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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 12929 | 12929 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2010-01-28 | 280 | D | 6DM511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.09C1b Based on record review and staff interview; the facility staff failed to review and revise a Comprehensive Care Plan (CCP) related to signs and symptom of potential suicidal behavior for 1 (Resident 6 ) of 14 sampled Residents. The facility staff identified a census of 51. Findings are: Record review of a Admission Record dated 10/21/2009 revealed That Resident 6 was admitted to the facility on [DATE] and re-admitted on [DATE]. Record review of Resident 6's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 1/23/2010 revealed that the facility staff assessed the following about the resident: -Resident 6 had short term memory problems, long term memory was ok. -Modified independence with decision making. Required extensive assistance with bed mobility, transfers, dressing, eating, toilet use and personal hygiene. Record review of Resident 6's Nurse's Notes dated 10/08/09 revealed the following entry: "...I'm going to drink water until I choke then hold my breath until I die". Resident 6 was monitored, family and physician was contacted and the resident was sent to the hospital for an evaluation. Record review of Resident 6's CCP dated 10/21/09 revealed that Resident 6 had a potential for suicidal ideation. The CCP did not identify specific intervention related to suicidal statements or potential self harm issue. An interview with the Director of Nursing (DON) was conducted on 1/28/2010 at 9:40 AM. Resident 6's CCP was reviewed with the DON. The DON confirmed that Resident 6's CCP did not identify specific signs and symptoms for staff to follow for the suicidal statement. Record review of the facility's Suicide and Suicidal Ideation Recognition Guideline dated 4/28/03, section 5.1.3 Titled Care Plan revealed the following instructions: " Any suicide attempt or expressed [MEDICAL CONDITION] must be integrated into the resident… | 2014-02-01 | ||
| 12930 | 12930 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2010-01-28 | 246 | D | 6DM511 | LICENSURE REFERENCE NUMBER 12-006.18B1 Based on observations, record review and interviews; the facility failed to identify positioning needs and assess for causative factors and interventions to assist in the maintenance of upper body symmetry and alignment for 1 (Resident 8) of 14 sampled residents. The sample size was 14 including 1 closed record. The facility census at the time of the survey was 51. Findings are: Record review of Resident 8's most recent Significant Change Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 11/11/09 identified that Resident 8 exhibited severely impaired decision making, was totally dependent on staff for transfers and was not able to maintain position or upper body control while sitting without physical help from another person. Record review of Resident 8's Comprehensive Care Plan (CCP) identified no documentation of the use of assist devices in the wheelchair to maintain body symmetry and alignment of the body while seated in a wheelchair and no assessment of positioning needs or causative factors for Resident 8. Observation on 1/26/10 at 10:30 AM revealed Resident 8 seated in a regular wheelchair with no devices present to maintain upright body alignment. Resident 8's upper body leaned far to the left while seated in the wheelchair. Observation on 1/26/10 at 3:10 PM revealed Resident 8 seated in a regular wheelchair in the dining room. Resident 8's upper body leaned far to the left. Observation on 1/27/10 at 7:55 AM revealed Resident 8 seated in a wheelchair with the upper body leaning far to the right. Interview on 1/27/09 at 7:55 with MA A confirmed that Resident 8 leaned to the side in the wheelchair and that no positioning devices were used in Resident 8's wheelchair. Observation at that time revealed MA A attempted to push Resident 8's upper body back into an upright position in the wheelchair. Observation on 1/27/09 at 8:40 AM revealed Resident 8 seated in a wheelchair at the dining room table with the upper body le… | 2014-02-01 | ||
| 12931 | 12931 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2010-01-28 | 274 | D | 6DM511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 12-006.09b1(2) Based on observation, record review and interview, the nursing facility staff failed to conduct a significant change assessment for 1(Resident 5)at the required time of an annual assessment review when the resident presented with a significant change in resident status. The sampled residents totaled 14, including 1 closed record, from a facility census of 51. Findings are: On 1/26/10, at 3:30 PM observation revealed Resident 5 sitting in the bath room. Nurse Aide (NA)-C attempted to assist the resident with personal hygiene cares. Resident 5 resisted the NA ' s assistance and remarked that 'resident puts self on the toilet. ' The resident continued to talk about how the staff left the resident on the toilet for an hour at a time. Interview with NA-C on 1/26/10, during the personal hygiene cares revealed the resident does what (gender) wants to do; the resident refuses to have cares provided and or resists the NA ' s to assist with procedures for cares. Observation and interview on 1/27/10, at 8:10 AM, NA-D revealed that Resident 5 refuses to get up to go to the bathroom when the resident is in bed. The resident always requests a bedpan. On 1/27/10, at 9:10 AM, observation revealed Resident 5 eating breakfast. Resident 5 remarked; " I refuse a lot of things to eat, sometimes they all are too spicy; I ' ve lost weight in the 2 years that I ' ve been here, but not a whole lot. " Record review revealed that Resident 5's weight had remained stable since 2/08/08 (182 pounds); a current weight taken 1/27/10 at 178 pounds; and the resident remains above the Ideal Body Weight of 117-143 pounds. Review of Resident 5 ' s MDS (Minimum Data Set -a Federal required comprehensive assessment tool used for care planning) assessments revealed: *The last annual assessment MDS had been completed by the facility interdisciplinary team on 2/19/09. * The MDS quarterly assessments dated 10/02/09, 07/03/09, and 04/10/09 had b… | 2014-02-01 | ||
| 12932 | 12932 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2010-01-28 | 441 | D | 6DM511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 12-006.17A4 Based on observation, record review and interview, the nursing facility staff failed to separate residents into separate rooms who had infection of different microorganisms for 1 (Resident 2), from 2 residents in contact isolation in the facility. The sampled residents totaled 14, including 1closed record, from a facility census of 51. Findings are: On 1/26/10, during the orientation entrance tour of the facility, observation revealed that 2 residents (Resident 2 and the roommate) were located in the same room with Contact Isolation to be carried out. The Registered Nurse (RN) Staff-O identified that Contact Isolation had been ordered for Resident 2 because of the presence of the microorganism of[DIAGNOSES REDACTED]. (Clostridium Difficile). The room mate had been ordered for Contact Isolation because of the presence of MRSA (Methicillin Resistant Staphylococcus Aureus) in a leg ulcer, wrapped with a dressing and changed daily. Record review of Resident 2 revealed the resident had been admitted [DATE] following an Ischemic Stroke September 2009, according to the physician ' s hospital notes. The hospital History and Physical dated 11/5/09 revealed the resident had a fall and fractured the right hip. Following the surgical repair of the hip returned to the nursing facility 11/11/09. The hospital notes identified right sided weakness and aphasia. Review of the laboratory reports dated 01/06/2010 revealed Resident 2 ' s Stool Culture was positive for Clostridium Difficile. On 01/22/2010, the physician ordered [MEDICATION NAME] 250 mgm (milligram) tablets, TID (three times daily), x (times) 2 wks (weeks). On 01/27/10 at 8:35 AM, observation revealed Nurse Aide (NA)-I and NA-J completed personal hygiene cares. Observation revealed Resident 2 had had diarrhea stool. The resident ' s skin was reddened, however, no breakdown. NA-I and NA-J remarked how the resident had come from the hospital with diarrhea and 2 … | 2014-02-01 | ||
| 12933 | 12933 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2010-01-28 | 463 | F | 6DM511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER:12-007.04G Based on observation and interview; the facility staff failed to ensure that the call light system was operational at the nurse's station. This practice effected all residents in the facility. The survey sample was 14. The facility staff identified a census of 51. Findings are: Record review of a Admission Record dated 10/21/2009 revealed That Resident 6 was admitted to the facility on [DATE] and re-admitted on [DATE]. Record review of Resident 6's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 1/23/2010 revealed that the facility staff assessed the following about the resident: -Resident 6 had short term memory problems, long term memory was ok. -Modified independence with decision making. Required extensive assistance with bed mobility, transfers, dressing, eating, toilet use and personal hygiene. During an interview on 1/27/10 at 8:00 AM, Resident 6 stated " it takes a long time for them to answer my call light". Observation on 1/27/10 at 8:55 AM revealed that Resident 6's light was on above the door to Resident 6's room. Observation of the call light system panel at the nurse's station did not light up or sound indicating that Resident 6 was requesting assistance in the room. Registered Nurse B confirmed the call light was not functioning at the nurses station. A follow up interview was conducted with the facility administrator on 1/28/2010 at 7:50 AM. The Administrator confirmed that the call light system had not been functioning and that all residents were on 15 minute checks until the call light was repaired. | 2014-02-01 | ||
| 12934 | 12934 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2010-01-28 | 465 | E | 6DM511 | LICENSURE REFERENCE NUMBER: 12.006.18 Based on observation and interview; the facility staff failed to maintain a functional, sanitary and comfortable environment as issues were identified during the environmental tour of the facility. Observation on 1/27/2010 at 8:00 AM with the Administrator, Maintenance Supervisor and Housekeeping Supervisor revealed the following: -100 Hall: -Wood hand rails worn to bare wood making the hand rails uncleanable. -Heating element next to east exit door with large areas of rust. -Areas of ripped wall paper in the hall. -200 Hall: -Wood hand rail worn portions to bare wood making them uncleanable. -Room 204 kick plate with sharp edges. -Wall paper in hall with areas that are ripped. -Room 217 with chair with wood legs chipped and scratched to bare wood. -Room 211 with fall mat that has rips revealing the foam filling and scraped and gouged wall. -8 of 12 wooden dinning room and 2 wood lobby chairs with scrapes and gouges. During an interview with the Administrator on 1/28/2010 at 12:00 confirmed the above findings. | 2014-02-01 | ||
| 12913 | 12913 | MATNEY'S COLONIAL MANOR | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2010-02-04 | 253 | E | QGTM11 | LICENSURE REFERENCE NUMBER: 12-006.18 B Based on observation and interview; the facility staff failed to maintain the cleanliness of floors and caulking surrounding the base of the toilets in resident bathrooms and failed to maintain furniture and window seals in good condition. This affected 19 (Rooms 101,106, 109, 110, 112, 202, 206, 209, 302, 304, 305, 306, 310, 312, 501, 505, 507 and 508 ) of 39 occupied resident rooms in the facility. The facility staff also failed to maintain a radiator baseboard heater and a cement patio in the enclosed courtyard in good condition. The census at the time of survey was 44. Findings are: Observation on 2/3/10 between 9:40 AM and 11:00 AM with the Facility Maintenance Director (MS) and the Housekeeping Supervisor (HS) and the Owner revealed concerns in the following areas: - Soiled, stained or broken caulking and floor tiles surrounding the base of the toilet in resident bathrooms Rooms 101,106, 109, 110, 112, 202, 206, 209, 302, 304, 305, 306, 310, 312, 501, 505, 507 and 508. - Loose dresser handles in rooms 109, 110, 112 and 501. - Drafty window seal in room 304. - A metal baseboard radiator heater torn away from the wall in the hall leading to the dining room. - In the enclosed outdoor courtyard cement slabs were buckled which resulted in a difference in levels of 2 inches between the slabs. This had the potential to affect 5 ( Residnets 1, 3, 15, 16 and 17) residents that utalized wheelchairs and used the courtyard for a smoking area. Interview on 2/3/10 at 2:50 PM with the MS confirmed the above observations and that the facility had not identified the above areas of concern prior to 2/3/10 and did not have any work orders for the identified concern areas. | 2014-02-01 | ||
| 12914 | 12914 | MATNEY'S COLONIAL MANOR | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2010-02-04 | 371 | F | QGTM11 | LICENSURE REFERENCE NUMBER 12-006.11E NEBRASKA FOOD CODE 2-301.14(F), 2-301.12(A), 3-304.15(A) Based on observation, interview and record review; the facility kitchen staff failed to prepare and serve food under sanitary conditions related to hand washing. This had the potential to affect all residents that were served food from the facility kitchen. The facility census was 44. Findings are: Record review of a facility policy entitled Hand washing and Use of Plastic Gloves dated 2000 revealed the following policies: Dietary staff will wash hands after glove removal, when tasks are changed, after a return to the kitchen from another area, after touching meat, before touching items such as door, cupboard or oven handles and at other times hands have been soiled. Remember gloves are just like hands. They get soiled. Any time a contaminated surface is touched, the gloves must be changed: after coughing, sneezing into hands or touching hair or face, after handling garbage, after handling anything soiled. After handling boxes, crates or packages, anytime after you touch any contaminated surface. Interview on 2/2/10 at 1:45 PM with the Dietary Manager (DM) confirmed the Policy and Procedures dated 2000 and confirmed that the expectation for hand washing in the kitchen was that hands were to be washed with soap as follows: - after glove removal. - when tasks were changed. - after a return to the kitchen from another area. - after touching meat. - before touching items such as door, cupboard or oven handles. Observation of Breakfast food service with the DM on 2/2/10 between 8:10 AM and 8:30 AM revealed that Cook G wore gloves and was serving sausages, oatmeal and pancakes for breakfast. Cook G began the meal service by using tongs to pick up sausage links and pancakes. At 8:20 AM, Cook G began using gloved hands to pick up portions of sausage links and pancakes. Cook G then proceeded to touch the handles of the scoops for the oatmeal and dry cereal for each tray served with soiled gloves. Cook G continued that practice t… | 2014-02-01 | ||
| 12915 | 12915 | MATNEY'S COLONIAL MANOR | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2010-02-04 | 323 | E | QGTM11 | LICENSURE REFERENCE NUMBER 12-007.03A21. And LICENSURE REFERENCE NUMBER 12-006.18E3a1. Based on observation, interviews, policy and procedures, the nursing facility staff failed to maintain resident rooms 303, 304, 309 and 312 free from portable space heaters; and maintain the 300 hallway shower's water temperature not to exceed 110 degree Fahrenheit(F)regulation, which has the potential to affect 4 residents (Resident 1, 20, 21, and 22) that use this bathing area. The total sample size consisted of 11 residents, including 1 discharged resident, plus 11 non sampled residents. The facility census totaled 44. Findings are: PORTABLE SPACE HEATERS: A. Observation during the orientation tour 02/01/ at 3:30 PM revealed what appeared to be a small white space heater placed in the middle of the floor and plugged into an electrical outlet in room 309. Upon inquiry, the resident revealed it was an electric space heater that the family had given to the resident as a present at Christmas. B. On 02/02/2010, during the medication administration pass at 8:10 A.M to Resident 2, revealed the observation of an old space heater placed between the night stand and the wall, in front of the resident's legs. The heating element felt hot when the hand drew near to the reddened heater's element. The space heater appeared to hot to touch with the hand. Observation on 2/2/10 at 9:15AM revealed Staff-A, maintenance person, replacing the "old" heater with a black space heater. Staff-A replied, "Yes, I just got back, - "bought a newer one" and placed the heater in front of Resident 2's legs. Observation on 2/2/10 at 1:00 PM revealed a "radiator" type heater had been placed in Resident 2's room. Observation revealed the room space around the heater was hot. The front of the heater had been placed near the resident's foot stool. The rug covering over the foot stool was hot to touch with a bare hand. Observation revealed the temperature gauge had been set on 7, with a gauge that numbered 1(one) through 7 (seven), the highest setting. Staff-B, ho… | 2014-02-01 | ||
| 12916 | 12916 | MATNEY'S COLONIAL MANOR | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2010-02-04 | 492 | F | QGTM11 | Based on record review and interview; the facility staff failed to complete the demand billing process correctly to ensure that the resident or the responsible party had accurate knowledge of the potential liability of payment and the right to request that a standard claim appeal ( i.e. demand bill) be submitted to Medicare for 4 ( Residents 3, 16, 18 and 19) of 4 residents files reviewed. The resident sample size was 11 including 1 closed record plus 11 non-sampled residents. The facility census was 44. Findings are: Record review of a Centers for Medicare and Medicaid Services Survey and Certification Letter 09-20 revealed that the Skilled Nursing Facility (SNF) must inform the beneficiary of potential liability for payment for non-covered services when limitation of Liability applies. The SNF's responsibility to provide notice can be fulfilled by use of either the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) or one of 5 uniform Denial Letters. The SONANT and the Denial Letters also inform the beneficiary of the right to have a claim (i.e. demand bill) submitted to Medicare. Record review of the facilities Demand Billing process revealed that 4 ( residents 3, 16, 18 and 19) of 4 residents were informed of the right to request a demand bill and to submit a claim and that each resident or responsible party had requested that they wanted a decision made by the fiscal intermediary. A review of the portion of the SNFABN entitled Request for Medicare Intermediary Review for Residents 3, 16, 18 and 19 revealed that the "I do" box had been marked for each of the identified residents. Interview on 2/2/10 at 9:00 AM with the Business Office Manager (BOM) revealed that the documentation of requests for demand bills had been made in error and that none of the 4 residents reviewed wanted their information submitted for an independent review and decision. The BOM stated that the residents had checked "I do" on the SNFABN in error. The BOM thought that by checking the "I do" box that meant that the resident h… | 2014-02-01 | ||
| 12917 | 12917 | MATNEY'S COLONIAL MANOR | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2010-02-04 | 246 | E | QGTM11 | LICENSURE REFERENCE NUMBER 12-006.18B2 Based on observation, interview and record review; the facility failed to provide comfortable table heights and positioning for ease of eating for 2 sampled (Residents 9 and 3) residents and 3 non-sampled (Residents 12, 13 and 14) residents of 40 residents that ate in the main dining area in the facility. The sample size was 11 residents including 1 closed record and 11 non-sampled residents. The facility census was 44 at the time of survey. Findings are: A. Observations on 2/3/10 between 8:05 AM and 8:40 AM and on 2/3/10 between 12:05 PM and 12:25 PM revealed Residents 12 and 3 seated in their respective wheelchairs in the main dining area at a dining table. Observation revealed that Resident 12 and 3 ' s wheelchair pedals were touching underneath the table preventing the Resident ' s 12 and 3 from sitting close enough to the table to easily reach the food and beverages. Resident 3 leaned forward to reach the food. Resident 12 moved the plate so that it was partially off of the table edge closer to Resident 12. Both residents ' s had to bring the food a long distance from the plate to their mouths which resulted in food being spilled on the residents' laps and on their clothing protectors. Resident 12 and 3 were able to eat independently without staff assistance. B. Observations on 2/3/10 between 8:05 AM and 8:40 AM and on 2/3/10 between 12:05 PM and 12:25 PM revealed Residents 13 and 14 seated in their respective wheelchairs in the main dining area at a dining table. Resident 13 ' s wheelchair had leg extension foot pedals attached and Resident 13's legs and feet rested on these pedals. During the observations it was noted that the leg extension foot pedals hit the feet of Resident 13 ' s table mate, Resident 14, which prevented both Resident ' s 13 and 14 from sitting close enough to the table to easily reach the food and beverages. Both Resident ' s 13 and 14 leaned forward to reach the food and food spilled on Resident 13's clothing protector. Both residents were able t… | 2014-02-01 | ||
| 12918 | 12918 | MATNEY'S COLONIAL MANOR | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2010-02-04 | 281 | D | QGTM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 12-006.09 Based on observations, record review, and staff interviews; the facility staff failed to ensure that physician orders [REDACTED]. The facility census was 44. Findings are: Record review of Resident 9's Admission Face Sheet revealed admission [DIAGNOSES REDACTED]. Record review of Resident 9's MDS dated [DATE] revealed that Resident 9 exhibited moderately impaired cognitive skills, exhibited no adverse behaviors and had limited range of motion on one side and partial loss of voluntary movement on one side. Record review of Physician order [REDACTED]." Record review of an Occupational Therapy (OT) Evaluation for Resident 9 dated 12/30/09 revealed a functional goal that included that resident would hold activities of daily living (ADL) items in right hand to assist with function. The Functional Level Progress Report indicated that the hand positioning device did help decrease tightness and pain in the right hand for Resident 9. Record review of OT weekly notes dated 12/30/09 indicated that facility staff had been instructed by the OT to keep a therapeutic carrot in Resident 9's hand at all times. Record review of the OT weekly notes dated 1/5/10 indicated that Resident 9 had been found in bed with nothing in the right hand. Record review of OT weekly notes dated 1/19/10 indicated that Resident 9 had physician orders [REDACTED]. Record review of a Occupational Therapy Restorative Referral Form dated 1/19/10 revealed program recommendations that a rolled washcloth or palm protector or a small cone be kept in Resident 9's right hand. Observations on 2/3/10 at 8:15 AM, 2:00 PM, 3:15 PM, 4:00 PM, 5:00 PM and 5:30 PM revealed Resident 9 seated in a wheelchair in the main dining and activity area with no rolled washcloth in the right hand. The fingers of the right hand were curled into the palm of the right hand. Interview on 2/3/10 at 5:30 PM with Nursing Assistant (NA) I confirmed that Resident 9 did not have anyt… | 2014-02-01 | ||
