cms_WY
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3,594 rows sorted by scope_severity
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 17 | 17 | GRANITE REHABILITATION AND WELLNESS | 535013 | 3128 BOXELDER DRIVE | CHEYENNE | WY | 82001 | 2017-10-04 | 208 | B | 1 | 1 | GX9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of the facility's admission agreement and staff interview, the facility failed to ensure admission agreements did not request or require residents to waive potential facility liability for losses of personal property for 5 of 6 sample residents (#3, #14, #47, #65, #94) admitted after 11/28/16. The findings were: 1. Review on 10/4/17 at 10 AM of the facility's admission agreement, under section 11: Elections and Designations, last published 3/29/16 showed section 11.7 Laundry Services. The Center provides residents with laundry services .The Resident Group understands that the Center may lose or damage the Resident's clothing and the Resident Group agrees that the Center is not responsible for such loss or damage, except as required by law. Further review showed the resident or resident representative was asked to initial whether to Authorizes the Center to clean and mark with the Resident's name the Resident's laundry. The Center will not be responsible for lost or damaged laundry, except as required by law . or Do not authorize the Center to clean the Resident's laundry . The following concerns were identified: a. Review of resident #3's 7/6/17 quarterly MDS assessment showed the resident was admitted to the facility on [DATE]. Review of section 11.7 of the resident's admission agreement showed the resident initialed the section which authorized the facility to provide laundry services. b. Review of resident #14's 9/26/17 quarterly MDS assessment showed the resident was admitted to the facility on [DATE]. Review of section 11.7 of the resident's admission agreement showed the resident initialed the section which authorized the facility to provide laundry services. c. Review of the resident #47's 9/6/17 quarterly MDS assessment showed the resident was admitted to the facility on [DATE]. Review of section 11.7 of the resident's admission agreement showed the resident initialed the section which authorized the facility to prov… | 2020-09-01 |
| 24 | 24 | GRANITE REHABILITATION AND WELLNESS | 535013 | 3128 BOXELDER DRIVE | CHEYENNE | WY | 82001 | 2017-10-04 | 356 | B | 0 | 1 | GX9L11 | Based on record review and staff interview the facility failed to ensure the posted 24 nursing staff information was maintained and updated to reflect the correct number of staff and actual hours worked for 16 of 16 days. The following concerns were identified: 1. Review of the POS [REDACTED]. 2. Interview with the nurse scheduler on 10/4/17 at 1:55 PM confirmed the posted daily staffing schedule was not updated. She stated, I post the sheet at the beginning of the day and on Friday evenings for the weekend. I don't update the numbers at the beginning of each shift, based on actual staff on duty. She revealed the accurate staffing numbers are on her master nursing schedule. Both the nurse scheduler and DON stated they did not know the posted staffing sheets must be updated when staff numbers or hours changed. | 2020-09-01 |
| 74 | 74 | BONNIE BLUEJACKET MEMORIAL NURSING HOME | 535019 | 388 SOUTH US HWY 20 | BASIN | WY | 82410 | 2019-03-27 | 575 | B | 0 | 1 | GU4111 | Based on observation and staff interview, the facility failed to post the mailing and email addresses of all pertinent State agencies and advocacy groups and include a statement that the resident may file a complaint with the State Survey Agency. The census was 29. The findings were: Observation of the information board located in the main area of the facility during the survey timeframe showed the posting failed to include the mailing and email addresses of all pertinent State agencies and advocacy groups. In addition the posting failed to include the required statement pertaining to the resident's right to file a complaint with the State Survey Agency. Interview with the social service director on 3/26/19 at 5 PM revealed she was unaware of the information that must be included in the required posting. | 2020-09-01 |
| 76 | 76 | BONNIE BLUEJACKET MEMORIAL NURSING HOME | 535019 | 388 SOUTH US HWY 20 | BASIN | WY | 82410 | 2019-03-27 | 585 | B | 0 | 1 | GU4111 | Based on observation, review of policy and procedure, and staff interview, the facility failed to ensure the grievance policy contained all required information. The census was 29. The findings were: 1. Observation of the facility during the survey timeframe showed Resident/Family Grievance forms were located next to the information board in the main area of the facility. However, the grievance policy and contact information for the grievance official were not posted. 2. Review of the policy and procedure entitled Resident Grievance Policy last revised 4/25/16 showed the policy failed to contain required information including the contact information of the grievance official and the contact information of independent entities with whom a grievance could also be filed. Further, the policy did not address the residents' right to file a grievance anonymously. 3. Interview with the social service director on 3/26/19 at 5 PM verified the policy did not contain the required information and the residents had not been informed individually or through postings. | 2020-09-01 |
| 89 | 89 | BONNIE BLUEJACKET MEMORIAL NURSING HOME | 535019 | 388 SOUTH US HWY 20 | BASIN | WY | 82410 | 2017-04-06 | 167 | B | 0 | 1 | 508H11 | Based on observation, and resident and staff interview, the facility failed to ensure survey results and a notice of the availability of previous surveys were posted in an area readily accessible to residents. The census was 25. The findings were: 1. Observation on 4/4/17 at 9:26 AM showed a binder containing the most recent survey results was in a file wall pocket, behind the piano in the main lobby, not easily viewable or accessible to all residents. Further observation showed there was no posted notice that surveys from the preceding 3 years were available for review upon request. 2. Group interview on 4/4/17 at 1 PM with 11 residents present revealed that they did not know where the survey results were located. 3. Interview on 4/5/17 at 5:54 PM with the social services director confirmed that the survey results binder was behind the piano and not easily accessible to all residents, and that only the last survey is in the binder. She further revealed she had the prior year's surveys somewhere. | 2020-09-01 |
| 111 | 111 | WYOMING RETIREMENT CENTER | 535021 | 890 US HWY 20 SOUTH | BASIN | WY | 82410 | 2017-05-11 | 166 | B | 0 | 1 | YKWZ11 | Based on review of policy and procedure and staff interview, the facility failed to ensure the grievance policy contained all required information. The census was 74. The findings were: Review of Grievance Policy and Procedure, last revised (MONTH) 2013, showed the policy failed to include required information including the name, address, and phone number of the grievance official, the expected time frame for completion of the grievance, the contact information of independent entities with whom a grievance could also be filed, and did not address the right to file a grievance anonymously. Interview on 5/10/17 at 4:20 PM with the social worker confirmed the policy and procedure did not contain all necessary information. | 2020-09-01 |
| 133 | 133 | THE LEGACY LIVING AND REHABILITATION CENTER | 535022 | 1000 S DOUGLAS HWY | GILLETTE | WY | 82716 | 2017-10-19 | 167 | B | 0 | 1 | 9QJU11 | Based on observation and staff interview, the facility failed to ensure a notice indicating the availability of surveys for the preceding 3 years was posted as required. The resident census was 148. The findings were: Observation on 10/17/17 at 1:18 PM showed a binder placed at the reception area contained the most recent health survey and life safety code survey. Further observation showed there was no notice posted to let individuals know that survey results from the previous 3 years were available for review upon request. Interview with the administrator on 10/19/17 at 12:15 PM confirmed there was no such notice posted. | 2020-09-01 |
| 160 | 160 | WESTON COUNTY HEALTH SERVICES | 535023 | 1124 WASHINGTON BLVD | NEWCASTLE | WY | 82701 | 2017-02-09 | 496 | B | 0 | 1 | 0JJ011 | Based on employee record review and staff interview, the facility failed to ensure employees met competency evaluation requirements for 2 of 2 employees (CNA #1, CNA #2) working at the facility. The findings were: 1. Review of the employee file for CNA #1 on 2/9/17 at 9 AM showed the CNA was hired on 11/15/16. Further review showed the CNA certification was not verified until 12/7/16 and the CNA abuse registry was not verified until 12/16/16. 2. Review of the employee file for CNA #2 on 2/9/17 at 9 AM showed the CNA was hired on 11/1/16. Further review showed the CNA certification was not verified until 12/7/16 and the CNA abuse registry was not verified until 12/7/16. The information to place the CNA on the registry was sent in to the State survey agency on 12/7/16 since the CNA had recently received her certification on 10/20/16. 3. Interview with the human resources coordinator on 2/9/17 at 9:12 AM revealed the facility usually checked licensure and the abuse registry before staff were hired; however, she did not have evidence the verification was done prior to employment or resident contact. | 2020-09-01 |
| 161 | 161 | WESTON COUNTY HEALTH SERVICES | 535023 | 1124 WASHINGTON BLVD | NEWCASTLE | WY | 82701 | 2017-02-09 | 499 | B | 0 | 1 | 0JJ011 | Based on employee record review and staff interview, the facility failed to ensure staff were licensed for 1 of 1 employees (LPN #1) in accordance with State law. The findings were: Review of the employee file for LPN #1 on 2/9/17 at 9:10 AM revealed the LPN was hired on 10/11/16. Further review showed the LPN's license was verified on 12/8/16. Interview with the human resource coordinator on 2/9/17 at 9:12 AM revealed the facility usually checked licensure before staff were hired; however, she did not have evidence the verification was done prior to employment or resident contact. | 2020-09-01 |
| 162 | 162 | WESTON COUNTY HEALTH SERVICES | 535023 | 1124 WASHINGTON BLVD | NEWCASTLE | WY | 82701 | 2018-03-15 | 577 | B | 1 | 1 | 666111 | > Based on observation and resident and staff interview, the facility failed to ensure the results of the most recent survey were available for review and residents were made aware of the location of the survey results. The census was 54. The findings were: Group interview with 10 residents on 3/13/18 at 1 PM revealed they were unaware of where survey results were posted. Further, they stated they had not been told they could read the results if they wanted to. Observation on 3/13/18 at 2 PM revealed the survey results were located in a binder on a shelf in the resident solarium. The binder contained survey results for (YEAR), 2014, and 2013. Survey results from (YEAR) were not in the binder. Interview with the activities director on 3/13/18 at 3:40 PM revealed she did talk to the residents about the availability of the results, but it had been a long time since it was discussed. Further, she stated the results used to be hung on the bulletin board in the entrance but that board had been taken down recently due to construction. Interview on 3/13/18 at 3:30 PM with the DON confirmed the (YEAR) survey results were not in the binder. | 2020-09-01 |
| 292 | 292 | CODY REGIONAL HEALTH LONG TERM CARE CENTER | 535027 | 707 SHERIDAN AVENUE | CODY | WY | 82414 | 2017-06-22 | 166 | B | 0 | 1 | LH5811 | Based on review of policy and procedure and staff interview, the facility failed to ensure the grievance policy contained all required information. The census was 79. The findings were: Review of Concerns/Complaints of residents or family, last revised (MONTH) 2000, showed the policy failed to contain all required information including the name, address, and phone number of the grievance official, the expected timeframe for completion of the grievance, the contact information of independent entities with whom a grievance could also be filed, and did not address the right to file a grievance anonymously. Interview with the administrator on 6/22/17 at 12:50 PM confirmed the policy did not contain the required information. | 2020-09-01 |
