cms_NV
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6,037 rows sorted by facility_name
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2220 | 2220 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-01-09 | 580 | D | 0 | 1 | UY9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review, the facility failed to ensure physician notification was completed for 1 resident who refused blood sugar monitoring, (Resident #101.) Findings include: Resident #101 (R101) R101 was admitted on [DATE], with [DIAGNOSES REDACTED]. The physician's orders [REDACTED]. The Medication Administration Record [REDACTED]. The Nurse Progress Note dated 12/10/18 and 12/11/18, documented R101 refused the blood sugar check. The facility lacked documented evidence in R101's medical record the Physician was notified regarding R101's refusal for blood sugar check. On 01/09/19 10:50 AM, the Licensed Practical Nurse (LPN) confirmed R101 was a diabetic and had been refusing the blood sugar check for three consecutive days from 12/10/18 to 12/12/18. The LPN confirmed the physician was not notified. The LPN indicated the Physician should have been notified. On 01/09/19 11:53 AM, the Director of Nursing indicated the staff were expected to notify the physician if the resident had been refusing the blood sugar check for three consecutive days. A facility policy titled Change in Patient Condition dated 03/12/18, revealed the facility staff would have notified the resident's attending Physician or on-call Physician for the refusal of treatment or medications for two or more consecutive times. | 2020-09-01 |
| 2221 | 2221 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-01-09 | 660 | D | 0 | 1 | UY9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review, the facility failed to ensure a discharge plan of care was documented timely in the medical record for 1 of 1 resident (Resident #251). Findings include: Resident #251 (R251) R251 was admitted [DATE] with [DIAGNOSES REDACTED]. A hospital discharge summary dated 01/03/19, indicated R251 lived in an apartment with a son who had a [DIAGNOSES REDACTED]. The summary indicated R251 required physical rehabilitation to restore prior level of function and assistance with discharge planning. A nurses note dated 01/06/19 indicated R251 was concerned regarding the facility's discharge plan. On 01/08/19 at 11:11, R251 revealed having difficulty sleeping due to increased anxiety over the facility's discharge plan. R251 indicated not being able to pay utility bills and arrange care for a pet dog. On 01/08/19 at 11:15 AM, R251 indicated being unaware of the discharge location. R251 revealed residing in an apartment independently prior to admission. R251 indicated being told that a group home would be an alternate discharge location. R251 did not know the reason for not being able to return home. On 01/09/19 at 9:00 AM, a Certified Nursing Assistant (CNA) indicated being told by the R251 on 01/07/19 that R251 did not want to live with the son. The CNA stated R251 was worried of the son being unemployed. On 01/09/19 at 10:27 AM, the Transitional Care Coordinator indicated being in charge of assisting the R251 with discharge planning. Transitional Care Coordinator revealed R251 preferred to be discharged back to home with the son and an alternate discharge location was discussed. On 01/09/19 at 10:40 AM, the Transitional Care Coordinator revealed not being aware of R251 having a pet dog at home or any concerns with paying utility bills. On 01/09/19 at 10:41 AM, the Transitional Care Coordinator revealed not documenting after each discussion with the R251 since changes with the discharge plan may occur. The … | 2020-09-01 |
| 2222 | 2222 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-01-09 | 661 | D | 0 | 1 | UY9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review, the facility failed to ensure a discharge summary was prepared for 1 resident (Resident #101.) Findings include: Resident #101 (R101) R101 was admitted on [DATE], with [DIAGNOSES REDACTED]. The Nurse Progress Note dated 12/12/18 documented R101 was discharged to home. On 01/09/19 at 10:46 AM, a Licensed Practical Nurse (LPN) confirmed R101 was discharged home on[DATE]. The LPN indicated R101's discharge summary or the recapitulation of stay was not available in R101's medical record. On 01/09/19 at 11:32 AM, the Director of Nursing (DON) confirmed there was no recapitulation of R101's stay in the facility upon R101's discharge. The facility lacked documented evidence the discharge summary was prepared for R101 to include the following: - A recapitulation of the resident stay; that includes, diagnoses, course of illness/treatment or therapy, and pertinent laboratory, radiology and consultation results. - A final summary of the resident's status reconciliation of all pre-discharge medications with the resident's post-discharge medication (both prescribed and over-the-counter). - A post-discharge plan of care that was developed with the participation of the resident and, with the resident consent , the resident representative, which would have assist the resident to adjust to her new living environment. The post-discharge plan of care would have indicated where the individual plans to reside, any arrangements that had been made for the resident's follow up care and any post-discharge medical and non-medical services. A facility policy titled Patient discharge date d 02/21/18, documented when the facility anticipated discharge of a resident to another skilled nursing facility, to a lower level of care or home, a discharge summary and post-discharge plan of care was documented in the resident's clinical record. The discharge summary includes: a recapitulation of the resident's stay; a final su… | 2020-09-01 |
| 2223 | 2223 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-01-09 | 757 | D | 0 | 1 | UY9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review, the facility failed to follow physician ordered parameters for administering pain medication for 1 resident (Resident #101.) Findings include: Resident #101 (R101) R101 was admitted on [DATE], with [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. The Medication Administration Record [REDACTED] 12/08/18 at 9:34 AM - pain level was 4 12/08/18 at 1:02 PM - pain level was 2 12/08/18 at 5:11 PM - pain level was 5 12/09/18 - pain level was 2 A physician's orders [REDACTED]. The MAR indicated [REDACTED] 12/08/18 at 9:22 PM, pain level was 6 12/09/18 at 3:04 AM, pain level was 6 12/09/18 at 6:52 PM, pain level was 7 12/10/18 at 4;23 AM, pain level was 6 The Care Plan for pain dated 12/05/18, documented the approach was to administer pain medication per physician's orders [REDACTED].>On 01/09/19 at 10:50 AM, the Licensed Practical Nurse (LPN) confirmed R101's [MEDICATION NAME] was for pain medication as needed and the ordered parameters were not followed. The LPN indicated the physician's orders [REDACTED]. On 01/08/18 at 11:00 AM, the Director of Nursing indicated the staff were expected to follow the physician's orders [REDACTED]. A facility policy titled Pain Management dated 02/21/18, documented PRN medications would have been administered following assessment of pain, location, onset, duration and intensity. Pain intensity from one to five (1-5) should receive one tablet or the lowest dose; and a pain level from 6-10 should have received two tablets or the highest dose. A facility policy titled Administration of Medication dated 02/27/18, documented licensed personnel, in accordance with professional standards of practice, would have appropriately administered the prescribed medications. | 2020-09-01 |
| 2224 | 2224 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-01-09 | 812 | E | 0 | 1 | UY9L11 | Based on observation, interview and document review, the facility failed to maintain the kitchen equipment and environment clean, label opened and stored food items and follow safe food handling practices. Findings include: On 01/08/19 at 8:45AM, during the initial dietary tour, the walk-in freezer revealed chicken stored in a plastic bag placed on top of the cardboard box of chicken. One beef patty in plastic that had been removed from the large cardboard container of beef and placed on the top shelf. The Dietary Manager indicated the chicken should be placed inside the cardboard box container and the beef patty was required to be put back in the box of beef patties. On 01/08/19 11:35 AM, during the second tour of the kitchen the following were observed: Dry storage room: - a scoop and a plastic transparent lid were stored on top of boxes of cold cereal. - a box of cream of rice had a received date however no date indicating when the box had been opened. - a container of pure Honey did not have an open date and was sticky to touch and had visible residual honey on the side of the container. - a container of sesame seeds with no received date - a case of Barilla Orzo pasta with no received date - a punctured bag of pasta that was not re-bagged and dated - an opened package of potato peals placed inside a plastic zip lock bag but not completely sealed - a dented can of Bountiful Harvest Sweetened Apple Sauce on the shelf Baking section of the kitchen: - a bar of Baker's Chocolate with no open date - a stack of Graham Cracker tart shells with no open date - a scoop was stored inside the powdered sugar bin, the handle was covered with powered sugar. - a box of fudge brownie mix was not resealed completely after opening and did not have a date when the product was opened. - the front section of the ice machine was in need of cleaning. - the side of the preparation table located in the baker's area of the kitchen had food crumbs and a cupcake paper on the floor - the reach-in refrigerator had a spill of clear liquid a… | 2020-09-01 |
| 2225 | 2225 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 554 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and document review, the facility failed to ensure an assessment for the safety of self-administration of medication was completed for 2 of 13 sampled residents. (Resident #15 & Resident #28). Findings include: Resident #15 (R15) R15 was admitted on [DATE], with a primary [DIAGNOSES REDACTED]. On 12/17/19 at 9:45 AM, refresh eye drops 15 Millimeters (ml) were observed on the bed side table in R15's room. R15 revealed they self-administered the eye drops. On 12/17/19 at 11:50 AM, the Clinical Nurse Manager (CNM) revealed there was no documentation R15 could self-administer the eye drops. On 12/19/19 at 10:13 AM, the Director of Nursing (DON) revealed a self-administration assessment should have been completed for residents self-administering medications. The DON confirmed there was no assessment completed to determine if R15 could self-administer medication. On 12/19/19 at 10:58 AM, the Unit Manager, (UM) revealed for self-administration of medications, a resident should be assessed by a Registered Nurse (RN), utilizing the facility's self-medication administration assessment. Resident #28 (R28) R28 was admitted on [DATE], with a primary [DIAGNOSES REDACTED]. On 12/17/19 at 9:09 AM, generic brand eye drops 15 ml were observed on a tray table in R28's room. On 12/17/19 at 9:40 AM, the CNM revealed if a resident was to self-administer medications, an assessment for the self-administration of medications should have been completed. The CNM revealed there was no assessment for the self- administration of medication. The CNM confirmed R28 was not capable of self-administration of medications. 12/19/19 10:15 AM the DON revealed a self-administration assessment should have been completed for residents self-administering medications. The DON confirmed there was no assessment completed for R28, and R28 was not capable of self-administering medications. On 12/19/19 at 11:00 AM, the UM revealed a resident s… | 2020-09-01 |
| 2226 | 2226 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 655 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure an initial care plan was developed for pain management and a [DEVICE] system for 1 of 13 sampled residents (Resident #233). Findings include: Resident #233 (R233) R233 was admitted on [DATE] with [DIAGNOSES REDACTED]. A hospital report dated 12/05/19, indicated a PICO (Negative Pressure Wound Therapy System) was initiated on 12/05/19. R233's medical record lacked documented evidence a care plan to address the care and monitoring of the PICO [DEVICE] system was created. On 12/18/19 at 10:30 AM, the Clinical Nurse Manager (CNM) confirmed R233's medical record did not have a care plan for the PICO and there should have been one in the medical record. R233's medical record contained a physician order [REDACTED]. The pain medication was to be administered every 6 hours as needed for pain. The medical record did not contain a care plan for pain management On 12/18/19 at 2:20 PM, the CNM confirmed the medical record did not have a care plan for pain management. The CNM indicated there should have been a Pain Management care plan in the medical record. | 2020-09-01 |
| 2227 | 2227 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 676 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to ensure a resident was bathed and hair was shampooed for 1 of 13 sampled residents (Resident #233). Findings include: Resident # 233 (R233) R233 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 12/17/19 at 11:29 AM, R233 indicated they had not been bathed or had their hair shampooed in a week. The resident was wearing a hat. When the resident removed the hat, the resident's hair was tangled and greasy. R233's Minimum Data Set ((MDS) dated [DATE], indicated the resident required one person to physically assist the resident with bathing R233's medical record lacked documented evidence the resident was bathed or had their hair shampooed between 12/11/19 through 12/18/19. On 12/18/19 at 2:17 PM, R233 indicated facility staff had not offered to bathe or wash the resident's hair. On 12/18/19 at 2:25 PM, the Certified Nursing Assistant indicated residents were bathed three times weekly based on the shower schedule note book in the Nursing Station. On 12/18/19 at 2:35 PM, the Clinical Nurse Manager (CNM) reviewed the shower schedule and indicated R233 should have had showers every Tuesday, Thursday and Saturday. The CNM reviewed R233's medical record and confirmed the record lacked documentation a shower and shampoo were provided to the resident between 12/11/19 to 12/18/19. | 2020-09-01 |
| 2228 | 2228 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 684 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to provide care of a wound for a resident with a [DEVICE] system, and failed to notify the physician the system was not working for 1 of 1 residents with a [DEVICE] system (Resident #233). Findings include: Resident #233 (R233) R233 was admitted on [DATE], with [DIAGNOSES REDACTED]. A hospital report dated [DATE], indicated a PICO (Negative Pressure Wound Therapy System) was initiated on [DATE]. Cultures revealed the wound was infected with two germs. A PICC (peripherally inserted central-venous catheter) line was placed due to the need for ongoing intravenous anti-biotic treatment. R233 was discharged from the hospital to home, but was unable to self administer the intravenous medications and returned to hospital on [DATE] and subsequently admitted to this facility. On [DATE] at 11:24 AM, R233 explained the right ankle was broken several months ago and required surgery. The ankle incision site was healing very slow and had become infected. R233's right lower leg was wrapped with an ace bandage. A PICO 7 [DEVICE] system was observed tucked under the ace wrap. The PICO was not working as there were no lights on to indicate functioning status. R233 indicated the battery had died several days ago and the Director of Nursing(DON) had been informed. The DON had informed R233 the facility would help the resident to get a physician to fix the PICO. The resident reported they were to be followed by an infectious disease specialist due to the wound being infected. A physician order [REDACTED]. The Admission Minimum Data Set ((MDS) dated [DATE], indicated R233 was alert and oriented with no cognitive impairments. The resident required one person assistance for all activities of daily living with the exception of eating. The resident needed set up assistance with meals. The initial nursing observation note dated [DATE], documented R233 had a non-removable [DEVICE] dressing in place… | 2020-09-01 |
| 2229 | 2229 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 690 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to 1) remove an indwelling urinary catheter for 1 of 6 residents with catheters (Resident #230); and 2) failed to obtain and follow physician's orders [REDACTED].#15 and #28). Findings include: Resident #230 (R230) R230 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 12/16/19, R230 had an indwelling urinary catheter. On 12/19/19, R230's medical record lacked documented evidence of a [DIAGNOSES REDACTED]. A nursing progress note dated 12/12/19, documented the resident would start bladder training and the urinary catheter was to be removed on 12/13/19. R230's Admission Note dated 12/12/19, documented the resident was to start bladder re-training for 24 hours and then the urinary catheter was to be removed. On 12/19/19 at 9:05 AM, the Clinical Nurse Manager (CNM) confirmed R230 did not have a [DIAGNOSES REDACTED]. The CNM explained the process for residents who were admitted with catheters and lacked medical justification for the continued use, were to be started on bladder re-training. Nursing staff were to follow the bladder re-training protocol to remove the catheter. The CNM confirmed R230's indwelling urinary catheter should have been removed at least two days after admission. Facility policy titled Indwelling Catheter (undated) documented if a resident did not have an appropriate [DIAGNOSES REDACTED]. Resident #15 (R15) R15 was admitted to the facility on [DATE], with a primary [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. A physician's orders [REDACTED]. A progress note dated 11/30/19 documented, Foley catheter was removed as ordered by Physician. If unable to void after six hours, conduct bladder scan. If residual was greater than 300 milliliters (ml), utilize straight catheter. A progress note dated 12/01/19 documented, after unable to void straight catheter utilized with 800 ml of urine from bladder. R15's medical record lacked documented evidence a… | 2020-09-01 |
| 2230 | 2230 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 692 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and document review, the facility failed to accurately calculate, monitor, and document fluid intake for a resident on fluid restriction, for 1 of 13 sampled residents. (Resident #28) Findings include: Resident #28 (R28) R28 was admitted to the facility on [DATE], with a [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. On 12/17/19 at 9:09 AM, a water pitcher and a half empty cup of water was observed on R28's bed side table. On 12/19/19 at 12:59 PM, R28 was observed in the dining room eating lunch, with a full glass of fluid. The Treatment Administration Record (TAR) for (MONTH) 2019, lacked documented evidence of R28's total daily amount of fluid intake on the following dates: -12/11/19 -12/12/19 -12/13/19 -12/14/19 -12/15/19 -12/16/19 -12/17/19 On 12/19/19 at 1:24 PM, a Registered Nurse (RN) indicated nursing staff should have documented the total amount of fluid intake onto the TAR at the end of every shift. The RN explained residents on fluid restriction should have their fluid intake documented on the medical record throughout their shift by all nursing staff. The RN revealed at the end of every shift, the RN would tally up the total amount of fluid intake and document it on the TAR. On 12/19/19 at 11:07 AM, the Unit Manager (UM) revealed fluid intake should be recorded on the TAR. The UM confirmed R28's fluid intake should have been documented on the TAR, as soon as the facility received the physician's orders [REDACTED]. On 12/19/19 at 10:46 AM, the Director of Nursing (DON) revealed all nursing staff caring for residents on fluid restrictions are responsible for documenting the amount of fluid intake in the resident's medial record, throughout the shift. The DON explained at the end of every shift, the RN would add up the total amount of fluid intake and it would be documented on the TAR. The DON confirmed the R28's total amount of fluid intake was not documented on the TAR… | 2020-09-01 |
| 2231 | 2231 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 695 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and document review, the facility failed to obtain a physician's order for the use of [REDACTED]. Findings include: Resident #480 (R480) R480 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. On 12/17/19 at 1:23 PM, R480 was observed receiving oxygen at 2.5 Liters (L) via nasal cannula. On 12/19/19 at 8:48, AM R480 was observed receiving oxygen at 2L via nasal cannula. An admission assessment dated [DATE], documented R480 was receiving oxygen per nasal cannula. R480's medical record lacked documented evidence a Physician's order was obtained for the use of oxygen via nasal cannula and the flow rate of oxygen R480 was to receive. On 12/19/19 at 08:54 AM, a Registered Nurse (RN) confirmed R480 was receiving 2L of oxygen via nasal cannula. The RN confirmed there was no order for oxygen via nasal cannula in R480's medical record. The RN indicated there should be a Physician's order confirming how many liters of oxygen R480 should have been receiving. On 12/19/19 at 10:05 AM, the Director of Nursing (DON) explained a physician's order should have been obtained if a resident is receiving oxygen via nasal cannula, and the order should include the flow rate of oxygen the resident is receiving. The DON confirmed there was no physician's order for R480. On 12/19/19 at 10:56 AM, the Unit Manager (UM), explained there should have been a Physician's order confirming the use of oxygen for R480. The facility policy titled Oxygen Administration last revised on 03/12/18, documented the facility should have verified there was a physician's order for administering oxygen. The physician's order must include liter flow with parameters, frequency, and duration of oxygen. | 2020-09-01 |