| 12669 | 12669 | ALEGENT HEALTH IMMANUEL FONTENELLE HOME | 285085 | 6809 N 68TH PLAZA | OMAHA | NE | 68152 | 2010-03-03 | 332 | D | 9OFY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.10D Based on observation, record review and interview: the facility staff failed to ensure a medication error rate of 5 percent or less. A total of 45 opportunities were observed with 3 medication errors which gave an error rate of 6.66 percent. The survey consisted of 24 sampled and 6 non-sampled residents. The facility staff identified a census of 152. Findings are: Record review of a Resident Face Sheet dated 10/15/2009 revealed that Resident 4 was admitted to the facility on [DATE]. Record review of Resident 4's Physician order [REDACTED]. that the resident's physician had ordered medication including [MEDICATION NAME] ( antiemetic) 10 mg (milligrams) before meals and at bed time by a tube. Resident 4 had a gastrostomy tube in place. (a tube placed into the stomach usually through the abdomen). Record review of an physician's orders [REDACTED]. Observation on 2/25/2010 at 12:30 PM of a medication administration revealed that Certified Medication Assistant (CMA) G administered the [MEDICATION NAME] and [MEDICATION NAME] to Resident 4. When asked if Resident 4 had eaten lunch, CMA G stated "yes". When asked if the medication identified above was to be given before meals, CMA G stated ''yes". CMA G confirmed that the medications had been given after the meal and not before as ordered. Record review of a Face Sheet dated 3/01/2010 revealed that Resident 25 was admitted to the facility on [DATE]. Record review of a transfer sheet dated 6/16/09 revealed that Resident 25's Physician had ordered Asprin 81 mg a day. Observation on 3/01/2010 at 7:10 AM revealed Licensed Practical Nurse (LPN) H prepared Resident 25 medications. Observation at this time revealed the Asprin was [MEDICATION NAME] coated. LPN G placed the Asprin in a small package with several other medications and crushed those medication. LPN H placed the crushed medications into apple sauce and administered them to Resident 25. An interview on 3/02/… | 2014-04-01 | ||
| 12670 | 12670 | ALEGENT HEALTH IMMANUEL FONTENELLE HOME | 285085 | 6809 N 68TH PLAZA | OMAHA | NE | 68152 | 2010-03-03 | 280 | D | 9OFY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 12-006.09C1c Based on record review and interview; the facility staff failed to revise Comprehensive Care Plans to include specific interventions to address [MEDICAL CONDITION] for 1 (Resident 18) of 24 sampled residents. The facility census was 152. Findings are: Record review of Resident 7's Admission Face Sheet showed an admission date of 2/5/10. Record review of an Admission History and Physical dated 1/29/10 revealed [DIAGNOSES REDACTED]. Record review of Resident 7's Skilled Admission Note by the Nursing Home Network dated 2/8/10 revealed that a Short Geriatric Depression Scale assessment for Resident 7 had been completed on that date. The score for Resident 7 was 3 out of 5 possible points with "yes" answers given to the questions " Do you often feel helpless" and "Do you feel pretty worthless the way you are now". Documentation was present on the form that Resident 7 indicated that those feelings were related to the recent illness. Record review of an E.A.C. H. ( A facility process initiated each time a resident makes a suicidal statement or gesture) document dated 2/10/10 revealed that Resident 7 had made the comment " I don't know if life is worth living". Record review of the E.A.C.H Process for the incident dated 2/10/10 revealed that, after this comment was made by Resident 7, the facility followed their process as required. Record review of an E.A.C.H. document dated 2/11/10 revealed that Resident 7 made another suicidal statement to facility staff. Record review of the E.A.C.H Process for the incident dated 2/11/10 revealed that, after this comment was made by Resident 7, the facility followed their process as required. Record review of Resident 7's Comprehensive Care Plan (CCP) dated 2/18/10 revealed that the E.A.C.H. process was done on 2/10/10 and 2/11/10 and that Resident 7 was sent to the emergency room after the 2/11/10 incident. The CCP did not contain any specific interventions related to the … | 2014-04-01 | ||
| 12671 | 12671 | ALEGENT HEALTH IMMANUEL FONTENELLE HOME | 285085 | 6809 N 68TH PLAZA | OMAHA | NE | 68152 | 2010-03-03 | 441 | E | 9OFY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** F441 LICENSURE REFERENCE NUMBER-12-006.17B-Prevention of Cross-Contamination LICENSURE REFERENCE NUMBER-12-006.17D -Hand washing Based on observation, record review and interview the nursing staff failed to follow infection control practices during the provision of treatment and services related to hand washing and gloving during personal hygiene cares for incontinent residents, administering fluids per Gastrostomy tube, handling and transporting soiled linens and disinfecting the glucose meter. The total samples of 24 residents within the nursing facility census of 152 were reviewed. Findings are: A. Review of the Alegent Health Skills Demonstration, revised 01/06/10, requires Hand Washing, Item 3. Lathers all surfaces of fingers, hands and wrists, producing friction for at least 20 seconds; And Item 4. Can state that the minimum length of time to wash hands is 20 seconds. B. Review of GLOVE INFORMATION HEALTH CARE WORKERS, Occupational safety and Health Administration updated Blood borne pathogens Standard, effective April 2001: in part states: *it is crucial for Health Care Worker ' s (HCW ' s) to wash hands following glove removal when hands are visibly soiled. Hands should also be washed when the integrity of the gloves has been compromised (torn, etc.) during use. In the absence of visible (or any perceived) contamination of hands, hand hygiene with alcohol hand rubs is appropriate, following glove removal. Gloves should also be changed any time the healthcare worker switches from contaminated to clean tasks. C. On 3/2/2010, from 8:15 to 9:10 A.M., observation of both NA (Nurse Aide) F and E during the provision of personal hygiene cares for Resident 1 revealed both NA (Nurse Aide) F and E contaminated their hand gloves with stool while attempting to remove the resident ' s brief. NA-F commented, " I ' m contaminated " and held both hands up off the resident. While NA-E continued to hold the resident over by the buttock covered with sto… | 2014-04-01 | ||
| 12672 | 12672 | ALEGENT HEALTH IMMANUEL FONTENELLE HOME | 285085 | 6809 N 68TH PLAZA | OMAHA | NE | 68152 | 2010-03-03 | 281 | D | 9OFY11 | LICENSURE REFERENCE NAC 175 12-006.10B1 Based on interview and observation and record review, the Facility staff failed to document medications after administration for 2 residents (Resident 7 and Resident 29).These observations were made during the survey that occurred from February 25, 2010 to March 3, 2010. The facility census was 152 and the sample size was 24 plus 6 non-sampled residents. Findings are: A. Observation was on March 2, 2010 at 08:!0 AM of LPN K preparing insulin for Resident 29. When finished drawing insulin into the syringe, LPN K was observed initialing the MAR. (Medication Administration Record). Review of the facility ' s Skills Demonstration Document of Medication Administration, item #13 states, " Meds charted immediately after given " . In an interview with LPN K done at the time of the initialing, LPN K admitted to initialing the medication prior to giving, stating that it was known that was not a correct procedure and this is not the way LPN K normally charts medications. B. On 03/01/2010 at 4:05 P.M. observation of the LPN (License Practical Nurse) Nurse-A revealed the nurse charted the medications for Resident 7 at the time the medications were prepared instead of documenting the medications as given following the administration of the medications. During the discussion of the administration and documentation of medications with LPN Nurse-A, the nurse confirmed that medications are to be charted after the administration of the medications. C. Review of the ALEGENT HEALTH I Skills Demonstration, MEDICATION ADMINISTRATION, last revised 04/08, has documented under item 13. Meds charted immediately after given. | 2014-04-01 | ||
| 12673 | 12673 | ALEGENT HEALTH IMMANUEL FONTENELLE HOME | 285085 | 6809 N 68TH PLAZA | OMAHA | NE | 68152 | 2010-03-03 | 322 | D | 9OFY11 | LICENSURE REFERENCE NUMBER 12-006.09D6(1) Based on observation, interview and the policy for Skills Demonstration the faculty failed to ensure cleansing of the equipment for administration of fluids through a Gastrostomy tube for 1 (Resident 7) resident. The total samples of 24 residents within the nursing facility census of 152 were reviewed. Findings are: On 03/01/2010, 4:05 P.M., observation during the administration of Resident 7 ' s water flush per Gastrostomy tube, revealed the LPN (License Practical Nurse) Nurse-A prepared the graduate with 200cc (Centimeters) water; placed the graduate and the syringe on the resident ' s bed linens. Upon completion of the water flush through the Gastrostomy tube, LPN-A separated the syringe, placed the barrel and plunger into the graduate and returned the equipment, without rinsing, to Resident 7 ' s bedside table. On 03/01/2010, following the Gastrostomy tube water flush for Resident 7, an interview with LPN-A revealed " it didn ' t occur to me to rinse it " . Review of the ALEGENT HEALTH Senior Health Services Skills Demonstration, MEDICATION ADMINISTRATION VIA GASTROINTESTINAL TUBE, last revised 12/08, has documented under item 21. Rinses graduate and syringe (separate barrel and plunger) and sets in clean area to dry. | 2014-04-01 | ||
| 12827 | 12827 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 371 | E | Y0WD11 | LICENSURE REFERENCE NUMBER 12-006.11E Based on observation, record review and interview; the facility staff failed to prepare food under sanitary conditions as evidenced by handwashing practices during 1 of 3 food preparation observations. This had the potential to affect 15 residents that received pureed diets and speciality eggs. The facility census at the time of survey was 88. Findings are: Record review of a facility dietary Policy and Procedure for Handwashing dated 2/10/09 revealed a policy that hands were to be washed after handling garbage. Observation on 3/23/10 between 6:55 AM and 7:10 AM during breakfast preparation revealed Cook I wore gloves and prepared pureed scrambled eggs and toast. After Cook I had put the scrambled eggs into the food processor, Cook I went to the griddle and proceeded to break 2 eggs onto the griddle to make fried eggs. Cook I took the broken eggs shells to the trash can, lifted the lid of the trash can with a gloved hand and threw away the eggs shells. Cook I repeated this process 2 more times. Cook I then returned to the puree preparation and proceeded to add toast to the eggs in the processor. Cook I did not remove the soiled gloves or wash hands after touching the trash can lid during the preparation of the fried eggs or before returning to the preparation of puree foods. Interview on 3/23/09 at 10:10 AM with the Dietary Manager confirmed the dietary policy related to handwashing, confirmed that Cook I should not have touched the trash can lid during food preparation and that the soiled gloves should have been removed and handwashing performed prior to returning to the preparation of puree foods. | 2014-03-01 | ||
| 12828 | 12828 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 164 | D | Y0WD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.05(21) Based on observation, and interviews; the facility staff failed to ensure personal privacy during personal hygiene care and treatments for 3 (Resident 3, 6 and 15) of 19 sampled and 2 non-sampled residents. The facility staff identified a census of 88. Findings are: A. Record review of an undated Admission Record revealed that Resident 3 was admitted to the facility on [DATE] with the diagnose that included Diabetes. Record review of Resident 3's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed on 5/08/2009 as completed revealed that the facility staff assessed the following about the resident: -Resident 3 had short term memory problems and long term memory was ok. -Moderately impaired decision making. -Required extensive assistance with bed mobility, toilet use and personal hygiene. -Incontinent of bowel and had an indwelling catheter. Additional [DIAGNOSES REDACTED]. Observation on 3/23/10 at 5:15 AM of personal care revealed that Nursing Assistant (NA) J and NA K removed Resident 3's adult brief and began to cleanse Resident 3's groin area. NA J noticed that Resident 3's groin folds were reddened and asked NA K to have the nurse look at the area. Resident 3 was exposed from the lower waist to the knees. NA K without ensuring that Resident 3 was covered, left the room to obtain the Nurse. NA K returned to Resident 3's room with Registered Nurse (RN) L. NA K or RN L did not close Resident 3's door. Resident 3 had remained uncovered from the lower waist to knee's and was exposed to the hall. B. Record review of an Admission Record sheet dated 6/22/09 revealed that Resident 6 was admitted to the facility on [DATE]. Record review of an Admission Nursing Assessment form dated 6/19/09 revealed that Resident 6 was admitted to the facility with a pressure area to the right heel. Record review of Resident 6's treatment record revealed that Res… | 2014-03-01 | ||
| 12829 | 12829 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 492 | B | Y0WD11 | Based on record review and interview; the facility staff failed to complete the demand billing process to ensure that the resident or the responsible party were offered the choice whether or not to request a standard claim appeal (Demand Bill) be submitted to Medicare for 2 ( Resident 19 and 21) of 4 resident files reviewed. The resident sample size was 19 plus 2 non-sampled residents from a facility census of 88. Findings are: Record review of 2 ( Residents 19 and 21) of 4 Skilled Nursing Facility Determination on Continued Stay notification letters revealed that the choice boxes under the Request for Intermediary Review had been left blank. This indicated that the resident or responsible party had not made a decision as to whether or not to request an Intermediary Review for a Medicare decision. Interview on 3/22/10 at 11:25 AM with the Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) Coordinator confirmed that the boxes had been left blank. The MDS Coordinator confirmed that no follow-up was completed with the residents or the responsible party to ensure that they were aware of the right to request an Intermediary decision. The MDS Coordinator stated that when the letters are returned by the families or resident they come directly to the facility Medical Records department and are filed. Interview on 3/22/10 at 11:25 AM with Medical Records Staff N confirmed that the letters were not routinely reviewed to ensure that a choice had been documented in regards to the request for an Intermediary decision. Interview on 3/22/10 at 11:30 AM with the Director of Nursing revealed the expectation that facility staff should have followed up to ensure that the documentation on the letters was complete. | 2014-03-01 | ||
| 12830 | 12830 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 315 | D | Y0WD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.09D3(1) Based on observation record review and interview; the facility staff failed to provide complete catheter care and technique to prevent potential cross contamination for 2 (Resident 8 and 5) of 19 sampled and 2 non-sampled residents. The facility staff identified a census of 88. Findings are: A. Record review of an undated Admission Record revealed that Resident 8 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 8's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated dated and signed as completed on 12/31/09 revealed that the facility staff assessed the following about the resident: -Resident 8 had short and long term memory problems. -Severely impaired decision making. -Dependent for bed mobility, transfers, locomotion, toilet use and personal hygiene. -Incontinent of bowel and had an indwelling catheter (tube placed into the bladder). Observation on 3/18/10 at 1:07 PM of personal cares revealed Nursing Assistant (NA) J and NA Q entered Resident 8's room washed their hands and donned gloves. NA Q and NA J unfastened the adult brief that Resident 8 had been wearing and pushed the front part of the brief down between Resident 8's legs. NA Q obtained wash cloths and began to clean Resident 8's groin area. NA Q washed each side of the groin, rinsed and dried each area. NA Q and NA J re-positioned Resident 8 onto a side lying position. NA Q cleansed the buttocks and applied and adult brief. The indwelling catheter had not been cleansed. An interview was conducted with the Director of Nursing (DON) on 3/25/10 at 9:30 AM. when asked if the indwelling tubing should be cleansed from the insertion site out, the DON stated "absolutely". B. During the observation of Resident 5's personal hygiene cares on 3/22/10, Nurse Aide (NA) -H cleansed the indwelling catheter from the thigh area toward the labia area. Review o… | 2014-03-01 | ||
| 12831 | 12831 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 441 | E | Y0WD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.17D Based on observation, record review and interview, the facility staff failed to utilize washing and gloving techniques to prevent ongoing contamination during the provision of personal cares and treatments for 5 residents (Residents 3, 6, 8, 4, 2, 22, and 20)from 19 sampled residents reviewed, including 3 closed records; and failed to ensure cleanliness of the glucose meter to prevent cross contamination from 19 sampled residents reviewed and 3 (Residents 24, 23, and 2) non sampled residents. The facility census totaled 88 residents.The facility census totaled 88 residents. Findings are: A. Record review of an undated Admission Record revealed that Resident 3 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 3's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed on 5/08/2009 as completed revealed that the facility staff assessed the following about the resident: -Resident 3 had short term memory problems and long term memory was ok. -Moderately impaired decision making. -Required extensive assistance with bed mobility, toilet use and personal hygiene. -Incontinent of bowel and had an indwelling catheter. Additional [DIAGNOSES REDACTED]. Observation on 3/23/10 at 5:15 AM of personal care revealed that Nursing Assistant (NA) J and NA K washed their hands and donned gloves. Nursing Assistant (NA) J and NA K un-fastened Resident 3's adult brief. Resident 3 was noted to have an indwelling catheter ( tube placed into the bladder). NA K began to cleanse Resident 3's groin folds, changing site on the cloth during the process. NA K cleansed in between Resident 3 legs revealing that Resident 3 was incontinent of bowel. With out changing the soiled gloves, NA K assisted NA J with repositioning Resident 3 onto the left laying position. NA K touched Resident 3's hips, legs, catheter tubing and blanket with th… | 2014-03-01 | ||
| 12832 | 12832 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 323 | E | Y0WD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.18 B Based on observations, record review and interviews; the facility staff failed to ensure mechanical lift slings were maintained in good condition and repair to ensure safety with resident transfers for 1(Resident 3), failed to apply a transfer sling safely for 1 (Resident 2). The effected number of slings was 7 from a total of 23 medium slings. This had the potential to effect 24 residents that required the Hoyer type of slings for transfers. The survey consisted of 19 sampled and 2 non-sampled residents. The facility staff identified a census of 88. A. Record review of an undated policy and procedure titled "Safe Lift Program" revealed the following: -Condition of Equipment. -A. Maintenance will establish a routine maintenance schedule for all equipment. -B. Staff will inspect equipment prior to use. -C. Staff will notify maintenance immediately of any equipment problems. -D. Staff will not use equipment until it has been repaired. Record review of an undated Sling Inspection Sheet revealed the following " Slings are an integral part of the no lift policy. In order to maintain and replace slings for resident lifting equipment laundry personal must inspect the slings after each cleaning... If there are any signs of fraying, loose threads, and or stains the sling must not be utilized until repaired and/or replaced". B. Record review of an undated Admission Record revealed that Resident 3 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 3's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed on 5/08/2009 as completed revealed that the facility staff assessed the following about the resident: -Resident 3 had short term memory problems and long term memory was ok. -Moderately impaired decision making. -Required extensive assistance with bed mobility, toilet use and personal hygiene. -Required total … | 2014-03-01 | ||
| 12833 | 12833 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 327 | E | Y0WD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.09D9 Based on observation, record review and interviews; the facility staff failed to ensure water pitchers and drinking cups were accessible with in resident reach and offer fluids following resident cares for 5 (Resident 3,6,8,2 and 19) of 19 sampled and 2 non-sampled residents. The facility staff identified a census of 88. Findings are: Record review of the facility Policy on hydration revealed the following information: -Policy Statement: Nursing staff will ensure that each resident is provided with sufficient fluid intake to maintain proper hydration and health. -Procedure: Fresh drinking water will be accessible to the residents at all times. -Fluids will be offered every two hours during waking hours to residents who are unable to assist them selfs. A. Record review of an undated Admission Record revealed that Resident 3 was admitted to the facility on [DATE] with the diagnose that included Diabetes. Record review of Resident 3's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed on 5/08/2009 as completed revealed that the facility staff assessed the following about the resident: -Resident 3 had short term memory problems and long term memory was ok. -Moderately impaired decision making. -Required extensive assistance with bed mobility, toilet use and personal hygiene. -Was understood and could understand. -Incontinent of bowel and had an indwelling catheter. Additional [DIAGNOSES REDACTED]. Record review of RAP (Resident Assessment Protocol) worksheet dated 5/18/09 revealed that Resident 3 had the potential for dehydration related to a diuretic use. The RAP work sheet also indicated that Resident 3 "needs staff assist (assistance) with hydration due to impaired mobility". Observation on 3/18/10 at 11:53 revealed that Resident 3 did not have fluids at bed side. Observation on 3/22/10 at 7:40 AM revealed that Resident 3 did not have fluids… | 2014-03-01 | ||
| 12834 | 12834 | HUNTINGTON PARK CARE CENTER | 285251 | 1507 GOLD COAST ROAD | PAPILLION | NE | 68046 | 2010-03-25 | 322 | D | Y0WD11 | LICENSURE REFERENCE NUMBER 12-006.09D6(1) Based on observation, record review and interview, the facility nursing staff failed to provide correct technique for checking the residual gastric content and the administration of medications per Gastrostomy Tube (GT) for Resident 20. The sample consisted of 19 residents,including 3 closed records, plus 5 non sampled residents. The facility census totaled 88 residents. Findings are: A. On 03/22/10 at 7:03 A.M., observation of Resident 20's residual gastric content checked by Licensed Practical Nurse LPN-A revealed the nurse withdrew the gastric contents with a 30cc Syringe. The gastric contents were placed into a graduate and set on the sink counter top in the Resident 20 ' s room. The contents were never measured. LPN-A then poured the gastric contents down the sink. On 03/22/10 following the incident at 7:03 A.M., an interview with LPN-A replied, "I always do". (discard the gastric contents). Review of the facility's policy and procedure revised 9-07 for ENTERAL FEEDING MECHANICAL PROBLEMS contains the following information for Checking Residual: 1. Use 30-60 ml (milliliter) syringe to slowly withdraw stomach contents. Check and record amount and appearance of residual. 2. Inject residual back through feeding tube into stomach, unless residual is very large. 3. After re-injecting residual through feeding tube, flush tube with 20-30 ml water. B. On 03/22/10 at 7:03 A.M., observation of Resident 20's administration of medications, water flushes, and formula were given by LPN-A per GT by pushing the medications, water flushes and formula through a syringe into the GT. On 03/22/10, after the above observation, LPN-A revealed during an interview that the resident always gets a bolus. When asked about pushing liquid contents through the GT and/or allowing the contents to be administered by gravity, LPN-A replied " Yes, I do it this way all the time by pushing the liquid through the syringe. No, no gravity feed " . Review of the facility ' s policy and procedure revised 9-07… | 2014-03-01 | ||