| 335 | 335 | NEW HORIZONS CARE CENTER | 535030 | 1111 LANE 12 | LOVELL | WY | 82431 | 2017-04-06 | 156 | B | 0 | 1 | 8GLZ11 | Based on observation and staff interview, the facility failed to ensure information regarding resident right was posted as required. The census was 70. The findings were: Observation on 4/5/17 at 3:32 PM revealed the facility had contact information posted for the regional ombudsman; however, there was no evidence of contact information posted for the State Survey Agency, home and community based programs, adult protective services, or the Medicaid fraud control unit. Further, there was no evidence of a posted statement informing residents of the process for filing a complaint with the State Survey Agency. Finally, there was no evidence of written information regarding how to apply for Medicare and Medicaid benefits. Interview with the DON on 4/6/17 at 11:05 AM revealed the facility had painted the walls several months earlier, and she believed the postings were taken down at that time and not replaced. | 2020-09-01 |
| 337 | 337 | NEW HORIZONS CARE CENTER | 535030 | 1111 LANE 12 | LOVELL | WY | 82431 | 2017-04-06 | 167 | B | 0 | 1 | 8GLZ11 | Based on observation and staff interview, the facility failed to ensure a notice of the availability of surveys for the preceding 3 years was posted as required. The resident census was 70. The findings were: Observation on 4/5/17 at 3:32 PM showed the results from the most recent survey were available in a folder next to the main entrance to the facility. Further observation showed there was no notice posted to let individuals know surveys from the preceding 3 years were available for review upon request. Interview with the DON on 4/6/17 at 11:05 AM revealed she was unaware of this requirement. | 2020-09-01 |
| 346 | 346 | NEW HORIZONS CARE CENTER | 535030 | 1111 LANE 12 | LOVELL | WY | 82431 | 2017-04-06 | 356 | B | 0 | 1 | 8GLZ11 | Based on observation and staff interview, the facility failed to ensure that nurse staffing information was posted in a manner that met all requirements for 5 of 5 days (April 1-5, (YEAR)) reviewed. The findings were: Review of the POS [REDACTED]. Further, the name of the facility was not listed on the staffing information sheet. Interview with the DON on 4/6/17 at 9:00 AM revealed the facility was not aware of these requirements. | 2020-09-01 |
| 366 | 366 | NEW HORIZONS CARE CENTER | 535030 | 1111 LANE 12 | LOVELL | WY | 82431 | 2019-06-27 | 732 | B | 0 | 1 | ZKQH11 | Based on observation, staff interview, and family interview, the facility failed to have posted, in a readable readily accessible format, the complete daily licensed nurse staffing information for 20 out of 20 days reviewed (6/7/19 to 6/27/19). The findings were: In interview with the family of resident #58 on 6/25/19 at 11:11 AM they denied seeing or knowing about nurse staffing information being posted. Observation on 6/27/19 at 8:30 AM showed the clipboard with the nurse staffing information was located on the desk behind the privacy wall at the downstairs nursing station. The information was not posted and also failed to contain the number of licensed staff per required discipline (CNA, LPN, RN). The last 20 days reviewed showed only the total number of hours worked for each discipline was documented. Interview on 6/27/19 at 12:30 PM with the resident care director revealed she was unaware of these requirements for the postings. | 2020-09-01 |
| 408 | 408 | LIFE CARE CENTER OF CHEYENNE | 535032 | 1330 PRAIRIE AVENUE | CHEYENNE | WY | 82009 | 2017-03-23 | 156 | B | 0 | 1 | 12VP11 | Based on observation and staff interview the facility failed to post the required notices in a form and manner readily accessible to residents and resident representatives. The census was 143. The findings were: Observation of the facility during the survey timeframe showed the names, addresses, and phone numbers of all pertinent State agencies and advocacy groups were listed on an 8 by 11 inch framed document located on a table in the main entrance vestibule. The doors into the vestibule from the facility remain locked at all times and required the manual depression of a red button to open them, which made this document inaccessible to residents. In addition, the document did not contain the required email addresses or a statement to show residents may file a complaint with the State Survey Agency. The administrator declined to comment during an interview on 3/23/17 at 12 PM. | 2020-09-01 |
| 409 | 409 | LIFE CARE CENTER OF CHEYENNE | 535032 | 1330 PRAIRIE AVENUE | CHEYENNE | WY | 82009 | 2017-03-23 | 166 | B | 0 | 1 | 12VP11 | Based on staff interview and review of policy and procedure, the facility failed to ensure the grievance policy contained all the required information. The census was 143. The findings were: Review of Grievance Procedures, last revised 11/19/16, showed the policy failed to include required information including the name, address, and phone number of the grievance official, the expected time frame for completion of the grievance, the contact information of independent entities with whom a grievance could also be filed, and did not address the right to file a grievance anonymously. Interview with the administrator on 3/23/17 at 10:10 AM confirmed the policy and procedure did not contain all necessary information. | 2020-09-01 |
| 439 | 439 | WESTWARD HEIGHTS CARE CENTER | 535034 | 150 CARING WAY | LANDER | WY | 82520 | 2017-07-14 | 167 | B | 0 | 1 | W6R211 | Based on observation, resident, family and staff interview, the facility failed to post most recent survey results in a readily accessible place, and failed to post a notice of the availability of facility surveys and complaint investigations for the previous 3 years during 5 of 5 days of the survey. The findings were: 1. Observation from 7/10/17 to 7/14/17 showed there was a wall-mounted display with a binder labeled survey behind the receptionist desk across from the facility entrance which contained the (YEAR) Form CMS-2567 survey results and plan of correction. Accessing the survey binder required going behind the receptionist desk. There was no notice posted to indicate the availability of the facility surveys and complaint investigations for the preceding three years. 2. Interview on 7/11/17 at 2 PM with a group of residents revealed 7 of 8 residents could not state where the survey results were located. 3. Interview with a resident's family member on 7/14/17 at 10:30 AM revealed s/he was not aware survey results were available to inspect and could not identify where the survey binder was located. Further, the resident had been living at the facility for two years. 4. Interview with the administrator on 7/14/17 at 10:54 AM confirmed the facility had failed to prominently post a notice regarding the availability of facility surveys and complaint investigations for the preceding three years. Further, she revealed the binder had been moved from its previous location, and confirmed it was not available to visitors or residents in its current location. | 2020-09-01 |
| 474 | 474 | RAWLINS REHABILITATION AND WELLNESS | 535036 | 542 16TH STREET | RAWLINS | WY | 82301 | 2017-05-24 | 356 | B | 0 | 1 | XTCS11 | Based on observation, staff interview, and review of daily staff postings, the facility failed to ensure the nurse staff posting met all required elements for 13 of 14 days reviewed. The finding were: 1. Observation of daily nurse staff postings on 5/21/17 through 5/24/17 showed the facility failed to include the actual hours worked for Licensed and Certified nursing staff. In addition, the observation of the postings showed it was a regular letter-sized sheet of paper posted on the wall near the front lobby at a height of 6 feet. Due to the size and the height of the posting, it was not in a prominent place where it was visible to those in wheelchairs. 2. Interview with administrator on 5/24/17 at 10:49 AM confirmed the facility failed to include the actual hours worked. | 2020-09-01 |
| 479 | 479 | ROCKY MOUNTAIN CARE - EVANSTON | 535038 | 475 YELLOW CREEK ROAD | EVANSTON | WY | 82930 | 2017-03-09 | 167 | B | 0 | 1 | 2V2N11 | Based on observation and staff interview, the facility failed to publicly display the availability of facility surveys, certifications and complaint investigations for the previous 3 years during 4 of 4 days of the survey. The findings were: 1. Observation from 3/6/17 to 3/9/17 showed the facility entrance lobby had a wall-mounted display with a binder which contained the (YEAR) survey results and plan of correction. However, there was no notice displayed that indicated the availability of the facility surveys, certifications and complaint investigations for all of the preceding three years. 2. Interview on 3/9/17 at 9:48 PM revealed the DON was not aware of the requirement for the facility to prominently post a notice regarding the availability of facility surveys, certifications and complaint investigations for the preceding three years. | 2020-09-01 |
| 487 | 487 | ROCKY MOUNTAIN CARE - EVANSTON | 535038 | 475 YELLOW CREEK ROAD | EVANSTON | WY | 82930 | 2017-03-09 | 356 | B | 0 | 1 | 2V2N11 | Based on observation and staff interview, the facility failed to ensure that nurse staffing information was posted in a manner that showed actual hours of staffing per shift for 3 of 4 days during the survey. The findings were: 1. Observation from 3/6/17 to 3/8/17 showed a staffing information sheet was posted in the hall near the lobby. The posted sheet listed the hours worked for RNs, LPNs and CNAs per 24 hour day, but did not reflect the hours that were scheduled for each position per shift. 2. Interview with the DON on 3/8/17 at 4:27 PM revealed the facility was not aware it was required to post staffing information on a per shift basis. | 2020-09-01 |
| 491 | 491 | ROCKY MOUNTAIN CARE - EVANSTON | 535038 | 475 YELLOW CREEK ROAD | EVANSTON | WY | 82930 | 2018-04-12 | 577 | B | 0 | 1 | F6JR11 | Based on observation and resident and staff interview, the facility failed to ensure survey results were posted in a place readily accessible to the residents. The census was 48. The findings were: Observation of the facility during the survey from 4/9/18 to 4/12/18 showed the survey binder was located in the reception area of the facility. The reception area was separated from the resident area by a door, which was kept closed. The binder was kept in the back of a receptacle mounted to the wall next to the business office. Brochures from the Ombudsman were located in front of the binder, which obscured the title of the binder. Group interview with 8 residents on 4/11/18 at 10:30 AM revealed they were unaware of where survey results were posted. Interview with the RA on 4/11/18 at 3:57 PM revealed she could not remember when the last time she had discussed the survey results with the resident council. | 2020-09-01 |
| 505 | 505 | WESTVIEW HEALTH CARE CENTER | 535039 | 1990 WEST LOUCKS STREET | SHERIDAN | WY | 82801 | 2017-07-27 | 167 | B | 1 | 1 | 88MP11 | > Based on observation and staff interview, the facility failed to ensure a notice indicating the availability of surveys for the preceding 3 years was posted as required. The resident census was 70. The findings were: Observation on 7/24/17 at 5:30 PM showed the results from surveys completed in (YEAR) and (YEAR) were available in a binder on an end table in the main entrance to the facility. Further observation showed there was no notice posted to let individuals know surveys from the preceding 3 years were available for review upon request. Interview on 7/27/17 at 8 AM with the administrator revealed she was unaware of this requirement. | 2020-09-01 |
| 536 | 536 | DOUGLAS CARE CENTER LLC | 535040 | 1108 BIRCH STREET | DOUGLAS | WY | 82633 | 2017-07-20 | 166 | B | 1 | 1 | JPN611 | > Based on review of policy and procedure and staff interview, the facility failed to ensure the grievance policy contained all required information. The census was 57. The findings were: Review of the policy and procedure entitled Grievance/Complaint Log, last updated 6/14/17, showed the policy failed to contain all required information including the contact information of the grievance official, the expected timeframe for completion of the grievance, and the contact information of independent entities with whom a grievance could also be filed. Further, the policy did not address the residents' right to file a grievance anonymously. Interview with the social worker on 7/19/17 at 5:10 PM confirmed the policy did not contain the required information. | 2020-09-01 |
| 538 | 538 | DOUGLAS CARE CENTER LLC | 535040 | 1108 BIRCH STREET | DOUGLAS | WY | 82633 | 2017-07-20 | 242 | B | 0 | 1 | JPN611 | Based on observation, and staff and resident interview, the facility failed to ensure residents were provided a choice related to coffee. The census was 57. The findings were: Observation on 7/17/17 at 4:50 PM showed the coffee available in the main dining room was labeled as decaffeinated. Interview with cook #1 at that time revealed there was regular coffee in the employee lounge, but residents were only provided decaffeinated coffee. The cook then stated they had never offered regular coffee to residents that he was aware of. Interview with resident #20 on 7/20/17 at 9:29 AM revealed s/he liked to have a cup of coffee in the morning and preferred it to be regular, not decaffeinated. Interview with resident #11 on 7/20/17 at 9:32 AM revealed s/he liked to drink coffee during the day. S/he stated there were times when his/her choice was regular, and times when decaffeinated was better. She stated, I think I get a choice. | 2020-09-01 |