| 2232 | 2232 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 726 | F | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to 1) assess the competency for the provision of ostomy care for 1 of 16 licensed nursing staff (Employee #4); and 2) ensure nursing staff obtained training and maintained competency to provide nursing care for a resident with a [DEVICE] system for 4 of 5 Registered Nurses (Registered Nurse #1, #3, #4, #5 and #9). Findings include: 1) Ostomy Care On 12/17/19 at 12:42 PM, a resident's family member indicated some nursing staff required training on how to change an ostomy pouch and cut and attach adhesive wafers to the skin around a stoma. The family member indicated some nursing staff could have benefited from training on ostomy supplies and how to provide ostomy care. On 12/18/19 at 8:45 AM, Employee #4 (E4) recalled providing ostomy care over a month ago and did not feel competent to demonstrate proficiency in ostomy care. The RN explained the facility had an orientation program and had not been trained on providing ostomy care. The RN expressed wanting more training on ostomy care. E4's personnel record lacked documented evidence E4's competency was assessed and E4 demonstrated proficiency in ostomy care. On 12/18/19 at 1:30 PM, the Director of Nursing (DON) indicated the facility accepted residents requiring ostomy care. The DON explained when a new employee was hired, an orientation was completed. For a new nurse, the expectation was the licensed nurse's competency was assessed for proficiency in ostomy care by performing a return demonstration for the assigned trainer. The DON explained if a resident with an ostomy was available at the time the new nurse was being trained, then the new nurse had the opportunity to perform a return demonstration of ostomy care to the trainer. If a resident was unavailable, the new nurse would not have the opportunity to do the return demonstration. The DON acknowledged E4's personnel record lacked documented evidence E4's competency … | 2020-09-01 |
| 2233 | 2233 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 755 | D | 0 | 1 | OCTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and documentation review, the facility failed to ensure a cardiac medication was reordered timely for 1 of 13 sampled residents (Resident #19). Findings include: Resident #19 (R19) R19 was admitted on [DATE] with [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. A Care Plan dated 11/29/19, documented R19 had an alteration in cardiac function. The goal was for R19's condition to remain stable throughout the next 90 days. Medication was to be administered per physician's orders [REDACTED].>A Medication Administration Record [REDACTED]. A Nursing Progress Note dated 12/15/19, documented [MEDICATION NAME] was out of stock. The MAR indicated [REDACTED]. A Nursing Progress Note dated 12/15/19, documented numerous attempts were made to call the pharmacy regarding [MEDICATION NAME] refill. The physician was notified the medication was not administered the night before and during 12/15/19's morning and second dose due to unavailable medication. The progress note documented R19's heart rate was 118-123 with irregular rhythm. An email to the facility from the Pharmacist dated 12/19/19, documented [MEDICATION NAME] was refilled on 12/15/19 at 12:40 PM. On 12/18/19 at 3:30 PM, a Registered Nurse (RN) indicated [MEDICATION NAME] three times a day was administered to treat heart conditions such as [MEDICAL CONDITION]. The RN indicated R19 had a [DIAGNOSES REDACTED]. The RN indicated medication was reordered at least three days in advance of the last dose. The RN indicated a refill form was completed and submitted to the pharmacy. The RN recalled on 12/15/19, R19's heart rate went up to between 118-123 beats per minute (bpm). The RN explained R19's heart rate was commonly in the 90's. The RN indicated the heart rate of 118-123 was irregular and the physician was notified. The RN texted the physician numerous times regarding the missed dose of [MEDICATION NAME] the night before, the two missed doses on 12/15/19 and R19's… | 2020-09-01 |
| 2234 | 2234 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 812 | D | 0 | 1 | OCTI11 | Based on observation, interview, and document review, the facility failed to ensure the general sanitation of the kitchen and utensils was maintained. Findings include: On 12/17/19 at 8:25 AM, an ice scoop was observed on the top of the ice machine. The Dietary Aide (DA) explained the ice scoop should have been stored and secured to the side of the ice machine. On 12/18/19 at 12:10 PM, the Director of Nutrition confirmed the ice scoop should have been secured on the side of the ice machine On 12/17/19 at 8:30 AM, an uncovered garbage can was observed in the food preparation area. The DA confirmed all garbage cans in the kitchen should be covered at all times. On 12/18/19 at 12:10 PM, the Director of Nutrition confirmed garbage cans in the kitchen should have been covered at all times. On 12/17/19 at 8:32 AM on the heating table, an entire utensil (including the handle being used to serve the scrambled eggs) was observed in the pan of scrambled eggs which was being served for breakfast. The DA revealed the entire utensil should not have been placed in the scrambled eggs pan. | 2020-09-01 |
| 2235 | 2235 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 880 | D | 0 | 1 | OCTI11 | Based on observation, interview and document review, the facility failed to ensure linen was transported safely to prevent spread of infection. Findings include: On 12/19/19 at 12:05 PM, the housekeeper was observed dragging a bag of soiled linen on the floor in the 100 hallway. The employee confirmed soiled linen bags should not have been dragged on the floor. At 12:15 PM, during a tour of the Laundry room, the housekeeper revealed clean linen was transported to the resident care areas in an open, uncovered wire cart. The housekeeper confirmed transporting uncovered clean linen could result in unsanitary conditions if a resident or other person handled the linen while in the hallways. On 12/19/19 at 1:22 PM, the Infection Preventionist indicated it was not appropriate for staff to drag soiled linen bags on floors. Facility policy titled Infection Control General Precautions (revised 06/15/18), documented linen would be transported in a manner that avoided transfer of microorganisms to other patients and environments. | 2020-09-01 |
| 2236 | 2236 | ADVANCED HEALTH CARE OF HENDERSON | 295102 | 1285 E CACTUS AVENUE | LAS VEGAS | NV | 89183 | 2019-12-19 | 881 | D | 0 | 1 | OCTI11 | Based on document review and interview, the facility failed to provide annual antibiotic stewardship education to prescribing practitioners, medical and nursing staff. Findings include: Facility policy titled Antibiotic Stewardship, revised 10/07/19, documented the facility would provide annual education on antibiotic stewardship and protocols for prescribing practitioners, medical and nursing staff to promote the appropriate use of antibiotics while also attempting to reduce the development of antibiotic-resistant organisms. This education would be documented. On 12/19/19 at 1:22 PM, the Infection Preventionist (IP) was unable to provide documented evidence of annual education regarding antibiotic stewardship and prescribing protocols. The IP confirmed the facility had not conducted annual antibiotic stewardship education to prescribing practitioners, medical and nursing staff. | 2020-09-01 |
| 1836 | 1836 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 580 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review, the facility failed to notify a resident's representative of the change in a resident's condition for 1 of 12 sampled residents (Resident #27). Findings include: Resident #27 Resident #27 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/15/18 at 10:49 AM, signage for contact precautions was observed by the door of the resident's room. A Nurse Progress Note dated 05/14/18, documented the resident had diarrhea with watery stools. A Care Plan dated 05/14/18, indicated the resident was at risk for fluid deficit related to diarrhea, infection and positive [MEDICAL CONDITIONS]. A stool culture dated 05/16/18, revealed the resident was positive for [MEDICAL CONDITION]. On 05/17/18 at 08:45 AM, a Licensed Practical Nurse (LPN) confirmed the resident was on contact isolation for [MEDICAL CONDITION]. The LPN acknowledged there was no documentation the family or representative was notified. On 05/17/18 at 11:45 AM, the Infection Control Nurse explained the change of condition should have been documented in the progress notes. The Infection Control Nurse indicated the resident's family or representative should have been notified promptly or within the shift where the change of condition had occurred regardless if the resident was alert or not. The Infection Control Nurse acknowledged there was no documented evidence the resident's family was notified. On 05/17/18 at 12:05 PM, the Director of Nursing explained the physician, resident, and family should have been notified immediately if change of condition had occurred and documented in the progress notes. A facility policy titled Change In Patient Condition dated 03/12/17, the facility should have promptly notified the patient and representative of changes in the patient's medical/mental condition and or status. Notification would have been made within 24 hours of a change occurred in the patient's medical condition or status. | 2020-09-01 |
| 1837 | 1837 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 602 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review, the facility failed to ensure an allegation of misappropriation of property for an unsampled resident was reported to law enforcement (Resident #239). Findings include: Resident #239 was admitted on [DATE], with [DIAGNOSES REDACTED]. A facility reported incident of an alleged misappropriation of property by the resident revealed the incident was not reported to law enforcement. On 05/17/18 at 11:55 AM, the previous Administrator explained the resident declined law enforcement be notified. On 05/17/18 at 1:58 PM, the Administrator explained law enforcement should have been informed immediately of the use of the debit card without the resident's permission. | 2020-09-01 |
| 1838 | 1838 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 658 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and document review the facility failed to ensure a Licensed Practical Nurse (LPN) performed the duties as outlined in the State Board of Nursing Nurse Practice Act for an unsampled resident (Resident #25). Findings include: Resident #25 Resident #25 was admitted on [DATE], with [DIAGNOSES REDACTED]. The State Board of Nursing Nurse Practice Act revised (MONTH) 2014, documented: NAC (Nevada Administrative Code) 632.236 Understanding and verifying orders. Before carrying out an order, an LPN must: 1. Understand the reason for the order 2. Verify that the order was appropriate On 05/16/18 at 8:41 AM, during the Medication Administration Pass observation, an Licensed Practical Nurse (LPN) administered [MEDICATION NAME] 5 milligram (mg) to the resident. The LPN indicated the resident's blood pressure was 130/70 millimeter of mercury (mmHg). A handwritten physician's orders [REDACTED]. An physician's orders [REDACTED]. Special instructions: Hold SBP greater than (>) 110 mmHg and below. A LPN created and verified the order. The Medications Administration History from 5/01/18 to 5/16/18, indicated [MEDICATION NAME] tablet 5 mg 1 tablet daily. Special instructions: Hold SBP > 110 mmHg and below. The resident received [MEDICATION NAME] 5 mg from 05/08/18 to 05/16/18 with an SBP greater then 110 mmHg. On 05/16/18 at 1:04 PM, a LPN confirmed the resident received [MEDICATION NAME] 5 mg during the Medication Administration Pass observation and the resident's blood pressure was 130/70 mmHg. The LPN acknowledged the electronic physician's orders [REDACTED]. The medication was ordered for the resident's [DIAGNOSES REDACTED]. The LPN who transcribed the order should have verified the order prior to entering the order in the electronic chart. On 05/16/18 at 1:13 PM, the Director of Nursing (DON) acknowledged there was a transcription error in the physician's orders [REDACTED]. The nurses were expected to clarify… | 2020-09-01 |
| 1839 | 1839 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 677 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure feeding assistance was provided for 1 of 12 sampled residents (Resident #3). Findings include: Resident #3 Resident #3 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/15/18 at 1:34 PM, the resident's lunch tray had been set up on the bedside table and was untouched. No staff or family was at bedside feeding the resident. On 05/16/18 at 1:00 PM, the resident's lunch tray had been set up on the bedside table and was untouched. No staff or family was at the bedside feeding the resident. The medical record lacked documented evidence of an order for [REDACTED].>On 5/17/18 at 01:30 PM, a Licensed Practical Nurse (LPN) acknowledged the resident had not been eating her meals and needed assistance with eating. The LPN confirmed there was no order for assistance with feeding. The LPN verbalized there should have been an order for [REDACTED].>On 05/17/18 at 4:03 PM, the Minimum Data Sheet Coordinator, indicated the resident required extensive assistance or a caregiver to assist the resident. On 05/18/18 at 10:25 AM, an Occupational Therapist confirmed the resident was an extensive assist and needed help with eating. On 05/18/18 10:41 AM, Certified Nursing Assistant (CNA) acknowledged the resident was fully dependent with Activities of Daily Living. The CNA confirmed the resident could not eat by herself and was a poor eater. | 2020-09-01 |
| 1840 | 1840 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 684 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and document review, the facility failed to clarify and follow a diet order for 1 of 12 sampled residents (Resident #3). Findings include: Resident #3 Resident #3 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/15/18 at 1:34 PM, the resident's meal ticket documented a regular diet. On 05/16/18 at 1:00 PM, the resident's meal ticket documented a regular diet. On 05/17/18 at 1:30 PM, the resident's meal ticket documented a regular diet. A Licensed Practical Nurse (LPN) and a Certified Nurse Assistant (CNA) acknowledged the resident had been receiving a regular diet since admission. The Medication Administration Record [REDACTED]. The MAR indicated [REDACTED]. On 05/17/18 at 1:25 PM, the Registered Dietitian (RD) acknowledged there were two active diet orders. The RD explained the dietary department did not receive the communication for the diet downgrade dated 05/09/18. The RD explained the new diet order should have been communicated to the RD and the kitchen. On 05/17/18 at 2:00 PM, two CNA's confirmed the resident had been receiving a regular diet and not eating most of the time. On 05/17/18 at 2:23 PM, the Dietary Supervisor explained the communication of diet orders would have been handed directly to the Dietary Supervisor or placed in dietary mail box or on the desk. The Dietary Supervisor indicated a diet order was received on 04/28/18 with RCS diabetic regular consistency liquid thin. The Dietary Supervisor indicated no other diet order had been received since then. On 05/17/18 at 2:25 PM, a LPN explained a Telephone Order from the Speech Therapist (ST) was received on 05/09/18 and transcribed on the resident's electronic record. The LPN indicated the night nurse would have been required to review the order and place it in the dietary communication box. The LPN indicated usually the ST would have been the one who informed the kitchen for new diet orders or changes. The LPN acknowle… | 2020-09-01 |
| 1841 | 1841 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 689 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a tab alarm was in place according to physician orders [REDACTED].#3). Findings include: Resident #3 Resident #3 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/15/18 at 11:46 AM, Resident #3 was lying in bed with bilateral floor mats in place. On 05/15/18 at 12:38 PM, a Licensed Practical Nurse (LPN) acknowledged the resident was a fall risk and confirmed a tab alarm was not provided. The medical record revealed General Orders dated 04/28/18, for a tab alarm in bed or wheelchair. The order documented to verify placement every shift. A Physician order [REDACTED]. The Physician order [REDACTED]. A Care Plan revised on 05/09/18, indicated the resident was at risk for the following: 1. Falls related to [MEDICAL CONDITION] disorder, anxiety, [MEDICAL CONDITIONS] and brain metastasis. 2. Alteration in thought processes related to intermittent confusion. 3. Cognitive Loss/Dementia. A Treatment Administration History dated 05/01/2018-05/17/2018, revealed the tab alarm in bed and wheelchair placement had been verified and signed by a Licensed Nurse every shift. On 05/16/18 at 2:37 PM, the LPN acknowledged the order for the tab alarm. The LPN confirmed the resident was a fall risk and there should have been a tab alarm in place. On 05/17/18 at 9:30 AM, the Director of Nursing verbalized if there was an order for [REDACTED]. | 2020-09-01 |
| 1842 | 1842 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 697 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review the facility failed to ensure the physician was notified of resident's family refusal of pain medication and prescribed pain medication was administered as ordered for 1 of 12 sampled residents (Resident #87). Findings include: Resident #87 was admitted on [DATE], with [DIAGNOSES REDACTED]. A Physician order [REDACTED]. A Progress note dated 05/14/18, documented the Resident moaned and cried every time the resident was touched. The progress note indicated the resident's daughter requested pain medications be held until needed for therapy. Progress notes dated 05/15/18, revealed the resident's family refused all pain medication, and resident's husband declined Tylenol during removal of the resident's Foley catheter. The Progress notes for 05/14/18 and 05/15/18 lacked documented evidence the physician and the Director of Nursing was notified of the resident's family refusal of the resident's pain medications. The Medication Administration Record [REDACTED]. The MAR for (MONTH) (YEAR), lacked documented evidence the resident was given alternatives such as repositioning to alleviate pain. On 05/17/18 at 1:00 PM, a Registered Nurse (RN), explained if a resident had dementia and was crying, moaning, verbalizing pain the RN would give the resident pain medication if prescribed by a physician. The RN indicated if the family refused, the family would have been educated on the need for the resident's pain medication. On 05/17/18 at 2:26 PM, a RN explained facial expressions, verbalization of pain, moaning and crying could mean a resident was in pain and pain medications should have been offered. The RN indicated if the family refused the pain medication the RN would have explained to the family a milder form of pain medication such as Tylenol would have been administered first. The RN indicated the family would have been educated on pain management. The RN verbalized The physician would have been no… | 2020-09-01 |
| 1843 | 1843 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 761 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and document review the facility failed to ensure medications were stored securely in a resident's room for 2 of 12 sampled residents (Resident #84 and #238); manufacturer's instructions for the storage of medications were followed for 1 of 12 sampled residents (Resident #27) and 2 unsampled residents (Resident #33 and #240); maintain a safe temperature range in a refrigerator used for medications. Findings include: Resident #84 Resident #84 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 05/15/18 at 10:36 AM, a bottle of [MEDICATION NAME] medication was located under the resident's bed. A bottle of Luten, Vitamin D, restore digestive aid, Vitamin C and Magnesium were found in a bag in the resident's closet. The resident explained the medications were brought from home. The resident had not taken any of the medications. The resident indicated when admitted the staff informed medications from home were not allowed in the room and the staff removed the medications. The resident did not know how the medications were put back into the cabinet. On 05/15/18 at 10:37, a Certified Nurse Assistant (CNA) verified the medications were under the resident's bed. The CNA explained the linens were changed in the morning and the bottle of pills were not observed at that time. On 5/15/18 at 10:45 AM, a Licensed Practical Nurse (LPN) verified the medications were in the closet. The LPN explained the medications should not have been in the resident's room. The LPN indicated the medications should have been locked in the medication cart. On 05/17/18 at 3:12 PM, a Registered Nurse (RN) explained the assessment nurse would have told the family all home medications should have been taken home. If medications were found in a resident's room the RN would have taken the medications and secured them in the medication cart until the family was able to take the medications home. On 05/17/18 at 3:43 PM, a CNA explained i… | 2020-09-01 |
| 1844 | 1844 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 812 | D | 0 | 1 | W1JM11 | Based on observation, interview and record review the facility failed to clean dirt buildup under the dishwasher and the oven filters were free of grease build up. Findings include: On 05/15/18 at 10:03 AM, the following observations were made during an inspection of the kitchen: Two doors did not close properly on a cabinet in the food prep area. Chicken was thawing over bacon. Food particles, dirt buildup and a paper cup were under the dishwasher. Filters above the stove had heavy grease build up. On 5/15/18 at 10:07 AM, a dietary staff member explained the filters were cleaned once a month. On 5/15/18 at 10:15 AM, the Dietary Manager explained she was new to the position and had not written up a cleaning schedule. The Dietary Manager acknowledged the above items. A facility policy titled General Sanitation of Kitchen (undated), documented the staff would have maintained the sanitation of the kitchen through compliance with a written comprehensive cleaning schedule. | 2020-09-01 |