| 12351 | 12351 | DOUGLAS COUNTY HEALTH CENTER | 285019 | 4102 WOOLWORTH AVENUE | OMAHA | NE | 68105 | 2010-04-28 | 309 | D | 0 | 1 | V26R11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER:12-006.09 Record review of a Physician's Orders sheet dated 3/29/10 revealed that Resident 5 was admitted to the facility with [DIAGNOSES REDACTED]. Record review of a Long-Term Care Pain Assessment Form dated 3/30/10 revealed that Resident 5 was not assessed with [REDACTED]. Record review of Resident 5's progress notes date 4/08/2010 revealed that Resident 5 had complained of Right arm pain. Resident 5's Physician was notified of the complaints of pain and ordered that an x-ray be obtained and that PRN Tylenol was to be scheduled every 6 hours. On 4/12/2010 the physician ordered that the PRN Tylenol be stopped and Tylenol 1 gram was to be given 4 times a day, [MEDICATION NAME] 2.5 mgs be given with severe pain and warm or cold packs to the right shoulder prn for pain. Observation on 4/26/2010 with RN H (Registered Nurse) of personal cares for Resident 5 revealed that NA K (Nursing Assistant) and NA L washed their hands and donned gloves. Observation revealed that as NA L washed and lifted Resident 5's right arm, Resident 5 complained of pain and stated " that hurts". NA K and NA L completed cleansing the front of Resident 5 and positioned Resident 5 onto the right side. Resident 5 stated " oh that hurts. Resident 5's face had become red, Resident 5 moaned, groaned and held (gender) breath. NA L and NA K completed cares on Resident 5's right side. Resident 5 was positioned onto the left side. Resident 5 stated "oh my god that hurts" and further stated " I can't do it". NA K and NA L prepared Resident 5 for a mechanical lift transfer. NA K and NA L placed the transfer sling under the resident. Resident 5 complained of pain with the repositioning needed to place the sling under the resident for the transfer into a wheelchair. Observation of Resident 5 revealed that with the repositioning Resident 5's face turned red, Resident 5 moaned, groaned, was holding (gender) breath and stated "oh my back". NA K and NA L started… | 2014-07-01 |
| 12352 | 12352 | DOUGLAS COUNTY HEALTH CENTER | 285019 | 4102 WOOLWORTH AVENUE | OMAHA | NE | 68105 | 2010-04-28 | 441 | D | 0 | 1 | V26R11 | LICENSURE REFERENCE NUMBER 12-006.17 Based on observations and interviews and policy review, the facility staff failed to provide hand washing hygiene and gloving procedures to prevent cross-contamination during personal hygiene cares and treatments for Resident ' s 8, 9, 6, and 22. The facility census consisted of 232. The sample size consisted of 30 residents, including 3 closed records. Findings are: A. Observation during Resident 8 ' s personal hygiene cares on 4/26/10 at 7:05 A.M., revealed Nurse Aide (NA)-A completed hand washing hygiene for 6-8 seconds prior to donning gloves. NA-A gave Resident 8 a wash cloth to wash the face. Obtaining a clean wash cloth, NA-A completed the frontal peri care for Resident 8. NA-A removed the hand gloves and continued to assist Resident 8 to dress the lower torso. After completion of dressing, NA-A assisted Resident 8 to walk to the dining room. NA-A failed to complete hand washing hygiene upon the removal of the gloves; And after assisting the Resident with toilet needs and donning daytime wearing apparel. . B. On 4/27/10 at 7:32 A.M., during Resident 9's morning personal cares revealed NA-B used Hand Sanitizer Gel prior to putting on gloves. NA-B started to use double gloves on the hands. When NA-B was asked about ' double gloving ' commented, " I use double gloves because the gloves split " . When asked about the policy for the use of hand gloves, NA-B replied, " No, there is no policy for double gloving. Observations during Resident 9's morning cares on 4/27/10, NA-B changed gloves following each task: after giving wash cloth to wash face, removed resident ' s gown, cleansed upper torso, applied lotion to skin and the deodorant. NA-B removed gloves, used Gel Sanitizer and donned clean gloves. Upon completion of personal hygiene cares, NA-B removed gloves and completed hand washing hygiene for 8 seconds. NA-B donned clean gloves, removed the used linens to the linen carts, removed gloves, used Gel Sanitizer and donned clean gloves; removed the bilateral sheepskin boots,… | 2014-07-01 |
| 12780 | 12780 | GOLDEN LIVINGCENTER - COLUMBUS | 285092 | P O BOX 625, 2855 40TH AVENUE | COLUMBUS | NE | 68602 | 2010-05-10 | 318 | D | I73W11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 12-006.09D4 Based on observation, interview and record review; the facility failed to identify the potential for and implement interventions to prevent a potential decline in Range of Motion (ROM - the distance and direction a joint can move to its full potential) for one resident (Resident 19). Sample size was 24 and the facility census was 127. Findings are: Review of Resident 19's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 4/8/10 revealed Resident 19 had impaired cognition, was dependent upon staff for assistance with all Activities of Daily Living, had limited range of motion in both legs - including the hip and knee, had a [DIAGNOSES REDACTED]. Review of Resident 19's Plan of Care last reviewed on 4/8/10 revealed no identified actual or potential for a decline in range of motion. Observation of Resident 19 with restorative coordinator, RN (Registered Nurse) C on 5/6/10 at 9:25 AM revealed that Resident 19's right hand to be in a closed position. RN C was unable to fully open Resident 19's right hand and stated that it would only open about "50 percent". Resident 19 was not resistive during these attempts. When RN C was questioned why Resident 19 was not receiving PROM exercises to prevent contractures, RN C stated, "I don't know." RN C went on to report that residents were started on restorative programs when a change or decline was noted to have already occurred. RN C reported that a referral would be made to Occupational Therapy for screening. Review of Occupational Therapy (OT) progress notes dated 5/7/10 revealed, "OT orders received. Eval (evaluation) completed. Decreased shldr (shoulder) ROM, decreased UE (upper extremity) str. (strength). OT to assess for appropriateness of orthotics (devices which support or correct the function of a limb. Example: splints) and establish UE ROM FMP (functional maintenance program). " Review of the Occupationa… | 2014-03-01 | ||
| 12781 | 12781 | GOLDEN LIVINGCENTER - COLUMBUS | 285092 | P O BOX 625, 2855 40TH AVENUE | COLUMBUS | NE | 68602 | 2010-05-10 | 369 | D | I73W11 | Licensure Reference Number: 12-006.09D8c Based on observation, record review, and interview; the facility failed to ensure that one Resident (Resident 20) was provided adaptive eating utensils as needed. Sample size was 24 and facility census was 127. Findings are: Review of Resident 20's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 2/25/01 revealed Resident 20 had no cognitive impairment and was independent with eating after set up assistance. Review of a facility list dated 5/2/10 titled Adaptive Equipment List revealed, "(Resident 20) - tan large utensils. Observation of Resident 20 during the noon meal on 5/6/10 revealed Resident 20 eating food with regular silverware. No large utensils were available. Interview with Resident 20 on 5/10/10 at 10:30 AM revealed that Resident 20 had difficulty picking up regular silverware due to arthritic hands and that eating "took a long time" because of it. Resident 20 went on to say that the the large handled silverware just stopped coming on the tray one day. | 2014-03-01 | ||
| 12782 | 12782 | GOLDEN LIVINGCENTER - COLUMBUS | 285092 | P O BOX 625, 2855 40TH AVENUE | COLUMBUS | NE | 68602 | 2010-05-10 | 246 | D | I73W11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 12-006.18B1 Based on observation and interview, the facility failed to ensure that call lights were accessible for two residents (Residents 13 and 20) and failed to ensure the call light system was in a format that promoted ease of use for one resident with arthritis (Resident 20) and 2 confidential interviews. Sample size was 24 and facility census was 127. Findings are: A. Review of Resident 20's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 2/25/10 revealed Resident 20 had no cognitive impairment and required limited assistance with Activities of Daily Living. Interview with Resident 20 on 5/10/10 at 10:00 AM revealed that Resident 20 did not have the call light within reach for the entire previous night. Resident 20 reported yelling "help help" in order to obtain staff's assistance about 4 AM. Resident 20 went on to report that having the call light out of reach is a repeated problem. Resident 20 also voiced concerns about the difficulty of utilizing the current call system which consists of a thin string on which the residents are to pull if they require assistance. Resident 20 attributed (gender's) arthritic hands with having difficulty in utilizing the call light system. Interview with the Director of Nursing (DON) on 5/10/10 at 2:45 PM confirmed that call lights should be accessible to residents at all times. B. Review of Resident 13's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 2/23/10 revealed Resident 13 was admitted to the facility with a [MEDICAL CONDITION], had modified independence with decision making and required assistance with Activities of Daily Living. Review of Resident 13's Plan of Care dated 3/5/10 revealed, "physical functioning deficit: Interventions - Call bell within reach." On 5/5/10 at 11:33 AM Resident 13 was observed sitting in wheelchair in residents's room with the … | 2014-03-01 | ||
| 12783 | 12783 | GOLDEN LIVINGCENTER - COLUMBUS | 285092 | P O BOX 625, 2855 40TH AVENUE | COLUMBUS | NE | 68602 | 2010-05-10 | 371 | F | I73W11 | LICENSURE REFERENCE NUMBER: 12-006.11 E Based on observation and interview the facility failed to prepare and distribute food in a manner to prevent the potential for cross contamination and foodborne illness. This was related to serving utensils, drinking glasses, food contact and non-food contact surfaces that were not clean to sight and touch and alternate menu items served below 135 degrees Farenheit. This practice had the potential to affect all residents who were served from the kitchen. The facility census was 127 with 24 residents sampled. Findings are: During the initial tour of the kitchen on 5/2/10 at 6:45PM the following observations were made in the main kitchen: -Twenty one serving utensils were found in the drawers of the center island that had food on them which had not been removed during the washing process. -Four of four serving carts inspected had an accumulated brownish colored sticky substance in the corners and a pink colored sticky spill on the wheels of one of the carts. Other spills were visible on the vertical and horizontal surfaces of the carts. -The ledge of the Vulcan oven over the burners had an accumulation of dust and food debris and was sticky to the touch. -The can opener which was affixed to the center island had an accumulated brown sticky substance on the metal piece that pierces the cans. -The surface under the steam table where serving trays are stacked had an accumulation of dust, spills and food debris. -Inside the storage area under the center island and in the door tracks of the island was an accumulation of food debris and spills. At 7:15 PM on 5/2/10 Cook A was shown the condition of the serving utensils and acknowledged that they were not clean. On 5/3/10 at 11:30 AM the Dietary Manager (DM) was shown the condition of the snack carts from the main kitchen area and acknowledged the condition was not "new spills." The DM also acknowledged the areas in the main kitchen which were found on initial tour. The following observations were made during the initial tour of the… | 2014-03-01 | ||
| 12784 | 12784 | GOLDEN LIVINGCENTER - COLUMBUS | 285092 | P O BOX 625, 2855 40TH AVENUE | COLUMBUS | NE | 68602 | 2010-05-10 | 253 | E | I73W11 | LICENSURE REFERENCE NUMBER:12-006.18A Based on observation and interview; the facility failed to maintain the environment related to damaged walls, torn wallpaper, scratched paint, exposed nails, and screws and hooks on walls. This had the potential to affect residents in 14 resident rooms (W2,3,4,5, and 8; EC7; D2,4,6,8, and 10; and N3,4 and 5), and 16 residents who could potentially use the family/visitor room on the 'W' Wing and the dining room on the 'W' Wing. The facility census was 127 with 24 residents sampled. Findings are: During the environmental tour of the facility on 5/5/10 at 2:30 PM these observations were made: -Areas of unpainted walls or marred paint in 'W' Wing rooms 4, 5, 6, and 8 and 'N' Wing rooms 3, 4, 5, and EC Wing room 7. -Areas of unpainted walls or marred paint on the south wall and east wall in the 'W' Wing dining room. -Bare nails, hooks or screws on walls in resident rooms W 2, N 3, D 10 and EC 7. -Damaged walls and wall paper in resident rooms D 2,4,6,8 and EC 7. -Damaged wallpaper and wallpaper border coming down in the family/visitor room on 'W' Wing. The Maintenance Director and the Administrator acknowledged the need for these repairs at the time of the tour on 5/5/10 which began at 2:30 PM. | 2014-03-01 | ||
| 12674 | 12674 | GOLDEN LIVINGCENTER - OMAHA | 285097 | 5505 GROVER STREET | OMAHA | NE | 68106 | 2010-05-18 | 371 | F | E8GK11 | LICENSURE REFERENCE NUMBER 12-006.11E Based on observation, record review and interview; the facility staff failed to prepare food under sanitary conditions as evidenced by hand washing practices during 2 food preparation observations. This had the potential to affect all residents that ate food prepared from the facility kitchen. The facility census at the time of survey was 106. Findings are: Record review of a facility dietary Policy and Procedure for Hand washing dated 2002 revealed a policy that hands were to be washed upon entering the dietary department, during food preparation, after touching bare human body parts such as the face, after handling any soiled or contaminated equipment, cleaning cloths, utensils, soiled aprons, after obtaining food supplies for preparation, after signing invoices for food delivery, after handling raw foods and before handling cooked or ready to eat foods. Observation on 5/13/10 between 7:02 AM and 7:50 AM during breakfast preparation revealed Cook I went to the griddle and proceeded to break eggs onto the griddle to make fried eggs. Cook I then rinsed hands in a bucket with sanitizer solution, touched pants and pulled them up and put bare hands on hips. Cook I turned the fried eggs over with a spatula and then turned and signed a grocery invoice. Cook I then repeated the process of making fried eggs and turned them over with a spatula. Cook I put the soiled spatula into the small sink. Cook I removed a pan of fried bacon from the oven, picked the soiled spatula out of the small sink and used it to remove the bacon from the pan. Cook I then washed the counters with a sanitizer solution cloth. Cook I did not at any time wash hands during the food preparation observation. Observation on 5/13/10 between 9:30 AM and 10:35 AM during lunch preparation revealed Cook I prepared Pureed Ham. Cook I took the meat soiled puree machine to the dirty dish area and rinsed the equipment with water. Cook I did not immerse the equipment in sanitizer solution or wash hands before returning to th… | 2014-04-01 | ||
| 12675 | 12675 | GOLDEN LIVINGCENTER - OMAHA | 285097 | 5505 GROVER STREET | OMAHA | NE | 68106 | 2010-05-18 | 441 | D | E8GK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 12.006.17D Based on observations, interviews and policy review; the facility failed to follow facility policy for providing hand washing hygiene during personal cares and medication pass for Residents 3, 23, and 24. The facility census was 106 and the sample size was 22 plus 2 un-sampled resident. Findings are: A. Review of the facility policy titled Hand Washing Procedure 430 dated 2006 included the following information: ? General Instructions: Wash hands before and after resident contact and wash hands when soiled. ? Procedure item 7. Rub hands briskly using sufficient lather and friction for fifteen seconds, pay special attention to area between fingers. On May 13 at 09:47 AM, Licensed Practical Nurse A (LPN A) entered the room of Resident 3 to give assistance with personal cares. Upon entering the room, LPN A washed hands for 3 seconds using no soap and no friction. Gloves were donned after drying hands with a paper towel. LPN A then helped reposition Resident 3. In an interview conducted later that same day, LPN A stated the hand-washing time should have been 15 seconds. B. On May 13, LPN A was observed during the 9AM medication pass, preparing medications for Resident 23. While at the medication cart, no hand -sanitizing was done prior to preparing [MEDICATION NAME] in a syringe, for a subcutaneous injection. The RN Nurse Consultant kept the [MEDICATION NAME] back for a short time while the orders were verified. Meanwhile, LPN A went to Resident 23 ' s room to give the other medications. Upon entering the room, hands were washed for 3 seconds before donning gloves. No soap or friction was used. LPN A then administered eye drops for Resident 23. C. On May 13, 2010 at 11:45 AM, LPN B was observed preparing insulin for Resident 24. No hand-washing or hand -sanitizing was done prior to preparing the syringes with insulin. The Resident was found in Physical Therapy and LPN B went to that department to administer the shot… | 2014-04-01 | ||
| 12992 | 12992 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2010-05-20 | 204 | D | 8VHJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.09C2 Based on record review, staff and resident interviews; the facility failed to establish a discharge plan of care to ensure a safe and orderly discharge for 1 resident (Resident 40) that had expressed a desire on admission to return to the resident's prior living arrangements. The facility census was 55 and the survey sample size was 14. Findings are: Review of a FACE SHEET dated 3/11/10 revealed Resident 40 was admitted to the facility on [DATE]. Review of a 4/19/10 physician's orders [REDACTED]. The physician's orders [REDACTED]. Review of Resident 40's INITIAL/TEMPORARY CARE PLAN revealed "Discharge Plan: Goal is to return home". There was no documentation of a discharge plan that specified supportive services the resident would need or a target date for discharge. Review of Resident 40's INTERDISCIPLINARY PROGRESS NOTES revealed the 3/13/10 entry "Discharge Plan: Resident goal is to regain strength & (and) return to own home (with spouse)". Review of a Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) with an assessment date of 3/14/10 revealed Resident 40 had: - No short-term or long-term memory problems; - Modified independent cognitive skills for daily decision making; - Required physical assistance with transfers between surfaces, dressing, personal hygiene, and bathing; - "DISCHARGE POTENTIAL" was that Resident 40 expressed preference to return to the community and had a support person who was positive towards discharge. Review of Resident 40's 4/22/10 OUTPATIENT/COMMUNITY UPDATED PLAN OF treatment for [REDACTED]. Review of Resident 40's COMPREHENSIVE CARE PLAN dated 3/31/10 revealed; DISCHARGE PLAN: LIVES W/ (with) (spouse), NEEDS TO REGAIN ABILITIES TO CARE FOR SELF. WILL EVAL (evaluate) DISCH (discharge) PLAN ONGOING. Review of handwritten documentation added to the COMPREHENSIVE CARE PLAN revealed: - 5/11/10: (Resident 40) has been improving (w… | 2014-01-01 | ||
| 12993 | 12993 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2010-05-20 | 281 | D | 8VHJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 12-006.09 Based on record review and staff interview, the facility failed to ensure physician's orders were followed for the collection of laboratory tests for 3 residents (Residents 33, 18, and Closed Record 102). The facility census was 55 and the survey sample size was 14. Findings are: A. The "Fundamentals of Nursing, 6th Edition" by Potter and Perry, copyright 2005, stated the following: "The physician is responsible for directing medical treatment. Nurses are obligated to follow physicians' orders unless they believe the orders are in error or could be detrimental to clients". B. Review of an August 2008 PHYSICIAN'S ORDERS facility policy revealed: "Order Processing" "49. An order must be processed in Resident services exactly as it is written and signed; if unclear, clarification must be obtained by the Nursing Services department in the form of another physician's order". C. Review of a 1/6/10 FACE SHEET revealed Resident 33 was admitted to the facility on [DATE]. Review of a 3/31/10 COMPREHENSIVE CARE PLAN revealed Resident 33 had [DIAGNOSES REDACTED]. Review of Resident 33's medical record revealed that a PT/INR ([MEDICATION NAME] time/international normalized ratio) (a blood test that measures how long it takes blood to clot) had been drawn on 4/1/10, showing a result for the PT = 31.9 H (meaning high) (referencing range 11.9 - 14.7 seconds) and the INR = 3.03 (reference range 2.0-3.0). The physician had written that the laboratory (lab) results were to be rechecked in 2 weeks. Review of a REFERENCE LAB REQUEST revealed PT/INR blood test was to be "recheck in 2 wk" (weeks) and specified the DATE TO DRAW was 4/15/10. Review of Resident 33's medical record revealed no lab results for 4/15/10. Lab results revealed that a PT/INR had been drawn on 5/6/10 showing a result for the PT = 21.5 H and INR result was 1.84. Review of Resident 33's INTERDISCIPLINARY PROGRESS NOTES revealed: - 4/1/40 at 6:50 AM; "LAB DR… | 2014-01-01 | ||
| 12994 | 12994 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2010-05-20 | 441 | D | 8VHJ11 | LICENSURE REFERENCE: 12.006.17D Based on observation and record review, the facility failed to assure that staff washed hands as indicated, using proper technique, during resident interaction. The facility had a census of 55 and survey sample of 14. This affected the following residents: 26, 52 and 09. Findings are: A. Review of the facility policy and procedure titled INFECTION CONTROL POLICIES/PROCEDURES HAND HYGIENE AND HANDWASHING, revised and dated July 2009 revealed the following: "Wash hands with plain soap and water or with anti-microbial soap and water: If hands are visibly soiled (dirty). If hands are visibly contaminated with blood or body fluids. Before eating. After using the restroom. If hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based hand rub for routinely cleaning your hands: Before having direct contact with residents. After having direct contact with a resident's skin. After having contact with body fluids, wounds or broken skin. After touching equipment or furniture near the resident. After removing gloves". The procedure for HAND WASHING stated the following: 1. "Wet hands with water. (Avoid hot water.) 2. Apply three to five ml (milliliter) of soap. 3. Rub hands together for at least 15 seconds. 4. Cover all surfaces of hands and fingers. 5. Rinse hands with water and dry thoroughly. 6. Use paper towel to turn off water faucet". B. Observation on 5/18/10 at 10:25 AM revealed that NA-A (Nursing Assistant) was assisting Resident 52 to use the toilet and with incontinence care. NA-A donned gloves to assist the resident with incontinence care. When NA-A removed the gloves to wash hands, the hands were rubbed together for approximately 3 seconds with failure to cover all surfaces of hands and fingers with lather before rinsing. C. Observation on 5/18/10 at 9:50 AM revealed that NA-A and MA-L (Medication Aide) were assisting Resident 26 with removing a soiled brief and providing incontinence care. Upon completion of the task, NA-A washed hands at the sin… | 2014-01-01 | ||