| 541 | 541 | DOUGLAS CARE CENTER LLC | 535040 | 1108 BIRCH STREET | DOUGLAS | WY | 82633 | 2017-07-20 | 356 | B | 0 | 1 | JPN611 | Based on observation, staff interview, and review of daily staff postings, the facility failed to ensure the nurse staff posting met all required elements for 4 of 4 days reviewed in (MONTH) (YEAR) (7/17, 7/18, 7/19, 7/20). The findings were: 1. Observation of daily staff postings from 7/17/17 to 7/20/17 showed the following elements were missing: a. The total and actual hours worked for the RN, LPN and CNAs. b. The posting information was not visible. The daily sheets were placed on a clip board which was tucked into a black wall-mounted file holder by the DON's office making it difficult to see or find. 2. Interview with the administrator on 7/20/17 at 10 AM confirmed the actual hours and total hours for each category of staff were not included. | 2020-09-01 |
| 556 | 556 | DOUGLAS CARE CENTER LLC | 535040 | 1108 BIRCH STREET | DOUGLAS | WY | 82633 | 2019-09-12 | 582 | B | 1 | 1 | BOE011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and staff interview, the facility failed to ensure the appropriate Notice of Medicare Provider Non-Coverage (NOMNC) and Skilled Nursing Facility (SNF) Advance Beneficiary Notice of Non-coverage (ABN) were issued correctly for 3 of 3 sample residents (#1, #42, #154). The findings were: 1. The NOMNC/ABN for resident #1 indicated the last covered day for Medicare Part A services was 6/20/19; however the notices were not signed by the resident's representative until 7/24/19. 2. The NOMNC/ABN for resident #42 indicated the last covered day for Medicare Part A services was 7/12/19; however the notices were not signed by the resident's representative until 7/26/19. 3. Review of the SNF Beneficiary Protection Notification Review for Resident #154 showed the facility did not provide a NOMNC due to the resident initiating the discharge on 8/7/19. a. Review of a physician's orders [REDACTED]. b. Review of a nurse progress note on 8/5/19 showed the resident was excited to be discharged to home soon. 4. Interview with the business office manager on 9/11/19 at 5:20 PM revealed the NOMNC was not provided to resident #154. She confirmed it was a planned discharge, and that a NOMNC form should have been issued. In addition, she revealed the NOMNC/ABN forms for resident #42 had not been provided within the required time frame. She believed she may have mailed the notices to resident #1's representative within the required time frame, however was unable to provide documentation to confirm that information. | 2020-09-01 |
| 568 | 568 | SHEPHERD OF THE VALLEY REHABILITION AND WELLNESS | 535042 | 60 MAGNOLIA | CASPER | WY | 82604 | 2020-01-31 | 582 | B | 0 | 1 | Y63K11 | Based on medical record review and staff interview, the facility failed to ensure the appropriate Notice of Medicare Provider Non-Coverage (NOMNC) and Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (ABN) were issued correctly for 3 of 3 sample residents (#78, #108, #334). The findings were: 1. Review of the NOMNC/ABN forms for resident #78 showed the last covered day for Medicare Part A services was 8/21/19 and both forms were signed by the resident. Review of the medical record showed the resident was deemed incompetent before that date, and his/her guardian was the one responsible for signing the notices. Further, neither of the notices were signed within the required timeframe; the NOMNC was signed on 8/20/19 and the ABN was signed on 8/22/19. 2. Review of the NOMNC/ABN forms showed the last covered day for Medicare Part A services for resident #108 was 1/1/20. A note on the form showed the resident's responsible party was verbally notified on 12/20/19. However, there was no evidence of the notice being sent or given to the resident's responsible party. 3. Review of the NOMNC information showed resident #334 had a last covered day for Medicare Part A services on 12/12/19. However, the facility failed to provide the notice. 4. Interview with the social services director (SSD) and social services assistant (SSA) on 1/30/20 at 11:19 AM revealed the following: a. Resident #78 had a guardian at the time the notice was signed, and the guardian should have been given the notice. b. The SSA stated she had contacted the responsible party for resident #108, who said he would be in to sign the form, however she did not mail a copy of the notice following the verbal notification. c. The SSD stated they did not know of any NOMNC form signed by resident #334. d. Regarding the ABN forms for residents #78 and #108: The SSD and SSA confirmed there were 3 options to choose from and they had been uncertain about what each of the options meant. They used a default of having the resident select the option of I… | 2020-09-01 |
| 619 | 619 | SHEPHERD OF THE VALLEY REHABILITION AND WELLNESS | 535042 | 60 MAGNOLIA | CASPER | WY | 82604 | 2017-11-16 | 166 | B | 0 | 1 | VO8Y11 | Based on observation, review of policy and procedure, and staff interview, the facility failed to ensure a grievance posting with the required information. The census was 170. The findings were: Review of the Grievance/Concern policy last revised 11/2016 showed there was to be a posting which contained information related to the right to file grievances orally or in writing, the right to file grievances anonymously, the contact information of the grievance official, the expected time frame for completing a review of grievances, the resident's right to receive a written decision regarding concern/grievance, and contact information of independent entities with whom grievances may be filed, that is, the pertinent State Agency; Quality Improvement Organization; State Survey Agency and State LTC Ombudsman program. The following concerns were identified: a. Observation on 11/16/17 at 9 AM showed there were grievance forms available in holders on the wall in various areas of the facility. However, there was no posting related to filing grievances including the use of the forms, or how to submit them. b. Interview with the director of nursing on 11/16/17 at 5:04 PM confirmed the policy was consistent with the requirements; however, it was not implemented. | 2020-09-01 |
| 683 | 683 | POWELL VALLEY CARE CENTER | 535045 | 777 AVENUE H | POWELL | WY | 82435 | 2017-06-22 | 167 | B | 0 | 1 | TQ2U11 | Based on observation and staff interview, the facility failed to ensure a notice was posted regarding the availability of survey inspection results for surveys conducted during the 3 preceding years. The findings were: Observation on 6/20/17 at 10:15 AM showed the current survey inspection report was available in a binder near the front lobby for all to read; however, there was no notice posted to inform residents, families and visitors that reports from the preceding 3 years were available. Interview with the administrator on 6/22/17 at 9:37 AM verified she was unaware of this requirement and a notice would need to be posted. | 2020-09-01 |
| 706 | 706 | WORLAND HEALTHCARE AND REHABILITATION CENTER | 535048 | 1901 HOWELL AVENUE | WORLAND | WY | 82401 | 2017-06-29 | 167 | B | 0 | 1 | JGHQ11 | Based on observation and staff interview, the facility failed to ensure a notice of the availability of survey reports for the preceding 3 years was posted as required. The census was 67. The findings were: Observation on 6/29/17 at 7:15 AM showed a binder placed in the lobby contained the most recent health and life safety survey results. Further observation showed no notice posted informing the public that the previous 3 years' survey results were available upon request. Interview with the administrator on 6/29/17 at 7:30 AM confirmed the notice was not posted. She further revealed she was unaware of the requirement. | 2020-09-01 |
| 714 | 714 | WORLAND HEALTHCARE AND REHABILITATION CENTER | 535048 | 1901 HOWELL AVENUE | WORLAND | WY | 82401 | 2019-08-01 | 582 | B | 0 | 1 | 07FS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure the Notice to Medicare Provider Non-coverage (NOMNC) was issued to 1 of 3 sample residents (#264) reviewed. The findings were: Review of the medical record showed resident #264 had a planned discharged on [DATE] and there was no evidence the NOMNC was provided and signed. Review of the discharge evaluation from a care conference on 3/25/19 at 13:30 showed the discharge date was set to occur on 3/28/19 at 9:30 AM. Interview with MDS coordinator on 7/31/19 at 2:32 PM confirmed the NOMNC was not given. The MDS coordinator believed the notice was not required because the resident chose to discharge to the community. | 2020-09-01 |
| 726 | 726 | LIFE CARE CENTER OF CASPER | 535049 | 4041 SOUTH POPLAR STREET | CASPER | WY | 82601 | 2017-04-20 | 156 | B | 0 | 1 | G8O011 | Based on observation and staff interview the facility failed to ensure the posting of all pertinent State regulatory and informational agencies and resident advocacy groups contained all required information. The census was 111. The findings were: Observation of the facility posting during the survey timeframe showed it was on an 8 by 11 inch framed document and was located in the front lobby on a wall near the front entrance door across from the reception desk. The document did not contain the required email addresses or a statement to show residents may file a complaint with the State Survey Agency. Interview with the administrator on 4/20/17 at 10:10 AM confirmed the posting did not contain the necessary information. | 2020-09-01 |
| 730 | 730 | LIFE CARE CENTER OF CASPER | 535049 | 4041 SOUTH POPLAR STREET | CASPER | WY | 82601 | 2017-04-20 | 356 | B | 0 | 1 | G8O011 | Based on review of daily staff postings, and staff interview, the facility failed to accurately post the number of nursing staff and their actual hours worked for 4 of 4 days of survey (4/17/17 - 4/20/17). The findings were: Review of the daily staff postings for 4/17/17 through 4/20/17 showed each day the facility identified licensed nursing staff and unlicensed nursing staff. The facility failed to break down the categories of staff as required (RNs, LPNs, CNAs). Further, the postings failed to show the actual hours worked for each category of licensed and unlicensed nursing staff directly responsible for resident care per shift. Interview on 4/20/17 at 11:09 AM with the staff scheduler and the receptionist verified that the daily posting did not include all of the required information. | 2020-09-01 |
| 747 | 747 | MORNING STAR CARE CENTER | 535050 | 4 NORTH FORK ROAD | FORT WASHAKIE | WY | 82514 | 2019-10-03 | 582 | B | 0 | 1 | 896Q11 | Based on medical record review and staff interview, the facility failed to ensure the appropriate Notice of Medicare Provider Non-Coverage (NOMNC) form was issued correctly for 1 of 3 sample residents (#132). The findings were: Review of a Skilled Nursing Facility Beneficiary Protection Notification Review form completed by the facility showed resident #132 had a Medicare Part A stay that used fewer than the maximum 100 days covered by Medicare Part [NAME] Further review showed the NOMNC (Notice of Medicare Non-Coverage) was not issued due to the resident initiating discharge. The following concerns were identified: a. Review of an occupational therapy note dated 9/5/19 showed the resident had met therapy goals and was safe to return home upon discharge from the facility. b. Review of a physical therapy note dated 9/6/19 showed the resident met with physical therapy and social services to plan for a discharge on 9/11/19. c. Review of the medical record showed a discharge order request was sent to the physician on 9/6/19. The request was signed by the physician on 9/9/19. Interview on 10/2/19 at 9:40 AM with the DON, social worker, PTA, and a business office representative revealed the facility was unaware of the NOMNC form or its purpose. The PTA confirmed the home safety assessment had been completed and the discharge was planned. | 2020-09-01 |
| 772 | 772 | MORNING STAR CARE CENTER | 535050 | 4 NORTH FORK ROAD | FORT WASHAKIE | WY | 82514 | 2017-10-26 | 356 | B | 0 | 1 | LEZ111 | Based on review of staffing documentation and staff interview, the facility failed to ensure the posted 24 hour nursing staff information was maintained and updated to reflect the correct number of staff and actual hours worked for 8 of 8 days reviewed (10/16/17 through 10/23/17). The following concerns were identified: 1. Review of the POS [REDACTED]. 2. Interview with the ADON on 10/25/17 at 1:55 PM confirmed the posted daily staffing schedule was not updated. She stated, The daily posting is not reflective of true hours worked. There's a separate notebook for staff who call in. The daily staffing information is posted at midnight. | 2020-09-01 |