| 1845 | 1845 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 842 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and document review the facility failed to ensure a resident's medical record was accurately documented in accordance with accepted professional standards for an unsampled resident (Resident #25). Findings include: Resident #25 Resident #25 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/16/18 at 8:41 AM, during a Medication Administration Pass observation, a Licensed Practical Nurse (LPN) administered [MEDICATION NAME] 5 milligram (mg) to the resident. The LPN indicated the resident's blood pressure was 130/70 millimeter of mercury (mmHg). A handwritten physician's orders [REDACTED]. A physician's orders [REDACTED]. Special instructions: Hold SBP > (greater than) 110 mmHg and below. A LPN created and verified the order. The Medications Administration History from 05/01/18 to 05/16/18, indicated [MEDICATION NAME] tablet 5 mg 1 tablet daily. Special instructions: Hold SBP > 110 mmHg and below. The resident received [MEDICATION NAME] 5 mg from 05/08/18 to 05/16/18 with an SBP greater then 110 mmHg. On 05/16/18 at 1:04 PM, a LPN confirmed the resident received [MEDICATION NAME] 5 mg during the Medication Administration Pass observation and the resident's blood pressure was 130/70 mmHg. The LPN acknowledged the electronic physician's orders [REDACTED]. The medication was ordered for the resident's [DIAGNOSES REDACTED]. The LPN who transcribed the order should have verified the order prior to entering the order in the electronic chart. On 05/16/18 at 1:13 PM, the Director of Nursing (DON) acknowledged there was a transcription error in the physician's orders [REDACTED]. The nurses were expected to clarify the order. The order should have been to hold the medication if SBP was less than 110 mmHg. The DON revealed the facility used the Nurse Practice Act for professional standards of practice. The State Board of Nursing Nurse Practice Act revised (MONTH) 2014, documented: NAC (Nevada Administr… | 2020-09-01 |
| 1846 | 1846 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-05-18 | 880 | D | 0 | 1 | W1JM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and document review, the facility failed to ensure hand hygeine was performed in between resident care and obtain and clarify a physician order for [REDACTED]. On 05/15/18 at 12:40 PM, a Certified Nurse Assistant (CNA) did not wash his hands before and after care was provided. The CNA acknowledged the observation and verbalized the importance of hand hygiene to prevent the spread of germs. On 05/16/18 at 2:04 PM, a Physical Therapy Assistant (PTA) and a Certified Nurse Assistant (CNA)provided resident care at the bedside. The PTA nor the CNA washed their hands before or after resident care was provided. In an interview following the observation, the PTA confirmed the importance of hand hygiene being a basic factor of infection control. The PTA admitted their hands were not washed before and after resident care was provided. The CNA verbalized hand hygiene should have been done in between resident care. Resident #27 Resident #27 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/15/18 at 10:49 AM, signage for contact precautiond was posted at the door of resident's room. A Nurse Progress Note dated 05/14/18, documented the resident had diarrhea with watery stools. A Care Plan dated 05/14/18 indicated the resident was at risk for fluid deficit related to diarrhea, infection and positive [MEDICAL CONDITIONS]. On 05/15/18 at 3:25 PM, the resident verbalized contact precautions was for the leg wound infection. A stool culture dated 05/16/18, revealed the resident was positive result for [MEDICAL CONDITION]. On 05/17/18 at 8:45 AM, a Licensed Practical Nurse (LPN) confirmed the resident was on contact isolation for [MEDICAL CONDITION]. The LPN acknowledged there was no physician's order for transmission based precautions for [MEDICAL CONDITION]. The LPN verbalized there should have been an order for [REDACTED].>On 05/17/18 at 11:45 AM, Infection Control Nurse explained the transmission based prec… | 2020-09-01 |
| 1847 | 1847 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2019-06-20 | 684 | D | 0 | 1 | D7CZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure [MEDICATION NAME] was administered per physician orders [REDACTED].#1). Findings include: Resident #1 Resident #1 was admitted on [DATE], with [DIAGNOSES REDACTED]. A physician order [REDACTED]. The normal range for blood pressure is between 90/60 and 130/80 millimeter of mercury (mmHg) mm Hg, and the average blood pressure is 120/80 mmHg. The (MONTH) 2019 Medication Administration Record (MAR) revealed [MEDICATION NAME] was not administered for a SBP blood pressure greater than 160 as ordered on the following dates: - On 06/06/19 at 7:30 AM - 161/78 mmHg. - On 06/08/19 at 7:30 AM - 169/85 mmHg. - On 06/09/19 at 7:30 AM - 169/89 mmHg. - On 06/14/19 at 7:30 AM - 171/74 mmHg. On 06/20/19 at 2:06 PM, the Director of Nursing (DON) reviewed the (MONTH) 2019 MAR and confirmed inconsistencies with [MEDICATION NAME] administration. The DON expressed a concern the [MEDICATION NAME] was administered with morning medications, which included other blood pressure medication. The DON indicated the [MEDICATION NAME] order needed physician clarification. The DON reported there was another document, other than the MAR where blood pressure reassessments may have been documented, however, the DON did not search for or provide the documentation. | 2020-09-01 |
| 1848 | 1848 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2019-06-20 | 689 | D | 0 | 1 | D7CZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to follow a physician order [REDACTED]. Findings include: Resident #283 Resident #283 was admitted on [DATE] and readmitted on [DATE], with [DIAGNOSES REDACTED]. On 06/17/19 at 9:22 AM, the resident was in bed. The bed height in the lowest position with no fall mats present. On 06/17/19 in the afternoon, the resident was in bed. The bed height in the lowest position with no fall mats present. An Event Report revealed Resident #283 fell on [DATE], 05/11/19, 05/24/19 and 05/25/19. A Fall Risk Protocol and Care Plan for 05/9/19 and 05/24/19 documented interventions included bed in lowest position, occupational and physical therapy, frequent checks and fall mats. The Fall Risk assessment dated [DATE] documented the resident was assessed with [REDACTED]. A score of 16 indicated moderate risk which initiated fall mats, occupational and physical therapy consult, bed in lowest position, frequent checks and comfort measures. A physician order [REDACTED]. On 06/20/19 at 12:49 PM, a Licensed Practical Nurse (LPN) explained after the admissions process, the office notified the nurses of high fall risk patients. The LPN reported if a resident had a new order for fall mats, staff was notified during report at shift change. The LPN indicated staff could also see the orders in the computer. On 06/20/19 at 2:06 PM, the Director of Nursing (DON) confirmed Resident #283 had a physician's orders [REDACTED]. The DON confirmed fall mat orders were placed at admission, however, nurses had the discretion to determine if fall mats were needed or not. The DON denied having a facility policy or procedure in place to give nurses the discretion not to follow orders to place fall mats. | 2020-09-01 |
| 1849 | 1849 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2019-06-20 | 695 | D | 0 | 1 | D7CZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to follow a physician's order for Oxygen (O2) administration for 1 of 13 sampled residents (Resident #283). The resident was receiving Hospice Services. Findings include: Resident #283 Resident #283 was admitted on [DATE] and readmitted on [DATE], with [DIAGNOSES REDACTED]. On 06/17/19 at 9:22 AM, the resident was on humidified O2 at 2 liters per minute (LPM) via nasal canula. The resident's respirations were even and not labored. On 06/17/19 at 2:55 PM, the resident was on humidified O2 at 2 LPM via nasal canula. The resident's respirations were even and not labored, with a gurgling sound. On 06/18/19 at 9:14 AM, the resident was on humidified O2 at 2 LPM via nasal canula with a suction machine and canister on the bedside table. A Physician Order dated 6/18/19 documented to administer O2 via nasal canula at 3.5 LPM to maintain serum pressure and O2 (SpO2) greater than (>) 90%. On 06/19/19 at 11:00 AM, the resident was on humidified O2 at 3.5 LPM via nasal canula. The resident's respirations were at a rate of 30 per minute and labored. A Vitals Record dated 06/19/19 at 1:37 AM, documented the resident's O2 saturation was 86% and O2 at 3 LPM. The vitals record lacked documented evidence the resident's saturations was reported to a nurse and resident was reassessed. A Progress Note dated 06/19/19 at 3:43 AM, documented the resident was on O2 at 3 LPM and the O2 saturation had been on low side. The Progress Note lacked documented evidence the resident was reassessed. The Vitals Record dated 06/19/19 at 6:31 AM, documented the resident's O2 at 3 LPM and the saturation was 91%. On 06/20/19 at 12:49 PM, a Licensed Practical Nurse (LPN) explained O2 orders were to be checked every shift. The LPN indicated low O2 readings must be reassessed in 30 minutes. On 06/20/19 at 2:06 PM, the Director of Nursing (DON) confirmed the Progress Note and the Vitals Record lacked documented evide… | 2020-09-01 |
| 1850 | 1850 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2019-06-20 | 880 | D | 0 | 1 | D7CZ11 | Based on observation and interview, the facility failed to provide personal protective gowns to housekeeping assistants, keep clean linen cabinets free of food, drinks and personal items and keep clean linen and supplies stored off the floor. Findings include: On 06/20/19 at 1:05 PM, an inspection of the facility laundry room revealed the following: -Lacked personal protective gowns for housekeeping assistants to sort heavily soiled laundry. -The clean area of the laundry room contained food items, such as bottled water and soda, a coffee cup and an employee's personal belongings stored in cabinets with clean linen. -Supply boxes and clean pillows were stored under a counter directly on the floor. On 06/20/19 at 1:05 PM, three Housekeeping Assistants confirmed personal protective gowns were not available in the laundry room. The Housekeeping Assistants explained Certified Nursing Assistants (CNA's) sorted heavily soiled items prior to transporting to laundry room. The Housekeeping Assistants explained when CNA's did not sort correctly, the housekeeping assistants had to sort the heavily soiled laundry. The Housekeeping Assistants reported only gloves were used to sort heavily soiled laundry and they did not use gowns. The Housekeeping Assistants also confirmed food, drink and personal belongings were not to be stored with clean linen. The Housekeeping Assistants explained they were aware of facility policy and drinks, food and personal items should have been stored in lockers and not in clean linen cabinets. The Housekeeping Assistants acknowledged supply boxes and clean pillows were stored under the counter, directly on the floor. On 06/20/18 at 1:30 PM, the Director of Nursing (DON) and the Clinical Nurse Manager confirmed protective gowns were not provided in the laundry room. The DON and Clinical Nurse Manager indicated the housekeeping assistants had to find nursing staff to provide gowns or go to a centralized supply room. The Clinical Nurse Manager indicated personal protective gowns should have been provi… | 2020-09-01 |
| 1851 | 1851 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2017-07-06 | 246 | D | 0 | 1 | NRKI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure a call light for 1 of 10 residents (Resident #1) was within reach. Findings include: Resident #1 Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 7/6/17 at 9:00 AM, Resident #1 was sitting up in bed, positioned at a 40 degree angle. Discomfort was expressed in the residents face. The resident indicated an urgent need to urinate and needed assistance to the bathroom. The call light was tangled at the headboard and was not within reach of the resident. On 7/6/17 at 9:00 AM, a Certified Nurse Assistant (CNA) acknowledged the tangled call light at the headboard and confirmed the call light was not within reach of the resident. | 2020-09-01 |
| 1852 | 1852 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2017-07-06 | 328 | E | 0 | 1 | NRKI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure intravenous (IV) access sites including peripherally inserted central catheter (PICC) lines were assessed for 4 of 10 residents (Residents #3, #6, #7 and #8), and failed to develop policies and procedures concerning dressing changes and site access. Resident #3 Resident #3 was admitted into the facility on [DATE] with a [DIAGNOSES REDACTED]. A physician order [REDACTED]. The Resident Care Plan indicated a peripheral line was placed in the resident's left fore arm. The care plan documented to monitor the site for redness, [MEDICAL CONDITION], tenderness, infiltration or complications. The Medication Administration Record (MAR) dated 7/4/17 noted [MEDICATION NAME] solution 40 mg/milliliters (ml) was administered. The Treatment Administration Record (TAR), MAR and the clinical record lacked documented evidence the site was assessed prior to flushing. A nurse's note dated 7/4/17 at 5:40 PM, indicated the IV [MEDICATION NAME] lock on the left arm. There was no documentation the site was assessed on 7/4/17 or 7/5/17 prior to medication administration. Resident #8 Resident #8 was admitted into the facility on [DATE], with a [DIAGNOSES REDACTED]. A physician order [REDACTED]. The clinical record lacked documented evidence the site was monitored/assessed after the IV fluid was administered and the [MEDICATION NAME] lock was removed. On 7/6/17 at 9:05 AM, a Licensed Nurse reported IV access sites were checked for redness, swelling and leakage prior to medication administration. Findings were documentation in nursing notes at the end of shift. On 7/6/17 at 10:10 AM, a Licensed Nurse explained IV sites were checked for inflammation, infection and patency prior to medication administration. Findings were documented under progress notes. The nurse confirmed the site assessment should have been documented. Resident #6 Resident #6 was admitted to the facility on [DATE] with [DIA… | 2020-09-01 |
| 1853 | 1853 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2017-07-06 | 431 | D | 0 | 1 | NRKI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to ensure medications were secured for a resident who did not have a physician's orders [REDACTED].#5). Findings include: Resident #5 Resident #5 was admitted on [DATE], with [DIAGNOSES REDACTED]. The 5-Day Minimum Data Set (MDS) 3.0 dated 6/28/17, documented a Brief Interview for Mental Status (BIMS) score of 15 which indicated the resident was cognitively intact. On 7/5/17 at 2:15 PM, a 0.5 fluid once bottle of Refresh Tears lubricant eye drops was on Resident #5's bedside table and a container of TUMS chewable flavored antacid tablets were on the resident's night stand. On 7/5/17 at 2:28 PM, a Registered Nurse (RN) verbalized Resident #5 had an as needed order for hypotears drops, but had not needed them. The RN was informed the medications were observed in the resident's room. On 7/5/17 at approximately 2:30 PM, Resident #5 indicated she brought the eyedrops in from the hospital. The resident said the Refresh Tears were used while in the hospital and they worked the best. Resident #5 indicated her daughter brought the TUMS in, but she had not used them yet. On 7/5/17 in the afternoon, the RN explained if a resident brought in medications the doctor would have been called to get an order for [REDACTED].#5 did not have an order for [REDACTED]. On 7/5/17 at 2:36 PM, the Director of Nursing (DON) explained the facility did not allow medications to be brought in for self administration unless there was an order from the doctor. The DON indicated the nurse was required to get an order, assess the resident and complete the form for self administration. A Physician order [REDACTED].#5 had orders for the following: Hypotears over-the-counter drops; 1-1 percent (%). Apply 2 drops to each eye as needed for dry eyes. Geri-Lanta over-the-counter suspension; 200-200-20 milligrams/5 milliliters. Give 30 cubic centimeters every four hours for gastrointestinal (GI) distress as needed… | 2020-09-01 |
| 1854 | 1854 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2018-10-04 | 804 | D | 1 | 0 | 8IF011 | > Based on observation, interview, and document review, the facility failed to ensure food temperatures at the point of service were kept at a hot enough temperature per facility policy. Findings include: On 09/27/18, the breakfast meal included a choice of bacon, scrambled eggs or omelettes, pancakes or toast, cold cereal or hot cereal, juice or milk, and fresh fruit. The residents were served one at a time, first in the Dining Room, then the residents in the rooms were served. On 09/27/18 at 8:41 AM, a test tray was completed at the point of service (the pass-through window between the Kitchen and the Dining Room) and the test tray temperatures were verified by the Cook. The bacon was lukewarm to the touch. The toast was cold and dry to the touch. On 09/27/18 during the breakfast meal, residents in the Dining Room indicated the food was sometimes cold. On 09/27/18, the lunch meal included roast turkey, gravy, stuffing, brussel sprouts, rolls, and blueberry cake. On 09/27/18 at 12:20 PM, a test tray was completed at the point of service after all residents in the Dining Room and resident rooms were served. The temperatures were verified by the Cook and the Interim Dietary Manager. The stuffing was 130 degrees Fahrenheit (F). On 09/27/18 during the lunch meal, one resident in the Dining Room indicated the lunch was not hot sometimes. On 09/27/18 at 8:45 AM, the Cook indicated it was the facility's standard to make sure the temperatures on the steam table were maintained at at least 140 degrees F. The Cook indicated the steam tray food items were measured for quality purposes while in the kitchen, but there was no practice in place to measure temperatures of foods at the point of service to ensure the food was served hot. On 09/27/18 at 12:30 PM, the Interim Dietary Manager indicated hot foods should be served at least 140 degrees F. The facility's policy, Food Safety For Your Loved One, Policy and Procedure Manual 2013, indicated hot foods should be stored at 140 degrees Fahrenheit or higher. Hot foods should be … | 2020-09-01 |
| 2638 | 2638 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2016-06-30 | 309 | D | 0 | 1 | Z5ZH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure appropriate antibiotic therapy was provided to treat a gastrointestinal infection for 1 of 10 sampled residents (Resident #3). Findings include: Resident #3 Resident #3 was admitted on [DATE], with [DIAGNOSES REDACTED]. The resident was admitted to complete intravenous (IV) antibiotic therapy for the osteomylitis. On 6/28/16 at 8:20 AM, the resident was observed in her room. A red sign was posted on the door of the room directly visitors to contact a nurse prior to entering the room. A License Practical Nurse (LPN) confirmed the resident was in contact isolation for [MEDICAL CONDITION] gastrointestinal infection. Review of the clinical record revealed a physician order [REDACTED]. A nursing progress note dated 6/20/16 at 2:32 PM indicated the resident complained of loose stools due to the administration of [MEDICATION NAME]. The note documented the Attending Physician was notified and a new order for stool laboratory analysis for [MEDICAL CONDITION] (C. diff) was obtained. Laboratory report dated 6/25/16, revealed a positive stool analysis for [DIAGNOSES REDACTED]. On 6/29/16 at 9:02 AM, the Registered Nurse Clinical Manager responsible for the infection control program confirmed the resident was in contact precautions due to a positive laboratory result for [DIAGNOSES REDACTED]. The Manager indicated the resident complained of loose stools due to the IV [MEDICATION NAME] and orders were obtained for laboratory analysis and oral [MEDICATION NAME] for suspected case of [DIAGNOSES REDACTED]. On 6/22/16, an order for [REDACTED]. diff gastrointestinal infection. The same day, another order was obtained to discontinue the [MEDICATION NAME] and start [MEDICATION NAME] 600 mg IV every 12 hours. The order for [MEDICATION NAME] did not document the [DIAGNOSES REDACTED]. On 6/26/16 at 10:00 AM, a telephone order documented the [DIAGNOSES REDACTED]. diff. On 6/28/16 at 4:39… | 2019-08-01 |
| 2639 | 2639 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2016-06-30 | 441 | D | 0 | 1 | Z5ZH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and document review, the facility failed to ensure transmission based precautions were implemented timely for a suspected case of gastrointestinal infection and failed to ensure a patient with confirmed gastrointestinal infection was treated accordingly for 1 of 10 sampled residents (Resident #3). Findings include: Resident #3 Resident #3 was admitted on [DATE], with [DIAGNOSES REDACTED]. The resident was admitted to complete intravenous (IV) antibiotic therapy for the osteomylitis. Review of Resident #3's clinical record revealed a physician order [REDACTED]. On 6/20/16 at 2:32 PM, a nursing progress note indicated the resident complained of loose stools due to the administration of [MEDICATION NAME]. The note documented the Attending Physician was notified and a new order for stool laboratory analysis for Clostridium difficile (C. diff) was obtained. The note did not document transmission based precautions were implemented. Laboratory report dated 6/25/16, revealed a positive stool analysis for [DIAGNOSES REDACTED]. On 6/26/16 at 10:00 AM, a Physician order [REDACTED]. diff. The precautions were implemented six days after the onset of the infection. On 6/29/16 at 9:02 AM, the Registered Nurse Clinical Manager responsible for the infection control program confirmed the resident was in contact precautions due to a positive laboratory result for [DIAGNOSES REDACTED]. The Manager indicated the resident complained of loose stools due to the IV [MEDICATION NAME] and orders were obtained for laboratory analysis and oral [MEDICATION NAME] for suspected case of [DIAGNOSES REDACTED]. The Manager explained in the event of a suspected case of C. dif infection, the transmission based precautions should be implemented immediately. The precautions could be maintained as long as symptoms were presented. The Manager acknowledged the precautions were not implemented in timely manner. Facility policy titled Contact Precaution… | 2019-08-01 |