| 12995 | 12995 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2010-05-20 | 225 | D | 8VHJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: ,[DATE].02(8) Based on record review and staff interview, the facility failed to report 2 incidents of possible abuse and/or neglect to Adult Protective Services (APS) within 24 hours in accordance with state law involving 3 residents (Residents 101, 20, and 103). The facility failed to ensure that staff immediately notified Administration of allegations of abuse to assure complete investigations for 2 documented incidents involving 2 residents (Residents 101 and 04). The failure to report and investigate allegations of abuse has the potential to affect the residents safety. The facility census was 55 and the survey sample size was 14. Findings are: A. Review of an ,[DATE] ABUSE AND NEGLECT facility policy revealed: - PURPOSE: "To ensure that all identified incidents of alleged or suspected abuse/neglect are promptly investigated and reported"; - PROCEDURE: "1. If a staff member receives an allegation of abuse, neglect or misappropriation of resident property or witnesses suspected abuse, neglect or misappropriation of resident property, the staff member will immediately report this to a supervisor"; -- "5. Notification Procedures: a. Notify the center administrator immediately of any incidents of resident abuse, misappropriation of resident property, alleged or suspected abuse" "Immediately," in this procedure means as soon as possible after discovery of the incident, and ought not to exceed the end of the shift in the absence of a shorter state time frame requirement"; "b. Notify the designated agencies in accordance with state law, including the state survey and certification agency". B. Review of a DISCHARGE SUMMARY signed by the physician on [DATE] revealed that Resident 101 was admitted to the facility on [DATE] and expired on [DATE]. Cause of death was due to end stage Alzheimer's dementia. Review of a facility investigation dated [DATE] revealed: - "[DATE] it was reported to the Administrator that two aides… | 2014-01-01 | ||
| 12996 | 12996 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2010-05-20 | 323 | D | 8VHJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and staff interview, the facility failed to provide adequate supervision, assess for causal factors and implement interventions to prevent accidents from occurring for 1 (Resident 09) of 14 residents reviewed. The facility census was 55 at the time of the survey and the survey sample size was 14. Findings are: Resident 09 was admitted to the facility on [DATE] according to the FACE SHEET on the medical record. The following [DIAGNOSES REDACTED]. Review of Resident 09 ' s Nurse ' s Notes revealed that on 1/31/2010, it was noted that the resident had a skin tear on the left lower leg, with the area measuring 4 cm (centimeter) by 3 cm. Review of the investigation performed after the skin tear occurred did not contain any evidence that transfers were observed or any documentation of interviews to ensure that proper techniques were utilized by facility staff. Interview on 5/19/2010 at 3:10 PM with the DON (Director of Nursing) confirmed that there had been no observations made of the transfers of this resident or any other resident to ensure that correct techniques were utilized or that wheelchair pedals were actually removed from wheelchairs to prevent further skin tears from occurring. In addition, the DON confirmed that there were no documented interviews with the involved staff to ensure that correct techniques were utilized during transfers and that facility staff were not the cause of the skin tears. Review of Resident 09 ' s Nurse ' s Notes also revealed that on 2/9/2010 during provision of morning cares, the resident sustained [REDACTED]. Review of the investigation dated 2/9/2010 of the incident revealed that Resident 09 had very fragile skin and apparently when the staff member pulled the sleeve of the robe over forearm, the staff member pulled on the skin causing skin tears. The intervention implemented was for tubigrips to both arms for protection. Review of Resident 09 ' s comprehensive care plan da… | 2014-01-01 | ||
| 12735 | 12735 | BROOKEFIELD PARK | 285226 | 1405 HERITAGE DRIVE | ST PAUL | NE | 68873 | 2010-06-02 | 166 | E | CCHB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC 12-006.05(7) Based on observations, record review, and interviews with staff and residents; the facility failed to resolve a grievance voiced by 19 residents (Residents 07, 08, 09, 11, 13, 14, 18, 20, 21, 23, 24, 26, 27, 31, 32, 34, 35, 37, and 39) that meals were served late. This failure had the potential to affect the quality of life for residents living in the facility. The facility census was 41 and the survey sample was 11. Findings are: A. Review of an 10/2008 COMPLAINT/GRIEVANCE POLICY AND PROCEDURE revealed: - "Our facility addresses and investigates all complaints and grievances expressed to the facility. This process provides feedback and follows up on action to address any oral or written complaint/grievance from a resident or resident's representative"; - "5. The designated person will also be responsible to complete the last section (Resolution) on complaint/Grievance Report Form and see to informing the results to the complainant within 5-7 days of the initial onset of the report"; - "8. The Administrator is responsible for maintaining compliance with the Complaint/Grievance process". B. Information provided by the facility and confirmed by the Dietary Manager (DM) revealed that meal service for breakfast was scheduled to begin at 7:45 AM, lunch at 12:00 PM, and supper at 5:45 PM. C. Observations of meal services throughout the survey revealed: - 5/26/10 = lunch service began at 12:20 PM. At 12:45 PM, 9 residents (Residents 03, 10, 11, 19, 21, 24, 30, 37, and 39) had not been served when dietary ran out of the main entree, beef tips in gravy. The DM prepared an additional entree and lunch service resumed at 1:10 PM. The last resident (Resident 10) was served at 1:23 PM. - 5/26/10 at 1:12 PM, Resident 24 was served lunch 15 minutes after everyone else at the table had been served. 2 of Resident 24's tablemates finished eating and had left the dining room. - 5/26/10 at 1:14 PM, Resident 37 was … | 2014-04-01 | ||
| 12736 | 12736 | BROOKEFIELD PARK | 285226 | 1405 HERITAGE DRIVE | ST PAUL | NE | 68873 | 2010-06-02 | 371 | E | CCHB11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.11E Based on observations, document review, and staff interview; the facility failed to maintain the temperatures of cold foods at the time of meal service for 5 residents (Residents 03, 04, 26, 27, and 32) that received extra protein with meals, as well as residents that chose the alternate entree offered. This failure increased the risk that bacterial growth and food borne illness could occur which could pose a food safety risk to the residents. The facility census was 41 and the survey sample size was 11. Findings are: Review of the facility's COMPLETE INFORMATION ON ALL RESIDENTS list revealed Residents 03, 04, 26, 27, and 32 were to receive extra protein at lunch. A. Observation on 5/26/10 from 12:15 - 1:23 PM revealed Cook-J gave a sliced, hard-boiled egg to Residents 03, 04, 26, 27, and 32 for lunch. Observation on 5/26/10 at 1:23 PM, after the last resident was served lunch, the temperature of the hard-boiled eggs, taken by Cook-J with a probe thermometer, was 43.5 degrees F (Fahrenheit). During an interview on 5/26/10 at 12:35 PM, Cook-J revealed hard-boiled eggs were given to residents that received extra protein with lunch. B. Observation on 5/27/10 from 12:13 - 1:23 PM revealed Cook-J added a tablespoonful of grated cheddar cheese to the peas served to Residents 03, 04, 26, 27, and 32 for lunch. The cheese was in a container approximately 8 " (inches) tall and was set on top of ice in another container. The ice was not around the container of cheese. Further observation revealed egg salad sandwiches available and were requested by at least 2 residents as an alternative to the main entree. The cold food items were in container set on ice next to the steam table. Observation on 5/27/10 at 1:13 PM, after the last resident was served lunch, Cook-J took temperatures of the cold food items with a probe thermometer and got the following results: egg salad sandwiches = 43 degrees F and cheddar cheese = 56 degrees F. During an interview on 5/27/10 at 1:23 PM, Cook-J s… | 2014-04-01 | ||
| 12737 | 12737 | BROOKEFIELD PARK | 285226 | 1405 HERITAGE DRIVE | ST PAUL | NE | 68873 | 2010-06-02 | 225 | D | CCHB11 | Based on record review and staff interview, the facility failed to ensure that all staff immediately notified Administration of allegations of abuse for 1 incident involving 2 staff members. The facility census was 41 at the time of the annual survey/complaint investigation and the survey sample size was 11. Findings are: A. Review of the facility policy and procedure concerning ABUSE AND NEGLECT PREVENTION STANDARD dated 4/2009 revealed the following definition of verbal abuse: " The use of oral, written or gestured language that willfully includes disparaging and derogatory terms used with or to residents, their families or within their hearing distance, regardless of their age, ability to comprehend or disability. Examples of verbal abuse include but are not limited to: threats of harm, saying things to frighten a resident, such as telling a resident that he/she will never be able to see his/her family again " . B. Further review of the facility policy and procedure concerning ABUSE AND NEGLECT PREVENTION STANDARD dated 4/2009 revealed the following under REPORTING/RESPONSE: " It is the responsibility of any employee, visitor or resident to report any act of witnessed or suspected abuse to their supervisor or the Administrator immediately " . C. Review of the facility abuse investigations for the past 9 months revealed that on 9/29/2009, allegations of verbal abuse were reported to the SSD (Social Service Designee) of the facility. Documentation on the ABUSE/NEGLECT INVESTIGATION REPORT dated 9/29/2009 revealed that NA (Nursing Assistant) J had been caring for Resident 15. Resident 15 had become combative/resistant with cares and NA J had told Resident 15 that " If you ' f_____g ' hit me again, I ' ll knock you out " . According to documentation on the ABUSE/NEGLECT INVESTIGATION REPORT, the incident had been witnessed by NA A approximately 2 weeks prior to being reported. D. Interview on 6/1/2010 at 10:00 AM with the SSD revealed that NA J and NA A had been working with Resident 15 when the incident occurred.… | 2014-04-01 | ||
| 12738 | 12738 | BROOKEFIELD PARK | 285226 | 1405 HERITAGE DRIVE | ST PAUL | NE | 68873 | 2010-06-02 | 441 | D | CCHB11 | LICENSURE REFERENCE 175NAC 12-006.17D Based on observation and record review, the facility failed to ensure that nursing personnel performed hand hygiene/glove changing as required during provision of incontinent cares for 1 (Resident 16) resident. The facility census was 41 at the time of the survey and the survey sample size was 11. Findings are: A. Review of the facility policy and procedure concerning BLOODBORNE PATHOGEN PROGRAM EXPOSURE CONTROL PLAN METHODOLOGIES dated 6/30/2008 revealed the following: " precautions must be consistently used against contact with blood and body fluids when dealing with all residents ....All staff members must routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any residents is anticipated. Gloves must be worn for touching blood and body fluids, mucous membranes, or non-intact skin of all residents, for handling items or surfaces soiled with blood or body fluids ....Gloves must be changed after contact with each resident ....Hands must be washed immediately after gloves are removed " . B. Review of the facility policy and procedure titled PROCEDURE FOR HANDWASHING, undated, revealed that handwashing should occur " before and after each resident contact, after touching a resident or handling his or her belongings and after contact with any body fluids " . C. During observation on 5/27/2010 at 11:45 AM of incontinent cares for Resident 16 revealed the following lack of appropriate glove changing and handwashing: NA (Nursing Assistant) D and NA B entered Resident 16 ' s room to provide incontinent cares and get the resident up for lunch. NA D and NA B put on gloves. There was no handwashing performed by NA D and NA B prior to putting on the disposable gloves. NA D provided the incontinent care, using a disposable wipe. NA D washed the mons pubis and then wiped down over the labia, smearing feces on the disposable glove. NA D got more periwipes out of the package, touching the outside of the pac… | 2014-04-01 | ||
| 12739 | 12739 | BROOKEFIELD PARK | 285226 | 1405 HERITAGE DRIVE | ST PAUL | NE | 68873 | 2010-06-02 | 281 | D | CCHB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09 Based on record review and staff interview, the facility failed to ensure that laboratory work was drawn as ordered by the physician for 2 (Resident 32 and 22) of 11 residents reviewed. The facility census was 41 at the time of the survey and the survey sample size was 11. Findings are: A. Resident 32 was admitted to the facility on [DATE] according to the FACE SHEET on the medical record. The following [DIAGNOSES REDACTED]. Review of Resident 32 ' s admission orders [REDACTED]. Review of Resident 32 ' s laboratory results section of the medical record revealed no evidence that the H/H and INR had been drawn every week for 4 weeks as ordered by the physician on 4/9/2010. Interview on 6/1/2010 at 11:00 AM with the DON (Director of Nursing) revealed that Resident 32 had an H/H and INR performed on 5/4/2010 and the ordered lab work had not been done every week as ordered by the physician on 4/9/2010. B. Resident 22 was admitted to the facility on [DATE] according to the FACE SHEET on the medical record. The following [DIAGNOSES REDACTED]. Review of Resident 22 ' s admission orders [REDACTED]. Review of Resident 22 ' s laboratory results section of the medical record revealed no evidence that the PT/INR had been performed as ordered on [DATE]. Interview on 6/1/2010 at 10:56 AM with the DON confirmed that the PT/INR was not performed on 4/27/2010 as ordered by the physician. | 2014-04-01 | ||
| 12416 | 12416 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 248 | D | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC-12-006.09D5b Based on observation, record review and interview, the facility staff failed to provide ongoing individualized program of activities for 2 (Resident 1 and 6) of 16 sampled and 10 non-sampled residents. The facility staff identified a census of 80. Findings are: A. Record review of an Admission and Discharge Summary sheet dated 11/16/2009 revealed Resident 1 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 1's significant change in condition Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 4/01/2010 revealed the staff assessed the following about the resident: -Short and long term memory problems. -Modified independence in daily decision making. -At ease doing planned or structured activities. -Extensive assistance with toilet use. -Total dependence with bed mobility, transfers, locomotion, eating and personal hygiene. -Declines in function. -Frequently incontinent of bowel and bladder. -Weight loss. -1 Stage II pressure ulcer ( the ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater). -General activity preferences included card/other games, crafts, arts, music, spiritual, religious activities, trips shopping, walking, wheeling outdoors, TV and talking. The preferred activity setting was assessed as in "own room", day activity room, inside nursing home, outside facility. Record review of Resident 1's Comprehensive Care Plan (CCP) dated 12/04/2007 revealed that Resident 1 had a goal of attending music one time a week, read books daily and baking twice a month. The approaches included to invite to activities, offer music, reading material, baking cookies, encourage devotions, exercises, coffee hour and outings. Record review of an Resident Activity sheet for May 2010 revealed Resident 1 had attended devotions 20 times ( devotions are h… | 2014-07-01 |
| 12417 | 12417 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 283 | D | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C3a Based on record review and interview; the facility staff failed to complete a Discharge Summary that included a recapitulation of the residents stay for 1 (Resident 16) closed record of 16 sampled residents. The sample size was 16 including 3 closed records plus 10 non-sampled residents. The facility census was 80. Findings are: Record review of Resident 16's closed record revealed a discharge date of [DATE]. Record review of Resident 16's Interdisciplinary Discharge Summary dated 4/21/10 revealed that the area of the document entitled Recapitulation of Residents's Stay was blank. The information in this area included the admitted , reason for admission, treatment provided, progress or complications experienced and reason for discharge/ discharge diagnosis. All of these areas were left blank. Interview on 6/10/10 at 11:00 AM with the Director of Nursing confirmed that the Recapitulation of Stay for Resident 16 was left blank and should have been completely filled out. | 2014-07-01 |
| 12418 | 12418 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 176 | D | 0 | 1 | P9FH12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility staff failed to evaluate 1 (Resident 30) of 11 sampled residents ability to self administer medications safely. The sample size was 11 plus 6 non-sampled residents. The facility had a total census of 75 residents. Findings are: A. Resident 30 was admitted to the facility on [DATE]. A review of Resident 30's physician's orders [REDACTED]. In an interview during a medication pass at 12:02 PM on 8/18/10, Medication Aide D reported Resident 30 administered eye drops to self. A review of Resident 30's medical record did not reveal an evaluation of Resident 30's ability self administer medications. On 8/19/10 at 9:05 AM, the DON (Director of Nursing) could not locate an evaluation of Resident 30's ability to self administer medications. The DON reported the DON was not aware that Resident 30 self administered any medications. | 2014-07-01 |
| 12419 | 12419 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 280 | D | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C1c Based on record review, observation and interview; the facility staff failed to review and revise comprehensive care plans (CCP) related to elopement (Residents 8), weight loss (Residents 1 and 10) and pressure sores (Resident 1) for 3 of 16 sampled residents. The facility sample size was 16 plus 10 non-sampled residents. The facility census at the time of survey was 80. Findings are: A. Record review of Resident 8's Admission Face Sheet dated 5/17/10 revealed an admission date of [DATE]. Resident 8's admission [DIAGNOSES REDACTED]. Record review of a Hospital Discharge Summary dated 3/6/10 prior to admission to the nursing facility identified Resident 8 with moderate to severe Dementia. Record review of Resident 8's Admission Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 4/9/10 and 30 day assessment dated [DATE] identified Resident 8 with moderate cognitive impairment, periods of restlessness, wandering behavior, independent with ambulation in room and corridor and supervision with locomotion off of the unit. Record review of a facility document dated March 2010 entitled Elopement defined the term elopement as follows: escape, flees, runs off, disappears or leaves a care-giving environment unsupervised or unnoticed by staff or prior knowledge. Observation on 6/7/10 at 3:45 PM revealed Resident 8 laying on a bed in Resident 8's room. Observation revealed a wanderguard security device (an electronic device that will set off an alarm to inform staff that the resident has come to close to the security devices at the exit doors to the facility) located on the right and left ankles of Resident 8. Record review of a daily Skilled Nurses Note dated 4/5/10 indicated that a wanderguard system was placed on Resident 8's left leg per family request. Record review of a Daily Skilled Nurses Note dated 4/27/10 revealed that on 4/27/10, Resident 8 walke… | 2014-07-01 |
| 12420 | 12420 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 520 | G | 0 | 1 | P9FH11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.07C Based on staff interview and record review; the facility's Quality Assurance/Quality Improvement committee failed to identify ongoing issue relevant to F176, F248, F252, F274, F280, F281, F283, F314, F319, F323, F325, F332, F363, F371, F428, F441, F 467 and F465. and failed to implement effective plans of action to correct the deficient practice. F314, F319 and F325 were identified at a harm level and isolate scope. The survey sample consisted of 16 sampled and 9 non-sampled residents. The facility staff identified a census of 80. Findings are: Record review of the facility's Quality Assurance/Quality Improvement policy and procedure dated 7/2006 revealed the following: -Purpose: The purpose of the Quality Assurance/Quality Indicator (QA/QI) program is to insure and/or review the processes and procedures in place to meet the needs and provide optimum quality of care for those that we serve and also for those employed at good Shepherd Lutheran Community. -Objective: The object of the Quality Assurance/Quality Indicator program is to identify and select concerns for investigation based on information received within the facility from various resources. -Procedure: The committee determines areas of potential concern based on information received from various resources, committee reports, complaints, grievances, etc. An interview on 6/10/2010 at 9:50 AM was conducted with the facility Administrator. When asked what type of issues the facility QA/QI committee was working on, the Administrator stated " Marketing and the QIS (Quality Indicator Survey)". When asked if the committee was working on anything relating to weight loss or pressure ulcers, the Administrator stated "no". "We have routine meetings for pressure and weight, those areas are ok". An interview on 6/10/2010 at 10:00 AM was conducted with the Director of Nursing (DON). During the interview the DON stated the committee had completed work on the "use of catheters and staff skills in the maintance and cleansing … | 2014-07-01 |
| 12421 | 12421 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 323 | E | 1 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7 Based on observation, record review and interview; the facility failed to complete Elopement Risk Assessments (ERA) for residents identified with wandering or increased anxious behaviors and elopements (Residents 8 and 9), failed to monitor security devices per the plan of care (Resident 11) and failed to implement interventions to prevent falls (Resident 15) for 4 of 16 sampled plus 10 non-sampled residents. The facility census was 80. Findings are: A. Record review of a facility document dated March 2010 entitled Elopement defined the term elopement as follows: escape, flees, runs off, disappears or leaves a care-giving environment unsupervised or unnoticed by staff or prior knowledge. Observation on 6/7/10 at 3:45 PM revealed Resident 8 laying on a bed in Resident 8's room. Observation revealed a wanderguard security device (an electronic device that will set off an alarm to inform staff that the resident has come to close to the security devices at the exit doors to the facility) located on the right and left ankles of Resident 8. Record review of Resident 8's Admission Face Sheet dated 5/17/10 revealed an admission date of [DATE]. Resident 8's admission [DIAGNOSES REDACTED]. Record review of a Hospital Discharge Summary dated 3/6/10 prior to admission to the nursing facility identified Resident 8 with moderate to severe Dementia. Record review of Resident 8's Admission Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 4/9/10 and 30 day assessment dated [DATE] identified Resident 8 with moderate cognitive impairment, periods of restlessness, wandering behavior, independent with ambulation in room and corridor and supervision with locomotion off of the unit. Record review of Resident 8's ERA dated 4/2/10, on the day of Resident 8's admission, revealed incomplete documentation of summary, conclusions, recommendations or interventions impleme… | 2014-07-01 |