| 790 | 790 | THERMOPOLIS REHABILITATION AND WELLNESS | 535051 | 1210 CANYON HILLS RD | THERMOPOLIS | WY | 82443 | 2017-05-11 | 150 | B | 0 | 1 | KIK911 | Based on resident interview and staff interview, the facility failed to ensure residents had access to a list of resident's rights. A census of 46 residents were affected. The findings were: 1. Observation during the course of the survey failed to show resident rights information was posted in the facility. 2. Group interview on 5/9/17 at 11 AM revealed 11 out of 11 residents were not sure where resident's rights were posted within the facility. 3. Interview with the administrator on 5/10/17 at 4:30 PM revealed he had taken down the posting of the resident's rights and stated I did not know posting resident's rights was a regulation. | 2020-09-01 |
| 845 | 845 | GREEN HOUSE LIVING FOR SHERIDAN | 535054 | 2311 SHIRLEY COVE | SHERIDAN | WY | 82801 | 2020-01-15 | 641 | B | 0 | 1 | H82311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of the Resident Assessment Instrument (RAI) manual, the facility failed to ensure the MDS assessment was an accurate reflection of resident status for 1 of 13 sample residents (#5) reviewed. The findings were: 1. Review of the 12/31/19 quarterly MDS assessment showed resident #5 received an anticoagulation medication every day of the 7-day look-back period. The following concerns were identified: a. Review of the most current physician orders [REDACTED]. Further review showed the resident was not prescribed an anticoagulant. b. Interview with the MDS coordinator on 1/14/20 at 2 PM confirmed the resident's medications did not include an anticoagulant. In addition she was unaware [MEDICATION NAME] bisulfate ([MEDICATION NAME]) was not coded as an anticoagulant. 2. Review of MDS 3.0 RAI Manual version 1.15 page 478: Section N0410E, Anticoagulant (e.g. [MEDICATION NAME], or low-molecular weight [MEDICATION NAME]): showed: Do not code antiplatelet medications such as aspirin/extended release, [MEDICATION NAME], or [MEDICATION NAME] here. | 2020-09-01 |
| 894 | 894 | SAGE VIEW CARE CENTER | 535056 | 1325 SAGE STREET | ROCK SPRINGS | WY | 82901 | 2017-08-30 | 156 | B | 1 | 1 | TZL311 | > Based on observation and staff interview the facility failed to post the required notices in a form and manner accessible to residents and resident representatives. The census was 46. The findings were: Observation of the facility during the survey timeframe showed the names, addresses (mailing and email), and phone numbers of all pertinent State agencies and advocacy groups and the required statement to inform residents they may file a complaint with the State Survey Agency or request information with regard to returning to the community was not available. Interview with the administrator on 8/29/17 at 4 PM verified the absence of the required postings. | 2020-09-01 |
| 945 | 945 | AMIE HOLT CARE CENTER | 53A002 | 497 W LOTT | BUFFALO | WY | 82834 | 2017-01-26 | 156 | B | 0 | 1 | D5W811 | Based on observation, resident interview, and staff interview the facility failed to post the required notices in a form and manner accessible to residents and resident representatives. The findings were: 1. Observation of a bulletin board in the common area on the first floor of the facility showed a 3 foot long by 5 foot wide enclosed information board. The bottom of the board was 4 feet off the floor and the top was 7 feet off the floor. The board contained the required information, however, it was displayed in a manner not easily seen or read by the residents. 2. Interview with a group of 9 residents on 1/24/17 at 10:45 AM revealed 7 of the 9 residents did not know how to contact the ombudsmen, file a complaint, or where the list of resident rights was located. 3. Interview with the DON on 1/25/17 at 4:25 PM confirmed the information was not presented in a manner that was readily accessible to the residents. | 2020-09-01 |
| 963 | 963 | STAR VALLEY CARE CENTER | 53A050 | 130 HOSPITAL LANE | AFTON | WY | 83110 | 2017-02-24 | 167 | B | 0 | 1 | 5AC811 | Based on observation and staff interview, the facility failed to publicly display the availability of facility surveys, certifications, and complaint investigations for the 3 preceding years for 4 of 4 days during the survey. The findings were: 1. Observation on 2/21/17 at 4:45 PM showed the entrance hall near the nursing station had a wall-mounted display with a binder which contained the Form CMS-2567 (YEAR) survey results and plan of correction. However, there was no display to indicate the availability of the facility surveys, certifications and complaint investigations for all of the preceding three years. 2. Interview on 2/23/17 at 3:35 PM revealed the facility administrator was not aware of the requirement for the facility to prominently post a notice regarding the availability of facility surveys, certifications and complaint investigations for the preceding three years. | 2020-09-01 |
| 1024 | 1024 | IVINSON MEMORIAL HOSPITAL | 535035 | 255 N 30TH STREET | LARAMIE | WY | 82072 | 2017-11-14 | 167 | B | 0 | 1 | 6MJA11 | Based on observation and staff interview, the facility failed to ensure a notice was posted regarding the availability of survey inspections made during the 3 preceding years. The findings were: Observation on 11/13/17 at 10:36 AM showed the (YEAR) and (YEAR) survey inspection reports were available in a binder in the common room for all to read; however, there was no information posted to inform the residents, families and visitors that reports from the preceding years were available. Interview with the administrator on 11/14/17 at 1:56 PM verified she was unaware of this requirement and a notice would need to be posted. | 2020-07-01 |
| 1059 | 1059 | CHEYENNE REG MEDICAL CTR TRANSITIONAL CARE UNIT | 535044 | 214 EAST 23RD STREET | CHEYENNE | WY | 82001 | 2017-11-15 | 167 | B | 0 | 1 | FNV311 | Based on observation and staff interview, the facility failed to ensure a notice indicating the availability of surveys for the preceding 3 years was posted as required. The census was 16. The findings were: Observation on 11/13/17 at 11:30 AM showed the most recent health survey and life safety code survey were hanging on a bulletin board at the entrance to the facility, however, no additional surveys were available. Further observation showed there was no notice posted to let individuals know that survey results from the previous 3 years were available for review upon request. Interview with the NHA on 11/14/17 at 9:20 AM confirmed there was no such notice posted. | 2020-02-01 |
| 1071 | 1071 | THE LEGACY LIVING AND REHABILITATION CENTER | 535022 | 1000 S DOUGLAS HWY | GILLETTE | WY | 82716 | 2016-09-29 | 156 | B | 0 | 1 | 36X711 | Based on observation and staff interview, the facility failed to ensure State survey and certification agency information was prominently displayed. The findings were: Observation of the facility notification board on 9/28/16 at 5 PM showed no information for the State survey and certification agency was posted. Interview with the administrator on 9/29/16 at 10 AM confirmed the information was available to residents within the admission packet; however, it was not posted elsewhere. | 2020-01-01 |
| 1130 | 1130 | PLATTE COUNTY LEGACY HOME | 535053 | 100 19TH ST | WHEATLAND | WY | 82201 | 2017-03-02 | 166 | B | 0 | 1 | CTIU11 | Based on observation, staff interview, and review of policy and procedure the facility failed to ensure the grievance policy and procedure contained all required information. The census was 46. The findings were: Observation of the facility showed an 8 by 11 inch framed document located near the entrance to the activity room which explained the procedure for filing a grievance, however, the document did not contain all required information. The policy did not contain the name, address, or phone number of the grievance official and did not address the right to file a grievance anonymously. Interview with the SSD on 3/2/17 at 8:05 AM confirmed the policy and procedure did not contain the necessary information. | 2019-11-01 |
| 1149 | 1149 | SOUTH LINCOLN NURSING CENTER | 53A051 | 711 ONYX STREET | KEMMERER | WY | 83101 | 2017-01-05 | 167 | B | 0 | 1 | DQAK11 | Based on observation and staff interview, the facility failed to publicly display the most current survey results for 2 of 3 days during state surveyor visitation. The findings were: Observation on 1/3/17 at 5:23 PM showed the common area near the nurse's station had a wall-mounted display with a binder which contained survey results and plans of correction. However, the survey results and plan of correction on display were dated 2014, and were not current. Interview on 1/5/17 at 2:35 PM revealed the DON had removed the most current survey results and plan of correction in the prior week in preparation for a staff meeting. She further stated she had not put the paperwork back into the display binder until 1/5/17 in the morning. | 2019-11-01 |
| 1178 | 1178 | CHEYENNE HEALTH CARE CENTER | 535025 | 2700 E 12TH STREET | CHEYENNE | WY | 82001 | 2017-08-03 | 167 | B | 0 | 1 | LPLK11 | Based on observation and staff interview, the facility failed to ensure a notice of the availability of surveys for the preceding 3 years was posted as required. The resident census was 93. The findings were: Observation on 8/1/17 at 9:45 AM showed the results from surveys completed from (MONTH) (YEAR) through 5/11/17 were available in a binder by the main entrance to the facility. Further observation showed there was no notice posted to let individuals know all survey results from the preceding 3 years were available for review upon request. Interview with receptionist #1 on 8/3/17 at 8:20 AM confirmed the facility had no survey results available before (MONTH) of (YEAR), and no information was posted to inform the public that surveys prior to (MONTH) of (YEAR) could be provided by the facility for review. She further stated that the facility was unaware of that requirement. | 2019-09-01 |
| 1203 | 1203 | WORLAND HEALTHCARE AND REHABILITATION CENTER | 535048 | 1901 HOWELL AVENUE | WORLAND | WY | 82401 | 2016-09-01 | 167 | B | 0 | 1 | X4QC11 | Based on observation, and resident and staff interview, the facility failed to ensure survey results were posted in a location readily accessible to all residents. The census was 62. The findings were: 1. Observation on 8/30/16 at 11:30 AM showed survey results were in a binder located in the facility nook. Further observation showed the binder was in a plastic holder mounted on the wall beside a chair, with a shelf and antique radio placed in front of the mounted holder, which obstructed access. 2. Group interview with 8 residents on 8/30/16 at 10 AM revealed none of the residents participating were able to verify the location of the survey results, and they were not aware they had the right to review survey results. 3. Interview with the administrator, DON, and ADON on 8/31/16 at 7:10 PM confirmed the survey results were not easily accessible to the residents. | 2019-09-01 |
| 1215 | 1215 | WESTWARD HEIGHTS CARE CENTER | 535034 | 150 CARING WAY | LANDER | WY | 82520 | 2016-08-11 | 156 | B | 0 | 1 | 392Z11 | Based on observation and staff interview, the facility failed to ensure the posting of State advocacy group contact information was accurate for 2 of 2 postings (100 hall, 200 hall). The findings were: Observation of the facility's posting of advocacy group contact information on 8/11/16 at 9:45 AM showed the telephone number and address for the State survey agency was incorrect. Further, the telephone number for the regional ombudsman was incorrect. Interview with the administrator on 8/11/16 at 11:15 AM verified the postings were incorrect and needed to be updated. | 2019-08-01 |
| 1323 | 1323 | GRANITE REHABILITATION AND WELLNESS | 535013 | 3128 BOXELDER DRIVE | CHEYENNE | WY | 82001 | 2016-09-09 | 153 | B | 0 | 1 | EX9T11 | Based on observation and staff interview, the facility failed to ensure Medicare and Medicaid benefit application information was prominently displayed. The findings were: Observation on 9/9/16 at 12:20 PM revealed no evidence the facility had displayed Medicare and Medicaid benefit application information. Interview with the administrator at that time revealed the facility provided that information in writing upon admission to residents and the Power of Attorney. However, she confirmed the facility failed to prominently display that information in the facility. | 2019-05-01 |