| 3240 | 3240 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2015-08-20 | 323 | D | 0 | 1 | CQ9511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review the facility failed to ensure fall precautions were implemented for 2 of 10 sampled residents (Resident #1 and #6). Findings include: Resident #6: Resident #6 was admitted on [DATE] with [DIAGNOSES REDACTED]. Review of facility policy titled, Fall prevention, created on 3/27/07 and revised on 1/31/11, documented in part, the admitting nurse/nurse manager would be responsible for ensuring interventions are initiated and communicated to appropriate staff for follow through. The Fall Risk Assessment form documented in part, If the resident's fall risk score was 12 or greater the resident was considered a risk for falls. The resident fall risk score was 12. The fall assessment documented, prevention protocol should be initiated immediately and documented. Physician recapitulation report dated 8/1/15 - 8/31/15, documented, fall mats to floor while patient in bed. Bed in lowest position every shift. The general flow sheet dated 8/1/15 - 8/31/15, documented, the fall mats are to be on the floor while patient was in bed. Bed in lowest position, every shift. On 8/18/15 at 8:20 AM, the resident was in bed sleeping. The bed was not in the lowest position. The landing strips/floor mats were rolled up and placed in the corner of the room by a dresser. On 8/19/15 at 10:38 AM, the resident was in bed sleeping. The bed was not in the lowest position. The landing strips/floor mats were rolled up and placed in the corner by the dresser. On 8/19/15 at 10:40 AM, a Licensed Practical Nurse confirmed the bed was not in the lowest position and the landing strips/floor mats were not placed beside the bed. The LPN did not know why the landing strips/floor mats were not placed beside the bed or why the bed was not in the lowest position. Resident #1: Resident #1 was admitted to the facility on [DATE] with medical [DIAGNOSES REDACTED]. Review of facility policy titled, Fall prevention, created on 3/27/07 and revised o… | 2018-05-01 |
| 3241 | 3241 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2015-08-20 | 329 | D | 0 | 1 | CQ9511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to document interventions provided prior to administration of pharmacological intervention for 2 of 10 sampled residents (Resident #4 and #6). Resident #4: Resident #4 was admitted on [DATE] with [DIAGNOSES REDACTED]. A review of facility's policy titled, Psychopharmacological Medication Management, undated, documented in part: (8) Patients receiving [MEDICAL CONDITION] medications for management of behavioral symptoms will have a behavior monitor in place identifying non-pharmacological interventions and their outcomes with quantitative and objective evaluation to be completed by the D.O.N. or designee. A Physician Recapitulation Report dated 8/1/15 - 8/31/15, documented: - [MEDICATION NAME] 15 milligrams (mg), 1 tablet at bedtime as needed. Start date: 7/14/15. A care plan documented, Problem start date: 7/14/15, category: mood state; goal: patient will report feeling rested with adequate sleep throughout stay. An approach listed documented: offer alternative sleep solutions, i.e. warm milk, herbal tea, massage, white noise etc. On 8/19/15 in the morning, the resident and son indicated the resident is prescribed medication to assist with sleeping. They reported the facility did not provide any non-pharmacological interventions prior to administering the sleep medication. The resident stated, I'm not really a warm milk kind of resident but would like some music options to assist with sleep. On 8/19/15 at 3:50 PM, Employee #6, a Licensed Practical Nurse, revealed non-pharmacological interventions are offered prior to giving a sleep medication. The interventions are documented in the computer system. A review of the 8/1/15 - 8/18/15 Medication Administration Record [REDACTED]. The MAR failed to document any non-pharmacological interventions prior to administering the medication on these dates. On 8/18/15 at 3:20 PM the Director of Nursing verbalized the facility did not do… | 2018-05-01 |
| 3242 | 3242 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2015-08-20 | 441 | D | 0 | 1 | CQ9511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow appropriate isolation precautions for 2 of 2 residents (Resident #2 and #5). Findings include: Review of the facility's policy entitled, Contact Precautions, no date, documented the following: - In addition to Standard Precautions, use Contact Precautions, or the equivalent, for specified residents known or suspected to be infected or colonized with epistemologically important microorganisms that can be transmitted by direct contact with the resident (Hand or skin-to-skin contact that occurs when performing patient care activities that require touching the resident's dry skin) or indirect contact (touching) with environmental surfaces or patient care items in the resident's environment. - Gloves and hand washing: In addition to wearing gloves as outlined under Standard Precautions; wear gloves when entering the room. - Gown: In addition to wearing a gown as outlined under Standard Precautions, wear a gown when entering the room if you anticipate that your clothing will have substantial contact with the resident, environmental surfaces, or items in the resident's room, or if the resident is incontinent or had diarrhea. - Resident Transport: If the resident is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other residents and contamination of environmental surfaces or equipment. Resident #2: Resident #2 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 8/18/15 in the morning, personal protective equipment (PPE) was observed in a small cabinet outside of the resident's door which included the following: gloves, gowns, hand sanitizer, shoe covers and masks. A red sign was posted on the door of the resident's room with instructions for visitors to see the nurse at the front desk. On 8/18/15 at 1:27 PM, the Certified Nursing Assistant (CNA) indicated if a visitor went into a room that ha… | 2018-05-01 |
| 3616 | 3616 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-09-04 | 248 | D | 1 | 0 | QC7B11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and document review the facility failed to ensure an ongoing program of activities was designed to meet the interests of each resident for 1 of 5 sampled residents (Resident #5). Findings include: Resident #5 Resident #5 was admitted to the facility on [DATE] and was discharged on [DATE], with [DIAGNOSES REDACTED]. The Initial Activity assessment dated [DATE], revealed the resident's activity pursuit patterns included spiritual/religious as a current interest. The Activity Participation Record dated July 2014, documented Resident #5 refused to attend the activities listed such as bingo, card games, movie, board games, ice cream, root beer floats, wii games, and art and crafts during the resident's stay at the facility. The facility's calender of activities from July 2014 to September 2014, indicated spiritual/religious activities were not scheduled during these months. On 9/4/14 at 2:30 PM, an Occupational Therapist (OT)/Activity Director verbalized the information on the Initial Activity Assessment for each resident and the turn-out of participants on scheduled activities determined the activities to be offered for each resident. The OT/Activity Director confirmed no spiritual/religious activities were scheduled from July 2014 to September 2014. The OT/Activity Director acknowledged there was no documentation other activities were offered to Resident #5 when the resident refused to participate in activities. The facility's policy titled ACTIVITY PROGRAM undated, documented: .PROCEDURE .4. Activities will consist of individual, small and large group activities designed to meet the needs and interests of each patient and may includes (sic), but is not limited to: .d. Religious programs; .6. Individualized and group activities are provided that: a. Reflect the choices and rights of the patients; . c. Reflect the cultural and religious interests of the patient . Complaint #NV 196 | 2017-09-01 |
| 3617 | 3617 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-09-04 | 309 | D | 1 | 0 | QC7B11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and document review the facility failed to ensure a wound treatment was provided per physician's order to 1 of 5 sampled residents (Resident #5). Findings include: Resident #5 Resident #5 was admitted to the facility on [DATE] and was discharged on [DATE], with [DIAGNOSES REDACTED]. The physician's order dated 7/22/14, documented: .1. Cleanse wound with Dakin's wash 0.25% with vac changes 2. Reapply vac and change 3x/wk (three times per week) @ (at) 125 mg (sic) neg (negative) pressure with Black Foam . The Treatments Flowsheet dated July 2014, indicated the treatment orders mentioned above were scheduled on 7/27/14, but were not done per physician's order. On 9/4/14 at 2:50 PM, a Registered Nurse (RN)/Treatment Nurse confirmed wound treatment for [REDACTED]. The RN/Treatment Nurse verbalized the reason why the treatment was not done should be documented in the TAR (Treatment Administration Record) or the nurse's notes, and the physician should also be notified. The RN/Treatment Nurse indicated there was no documentation in the resident's clinical record indicating the reason the wound treatment was not done on 7/27/14, or the physician notified. The RN/Treatment Nurse acknowledged a resident could have a risk of infection if wound treatment was not done as scheduled and ordered by the physician. On 9/4/14 at 3:10 PM, the Director of Nursing (DON) verbalized the medication nurses were assigned to do wound treatment and the charge nurse would do the wound vac with dressing changes on weekends. The DON indicated if the wound treatment was not done, the reason should be documented in the TAR or nurse's notes and the physician should be notified. On 9/4/14 at 3:15 PM, the DON confirmed Resident #5 did not receive wound treatment on 7/27/14, and there was no documentation in the resident's clinical record why the treatment was not done or the physician notified. The DON also verbalized a resident could have an in… | 2017-09-01 |
| 3727 | 3727 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-10-10 | 322 | D | 0 | 1 | YTSW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and document review, the facility failed to ensure a gastrostomy tube flush was performed correctly for 1 of 1 residents with a gastrostomy tube (Resident #2). Findings include: Resident #2 was admitted on [DATE] with [DIAGNOSES REDACTED]. Medical record review revealed the resident had a gastrostomy tube ([DEVICE]) for feeding and medication administration. On 10/9/14 at 12:00 pm, observed the licensed nurse (LN) administer medications through the resident's [DEVICE]. Prior to administering the medications, the LN checked the placement of the [DEVICE]. The LN disconnected the [DEVICE] from the feeding, attached a syringe, then instilled about 10 cc (cubic centimeters) of air into the tube while auscultating the resident's abdomen with a stethoscope. The LN then started to instill water into the tube by gravity. The LN then administered the resident's medications. The LN did not aspirate the [DEVICE] to check for residual fluid prior to instilling the water. On 10/10/14 in the afternoon, the LN confirmed that she had not aspirated the [DEVICE] prior to instilling the water and administering the resident's medications. The facility policy titled Administering Medications through an Enteral Tube dated 01/18/2012, documented: - 17. For nasogastric, esophagostomy, or gastrostomy tubes, check placement and gastric contents: - a. Attach a 60 ml (milliliter) syringe containing approximately 10 cc air. - b. Auscultate the abdomen approximately 3 inches below the sternum while injecting the air from the syringe into the tubing. - c. Listen for whooshing sound to check placement of the tube in the stomach. d. Pull back gently on the syringe to aspirate the stomach content. e. If the stomach content cannot be aspirated, pull back slightly on the tube to reposition. If the tube is still not patent, withhold medication and notify the physician. - f. If there is more than 100 ml of stomach content, withhold medication and n… | 2017-07-01 |
| 3728 | 3728 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-10-10 | 364 | D | 0 | 1 | YTSW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and policy review, the facility failed to maintain a system in place to ensure foods were served at appropriate temperatures to residents in their rooms in accordance with facility policies and procedures. Findings include: The facility's policy and procedure regarding food temperatures indicated: Resource: Taking Accurate Temperatures (Policy & Procedure Manual 3-27, 2013): .2 Normally, hot foods will be 165 degrees to 180 degrees F (Fahrenheit) or higher when removed from the cooking heat source. Assure a high enough holding temperature to maintain a temperature at or above 135 degrees F during holding, distribution and service .4. Temperatures should be taken periodically to assure hot foods stay above 135 degrees F and cold foods stay below 41 degrees F during the portioning, transporting and serving process until received by the customer . 1) 10/9/14: Lunch Meal: On 10/9/14 at approximately 11:40 AM tray line observations for the lunch meal were conducted. The lunch meal consisted of roast beef, potatoes, gravy, peas, bread, and cherry pie with ice cream. There were 11 residents served in the dining room. The remaining residents (27) received lunch in their rooms. At approximately 12:15 PM the meals for the residents eating in their rooms were plated, covered with a lid, and placed on an open cart. (The plates were not equipped with a metal liner to maintain a hot temperature.) Several of these plates had covers which were slightly askew and not completely covered upon leaving the kitchen at approximately 12:20 PM. A lunch tray (mechanical soft diet) was tested following the last meal served on the unit, with the following temperatures: -Roast Beef: 110 degrees F -Gravy: 90 degrees F -Mashed potatoes: 121 degrees F. The meat, gravy, and potatoes were tasted, and were not hot to the touch. The Dietary Manager indicated the facility's standards for hot food temperatures were 145 degrees F for meat, 175 degr… | 2017-07-01 |
| 3729 | 3729 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-10-10 | 514 | D | 0 | 1 | YTSW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure care plans accurately reflected the problems and interventions of the current admission for 1 of 10 sampled residents (Resident #8); and, failed to ensure the physician standing orders were appropriate for 1 resident who had a [MEDICAL CONDITION] (Resident #5). Findings include: Resident #8 Resident #8 was admitted on [DATE] with [DIAGNOSES REDACTED]. Medical record review revealed the resident had been an inpatient at this facility in the past. The resident's care plan for the current admission included the following problems and approaches: - Problem Start Date 09/17/14 - Resident is at risk for alteration in respiratory status r/t (related to ) use of continuous supplemental oxygen. - Approach Start Date : 02/05/2014 - Assess lung sounds ., Elevate HOB (Head of Bed) to maximize air exchange; Medications and labs per MD - Problem Start Date 09/17/14 - Resident is at risk for injury r/t (related to) [MEDICAL CONDITION] dx (diagnosis). - Approach Start Date 02/05/2014 - Medication and labs per MD order, Monitor for side effects of medication regimen Problem Start Date 09/17/14 - Resident has a functional mobility deficit r/t [MEDICAL CONDITION] dx, debility, [MEDICAL CONDITION] . - Approach Start Date 05/10/13 - Assist with ambulation and/or wheelchair mobility as needed.; Encourage participation in mobilities - There were 5 other approaches with the Start date of 05/10/13. Additional problems identified with a start date of 09/17/2014 included; - Urinary and Bowel Incontinence - Cognitive Loss/Dementia - Self Care Deficit - Prolonged Bleeding r/t use of anticoagulants - Alteration in cardiac function r/t [MEDICAL CONDITION] . - Alteration in fluid maintenance r/t use of diuretic - Alteration in mood r/t depression The approach dates to these problems was documented as either 05/10/2013, 02/05/2014 or 05/05/2014 On 10/10/14 in the afternoon, the MDS (Minimum Data Set)… | 2017-07-01 |
| 4430 | 4430 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 152 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review the facility failed to ensure a resident or legal surrogate was informed in advance about care and treatment for 1 of 11 sampled residents (Resident #1). Findings include: Resident #1 Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Resident #1's face sheet indicated the resident was her own responsible party and to contact a designated family member in the event of an emergency. On 12/4/13, Resident #1's clinical record documented the influenza and pneumococcal immunizations were declined until son notifies the facility. Resident #1's Pneumococcal and Influenza consent form dated 12/4/13, contained the signatures of two staff members. The clinical record lacked evidence the patient was offered the vaccine. On 1/21/14 at approximately 9:00 AM, the Nurse Manager (NM) verbalized he/she would clarify if the resident was self responsible or a family member. On 1/22/14 at approximately 10:15 AM, the Director of Nursing (DON) verbalized the son was contacted. The DON indicated the POA document was not in the clinical record and verified the face sheet documented the resident was self responsible. On 1/22/14 at approximately 11:15 AM, the Social Worker (SW) verbalized the residents had a right to self determination. The SW indicated the physician would be the person who determined if a resident was not able to make health care decisions. The SW acknowledged POA paperwork should be filed in the chart. The SW revealed if the face sheet indicated the resident was his/her own responsible party and the clinical record lacked evidence of an existing POA, the resident was his/her own responsible party. The SW indicated the POA document would not be invoked (or become effective) without the documentation from the court or the physician indicating the resident did not have the capacity to make his/her own health decisions. On 1/22/14 at approximately 4:00 PM, a Registered Nur… | 2016-07-01 |
| 4431 | 4431 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 281 | E | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review, the facility failed to ensure the [MEDICAL CONDITION] screening program followed current standards for training employees for skin testing, assessment and documentation of test results as outlined in the Center for Disease Control Guidelines for preventing [MEDICAL CONDITION] in Health-Care settings and the facility failed to ensure licensed staff properly documented the results of [MEDICATION NAME] (TB) Skin Tests including 0 millimeters (mm) of induration for 6 of 11 sampled residents (Resident #2, #5, #3, #4, #10, #7). Findings include: On 1/23/14 in the afternoon, during an interview, the Infection Control Nurse explained, the facility follows the CDC (Center for Disease Control) guidelines in their Infection Control Program for screening residents for [MEDICAL CONDITION] (TB). The Infection Control Nurse provided a black three ringed binder and explained this binder contained the CDC guidelines the facility followed. The cover of the binder was titled Infection Control Policy. Review of the material in the binder revealed multiple policies some of which made reference to CDC. The binder did not contain CDC guidelines for [MEDICAL CONDITION] infection control standard of practice. The Infection Control Nurse was unable to provide the current [MEDICAL CONDITION] CDC guidelines which was reportedly currently used by the facility in their infection control program. The Infection Control Nurse further reported the following information: - All newly admitted residents receive a two step [MEDICAL CONDITION] skin test. If the resident refuses the skin test we obtain a chest x-ray and call the physician. - No special training was provided to nursing staff for the process of [MEDICAL CONDITION] screening of residents. The staff used information learned in nursing school to perform [MEDICAL CONDITION] testing. - A resident who is immune suppressed does not receive TB testing and the doctor was notified. - Whe… | 2016-07-01 |
| 4432 | 4432 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 309 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to ensure nursing staff followed physician orders [REDACTED].#4); 2) reporting blood glucose levels greater than 200 for 1 of 11 sampled residents (Resident #10). Findings include: Resident #4 Resident #4 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #4's medical record revealed a facility document entitled Standing Orders noted as a telephone order on 1/17/14. The order documented .4. May apply oxygen per mask/nasal cannula; titrate to maintain SaO2 (measure of oxygen in the blood cells) above 85% until able to notify MD (medical doctor) during normal business hours . These orders shall be noted in the interdisciplinary notes and placed on the medication or treatment record as appropriate. No other medication or treatments should be given without specific authorization from a physician. Resident #4's nursing progress notes documented the following: - On 1/18/14 at 2:28 AM, On O2 (Oxygen) @ (at) 2L/min (liters per min) via n/c (nasal cannula). 02 sat 97% .no s/s (signs or symptoms) of acute respiratory distress noted. - On 1/18/14 at 8:11 PM, On O2 at 2L/min via NC. - On 1/19/14 at 2:55 AM, O2 at 2 LPM per nc in use. - On 1/20/14 at 3:01 AM, O2 at 2 LPM per NC in use. - On 1/22/14 at 2:46 AM, kept on O2 @ 3L via nasal cannula. Resident #4's vitals report dated 1/17/14 - 1/22/14 documented the resident's O2 saturation from 94 % to 100%. The vital signs report and nursing progress lacked documented evidence the resident's O2 saturations were below 85%. The medical record lacked documented evidence the physician was notified regarding the resident's 02 saturations and oxygen use during the night. Resident #4's medical record lacked evidence of an order for [REDACTED]. On 1/21/14 at 1:30 PM, Resident #4 was observed in the resident's room seated in a wheelchair. The resident was not using oxygen. On 1/21/14 at 2:25 PM, Resident #4 was observed in the therapy de… | 2016-07-01 |
| 4433 | 4433 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 314 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, policy review and observation, the facility failed to ensure 1 of 11 sampled residents (Resident #1) with pressure ulcers received necessary assessment, treatment, and services to promote healing and prevent new sores from developing. Findings include: Resident #1 Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. On 12/03/13, Resident #1's skin assessment indicated a Deep Tissue Injury (DTI) on the left heel. The area was described as a closed black blister measured 6 cm x 6 cm (centimeters). The skin assessment documented non-blanching redness with excoriation to the coccyx measured 15 cm x 2.5 cm. On the admission assessment form the coccyx was described as open areas unstageable at this time. On 12/11/13, Resident #1's clinical record described the skin as DTI to the left heel. The wound bed is 50% blister and 50% scab. The description of the skin indicated the buttocks were 50% less excoriated than the previous assessment had documented. The documentation noted a dark red spot on the left buttocks which measured 2 cm x 1 cm and was documented as a DTI. On 1/21/13 at approximately 11:30 AM, the Nurse Manager (NM) indicated the assessments were different because two different nurses had completed the forms. The NM indicated the assessments were completed by nursing management. The NM indicated Management had documented the wounds every week according to the facility's policy. Review of the NM weekly notes revealed on 12/11/13, the left heel measured 7 cm x 6 cm. The description documented 50% scab and 50% blister. The left buttocks measured 2.0 cm x 1.0 cm. The description revealed the area was dark red purplish color. The area on the form for the actual stage documented DTI and visual stage was a 4. The coccyx was 15 cm x 2.5 cm. The description was non blanching redness with excoriation. The actual stage was documented as 1 and the visual stage a 1. On 12/17/13, the weekly sk… | 2016-07-01 |