| 12422 | 12422 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 274 | D | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175NAC-12-006.09B1(2) Based on observation, record review and interview; the nursing staff failed to initiate a significant change in status assessment for Resident 3 and failed to complete a significant change in status assessment for Resident 1 within the required 14 day timeframe. The sampled residents consisted of 16 plus 10 non-sampled residents. The facility census totaled 80 residents. Findings are: A. Record review of the Long Term Care Facility Resident Assessment Instrument User's Manual (MDS Manual) revised on March 2007 identified a Significant change in status assessment as: -A significant change is a decline or improvement in a resident's status that: 1. Will not normally resolve itself without intervention by staff or implementing standard disease-related clinical interventions, is not "self limiting". 2. Impacts more than one area of the residents health status; and 3. Requires interdisciplinary review and/or revisions of the plan of care. The MDS further instructs that a change in status assessment should be completed with in 14 days after the determination was made of a significant change has occurred. B. According to the Admission Discharge Face sheet, Resident 3 had been admitted on [DATE]. According to the Physician's History and Physical dated 5/19/10, Resident 3 had the following Diagnosis: [REDACTED]. Record review of the MDS (Minimum Data Set- a federally mandated comprehensive assessment tool used for care planning) assessments revealed the Resident 3 had a Significant Change In Status Assessment (SCSA) completed 10/06/09; A Quarterly MDS Assessment completed 12/29/09; and a Quarterly MDS Assessment completed 04/05/10. Review of the Quarterly assessment dated [DATE] revealed Resident 3 had been coded with a decline in physical functioning and the increased need of physical support from 1 person to 2 persons for the performance of the activities of daily living: bed mobility, transfer, ambul… | 2014-07-01 |
| 12423 | 12423 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 332 | D | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.10D Based on observation, record review and interview; the facility staff to ensure that the medication error rate was less then 5%. A total of 44 medications were observed with 4 errors resulting in an error rate of 9.09 percent. Residents with the medication error were Resident 2, 17 and 18. The survey consisted of 16 sampled and 10 non-sampled residents. The facility staff identified a census of 80. Findings are: A. Record review of Resident 2's Comprehensive Care Plan (CCP) dated 4/26/2010 revealed Resident 2 was NPO (nothing by mouth) and had a Peg Tube (tube placed into stomach for food and fluids). Observation on 6/08/2010 at 7:10 AM of a medication administration revealed that Licensed Practical Nurse (LPN) E prepared medication that had been ordered for Resident 2. LPN E checked for placement of the tube and, once it had been determined to be in-place, LPN E administered the medication through the Peg tube. The tubing was not flushed with 30cc (cubic centimeter) of water before the administration of the medications. Review of an web based information site titled Allnurses.com revealed that the tube was to be flushed with 30 cc of fluid before that administration of medications. B. Observation on 6/08/2010 at 8:20 AM revealed that LPN F prepared medication to be administered to Resident 17. LPN F administered medication that included [MEDICATION NAME] ([MEDICAL CONDITION]) 120 mg (milligram) per day and Asprin 81mg entric coated per day. Record review of a physician's orders [REDACTED]. An interview with LPN F was conducted on 6/08/2010 at 11:10 AM. LPN F confirmed that the [MEDICATION NAME] had not been given as ordered. A follow up interview was conducted with LPN F on 6/09/2010 at 8:45 AM. During the interview, LPN F confirmed that the Asprin had not been given as ordered. C. Observation of administration of medications on 06/09/2010 at 8:17 A.M. revealed LPN-T prepared crushed medications … | 2014-07-01 |
| 12424 | 12424 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 325 | G | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09D8b Based on observation, record review and interview; the facility staff failed to evaluate the effectiveness nutritional interventions and food preference for 3 (Resident 10, 6 and 3) of 16 sampled and 10 non-sampled residents. The facility staff identified a census of 80. Findings are: Record review of an Admission and Discharge Summary sheet dated 2/12/2010 revealed Resident 10 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 10's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 2/11/2010 revealed the facility staff assessed the following about the resident: -Ok short and long term memory. -Independent with decision making. -Able to make self understood and understands. -Independent with ADL's (Activities of Daily living). -Significant weight loss in the last 180 days. Record review of a Vital Sign and Weight Flow Sheet revealed the following recorded weights: -7/7/2009: weight 165 lbs (pounds). -8/7/2009: weight 160 lbs. -9/01/2009: no weight recorded. -10/01/2009: weight 155 lbs. -11/2009: weight 149 lbs. -12/01/2009: no weight recorded. -1/11/2010: weight 144 lbs. -2/11/2010: weight 141 lbs. -3/07/2010: weight 139 lbs. -4/27/2010: weight 137 lbs. -5/04/2010: weight 136 lbs. Record review of Resident 10's Dietary Progress Notes dated 12/18/2009 revealed the Registered Dietician (RD) identified that Resident 10 "continues to trigger out as a significant weight loss of 11.4% in the last 180 days. [MEDICATION NAME] (diuretic medication) was changed to increase [MEDICAL CONDITION] at that time, which contributed to weight loss". No recommendations were made at this time for Resident 10. Record review of Resident 10's Dietary Progress Notes dated 1/15/2010 revealed the RD identified Resident 10 with a " significant weight loss (of) 12.7% in 180 days. CBW ( current body w… | 2014-07-01 |
| 12425 | 12425 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 281 | D | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference: 175 NAC 12-006.09 Based on record review and interview, the facility failed to administer medications in accordance with physician orders [REDACTED]. The facility had a total census of 80 residents. Findings are: A. Resident 6 was admitted to the facility on [DATE] according to admission and discharge summary. The admission and discharge summary listed the following [DIAGNOSES REDACTED]. A review of physician's orders [REDACTED]. Physician order [REDACTED]. A review of Nurses 24 Hour Report sheet dated 6/4/10 revealed Resident 6's blood pressure on 6/4/10 was 102/42. A review of Resident 6's 6/10 MAR (Medication Administration Record) revealed [MEDICATION NAME] 10 mg (milligram) was initialed indicating the medication was administered on 6/4/10. In an interview on 6/9/10 between 3:30-3:35 PM, the DON (Director of Nursing) confirmed Resident 6 should not have been administered the [MEDICATION NAME] on 6/4/10. The DON also stated Resident 6's doctor should have been notified of Resident 6's blood pressure. A review of Resident 6's MAR, 24 hour report sheet for 5/10, and Resident 6's Nursing Notes for 5/10 revealed no recorded blood pressures on 19 of 31 days in 5/10 as follows: 5/7, 5/8, 5/12, 5/13, 5/15, 5/16, 5/17, 5/18, 5/19, 5/20, 5/21, 5/22, 5/25, 5/26, 5/27, 5/28, 5/29, 5/30, and 5/31/10. In an interview on 6/10/10 at 8:30 AM, the DON confirmed Resident 6's physician order [REDACTED]. | 2014-07-01 |
| 12426 | 12426 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 314 | G | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference: 175 NAC 12-006.09D2a and 12-006.09D2b Based on observation, interview, and record review, the facility failed to assess skin breakdown and follow facility skin policy for 1 (Resident 6) and evaluate causal factors and implement additional interventions to prevent pressure sores from developing for 1 (Resident 1) of 16 sampled and 10 non-sampled residents. The facility had a total census of 80. Findings are: A. Resident 6 was admitted to the facility on [DATE] according to admission and discharge summary. The admission and discharge summary listed the following [DIAGNOSES REDACTED]. A review of Resident 6's quarterly MDS (Minimum Data Set; a comprehensive assessment used for care planning) dated 6/7/10 listed Resident 6 as requiring extensive assistance of one for bed mobility and limited assist of one for transfer, toilet use, walk in room, and personal hygiene. Resident 6 was listed as having an OK short and long term memory and being independent with cognitive skills for daily decision making. A review of Resident 6's Care Plan revealed a problem dated 3/8/10 of potential for altered skin integrity with the following interventions: - " [MEDICATION NAME] paste/moisture barrier cream to peri/rectal areas prn (as needed) redness " - " Res (Resident) sleeps on pressure relief mattress " - " Encourage Res to use commode, may use bed pan for no longer than 5 minutes " - " Encourage Res to roll over and transfer weight " A review of Skin Charting Notes dated 2/16/10 revealed Resident 6's open area to left buttock was healed. On a 4/30/10 Braden Scale (a tool used to predict pressure sore risk), Resident 6 scored 22. A Braden Scale score of 9 or below was considered severe risk, 10-12 high risk, 13-14 moderate risk, and 15-18 mild risk for development of pressure sores. In interviews between 2:20-2:50 PM and at 4:50 PM on 6/8/10, Resident 6 reported Resident 6 had a " bed sore " on Resident 6's bottom. Resident 6 estimated Resi… | 2014-07-01 |
| 12427 | 12427 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 319 | G | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference: 175 NAC 12-006.09D5 Based on interviews, observations, and record review, the facility failed to evaluate psychosocial needs and implement interventions to promote social interaction for 1 (Resident 6) of 16 sampled and 10 non-sampled residents. The facility had a total census of 80 residents. Findings are: A. Resident 6 was admitted to the facility on [DATE] according to admission and discharge summary. The admission and discharge summary listed the following [DIAGNOSES REDACTED]. A review of Resident 6's quarterly MDS (Minimum Data Set; a comprehensive assessment used for care planning) dated 6/7/10 revealed Resident 6 exhibited an OK short and long term memory and was independent with cognitive skills for daily decision making. A review of Resident 6's Care Plan revealed a problem dated 5/12/10 of "resident displays a sad/anxious mood that is easily altered" and "resident exhibits persistent anger with self or others." Resident 6's Care Plan listed the following interventions: - " Provide 1:1 visits prn (as needed) " - " Attempt to identify and situational cause for sadness/anxiety; help to correct if possible " - " Encourage resident to ventilate feelings. Give realistic, positive feedback " - " Medicate as ordered with [MEDICATION NAME] " - " Discuss possible need for psychological consult with health care team prn " - " Encourage participation in activities of facility " - " Attempt to identify and resolve basis for voiced/demonstrated anger " - " Encourage family/friends to communicate frequently with resident via visits/phone calls " Observations on 6/8/10 at 7:45 AM, 8:30 AM, 10:05 AM, 11:30 AM and 5:16 PM and on 6/9/10 at 8:30 AM, 9:46 AM, and 11:55 AM, revealed Resident 6 resting in bed on back with head of bed elevated. Resident 6 was not observed to change out of Resident 6 ' s pajamas. Observations on 6/8/09 and 6/9/09 revealed Resident 6 did not attend any facility activities and ate breakfast and lunch in … | 2014-07-01 |
| 12428 | 12428 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 363 | E | 0 | 1 | P9FH11 | Licensure Reference: 175 NAC 12.006.11A1 Based on observation, record review, and interview, the facility failed to prepare and serve menu items as listed on menu for pureed diets for 7 residents (Residents 1, 19, 20, 21, 22, 23, and 24) that received pureed diets. The facility had a total census of 80 residents. Findings are: A. Observations and interview with Dietary Staff Member H at 10:45 AM on 6/8/10 revealed apple crisp had not been pureed for residents that received a pureed diet. Dietary Staff Member H reported pudding had been substituted for the apple crisp. Dietary Staff Member H confirmed that was not how the menu was written. In an interview at approximately 12:20 PM on 6/8/10, Dietary Staff Member I reported diet pudding had been served for lunch on 6/8/10 to all residents on a pureed diet as some residents receiving pureed food required diet pudding. B. Observation and interview of Cook J at 11:36 AM on 6/8/10 revealed the # 12 (1/3 cup) scoop would be used to serve the pureed roast beef. A review of menu for 6/8/10 menu revealed pureed roast beef was to be served with # 8 (1/2 cup) scoop. C. Observation and interview of Dietary Staff Member K at 5:20 PM on 6/8/10 revealed sugar free cookies with 2% milk slurry was prepared to be served to all residents on a pureed diet. A review of Resident diet list dated 6/7/10 revealed 3 of 7 residents receiving pureed diets where restricted to no concentrated sweets. D. A review of supper menu for pureed diet on 6/8/10 revealed residents on a pureed diet were to receive either pureed chili dogs or a substitute of pureed tuna salad sandwiches. Interview with Cook J between 5:20-6:10 PM on 6/8/10 revealed tuna salad sandwiches where to be prepared for residents on pureed diets as chili dogs don't puree well. Cook L reported whatever makes the best puree was what Cook L makes for the meal. Interview with Cook L also revealed mashed potatoes would be served with pureed tuna salad sandwiches. A review of dinner menu for 6/8/10 for residents on a pureed diet did not… | 2014-07-01 |
| 12429 | 12429 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 371 | F | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference: 175 NAC 12-006.11E Based on observations, interviews, and record review, the facility failed to ensure sanitizing rinse in 3 compartment sink met manufacturer recommendation, food items were covered, range hood was maintained in a clean manner, clean gloves were used when handling food and outdated food was disposed of. This practice had the potential to affect 77 of 80 residents who ate meals at the facility. Findings are: A. Observations revealed the sanitizing rinse concentration level did not meet the manufacturer's recommendations of 200 ppm (parts per million) for a quaternary during the initial tour of the kitchen between 10:25-11 AM on 6/7/10 when checked by Dietary Manager. In an interview on 6/8/10 at 8:05 AM, Dietary Staff Member M, who was doing dishes in the 3 compartment sink, reported Dietary Staff Member M did not know how to test the concentration of the sanitizing rinse in the 3 compartment sink. Another staff member checked the rinse and demonstrated that the rinse met the manufacturer's recommendation concentration of 200 ppm. In an interview at 8:52 AM on 6/8/10, the Certified Dietary Manager reported staff did not routinely check the 3 compartment sink for sanitizer concentration. Follow up interview with Certified Dietary Manager at 2 PM on 6/8/10 revealed Ecolab representative had been to the facility on [DATE] to adjust the concentration of the sanitizing solution. Review of the 7/1/2007 version of the "Food Code" , based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices revealed the following: -A quaternary ammonium compound solutions hall nave a concentration as indicated by manufacturer's use directions. B. Observations between 10:25-11 AM on 6/7/10 revealed 3 trays of dished fruit and 2 trays of dished cake uncovered in the walk in refrigerator. Observations in the dining room on 6/8/10 at 8:05 AM and 6/9/10… | 2014-07-01 |
| 12430 | 12430 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 465 | F | 0 | 1 | P9FH11 | Licensure Reference: 175 NAC 12-006.18A Based on observations and interviews, the facility failed to maintain kitchen walls, ceiling vents, and floors in a clean manner and failed to maintain one housekeeping closet in hall next to the main dining room. This practice had the potential to affect 77 of 80 residents who eat meals at the facility. Findings are: A. Observations between 10:25-11 AM on 6/7/10 and 9:35 AM on 6/10/10 revealed the kitchen floor was soiled near the walls and under the kitchen equipment. The ceiling vent above the 3 compartment was soiled with dust. Observations at between 9:20-9:35 AM on 6/8/10 and at 9:35 AM on 6/10/10 revealed mold on the tile wall behind the dirty side of the dishwasher. In an interview on 6/10/10 between 9:35-10:06 AM, the Certified Dietary Manager confirmed the kitchen floor needed to be scrubbed by the walls. The Dietary Manager reported maintenance cleaned the ceiling vents and dietary staff members have been told to wipe off the wall by the dishwasher to keep mold from growing. B. Observation on 06/09/2010, from 10:00 A.M. to 11:50 A.M., during the environment tour revealed the housekeeping closet floor contained balls of dust along the floor edges and the corners of the room. The closet was located in the corridor that leads to the main Dining Room. The staff on the environmental tour confirmed the house keeping closet floor had accumulated dust balls and the closet had a strong odor. The staff consisted of the Director of Maintenance, the Administrator and the Maintenance Staff person for the nursing facility building. C. Observation on 06/09/2010, from 10:00 A.M. to 11:50 A.M., during the environment tour revealed the fluorescent overhead light fixture located in the closet that stored oxygen tanks, contained no undercover for the 2 -3 foot long fluorescent bulbs in the fixture. The staff on the environmental tour consisted of the Director of Maintenance, the Administrator and the Maintenance Staff person for the nursing building. The staff did confirm that the l… | 2014-07-01 |
| 12431 | 12431 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 441 | D | 0 | 1 | P9FH12 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.17D Based on observation, record review and interview; the facility staff failed to utilize handwashing and gloving techniques to prevent the potential for cross contamination during accu-checks ( method of checking blood sugar level ) for 3 (Resident 33, 34 and 35) of 11 sampled and 6 non-sampled residents. The facility staff identified a census of 75. Findings are: A. Observation on 8/18/2010 at 11:00 AM Licensed Practical Nurse (LPN) A prepared to to an accu check ( checking blood sugar level by sticking a finger and placing a drop of blood onto a strip, placing it into a glucometer and obtaining the results) for Resident 33. LPN A donned gloves, prepared Resident 33's finger for the accu-check. LPN A using a lancet, pricked Resident 33's finger. LPN A squeezed Resident 33's index finger on the left hand to produce a drop of blood, placed the drop of blood onto the test strip that had been placed into the glucometer. LPN A placed a cotton ball onto Resident 33's finger where the blood drop had been obtained. LPN A removed the cotton ball and placed it into a pile of items to be discarded. LPN A without changing the soiled gloved cleaned the glucometer using a alcohol wipe. LPN A cleansed the front of the glucometer and then turning it over in the left hand, cleansed the back of the meter with the soiled gloves on. B. Observation on 8/18/2010 at 11:05 AM LPN A entered Resident 34's room with the supplies for the accu-check and placed them on paper towels for a barrier. LPN A washed (gender) hands for 24 seconds and donned clean gloves. LPN A placed the test strip into the glucometer and placed the meter onto a barrier on a tray table. LPN A using the lancet, pricked Resident 34's 2nd finger on the left hand. LPN A squeezed Resident 34's finger to produce a drop of blood. LPN A placed the drop of blood onto the test strip. LPN A obtained a cotton ball and placed it onto the finger that had been used for the test. LPN A obtained the results and removed the cotton ball fro… | 2014-07-01 |
| 12432 | 12432 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 252 | E | 0 | 1 | P9FH11 | LICENSURE REFERENCE NUMBER 175 NAC-12-006.18 Based on observation, and interviews, the nursing facility staff failed to provide a save, homelike environment that was in good repair, in the whirlpool bathing area, the window in room 201, and the dust covered ventilation grille in rooms 201, 303, 304 and 306. The sampled residents consisted of 16 plus 10 non-sampled residents. The facility census totaled 80 residents. Findings are: On 06/09/2010, from 10:00 A.M. to 11:50 A.M., during the tour of the nursing facility accompanied by the Director of Maintenance, the Administrator and the Maintenance person for the nursing facility; the following concerns were observed: *The wall sconce in the whirlpool bathing area had no cover over the exposed light bulb. This had the potential to effect 36 residents that receive whirlpool baths. * In room 201, Resident 26 commented, " when it rains the window leaks; the water comes in and runs by the bed side when it rains " . Interview with the Maintenance Director noted that the window had been replaced just 2 weeks ago and did not know it leaked until now. On 6/10/10, heavy rain showers were received in the early morning. The Director of Maintenance checked room 201 around 8:30 A.M. and confirmed the rain had come through the window and had run down by the bed side. *The grille cover to the outside air vent were coated with an accumulation of gray substance in 201, 303 304 and 306. - The observations were confirmed by the facility staff. | 2014-07-01 |
| 12433 | 12433 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 467 | E | 0 | 1 | P9FH11 | LICENSURE REFERENCE NUMBER 175 NAC 12-007.04D Based on observation and interviews, the facility staff failed to maintain the functioning of the outside ventilation systems in 2 of 5 hallways. The sampled residents consisted of 16 plus 10 non-sampled residents. The facility census totaled 80 residents. Findings are: On 06/09/2010, from 10:00 A.M. to 11:50 A.M., during the environment tour of the nursing facility, the vents, located in the bathrooms, were tested for outside air circulation. The Director of Maintenance, the Administrator and the Maintenance Staff person for the nursing building observed with the tour. The 200 hallway contains 2 rooms with a potential of 2 residents in each room. Room 200 and 201 failed to draw air through the vent when tested with 1ply toilet tissue held to the vent. The 400 hallway contained 16 rooms with a potential of 1 resident per room. The vents were tested with the 1ply toilet tissue and failed to draw air through the vent in room 400 and room 415. Interview, during the environment tour, with the 2 maintenance staff revealed the same fan and motor does the whole corridor. The Director of Maintenance noted that the 400 hallway had just had a new motor and belt replaced 3/24/10. | 2014-07-01 |