| 1366 | 1366 | BONNIE BLUEJACKET MEMORIAL NURSING HOME | 535019 | 388 SOUTH US HWY 20 | BASIN | WY | 82410 | 2016-04-14 | 168 | B | 0 | 1 | B3JV11 | Based on observation and staff interview, the facility failed to ensure the correct contact information for the State Survey Agency was posted on 1 of 1 information boards. The findings were: Observation of the information board located in the main area of the facility showed the mailing address, the phone number and the name of the State Survey Agency was out of date. Interview with the DON on 4/13/16 at 4:05 PM verified the information needed to be corrected so it was accurate for the residents. | 2019-04-01 |
| 1407 | 1407 | SHEPHERD OF THE VALLEY REHABILITION AND WELLNESS | 535042 | 60 MAGNOLIA | CASPER | WY | 82604 | 2015-10-22 | 356 | B | 0 | 1 | WTHZ11 | Based on review of daily staff postings, and staff interview, the facility failed to accurately post the number of nursing staff and their actual hours worked for 4 of 4 days of survey (10/19/15 - 10/22/15). The findings were: Review of the daily staff postings for 10/19/15 through 10/22/15 showed each day the facility identified RNs, LPNs, and CNAs. The facility included certified medication aides (CMAs) in the actual numbers for CNAs. Interview with Corporate RN #1 on 10/22/15 at 2:30 PM revealed the CMAs were included with the numbers of CNAs on the posting. She then verified the CMAs were not assigned to provide resident care tasks, their assignment was to pass medications. | 2019-04-01 |
| 1474 | 1474 | POPLAR LIVING CENTER | 535024 | 4305 S POPLAR | CASPER | WY | 82601 | 2016-01-15 | 356 | B | 1 | 0 | RRZ811 | > Based on observation, staff interview, and review of daily nurse staffing sheets, the facility failed to ensure the posted nurse staffing sheets met the requirements for 20 of 20 days reviewed (12/27/15-1/15/16). The findings were: Observation on 1/15/16 at 9:05 AM revealed the posted daily nurse staffing sheets were not located in a readily accessible place. The posting was placed in a plastic holder which was attached to the wall near the chart room. The posting was high enough on the wall a resident in a wheelchair would not be able to see it or reach it. In addition, review of the daily sheets from 12/27/15 to 1/15/16 showed the information failed to separate the Certified Nurse Aides from non-certified aides. Interview with the administrator, unit assistant, and LPN #1 on 1/15/16 at 9:38 AM revealed they were not aware of the posting placement/accessibility requirement and that the number of and the actual hours worked needed to be listed specifically for CNAs. | 2019-01-01 |
| 1480 | 1480 | LARAMIE CARE CENTER | 535043 | 503 S 18TH ST | LARAMIE | WY | 82070 | 2015-11-19 | 167 | B | 0 | 1 | 6RNK11 | Based on observation and staff interview, the facility failed to ensure the most recent survey results were available to facility residents for review. The findings were: Observation on 11/17/15 at 9:10 AM showed a survey book was available near the front entrance to the facility. In the book there was a copy of the 10/9/14 Federal health and life safety code surveys. However, the complaint survey which was completed on 8/27/15 was not included. Interview with the administrator on 11/18/15 at 5:50 PM revealed she was not aware complaint surveys needed to be included for the residents to review. | 2019-01-01 |
| 1744 | 1744 | AMIE HOLT CARE CENTER | 53A002 | 497 W LOTT | BUFFALO | WY | 82834 | 2014-11-07 | 356 | B | 0 | 1 | WOLO11 | Based on Review of the POS [REDACTED]. Further, the daily postings did not consistently include the resident census. The findings were: Review of the daily nursing staff information sheet on 11/6/14 at 9:45 AM showed a list of staff names to include the shift they were assigned and the full time equivalents. It did not clearly show the total hours worked during each shift by the individual nursing discipline; RNs, LPNs and CNAs. Further, the daily postings did not always include the resident census. During an interview with the DON at the time of the review, she acknowledged the census needed to be included on all the daily postings and the number of hours worked by each discipline needed to be more clearly defined. | 2018-05-01 |
| 1755 | 1755 | WESTON COUNTY HEALTH SERVICES | 535023 | 1124 WASHINGTON BLVD | NEWCASTLE | WY | 82701 | 2014-12-17 | 356 | B | 0 | 1 | 34FO11 | Based on observation, review of facility posted staffing, and staff interview, the facility failed to post all required information on their daily staff postings for 3 of 3 days observed. The findings were: Random observations during the period from 12/15/14 through 12/17/14 showed the facility posted daily staffing detailing only the number of hours staff were scheduled to work. Review of 3 months of staffing revealed the facility failed to post actual numbers of employees in the categories of RN, LPN and CNA that worked; only listing hours in each category. Interview with the administrator on 12/17/14 at 2:55 PM confirmed that the facility only posted the staff hours, and not the actual number of staff in each category. | 2018-04-01 |
| 1786 | 1786 | BONNIE BLUEJACKET MEMORIAL NURSING HOME | 535019 | 388 SOUTH US HWY 20 | BASIN | WY | 82410 | 2015-03-26 | 411 | B | 0 | 1 | Y8XO11 | Based on staff interview and review of the dental agreement, the facility failed to ensure emergency dental services were available for residents. The findings were: Review of the dental agreement showed routine services would be provided, however, there was no provision for emergency dental services. Interview with the administrator on 3/26/15 at 9:15 AM verified the consulting dentist was not local and would not be available to provide emergency dental services. | 2018-03-01 |
| 1806 | 1806 | LIFE CARE CENTER OF CHEYENNE | 535032 | 1330 PRAIRIE AVENUE | CHEYENNE | WY | 82009 | 2015-01-08 | 356 | B | 0 | 1 | 2NWJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to complete the nurse staff posting at the beginning of each shift during four of four days of survey. The findings were: Observation upon entrance into the facility on [DATE] at 9:50 AM and periodically throughout the survey which concluded on 1/8/15, revealed there was no posting of the required nurse staffing anywhere in the facility. On 1/8/15 at 1:10 PM an interview with the staff member responsible for posting the nurse staffing stated the posting was taken down during the remodeling of the unit and just had not yet been re-posted. | 2018-03-01 |
| 1840 | 1840 | GREEN HOUSE LIVING FOR SHERIDAN | 535054 | 2311 SHIRLEY COVE | SHERIDAN | WY | 82801 | 2014-10-22 | 356 | B | 0 | 1 | FJ4O11 | Based on observation and staff interview, the facility failed to post, on a daily basis, the total number of and actual hours worked by RNs, LPNs and CNAs (Shahbazim), and the resident census. The findings were: Periodic observation from 10/19/14 through 10/22/14 failed to reveal posted nurse staffing and resident census. Interview with the facility administrator on 10/22/14 at 3:03 PM confirmed the facility was not posting nurse staffing and resident census as required. | 2018-03-01 |
| 1900 | 1900 | SHEPHERD OF THE VALLEY HEALTHCARE CENTER | 535042 | 60 MAGNOLIA | CASPER | WY | 82604 | 2014-08-27 | 356 | B | 0 | 1 | WSZ111 | Based on observation and staff interview, the facility failed to post the total number of nursing staff and their actual hours at the beginning of each shift worked for 4 of 4 days of observation. The findings were: Observation of the nurse staffing board on 8/24/14, 8/25/14, 8/26/14, and 8/27/14 showed it was posted for a 24-hour period instead of at the beginning of each shift as required. Interview with the staff development coordinator and staff coordinator on 8/27/14 at 4:45 PM verified the hours were posted for an entire day rather than at the beginning of each shift. Further, they said changes to the schedule based upon call-ins or changes in acuity or need were not noted on the postings until the following day prior to being filed. | 2017-12-01 |
| 1919 | 1919 | MORNING STAR CARE CENTER | 535050 | 4 NORTH FORK ROAD | FORT WASHAKIE | WY | 82514 | 2014-09-12 | 356 | B | 0 | 1 | 8O1Q11 | Based on observation, Review of the POS [REDACTED]. The findings were: Periodic observations during the survey showed the facility posted a daily staffing and resident census list. Review of the staffing for the last 15 months revealed the facility failed to post actual numbers of employees in each category that worked, only listing category hours. Also, the facility failed to revise the posting when warranted. The facility also posted for 24 hours, and not per shift. Interview with the DON on 9/12/14 at 10 AM confirmed the facility posted staff hours only, and not staff numbers. She also confirmed the facility posted staffing for 24 hours and not per shift, and did not revise the posting for changes. | 2017-12-01 |
| 1946 | 1946 | GRANITE REHABILITATION AND WELLNESS | 535013 | 3128 BOXELDER DRIVE | CHEYENNE | WY | 82001 | 2014-08-01 | 356 | B | 0 | 1 | OUX111 | Based on observation and staff interview, the facility failed to post the total number of nursing staff and their actual hours worked for 4 of 5 days of observation. The findings were: Observation of the nurse staffing board on 7/28/14 at 10:45 AM showed the board was dated 7/28/14 and there were 16 licensed staff working the day shift, 16 licensed staff working the evening shift, and 10 licensed staff working the night shift. The column listing unlicensed nursing staff was blank for all shifts. In addition, the data was not divided by the categories of registered nurses, licensed practical nurses and certified nurse aides. Observations on 7/29/14, 7/30/14, 7/31/14, and 8/1/14 showed no changes were made to the board; it remained dated 7/28/14 and was not updated. Interview with the DON on 8/1/14 at 11:55 AM confirmed the board had not been updated, and should have been. | 2017-11-01 |
| 1980 | 1980 | WESTVIEW HEALTH CARE CENTER | 535039 | 1990 WEST LOUCKS STREET | SHERIDAN | WY | 82801 | 2014-05-08 | 283 | B | 0 | 1 | QCCN11 | Based on review of closed medical records [REDACTED]. The findings were: 1. Review of the closed medical record revealed resident #62 was discharged to home on 2/25/14. Further review of the medical record showed no evidence of a discharge summary, including a recapitulation of the resident's stay. 2. Review of the closed medical record showed resident #61 was discharged to home on 2/25/14. Further review of the medical record showed no evidence of a discharge summary. 3. On 5/7/14 at 11:10 AM the medical records manager looked at the two closed records with the surveyors. She stated the discharge summary should be located in the front of the medical records, and confirmed she was unable to locate it for either record. In addition, she stated she had noticed issues with the discharge summaries not making it back to the records. | 2017-10-01 |
| 1989 | 1989 | POPLAR LIVING CENTER | 535024 | 4305 S POPLAR | CASPER | WY | 82601 | 2016-01-15 | 156 | B | 0 | 1 | RRZ811 | Based on observation and staff interview, the facility failed to ensure written information regarding Medicare and Medicaid benefits and contact information for the State survey agency were prominently displayed. The census was 111. The findings were: Observation on 1/12/16 at 10:30 AM showed no evidence of posted contact information for the State survey agency. Additionally, information regarding Medicare and Medicaid benefits was not on display. Interview with the administrator on 1/15/16 at 4:40 PM verified the information was not posted. | 2017-09-01 |
| 1990 | 1990 | POPLAR LIVING CENTER | 535024 | 4305 S POPLAR | CASPER | WY | 82601 | 2016-01-15 | 167 | B | 0 | 1 | RRZ811 | Based on observation and staff interview, the facility failed to ensure the most recent survey results were available and accessible to all residents in the facility for review. The census was 111. The findings were: Observation on 1/12/16 at 11:30 AM showed a notebook containing state survey results was posted next to the front door in a sitting area. The notebook was located approximately 5 feet off the floor with an armchair below it, putting it out of reach for residents in wheelchairs. Additionally, the most recent health survey found in the notebook was from the 7/23/15 complaint survey. The 11/6/15, 11/18/15, and 12/2/15 complaint surveys were not in the book. Interview with the administrator on 1/15/16 at 11:45 AM confirmed the survey results were not accessible to all residents, and needed to be lowered. He further confirmed the most recent survey results were not available in the notebook. | 2017-09-01 |
| 2048 | 2048 | DOUGLAS CARE CENTER LLC | 535040 | 1108 BIRCH STREET | DOUGLAS | WY | 82633 | 2014-08-07 | 167 | B | 0 | 1 | 0IJ311 | Based on observation and staff interview, the facility failed to post the results of the most recent State survey in an area readily accessible to residents. The census was 58. The findings were: Observation on 8/7/14 at 10 AM revealed State survey results were posted in the foyer of the facility. However, there was a locked door between the resident living areas and the survey results. In order to access the results, residents had to ask a staff member to unlock the door. Interview with the DON on 8/7/14 at 11 AM confirmed the survey results were not available to residents without the intervention of staff. | 2017-08-01 |