| 4434 | 4434 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 323 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to ensure a safe environment by leaving an unlabeled full syringe in 1 of 38 resident rooms (Resident #12's room). Findings include: Review of facility policy from the Pharmaceutical Service Manual (revised 9/05) titled Administering of Drugs revealed: Bedside Medications When medication is ordered for use at the bedside the medication label must contain an indication that it is to be stored at the bedside in addition to the instructions for use. Resident #12 Resident #12 was admitted for rehabilitation and wound care. The resident was receiving IV (intravenous) antibiotics every 12 hours through a PICC (peripherally inserted central venous catheter) line. Resident #12's medical record revealed in addition to the IV antibiotics, there was a physician order [REDACTED]. The order included the use of 5 cc's (cubic centimeters) of normal saline (NS) followed by 3 cc's of heparin. On 1/23/14 at 6:50 AM, the LPN (Licensed Practical Nurse with a Nevada State Board of Nursing approved IV Certification) was observed performing medication pass to Resident #12. The resident's IV anti-biotic infusion was complete and the NS and Heparin flush was due to be administered. The LPN obtained a 10 cc capped needles syringe full of a clear liquid which was wrapped in clear cellophane from the manufacturer and labeled Normal Saline. A second syringe labeled Heparin with 5 cc of clear fluid was also obtained. The nurse removed the cellophane from both syringes and proceeded to flush Resident's PICC line using proper technique. A 10 cc needles capped syringe which was not wrapped in cellophane and was not labeled with any other identifiable information was observed sitting on the counter next to the Resident #12's bed. After completing the procedure, the LPN turned to leave the room and picked up the unlabeled 10 cc syringe from the counter. The nurse began to discard the syringe. The nurse ex… | 2016-07-01 |
| 4435 | 4435 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 329 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review, the facility failed to ensure consent was obtained and behavior monitored when administering antipsychotic medication for 3 of 11 sampled residents (Resident #5, #7 and #1). Findings include: Resident #5 Resident #5 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #5's medical record contained the following: - A signed physician order [REDACTED]. - A psychopharmocological medication review form for [MEDICATION NAME] dated 12/17/13 indicated a consent for the use of [MEDICATION NAME] was signed. This form further indicated behavior monitoring was in place. - The consent to use [MEDICATION NAME] dated 12/17/13, did not indicate signature by resident or legal representative was obtained prior to medication administration. This form contained instructions to monitor and record episodes of behavior. Resident #5's medical record lacked documented evidence behavior monitoring was in place or being performed related to the use of [MEDICATION NAME] with Resident #5. Resident #7 Resident #7 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Resident #7's clinical record contained a physician's orders [REDACTED]. The physician's orders [REDACTED]. Resident #7's clinical record contained consent for the use of psychotherapeutic medications dated 11/19/13, lacked documented evidence of a specific behavior to monitor for the use of the medication [MEDICATION NAME]. The Medication Administration Record (MAR) dated November 2013, December 2013 and January 2014, documented Resident #7 received [MEDICATION NAME] 25 mg orally once in the morning, and 50 mg in the evening for the [DIAGNOSES REDACTED]. The clinical record lacked documented evidence a specific behavior was monitored for the signs and symptoms of the medication [MEDICATION NAME]. Resident #7's clinical record contained a care plan 12/9/13, at risk for alteration and mood, status related to mood disorder. The documented approaches in… | 2016-07-01 |
| 4436 | 4436 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 332 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure it was free of a medication error rate of five percent or greater. Findings include: The facility medication error rate was 6.4 percent. Resident #13 Resident #13 was admitted on [DATE] with [DIAGNOSES REDACTED]. The medical record of Resident #13 contained a signed physician order [REDACTED]. A Registered Nurse (RN) was observed performing the 8:00 AM medication pass on 1/23/14. [MEDICATION NAME] was not administered to Resident #13. The Medication Administration Record [REDACTED]. The administration time was originally typed 08:00 (8:00 AM). Hand written over the 08:00 was 20 (indicating administration time was 8:00 PM). The altered time of administration on the MAR indicated [REDACTED]. The medical record of Resident #13 lacked documented evidence the physician had changed the time the [MEDICATION NAME] was to be administered. On 1/24/14 in the afternoon, the RN reviewed the physician order [REDACTED].#13. The nurse confirmed the [MEDICATION NAME] order was not clear and should have been clarified with the physician. Resident #14 Resident #14 was admitted on [DATE], with [DIAGNOSES REDACTED]. The medical record of Resident #14 contained a signed physician order [REDACTED]. The RN was observed performing the 8:00 AM medication pass on 1/24/14. [MEDICATION NAME] was not administered to Resident #14. The Medication Administration Record [REDACTED]. The administration time was originally typed 08:00 (8:00 AM). Hand written over the 08:00 was 20 (indicating administration time was 8:00 PM). The altered time of administration on the MAR indicated [REDACTED]. The medical record of Resident #14 lacked documented evidence the physician had changed the time the [MEDICATION NAME] was to be administered. On 1/24/14 in the afternoon, the RN confirmed the physician order [REDACTED].#14. The nurse confirmed the [MEDICATION NAME] order was not clear and should have been clari… | 2016-07-01 |
| 4437 | 4437 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 371 | D | 0 | 1 | 0S0X11 | Based on observation, interview and policy review, the facility failed to ensure food was covered, labeled and dated when stored in the kitchen. Findings include: On 1/21/14, in the kitchen, two containers of cottage cheese, four 8 ounce glasses of crystal light and cranberry juice were not labeled or dated. The Dietary Manager (DM) indicated all containers should be labeled and dated. On 1/22/14, in dry storage, a large container of cheerios did not have a label or date. The DM indicated the container should have a label and date. A blue pitcher located in the refrigerator contained iced tea did not have a label or date. During the observation on 1/22/14, the containers for parsley, salt, black pepper, Italian seasoning, dill weed, ginger, oregano, and poultry seasoning were stored on a shelf above the steam table had a layer of dust and grease on the containers. The 10 ounce container of tartar, basil, and seasoning salt were stored with the lid open and contained a layer of dust and grease on the top lid. On 1/22/14, the DM confirmed the observation and verbalized the spice containers should be wiped off after every use and cleaned weekly. According to the facility policy and procedure entitled Food Storage dated 2009, indicated all containers must be legibly and accurately labeled. The food storage policy indicated all foods should be covered, labeled and dated in the refrigerator. | 2016-07-01 |
| 4438 | 4438 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 441 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to ensure the infection control program maintained acceptable hand hygiene and glove change practices during wound care for 1 of 11 residents (Resident #5), and during kitchen food service preparation. Findings include: On 1/23/14 in the afternoon, during an interview, the Infection Control Nurse explained, the facility follows the CDC (Center for Disease Control) guidelines in their Infection Control Program. The Infection Control Nurse provided a black three ringed binder and explained this binder contained the CDC guidelines the facility followed. The cover of the binder was titled Infection Control Policy. Review of the material in the binder revealed multiple policies some of which made reference to CDC. The binder did not contain CDC guidelines for infection control standard of practice. The infection control nurse was unable to provide any CDC guidelines which was reportedly used by the facility in their infection control program. The infection control policy binder contained handwashing policy and procedure which documented, handwashing will occur immediately before donning gloves to touch nonintact skin, before and after contact with nonintact skin and before applying and after removing any PPE (personal protective equipment). All employees must wash their hands. Resident #5 Resident #5 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #5's medical record revealed the resident was receiving care for an area of redness on the buttocks. On 1/22/14 at 1:35 PM, the Infection Control Nurse was observed performing care to Resident #5's buttock area. Resident #5 was positioned on the right side. The bilateral buttocks were red and excoriated (stage two). A white powder film covered this area. A second stage three wound was observed on the lumbar spinal area above the buttock. The second wound was approximately 6 centimeters by 10 centimeter and was beefy red,… | 2016-07-01 |
| 4439 | 4439 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2014-01-24 | 514 | D | 0 | 1 | 0S0X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and clinical record review, the facility failed to document behaviors monitored for 1 of 11 sampled residents on [MEDICATION NAME] (Resident #7) and to ensure contact precautions were discontinued on 1 of 11 sampled residents Treatment Administration Record (TAR) (Resident #1). Findings include: Resident #7 Resident #7 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #7's clinical record contained a physician's orders [REDACTED]. The physician's orders [REDACTED]. Resident #7's clinical record contained consent for the use of psychotherapeutic medications dated 11/19/13, lacked documented evidence of a specific behavior to monitor for the use of the medication [MEDICATION NAME]. The Medication Administration Record (MAR) dated November 2013, December 2013 and January 2013, documented Resident #7 received [MEDICATION NAME] 25 mg orally once in the morning, and 50 mg in the evening for the [DIAGNOSES REDACTED]. The clinical record lacked documented evidence a specific behavior was monitored for the signs and symptoms of the medication [MEDICATION NAME]. The Psychopharmocological Medication Review form documented Resident #7 was started on [MEDICATION NAME] 25 mg every morning and 50 mg every evening on 11/19/13. The area on the form to document the manifested behavior was blank or not filled in. The area on the form revealed behavior monitoring was in place, however, the date the behavior monitoring was initiated and the listed behavior to be monitored was blank or not filled in. On 1/22/14 at 8:30 AM, the Director of Nursing (DON) the physician should document the [DIAGNOSES REDACTED]. The DON verbalized the behavior monitoring should be documented on the MAR. Resident #1 Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Resident #1's clinical record contained a physician's orders [REDACTED]. Resident #1's clinical record contained a physician's orders [REDACTED]. Resident #1's TAR for… | 2016-07-01 |
| 4792 | 4792 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 157 | D | 1 | 0 | DWTT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, clinical record review, and policy review, the facility failed to notify the physician of a change in condition for 3 of 10 sampled residents (Resident #10, #4, #2). Findings include: Resident #10 Resident #10 was admitted on [DATE], with [DIAGNOSES REDACTED]. The Policy and Procedure titled Change in a Patient's Condition, no date, stated in part, The Nurse Supervisor/Charge Nurse will notify the patient's Attending Physician or On-Call Physician when there has been: .A significant change in the patient's physical/emotional/mental condition . A review of Resident #10's Vital Signs & Weight Record indicated that on 10/28/2012 at 3:09 PM, his temperature was 100 degrees. The Director of Nursing was interviewed on 12/27/2012 at 9:08 AM. She stated that the facility should have notified the physician of the fever. The Interdisciplinary Progress Notes for 10/28/2012 were reviewed with her. She acknowledged there was no documentation the facility had notified the physician for the change in resident's condition until 10/29/2012. Resident #4 Resident #4 was originally admitted on [DATE], and re-admitted on [DATE], with [DIAGNOSES REDACTED]. The resident was sent to the emergency roiagnom on [DATE] due to an abnormal heart rate. Resident #4's Vital Signs and Weight Record form documented on 12/19/12, at 3:00 PM, a heart rate of 151. The heart rate was not re-checked until 8 hours later at 11:00 PM. There was no documented evidence the physician was contacted regarding the resident's heart rate of 151. On 12/27/12 in the afternoon, the Director of Nursing confirmed Resident #4's heart rate should have been re-checked sooner and the physician should have been notified. Resident #2 Resident #2 was admitted on [DATE] with [DIAGNOSES REDACTED]. Resident #2's physician orders [REDACTED]. - .BG (blood glucose) Resident #2's December 2012 Medication Administration Record [REDACTED] -12/2/12 at 7:30 AM BG level was 66 -12/9/12 at 7:30 AM … | 2015-12-01 |
| 5169 | 5169 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 309 | D | 0 | 1 | DWTT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to obtain and follow physician orders [REDACTED].#2, #5, #9) and one un-sampled resident (Resident #11). Findings include: Resident #2 1. Resident #2 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #2's Physician orders [REDACTED]. On 12/26/12 in the morning, Resident #2 was lying in bed with no immobilizer on her left knee. On 12/26/12 in the morning, Resident #2 and the family member was asked when the knee immobilizer was placed on her left knee. The resident and family member indicated they had not worn the knee immobilizer for over a week and did not know when the knee immobilizer was to be placed on. There was no documented evidence to discontinue the left knee immobilizer while in bed. On 12/27/12 in the afternoon, the Director of Nursing confirmed there was no order to discontinue the left knee immobilizer while in bed for Resident #2. 2. Resident #2's physician orders [REDACTED]. -"...BG (blood glucose) < (less than) 70 = Juice PO (orally) if no increase in BG, then give [MEDICATION NAME] 1 mg (milligrams) IM (intramuscular) x1, notify MD (medical doctor) ..." Resident #2's December 2012 Medication Administration Record [REDACTED] -12/2/12 at 7:30 AM BG level was 66 -12/9/12 at 7:30 AM BG level was 64 -12/15/12 at 11:30 AM BG level was 67 -12/15/12 at 4:30 PM BG level was 63 There was no documented evidence physician orders [REDACTED]. There was no documented evidence BG levels were re-checked when BG levels were below 70. There was no documented evidence the physician was informed regarding the low BG levels. On 12/27/12 in the afternoon, the Director of Nursing confirmed the physician orders [REDACTED]. Resident #11 Resident #11 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #11's physician orders [REDACTED]. During the medication pass observation on 12/27/12, Resident #11 did not receive the fish oil in the morning. Revie… | 2015-08-01 |
| 5170 | 5170 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 315 | D | 0 | 1 | DWTT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to medically justify indwelling catheter use for 1 of 10 sampled residents (Resident #5) and provide appropriate catheter care for 2 of 10 sampled residents (Resident #5 and #9). Findings include: Resident #5 Resident #5 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 12/26/12 during the morning, Resident #5 was observed with an indwelling Foley catheter. Physician admission orders [REDACTED] "...routine Foley catheter care per protocol; may D/C (discontinue) as appropriate" Review of Interdisciplinary Progress Notes dated 12/21/12, read: "...Patient continent of bowel and has Foley catheter, has [DIAGNOSES REDACTED]. Review of the Resident #5's record revealed there was not documented evidence the resident was diagnosed with [REDACTED]. Resident #5's Bowel and Bladder assessment dated [DATE], did not document reasons to justify indwelling catheter use. On 12/28/12 at 10:00 AM, the Director of Nursing (DON) affirmed if there is not a medical justification, Foley catheters must be discontinued. Physician admission orders [REDACTED] "...routine Foley catheter care per protocol; may D/C (discontinue) as appropriate" Resident #5's interim care plan dated 12/21/12, under the section of Altered in Bowel/Bladder checked off for "Catheter Care QS (every shift) and PRN (as needed)". On 12/27/12 at 8:10 AM, Employee #3 admitted during an interview the order for Foley catheter care for Resident #5 was not transcribed to the Medication Administration Record [REDACTED] Resident #5's record lacked documented evidence the Foley catheter care was performed per physician orders. Resident #9 Resident #9 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 12/26/12 during the morning, Resident #9 was observed with an indwelling Foley catheter. Review of Resident #9's admission assessment dated [DATE], documented Resident #9 had an indwelling catheter at the time of his admission. Res… | 2015-08-01 |
| 5171 | 5171 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 167 | B | 0 | 1 | DWTT11 | Based on observation and interview, the facility failed to ensure the previous survey results were easily accessible for review. Findings include: On 12/27/12 at 2:00 PM, a group meeting was conducted with 10 alert, oriented and verbal residents. None of the residents new the results of the previous survey were available for their review. On 12/27/12 at 3:00 PM, the Administrator verbalized there was a sign posted outside the case managers' office which indicated the survey results were available in the library. On 12/27/12, the inspector looked for the survey book in the library and was not able to locate it. The Administrator then entered the library and took the survey result binder, which had a small label identifying the binder, from an upper shelf of the bookcase. The binder was not easy to locate amongst the other books in the library. The location of the binder on an upper shelf in the library would not be accessible to residents in a wheelchair. | 2015-08-01 |
| 5172 | 5172 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 441 | D | 0 | 1 | DWTT11 | Based on facility policies, observations, and interviews, the facility failed to ensure staff followed infection control policies when cleaninig and disinfecting equipment for residents' care. Finding Include: 1) On 12/27/12 at 9:40 AM, during an observation in the physical therapy room, Employee #8 was using a clipper to cut finger nails of a resident. After the procedure, the employee washed the clipper with soap and water and disinfected using regular nail polish remover. The clipper was stored in a ziplock bag with two other clippers and a used nail file. On 12/27/12 at 10:00 AM, Employee #8 explained during an interview the clipper was used to cut nails of residents and was cleaned after each use. The employee indicated after washed with soap and water, she disinfected with the nail polish remover. On 12/27/12 at 10:30 AM, Employee #5 indicated during an interview, nail files are for single use and must be discarded after each use. Facility's Infection Risk Assessment (IRA) self assessment, dated 12/26/12, under the Module II Infection Control Program checked off for Centers for Disease Control and Prevention (CDC) as an infection control standard of practice followed by the facility. CDC 2008 Guideline for Disinfection and Sterilization in Healthcare Facilities, read: "...4. Selection and Use of Low-Level Disinfectants for Noncritical Patient-Care Devices... ...b. Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA-registered hospital disinfectant using the label's safety precautions and use directions..." 2) On 12/26/12 during the inspection of the kitchen, the surveyor attempted to wash his hands and noted that soap dispensers were empty in two of the three hand washing stations. | 2015-08-01 |
| 5173 | 5173 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 514 | D | 0 | 1 | DWTT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facilty failed to ensure medications were accurately documented in the resident's medical record for 1 of 10 residents (Resident #3). Findings Include: Resident #3 Resident #3 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #3's physician orders [REDACTED]. Resident #3's medication administration record dated December 2012, lacked documented evidence the [MEDICATION NAME] was administered from 12/16/12 through 12/21/12. On 12/27/12 at 1:00 PM, the Director of Nurses (DON) confirmed the medication had not been signed for from 12/16/12 through 12/21/12. The DON added, the licensed nurse should always sign the medication administration record with their initials to indicate a medication was administered. On 12/28/12 at 9:00 AM, the DON verbalized she checked the bubble pack which contained Resident #3's [MEDICATION NAME]. The medication was received on 12/16/12 and the number of pills dispensed from the bubble packet corresponded to the seven doses the resident should have received. The medication was not properly signed for by the licensed nurse. | 2015-08-01 |