| 12434 | 12434 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 428 | D | 0 | 1 | P9FH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.12B Based on observation, record review and interview; the Consulting Pharmacist failed to identify drug irregularities related to the crushing of Enteric Coated (EC) medication for Resident 18 and documenting the Antianxiety had been discontinued for Resident 3. The survey consisted of 16 sampled and 10 non-sampled residents. The facility census consisted of 80 residents. Findings are: A. Observation of Resident 18's administration of medications on 6/9/10 at 8:17 A.M. revealed LPN (Licensed Practical Nurse)-T crushed the medication Aspirin 81 mgm (milligram) tablet ec (Enteric Coated) oral QD; and the medication had been identified on Resident 18's Medication Administration Record [REDACTED]. The MAR indicated [REDACTED]. Give as QS. Record review of Resident 18's Monthly Drug Regimen Reviews from 11/25/08 through 05/25/10 revealed the Consulting Pharmacist had never identified the irregularity of crushing the medication Aspirin EC. The physician's orders [REDACTED]. The Monthly Drug Regimen Reviews from 11/25/08 through 05/25/10 had not identified that the physician had been notified of the crushing of the medication to obtain additional rational for the administering of the medication. Interview on 6/16/10 from 9:35 t0 9:50 A.M. with the Consulting Pharmacist revealed there should be information in the clinical record from the Physician related to the rationale for medications that are not supposed to be crushed, if there is an order for [REDACTED]. B. On 6/8/10, review of Resident 3's May 2010 MAR indicated [REDACTED]. On 6/8/10 record review of Resident 3's Monthly Drug Regimen Reviews revealed the Antianxiety Xanax had been documented as discontinued on 11/17/2009 by the Consulting Pharmacy. On 06/8/10 at 11:05 A.M. the Director of Nurses (DON) contacted the Consulting Pharmacist. A written response dated 6/10/10 was received from the Pharmacist. The report noted the Pharmacist had inadvertentl… | 2014-07-01 |
| 12435 | 12435 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2010-06-10 | 279 | D | 0 | 1 | P9FH11 | LICENSURE REFERENCE NUMBER 175 AC 12-006.09c Based on observation, record review and interview; the facility staff failed to develop a Comprehensive Care Plan (CCP) related to the self-administration of medication for 1 (Resident 9) of 10 sampled residents plus 1 non-sampled resident. The facility census was 24. Findings are: Observation on 9/2/10 at 8:15 AM with the Director of Nursing (DON) revealed a locked safe in Resident 9 ' s room at the facility. Interview on 9/2/10 at 8:15 AM with the DON confirmed that Resident 9 self-administered some medications. A visual check on 9/2/10 at 9:20 AM of the inside of the safe revealed several bottles of medications secured in the safe. Record review of Resident 9's CCP dated 6/14/10 revealed no information related to Resident 9's self-administration of medications. Interview on 9/2/10 at 9:30 AM with the DON confirmed that Resident 9's current CCP dated 6/14/10 did not contain any information related to Resident 9's self-administration of medications. The DON confirmed that this information should have been included in Resident 9's current CCP. | 2014-07-01 |
| 12836 | 12836 | BEAVER CITY MANOR | 285269 | P O BOX 70, 905 FLOYD STREET | BEAVER CITY | NE | 68926 | 2010-07-08 | 371 | F | QLVI11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.11E Based on observations, staff and resident interviews and document review; the facility failed to 1) ensure the dietary staff completed hand washing when hands were contaminated 2) Insure that potentially hazardous foods were held for service at temperatures to prevent bacterial growth, 3) clean the thermometer when used to temp foods between foods before the foods were served; and 4) enclose a container of sugar sweetener found sitting on the shelf and did not date a squeeze bottle in the refrigerator with a yellow substance when transferred from the original container. These failures increased the risk of cross contamination, bacterial growth and food borne illness occurrence which could pose a food safety risk to all residents. The facility census was 17, and the survey sample was 8. Findings are: A. During the initial tour of the kitchen on 7/6/10 at 1:00 PM found a container labeled Equal sitting open to the air on the shelf of the cupboard. Further observation found in the refrigerator a squeeze bottle with a yellow substance that contained no label of the content or date the substance was transferred from the original container. The Equal sat open to the air on 7/7/2010 at 8:00 AM and 7/8/2010 at 9:00 AM as did the squeeze bottle, with a yellow substance, sit in the refrigerator with no label and date the substance was put in the container. Interview with the Registered Dietician on 7/8/2010 at 9:00 AM confirmed the Equal sitting on the shelf of the cupboard open to the air. Also confirmed the squeeze bottle sitting in the refrigerator with no label or date the substance was transferred from the original container. Review of the 7/1/2007 version of the "Food Code", based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following: 3-302.12 statute revealed except for containers holding food that can be readily and unmistakably recognized such as dry pasta, worki… | 2014-03-01 | ||
| 12837 | 12837 | BEAVER CITY MANOR | 285269 | P O BOX 70, 905 FLOYD STREET | BEAVER CITY | NE | 68926 | 2010-07-08 | 441 | E | QLVI11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.17D Based on observations, staff interviews and record review; the facility staff failed to wash hands for at least 15 to 20 seconds when contaminated and to prevent cross contamination between residents for 3 sampled residents (Residents 6, 11, 17, and 14). The facility census was 17 residents. The sample size was 8. Findings are: A. Observation of LPN-C (Licensed Practical Nurse) on 7/6/2010 at 1:50 PM found LPN-C performed a 10 second hand wash before doning gloves to administer a nebulizer treatment to Resident 6. LPN-C stood beside the resident's chair while the nebulizer treatment was inhaled with gloves. Once the treatment had completed LPN-C removed the mask, placed the machine back on the shelf and removed the gloves. LPN-C washed the hands 10 seconds before leaving the room. Interview with the DON (Director of Nurses) on 7/8/2010 at 10:00 AM revealed the staff were expected to wash the hands for 20 seconds. Review of the facility form entitled Handwashing, with no date of origin, stated wash for a minimum of 20 seconds using a rubbing and circular motion. B. During the observation of care for Resident 11 on 7/7/2010 at 11:50AM, NA-D entered the restroom and completed a hand wash. The scrub (vigorous rubbing together of the hands with soap lather) period was 10 seconds prior to gloving. C. During the observation of care for Resident 17 on 7/7/2010 at 12:10PM, NA-E went into the restroom and completed a hand wash that included a 15-second scrub time prior to rinsing, drying and gloving. D. During the observation of care for Resident 14 on 7/7/2010 at 1:00PM, NA-D entered the restroom and completed a hand wash that included a 10-second scrub time prior to rinsing, drying and applying gloves. After changing the resident's clothes, at 12:15PM NA-E went into the restroom and completed a hand wash that had an 8 second scrub time. NA-D, who had been assisting and left to take the soiled clothes to the laundry, returned and completed a hand wash at 12:16PM that involved … | 2014-03-01 | ||
| 12838 | 12838 | BEAVER CITY MANOR | 285269 | P O BOX 70, 905 FLOYD STREET | BEAVER CITY | NE | 68926 | 2010-07-08 | 466 | F | QLVI11 | Licensure Reference: 12-007.04A Based on record review and interview, the facility failed to have a written protocol for estimating the amount of potable and non-potable water requirement in the event of a water supply disruption or contamination. This had the potential to affect all residents. The facility census was 17. Findings are: A review of the facility Disaster Preparedness Plan - Loss of Facility Water Supply, dated 10/25/2004; revealed in the event of a loss of water pressure to the facility and / or greater than 6 hour water supply line disruption, nurse aides and kitchen staff would gather sufficient water containers (e.g. coolers, buckets, anything sanitary that would hold water) and proceed to the nearest facility within the city limits that would supply water. Alternately, water could also be obtained from wells outside the city limits. Item number 4 of the plan stated "Gather as much water as needed for washing hands, faces of residents, and cooking for the kitchen." A undated second page of the Disaster Plan entitled Water Supply stated bottled water was to be supplied by the local supermarket, located downtown Beaver City if the facility's water supply was inoperable or contaminated. The Maintenance Supervisor or designee was to be responsible for retrieval of the bottled water. In an interview on 7/7/2010 at 12:30PM, the Maintenance Supervisor stated an unawareness of the amount of water that would be needed. In an interview on 7/7/2010 at 1:30PM, the Administrator confirmed the policy did not have a method to calculate how much water would be required, and was going to contact the store and other water suppliers. | 2014-03-01 | ||
| 12839 | 12839 | BEAVER CITY MANOR | 285269 | P O BOX 70, 905 FLOYD STREET | BEAVER CITY | NE | 68926 | 2010-07-08 | 329 | E | QLVI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a documented need existed for the medication, the effectiveness of the medication was monitored and that gradual dose reduction attempts or the clinical rationale for not attempting dose reductions were completed for Residents 1, 11 and 14. The facility census was 17 and 8 residents were reviewed on sample. Findings are: A) A review of Resident 11's record revealed a face sheet (a cover sheet to a multipage document that contains demographic information, preferences, contact information, and limited medical information) dated 7/11/2009 that showed the resident was admitted to the facility on [DATE]. A list of medical [DIAGNOSES REDACTED]. -[MEDICATION NAME] [DIAGNOSES REDACTED] -Diabetes Mellitus Type II -Hypertension -[MEDICAL CONDITION] -Aortic Valve Disorder - Mild Stenosis -[MEDICAL CONDITION] - Stage III -[MEDICAL CONDITION] Bladder A review of Resident 11's Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. A review of the MDSs located in Resident 11's record, dated 8/28/2009 and 5/9/2010, revealed the resident had not been coded as having any signs or symptoms of depression in the 30 days prior to either assessment. Both MDS assessments had the resident coded for depression in the Disease [DIAGNOSES REDACTED]. A review of Resident 11's current (undated) care plan revealed no care plan for depression. A review of the Interdisciplinary Notes and the Social Service Director notes revealed Depression had not been addressed. A review of a History and Physical located in the record, dated 10/9/2009, from the hospital revealed the physician listed (under the heading of Impression) "History of Depression." No monitors of signs and symptoms of depression, or monitors for possible side effects from the medication were found. B. A review of the physician's orders [REDACTED]. A review of Resident 11's PRN (as needed) Medication Record revealed Re… | 2014-03-01 | ||
| 12840 | 12840 | BEAVER CITY MANOR | 285269 | P O BOX 70, 905 FLOYD STREET | BEAVER CITY | NE | 68926 | 2010-07-08 | 278 | E | QLVI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview; the facility failed to ensure residents with indwelling catheters and colostomies were coded on the Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) as continent for 2 residents (Residents 11 and 14) and that toileting plans were individualized for 2 residents (Residents 17 and 6). The facility census was 17 and the sample size for review was 8. Findings are: A) A review of Resident 11's record revealed a face sheet (a cover sheet to a multipage document that contains demographic information, preferences, contact information, and limited medical information) dated 7/11/2009 that showed the resident was admitted to the facility on [DATE]. A list of medical [DIAGNOSES REDACTED]. -[MEDICATION NAME] [DIAGNOSES REDACTED] -Diabetes Mellitus Type II -Hypertension -[MEDICAL CONDITION] -Aortic Valve Disorder - Mild Stenosis -[MEDICAL CONDITION] - Stage III -[MEDICAL CONDITION] Bladder A review of the MDSs located in Resident 11's record, dated 8/28/2009 and 5/9/2010, revealed dashes in the section for bowel and bladder continence. Options for coding and the explanations on the MDS, include: 0. Continent-complete control (includes use of indwelling catheter or ostomy device that does not leak urine or stool). 1. Usually Continent-Bladder, incontinent episodes one a week or less; Bowel, once a week 2. Occasionally Incontinent-Bladder, 2 or more times a week but not daily; Bowel, once a week 3. Frequently Incontinent-Bladder, tended to be incontinent daily, but some control present (e.g., on day shift); Bowel, 2-3 times a week 4. Incontinent-Had inadequate control Bladder, multiple daily episodes; Bowel, all (or almost all) of the time Observation of Resident 11 on 7/6/2010 through 7/8/2010 revealed the resident had an indwelling supra-pubic catheter and a [MEDICAL CONDITION] bag with no signs of leakage. A review of the record revealed no documentation o… | 2014-03-01 | ||
| 12196 | 12196 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 226 | D | 1 | 1 | 2KMG11 | Licensure Reference 175 NAC 12-006.04A3b Based on record review and interview, the facility failed to complete a Nurse Aide Registry check for 1 out of 3 nursing assistants (NA ' s) reviewed. The facility census at the time of survey was 170 and the sample size was 29 with 5 non sampled residents. A. Review of NA- E ' s employee file revealed that the facility did not have a copy of NA-E' s state registry report. This report tells if the NA has completed coursework and if there has been any discipline against the license. B. In an interview conducted on July 11, 2010 at 10 AM with RN-F, RN-F confirmed after reviewing the file that the report was not there. C. Facility policy titled Abuse, Neglect and Exploitation Revised 09/2006 section A item 4 states, " All potential nursing employees shall have appropriate licensure or certification verified". | 2014-09-01 |
| 12197 | 12197 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 323 | D | 0 | 1 | 2KMG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference: 175 NAC 12-006.09D7 Based on record review, interviews, and observations, the facility failed to transfer a resident in accordance with plan of care resulting in injury to lower extremity for 1 (Resident 6) of 29 sampled and 3 non sampled residents and failed to ensure the security of secured unit door to the enclosed courtyard for 1 (Resident 25) of 29 sampled and 5 non sampled residents. The facility had a total census of 170 residents. Findings are: A. Resident 6 was admitted to the facility on [DATE] according to admission information. A review of Resident 6's physician's orders [REDACTED]. Resident 6's quarterly MDS (Minimum Data Set; a comprehensive assessment used for care planning) dated 6/15/10 identified Resident 6 with an ok short and long term memory and had modified independence with cognitive skills for daily decision making. Resident 6 was identified as being totally dependent and requiring assistance of 2 plus person for transfer. A review of Resident 6's Care Plan revealed a problem dated 9/21/09 related to ADL (Activities of Daily Living). The Care Plan had an undated revision stating Resident 6 was to be transfer with 2 assist and with full body lift. A review of Resident 6's Daily ADL Care Plan revealed Resident 6 was to be transferred with a hoyer lift (a full body lift) beginning 1/7/10. A review of therapy referral dated 5/6/10 stated Resident 6 had been transferred with a hoyer lift since 1/20/10. Observation of Resident 6's room door on 7/8/10 at 10:29 AM revealed a butterfly with the center colored in. A review of facility's Transfer and Lift Policy (Butterfly) with an effective date of 5/05 revealed a resident with a butterfly with the body colored in required a mechanical full body lift. In an interview between 4-4:15 PM on 7/6/10, Resident 6 reported Resident 6's leg wound had occurred when staff member transferred Resident 6 to bed and bumped leg on the bed. Resident 6 reported staff member d… | 2014-09-01 |
| 12198 | 12198 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 225 | D | 1 | 1 | 2KMG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to report and investigate potential neglect for 1 (Resident 6) of 29 sampled and 3 non sampled residents and failed to forward investigation of allegation of abuse to state agency with in 5 working days for 1 (Resident 25) of 29 sampled and 5 non sampled residents. The facility had a total census 170 residents. Findings are: A. Resident 6 was admitted to the facility on [DATE] according to admission information. A review of Resident 6's physician's orders [REDACTED]. A review of Resident 6's Daily ADL Care Plan revealed Resident 6 was to be transferred with a hoyer lift (a full body lift) beginning 1/7/10. A review of therapy referral dated 5/6/10 stated Resident 6 had been transferred with a hoyer lift since 1/20/10. In an interview between 4-4:15 PM on 7/6/10, Resident 6 reported Resident 6's leg wound had occurred when staff member transferred Resident 6 to bed and bumped leg on the bed. Resident 6 reported staff member did not use lift to transfer resident. A review of Incident/Accident Report dated 5/25/10 stated "Resident was being transferred in bed by CMA (Certified Medication Aide) when residents left (lower) leg hit the knob of the side rail and got a skin tear." The Incident/Accident Report identified skin tear was on left lower leg. Incident report stated "Re-educate staff on transfers (properly) and the use of 2 assist (with) transfers." Nurse's Note dated 5/26/10 at 6:30 AM stated Resident 6 had skin tear of 3 cm x .3 cm on left lower lateral leg. In an interview on 7/8/10 between 2:30-2:40 PM, MA A (Medication Aide) reported MA A had transferred Resident 6 from wheel chair to bed with a gait belt and 1 assist and not with a hoyer lift. MA A reported Resident 6's skin rubbed against the bed causing bleeding. MA A reported Resident 6 did not have a hoyer transfer sling under Resident 6. MA A reported MA A had received training on how to place a hoyer sling under a residen… | 2014-09-01 |
| 12199 | 12199 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 371 | F | 0 | 1 | 2KMG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference: 175 NAC 12-006.11E Based on observations, interview, and record review, the facility failed to ensure hot foods were maintained above 135 degrees F (Fahrenheit) and cold food was maintained less than 41 degrees F during meal service, failed to ensure equipment was maintained in a clean manner and good repair, and failed to ensure adequate pest control in the kitchen. This has the potential to affect 167 residents who eat meals at the facility. The facility had a total census of 170 residents. Findings are: A. On 7/7/10 between 11:05-11:10 AM, the following food temperatures were taken by Dietary Staff Member C on the mobile steam table taken: -Coleslaw 45 degrees F -Pureed coleslaw 50 degrees F On 7/7/10 at 11:39 AM after service of lunch in the terrace dining room, the following food temperatures were taken by Dietary Staff Member C and Dietary Staff Member D on the mobile steam table: -Chicken breast 130 degrees F -Coleslaw 48 degrees F -Pureed coleslaw 45 degrees F Observations of lunch meal in the main dining room On 7/7/10 at approximately 12:45 AM after service in the main dining room, the following food temperatures were taken by Dietary Staff Member D on the mobile steam table: -Chicken breast 100 degrees F Following completion of the lunch meal in the main dining room at approximately 12:50 AM on 7/7/10, the following milk temperatures were taken by Dietary Staff Member C: -Skim milk 50 degrees F -Whole milk 50 degrees F In an interview on 7/12/10 between 9:26-9:50 AM, the Dietary Manager reported the facility thermometers needed to be recalibrated. Review of the 7/1/2007 version of the "Food code", based on the United States Food and Drug Administration Food code and used as an authoritative reference for food service sanitation practices, revealed the following: potentially hazardous food (time/temperature control for safety food) shall be maintained at 41 degrees F or less or above 135 degrees or above. B. Obs… | 2014-09-01 |
| 12200 | 12200 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 465 | F | 0 | 1 | 2KMG11 | Licensure Reference: 175 NAC 12-006.18A Based on observations and interviews, the facility failed to ensure kitchen floors and walls were maintained in a clean manner and in good repair. This practice has the potential to affect 167 residents who eat meals at the facility. The facility had a total census of 170 residents. Findings are: A. Observations on 7/6/10 at 9:55 AM, 7/7/10 between 10:30 AM-12:50 PM and 7/12/10 between 9:26-9:50 AM revealed the kitchen floor was soiled through the food preparation areas, the food storage areas, the walk in refrigerator, and food service areas. There was a build up of dirt and debris under equipment and around door jams. Observations on 7/7/10 between 10:30 AM-12:50 PM and 7/12/10 between 9:26-9:50 AM revealed standing water under the dirty side of the dishwasher were 5 tile were missing from the floor. The missing tile resulted in a depression which kept the water from draining away. In an interview on 7/12/10 at 11:25 AM, the Maintenance Director reported they had run out of query tile when the floor was redone in the dish wash room. The Maintenance Director reported the Maintenance Director planned to fill in the area missing tile with cement. The Maintenance Director could not give a date when the floor was re done. In an interview on 7/12/10 between 9:26-9:50 AM, the Dietary Director reported the kitchen floor is swept and mopped once a month and heavy duty cleaning is completed once a month. In a follow up interview at 1:10 PM on 7/12/10, the Dietary Director reported being unable to find any documentation of the last time the kitchen floor was deep cleaned. B. Observations between 10:30 AM-12:45 PM on 7/7/10 and 7/12/10 between 9:26-9:50 AM revealed the following: -The grout on the wall behind the beverage station was discolored and soiled. -There was an approximately 6 inch strip of missing edging on the corner by the refrigerator in the serving area -There was an approximately 40"strip of missing caulking between the wall and tile below the serving window. -The grou… | 2014-09-01 |
| 12201 | 12201 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 315 | D | 0 | 1 | 2KMG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER NAC 175 12-006.09D3 Based on observation, record review and interview; the facility staff failed to complete incontinence (involuntary leakage of urine) assessments for Residents 15, 16 and 24 and failed to implement a bowel and bladder program for Resident 12. The sample size was 29 plus 5 non-sampled residents from a facility census of 170. Findings are: A. Record review of a facility Policy and Procedure for Urinary Incontinence Management effective [DATE] revealed a procedure that directed staff to assess for urinary incontinence and to use the "Urinary Incontinence Assessment" to define the type of incontinence with the goal of keeping the resident dry. B. Record review of Resident 15's most recent Quarterly Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 5/20/10 revealed that Resident 15 was occasionally incontinent of bladder. Record review of Resident 15's incontinence assessment dated [DATE] revealed that the assessment was incomplete and did not identify or specify the type of incontinence that Resident 15 exhibited. C. Record review of Resident 16's most recent Quarterly Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 5/21/10 revealed that Resident 16 was usually continent of bladder with incontinence episodes 1 time per week or less. Record review of Resident 16's incontinence assessment dated [DATE] revealed that the assessment was incomplete and did not identify or specify the type of incontinence that Resident 16 exhibited. D. Record review of Resident 24's most recent Quarterly Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 5/30/10 revealed that Resident 24 was frequently incontinent of bladder. Record review of Resident 24's incontinence assessment dated [DATE] revealed that the assessment was incomplete and did not identify or speci… | 2014-09-01 |