| 2054 | 2054 | DOUGLAS CARE CENTER LLC | 535040 | 1108 BIRCH STREET | DOUGLAS | WY | 82633 | 2014-08-07 | 356 | B | 0 | 1 | 0IJ311 | Based on observation and staff interview, the facility failed to post the total number of nursing staff and their actual hours worked in an area readily accessible to residents. The findings were: Observation on 8/4/14 at 4 PM revealed the nurse staffing and actual hours were posted in the entryway of the facility. However, there was a locked door between the resident living areas and the posting. In order to access the information, residents had to ask a staff member to unlock the door. In addition, the staffing was posted for the entire day instead of at the beginning of each shift as required. Observation on 8/7/14 at 8 AM revealed the posting remained in the same location. Interview with the DON on 8/7/14 at 9 AM confirmed the nursing staff posting was posted for the entire day instead of at the beginning of each shift. She also verified the information was not readily accessible to residents without asking for staff assistance. | 2017-08-01 |
| 2127 | 2127 | POWELL VALLEY CARE CENTER | 535045 | 777 AVENUE H | POWELL | WY | 82435 | 2014-04-24 | 167 | B | 0 | 1 | HLHS11 | Based on observation, and resident and staff interviews, the facility failed to ensure the most recent survey results were identified as available for examination by the residents. The findings were: During a confidential resident meeting on 4/22/14 at 1 PM two residents stated they were not aware of the location of the most recent survey results. Further, the residents indicated they would like the opportunity to examine the write-up. During an interview and observation with the social worker on 4/22/14 at 2:15 PM, she acknowledged the survey results, located in an unmarked rack mounted on the wall, were not clearly identifiable. | 2017-07-01 |
| 2303 | 2303 | GOSHEN HEALTHCARE COMMUNITY | 53A049 | 2009 LARAMIE STREET | TORRINGTON | WY | 82240 | 2014-12-04 | 356 | B | 0 | 1 | B2DW11 | Based on staff interview and review of the daily nurse staffing sheets, the facility failed to ensure 18 months of nurse staffing data were maintained and available for review. The findings were: Review of the daily nurse staffing sheets revealed there were only 12 months of data available. Further review showed that of the months that were available, data was missing. For the month of June 2014, only 8 days of data were available for review; May 2014 had 14 days of data available; and April 2014 had 9 days of data available. Interview with the DON on 12/4/14 at 10:55 AM, confirmed the facility did not have 18 months of daily staffing data. | 2017-02-01 |
| 2311 | 2311 | LARAMIE CARE CENTER | 535043 | 503 S 18TH ST | LARAMIE | WY | 82070 | 2013-09-12 | 283 | B | 0 | 1 | YDP411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure the discharge summary was complete for 2 of 2 sample residents (#78, #79) with anticipated discharges. The findings were: 1. Review of the closed medical record for resident #78 showed s/he had been admitted to the facility on [DATE]. Continued review showed the resident and facility were making plans for the resident to discharge to an assisted living facility. Review of the discharge summary showed the resident discharged on [DATE], and the physician listed the [DIAGNOSES REDACTED]. However, the summary failed to include a recapitulation of the resident's stay. Interview with the DON on 9/12/13 at 3:45 PM verified there was no recapitulation of stay found in the resident's record. 2. Review of the closed medical record for resident #79 showed s/he had been admitted to the facility in November 2008. Continued review showed the resident's family was relocating and plans were made for the resident's discharge to another skilled facility. Review of the discharge summary showed the resident discharged on [DATE], and the physician listed the [DIAGNOSES REDACTED]. However, the summary failed to include a recapitulation of the resident's stay. Interview with the DON on 9/12/13 at 3:45 PM verified there was no recapitulation of stay found in the resident's record. | 2017-01-01 |
| 2375 | 2375 | GRANITE REHABILITATION AND WELLNESS | 535013 | 3128 BOXELDER DRIVE | CHEYENNE | WY | 82001 | 2013-10-04 | 493 | B | 1 | 0 | 8DJN11 | Based on staff interview and review of licensing agency documentation, the facility failed to ensure the acting administrator was licensed by the state of Wyoming. The findings were: a. Interview with the administrator on 10/2/13 at 4:30 PM revealed he had been acting as the intermittent administrator for the facility for, about the last 4 weeks. The interview further revealed he had submitted an application to be licensed as the administrator but had not completed the application process. b.Verification of the acting administrator's license on 10/3/13 at 10:00 AM confirmed the Wyoming Board of Nursing Home Administrators had received the administrator's application, however, the application process had not been completed and the administrator was not licensed by the state. | 2016-10-01 |
| 2620 | 2620 | GREEN HOUSE LIVING FOR SHERIDAN | 535054 | 2311 SHIRLEY COVE | SHERIDAN | WY | 82801 | 2012-05-10 | 386 | B | 0 | 1 | 8D5D11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure physician progress notes [REDACTED].#2, #4, #12, #16) who had physician visits. The findings were: 1. Review of the physician notes for resident #2 showed the physician made visits on 2/27/12, 4/20/12 and 5/8/12. The notes were transcribed into the electronic medical record by the DON; however, there was no evidence the physician signed the notes. 2. Review of the physician notes for resident #4 showed the physician made visits on 2/27/12, 4/20/12 and 5/8/12. The notes were transcribed into the electronic medical record by the DON; however, there was no evidence the physician signed the notes. 3. Review of the medical record for resident #12, who was admitted [DATE], revealed no physician progress notes [REDACTED]. access to the computer system. 4. Review of the physician notes for resident #16 showed the physician made visits on 2/27/12, 4/20/12 and 5/8/12. The notes were transcribed into the electronic medical record by the DON; however, there was no evidence the physician signed the notes. 5. Interview with the DON on 5/8/12 at 4:03 PM verified many of the physicians did not use the electronic medical record system. She stated the physicians would dictate their notes and she transcribed them into the system. The DON further revealed it was a system they needed to work on because the physicians were not electronically or otherwise signing these notes. | 2016-02-01 |
| 2633 | 2633 | LARAMIE CARE CENTER | 535043 | 503 S 18TH ST | LARAMIE | WY | 82070 | 2012-08-09 | 278 | B | 0 | 1 | ZY8Z11 | Based on medical record review and staff interview, the facility failed to ensure signatures of individual assessors at Z0400 were obtained in a timely manner for 4 of 16 sample residents (#3, #6, #72, #78). The findings were: 1. During the survey from 8/6/12 through 8/9/12, review of the most recent MDS assessments for residents #3, #6, and #72 revealed each had a sticky note attached to Section Z containing a list of names and dates. The following concerns were identified: a. The completion date for Section Z0500B for resident #3 was 7/2/12. The attached note indicated a staff member still needed to sign Section Z0400 for information obtained on 6/20 and 6/25/12. b. The completion date for resident #6 was entered as 7/30/12 on Section Z0500B. The attached note indicated a staff member had not yet signed Section Z0400 for information obtained on 7/24/12. c. Section Z0500B was signed as completed for resident #72 on 7/23/12. However, the attached note indicated a staff member still needed to sign Section Z0400 for information obtained on 7/20/12. 2. Review of Section Z0500B for resident #78 showed it was dated 5/13/12. However, one signature at Section Z0400 was dated 5/14/12, one day after the MDS coordinator signed the assessment as complete. 3. On 8/7/12 at 10 AM the MDS coordinator confirmed she had difficulty getting signatures for the assessments in a timely manner, so she left notes for the individual assessors. She stated the signatures at Section Z0400 were not always obtained before she signed each assessment as complete. | 2016-01-01 |
| 2638 | 2638 | LARAMIE CARE CENTER | 535043 | 503 S 18TH ST | LARAMIE | WY | 82070 | 2012-08-09 | 356 | B | 0 | 1 | ZY8Z11 | Based on staff interview and review of the daily staffing reports, the facility failed to ensure the daily staffing reports were completed each shift. The findings were: Review of three randomly selected nurse staffing reports for July 2012 showed the reports were incomplete and did not indicate the number of nursing staff assigned for every shift. Review of two staffing reports for June 2012 did not show staff assigned to any shift. During an interview with the DON on 8/9/12 at 10:10 AM, she verified the daily posted staffing reports were not always completed or updated by the supervisors each shift. | 2016-01-01 |
| 2696 | 2696 | PIONEER MANOR NURSING HOME | 535022 | 900 W 8TH ST | GILLETTE | WY | 82716 | 2012-06-21 | 174 | B | 0 | 1 | E81G11 | Based on observation and interviews with residents and staff, the facility failed ensure effective measures were utilized by the laundry service to safeguard personal clothing for 6 of 13 residents who attended the group meeting. The findings were: During a confidential meeting on 6/19/12 at 3 PM, six of thirteen residents stated they were recently seeing an increase in lost clothing in the laundry department. Interview with laundry supervisor #1 on 6/20/12 at 10:48 AM revealed the following information: The facility policy was to minimize lost clothing by encouraging residents to allow laundry staff to stamp their clothing with an identification label upon admission and whenever they received new clothing items. Items with faded labels or no labels were placed in a lost clothing bin, and laundry staff were to attempt to identify the owner by remembering what each resident wore. The laundry was no longer being done at the nursing home, but rather by the laundry department at the hospital. The hospital laundry staff were unfamiliar with nursing home residents. Therefore, there was an increase in unlabeled clothing being placed in the lost clothing bin. In the past three months the amount of lost clothing had increased and currently there were two full lost clothing bins. Observation on 6/20/12 at 10:48 AM confirmed the two bins were full of unlabeled clothing that belonged to residents. | 2015-11-01 |
| 2699 | 2699 | PIONEER MANOR NURSING HOME | 535022 | 900 W 8TH ST | GILLETTE | WY | 82716 | 2012-06-21 | 248 | B | 0 | 1 | E81G11 | Based on resident and staff interviews and review of resident council meeting minutes, the facility failed to ensure residents' requests for additional activity choices were addressed for 7 of 13 residents in the group meeting. The findings were: During a confidential meeting on 6/19/12 at 3 PM, seven of thirteen residents stated they would like to have more activity options from which to choose. They also stated the issue was discussed at the resident council meetings. Review of the previous three months resident council meeting minutes revealed very little discussion was held regarding the actual current activities program, and the issue of adding more activities was not mentioned. Interview with two activities staff members (#1 and #2) on 6/20/12 at 10:48 AM revealed activities staff were aware of the residents' desire to have more activity choices, but they had not addressed this concern. | 2015-11-01 |
| 2791 | 2791 | WESTWARD HEIGHTS CARE CENTER | 535034 | 150 CARING WAY | LANDER | WY | 82520 | 2012-06-01 | 167 | B | 0 | 1 | LBRD11 | Based on observation and staff interview, the facility failed to ensure the results of the most recent survey was displayed in a location readily accessible to residents. In addition, the facility failed to post a notice of the survey results availability. The findings were: Observation on 6/1/12 at 8:30 AM showed the survey results could not be found. Interview with the business office manager revealed the survey results were to be placed on the table located in the front lobby but she acknowledged they were not there. Further, she was not certain how long they had been missing. At 10 AM that day the office manager revealed the survey results were found in a drawer in the lobby area. The notebook the results were displayed in was not labeled indicating its contents; nor was there a posted notice to indicate the availability of the survey results. | 2015-09-01 |
| 2824 | 2824 | POPLAR LIVING CENTER | 535024 | 4305 S POPLAR | CASPER | WY | 82601 | 2012-06-07 | 356 | B | 1 | 0 | HQWG11 | Based on observation and staff interview, the facility failed to ensure the daily facility staffing sheets were posted and retained the for 18 months. The facility census was 110 residents. The findings were: Observation on 6/5/12 and 6/6/12 failed to reveal postings of the daily facility staffing. Interview with the director of nursing (DON) on 6/6/12 at 3:34 PM and observation with her at that time confirmed the daily staffing was not posted. All daily staffing sheets were then requested. On 6/6/12 at 3:49 PM the DON stated the daily posting was now up but that no postings had been done since 5/7/12. Interview on 6/6/12 at 4:25 PM revealed the DON was unable to find any other daily postings prior to the 5/7/12 posting. | 2015-08-01 |
| 2867 | 2867 | WEST PARK LONG TERM CARE CENTER | 535027 | 707 SHERIDAN AVENUE | CODY | WY | 82414 | 2012-02-02 | 356 | B | 0 | 1 | 6L8U11 | Based on observation and staff interview, the facility failed to post the required nurse staffing data at the beginning of each shift in 1 of 1 locations where the information was posted. The findings were: Observation on 2/1/12 at 3 PM showed staffing data was already posted for all three shifts. Interview with the administrative assistant at that time confirmed she posted the information. When asked if the night staff revised the information for their shift if the data changed, the administrative assistant reported that she changed it the next day. She reiterated that the night staff did not revise the posted information prior to the beginning of the shift. | 2015-07-01 |
| 2926 | 2926 | DESERET HEALTH AND REHAB AT ROCK SPRINGS LLC | 535037 | 1325 SAGE STREET | ROCK SPRINGS | WY | 82901 | 2012-03-29 | 225 | B | 1 | 1 | V3VY11 | Based on review of facility documentation and policies and procedures, and staff interview, the facility failed to ensure the results of investigations of allegations of abuse, neglect, or misappropriation of resident property were reported to Healthcare Licensing and Surveys (HLS) within 5 working days of the incident for 2 of 3 allegations reviewed. The findings were: 1. Review of facility documentation of investigations of allegations of abuse, neglect, or misappropriation of resident property revealed the following concerns: a. An allegation of verbal abuse involving resident #39 occurred on 2/7/12, but the results of the investigation were not faxed to HLS until 2/15/12, six working days later. b. An allegation of neglect involving resident #45 occurred on 1/26/12, but the results of the investigation were not reported to HLS until 2/3/12, six working days later. 2. Review of the facility's policy and procedure "Conducting an Investigation" (PRO , 6/30/06) revealed "...Submit the findings to the State Survey Agency within 5 working days of the initial incident or per state regulations, if applicable." On 3/28/12 at 4:45 PM the DON stated she thought it was five working days from the date the facility became aware of the incident, not five days from the date of the incident. | 2015-06-01 |
| 2982 | 2982 | DESERET HEALTH AND REHAB AT SARATOGA LLC | 535047 | 207 EAST HOLLY | SARATOGA | WY | 82331 | 2013-05-31 | 356 | B | 1 | 1 | 9HFK11 | Based on observation and review of the daily staffing sheet, the facility failed to ensure the actual daily staffing levels and hours worked were posted each shift. The findings were: Observation on 5/31/13 at 12 PM showed the staffing levels for each shift was posted for the entire day to include the evening and night shifts. An interview with the DON at that time revealed the night shift from the previous day posted the staffing levels for the next 24 hour period. Further, any changes due to issues such as staff calling in sick were not indicated on the posted schedule. | 2015-06-01 |
| 3026 | 3026 | THERMOPOLIS REHABILITATION AND CARE CENTER | 535051 | PO BOX 1325 | THERMOPOLIS | WY | 82443 | 2012-03-15 | 356 | B | 0 | 1 | 1KIQ11 | Based on observation and staff interview, the facility failed to post the nurse staffing data on a daily basis at the beginning of each shift. In addition, the facility failed to maintain the posted daily nurse staffing data for a minimum of 18 months. The findings were: Review of the facility's daily staffing and census reports on 3/15/12 at 9:15 AM, located at the front entrance, showed it was completed for the entire day to include the evening and night shifts. Interview with the medical records director on 3/15/12 at 10:45 AM verified the staffing report was posted at the beginning of the day for the next 24 hours. Any changes to the daily staffing report were made the following day. In addition, the facility only had 14.5 months of the daily nurse staffing schedules on file. | 2015-05-01 |
| 3039 | 3039 | CROOK CO MEDICAL SERVICE DISTRICT LONG TERM CARE | 535029 | 713 OAK STREET | SUNDANCE | WY | 82729 | 2012-07-26 | 156 | B | 0 | 1 | EL2611 | Based on observation and staff interview, the facility failed to ensure accurate information regarding the State survey agency was provided for residents during 2 of 2 random observations. The findings were: Observation of posted information on 7/23/12 at 5:30 PM and on 7/26/12 at 12 noon showed the State survey agency address was incorrect. Interview with the DON on 7/26/12 at 12:15 PM verified the address was incorrect. | 2015-04-01 |
| 3070 | 3070 | DESERET HEALTH AND REHAB AT SARATOGA LLC | 535047 | 207 EAST HOLLY | SARATOGA | WY | 82331 | 2012-08-22 | 253 | B | 0 | 1 | TPBS11 | Based on observation and staff interview, the facility failed to ensure the floors in 2 of 3 areas (the main hallway, and the dining room) were maintained in a manner to prevent soil build up. The findings were: Observation on 8/21/12 at 3:45 PM showed darkened build up of soil and/or wax around the edges of doorways in the main hallway and around the edges of the west and south wall under the radiator heaters in the dining room. Interview with the administrator and the housekeeping supervisor on 8/22/12 at 10:05 AM revealed the contracted services were responsible to strip the wax from the floors. They both verified they were aware of the build-up and according to the administrator, a request was made approximately 2 months ago to have the floors stripped/cleaned. As of this time, the facility was still waiting for the outside staff to come to the facility and perform the work. | 2015-04-01 |
| 3156 | 3156 | SUBLETTE CENTER | 535017 | 333 N BRIDGER AVE | PINEDALE | WY | 82941 | 2011-08-11 | 356 | B | 0 | 1 | WFA711 | Based on observation, staff interview, and review of hard copies of the posted information and the nursing schedule, the facility failed to ensure accurate staffing levels were posted for public review. The findings were: Observation on 8/9/11 at 11:40 AM showed staffing levels for the morning shift were posted on a large dry erase board. The information included 4 CNAs (each working 8 hours for a total of 32 hours that shift) and 1 restorative aide (RA) for 8 hours, as well as the remaining staff. Comparison of that information with the nursing schedule showed the RA was a CNA, but she was only working as the RA; therefore, the posted information was incorrect as there were only 3 CNAs available to provide a total of 24 hours of resident care. At 11:45 AM that day, DONs #1 and #2 confirmed the posted information was inaccurate. In addition, at 2:45 PM that afternoon, the DONs stated the night nurse would make a paper copy of information to be posted the next day. This copy was kept, but it did not include any changes made on the board throughout the day. Review of the copies showed no evidence changes had been made, and a staff member called in the morning of 8/9/11 to provide one-to-one care for a resident had not been added. | 2015-01-01 |
| 3367 | 3367 | DESERET HEALTH AND REHAB AT ROCK SPRINGS LLC | 535037 | 1325 SAGE STREET | ROCK SPRINGS | WY | 82901 | 2011-03-17 | 249 | B | 0 | 1 | S5L311 | Based on a review of qualifications and staff interview, the facility failed to ensure a qualified activity director was overseeing the activity program for 2 of 3 nursing units. The findings were: Interview with the corporate certified therapeutic recreation specialist (CTRS) on 3/17/11 at 3:45 PM revealed the facility had been without an activity director since 2/25/11. Currently, a nurse aide (NA) who had been working in the activity program since 12/12/10 and was providing the day-to-day activities for residents. She stated this NA did not have the education, experience, or qualifications required. Per interview, the corporate CTRS consultant had not been in the facility since 2/3/11, which was prior to the previous director's last day of work. During this same interview, the CTRS stated she had never worked with the NA providing activities prior to this week (3/14/11). The CTRS confirmed she had not provided oversight for the facility's activity program. | 2014-09-01 |
| 3395 | 3395 | DESERET HEALTH AND REHAB AT SARATOGA LLC | 535047 | 207 EAST HOLLY | SARATOGA | WY | 82331 | 2011-08-11 | 356 | B | 0 | 1 | I17711 | Based on staff interview, observation, and review of facility posting documents, the facility failed to ensure the posted nurse staffing information accurately identified certified nurse aide hours on a daily basis for 30 of 30 days. The findings were: Observation of the staff information posted on all four days of the survey showed NA hours were included in the count for CNA hours. Review of staff information posting documents from 7/13/11 through 8/11/11 showed NA hours were included in the CNA hours each day. Interview with the DON on 8/11/11 at 10:20 AM revealed she was unaware NA hours were not to be included as part of the CNA hours. | 2014-09-01 |
| 3407 | 3407 | WORLAND HEALTHCARE AND REHABILITATION CENTER | 535048 | 1901 HOWELL AVENUE | WORLAND | WY | 82401 | 2011-04-28 | 514 | B | 0 | 1 | PHFI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to assure medical record notations were accurate in regard to medication administration for 2 of 15 sample residents (#38, #47). The findings were: 1. According to the April 2011 Medication Administration Record [REDACTED]. The resident received [MEDICATION NAME] at 8 PM on 4/9/11, 4/10/11, 4/11/11 and on 4/24/11 without documentation of it being administered on the PRN flowsheet. Review of the April 2011 MAR indicated [REDACTED]. 2. Review of the March 2011 MAR for resident # 38 revealed s/he received Tylenol 650 mg for pain on 4/24/11, 4/25/11, and on 4/26/11. Review of the March 2011 PRN flowsheet revealed these medications were not documented as given on those three days. Review of the PRN flowsheet showed the resident received Tylenol 650 mg for a headache on 3/29/11. Review of the March 2011 MAR indicated [REDACTED]. 3. Interview with the DON and house supervisor on 4/28/11 at 8:25 AM revealed staff had been educated on proper and accurate documentation on forms. They stated the inaccuracies should not have occurred. | 2014-09-01 |
| 3410 | 3410 | GOSHEN HEALTHCARE COMMUNITY | 53A049 | 2009 LARAMIE STREET | TORRINGTON | WY | 82240 | 2012-07-26 | 167 | B | 0 | 1 | OSWO11 | Based on observation and staff interview, the facility failed to ensure the most recent survey results were made available to residents and the public. The findings were: Observation on 7/23/12 at 5:30 PM revealed a copy of the recertification survey dated April 2011 was posted in the lobby by the administrative offices. Interview with the administrator on 7/24/12 at 2 PM confirmed another recertification survey had been completed in December 2011 but had never been made available for resident and public review. | 2014-09-01 |
| 3423 | 3423 | GOSHEN HEALTHCARE COMMUNITY | 53A049 | 2009 LARAMIE STREET | TORRINGTON | WY | 82240 | 2012-07-26 | 356 | B | 0 | 1 | OSWO11 | Based on staff interview and review of staffing records, the facility failed to ensure the records accurately reflected the staff available on each shift for the past 3 months. The findings were: Observation on 7/23/12 at 5:30 PM revealed the staffing sheet for 7/23/12 was posted in the common area by the activity/dining room. Observation on 7/25/12 at 1 PM showed the posted staffing sheet was the one for 7/23/12. Interview on 7/26/12 at 9 AM with the DON revealed the afternoon charge nurse did the staffing sheet for all shifts, but she was on vacation. Review of the staffing sheets for the past 3 months revealed only one sheet had a correction on it. Further interview on 7/26/12 at 11 AM with the DON revealed she was sure staff had called in sick in the past 3 months and she confirmed the staffing sheets were probably not updated when staff called off. | 2014-09-01 |
| 3427 | 3427 | STAR VALLEY CARE CENTER | 53A050 | 110 HOSPITAL LANE | AFTON | WY | 83110 | 2011-05-26 | 492 | B | 1 | 1 | ETTO11 | Based on review of facility documentation and staff interview, the facility failed to ensure it was in compliance with federal regulations pertaining to nurse aide training for 2 of 6 CNAs hired in the past year. The findings were: During an interview on 5/26/11 at 8:15 AM, the DON and administrator stated they did not believe CNAs who were hired within 12 months of completing a nurse aide training and competency evaluation program were reimbursed for the costs associated with the program. The administrator stated that issue was brought up by the instructor of the nurse aide program, but the facility had not resolved the issue yet. According to a list provided by the human resources (HR) director, of the six CNAs hired in the past year, two would have completed the nurse aide training program within 12 months of being hired by the facility. On 5/26/11 at 9:35 AM, the HR director stated neither of the CNAs had been reimbursed for costs associated with the nurse aide training and competency evaluation program. According to 42 CFR (Code of Federal Regulations) Subpart D, 483.152, "(c) Prohibition of charges. (1) No nurse aide who is employed by, or who has received an offer of employment from, a facility on the date on which the aide begins a nurse aide training and competency evaluation program may be charged for any portion of the program (including any fees for textbooks or other required course materials). (2) If an individual who is not employed, or does not have an offer to be employed, as a nurse aide becomes employed by, or receives an offer of employment from, a facility no later than 12 months after completing a nurse aide training and competency evaluation program, the State must provide for the reimbursement of costs incurred in completing the program on a pro rata basis during the period in which the individual is employed as a nurse aide." | 2014-09-01 |
| 3445 | 3445 | STAR VALLEY CARE CENTER | 53A050 | 110 HOSPITAL LANE | AFTON | WY | 83110 | 2011-05-26 | 278 | B | 0 | 1 | ETTO11 | Based on medical record review and staff interview, the facility failed to ensure MDS assessments were signed as required for 4 of 10 sample residents (#10, #11, #21, #22). The findings were: 1. According to the Long-Term Care Facility Resident Assessment Instrument User's Manual, Version 3.0, September 2010, the RN coordinator signs and dates at section V0200 B1 and B2 which certifies that the CAAs have been completed. A staff member signs and dates section V0200 C1 and C2 after the care plan is complete. The following concerns were identified: a. Review of the 4/6/11 significant change MDS assessment for resident #11 showed Section V0200 B1 was not signed by the RN coordinator. In addition, Section V0200 C1 also lacked a signature. b. Review of the 1/21/11 annual MDS assessment for resident #21 showed there were no signatures at section V (V0200, B and C). c. Review of the 1/12/11 annual MDS assessment for resident #22 showed there was no signature at section V (V0200, B) for the MDS coordinator. In addition, the corresponding CAAs for dental care, ADLs, urinary incontinence, falls, and pressure ulcers were not signed. 2. According to the Long-Term Care Facility Resident Assessment Instrument User's Manual, Version 3.0, September 2010, at Section Z0500, the RN assessment coordinator must sign, and thereby certify the assessment is complete. However, review of the 3/10/11 quarterly MDS assessment for resident #10 revealed the RN assessment coordinator failed to sign at Section Z0500. 3. During an interview on 5/26/11 at 1:55 PM, the DON confirmed the assessments were lacking the necessary signatures. She stated "I usually sign those," and was not sure how they were missed. | 2014-07-01 |
| 3515 | 3515 | IVINSON MEMORIAL HOSPITAL EXTENDED CARE FACILITY | 535035 | 255 N 30TH STREET | LARAMIE | WY | 82072 | 2011-06-08 | 156 | B | 6WBS11 | Based on observation and staff interview, during 2 of 3 survey days the facility failed to display written information regarding application for and use of Medicare and Medicaid benefits. The findings were: Observation of the facility on 6/6/11 at 7:07 PM and on 6/7/11 at 7:35 AM revealed information related to applying for Medicare and Medicaid benefits was not posted. Interview with the administrator on 6/7/11 at 1:20 PM confirmed the information was not posted anywhere in the facility. The administrator stated she was unaware of the requirement to post the information. | 2014-04-01 | ||
| 3517 | 3517 | IVINSON MEMORIAL HOSPITAL EXTENDED CARE FACILITY | 535035 | 255 N 30TH STREET | LARAMIE | WY | 82072 | 2011-06-08 | 356 | B | 6WBS11 | Based on observation and staff interview, the facility failed to post nurse staffing data in the required format for 3 of 3 survey days. The findings were: Observation from 6/6/11 at 7:07 PM through the conclusion of the survey on 6/8/11 at 4:25 PM showed the nurse staffing data was not posted in the format required by regulation. The information failed to include the correct name of the facility and the resident census. During an interview on 6/8/11 at 10:03 AM, the administrator confirmed the posted information did not meet the requirements. | 2014-04-01 | ||
| 1748 | 1748 | STAR VALLEY CARE CENTER | 53A050 | 110 HOSPITAL LANE | AFTON | WY | 83110 | 2015-02-26 | 354 | C | 0 | 1 | S91611 | Based on staff interview, the facility failed to ensure a registered nurse was designated as the DON on a full-time basis. The census was 23. The findings were: Upon entering the facility on 2/23/15 at 4 PM, the social services director stated the facility did not have a full-time DON. She stated the previous DON was now also working at the hospital. During an interview on 2/23/15 at 4:15 PM the DON stated he was also the DON at the attached hospital. He stated he started at the hospital around the end of November 2014. When asked how many hours a week he spent in this facility, he stated about 10 to 15 hours. He stated the MDS coordinator helped with some of the DON duties, but was not formally sharing the role of DON. The DON further stated the facility had hired a full-time DON who would start the end of March 2014. | 2018-05-01 |
| 2415 | 2415 | WESTVIEW HEALTH CARE CENTER | 535039 | 1990 WEST LOUCKS STREET | SHERIDAN | WY | 82801 | 2013-03-14 | 356 | C | 0 | 1 | YSK111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to complete the nurse staff posting at the beginning of each shift during 4 of 4 days of the survey. In addition, the facility failed to maintain permanent copies of the nurse staff posting for the required 18 months. The findings were: Upon entrance into the facility on [DATE] at 3:20 PM, observation revealed the nurse staff posting dated 3/11/13 had all three shifts posted at the same time. Periodic observations on 3/12/13, 3/13/13, and 3/14/13 revealed all three shifts were again posted at the same time. During an interview with the business office staff on 3/14/13 at 10:35 AM, she stated she posted the nurse staffing for the entire day (all three shifts) each day. In addition, the interview revealed business office staff did not maintain a permanent copy of each day's postings for the required 18 months. The business office staff member said she was unaware a permanent copy was to be maintained and the facility had never retained copies. Interview with the DON on 3/13/13 at 4:20 PM revealed she too was unaware of the requirement to maintain a permanent copy of the nurse staff posting for 18 months. | 2016-09-01 |
| 2623 | 2623 | GREEN HOUSE LIVING FOR SHERIDAN | 535054 | 2311 SHIRLEY COVE | SHERIDAN | WY | 82801 | 2012-05-10 | 498 | C | 0 | 1 | 8D5D11 | Based on review of personnel files and staff interview, the facility failed to ensure nurse aides were competent in their duties for 3 of 3 shahbazim (#1, #2, #3) reviewed. The findings were: Review of personnel files for shahbaz #1, #2, and #3 revealed they were certified nurse aides (CNAs). Further review showed no evidence competency evaluations were completed to ensure they were competent in duties assigned. During an interview on 5/9/12 at 10:35 AM, the human resources director confirmed there were no competencies for any of the CNAs. She stated staff were asked to review their job description and confirm they could perform the tasks. She further stated the facility was in the process of developing an annual competency for staff. | 2016-02-01 |
| 2625 | 2625 | GREEN HOUSE LIVING FOR SHERIDAN | 535054 | 2311 SHIRLEY COVE | SHERIDAN | WY | 82801 | 2012-05-10 | 519 | C | 0 | 1 | 8D5D11 | Based on staff interview, the facility failed to have a written transfer agreement with a hospital. The findings were: On 5/9/12 at 10:25 AM the administrator was asked for a copy of the written transfer agreement with a hospital. The administrator stated the facility did not have a written agreement with a hospital. She stated they were in talks with the hospital, but did not have an agreement. | 2016-02-01 |
| 2794 | 2794 | WESTWARD HEIGHTS CARE CENTER | 535034 | 150 CARING WAY | LANDER | WY | 82520 | 2012-06-01 | 278 | C | 0 | 1 | LBRD11 | Based on medical record review and staff interview, the facility failed to ensure the MDS assessments were signed appropriately for 13 of 13 sample residents (#2, #8, #15, #16, #18, #28, #31, #40, #42, #45, #46, #56, #57) who required those assessments. The findings were: Review of all MDS assessments for residents #2, #8, #15, #16, #18, #28, #31, #40, #42, #45, #46, #56, and #57 showed signatures were lacking for Sections V (CAA Summary, VB and VC) and Section Z (Assessment Administration, Z0500). On 5/31/12 at 10:05 AM the MDS coordinator stated she thought the signatures were computer generated, so she was not checking them. At 9:50 AM on 6/1/12 the coordinator reported there was a glitch in the computer software system, and the signatures were not being generated. The coordinator confirmed she had not physically signed the assessments to certify their completion. Reference: Centers for Medicare & Medicaid Services Long-Term Care Facility Resident Assessment Instrument User's Manual, Version 3.0, April 2012. For Section V0200: Page V-5, Coding Instructions for V0200B, Signature of RN Coordinator for CAA Process and Date Signed. V0200B1, Signature. Signature of the RN coordinating the CAA process. V0200B2, Date. Date that the RN coordinating the CAA process certifies that the CAAs have been completed. For Section Z0500: Page Z-7, Signature of RN Assessment Coordinator Verifying Assessment Completion. Item Rationale: Federal regulation requires the RN assessment coordinator to sign and thereby certify that the assessment is complete. | 2015-09-01 |
| 2861 | 2861 | WEST PARK LONG TERM CARE CENTER | 535027 | 707 SHERIDAN AVENUE | CODY | WY | 82414 | 2012-02-02 | 278 | C | 0 | 1 | 6L8U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure the signatures of individual assessors were completed prior to the RN coordinator's signature, certifying overall completion of the MDS assessment, for 15 of 15 sample residents (#3, #10, #14, #16, #19, #26, #35, #37, #38, #41, #42, #47, #58, #76, #77). Specific evidence where signatures would either have to be dated after the completion date or backdated included residents #19 and #26. The findings were: 1. Review of the 1/17/12 quarterly MDS assessment for resident #26 showed the signature date of the RN coordinator at Z0500B was pre-printed by the computer as 1/17/12. However, the coordinator's signature was lacking, as were the signatures of the other assessors. Therefore, when signed, the signatures would be backdated, an unacceptable practice per the Long Term Care Facility Resident Assessment Instrument User's Manual Version 3.0, October 2011, or dated after the completion date. 2. According to the face sheet, resident #19 was admitted on [DATE], thus requiring that the admission MDS assessment be completed by 1/31/12. When the MDS was requested on 2/1/12 at 9:30 AM, unit secretary #1 immediately called the MDS coordinator. The secretary reported the coordinator had the MDS assessment in her office awaiting signatures from all the assessors. When the assessment was later produced, the coordinator's signature signifying completion was dated 1/31/12 at Z0500B; however, signatures of those assessors completing various sections were lacking. 3. During an interview on 2/2/12 at 9:45 AM, the MDS coordinator stated the computer automatically generated the date the MDS was printed, and she signed each assessment that day. However, the other assessors had not yet signed the assessment and might not do so for several days. The coordinator stated they either dated their signature when signed or backdated it. She was unaware that her dated signature indicated the ent… | 2015-07-01 |
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CREATE TABLE [cms_WY] ( [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 );