| 5174 | 5174 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 176 | D | 0 | 1 | DWTT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to properly assess residents who self-administer medications for 2 of 11 residents (Resident #8, #2). Findings include: Resident #8 1. Resident #8 was admitted on [DATE], with [DIAGNOSES REDACTED]. The resident was able to take her own blood sugar level with her own monitor and she administered her own insulin four times a day. The resident would inform the nurses what her blood sugar level results were and how much insulin she administered herself. Resident #8's physician orders [REDACTED]. -"...Humalog SQ (subcutaneous) TID (three times a day) AC (before meals) per sliding scale Blood sugar < (less than) _ (or equal) 130 give 5 units Blood sugar > (greater than) 130 Give 10 units ..." Resident #8 also had physician orders [REDACTED]. On 12/27/12 in the afternoon, Resident #8 indicated she took her own blood sugar three times a day and administered her own insulin four times a day. Resident #8 indicated if her blood sugar was greater than 150 she would administer ten units of Humalog insulin to herself and if her blood sugar was less than 150, she would administer five units of Humalog insulin. Resident #8 indicated she would not administer Humalog insulin if the blood sugar level was below 100. Also, Resident #8 indicated she administered 26 units of [MEDICATION NAME] every night. Resident #8 was asked by the inspector if she was aware the physician ordered on [DATE], to administer five units of Humalog if her blood sugar was less or equal than 130 and to administer ten units if her levels were greater than 130. Also, if she was aware the physician ordered to administer 27 units of [MEDICATION NAME] instead of the 26 units she was administering herself. The resident indicated she was not aware of the new orders. Resident #8 had kept a December 2012 log of her blood sugar levels and insulin coverage at her bedside night stand. The log followed the 150 blood sugar scale wh… | 2015-08-01 |
| 5175 | 5175 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-12-28 | 371 | D | 0 | 1 | DWTT11 | Based on observation and interview the facility failed to properly store foods. Findings include: On 12/26/12 in the morning, food was being improperly stored in the walk in refrigerator, walk in freezer, and food storage area. Before entering the walk in refrigerator, there was a large sign posted on the door. The sign read, "Label and date everything." Located in the walk in refrigerator was a cake container that was not completely closed. The cake container had half a cake inside it. The container was labeled with a resident's name but was not dated. Also, located in the walk in refrigerator was a pie container that had a resident's name on the box but no date on it. The container had half a pie inside the container. In the walk in freezer, ice cream scooped in little bowls and placed on a tray had the plastic wrap pulled back and not fully covering the food. Lemon ice containers also had the plastic wrap pulled back and not covering the lemon ice containers. In the walk in food storage area was a sack of onions being stored on the floor of the area. On 12/27/12 in the afternoon, the kitchen supervisor confirmed all foods that were open should have been dated and foods should have been properly covered. | 2015-08-01 |
| 5225 | 5225 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 283 | E | 1 | 0 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and document review, the facility failed to ensure 4 of 12 sampled residents were discharged safely and appropriately with documented evidence of a final summary of the resident's status and information related to the post-discharge plan in accordance with facility policy (Resident #10, #11, #12 and #6). Findings include: The Admission, Transfer, & Discharge Policy & Procedure, created 5/24/2007, current on 1/10/2011, stated, "...Upon discontinuation of rehabilitation or skilled need, patients will be assisted in transfer to an appropriate setting which may include, but is not limited to, a private residence, assisted living facility or long term care facility with necessary supportive services...The facility and/or the attending physician will document in the patient's medical record the reasons identified for transfer or discharge including recommendations for continued care and any assistance provided in arranging care services such as home health, durable medical equipment and home care needs necessary for successful transition...The facility discharge planner or representative coordinates discharge needs with the patient and family based on identified needs and goals." The Patient Discharge Policy Statement, current on 7/17/08, stated, "...Discharge summary. When the facility anticipates discharge of a resident to another skilled nursing facility, to a lower level of care or home, a discharge summary and post-discharge plan of care is documented in the resident's clinical record. The discharge summary includes:1. A recapitulation of the resident's stay;2. A final summary of the resident's status at the time of discharge.This information shall be documented upon discharge...The discharge summary and post-discharge plan of care documentation shall be completed by one or more of the following: 1. The nurse responsible for the resident's discharge;2. The social services department;3. The resident's attendin… | 2015-07-01 |
| 5556 | 5556 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 323 | E | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation interview and policy review the failed to ensure an environment free of accident hazards and to provide adequate supervision to prevent accidents for 4 of 12 residents (Resident #9, #4, #1, #2). The facility Fall Risk Assessment form documented: - " ...Instructions: Upon admission and at least quarterly, assess the patient status in the eight clinical condition parameters listed below by assigning the score which best describes the patient in the appropriate column. Add the column of numbers to obtain the Total score. If the total is 12 or greater, the patient should be considered at RISK for falls. A prevention protocol should be initiated immediately and documented on the care plan ... " The facility Fall Risk Protocol and Care Plan form documented: - " ...To be completed with the " Falls Risk Assessment " initiating the following interventions based upon the patient's history of falls and/or total score value. The following interventions are guidelines and may not be appropriate for each patient; if an intervention is not initiated, an explanation should be provided. Interventions indicated in lower risk categories should be provided for higher risk patients ... " Resident #9 Resident #9 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #9's Falls Risk Assessment form dated 2/29/12, documented a total score of 12 (Risk for falls). The back page of the Falls Risk Assessment form was titled Fall Risk Protocol and Care Plan. Resident #9's Falls Risk Protocol and Care Plan form dated 2/29/12, had a check mark on the box reflecting 12-20 = Moderate Risk. The Falls Risk Protocol and Care Plan form was incomplete. There was no intervention boxes check marked or no interventions documented. There was no explanation documented why there were no interventions documented. Resident #9's Interim Care Plan form was found in the CNA (certified nurse aide) ADL (Activities of Daily Living) binder. The front and back of the fo… | 2014-11-01 |
| 5557 | 5557 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 364 | D | 0 | 1 | SDOE11 | Based on observation, interview and policy review the facility failed to provide foods prepared by methods that conserved the proper temperature. Findings include: On 3/7/12 during the noon meal service, temperatures of foods on the tray line were taken. The temperature of the fish patties were 125.6 ?F (degrees Fahrenheit). At this time, Employee #8 verbalized "It's not coming up to temp". Employee #8 immediately took the fish patties out of the tray and dropped them into the fryer. Employee #8 asked another staff member for a thermometer and verbalized "I don't know where it is. It was right here in the basket". The fish was taken out of the fryer and revealed a temperature of 185.6 ?F. On 3/7/12 at approximately 12:40 PM during an interview, Employee #8 verbalized "I take the food temperature when I first put food out and at the end of service. I should check the temperatures in between". The facility policy entitled, Food Temperatures. Operations Manual ?2009 Becky Dorner & Associates, Inc. indicated: "3. Temperatures should be taken periodically to ensure hot foods stay above 135? F and cold food stay above 41?F during the portioning, transporting and serving process until received by the resident". 7. ....Be sure temperatures are taken again halfway through tray line to assure safety. 6) On 3/7/12 after the noon meal service, a box fish and hamburger patties were observed in the walk in freezer with the lid opened and the inner plastic liner not securely closed. Review of the facility's policy entitled, "Food Storage Policy", Operations Manual ?2009 Becky Dorner & Associates, Inc. indicated: "16. Frozen foods: c. All foods should be covered, labeled and dated". | 2014-11-01 |
| 5558 | 5558 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 371 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review the facility failed to ensure potentially hazardous foods were prepared and served and that food was foods under sanitary conditions. Findings include: 1) On 3/6/12 at 7:59 AM during initial tour of the facility's kitchen, observation of the dry storage area revealed the following: 5 gallon white plastic food storage containers with yellow lid covers consisted of ..... - A flour container dated [DATE], lid with a 2 inch opening. - A Corn Starch container dated April 2012, lid with 1 inch opening. - A Tri-colored rotini pasta container, lid with 2 inch opening. - Sugar, white rice, egg noodle containers, lids loose and not secured. Review of the facility's "Food Storage Policy", Operations Manual copy right 2009 Becky Dorner & Associates, Inc. indicated ..."Procedure: 4. Plastic containers with tight-fitting covers must be used for storing opened containers of cereal, cereal products, flour, sugar, dried vegetables, and broken lots of bulk foods". 2) Observation of a food preparation area across from the 3 compartment sink revealed the following: -A storage shelf that was in need of cleaning due to the presence of an excessive amount of food particles and debris. -A small stainless steel bowl that stored utensils such as stainless steel measuring spoons, a whisk, small serving spoons that contained dried food particles. 3) Observation of the walk in refrigerator revealed a 16 ounce container of cottage cheese with the manufacturers "used by" date stamp of 2/30/12. A facility open date of "2/25/12" was written on the container. Review of the facility's policy entitled, "Food Storage Policy", Operations Manual copy right 2009 Becky Dorner & Associates, Inc. indicated: "16. Refrigeration: g. Refrigerated foods should be stored upon delivery and careful rotation procedures should be followed". 4) On 3/7/12 at 1:05 PM, the third compartment of the 3 compartment sink revealed white particles floating… | 2014-11-01 |
| 5559 | 5559 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 176 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and policy review, the facility failed to properly assess if a resident could safely self-administer their own medication for one sampled resident and three unsampled resident (Resident #4, #13, #14, #15). Findings include: The facility's undated policy titled, Self-Administration Administration documented: -"...Patients may self-administer medications if it is determined that they are capable of doing so in a safe and consistent manner..." -"...As part of their overall evaluation, staff will assess each patient's mental and physical abilities to determine whether a patient is capable of self-administering medications..." -"...In addition to general evaluation of decision-making capacity, staff will perform a more specific skill assessment utilizing the "Self-Medication Administration Assessment" form which includes (but not limited to) the patient's: a. Ability to read and understand medication labels. b. Comprehension of the purpose and proper dosage and administration time for his or her medications. c. Ability to remove medications from a container and to ingest and swallow (or otherwise administer) them..." -"...The "Self-Medication Administration Assessment" form will be maintained in the medical record..." -"...If staff determines that a patient cannot safely self-administer medications, the nursing staff will administer the patient's medications..." -"...For self-administering patients, the nursing staff will be responsible for documenting that medications were taken on the MAR (medication administration record)..." -"...Self-administered medications must be stored in a safe and secure place, which is not accessible by other patients. If safe storage is not possible in the patient's room, the medication of patients permitted to self-administer will be stored on the medication cart or in the medication room. Nursing staff will transfer the medication to the patient requests them..." -"...S… | 2014-11-01 |
| 5560 | 5560 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 431 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and policy review, the facility failed to properly store resident medications that were left in resident rooms in a locked secured container for one sampled resident and three unsampled residents (Resident #4, #13, #14, #15). Findings include: The facility's undated policy titled, Self-Administration Administration documented: -"...Patients may self-administer medications if it is determined that they are capable of doing so in a safe and consistent manner..." -"...Self-administered medications must be stored in a safe and secure place, which is not accessible by other patients. If safe storage is not possible in the patient's room, the medication of patients permitted to self-administer will be stored on the medication cart or in the medication room. Nursing staff will transfer the medication to the patient requests them..." -"...Staff shall identify and remove any medications found at the bedside that are not authorized for bedside storage, for proper storage or return to the family or responsible party..." Resident #4 Resident #4 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #4's Interdisciplinary Progress Notes form dated 3/5/12, documented: -"...pt (patient) on bed awake AO ( alert and oriented) x3 with episodes of confusion..." On 3/6/12 in the morning during the initial tour, Resident #4 had an Optive eyedrop container that was full of liquid. The bottle was on top of the resident's bedside rolling table. There was no locked medication box in the room. There was no documented evidence Resident #4 was assessed to self-administer the eyedrops to herself. Resident #13 Resident #13 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 3/6/12 in the morning during the initial tour, Resident #13 had a medication bottle containing metamucil tablets. The bottle was located on a shelf in her room. The resident indicated she takes one tablet whenever she feels constipated. There was no… | 2014-11-01 |
| 5561 | 5561 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 315 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, policy review and record review, the facility failed to properly assess the need for an indwelling Foley catheter and assess the bladder status for three of twelve resident's (Resident #3, #9, #4). Findings include: The facility undated policy titled, Bowel and Bladder Assessment documented: -"...To accurately assess each patients bowel and bladder function and needs and to provide an appropriate Bowel and Bladder program to best meet their needs and abilities..." -"...Within 3 days of admission, each patient will have in progress a Bowel and Bladder Assessment to determine current function and elimination patterns..." -"...The Bowel and Bladder Assessment of flow record will capture at least 24 consecutive hours of elimination..." -"...Upon completion of the initial Bowel and Bladder Assessment or flow record, a licensed nurse will complete the Bowel and Bladder Assessment and assign an appropriate program as follows:..." -"...Level IV Catheter Utilization Individuals with justified medical need for catheter utilization. Residents will be monitored for signs and symptoms of urinary tract infection. Catheter care will be provided at least once each shift. Replacement of the catheter will be performed as directed by physician order..." Resident #3 Resident #3 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 3/7/12 in the morning, the Director of Nursing (DON) confirmed Resident #3 entered the facility with an indwelling Foley catheter and the resident continues to have the indwelling Foley catheter in place. The DON was unable to find documented evidence for the justification for using an indwelling Foley catheter for Resident #3. The DON indicated the documented evidence should have been documented on the Bowel and Bladder Assessment form. The DON confirmed Resident #3 did not have a Bowel and Bladder Assessment form completed. On 3/7/12 in the morning, Employee #3 indicated the certified nurses assistant (CNA) needed … | 2014-11-01 |
| 5562 | 5562 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 328 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and document review, the facility failed to properly maintain a peripheral intravenous (IV) catheter for one of twelve residents (Resident #4). Findings include: The facility's undated protocol titled, Intravenous Access Device Maintenance Protocol documented: -"...Peripheral Access Devices...FREQ (frequency) of saline flush (idle)...Over the needle catheter...Q (every) 8 hours..." Resident #4 Resident #4 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 3/8/12 in the morning, Resident #4 had a peripheral IV saline lock site to her left forearm area. Documented evidence on the Medication Administration Record [REDACTED]. There was no documented evidence the heplock site was being maintained with saline or [MEDICATION NAME] flushes after the bolus was completed. There were no physician maintenance orders. On 3/8/12 in the morning, the Director of Nursing confirmed the IV saline lock site should have been discontinued or a physician maintenance order should have been obtained when the normal saline bolus was complete. | 2014-11-01 |
| 5563 | 5563 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 314 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, policy review and record review, the facility failed to properly assess open wounds for 2 of 12 residents (Resident #3, #4). The facility policy undated and titled, Documentation of Wounds documented: - " ...1. A complete skin check or assessment will be performed on admission by the admission nurse or designee on the day of admission. 2. The admission skin assessment will be recorded on the Admission Assessment. Treatment record (TAR) 1. The Licensed Nurse assigned to each individual patient will be responsible for completing all daily monitoring, treatments, and weekly skin assessments on the date and shift indicated. 2. The Licensed Nurse will initial the appropriate box indicating that he/she has completed the assigned daily monitor, treatment and/or weekly skin assessment. Interdisciplinary Progress Notes (IDT Notes) 1. A narrative description of all wounds, treatments and interventions will be recorded in the IDT Notes. Interventions include daily monitoring and weekly skin assessments. 2. When appropriate, documentation will include: a. Date and time of evaluation b. Type of wound (surgical, ulcer, abrasion, skin tear, ect.) c. Location d. Staging ... e. Size (length x width x depth) in centimeters f. Presence, location and extent of any undermining or tunneling ... g. Exudate (type, color, odor, amount) h. Pain ... i. Condition of wound bed ... " Resident #3 Resident #3 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 3/7/12 in the afternoon, the Director of Nursing (DON) indicated wound measurements were completed and documented weekly. Resident #3's Admission assessment dated [DATE], documented an abdominal wound on section M0001. Measurements of the wound were documented on the M0001 body diagram. Resident #3 had Weekly Skin Report forms completed on: -2/17/12 -2/24/12 -3/2/12 There was no documented evidence Resident #3's weekly abdominal wound measurements were obtained on 2/10/12. On 3/8/12 i… | 2014-11-01 |
| 5564 | 5564 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 154 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to fully inform residents on changes with their care and treatment for 2 of 12 residents (Resident #3, #16). Findings include: On 3/7/12 in the morning, Employee #3 indicated when making an appointment for a resident an order must be obtained from the physician. Then the appointment is made for the resident and an appointment card with the appointment date would be given to the resident. On 3/8/12 in the morning, the Director of Nursing (DON) confirmed an order needs to be obtained from the physician before making an appointment to see a specialist or to have a procedure completed. Resident #3 Resident #3 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 3/6/12 to 3/8/12, a yellow post it note was attached to the front of Resident #3's chart that documented: - " When is Dr. (physician name) going to do the EMG (electromyography) family asking. " On 3/7/12 in the afternoon, Resident #3 stated, " The Doctor said he was going to do a test on my wrist because I can't move my wrist that well. I don't know when I am going to get the test done. " On 3/8/12 in the morning, Employee #3 indicated she spoke with the physician last week regarding Resident #3's wrist. The physician informed Employee #3 he would come to the facility during the weekend and perform the EMG test. Employee #3 was not aware that the physician did not come during the weekend to perform the test until the surveyor informed her about the family and resident concerns. On 3/8/12 in the morning, Employee #3 confirmed a physician order [REDACTED].#3 spoke with the physician regarding Resident #3's wrist and the physician's plans to conduct an EMG at the facility last weekend. There was no documented evidence the resident or family was informed about the EMG appointment or that the appointment was cancelled. there was no documented evidence another appointment was being made after the first appointment was not pe… | 2014-11-01 |
