| 2884 |
KEYSTONE RIDGE POST ACUTE NURSING AND REHAB |
285238 |
7501 KEYSTONE DRIVE |
OMAHA |
NE |
68134 |
2018-01-02 |
867 |
H |
0 |
1 |
51KH11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.07C Based on observations, record reviews and interviews conducted during the standard annual and extended survey process related to substandard equability of care. The facility failed to ensure an effective quality improvement plan as evidenced by new and repeat deficient practice. Facility census was 66. Findings are: Interview on 12/27/17 at 2:03 PM with the facility Director of Nursing (DON) and Nurse Consultant N revealed that the Quality Improvement Committee oversees the quality of Resident care. Nurse Consultant N confirmed the facility had not identified the current deficient practices and there were no PIP/QUAPI programs in place at this time for the following Tag citations The facility was found to be deficient in multiple areas of regulatory compliance requiring an extended survey process for substandard quality of care. Please refer to the Tag citations for specific detailed findings: -F 550; The facility failed to ensure water temperature for bathing was at a comfortable level for resident 56 one of one resident, the facility census was 66. -F580; The facility failed to notify Resident 39's representative of fall for one of three residents. Facility census was 66 -F609; The facility failed to submit an investigation to the state agency as required, within 5 working days. Resident 48, 3, 15. -F 655; The facility failed to include information related to antipsychotic medication in initial plan of care for use for Resident 52, 160. -F 656; The facility failed to develop activity care plans for Residents 49, 36. -F 657; The facility failed to revise plan of care for assisting resident with nutritional intake for Resident 36. -F675; The facility failed to implement a bowel care regimen to prevent impaction for Resident 36. -F 676; The facility failed to ensure dentures were available for use and failed to ensure Resident 51 was assisted with dressing. -F677; The facility failed to provide assistance with morning cares and meals for Resident 39 and provide standard of care for transfer with use of gait belt for Residents 12, 21. -F 679; The facility failed to provide activities to meet resident interest for Resident 36 and 49. -F680; The facility failed to have a activity director that meets the required qualifications. This has the potential to affect all residents in the facility. The facility Census was 66. -F684; The facility failed to ensure the coordination of care for Hospice Resident Resident 36. -F686; The facility failed to identify pressure ulcers, and failed to implement interventions to prevent development/redevelopment of pressure ulcers for Residents 160, 36, 51, and 3. -F688; The facility failed to implement a specific restorative program for Resident 3. - F689; The facility failed to implement interventions to prevent falls for Resident 38, failed to provide supervision during smoking for Resident 3, and failed to utilize gait belt in a manner to prevent potential accidents for Resident 12, 21. -F690; The facility failed to ensure that residents were free of indwelling catheters for Resident 23 and 49. -F692; The facility failed to assist Resident 36 with nutritional intake. -F712; The facility failed to ensure Residents receive primary physician visits in a routine manner for Residents 47,18,39,2,12,21. -F725; The facility failed to provide sufficient staffing levels to provide Activity of Daily Living services, nutritional intake prevention of pressure ulcer development, bowel elimination and accident prevention, with the potential to affect all residents residing in the facility. The facility census was 66. -F726; The facility failed to provide training for gait belt use and specialized equipment to maintain Range of Motion. -F758; The facility failed to monitor behaviors for use of [MEDICAL CONDITION] medication use for Resident 52 and 160 -F759; The facility failed to maintain a medication error rate less than 5 % the medication error rate was 7.69. -F760; The facility failed to ensure Resident number 23 was free of a significant medication error. -F801; The facility failed to have a qualified dietary manager, this had the potential to affect all resident. -F804; The facility failed to ensure food were provided in a manner that was maintained at a temperature that was appealing to residents. This had the potential to affect all residents the Facility census was 66 -F812; The facility failed to ensure hair restraints covered all hair during food service, and failed to utilize hand washing and gloving techniques to prevent food contamination during food service. -E0015; The facility failed to ensure sufficient supply of nutritional provisions food supplies were maintained for residents, and staff in case of emergency. -F835; The facility failed to ensure administer utilize resources in a manner to ensure provision of care, provision of services for residents. -F867; The facility failed to ensure an effective quality improvement plan as evidenced by new and repeat deficient practice Interview on 1/27/17 at 1:00 PM with NA(Nursing Assistant) J, revealed that NA J , worked mostly day shift, and was not able to identify any of the members of the Q A &A committee, or what current projects the committee were working on. Interview on 1/27/17 at 2: 00 PM with NA S revealed that NA S, worked mostly the afternoon shift, and was not able to identify any of the members of the Q A &A committee, or what current projects the committee were working on. Repeat tags included: (Tag numbers have changes, new and old listed) F157 on 09/06 16 survey andF580 for current survey. F225 on 9/6/16, 9/2015 and F 609 for current survey. F248 on 9/6/16 and F679 for current survey. F248 on 9/6/16 and F676 for current survey. F325 on 9/6/16 and F 692 for current survey. F332 on 9/6/16 and F759 for current survey. F371 on 9/6/16 and F812 for current survey. F520 on 9/6/16 and F867 for current survey. |
2020-09-01 |