| 12202 | 12202 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 281 | D | 1 | 1 | 2KMG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC 12-006.10 Based on record review and interview; the facility staff failed to follow a physician orders [REDACTED]. The facility staff identified a census of 170. Findings are: A. Record review of an Physicians Orders sheet for the date of 7/01/2010 revealed Resident 11 had the [DIAGNOSES REDACTED]. Record review of an information sheet dated June 21/2010 revealed Resident 11's weight had increased from 170.0 pounds to 180.1 pounds in 2 weeks. The facility staff had indicated on the information sheet that Resident 11 was on [MEDICATION NAME] (diuretic) every AM. The physician ordered that Resident 11 have a fluid restriction of 2500 cc(cubic centimeters) per day. An interview with Resident 11 was conducted on 7/06/2010 at 4:05 PM. During the interview, Resident 11 confirmed that the physician had ordered a fluid restriction. Resident 11 stated during the interview that " they always give me to much water". Record review of Resident 11's record did not contain evidence the facility was monitoring the fluid intake for Resident 11 to ensure the 2500 cc fluid restriction was not exceeded. An interview on 7/08/2010 was conducted with Registered Nurse (RN) K related to Resident 11's fluid restriction. During the interview, RN K was asked what the fluid restriction for Resident 11 was. RN K stated " I am not sure how much (gender) is getting". When asked if RN K was Resident 11's nurse, RN K stated "yes". An interview on 7/08/2010 was conducted with Licensed Practical Nurse (LPN) L. During the interview, LPN L stated the intake and output (I and O) should be on the Medication Administration Record [REDACTED]. LPN L stated "no" when asked if the physicians order had been followed. B. Record review of an information sheet dated 6/23/2010 revealed Resident 21 was admitted to the facility on [DATE]. Record review of a Discharge Summary sheet dated 5/10/2010 revealed Resident 21 had the [DIAGNOSES REDACTED]. Record revi… | 2014-09-01 |
| 12203 | 12203 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 492 | D | 0 | 1 | 2KMG11 | Based on record review and interview; the facility staff failed to complete the demand billing process to ensure that the resident or the responsible party were offered the choice whether or not to request a standard claim appeal (Demand Bill) be submitted to Medicare for 3 ( Residents 30, 31 and 32) of 7 resident files reviewed. The resident sample size was 29 plus 5 non-sampled residents from a facility census of 170. Findings are: Record review of 3 ( Residents 30, 31 and 32) of 7 Skilled Nursing Facility Determination on Continued Stay notification letters revealed that the choice boxes under the Request for Intermediary Review had been left blank. This indicated that the resident or responsible party had not made a decision as to whether or not to request an Intermediary Review for a Medicare decision. Interview on 6/8/10 at 9:15 AM with Social Service Worker (SSW) I confirmed that the choice boxes had been left blank. SSW I confirmed that no follow-up was completed with the residents or the responsible party to ensure that they were aware of the right to request an Intermediary decision. SSW I stated that when the letters are returned by the families or resident they come directly to the Social Services facility office and then are given to the bookkeeper to file. Interview on 6/8/10 at 9:30 AM with Bookkeeper J confirmed that the letters were not routinely reviewed to ensure that a choice had been documented in regards to the request for an Intermediary decision. | 2014-09-01 |
| 12204 | 12204 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 280 | D | 0 | 1 | 2KMG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09C1c Based on record review and interview; the facility staff failed to review and revise a Comprehensive Care Plan (CCP) for 1 (Resident 11) of 29 sampled and 5 non-sampled residents. The facility staff identified a census of 170. Finds are: A. Record review of an Physicians Orders sheet for the date of 7/01/2010 revealed Resident 11 had the [DIAGNOSES REDACTED]. Record review of a Physician order [REDACTED]. The Physician ordered that Resident 11 have a fluid restriction of 2500 cc (cubic centimeters) a day. Record review of Resident 11's record revealed resident 11 had developed a wound to the left calf area of the leg. The wound required a treatment that included a wound vac. Resident 11 had admitted to the hospital for a skin graft procedure and the wound vac was discontinued upon the residents return to the facility. Record review of Resident 11's CCP dated 5/06/2010 revealed the fluid restriction was not identified on the CCP. Further review of Resident 11 CCP revealed the wound vac treatment remained on the CCP. An interview on 7/08/2010 at 8:50 AM was conducted with Licensed Practical nurse (LPN) L. Resident 11's CCP was review with LPN L. LPN L confirmed that Resident 11's CCP had not been updated to reflect the fluid restriction or the discontinuation of the wound vac. | 2014-09-01 |
| 12205 | 12205 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 441 | D | 0 | 1 | 2KMG11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.17D Based on observation, record review and interview the nursing facility staff failed to perform complete hand hygiene during administration of eye drops, cleansing of the Glucometer machine and during Resident 3 and 4's personal hygiene cares. The total sample consisted of 26 residents, including 5 unsampled residents. The facility census totaled 170 residents. Findings are: A. On 7/7/10 at 6:28 A.M. Medication Aide (MA)-N donned gloves to administered eye drops to a resident. Upon completion of procedure, MA-N removed the gloves, charted the medication as given, and without the performance of hand washing hygiene continued with the administration of medications to the next resident. Review of the Policy and Procedure, HAND WASHING, Revised 2/2009 under the section WHEN TO WASH HANDS confirmed: * Before and after each resident contact. *After touching a resident or handling his or her belongings. On 7/12/10 at 8:55 A.M. interview with MA-N revealed "I used the gel". MA-N confirmed when going "from a resident to another resident must remove gloves and hand wash". On 7/12/10 at 9:45 A.M. interview with the Staff Development Registered Nurse- RN-F confirmed "if remove gloves, equals hand washing". B. On 7/7/10 at 6:50 A.M. the Licensed Practical Nurse, LPN-M, completed hand washing for 5 seconds prior to the beginning of the Glucometer check. After completion of the Accu check procedure using the Glucometer machine, LPN-M removed the hand gloves, took the Glucometer machine to the medication cart and placed it on the top surface of the cart. LPN-M proceeded to administer insulin to the resident. After removing the hand gloves, no hand washing completed, and the LPN charted the insulin given. LPN-M donned gloves obtained a Super Sani Cloth wipe and cleansed the outside of the Glucometer and then placed it in a small basket on top of the medication cart. LPN-M removed the gloves. Hands were never cleansed with hand washing and or gel. On 7/12/10 at 10:20 A.M. interview with… | 2014-09-01 |
| 12206 | 12206 | ST. JOSEPH VILLA NURSING CENTER | 285078 | 2305 SOUTH 10TH STREET | OMAHA | NE | 68108 | 2010-07-12 | 368 | E | 0 | 1 | 2KMG11 | Based on interview and observation, the facility failed to offer each resident a snack before bedtime. The sample size was 29 with 5 non sampled residents and the facility census was 170. Findings are: A Observation was made of the evening staff on July 7, 2010 from 8PM to 9PM. There was a large bin with labeled snacks and a smaller bin with unlabeled snacks on the North Nurses Station desktop. At 8 PM the large bin was nearly full the small bin was partially full. At 9 PM it was noted that the labeled snacks had been passed. Most of the unlabeled snacks were still in bin. Observation of the South Nurses Station revealed there was also a large bin with labeled snacks and a smaller bin with 25 unlabeled snacks in it. LPN U was observed passing the snacks with the labels. In an interview with LPN U, it was revealed that the labeled snacks are for diabetics and those always get passed out by staff. The non-diabetic snacks are not passed " that ' s strictly on a first come first serve basis " . Staff member U stated residents come to desk if they want a snack. When asked if staff are required to go room to room to offer snacks, LPN U answered " no " . B.. In the group discussion that was held on July 6, 2010, residents of the facility stated that not every resident is offered snacks every evening. When asked the procedure the residents stated the snacks sit at the nurses station and you go get them if you want one. C. In an interview conducted in evening of July 7, 2010 between 8 and 9 PM Resident 33 was asked if snacks were offered every night. Resident 33 stated snacks were not offered in the rooms at night. In an interview conducted in evening of July 7, 2010 between 8 and 9 PM, Resident 31 stated that if asked the aide would go get a snack but the snacks are not offered. In an interview conducted in evening of July 7, 2010 at 9 PM Resident 34 stated no snacks had been offered that night in the room. Resident 34 stated that snacks are not always offered but occasionally ice cream is offered. | 2014-09-01 |
| 12680 | 12680 | GOLDEN LIVINGCENTER - SCHUYLER | 285110 | 2023 COLFAX STREET | SCHUYLER | NE | 68661 | 2010-07-12 | 242 | E | L8LX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.05 (4) Based on observation and interview, the facility failed to honor food preferences for eight residents (Residents 1, 11, 14, 15, 16, 17, 18 and 19) and failed to honor preferred seating arrangements in the dining room for five residents (Residents 14, 15, 16, 17 and 18). Sample size was 13 plus 8 non sampled residents. The facility census was 49. Findings are: A. Review of Resident 11's undated record of admission revealed that Resident 11 was admitted to the facility on [DATE]. Observation of the noon meal on 7/6/10 revealed that Resident 11 was served a plate with spinach. Resident 11 was overheard saying," I don't like spinach. I have told them that. I can't even stand to smell it." Interview with Resident 11 on 7/12/10 at 11:30 AM revealed, "I have told them (facility staff) repeatedly since I got here that I can't stand the smell of spinach but they keep serving it to me." Interview with the RD on 7/12/10 at 11:45 AM revealed that all food preferences are to be entered into the computer system and will then appear on the dietary cards as indicated. When requesting a list of preferences for Resident 11 the RD revealed that spinach was not listed on the system as a dislike for Resident 11 but that the RD would enter it now. When asked if the RD was previously aware that Resident 11 did not like spinach the RD replied, "yes". B) Review of the Resident Council minutes of June 1st, 2010 revealed a note which had been added to the minutes which read: " Had a short meeting with most of the residents on June 28th, 2010 after golden stretchers, about all the tables with assisted eating residents were moved by the windows and the residents by the windows moved by the kitchen. The reason was : to let the air conditioning on high until serving meal, then on low during the meal, but turned back up when the assisted eating residents are done eating and taken out of the dining room." This addition to the… | 2014-04-01 | ||
| 12681 | 12681 | GOLDEN LIVINGCENTER - SCHUYLER | 285110 | 2023 COLFAX STREET | SCHUYLER | NE | 68661 | 2010-07-12 | 311 | D | L8LX11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.09 D1b Based on observation, interview and record review the facility failed to consistently implement an individualized toileting plan for 2 residents, Residents 5 and 6. The facility census was 49 with 13 sampled and 8 non-sampled residents. A) Review of Resident 5's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 5/17/10 indicated that Resident 5 required assistance of 2 persons to transfer to the toilet. During the initial tour of the facility on 7/6/10 at 10 AM the Assistant Director of Nursing (ADON) stated that Resident 5 was incontinent and transferred via a Sara Lift (a mechanical devise used to lift residents to a standing position) with 2 persons assisting. Observation of cares on Resident 5 on 7/7/10 at 11:15 AM revealed the resident being transferred from a recliner to the bed via the Sara Lift. After being transferred to the bed by Nursing Assistants A and B Resident 5's incontinent briefs were changed and Resident 5 was again transferred via the Sara Lift from the bed to the wheel chair and escorted to the dining room. Resident 5 was not offered the opportunity to be placed on the toilet or a bedside commode. Review of Resident 5's Comprehensive Care Plan revealed a problem of, "Needs assistance with ADLs (Activities of Daily Living) ....Requires 2 assist with transfers, dressing and toileting." An entry dated 12/07/09 "Harder time transferring and at times needs sit to stand lift." One of the (undated) interventions for this problem states, "Functional incontinence program and requires to be toileted upon request...upon getting up in the morning 6-8:30 AM and after breakfast 9:30 to 10:30 AM, prior to supper 3-5PM at HS (bedtime)..." Review of Resident 5's record did not reveal documentation that an individualized toileting assessment had been completed. On 7/08/10 at 9:45 AM Nursing Assistant B was interviewed. When asked what the toileting program was for Resident 5 Nursing Assistant B stated reside… | 2014-04-01 | ||
| 12682 | 12682 | GOLDEN LIVINGCENTER - SCHUYLER | 285110 | 2023 COLFAX STREET | SCHUYLER | NE | 68661 | 2010-07-12 | 253 | E | L8LX11 | Licensure Reference Number 175 NAC 12-007.18B3 Based on observations and interviews, the facility failed to maintain wheelchairs to assure safe, cleanable surfaces for 3 residents (Resident 5, 12, 21). Sample size was 13 plus 8 non-sampled residents. The facility census was 49. Findings are: A. Observation of Resident 5's wheelchair on 7/7/2010 at 8:30 am revealed the covering on the left armrest was cracked and non-cleanable. Observation of Resident 12 ' s wheelchair on 7/7/2010 at 8:30 am revealed both the right and the left wheelchair armrest were cracked, creating a non-cleanable surface. Observation of Resident 21 ' s wheelchair on 7/7/2010 at 8:30 am revealed the plastic frame of the left armrest was broken creating potential for injury. Interview with the maintenance supervisor at final meeting on 7/12/2010 at 3:00 pm reported that he was in charge of maintaining the wheelchairs and he only knew about them needed repair when the staff reported it to him. He stated that staff had notified him of Resident 5's wheelchair needing repair on 7/12/2010. | 2014-04-01 | ||
| 12895 | 12895 | SIDNEY REGIONAL MEDICAL CENTER | 2.8e+294 | 645 OSAGE STREET | SIDNEY | NE | 69162 | 2010-07-12 | 315 | D | 5DNG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: NAC 175 12-006.09D3 Based on observations, record reviews, and interview; the facility failed to ensure the use of an indwelling catheter was medically justified and assess and evaluate the bladder function and continued use of an indwelling catheter for 1 resident (Resident 45). The facility census was 53 and the sample size was 12 current residents. Findings are: Review of Resident 45's "History and Physical" dated 4/5/10 revealed the resident had [DIAGNOSES REDACTED]. Review of Resident 45's "Initial Physical Assessment" revealed the resident was admitted on [DATE]. Further review revealed the resident was admitted with an indwelling foley catheter. Observation on 7/8/10 at 7:25 AM revealed Resident 45 had an indwelling catheter. Review of Resident 45's medical record revealed no evidence of a [DIAGNOSES REDACTED]. Further review revealed no evidence that an assessment or evaluation to determine the bladder function or appropriateness of the continued use of the indwelling catheter had been completed. Interview on 7/12/10 at 3:30 PM with LPN/MDS Coordinator A (Licensed Practical Nurse/ Minimum Data Set) confirmed that Resident 45 did not have a diagnosis, assessment, or evaluation for the continued use of a catheter. | 2014-03-01 | ||
| 12896 | 12896 | SIDNEY REGIONAL MEDICAL CENTER | 2.8e+294 | 645 OSAGE STREET | SIDNEY | NE | 69162 | 2010-07-12 | 514 | D | 5DNG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC 12-006.16B (1) Based on record review and interviews, the facility failed to complete and sign a baseline depression scale form for one sampled resident (Resident 36) receiving routine anti-depressant medication. Sample size was 12 current residents. Facility census was 53. Findings are: Record review of Resident 36's chart revealed from Resident 36's "Resident Master Information" form that Resident 36 was admitted to the facility on [DATE]. Review of Resident 36's "Medication Record" forms revealed that Resident 36 received "[MEDICATION NAME] 10 mg (milligrams)" routinely every day since admission to the facility. Review of Resident 36's "Geriatric Depression Scale (Short Form)" dated 1/22/10 revealed that questions 7, 8, 10, and 15 of the form had not been completed. There was no score total tallied on the form to indicate the level of depressive symptoms assessed. There was no signature by the person obtaining the information on the form. Interviews with the MDS (Minimum Data Set, a federally mandated comprehensive assessment tool utilized to develop resident care plans) Coordinator, LPN-A on 7/12/10 at 3:30 PM and the DON (Director of Nursing) on 7/12/10 at 3:40 PM verified the depression scale form was not completed to determine Resident 36's level of depressive symptoms at the time of admission. LPN-A and the DON both stated that the facility procedures were for licensed nursing staff to complete and sign the form at the time of resident admission to the facility. | 2014-03-01 | ||
| 12897 | 12897 | SIDNEY REGIONAL MEDICAL CENTER | 2.8e+294 | 645 OSAGE STREET | SIDNEY | NE | 69162 | 2010-07-12 | 279 | D | 5DNG11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09C1a Based on record review and interviews, the facility failed to develop care plan problems, goals, and interventions for 1 sampled resident (Resident 1) at risk for skin impairment. Sample size was 12 current residents. Facility census was 53. Findings are: Review of Resident 1's "Annual assessment" MDS completed on 5/19/10 revealed that Resident 1 was assessed as having "Skin desensitized to pain or pressure". Review of the corresponding RAP (Resident Assessment Protocol) Summary form accompanying the assessment revealed that Resident 1 had triggered a "RAP Problem Area" for "Pressure Ulcers" and that additional RAP documentation could be found in the "Pressure Ulcer RAP" on 5/19/10. The RAP Summary form also indicated that a "Care Planning Decision" for this problem was "addressed in care plan". Review of Resident 1's "Pressure Ulcers RAP Module" dated 5/19/10 included documentation that a care planning decision to "proceed" was determined following assessment. "Additional Notes" on the form read: " ... Resident is at risk for impaired skin related to requiring extensive assistance with bed mobility. Does not independently reposition self while in chair. Has urinary incontinence and some episodes of bowel incontinence ..." Review of Resident 1's "Long Term Care Plan" modified on 5/25/10 revealed that no problem area, goals, or interventions had been developed on the resident's care plan pertaining to the risk for impaired skin identified on the RAP summary form and RAP documentation. Interviews with the MDS Coordinator, LPN-B on 7/12/10 at 3:30 PM, and the DON (Director of Nursing) on 7/12/10 at 3:40 PM verified that Resident 1's risk for skin impairment had not been developed on the resident's care plan. | 2014-03-01 | ||
| 12898 | 12898 | SIDNEY REGIONAL MEDICAL CENTER | 2.8e+294 | 645 OSAGE STREET | SIDNEY | NE | 69162 | 2010-07-12 | 250 | D | 5DNG11 | Licensure Refernce Number: NAC 175 12-006.09D5a Based on observation, record reviews, and interviews; the facility failed to identify medically related social services needs for 1 resident (Resident 26) in regards to obtaining medication. The facility census was 53 and the sample size was 12 current residents. Findings are: Observation on 7/8/10 at 6:35 AM revealed Resident 26 had an indwelling catheter. Review of Resident 26's consultation report dated 3/19/10 from the resident's Urologist (specializes in the disorders of the urinary tract) revealed: recurrent urinary tract infections, urgency, frequency, and incomplete bladder emptying. Review of Resident 26's consultation report dated 4/16/10 from the resident's Urologist revealed: in reviewing the medications, the resident is supposed to be taking Vesicare (medication used for overactive bladder) 5 mg (miligrams) every other day, the resident is actually not taking it at all. Further review revealed: chronic urinary tract infections, frequency, urgency, and urge incontinence. Restart Vesicare 5 mg every other day as previously ordered. Review of Resident 26's consultation report dated 5/28/10 from the resident ('s Urologist revealed "the resident was supposed to be taking Vesicare, however, apparently the Medicare Part D plan will not cover Vesicare....the majority of the office visit was spent discussing a plan to get the resident on medications versus placing a catheter...." Interview with the SSD (Social Services Director) on 7/12/10 at 3:40 PM revealed the SSD was responsible for assisting residents with prescription drug plans. The SSD was not aware of any issues regarding Resident 26's medications not being covered under the resident's current medication plan. When questioned if the medication plan could be changed if a new medication was ordered that wasn't covered by the current plan, the SSD indicated that it is possible to change plans and search for a plan that might cover the new medication. Interview with the DON (Director of Nursing) on 7/12/10 … | 2014-03-01 | ||
| 12899 | 12899 | SIDNEY REGIONAL MEDICAL CENTER | 2.8e+294 | 645 OSAGE STREET | SIDNEY | NE | 69162 | 2010-07-12 | 225 | D | 5DNG11 | Licensure Reference Number 175 NAC 12-006.02 (8) Based on record reviews and staff interview, the facility failed to investigate and report an accident with significant injuries for 1 current sampled resident (Resident 36) to the state agency within the required timeframe. The facility census was 53 with 12 current sampled residents. Findings are: Review of the facility "Investigative Report Incident/Unusual Occurrence" revealed that on 6/20/10, Resident 36 fell and had left radial, ulnar, humerus fractures and pubic rami fractures. Further review revealed that the investigation of this accident was started on 6/29/10 and was reported tot the state agency on 7/1/10. Interview on 7/12/10 at 1:30 PM with the Administrator confirmed that the investigation was not started immediately and completed within 5 working days and the state agencies were not notified within these time frames as required. Review of the facility procedure "Suspected Resident Abuse or Neglect", dated 9/15/98, revealed the following: ". .. 5. Investigation Procedure: . . . c. The Administrator of Long Term Care and/or Director of Nursing is responsible to: A. Investigate the abuse/alleged abuse . . . C. Provide the agencies, initially contacted, with a follow up report. . . . d. The process will be completed within 5 working days of the actual incident and faxed and mailed to the appropriate agency. . . . ". | 2014-03-01 | ||