| 5565 | 5565 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 226 | D | 0 | 1 | SDOE11 | Based on interview, policy review and record review, the facility failed to properly screen employees during initial employment. Findings include: The facility undated policy titled, Employee Background Screening documented: - " ...To provide a safe environment for all residents or patients by ensuring that all Covered Individuals (Direct Care Personnel) are appropriate for providing direct care to a residents or patients, and are without history of criminal convictions or charges which may indicate an inability to provide safe, effective direct care ... " - " ...Upon hire, all direct care employees or volunteers will be required to complete a background screening through the Department of Health and Welfare ... " - " ...All applicants will be required to present at the Department for fingerprinting ... " - " ...Based on department investigation and receipt of Notice of Agency Action, the facility will comply with the Departments recommendation for continuation or termination of employment. " - " Any conviction of a felony or misdemeanor unless excluded by State Law will be disqualified from providing direct care to residents/patients ... " There was no documented evidence fingerprints or a Nevada Highway Patrol repository result was obtained for Employee #4. On 3/8/12 in the afternoon, the Administrator confirmed Employee #4 had no fingerprints and repository results on file. The Administrator indicated Employee #4 was a contracted employee and he thought contracted employees were exempt from obtaining fingerprints and repository results. | 2014-11-01 |
| 5566 | 5566 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 309 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to obtain physician orders for wound care treatment for one of twelve residents (Resident #4). Findings include: Resident #4 Resident #4 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #4's Admission Assessment form dated 3/4/12 documented on section M0001, were bruising to the right wrist, left wrist and abdominal area on the body diagram. The body diagram also documented, " Stage 2 Coccyx. " There was no documented evidence initial measurements were made of the stage 2 wound ulcer to the coccyx area for Resident #4. Resident #4's March 2012, Treatment Sheet, documented: - " [MEDICATION NAME] Dressing to Coccyx Decub Q3D (every 3 days) due 3/7/12. " There was no documented evidence a physician order was obtained for the dressing change to resident #4's wound ulcer to the coccyx area. On 3/7/12 in the morning, the wound care nurse confirmed no initial measurements were obtained on Resident #4's coccyx stage 2 wound ulcer. Employee #3 confirmed a physician order was needed for Resident #4's wound treatment to the coccyx area. | 2014-11-01 |
| 5567 | 5567 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 325 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to appropriately assess the height of a resident to accurately calculate the ideal weight range (Resident #1). Findings include: Resident #1 Resident #1 was initially admitted on [DATE] and re-admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #1's Admission Assessment form dated 1/7/12, under the section K0200 Height and Weight, documented the resident height at 72 inches (6 feet tall). On 3/6/12 in the afternoon, Resident #1 was lying in her bed. The resident did not look like she was 6 feet tall. The resident indicated she was 5 foot 6 inches tall (66 inches tall). Resident #1's Nutritional Risk Review form dated 2/9/12 used the height of 72 inches to calculate the Ideal Weight Range (IWR) of 144 - 176 pounds for Resident #1. On 3/7/12 in the afternoon, the Director of Nursing (DON) indicated residents were measured with a measuring tape when they initially enter the facility. The DON had resident #1 re-measured for height with a measuring tape when she was informed by the surveyor that the height may be incorrect. After re-measuring the resident the DON confirmed Resident #1 was 5 feet 6 inches tall (66 inches). The Registered Dietitian was informed of the incorrect measurements. Resident #1's Nutritional Progress Notes dated 3/7/12, documented: - " ...Previous Ht (height) an error Res (Resident #1) re-measured today for confirmation at 66 " (66 inches) IWR 117 - 143 lb ... " | 2014-11-01 |
| 5568 | 5568 | ADVANCED HEALTH CARE OF LAS VEGAS | 295090 | 5840 W SUNSET RD | LAS VEGAS | NV | 89118 | 2012-03-08 | 279 | D | 0 | 1 | SDOE11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, policy review and record review, the facility failed to complete and follow resident care plans for three of twelve residents (Resident #9, #4, #1). Findings include: The Fall Risk Assessment form documented: - " ...Instructions: Upon admission and at least quarterly, assess the patient status in the eight clinical condition parameters listed below by assigning the score which best describes the patient in the appropriate column. Add the column of numbers to obtain the Total score. If the total is 12 or greater, the patient should be considered at RISK for falls. A prevention protocol should be initiated immediately and documented on the care plan ... " The Fall Risk Protocol and Care Plan form documented: - " ...To be completed with the " Falls Risk Assessment " initiating the following interventions based upon the patient's history of falls and/or total score value. The following interventions are guidelines and may not be appropriate for each patient; if an intervention is not initiated, an explanation should be provided. Interventions indicated in lower risk categories should be provided for higher risk patients ... " Resident #9 Resident #9 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #9's Falls Risk Assessment form dated 2/29/12, documented a total score of 12 (Risk for falls). The back page of the Falls Risk Assessment form was titled Fall Risk Protocol and Care Plan. Resident #9's Falls Risk Protocol and Care Plan form dated 2/29/12, had a check mark on the box reflecting 12-20 = Moderate Risk. The Falls Risk Protocol and Care Plan form was incomplete. There was no intervention boxes check marked or no interventions documented. There was no explanation documented why there were no interventions documented. Resident #9's Interim Care Plan form was found in the CNA (certified nurse aide) ADL (Activities of Daily Living) binder. The front and back of the form was left blank. On 3/8/12 in th… | 2014-11-01 |
| 2057 | 2057 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2020-01-23 | 657 | D | 1 | 0 | MLTX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, interview, and record review, the facility failed to update the comprehensive care plan to meet the needs of the resident for 1 of 5 sampled residents (Resident #1). Findings include: Resident #1 Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A Facility Reported Incident (FRI) was submitted to the State on 01/07/20. The FRI documented on 01/06/20, Resident #1 went outside with a family member, attempted to run away, tripped, and fell . Resident #1 sustained lacerations over the left eye and on the left hand. A progress note dated 12/30/19, documented Resident #1 was found on the floor at the left side of the bed. Resident #1 had abrasions on both knees, and an abrasion on the left toe; the nurse compared to [MEDICAL CONDITION] appearance. A physician progress notes [REDACTED].#1 had fallen out of bed two times. A progress note dated 01/04/20, documented Resident #1 became disruptive. Resident #1 was taken outside two times by a friend; however, Resident #1 refused to go back into the facility, and staff had to go outside to assist Resident #1 to return to the facility. A physician progress notes [REDACTED].#1 was confused and had fallen out of bed twice. Resident #1's facility care plan dated 12/21/19, lacked documented evidence of updated interventions reflecting Resident #1's increased confusion, disruptive behaviors, and falls. On 0[DATE] at 8:38 AM, the Clinical Nurse Manager (CNM) verbalized care plans and interventions for falls were developed individually for residents' needs and updated as needed to reflect a resident's current status. The CNM verbalized Resident #1's care plan had not been updated after the 12/30/19 fall. On 0[DATE] at 10:45 AM, the CNM confirmed the baseline care plan, nutritional care plans, and discharge care plans were the only care plans active for Resident #1. The facility policy titled Fall Prevention, dated 02/27/18, documented a Fall Risk Protocol and Ca… | 2020-09-01 |
| 2058 | 2058 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-01-31 | 623 | C | 1 | 0 | 0SY611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview and document review, the facility failed to provide written notification for discharge or transfer to the residents or the State Long Term Care Ombudsman's Office. Findings include: On [DATE] at 2:49 PM, the Care Coordinator Licensed Practical Nurse (LPN) confirmed the facility had not provided documentation of the written notification for discharge for any residents. The LPN verbalized the facility Ombudsman had spoken to her regarding the requirement. The LPN explained her directive from the facility administration had been the requirement was only for long term care residents. On [DATE] at 3:50 PM, the Care Coordinator LPN confirmed the facility had not identified resident initiated discharges and facility initiated discharges in resident medical records. The LPN explained a resident discharged Against Medical Advice (AMA) was the only documented evidence the facility had to establish resident initiated discharges for past discharges. The LPN verbalized she was unaware the facility was required to provide the State Long Term Care Ombudsman's Office a copy of the written notification for the facility initiated discharged residents. The Facility Admission/Discharge Report, with a run date of [DATE], documented 125 residents had discharged or transferred with return not anticipated from [DATE] to [DATE], including two expired residents and three residents discharged AM[NAME] The facility policy titled, Admission, Transfer and Discharge Rights Policy Statement, dated [DATE], documented subject to the resident's agreement, the facility must send a copy of the notice to a representative of the office of the State Long-Term Care Ombudsman. | 2020-09-01 |
| 2059 | 2059 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2019-07-24 | 623 | D | 0 | 1 | 8F2P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, document review and interview, the facility failed to provide a discharge/transfer notification to the State Ombudsman's Office for 1 of 2 unsampled residents (Resident # 53). Findings include: Resident #53 Resident #53 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #53 was transferred from the facility to the hospital on [DATE]. Resident #53's clinical record lacked documented evidence the Office of the State Long-Term Care Ombudsman was notified of the transfer. On 07/24/19 at 11:11 AM, the Discharge Planner verbalized the facility was unaware a discharge/transfer notification was to be sent to the Office of the State Long-Term Care Ombudsman when a resident was transferred to the hospital. The facility policy titled, Admission, Transfer & Discharge Rights, dated 02/21/18, documented the facility must send notice to the Office of the state Long-Term Care Ombudsman as soon as practical. | 2020-09-01 |
| 2060 | 2060 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2019-07-24 | 655 | D | 0 | 1 | 8F2P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, clinical record review, and document review the facility failed to develop a baseline care plan for a Foley catheter for 1 of 12 sampled residents (Resident #206). Findings include: Resident #206 Resident #206 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 07/22/19 at 10:26 AM, Resident #206 was lying in bed eating breakfast. Resident #206 had a urinary catheter bag hanging from the bottom of the bed frame. On 07/22/19 at 10:26 AM, Resident #206 verbalized having a Foley catheter since before admission to the facility. A physician's orders [REDACTED]. Resident #206's Observation Report completed during the admission process and dated 07/19/19, lacked documentation the resident had a Foley catheter. Resident #206's Baseline Person Centered Care Plan documented the resident was incontinent of bladder. Resident #206's Baseline Care Plan lacked documentation of the presence and care of the Foley catheter. On 07/24/19 at 11:04 AM, the Clinical Nurse Manager verbalized the Observation Report was the nursing assessment of Resident #206 and was used to develop the Baseline Care Plan based on the resident's needs. The Clinical Nurse Manager confirmed the Observation Report and the Baseline Care Plan did not document Resident #206 had a Foley catheter. The facility policy titled, Admission Process, dated 02/21/18, documented a complete and thorough assessment would be completed to ensure any immediate medical needs were addressed. The facility policy titled, Baseline and Temporary Care Plans, dated 02/27/18, documented the care plan was to be developed during the admission process, written to include care needed, and developed from the nursing assessment of the resident's needs. The facility policy titled, Indwelling Catheter Care, undated, documented each resident admitted to the facility with an indwelling catheter would be evaluated for appropriateness, the potential for bladder retraining and d… | 2020-09-01 |
| 2061 | 2061 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2019-07-24 | 761 | D | 0 | 1 | 8F2P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, document review and interview, the facility failed to store and label medications appropriately for 2 of 12 sampled residents (Resident #34 and #216). Findings include: Resident #34 Resident #34 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 07/22/19 at 11:47 AM, opened containers of [MEDICATION NAME] 1% Antifungal Spray Powder, 5.3 ounce (oz), Cortisone-10 cream, 2 oz bottle, and [MEDICATION NAME] ointment, 1/8 oz tube, were unsecured on the bathroom sink in Resident #34's room. On 07/22/19 at 11:48 AM, Resident #34 verbalized the nurse left the [MEDICATION NAME] ointment in the bathroom and the [MEDICATION NAME] Powder and Cortisone-10 cream were brought into the facility weeks ago by family members at Resident #34's request. Resident #34 confirmed resident was self-administering the [MEDICATION NAME] Power and Cortisone-10 cream daily while at the facility and the nurse administered the [MEDICATION NAME] ointment. Resident #34 verbalized not knowing why the [MEDICATION NAME] ointment was in the bathroom. Resident #34 was unaware the [MEDICATION NAME] Powder and Cortisone-10 cream had to be ordered by the physician, kept on the medication cart or administered by the nurse. On 07/22/19 at 11:49 PM, the Licensed Practical Nurse (LPN) confirmed the [MEDICATION NAME] Powder, Cortisone-10 cream and [MEDICATION NAME] ointment were on the bathroom counter of Resident #34's room. The LPN verbalized the medications should not have been in Resident #34's room and confirmed the facility had no assessment and no physician order for [REDACTED]. Resident #216 Resident #216 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 07/22/19 at 2:50 PM, two opened [MEDICATION NAME] 5% patches and an opened bottle [MEDICATION NAME]% nasal spray were unsecured, laying on Resident #216's tables in the room. On 07/22/19 at 2:51 PM, Resident #216 verbalized the [MEDICATION NAME]es wer… | 2020-09-01 |
| 2062 | 2062 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2017-08-10 | 309 | D | 0 | 1 | 6ICN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and document review, the facility did not ensure medications were administered according to physician's orders [REDACTED].#11) and 1 unsampled resident (Resident #12). Findings include: Resident #11 Resident #11 was a sampled resident originally admitted to the facility on [DATE], and readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident was discharged on [DATE]. On 08/10/17, the resident's closed record was reviewed. The documentation indicated on 08/25/16 the resident's Physician ordered a [MEDICATION NAME] to be applied [MEDICATION NAME] every 72 hours for pain. The patch was first administered on 08/25/16 at 7:05 AM. The resident's Medication Administration Record [REDACTED]. The Clinical Nurse Manager (CNM) reviewed the MAR indicated [REDACTED]. On 09/29/16, Resident #11's Physician ordered [MEDICATION NAME] R Insulin according to a sliding scale based on blood sugar level: If blood sugar is 150 to 200 give 2 Units. The Insulin was ordered to be given Before Meals and At Bedtime. On 09/29/16 at 5:04 PM, Resident #11's blood sugar level was documented to be 182. The Nurse documented Not Administered: Drug/Item unavailable. On 09/29/16 at 8:19 PM, Resident #11's blood sugar level was documented to be 152. The Nurse documented Units Not Charted: Due to condition. Comment: pharmacy did not deliver pt's [MEDICATION NAME] R Insulin. On 08/10/17, the CNM stated during that time period, the facility had a Pyxis and the Insulin would have been available from the Pyxis, however if a medication is unavailable, the Nurse should call the Pharmacy. Resident #12 Resident #12 was an unsampled resident admitted to the facility with [DIAGNOSES REDACTED]. On 08/15/17 during the morning Medication Administration Observation, the Nurse was observed to prepare an order for [REDACTED]. The Nurse administered the 15 milliliters and verified the order was correct. Policy titled, Administration… | 2020-09-01 |
| 2063 | 2063 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2017-08-10 | 323 | D | 0 | 1 | 6ICN11 | Based on observation, interview and record review, the facility did not remove lint from one of two dryers in the laundry room and did not secure the door to the beauty salon to prevent entry when the room was unoccupied. Findings include: A General Observation tour of the facility was conducted on 08/09/17. In the laundry room, the fire box and lint tray in 1 of 2 dryers was found to have excess lint. This observation was made in the presence of the Administrator and Housekeeping Supervisor. The Administrator stated the facility had a contract for dryer maintenance every six months and had the dryer hose replaced one time. The Housekeeping Supervisor stated the lint tray should be cleaned twice per day and should be documented in the Dryer Lint Log Sheet book. The book was reviewed from (MONTH) (YEAR) through (MONTH) (YEAR). The log book was reviewed with the Supervisor who acknowledged that staff were not documenting daily removal of lint and verified gaps existed in the documentation on multiple days during each month of the year. The Beauty Shop door, that had a keypad entry, was found unsecured. Eleven (11) three ounce boxes of Matrix Color Sync hair dye was stored in one cupboard that was not secured. The label stated Important: Haircolor can cause an allergic reaction. This observation was made in the presence of the Administrator. | 2020-09-01 |
| 2064 | 2064 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2017-08-10 | 329 | D | 0 | 1 | 6ICN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, clinical record review and document review, the facility did not follow the physician's blood pressure medication administration parameters and administered blood pressure medication for one resident when the parameters indicated the medication should not have been given for 1 of 11 sampled residents (Resident #6). Findings include: Resident #6 Resident #6 was admitted to the facility on [DATE], for rehabilitation for lower back, groin and hip pain and wound care for stage II pressure ulcer. [DIAGNOSES REDACTED]. Record review of Resident #6 revealed in physician's orders [REDACTED]. Per MAR indicated [REDACTED]. On 08/09/17 at 4:35PM, the acting Director of Nursing/MDS Coordinator RN read and reviewed the physician order [REDACTED]. RN confirmed physician order [REDACTED]. The RN confirmed on 08/08/17, the current MAR, dated 08/01/17 to 08/09/17, listed the BP as 96/54 and [MEDICATION NAME] medication orders were to hold the medication [MEDICATION NAME] with those parameters. The facility policy and procedure titled, Administration of Medication current version dated 2/19/2016, page 1, read that licensed personnel, in accordance with professional standards of practice, were appropriately administered prescribed medications. On page 2, licensed personnel were to verify the six Medication Administration Rights: Right Patient, Right Drug, Right Dose, Right Dosage form, Right Route and Right Time. Ancillary tasks such as blood pressure, apical pulse, etc. were performed with appropriate medications. | 2020-09-01 |
| 2065 | 2065 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2017-08-10 | 431 | D | 0 | 1 | 6ICN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to secure a heparin lock flush and a sodium chloride flush from a resident's room for 1 unsampled resident (Resident #13). Findings include: Resident #13 Resident #13 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. On 08/07/17 at 9:12 AM, a sealed, unopened heparin lock flush syringe and a sealed, unopened sodium chloride lock flush syringe were on the shelf above the counter in Resident 13's room. On 08/07/17 at 9:14 AM, the Registered Nurse (RN) confirmed the presence of the heparin lock and sodium chloride lock flush on the shelf, and acknowledged they should have been removed from the resident's room. A facility policy titled, Medication Storage, dated 2/1/16, revealed medications were to be stored securely and only accessible by authorized personnel. | 2020-09-01 |
| 2066 | 2066 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 550 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and document review the facility failed to ensure a resident's dignity was maintained by not providing a urinary drainage privacy bag for 2 of 12 sampled residents (Resident #181 and Resident #188). Findings include: Resident # 181 Resident # 181 was admitted to facility on 08/11/18 with [DIAGNOSES REDACTED]. On 08/13/18 at 9:00 AM, a resident was seated at the bed side chair and the resident's Foley drainage bag was draining clear yellow urine. There was no privacy bag provided for the resident's Foley bag. On 08/13/18 at 10:45 AM, the license Practical Nurse (LPN) confirmed the observation and verbalized the staff should have changed the Foley drainage bag to a privacy bag upon admission. Resident #188 Resident #188 was admitted to facility on 08/08/18 with [DIAGNOSES REDACTED]. On 08/13/18 at 10:32 AM, a resident was sitting on the wheelchair in the room with a Foley bag attached to the frame of the wheelchair. The drainage bag contained light cranberry colored urine. There was no privacy bag provided for the resident's Foley bag. On 08/13/18 at 10:47 AM, the LPN confirmed the observation and verbalized the staff should have changed the Foley drainage bag to a privacy bag upon admission. On 08/14/18 at 3:38 PM, the Director of Nursing (DON) confirmed the nurse should have replaced the Foley drainage bags with a privacy flap upon admission for both Resident #181 and #188. The facility's policy titled Resident's Rights, dated 02/27/18, indicated the resident has a right to dignity and respect. The center must treat the resident with respect and dignity and care for the resident in a manner and in an environment that promotes maintenance or enhancement of the quality of life. | 2020-09-01 |
| 2067 | 2067 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 609 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review, the facility failed to report an allegation of neglect to the state agency for 1 of 12 sampled residents (Resident #231.) Findings include: Resident #231 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #231's Fall Incident Event Report, completed by a Registered Nurse and dated 07/31/18, documented the following description: - a fall occurred on 07/30/18 - a Registered Nurse returned to the resident's room and found resident standing at the foot part to her bed naked from waist up, suddenly resident fell backwards hitting the back of her head on the bedside table and leaning on right side -resident remained awake and responsive to verbal and tactile stimuli -skin tear on right elbow, some limitation on left arm due to left shoulder pain from previous fall, no other injuries noted The Event details documented the resident was Sitting at the side of her bed facing the window . in response to what the resident doing just prior to the fall. On 08/13/18 at 10:01 AM, Resident #231 was observed with right wrist in a cast and verbalized the resident had a fall at the facility shortly after admission. The resident described the event. The resident had asked a staff member to help her with dressing into her gown. The staff member said yes. The resident thought the staff member was still in the room behind the resident but staff was not responding to her verbally. The resident was facing the window, turned, lost balance and fell . The resident verbalized she broke her arm. The resident verbalized she felt if staff had stayed in the room then the fall would not have occurred. On 08/15/18 at 3:17 PM, the Director of Nursing (DON) verbalized it was a fall and because the resident was able to explain the fall and cause of injury, it did not require a report to the state agency. The DON explained the DON was not at the facility at the time of the fall and needed to ask the administrator if a … | 2020-09-01 |
| 2068 | 2068 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 610 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review, the facility failed to investigate an abuse allegation of neglect or mistreatment for 1 of 12 sampled residents (Resident #231). Findings include: Resident #231 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #231's Fall Incident Event Report, completed by a Registered Nurse and dated 07/31/18, documented the following description: - a fall occurred on 07/30/18 - a Registered Nurse returned to the resident's room and found resident standing at the foot part to her bed naked from waist up, suddenly resident fell backwards hitting the back of her head on the bedside table and leaning on right side -resident remained awake and responsive to verbal and tactile stimuli -skin tear on right elbow, some limitation on left arm due to left shoulder pain from previous fall, no other injuries noted The Event details documented the resident was Sitting at the side of her bed facing the window . in response to what the resident doing just prior to the fall. On 08/13/18 at 10:01 AM, Resident #231 was observed with right wrist in a cast and verbalized the resident had a fall at the facility shortly after admission. The resident described the event. The resident had asked a staff member to help her with dressing into her gown. The staff member said yes. The resident thought the staff member was still in the room behind the resident but staff was not responding to her verbally. The resident was facing the window, turned, lost balance and fell . The resident verbalized she broke her arm. The resident verbalized she felt if staff had stayed in the room then the fall would not have occurred. On 08/15/18 at 3:17 PM, the Director of Nursing (DON) verbalized it was a fall and because the resident was able to explain the fall and cause of injury, it did not require a report to the state agency. The DON explained the DON was not at the facility at the time of the fall and needed to ask the administrato… | 2020-09-01 |
| 2069 | 2069 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 635 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, clinical record review and document review the facility failed to obtain physician orders [REDACTED].#2). Findings include: Resident #2 Resident #2 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 08/13/18 at 3:52 PM, located in Resident #2's room was a wall Oxygen unit and a [MEDICAL CONDITION] machine on the bedside table. On 08/13/18 at 3:52 PM, Resident #2 verbalized the nursing staff came in every evening before bedtime to help the resident with the [MEDICAL CONDITION] machine. On 08/14/18 at 3:35 PM, the Licensed Practical Nurse confirmed Resident #2 had a [MEDICAL CONDITION] machine on the bedside table. The physician order [REDACTED].#2 had an order for [REDACTED]. 08/14/18 at 3:38 PM, the Clinical Nurse Manager confirmed there were no orders for the [MEDICAL CONDITION] machine to include Oxygen use for Resident #2. The Clinical Nurse Manager verbalized there should have been physician orders [REDACTED]. On 08/14/18 at 3:51 PM, the Admission Nurse Manager confirmed Resident #2 had the [MEDICAL CONDITION] machine since the day of admission. The facility policy titled, [MEDICAL CONDITION]/Bilevel Positive Airway Pressure ([MEDICAL CONDITION]) Support, dated 03/12/18 documented the facility will support use of [MEDICAL CONDITION] or [MEDICAL CONDITION] used by all patients with appropriate physician orders. Physician orders [REDACTED]. | 2020-09-01 |
| 2070 | 2070 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 655 | E | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, clinical record review and document review, the facility failed to implement a baseline care plan inclusive of medications, treatments and care needs for 3 of 12 sampled residents (Resident #2, #134, and #21). Findings include: Resident #2 Resident #2 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 08/13/18 at 3:52 PM, located in Resident #2's room was a wall Oxygen unit and a [MEDICAL CONDITION] machine on the bedside table. On 08/13/18 at 3:52 PM, Resident #2 verbalized the nursing staff came in every evening before bedtime to help the resident with the [MEDICAL CONDITION] machine. On 08/14/18 at 3:35 PM, the Licensed Practical Nurse confirmed Resident #2 had a [MEDICAL CONDITION] machine on the bedside table. On 08/14/18 at 3:51 PM, the Admission Nurse Manager confirmed Resident #2 had the [MEDICAL CONDITION] machine since the day of admission. The Baseline Person Centered Care Plan, dated 08/02/18, lacked documented evidence the resident was on Oxygen Therapy for a [MEDICAL CONDITION] machine. On 08/14/18 at 3:38 PM, the Clinical Nurse Manager confirmed there was no Baseline Person Centered Care plan for Oxygen and the [MEDICAL CONDITION] machine for Resident #2. The Clinical Nurse Manager verbalized there should have been a baseline care plan in place for Oxygen and the [MEDICAL CONDITION] machine for Resident #2. On 08/14/18 at 3:38 PM, the Clinical Nurse Manager confirmed there was no Baseline Person Centered Care Plan for the [MEDICAL CONDITION] machine to include Oxygen use for Resident #2. The Clinical Nurse Manager verbalized there should have been a Baseline Person Centered Care Plan for the [MEDICAL CONDITION] machine and Oxygen. Resident #134 Resident #134 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The physician order, dated 08/13/18, for Oxygen documented may apply oxygen per mask/nasal cannula; titrate to maintain Oxygen Saturation (SaO2) above 85% until able to n… | 2020-09-01 |
| 2071 | 2071 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 656 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review, the facility failed to initiate a comprehensive care plan for [MEDICAL CONDITION] medications, rehabilitation therapy, and [MEDICAL CONDITION] for 2 of 12 sampled residents (Resident #21 and #6). Findings include: Resident #21 Resident #21 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #21's physician order, dated 07/02/18, documented [MEDICATION NAME] 30 milligrams (mg) at bedtime and [MEDICATION NAME] 60 mg once a day at 7:00 AM- 9:00 AM for depression as evidence by isolation. The order included a black box warning to monitor closely for worsening depression such as agitation, irritability, [MEDICAL CONDITION], hostility and impulsivity and signs of suicidal behavior. Side effects included suicidal behavior, fever, and [MEDICAL CONDITION]. The resident's physician order, dated 07/02/18, documented [MEDICATION NAME] 10 mg once a day 7:00 AM- 9:00 AM for depression as evidence by social isolation. The order included a black box warning to monitor closely for worsening depression such as agitation, irritability, [MEDICAL CONDITION], hostility and impulsivity and signs of suicidal behavior. Side effects included suicidal behavior, fever, and [MEDICAL CONDITION]. Resident #21's comprehensive care plan indicated a start date of 07/02/18 for the category: Psychosocial Well Being-Patient is prescribed a medication with an Food and Drug Association (FDA) issued black box warning and related potential for serious adverse side effects. The care plan included the approach to educate patient on potentially serious adverse effects as identified on the medication black box warning and to monitor for adverse side effects. The care plan lacked person centered information to include specific [MEDICAL CONDITION] medications and warnings and side effects as documented on the physician's orders [REDACTED]. Resident #21's Occupational Therapy (OT) Patient Evaluation and Plan of Care, signed by … | 2020-09-01 |
| 2072 | 2072 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 695 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and clinical record review, the facility failed to follow a physician order [REDACTED]. Findings include: Resident #134 Resident #134 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The physician order, dated 08/13/18, documented Oxygen may be applied per mask/nasal cannula; titrate to maintain SaO2 (oxygen saturation) above 85% until able to notify Doctor of Medicine (MD) during normal business hours. On 08/13/18 at 11:26 AM, the resident had Oxygen, via nasal cannula, flowing. On 08/14/18 in the afternoon, the resident had Oxygen, via nasal cannula, flowing. On 08/15/18 at 9:55 AM, the resident had Oxygen, via nasal cannula, flowing. On 08/15/18 at 11:14 AM, a Registered Nurse (RN) verbalized Resident #134 had a physician order [REDACTED]. The RN secured the nasal cannula to the resident. On 08/15/18 at 11:31 AM, the Director of Nursing (DON) verbalized it was inappropriate for an RN to take the resident's Oxygen saturation levels, then replace the nasal cannula back on the resident on a continuous basis if the saturation levels were at 90 percent. The DON confirmed the physician order [REDACTED]. The facility policy titled Oxygen Administration, revised 03/12/18, documented physician orders [REDACTED]. | 2020-09-01 |
| 2073 | 2073 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 698 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and document review the facility failed to monitor a resident's [MEDICAL TREATMENT] access as ordered by a physician for 1 of 12 sampled residents (Resident #184). Findings include: Resident #184 Resident #184 was admitted on [DATE], with [DIAGNOSES REDACTED]. The resident had an Arterio-venous fistula (AVF) (access to perform [MEDICAL TREATMENT]) on the upper left arm. A physician order, dated 08/07/18, indicated left arm AVF: Auscultate for bruit and palpate for thrill every shift. Notify the physician if bruit and thrill was not present. The facility lacked documented evidence the residents AVF was being monitored for patency as ordered by the physician. On 08/15/18 at 11:35 AM, The Clinical Nurse Manager confirmed the AVF was not monitored every shift as it was not charted in the resident's Medication Administration Record. The facility's policy titled [MEDICAL TREATMENT] Pre-Post Procedure Assessment, dated 03/12/18, indicated all patient with [MEDICAL TREATMENT] will have a pre and post-procedure assessment to be completed before the patients departs the facility for [MEDICAL TREATMENT] and upon return. This assessment should read AVF has been assessed for appearance, signs of infection, drainage and the presence of bruit and thrill. | 2020-09-01 |
| 2074 | 2074 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 761 | D | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and document review the facility failed to ensure medication was stored in a safe place and not accessible to the residents for 1 of 12 sampled residents (Resident #185). Findings include: Resident #185 Resident #185 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 08/13/18 at 11:41 AM, a resident's bed side table had a nebulizer machine with medications next to the machine. On 08/13/18 at 3:45 PM, The License Practical Nurse (LPN) verified the medication was placed next to the nebulizer machine. The medication was one individual foil packet of [MEDICATION NAME]-[MEDICATION NAME] solution for nebulization; 0.5 milligrams (mg)-3 mg. (2.5 mg. base)/ 3 milliliter (ml.) Lot # 18D41. The LPN confirmed medication should not be left in the resident's bedside and should be kept in a secured place. On 08/14/18 at 3:35 PM, the Director of Nursing confirmed the nebulizer medication should not be at the resident's bedside and medication should be kept at the medication cart. The facility's policy titled Medication Storage, dated 02/27/18, indicated the medication supply was accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medication. All drugs and biologicals were stored in locked compartments. | 2020-09-01 |
| 2075 | 2075 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2018-08-16 | 812 | F | 0 | 1 | IQX011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review, the facility failed to discard expired foods, properly store foods, and maintain sanitary conditions in a food prep area. Findings include: Expired Foods On [DATE] at 8:36 AM, the Nutrition Services Supervisor confirmed a cooked turkey breast was located in the walk-in refrigerator and labeled with a prep date of [DATE] and a use by date of [DATE]. The Supervisor verbalized the turkey breast should have been discarded two days ago. On [DATE] at 8:36 AM, located on a food serving cart was one expired cherry pie desert with a prepared date of [DATE] and use by date of [DATE]. The Nutrition Services Supervisor confirmed the expired cherry pie desert should have been discarded. The facility policy titled Food Storage, dated 2013, documented foods were dated when opened with a discard date. The foods would be discarded no later than the discard date. Food Storage On [DATE] at 8:54 AM, there was one opened 8 ounce can of Ensure located in the Nutrition Room cupboard. The label on the Ensure indicated the drink was to be kept cold and refrigerated after opening. The Nutrition Services Supervisor confirmed the can of Ensure was located in the Nutrition Room cupboard, opened, with liquid inside the can. The Supervisor verbalized it should not have been stored in the cupboard and could not explain why it had been placed there. The facility policy titled Food Storage, dated 2013, documented food was stored, prepared, and transported by methods designed to prevent contamination or cross contamination. Food Preparation Area On [DATE] at 12:30 PM, a Cook had taken eye glasses off and set them down on a cutting board. Located on the cutting board was broccoli being chopped. The Nutrition Services Supervisor confirmed the eye glasses were located on the cutting board next to the broccoli being prepared for residents. The Nutrition Services Supervisor verbalized the eye glasses and personal belongings were … | 2020-09-01 |
| 2322 | 2322 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2020-01-23 | 689 | D | 1 | 0 | MLTX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, interview, and clinical record review, the facility failed to provide supervision and ensure fall interventions were in place for 1 of 5 sampled residents (Resident #1). Findings include: Resident #1 Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A Facility Reported Incident (FRI) was submitted to the State on 01/07/20. The FRI documented on 01/06/20 Resident #1 went outside with a family member, attempted to run away, tripped, and fell . Resident #1 sustained lacerations over the left eye and on the left hand. A progress note dated 12/30/19, documented Resident #1 was on the floor at the left side of the bed. Resident #1 had abrasions on both knees, and an abrasion on the left toe; the nurse compared to [MEDICAL CONDITION] appearance. A physician progress notes [REDACTED].#1 was confused, had fallen out of bed twice, wandered outside, fell , and the family had requested a hospital transfer. Resident #1's facility care plan dated 12/21/19, lacked documented evidence of updated interventions reflecting Resident #1's increased confusion, disruptive behaviors, and falls. On 01/23/20 at 8:38 AM, the Clinical Nurse Manager (CNM) verbalized on the morning of 01/06/20, Resident #1 had been out to the facility parking lot with a family member. Resident #1 became agitated and refused to return to the facility. On 01/06/20, based on the morning incident, the CNM determined Resident #1 was a high risk for elopement and falls. The CNM verbalized due to Resident #1's increased risk; the facility implemented a plan. Resident #1 was to be escorted by a staff member at all times when outside. The CNM confirmed the CNM had discussed the new plan with the staff members on duty at the time of the incident, the clinical progress notes or care plan were not updated, and the CNM had not notified the evening staff of the new supervision requirement. The CNM verbalized Resident #1's care plan had not included ne… | 2020-05-01 |
| 2650 | 2650 | ADVANCED HEALTH CARE OF RENO | 295096 | 961 KUENZLI STREET | RENO | NV | 89502 | 2016-07-14 | 441 | D | 0 | 1 | L84011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and document review, the Finger Stick, Capillary Blood Sampling facility policy and procedure which required that glucometer machines were cleaned between patients was not followed for one resident, Resident #1. Findings include: Observation: Resident #1 was admitted to the facility on [DATE], for rehabilitation and wound care, following a below knee amputation. He had Diabetes Mellitus, Type II and had blood sugars monitored before meals using the facility's glucometer machine. On 7/13/16, at approximately 11:45AM, Licensed Practical Nurse (LPN) #1 was observed obtaining the glucometer machine from the medication cart drawer. The glucometer machine was removed from the case and taken into Resident #1's room and sat on the table. The glucometer machine was then used to obtain a Finger Stick blood sample from Resident #1. Following the procedure, the glucometer machine was taken from the room, placed back into the case and at no time was the glucometer machine cleaned or disinfected. Interview: Employee #1 was interviewed regarding not cleaning or disinfecting the glucometer machine and stated, since we only have one resident in the facility, cleaning and disinfecting is done at the end of the shift. Observation: On 7/14/16, at approximately 09:30AM, LPN #2 was observed obtaining the glucometer machine from the medication cart drawer. The glucometer machine was removed from the case and taken into Resident #1's room and sat on the table. Resident #1 picked up the glucometer machine and proceeded to complete the Finger Sick himself. Following the procedure, the glucometer machine was taken from the room, placed back into the case, and at no time was the glucometer machine cleaned or disinfected. Interviews: Licensed Practical Nurse #2 was interviewed regarding not cleaning or disinfecting the glucometer machine and stated, I am not sure what I am supposed to use to clean the glucometer referring to alcohol wipes… | 2019-08-01 |
| 1884 | 1884 | ADVANCED HEALTH CARE OF SUMMERLIN | 295092 | 2860 N TENAYA WAY | LAS VEGAS | NV | 89128 | 2018-02-06 | 623 | C | 1 | 0 | FPM111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview and document review, the facility failed to provide copies of discharge notices to the Long Term Care Ombudsman office as required by 483.15(c) of Title 42 of the Code of Federal Regulations for 2 of 2 discharged sampled residents (Resident #4 and #5). Findings include: Resident #4Resident #4 was admitted to the facility on [DATE], was discharged to Mountain View hospital on [DATE], and was re-admitted to the facility on [DATE] .Resident #5Resident #5 was admitted to the facility on [DATE], and was discharged to Mountain View hospital on [DATE].On 02/06/18 at 10:10 AM, a Case Manager indicated the facility did not do 30-day notices to their residents, because the facility was a short term stay facility. The Case Manager explained the Long-Term Care Ombudsman was not notified of every discharge or each resident. On 02/06/18 at 10:20 AM, the Director of Nursing (DON) confirmed the facility did not contact the Long-term Care Ombudsman for every resident discharge or transfer out of the facility. The facility only notified the Long-term Care Ombudsman when there was an unsafe discharge. The DON explained the facility did not do 30-day notices for facility initiated discharges or transfers, because the facility was a short term stay facility. On 02/06/18 at 11:45 AM, The Administrator acknowledged the facility was not aware of the regulation on notifying the Long-term Care Ombudsman for transfer and discharge. The Administrator confirmed the Long-term Care Ombudsman had not been notified of residents that were discharged or transferred from the facility.A policy on Admission, Transfer and Discharge (dated 12/08/16), documented before the facility transferred or discharged a patient, the facility must send a copy of the notice to a representative of the Office of the State Long-term Care Ombudsman. Complaint #NV 887 | 2020-09-01 |
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CREATE TABLE [cms_NV] ( [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 );