Code 0, no: if antipsychotic were not received . Code 1, yes: if antipsychotic's were received on a routine basis only: Continue to N0450B, Has a GDR (gradual dose reduction) been attempted? . Code 0, no: if a GDR has not been attempted. Skip to N0450D, Physician documented GDR as clinically contraindicated. Code 1, yes: if GDR has been attempted. Continue to N0450C, Date of last attempted GDR. - Review of Resident #6's medical record occurred on all days of survey and identified a physician's orders [REDACTED]. Review of the (MONTH) Medication Administration Record [REDACTED]. The record also showed the physician rejected a GDR in (MONTH) (YEAR) for the Quetiapine. The quarterly MDS, dated [DATE], failed to identify the use of an antipsychotic. Failure to identify antipsychotic use resulted in the system not triggering staff to identify the physician's rejection of a GDR in (MONTH) (YEAR). During an interview on 08/15/18 at 3:21 p.m., an administrative staff member (#18) confirmed she coded section N0450 incorrectly on Resident #6's 07/22/18 MDS. SECTION O 0100: Special Treatments, Procedures, and Programs The Long-Term Care Facility RAI Manual, page O-3, stated, . O 0100C Oxygen therapy, Code continuous or intermittent … | 2020-09-01 |
| 78 | 78 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 644 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the North Dakota Provider Manual for Preadmission Screening and Resident Review (PASARR) and Level of Care Screening Procedures For Long Term Care Services, and staff interview, the facility failed to complete a status change assessment for 2 of 4 sampled residents (Resident #2 and #48) reviewed for PASARR requirements. Failure to complete a change in status assessment may result in the delivery of care and services that are inconsistent with residents' needs. Findings include: The North Dakota PASARR Provider Manual page 13 states, . Change in Status Process . Whenever the following events occur, nursing facility staff must contact Ascend (contracted service provider for screening process) to update the Level I screen for determination of whether a first time or updated Level II evaluation must be performed. These situations suggest that a significant change in status has occurred: . If an individual with MI, ID, and/or RC (mental illness, intellectual disability, and conditions related to intellectual disability (referred to in regulatory language as related conditions or RC)) was not identified at the Level I screen process, and that condition later emerged or was discovered. - Resident #2's medical record, reviewed (MONTH) 14-16, (YEAR), identified the facility admitted the resident on 11/13/10. The record identified a diagnoses of Unspecified [MEDICAL CONDITION], dated 02/24/10 and [MEDICAL CONDITION], dated 02/10/12. The record lacked evidence staff completed a Level I assessment at the time of her admission or an updated Level I assessment with the new [DIAGNOSES REDACTED]. During an interview on 08/15/18 at 10:15 a.m., an administrative nurse (#17) stated she was unable to provide information indicating staff had completed the admission PASARR or an updated assessment in 2012. - Resident #48's medical record, reviewed on (MONTH) 14-16, (YEAR), identified the facility admitted the resident on 10/19/15.… | 2020-09-01 |
| 79 | 79 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 655 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to develop a baseline care plan for 1 of 2 sampled residents (Resident #229), newly admitted to the facility. Failure to develop and implement a baseline care plan limited staff's ability to provide effective and person-centered care for the resident. Findings include: Review of Resident #229's medical record, on all days of survey, identified an admission date of [DATE]. The facility staff could not locate a baseline care plan for the resident completed prior to 08/14/18. During an interview on 08/14/18 at 8:56 a.m., the unit manager (#5) stated a baseline care plan should be completed on paper in the first 48 hours of a resident's admission and placed in the facility's baseline care plan book. The unit manager (#5) stated she started, but had not completed a baseline care plan for Resident #229. The facility failed to complete a baseline care plan within 48 hours of the resident's admission. | 2020-09-01 |
| 80 | 80 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 656 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to develop a comprehensive care plan for 1 of 18 sampled residents (Resident #277). Care planning drives the type of care and services that a resident receives. Failure to develop a care plan that includes the care and services to be provided to the resident may negatively impact the resident's quality of life. Findings include: - Review of Resident #277's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. A skin assessment, dated 08/07/18, indicated a stage 2 pressure ulcer to the coccyx measuring 5 centimeters (cm) x (by) 5 cm, red with a small amount of drainage, and treated with foam bordered dressing. Review of Resident #277's care plan occurred on 08/16/18. The care plan failed to address the resident's current stage 2 pressure ulcer and failed to provide goals and interventions to manage Resident #277's pressure ulcer. During an interview on the afternoon of 08/16/18 an administrative staff member (#16) stated the care plan was currently in process. | 2020-09-01 |
| 81 | 81 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 657 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THIS IS A REPEAT CITATION FROM THE SURVEY COMPLETED ON 07/26/17. Based on observation, record review, and staff interview, the facility failed to review and revise the comprehensive care plan to reflect the current status for 2 of 18 sampled residents (Resident #8 and #35). Failure to revise the care plan limited staff's ability to communicate care needs and ensure continuity of care for each resident. Findings include: The facility failed to provide a policy regarding care plans per request. - Review of Resident #8's medical record occurred on all days of survey. The current physician's orders [REDACTED]. Observations on 08/15/18 at 3:59 p.m. and 08/16/18 at 9:33 a.m. showed Resident #8 not wearing her TED hose. The current care plan stated, . [MEDICAL CONDITION] . Administer medications as ordered, Assist with activities as needed, Dangle at edge of bed/chair before transfers, Encourage rest periods as needed, Obtain vital signs as indicated, report changes to physician, Obtain weights as needed/ordered, Report significant change. The facility failed to care plan the resident's need for/use of TED hose. - Review of Resident #35's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current care plan stated, . Potential for skin breakdown . Keep skin clean and dry, Use lotion on dry skin, Provide wound care as ordered, (brand name) (blue) boots at night as resident allows, Reposition at routine intervals, encourage to lay down between meals and to limit time spent sitting up in chair, Special mattress/cushion on wheelchair. The facility failed to care plan the resident's need for/use of a pillow between his knees to prevent skin breakdown. Observations showed the following: * 08/14/18 at 9:52 a.m., two certified nursing assistants (CNAs) (#8 and #9) transferred Resident #35 to bed using a mechanical lift. One of the CNAs (#9) placed a pillow between the resident's knees, covered him with a blanket, and handed him his call… | 2020-09-01 |
| 82 | 82 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 658 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** PRIMING INSULIN PENS 1. Based on observation and manufacturer's guidelines, the facility failed to follow professional standards of practice in priming insulin pens for 2 of 3 residents observed receiving insulin (Resident #16 and #42). Failure to remove the needle shield prior to priming an insulin pen and inverting the pen during priming may result in the resident receiving an inaccurate amount of insulin. Findings include: Prescribing information for [MEDICATION NAME]found at www.nov-pi.com/novolgpdf, stated, . Before each injection small amounts of air may collect in the cartridge during normal use. To avoid injecting air and to ensure proper dosing: Turn the dose selector to select 2 units. Hold your [MEDICATION NAME] with the needle pointing up. Tap the cartridge gently with your finger a few times to make any air bubbles collect at the top of the cartridge. Keep the needle pointing upwards, press the push-button all the way in. The dose selector returns to 0. A drop of insulin should appear at the needle tip. If not, change the needle and repeat the procedure no more than 6 times. - Observation on 08/14/18 at 12:10 p.m. showed a licensed nurse (#1) prepared an insulin pen for injection for Resident #16. After placing the needle on the insulin pen, the nurse failed to remove the outer needle shield before priming the insulin pen. With the shield still in place, the nurse was unable to visualize a stream of insulin from the needle. - Observation on 08/15/18 7:47 a.m. showed a licensed nurse (#24) prepared an insulin pen for injection for Resident #42. The nurse placed the needle on the pen, removed the needle shield, and primed the pen with two units of insulin while holding it with the needle pointing downward. Priming the pen with the needle pointing downward does not ensure an adequate amount of insulin is expelled during the priming process. OBTAINING/FOLLOWING physician's orders [REDACTED].>2. Based on observation, record review, re… | 2020-09-01 |
| 83 | 83 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 677 | E | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and family interview, the facility failed to provide dining assistance for 2 of 18 sampled residents (Resident #8 and #15) and 3 supplemental residents (Resident #39, #40, and #49) observed during meals. Failure to cue and/or assist a resident who required assistance may result in decreased intake and/or unwanted weight loss. Findings include: The facility failed to provide a policy regarding dining assistance per request. - During an interview on 08/13/18 at 11:30 a.m., when asked questions regarding the food being served and the assistance offered to residents, a family member (AA), stated, No, (there is) not sufficient staffing. It shows up in the dining room. (The residents) barely eat and (the staff) take them back to their rooms. Review of Resident #8's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current care plan identified, . Encourage and assist as needed to consume foods and/or supplements and fluids offered. A progress note, dated 07/21/18, identified, . Resident (#8) has been noted to have a weight loss from 106 pounds on 1/2018 to 97.4 pounds on 7/2018. Observations showed the following: * 08/13/18 at 12:22 p.m., A family member assisted Resident #8 throughout the noon meal and also provided cueing to Resident #8's tablemate. * 08/13/18 at 5:35 p.m., Resident #8 received her tray. At 5:43 p.m. (8 minutes later) an unidentified certified nursing assistant (CNA) cut her meat and potatoes into smaller pieces. No further assistance was provided, and staff later documented 26-50% intake. - Review of Resident #15's medical record occurred on all days of survey. The current care plan identified, . Encourage and assist as needed to consume foods and/or supplements and fluids offered. Observations showed the following: * 08/13/18 at 12:17 p.m., Resident #15 fed herself, demonstrating a very slow rate of intake. Staff failed to provide consistent cueing/assistance, and later… | 2020-09-01 |
| 84 | 84 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 684 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** SWALLOW SAFETY 1. Based on observation and record review, the facility failed to ensure 1 of 1 sampled resident (Resident #35) observed being assisted to drink while lying in bed received the necessary care and services to ensure his safety. Failure to properly position Resident #35 in bed has the potential to negatively affect his overall swallow safety and placed him at risk of aspiration. Findings include: The facility failed to provide a policy regarding dysphagia or feeding assistance per request. Review of Resident #35's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. A Speech Therapy Progress (and) Discharge Summary, dated 01/18/18, identified, . Precautions: Position at 90 degree angle during and 20 minutes after oral intake. Positioning during oral intake must be Approx. (approximately) 90 degrees. Observation showed the following: * 08/14/18 at 9:52 a.m., Resident #35 laid on his left side in bed, with the head of the bed reclined to an approximate 20 degree angle. A certified nursing assistant (CNA) (#9) raised Resident #35's bed (with the head of the bed in the reclined position) and gave him a drink of water via a straw. * 08/15/18 at 9:11 a.m., Resident #35 laid flat on his back in bed, with his head resting on two pillows (an approximate 20 degree angle). Two CNAs (#10 and #11) gave him a drink of water via a straw. In both instances, the staff members failed to raise the head of Resident #35's bed to a 90 degree angle prior to offering him a drink of water. TRANSFER SAFETY/BRUISES 2. Based on observation, record review, and family and staff interviews, the facility failed to provide the necessary care and services for 1 of 18 sampled resident (Resident #8) observed being transferred into their wheelchair. Failure to report, assess, and document residents' bruises may result in lack of identification of additional bruises and/or the cause for these bruises. Findings include: The facility failed to provide a… | 2020-09-01 |
| 85 | 85 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 689 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THIS IS A REPEAT DEFICIENCY FROM SURVEY COMPLETED ON 07/26/17 Based on observation, review of facility policy, record review, and staff interview, the facility failed to provide adequate supervision and assistive devices necessary to prevent accidents for 2 of 8 sampled residents (Resident #2 and #23) observed during gait belt transfers. Failure to properly use a gaitbelt and to ensure adequate assistance during gaitbelt transfers placed the residents at risk of accidents and injury. Findings include: Review of the facility policy titled Lifting and Movement of Residents occurred on 08/16/18. The policy, dated (MONTH) (YEAR), stated, . In order to protect the safety and well-being of staff and residents, and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents. 2. Manual lifting of residents shall be eliminated when feasible. 3. Nursing staff, in conjunction with the rehabilitation staff, shall assess individual residents' needs for transfer assistance on an ongoing basis. Staff will document resident transferring and lifting needs in the care plan . 6. Gait belts will be used when the resident can bear some weight, has some upper body strength, and is easily managed by one or more staff with non-mechanical lifting devices. - Review of Resident #23's medical record occurred on all days of the survey. A significant change Minimum Data Set (MDS), dated [DATE], identified the resident required extensive assist of two for transfers. The resident's current care plan stated, . Transfer with two assist with gait belt. During an observation on 08/14/18 at 5:00 p.m., a certified nursing assistant (CNA) (#7) placed a gait belt around Resident #23 and transferred him from the recliner to wheelchair without the assistance of a second staff member. Resident #23 showed difficulty with bearing weight and standing during the transfer. - Review of Resident #2's medical record occurred on (MONTH) 14-16, (YEA… | 2020-09-01 |
| 86 | 86 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 730 | C | 0 | 1 | B0I611 | Based on review of performance evaluations, review of twelve months of education records, and staff interview, the facility failed to provide twelve hours of in-service education per year for 3 of 3 certified nursing assistants (CNAs) (CNA A, B, and C) based on their individual performance review. Failure to provide twelve hours of in-service education per year to CNA A, B, and C may result in staff lacking the necessary skills and knowledge to provide care and services addressing special resident needs. Findings include: Review of staff performance evaluations and twelve months of education records occurred on (MONTH) 15-16, (YEAR). The records showed the facility failed to provide twelve hours of in-service education for 3 of 3 CNAs (CNA A, B, and C). During an interview on 08/16/18 at 3:34 p.m., an administrative nurse (#17) confirmed the facility failed to ensure all staff members were provided and/or completed twelve hours of in-service education during the period between (MONTH) (YEAR)-July (YEAR). The administrative nurse (#17) did report one of the three employees had recently returned from over-seas. | 2020-09-01 |
| 87 | 87 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 756 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policy, and staff interview, the consulting pharmacist failed to identify and report drug regimen irregularities regarding duplicate therapy of opiate pain medications to the attending physician, the medical director, and the director of nursing for 1 of 18 sampled residents (Resident #35) reviewed. Failure to ensure the pharmacist reported the medication irregularities may result in the residents receiving unnecessary medications and experiencing adverse consequences related to the medications. Findings include: Review of the facility policy titled Consultant Pharmacist Reports occurred on 08/16/18. This policy, dated (MONTH) 2011, stated, . The administration schedule is appropriate for the resident, considering side effects (such as sedation), compatibility with other medications and manufacturer's recommendations. Resident #35's record identified the following physician's orders for opiate pain medications: [REDACTED] * 04/05/18: [MEDICATION NAME] 50 milligrams (mg) by mouth three times a day for uncontrolled pain * 04/13/18: [MEDICATION NAME]-[MEDICATION NAME] 5-325 mg one tablet by mouth four times a day for pain Review of the resident's Medication Administration Record [REDACTED]. This schedule resulted in the resident receiving two opiate medications at 8:00 a.m. and at 8:00 p.m. each day. During an interview on 08/16/18 at 11:00 a.m., an administrative nurse (#16) reported she was unable to locate any Pharmacy reviews pertaining to either of these two pain medications. | 2020-09-01 |
| 88 | 88 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 757 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure the resident's medication regimen was free of unnecessary medications for 1 of 18 sampled residents (Resident #35) reviewed. Failure to ensure the resident's medication regimen did not include duplicate therapy of opiate pain medications may result in the resident receiving unnecessary medication and experiencing adverse consequences related to the medication. Findings include: Resident #35's record identified the following physician's orders [REDACTED]. * 04/05/18: [MEDICATION NAME] 50 milligrams (mg) by mouth three times a day for uncontrolled pain * 04/13/18: [MEDICATION NAME]-[MEDICATION NAME] 5-325 mg one tablet by mouth four times a day for pain Review of the resident's Medication Administration Record [REDACTED]. This schedule resulted in the resident receiving two opiate medications at 8:00 a.m. and at 8:00 p.m. each day. During an interview on 08/16/18 at 11:00 a.m., when shown a copy of Resident #35's MAR, an administrative nurse (#16) stated, You are wondering why these (pain medications) aren't staggered, and made no further comment. | 2020-09-01 |
| 89 | 89 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 803 | E | 0 | 1 | B0I611 | Based on observation, resident interview, group interview, and staff interview, the facility failed to ensure staff consistently followed dietary menus for all residents for 6 of 11 residents with food concerns (Resident #29, #BB, #CC, #EE, #GG, and #HH). Failure to offer the residents all the menu items listed, does not allow for residents' personal food choices or follow nutritional guidelines for a balanced meal. Findings include: - Observation on 08/13/18 at 12:15 p.m., showed the lunch meal consisted of chicken, noodles, and cauliflower with an alternative option of fish. Observation showed the facility ran out of foods listed on the posted menu. The menu posted by the dining area identified Sunday's menu. - During an interview on 08/13/18 at 12:20 p.m., Resident #29 stated she did not receive the food she ordered. The resident stated she wanted the chicken and two breadsticks, instead she received roast beef, fish, and one breadstick. - During an interview on 08/13/18 at 12:23 p.m., Resident BB stated the facility ran out of both meal options during lunch. Resident BB expressed he, Resident GG, and Resident HH received a different meal which consisted of cold sandwiches or corndogs. - During an interview on 08/13/18 at 3:15 p.m., Resident EE stated the facility frequently runs out of food at meal times. - During an interview on 08/13/18 at 5:39 p.m., Resident HH stated french toast has been on the menu the last couple weeks, however they have been unable to have this due to the syrup not coming on the food truck. He also mentioned the menu does not match the food the residents are served at the meal. - During an interview on the afternoon of 08/13/18, Resident CC stated the meal tickets do not always match the meal served. - During the resident council meeting, held the morning of 08/14/18, five of ten residents stated the facility often runs out of food before they are served and the menu frequently does not match what is served. During an interview on 08/16/18 at approximately 10:00 a.m., a dietary manage… | 2020-09-01 |
| 90 | 90 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 804 | E | 0 | 1 | B0I611 | Based on observation, resident interview, family interview, and group interview, the facility failed to serve foods at palatable temperatures for 7 of 12 resident/family interviews (Resident #55, #70, #BB, #CC, #DD, #FF, and family member AA). Failure to serve foods at a temperature acceptable to residents may result in decreased intake, weight loss, and inadequate nutrition. Findings include: - During an interview on the morning of 08/13/18, when asked questions about the meals being served, Resident #55 stated, The food is just terrible. A lot of things come cold. She reported complaining to a staff member, who replied, You can eat it, cause that's all we got. - During an interview on 08/13/18 at 11:30 a.m., when asked questions about the meals being served to residents, a family member (AA), stated, It would be nice to have a microwave in there (dining room). Mom will say, 'Now it's cold.' It takes her a while to eat. I complained about the fish. It was horrible. I couldn't eat it. - During an interview on the 08/13/18 at 12:08 p.m., when asked questions about the meals being served, Resident #70 stated, This morning my hot cereal was cold. - During an interview on the afternoon of 08/13/18, Resident BB stated the food is usually cold. - During an interview on the afternoon of 08/13/18, Resident CC stated the food is terrible and it is impossible to gain weight at the facility. - During an interview on 08/13/18 at 3:15 p.m., Resident EE voiced concerns with temperatures of the food being cold. - During an interview on 08/13/18 at 3:54 p.m., Resident DD stated the food is cold sometimes when delivered to her room. - During an interview on 08/13/18 at 4:30 p.m., Resident FF voiced concerns with temperatures of the food not hot enough. During the group interview on the morning of 08/14/18, four of ten residents stated the food is usually cold. The surveyors received a lunch test tray on 08/14/18 at approximately 12:05 p.m. The test tray consisted of fish, rice, vegetables, pears, and cornbread. The 3 surveyors co… | 2020-09-01 |
| 91 | 91 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 840 | D | 0 | 1 | B0I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documentation and staff interview, the facility failed to obtain a written agreement or arrangement between the nursing home and the Medicare Certified [MEDICAL TREATMENT] Facility regarding the roles and responsibilities for the provision of [MEDICAL TREATMENT] care/services and failed to have policies and procedures regarding [MEDICAL TREATMENT] care for 1 of 1 sampled resident receiving [MEDICAL TREATMENT] (Resident #277). Failure to ensure an agreement/arrangement and specific [MEDICAL TREATMENT] polices/procedure has the potential to place [MEDICAL TREATMENT] residents at risk for not receiving care and services in accordance with current standards of practice. Findings include: Review of documentation provided by the facility regarding [MEDICAL TREATMENT] occurred on the afternoon of 08/13/18. The documentation stated, A formal contractual agreement between the (name of local [MEDICAL TREATMENT] unit) and skilled care facilities is not required because the patients receiving services are patients of the physician who work directly with [MEDICAL TREATMENT]. During interview on the afternoon of 08/16/18, an administrative staff member (#16) confirmed the facility had no contract with the local [MEDICAL TREATMENT] unit and the facility had no policies regarding [MEDICAL TREATMENT]. | 2020-09-01 |
| 92 | 92 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2018-08-16 | 880 | E | 0 | 1 | B0I611 | Based on observation, review of facility policy, and staff interview, the facility failed to follow infection control practices for 9 of 19 sampled residents (Resident #6, #8, #14, #15, #35, #37,#46, #48, and #55). Failure to follow infection control practices during personal cares and in the laundry has the potential to transmit infections to other residents, staff, and visitors. Finding include: Review of the facility policy titled Infection Prevention and Control Manual Standard Precautions occurred on 08/16/18. The policy, dated (YEAR), stated, . Gloves . Sterile gloves and examination gloves are removed: . Between resident contacts. Before touching uncontaminated surfaces or other areas of the same resident's body that may be contaminated. Review of the facility policy titled, Hand Hygiene occurred on 08/16/18. The policy, dated (YEAR), stated, . Appropriate hand hygiene is essential in preventing transmission of infectious agents. Staff must perform hand hygiene even if gloves are utilized. - Observations on all days of survey showed the following infection control breaches: * 08/13/18 at 11:36 a.m., Two certified nursing assistants (CNAs) (#10 and #25) assisted Resident #48 to the toilet utilizing a gait belt. One CNA (#10) removed the resident's wet brief, and without performing perineal care, placed a clean brief. The second CNA (#25) placed an oxygen tank on Resident #48's wheel chair, bagged the trash, and left the room with the trash without performing hand hygiene. * 08/13/18 at 3:08 p.m., A CNA (#20) transferred Resident #55 to the toilet using a mechanical lift. The CNA (#20) removed her gloves, exited the room without performing hand hygiene, and pushed the stand lift to another unit. * 08/14/18 at 9:52 a.m., Two CNAs (#8 and #9) transferred Resident #35 into bed using a mechanical lift and provided personal cares. One of the CNA's (#8) removed her gloves and exited the room with the lift. The other CNA (#9) checked Resident #35's brief, removed her gloves, placed a pillow between his knees, cover… | 2020-09-01 |
| 93 | 93 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 561 | D | 0 | 1 | 6YYS11 | Based on review of facility policy, and resident, family, and staff interviews, the facility failed to honor resident choices for 2 of 9 residents (Resident C and D) from the group interview, one sampled resident (Resident #36), and a family member (AA). Failure to honor resident choices related to sleeping and waking times does not allow the residents the right to choose their own schedule. Findings include: Review of the facility policy titled Resident Rights occurred on 10/17/19. This undated policy stated, . You have the right : To be offered choices and allowed to make decisions important to you, To expect the facility to accommodate individual needs and preferences . During an interview on 10/15/19 at 10:06 a.m., a family member (AA) stated, They (facility staff) get her (the resident) up way too early. There should be no reason she has to get up that early. Then I find her sleeping all the time with her head hanging down or leaned back in her wheelchair. She's up in her wheelchair from 5:30 (a.m.) until 8:30 (p.m.) when they put her to bed. During the group interview on 10/16/19 at 9:00 a.m. with residents identified by the facility as interviewable, Resident C stated staff get her up earlier in the morning than she chooses. If I don't get up they (staff) take my blanket and I get cold so I get up. Resident D stated staff make her get up earlier in the morning than she chooses. During a dressing change on 10/16/19 at 11:32 a.m. by an administrative nurse (#3), Resident #36 stated, Last night they (staff) wouldn't put me to bed, they made me sit here and sit here way over an hour and my back hurt. During an interview on 10/17/19 at 3:59 p.m., an administrative nurse (#1) stated she expected staff to allow residents to sleep in if they wanted. | 2020-09-01 |
| 94 | 94 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 582 | B | 0 | 1 | 6YYS11 | Based on review of Medicare Part A letters/notices and staff interview, the facility failed to provide the Centers for Medicare/Medicaid Services (CMS) Notice of Medicare Provider Non-coverage (NOMNC) form (CMS- ) and/or Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNFABN) form (CMS- ) to 3 of 3 residents (Resident #15, A, and B) reviewed who were discharged from Medicare Part A services. Failure to provide the correct notices upon termination of Medicare Part A services, the updated contact information for the intermediary review agency, and ensure the resident's received the option to appeal the termination of coverage has the potential to hinder the residents' right to an expedited review of a service termination. Findings include: Review of the Medicare Part A letters/notices for Resident #15, A and B occurred on the afternoon of 10/17/19. The records identified the following: * Resident A received the NOMNC form (CMS - ) on 08/08/19. The form lacked the updated contact information for the intermediary review agency. * The facility failed to provide Resident B with the NOMNC form (CMS - ) when all covered services ended. * Resident #15 received the SNFABN form (CMS- ) on 05/06/19. The resident signed the form and returned it to the facility but failed to identify, by checking a box, whether they requested a demand bill. During an interview on 10/17/19 at 3:52 p.m., a business office staff member (#2) confirmed Resident B failed to receive the CMS - , the facility had failed to confirm if Resident #15 wanted to request a demand bill, and verified the CMS - form lacked the updated contact information for the intermediary review agency. | 2020-09-01 |
| 95 | 95 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 641 | B | 0 | 1 | 6YYS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 8/16/18. Based on record review, review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.16), and staff interview, the facility failed to ensure the Minimum Data Set (MDS) reflected residents' status for 1 of 18 sampled residents (Resident #9) and 1 closed record (Resident #65). Failure to accurately complete Section A (Identification Information) does not allow each resident's assessment to reflect their current status/needs and may result in the development of an inaccurate care plan. Findings include: The Long-Term Care Facility RAI Manual, revised (MONTH) (YEAR), Section A: Identification Information, stated the following: * pages A-18 to A-20, A1500: Preadmission Screening and Resident Review (PASRR) . All individuals who are admitted to a Medicaid certified nursing facility, regardless of the individual's payment source, must have a Level I PASRR completed to screen for possible mental illness (MI), intellectual disability (ID) . /developmental disability (DD), or related conditions . Individuals who have or are suspected to have MI or ID/DD or related conditions may not be admitted to a Medicaid-certified nursing facility unless approved through Level II PASRR determination. Coding Instructions: . Code 1, yes: if PASRR Level II screening determined that the resident has a serious mental illness and/or ID/DD or related condition, and continue to A1510, Level II Preadmission Screening and Resident Review (PASRR) Conditions. * page A-29, . A2100: Discharge Status . Code 02, another nursing home or swing bed: if discharge location is an institution (or a distinct part of an institution) that is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care or rehabilitation service for injured, disabled, or sick persons. - Review of Resident #9's medical record occurred on (MON… | 2020-09-01 |
| 96 | 96 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 657 | D | 0 | 1 | 6YYS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THIS IS A REPEAT DEFICIENCY FROM THE STANDARD SURVEY COMPLETED ON 8/16/18 AND THE COMPLAINT SURVEY COMPLETED ON 6/11/19. Based on observation, record review, and review of facility policy, the facility failed to review and revise a care plan to reflect the resident's current needs for 1 of 18 sampled residents (Resident #61). Failure to review/revise the care plan to reflect each resident's current status limited the staff's ability to communicate needs and ensure continuity of care for the resident. Findings include: Review of facility policy titled Care Plans - Comprehensive occurred on 10/17/19. This policy, dated (MONTH) (YEAR), stated, . An individualized, comprehensive care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental, psychological needs is developed for each resident. Review of Resident #61's medical record occurred on all days of survey. The record indicated the resident was hospitalized on (MONTH) 10-14, 2019 and again on (MONTH) 15-23, 2019 with [DIAGNOSES REDACTED]. The hospital discharge orders indicated Resident #61 to be NPO (nothing by mouth) status and for speech therapy to evaluate and treat. The facility failed to identify interventions/recommendations for aspiration pneumonia, NPO status, and speech therapy on Resident #61's care plan. | 2020-09-01 |
| 97 | 97 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 658 | D | 0 | 1 | 6YYS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 08/16/18. Based on observation, record review, professional reference, and staff interview, the facility failed to follow professional standards of practice regarding compliance with physician's orders [REDACTED].#12 and #36). Failure to follow physicians's orders for a dressing change (Resident #12) and notification of elevated blood sugars (Resident #36) may result in adverse health effects. Findings include: Kozier & Erb's Fundamentals of Nursing, Concepts, Process and Practice, 10th Edition, (YEAR), Pearson, Boston, Massachusetts, page 68, stated, Nurses are expected to analyze procedures and medications ordered by the physician. It is the nurse's responsibility to seek clarification . the nurse is responsible for carrying it out. - Observation on 10/15/19 at 5:41 p.m. showed Resident #12 had a [MEDICATION NAME] dressing to his right hand. Review of Resident #12's medical record occurred on all days of survey. A nursing progress note, dated 10/05/2019 at 10:44 a.m., stated, CNA (certified nursing assistant) reported resident bumped his right hand to the corner of the heater box in his room. Resident was noted to have a self inflicted injury on his right hand, sustained a skin tear (inverted L shape) measuring 3.4 cms (centimeters) x (by) 3.0 cms. Resident was so resistantduring (sic) the cleaning of the affected area so it was not well approximated. This nurse cleaned it with NS (normal saline), covered with paper tape to keep the skin together, covered with non adherent dressing, then a foam dressing to hold the non adherent dressing and wrapped with Kirlix (sic). A MD (medical doctor)/Nursing Communication sheet faxed to the MD, dated 10/05/19, stated the above information and Would you like to continue same dressing. Please advise., to which the MD responded continue (with) above dressing. Review of Resident #12's treatment record occurred on 10/16/19 and failed to identify an or… | 2020-09-01 |
| 98 | 98 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 677 | D | 0 | 1 | 6YYS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility policy, and resident, family, and staff interviews, the facility failed to provide activities of daily living (ADL) assistance to 1 of 8 sampled residents (Resident #17) and 1 supplemental resident (Resident #51) who required staff assistance for toileting/check and change. Failure to provide assistance in a timely manner to residents who cannot independently carry out ADLs may result in poor grooming/hygiene and decreased self-esteem. Findings include: Review of the facility policy titled Incontinence Prevention Program occurred on 10/17/19. This undated policy stated, To provide the appropriate bowel and bladder continence interventions based upon individualized evaluation of residents. Routine toileting (ADL based) - A scheduled bladder management program will be designed to toilet an incontinent patient/resident when a voiding pattern cannot be established or for a patient/resident who is unable to communicate the need to void. Goal: Keep the resident dry. Example schedule in care plan: 'Toilet the resident every 2 hours, before and after meals, at bedtime and once during the night.'. Check and Change . residents using briefs will be checked frequently as needed for incontinent episodes and removal/replacement of soiled briefs. Perineal care will be provided after each incontinent episode. - Review of Resident #17's medical record occurred on all days of survey. The resident's current care plan stated, . ADL self-care deficit as evidenced by requires assistance related to: decreased physical function . Check and change at routine times such as before and after meals, at HS (hour of sleep) and routinely throughout the night. Transfer with full body mechanical lift, full body sling, two staff . Urinary incontinence r/t (related to) Disease process dementia . Incontinence care at routine times such as upon arising in AM, before/after meals, activities, naps, at bedtime and on scheduled … | 2020-09-01 |
| 99 | 99 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 692 | D | 0 | 1 | 6YYS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and record review, the facility failed to adequately assess the nutritional needs to restore/maintain adequate nutritional status for 1 of 3 sampled residents (Resident #61) who received a tube feeding. Failure to meet residents' nutritional needs through diet (tube-feeding), supplements, or other interventions contributed to the resident's weight loss. Findings include: Review of the facility policy titled WEIGHT PROGRAM occurred on 10/17/19. This policy, dated (MONTH) (YEAR), stated, . Request reweighs on residents with weight change of 3 pounds or greater . Residents who are tube fed via an electric or battery powered pump should maintain a stable weight. If the resident losses 3 lbs (pounds) or greater OR gains 3 lbs or greater, the dietitian (RD) and nurse should complete a comprehensive assessment on the resident and the doctor needs to be notified as soon as possible . Review of Resident #61's medical record occurred on all days of survey. The current physician orders, dated 09/24/19, stated, . [MEDICATION NAME] 1.5 Cal (tube-feeding). Run over 15 hours at 78 ml (milliliters)/hour start at 1700 (5:00 p.m.) and end when total volume 1170 ml infused . A nutrition risk assessment, dated 09/24/19, identified the following . wasting noted in face, decrease fat and muscle mass noted. Current diet order NPO (nothing by mouth). Current feeding [MEDICATION NAME] HN (high calorie tube feeding) . does not meet estimated need . Risk for Malnutrition: low with tube feeding support . Nutritional Goal Summary: wt 180-190# (pounds) . The current care plan stated, Nutritional status I have abeen (sic) losing wt (weight) gradually. Refuses to be weighed swallowing problems I receive nutrition and hydration via tube feeding Increased need for healing . Review of Resident #61's weights identified the following: * 09/23/19 - 182.0 lbs * 10/01/19 - 175.6 lbs (failed to re-weigh and notify RD) * 10/07/19 - 176.8 lbs * 10/15… | 2020-09-01 |
| 100 | 100 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-10-21 | 695 | D | 0 | 1 | 6YYS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility policy, and staff interview, the facility failed to provide the necessary care and services for 1 of 4 residents (Resident #24) observed with continuous oxygen and/or bi-level positive airway pressure ([MEDICAL CONDITION]) use. Failure to provide humidification and utilize correct oxygen liter flow may complicate the resident's respiratory status. Findings include: Review of facility policy titled Oxygen Administration occurred on 10/17/19. This policy, dated (MONTH) (YEAR), stated, . PURPOSE: To deliver oxygen to the resident when insufficient oxygen is being carried by the blood to the tissues. PR[NAME]EDURE: . 1. Check with physician's orders [REDACTED]. 3. h. If a bubble-type humidifier is ordered/used fill it with sterile water. 8. Precaution: Constant flow of oxygen can cause drying and thickening of normal secretions resulting in laryngeal ulceration (sores on the vocal cords). 10. At regular intervals, check liter flow contents (sic) of oxygen, fluid level in humidifier . Review of Resident #24's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current physician's orders [REDACTED]. with 4 LPM (liter per minute) oxygen bleed (delivery of oxygen with one end of oxygen tubing attached to the oxygen concentrator and the other end of the tubing attached to the [MEDICAL CONDITION] unit), every day and night shift for Sleep apnea . O2 (oxygen) at 3L (liters) per NC (nasal cannula) every day and night shift for shortness of breath, [MEDICAL CONDITIONS] . must wear nightly [MEDICAL CONDITION] during the day if napping. The current care plan stated, . Interventions . Administer oxygen per MD (physician) orders. While not on [MEDICAL CONDITION] have oxygen concentrator at 3 LPM . [MEDICAL CONDITION] per MD orders. While on [MEDICAL CONDITION] set oxygen concentrator at 4 LPM . Observations for Resident #24 showed the following: * 10/15/19 at 9:53 a.m. - Laid in bed … | 2020-09-01 |
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CREATE TABLE [cms_ND] ( [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 );