| 12956 | 12956 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 253 | E | 5S8Y11 | LICENSURE REFERENCE 175 NAC 12-006.18A Based on observation, interview and record review; the facility failed to ensure that 2 out of 4 observed shower chairs were free from visible soiling and foreign material and that 2 of 8 observed bathroom doors (rooms 101, 209) were in smooth, cleanable condition. Facility census was 41. Sample size was 11 with 6 additional non sampled residents. Findings are: A. Observations during a tour of the environment on 7/13/10 at 8:20am revealed that 2 of 8 observed wooden bathroom doors had numerous holes, chips and/or sheared ragged areas. (Rooms 101, 209) An interview with the Maintenance Supervisor on 7/14/10 at 2:50pm indicated that (staff) was unaware of the condition of the doors, and review of the maintenance work request book with the Maintenance Supervisor at that time confirmed that no request for repair had been documented. B. Observations of the shower chairs in the North Shower House on 7/13/10 at 11:35am revealed that 2 shower chairs had visible brownish pink soil and buildup on underside areas of the frame. An interview with Bath Aide Z on 7/13/10 at 11:45am confirmed that the undersides of the chairs needed to be re-cleaned. | 2014-01-01 | ||
| 12957 | 12957 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 371 | F | 5S8Y11 | LICENSURE REFERENCE 175 NAC 12.006.11E Based on observation, interview, and record review; the facility failed to ensure that cooked ready to eat foods were stored in a manner to protect from potential contamination, sanitizer was used according to manufacturers direction, scoops were clean and free from dried food debris before use, foods were held for serving at required temperatures, food thermometers were accurate, gloves were used according to standards, and that ready to eat foods were not handled with bare hands. These deficient practices had the potential to affect all residents. Facility census was 41. Sample size was 11 with 6 additional non sampled residents. Findings are: A. An observation during an initial tour of the kitchen on 7/12/10 at 6:20am revealed that a reach in cooler was in use in the back hallway of the kitchen. The cooler contained a variety cooked and raw food items. Further observation revealed that the middle shelf of the cooler held 2 approximately 10 pound raw beef briskets. A cooked apple pie was on the same shelf as the raw briskets. An interview with Cook W at that time indicated that the pie had been placed by the raw meat by the previous shift kitchen. An interview with the Dietary Manager on 7/13/10 at 2:00pm indicated expectations were that raw meats would be stored below ready to eat food products. Review of the 7/1/2007 version of the "Food Code", based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following:" 3-302.11 Food shall be protected from cross contamination by 1a) separating raw animal foods during storage from cooked ready to eat food.." B. An observation on 7/12/10 at 10:55am revealed that Dietary Aide (DA)Y had prepared a bucket of sanitizing solution for use in the kitchen. An interview with DA Y confirmed that the solution would be used to wipe down counters and tables in the kitchen and dining area. DA Y was observed to test the solution with a test strip… | 2014-01-01 | ||
| 12958 | 12958 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 365 | E | 5S8Y11 | LICENSURE REFERENCE 175 NAC 12-006.11A2 Based on observation and interview, the facility failed to ensure that pureed foods were of an appropriate consistency for 5 residents who received pureed foods (Residents 3, 8, 9, 14, 15). Facility census was 41. Sample size was 11 with 6 non sampled residents. Findings are: An interview with Cook X on 7/12/10 at 8:00am revealed that pureed foods were prepared at each meal for 5 residents and indicated that the list of those residents was on the bulletin board in the kitchen. An observation of the list at that time revealed that Resident 3, 8, 9, 14 and 15 were to receive pureed food items. An observation of the noon meal serve out on 7/12/10 at 12:24 revealed that Cook X took a pan of pureed Salisbury steak out of the oven and sat it out on the counter by the serving window. Cook X removed the foil cover from the pan, stirred the contents with a scoop and stated "it got a little scorched on the bottom". The appearance of the pureed Salisbury steak at that time was dry with dry scorched pieces mixed in. A taste test of the pureed Salisbury steak with the Dietary Manager on 7/12/10 at 12:55pm confirmed that the finished product appeared to be scorched on the bottom, was dry in mouth and that it should not have been served. An observation of the noon meal serve out on 7/13/10 at 12:30pm revealed that pureed baked beef brisket had been prepared for residents who received pureed foods. Cook W placed a serving of the pureed beef on a plate for Resident 9. No gravy or broth was added to the serving. Further observations revealed that no gravy or broth was added to the pureed beef servings for any residents receiving pureed beef. A taste test of the pureed baked beef brisket on 7/13/10 at 12:50pm with Cook W revealed that the beef was dry and not of a moist, smooth consistency. Cook W confirmed at that time that no gravy had been made for lunch and stated "I should have put some broth on that, it is a little dry". An interview with the Dietary Manager on 7/14/10 at 2:30pm indicat… | 2014-01-01 | ||
| 12959 | 12959 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 363 | F | 5S8Y11 | LICENSURE REFERENCE 175 NAC 12-006.11A1 Based on observation, record review, and interview; the facility failed to ensure that correct serving sizes of foods were offered to residents. Facility census was 41. Sample size was 11 with 6 additional non sampled residents. Findings are: An observation on 7/12/10 at 12:45pm out revealed that the lunch menu included Salisbury steak in gravy, mashed potatoes and gravy, cooked broccoli, dinner roll and '7 Up' cake. Further observation revealed that residents with puree diet orders were served a #16 scoop (1/4 cup) of pureed Salisbury steak and a #16 scoop (1/4 cup) of pureed broccoli. Residents with regular diet orders were served one Salisbury steak cooked within a gravy sauce. No extra gravy was observed to be added to the Salisbury steaks as served. Upon request, Cook X used the facility scale and weighed a salibury steak coated with the gravy sauce it was cooked with, as served to the residents. Cook X confirmed the observed weight was slightly above 2 ounces. A review of the facility recipe for Salisbury steak puree revealed that the serving size was #10 scoop (2/5 cup). A review of the menu card revealed the serving size for broccoli residents receiving pureed foods was 1/2 cup (#8 scoop) and the serving size for Salisbury steak with gravy was 3 ounces. An observation on 7/13/10 at 12:30pm revealed that baked beef brisket was one of the lunch menu offerings. Further observation revealed that residents with puree diet orders were served a #12 (1/3 cup) scoop of pureed baked beef brisket and a #8 (1/2 cup) scoop of mashed potatoes. No gravy was available for the beef or potatoes. A review of the menu card revealed pureed baked beef brisket serving size was 4 ounces (1/2 cup) and that 2 ounces of gravy was to be served with the pureed food offerings. An interview with the Dietary Manager on 7/12/10 at 3:40pm revealed that the cooks who served meals were expected to follow the serving sizes indicated on the recipe or on the menu card. The Dietary manager stated that the… | 2014-01-01 | ||
| 12960 | 12960 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 246 | D | 5S8Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.18B1 Based on observation, record review, and interview; the facility failed to ensure that the call light was within reach for 1 resident (Resident 5). The facility census at the time of survey was 41 residents. The sample size was 11 sampled residents with 6 non-sampled residents. Findings are: A review of Resident 5's DAILY CARE PLAN dated 5/25/2010 revealed to keep the call light within reach. The Care Plan also revealed assistance of staff to transfer Resident 5 from the wheelchair to the bed and assistance from the bed to the wheelchair. A review of Resident 5's TRANSFER AND BED MOBILITY STATUS TOOL assessment dated [DATE] revealed; Extensive assistance for transfers; able to participate in part of the activity. Able to bear some weight for periods of time but needs weight bearing or balance assistance. Observation on 7/13/2010 at 8:47AM revealed the Resident 5 in the wheelchair in room at bedside with call light cord not within reach. Call light cord against wall behind bed. Resident 5 states "I want to go to bed" and self-transferred from the wheelchair to the bed. Resident 5 had chair alarm that was sounding while transferring. Interview on 7/13/2010 at 9:20AM with Nursing Assistant (NA) A revealed the call light was at foot of the bed where Resident 5 could not reach it. Resident 5 was lying in the bed at this time with eyes closed. NA A stated, "The call light should be where Resident 5 can reach it not down at the foot of the bed." Observation on 7/13/2010 at 12:35PM revealed the call light by wall not within reach. Resident 5 not in room at this time. Observation on 7/13/2010 at 1:00PM revealed Resident 5 in the room and the call light on the opposite side of the bed against the wall and not within reach for resident. Observation on 7/14/2010 at 8:43AM revealed Resident 5 in the room and call light not within reach on opposite side of bed against the wall. Resident 5 self-transferred from… | 2014-01-01 | ||
| 12961 | 12961 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 281 | E | 5S8Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview; the facility failed: to 1) provide medications according to the physician's order for 1 resident (Resident 12); 2) to provide eye medications in accordance with standards of practice for 1 resident (Resident 3); and 3) to provide 1 resident (Resident 5) with Prafo boots and splints according to physician's orders. The facility census at the time of survey was 41 residents. The sample size was 11 sampled residents, with 6 additional residents selected for non-sampled review. Findings are: LICENSURE REFERENCE NUMBER 175 NAC 12-006.10 A. Observation of Medication Administration by the facility Interim Director of Nursing (DON) on 7/12/2010 at 8:12AM; revealed that after checking the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The DON took the cup to the table, and after giving the resident oral medications on a spoon, stirred the cup with the [MEDICATION NAME] powder in it. After stirring, the DON handed the resident the cup with the [MEDICATION NAME]. The resident promptly drank the mixture. The DON then turned away from the resident and left the table to return to the medication cart. The resident was not observed drinking other fluids and the DON did not offer any additional fluids to the resident at the time. Observation of Medication Administration by Registered Nurse (RN) A on 7/13/2010 at 8:25AM; revealed that RN A measured Miramax and poured it into a plastic cup on the Medication Cart. RN A then added water so that the cup was approximately 3/4 full. RN A stirred the mixture and then proceeded to the table where Resident 12 was sitting. RN A handed the resident the cup and the resident immediately drank the [MEDICATION NAME]/water mixture. After watching the resident swallow the liquid, RN A left the table and returned to the medication cart. RN A was not observed offering the resident additional fluids or encouraging the resident to drink addit… | 2014-01-01 | ||
| 12962 | 12962 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 282 | D | 5S8Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C Based on observation, record review and interview; the facility failed to implement and follow the care plan interventions for 2 residents (Residents 5 and 3). The facility census at the time of the survey was 41 residents. The sample size was 11 residents with 6 non-sampled residents. Findings are: A. A record review of Resident 5's RESIDENT CARE PLAN dated 5/17/2010 revealed; -- the resident is to have the call light within reach and -- the resident is to have the Prafo Boot on the right leg while sleeping. Approach start date for both of these approaches was 2/16/2010. -- the resident is to wear the right hand splint per Occupational therapy schedule with the approach date of 10/7/2009. A record review of Resident 5's PHYSICIAN ORDERS [REDACTED]. --the resident is to have Prafo boot to the right leg while in bed and use the kick stand to position the foot in neutral position and --the resident is to have Splint to right hand on at 9:00AM for 2 hours and on at 2:00PM for 2 hours. Observation of Resident 5 on 7/12/2010 at 10:00AM and 7/13/2010 at 10:45AM revealed; the resident had no right hand splint on at this time. Observation of Resident 5 on 7/13/2010 at 5:00PM and on 7/14/2010 at 11:50AM revealed; the resident had the right hand splint still on the right hand. Observation of Resident 5 on 7/12/2010 at 10:00AM and on 7/13/2010 at 8:47AM and 9:20AM revealed; the resident in bed with no Prafo boot on right leg. Observation of Resident 5 on 7/13/2010 at 8:47AM, 9:20AM, 12:35PM, and 1:00PM revealed; the resident did not have the call light within reach. The resident self-transferred from the wheelchair to the bed on 7/13/2010 at 8:47AM and on 7/14/2010 at 8:43AM. Interview with ASSISTANT DIRECTOR OF NURSING on 7//14/2010 at 10:50AM revealed; the resident is always suppose to have the call light within reach and this is care planned. Resident 5 has a history of falls. Resident 5 is suppose to hav… | 2014-01-01 | ||
| 12963 | 12963 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 312 | E | 5S8Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D3(3) Based on observation, record review and interview, the facility failed to provide complete pericare for 3 residents (Residents 3, 4 and 5). The facility census at the time of survey was 41 residents. The sample size was 11 sampled residents with an additional 6 residents selected for non-sampled review. Findings are: A. A review of Resident 3's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 4/1/2010; revealed that the resident: - Required extensive assistance of two staff with toileting; - Required total assistance of two staff with personal hygiene issues; AND - Was occasionally incontinent of bladder (two or more times a week, but not daily). A review of Resident 3's RESIDENT CARE PLAN (7/6/2010); revealed that when Resident 3 is acutely ill or lethargic, two staff members are required for transfers and toileting. Observation of pericare for Resident 3 on 7/13/2010 at 11:45AM, revealed Nursing Assistant (NA) D and NA E in the resident's room standing by the resident who was lying on the bed. A gait belt was applied around the resident's waist and the resident's shoes were put on. Both staff members assisted Resident 3 to a sitting position on the side of the bed. Resident 3 was then assisted to a standing position, the resident's pants were pulled down and the resident was assisted onto a bedside commode by both staff members. Both staff members had gloves on prior to getting the resident out of bed. NA D was on the left side of the resident and NA E was on the right side. They assisted Resident 3 to a standing position by cueing the resident using a walker and a gait belt. NA D took 1 premoistened wipe out of the package that was lying on the Resident's bed and proceeded to wipe the underside of Resident 3's panniculus and groin on each side, without turning the wipe. NA D then folded the wipe in half and made one swipe from the front… | 2014-01-01 | ||
| 12964 | 12964 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 280 | E | 5S8Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C1c Based on observation, review of resident records and interviews; the facility failed to review and revise the comprehensive care plan to meet current needs with measurable goals for 4 (Residents 6, 10, 9 and 3) residents. The facility census was 41. The sample size was 11 plus 6 non-sampled residents. Findings are: A. Review of the Admission Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 02/19/2001 for Resident 6 revealed: -No nutritional problems, no weight change in the past 30 to 180 days; -Nutritional approaches: provide a therapeutic diet and is on a planned weight change program. Review of the RAP (Resident Assessment Protocol Summary) dated 03/03/2010 for Resident 6 revealed: -Therapeutic Diet of reduced concentrated sweets for DM (diabetes mellitus). Intakes is 88-100% and receives an HS (bedtime) snack. Review on 07/14/2010 of Physician Orders, dated 06/22/2010 revealed: -"...restrict fluids (with) 48ounces daily". Review of the MAR (Medication Administration Record) July/2010 revealed: -06/22/10 "restricted fluids to 48oz (ounces) (1440cc/cubic centimeters) daily. Review of the NURSE'S NOTES for Resident 6 revealed: -06/22/10 "...new orders noted....dietary notified of fluid restriction. (water) pitcher removed from room. Resident aware of all new orders..."; -06/24/10 "....continue on fluid restriction.."; -06/27/10 "...1:1 (with) resident about fluid restriction. Educated on intake....not having cups/water in room...Resident voiced understanding of restrictions. Aware of heart (diagnosis) and importance of being compliant (with) fluid restriction of 1440cc. Resident requesting to review ...intake log and inform nurse on where...would like to (decrease) fluids. Copy given to the dietary manager"; -06/28/10 "...agreed to prior fluid restriction sheet"; -06/29/10 "..requesting glass of (water) 1:1 (with resident)..fluid restrictio… | 2014-01-01 | ||
| 12965 | 12965 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 431 | D | 5S8Y11 | Licensure Reference Number: 175 NAC 12-006.12E5 Based on observation and staff interview; the facility failed to store medications requiring different routes of administration separately (from other routes) for 2 (Resident 16 and 17) residents. Facility census was 41. Sample size was 11 plus 6 non-sampled residents. Findings are: During a random audit for storage of medications and supplies in the medication carts the following was revealed: A. Resident 16 had three medications stored in one container without dividers. One medication is taken oral (by mouth) and two medications are instilled (eye drops) into the eyes. -Slow-Delay ER 64mg (milligrams) Tab (tablet) Slow Mag 3 tabs (192mg) by mouth every morning with breakfast (Do not crush or chew) Bulk; -Temolo opth (ophthalmic) 0.5% drops Timoptic Instill 1 drop in each eye daily; -Tranatan 0.004% drop Instill 1 drop in each eye at bedtime. B. Resident 17 had three medications stored in one container without dividers between medications administered by different routes (oral and inhalation). One medication given by mouth, one medication given by nebulizer four times a day and "as needed basis" and one medication given by nebulizer twice a day. -Boniva 150mg tab Take one tab by mouth every month w/8oz (with 8 ounces) of H2O (water) 60 minutes before food/med (medication) Bev (beverage). Stay upright; -Albuterol 0.5ml (milliliter) solution Mix 0.5ml (with) ipratropium via nebulizer four times daily Mix 0.5ml (with) ipratropium via nebulizer as needed; -Budesonide Inhalation Suspension 0.25mg/2ml Inhale 2ml (0.25mg) via nebulizer twice daily Rinse mouth after use. Interview with LPN Q on 07/13/10 at 10:30AM at the Medication Cart revealed: This shelf provided storage of medications that were not "bubble packed" (specific plastic wrapping of pills). Medications belonging to one resident were stored into one section/cube. Medications were not separated from each other according to routes (oral/swallow, inhaled, instilled/drops, from topical and/or sublingual/under the… | 2014-01-01 | ||
| 12966 | 12966 | CRESTVIEW CARE CENTER | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2010-07-14 | 318 | D | 5S8Y11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D4 Based on record review and interview, the facility failed to ensure that 1 resident (Resident 3) was provided restorative services in accordance with the resident's individualized restorative program. The facility census at the time of survey was 41 residents. The sample size was 11 sampled residents with an additional 6 residents selected for non-sampled review. Findings are: A review of Resident 3's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated 4/1/2010, revealed that the resident had a limitation in range of motion on one side of the body in the arm (including shoulder or elbow) and in the leg (including hip or knee). A review of Resident 3's NURSING REHAB/RESTORATIVE PROGRAM revealed that the resident was to receive restorative exercises three times weekly, consisting of UE (upper extremity) therapeutic exercises to maintain ROM (range of motion - the normal range of movements of the joints) to prevent discomfort; and was to ambulate 150 ft three times weekly and perform NuStep exercises to maintain LE (lower extremity strength). A review of Resident 3's NURSING REHAB/RESTORATIVE PROGRAM dated 6/2010, revealed that the resident received: - The week of 6/6/2010 - 6/12/2010 - exercises on 6/7 and 6/10. - The week of 6/13/2010 - 6/19/2010 - exercises on 6/14 and 6/18. - The week of 6/20/2010 - 6/26/2010 - exercises on 6/21 and 6/24. A review of Section III of the form (Resident's response and progress toward goals) revealed no documentation regarding why Resident 3 did not receive the restorative program three times weekly as the program was written. Interview with Restorative Aide (RA) C on 7/13/2010 at 9:50AM, confirmed that Resident 3 was supposed to receive restorative exercises three times weekly. RA C stated, "maybe it got documented somewhere else or maybe it got missed, I'm not sure". Interview with the facility ADON on 7/14/2010 at 12:10PM, revealed that the ADON was also the facility Restorative Coo… | 2014-01-01 | ||
| 12704 | 12704 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2010-07-21 | 323 | E | O8E211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.18E1 Based on observations, record review and staff interview; the facility failed to assure the environment was free from safety hazards as Resident 34's side rail (A side rail is a barrier extending upward at the side edges of the bed. It can be located on either one or both sides of the bed and extends either a partial distance or the entire length of the bed. The side rails can be used by the resident to assist with transfers, turning, and bed mobility.) use was not assessed as a potential risk for injury. In addition, the medication room door was left open and the area was not monitored for 10 minutes on 7/19/10 which allowed access to 10 residents of the facility who were at risk for wandering. A box of medications was sitting on a shelf in the medication room. Total sample size was 12 and facility census was 47. Findings are: A. Review of Resident 34 ' s Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 10/9/09 indicated [DIAGNOSES REDACTED]. The same MDS indicated the resident had short-term memory problems and moderately impaired cognitive skills for daily decision-making, required total assistance with transfers and bed mobility, and used a type of side rail daily. Review of the Bed Rail/Side Rail/Assist Bar Screening Tool dated 10/3/09 revealed side rails and/or other devices were not indicated for Resident 34. Review of a Resident/Visitor Incident Report dated 10/25/09 revealed Resident 34 had been restless while in bed and got left hand caught " between Assist bar & (and) mattress " . The form indicated Resident 34 sustained a 3 centimeter (cm) by 5 cm bruise to the left wrist with a 1 cm skin tear at the center of the bruise. The form indicated the facility initiated use of a U-shaped pillow (a pillow in the shape of a U with long sides that can be draped around the resident and used to position the resident in bed) since the resident … | 2014-04-01 |
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CREATE TABLE [cms_NE] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );