14
Inspections
30
Deficiencies
1
Actual Harm or Above
43
Occurrences
February 25, 2026
Last Inspection
S/S D/E/F Potential for harmS/S J Immediate jeopardy

The most recent inspection of BRIARWOOD HEALTH CARE CENTER on record is dated February 25, 2026. Across 14 published inspections, state surveyors cited 30 deficiencies, 1 of which reached actual harm or immediate jeopardy.

Colorado publishes inspections on a rolling window, so older surveys may no longer appear. Citation codes 0000 and 9999 are the surveyor's opening and closing comments, not deficiencies, and are excluded from the counts above. Where the state required one, the facility's own plan of correction is shown beneath the finding it answers.

Provider Information

Status
Active
Facility Type
SNF/NF Dual Certification
Administrator
Van Gorder, Andrew Ryan
Owner
LIFE CARE CENTERS OF AMERICA, INC.
Phone
(303) 399-0350
Payor Source
Medicare, Medicaid, Private Pay
City
DENVER
ZIP
80206-2016

Inspections & Citations

14 inspections · 30 deficiencies
2/25/2026Complaint Survey · ID 1F1A5D-H1No deficiencies
0000INITIAL COMMENTSSurveyor note
Findings
A complaint survey, prompted by #CO2734114 was conducted on 2/24/26 to 2/25/26. No deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
2/25/2026Licensure Complaint Survey · ID 1F1A5F-H1No deficiencies
0000Initial CommentsSurveyor note
Findings
A survey with #CO2734115 was completed on 2/24/26 to 2/25/26. No deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
7/16/2025Complaint Survey · ID ETDU111 deficiency
0000INITIAL COMMENTSSurveyor note
Findings
A survey, prompted by #CO1936676, #CO1936677 and #CO1936678 was conducted 7/15/25 to 7/16/25. One deficiency was cited.
Plan of correction
The state did not require a plan of correction for this citation.
0760Residents are Free of Significant Med Errors
Findings
Based on record review and interviews, the facility failed to ensure one (#5) of 12 residents reviewed for medication management were free from significant medication errors out of 12 sample residents. Resident #5 was admitted to the facility on 12/10/21 with diagnoses of hemiplegia and hemiparesis (weakness and paralysis on one side of the body) following cerebrovascular disease (a condition that affects the blood vessels in the brain) and epilepsy (seizure disorder). On 6/7/25 the facility received a delivery from the pharmacy. Licensed practical nurse (LPN) #1 signed for the delivery and did not open the box to check the contents. LPN #1 placed the box in the medication room. When LPN #1 went to administer Resident #5’s Dilantin medication (a medication used to prevent seizures) on 6/20/25 and 6/21/25, she was unable to locate the medication. This resulted in Resident #5 missing three consecutive doses of Dilantin. On 6/21/25 Resident #5 was transferred to the hospital for a possible seizure. The resident was monitored with a continuous electroencephalography (cEEG) (monitors brain activity), which showed focal status epilepticus (a prolonged seizure) as well as secondary generalized seizures. The resident was treated in the hospital with anticonvulsants intravenously (IV). Specifically, the facility failed to ensure Resident #5 was given her antiseizure medication as ordered. Findings include:Record review and interviews confirmed the facility corrected the deficient practice prior to the onsite investigation on 7/15/25 to 7/16/25, resulting in the deficiency being cited as past noncompliance with a correction date of 6/27/25. I. Medication error on 6/20/25 and 6/21/25On 6/7/25 LPN #1 received and signed for a delivery from the pharmacy. She did not open the box and inventory the contents. She placed the delivered box in the medication room. On 6/20/25 at 6:55 p.m. LPN #1 documented she was unable to administer Dilantin 150 milligrams (mg) due to not having the medication. On 6/21/25 at 8:21 a.m. LPN #1 documented she was unable to administer Dilantin 100 mg due to not having the medication. On 6/21/25 at 4:58 p.m. LPN #1 documented she was unable to administer Dilantin 150 mg due to not having the medication. On 6/21/25, Resident #5 was sent to the hospital for a possible seizure and treatment. On 6/22/25 it was discovered that Resident #5’s Dilantin medication was in the box that was delivered by the pharmacy on 6/7/25 and was not administered to the resident as ordered. II. Facility’s performance improvement planThe performance improvement plan (PIP) the facility implemented in response to Resident #5’s medication errors was provided by the nursing home administrator (NHA) on 7/15/25 at 12:18 p.m. The plan documented the problem identified was three doses of Dilantin were not given to Resident #5, resulting in the resident being sent to the hospital. The plan revealed the following:A. Root cause analysisLPN #1 failed to open the medication delivery box and the medication remained in the medication room, which was not noticed by any employees and the protocol for reporting unavailable medications to the physician was not followed. B. Identification of other residentsResident #5 was transferred to the hospital when she started showing signs of seizure activity. A medication administration record (MAR) audit of all residents who received anticonvulsant medication was implemented on 6/25/25 to ensure they were all receiving their anticonvulsant medications. The audit was still ongoing for monitoring. B. Systemic changesThe director of nursing (DON) completed a verbal corrective action form with LPN #1 and educated her on the process of receiving medication deliveries from the pharmacy and the process of when a resident was missing a medication. The education was given over the phone on 6/23/25 and the form was signed on the next shift that LPN #1 worked, which was 6/26/25. The staffing development coordinator (SDC) reeducated nursing staff on proper medication handling and documentation procedures and proper notification of the physician, the DON and the unit manager (UM) when medications were not available. Nursing staff were also given handouts on medication handling, when a medication was not available and significant medication errors. All nursing staff were educated by 6/27/25. C. MonitoringThe UM would conduct a weekly MAR audit on all residents receiving anticonvulsant medications to ensure no doses were missed. The UM would turn in the audit to the DON to double-check the audit. The audit was started on 6/25/25 and was ongoing. The UM or the DON would conduct a weekly audit on medications received to ensure that the medications are put away timely. The first audit was conducted on 6/20/25 and was ongoing. The UM or the DON would audit all medication rooms to ensure received medications were not left in the medication room. The DON conducted the first audit on 6/25/25 and was ongoing. The facility’s determined date of compliance was 6/27/25. III. Professional referenceAccording to Potter, P.A., Perry, A.G et.al,, Fundamentals of Nursing, 10th ed., Elsevier, St. Louis, Missouri, pp. 606-607, "Take appropriate actions to ensure the patient receives medication as prescribed. To prevent medication errors, follow the seven rights of medication administration consistently every time you administer medications: 1. The right medication 2. The right dose 3. The right patient 4. The right route 5. The right time 6. The right documentation 7. The right indication." IV. Facility policy and procedureThe Medication Administration policy, revised 2/13/23, was provided by the regional director of clinical services on 7/16/25 at 10:08 a.m. It read in pertinent part, “Staff who are responsible for medication administration will adhere to the 10 rights of medication administration: right drug, right resident, right dose, right route, right time and frequency, right documentation, right assessment, right to refuse, right evaluation/response, right education and information.”The Reordering, Changing, and Discontinuing Medication Orders policy, revised 7/1/24, was provided by the regional director of clinical services on 7/16/25 at 10:16 a.m. It read in pertinent part, “ Facilities are encouraged to reorder medications electronically or by fax whenever possible.“Facility staff should review the transmitted re-orders for status and potential issues and pharmacy response. “The facility should retain a copy of the refill/order form communicated to the pharmacy to reconcile the medications delivered by the pharmacy against what was ordered.”V. Resident #5A. Resident statusResident #5, age 83, was admitted on 12/10/21. According to the July 2025 computerized physician orders (CPO), diagnoses included hemiplegia and hemiparesis following cerebrovascular disease and epilepsy. The 6/6/25 minimum data set (MDS) assessment indicated the resident had severe cognitive impairments with a brief interview for mental status (BIMS) score of six out of 15. The assessment documented that the resident was dependent on staff for the majority of her activities of daily living (ADL). The assessment documented that the resident was taking anticonvulsant medication and had a diagnosis of epilepsy. B. Resident #5’s representative interview Resident #5’s representative was interviewed on 7/15/25 at 1:38 p.m. The representative said Resident #5 was receiving her medications as ordered from what he knew. The resident’s representative said he assumed Resident #5 was getting her medications, as when one of her medications became unbalanced, she had to be sent out to the hospital. The representative said Resident #5 was sent to the hospital two or three weeks prior. The representative said Resident #5 had been having seizures due to an imbalance in her medications, but the resident had been fine since she was readmitted to the facility. C. Record reviewThe June 2025 CPO revealed Resident #5 had physician’s orders for the following daily scheduled medications: Dilantin Infatabs Tablet Chewable 50 milligrams (mg) for seizures). Give 100 mg by mouth one time a day every Tuesday, Wednesday, Thursday, Friday, Saturday and Sunday, ordered on 9/1/23. Dilantin Infatabs Tablet Chewable 50 mg. Give 150 mg by mouth every evening shift, ordered on 9/1/23. Review of the June 2025 MAR (from 6/1/25 to 6/31/25) documented that Resident #5 did not receive the 150 mg dose of Dilantin on the evening of 6/20/25 and 6/21/25 and the 100 mg dose of Dilantin on the day shift on 6/21/25. The administration notes for each of the missed doses entered by LPN #1 documented that the Dilantin Infatabs were on order for Resident #5. A progress note, dated 6/21/25 at 9:25 p.m. revealed Resident #5 was sent to the hospital for a possible seizure. The hospital after visit summary, dated 6/24/25, documented Resident #5 was diagnosed with focal status epilepticus (a constant, unending seizure) caused by missed doses of her anti-seizure medication. The summary documented she was treated with intravenous anti-seizure medications while at the hospital and then restarted on her home medications. It was recommended that she was to take all her anti-seizure medications consistently to prevent any further seizures. The hospital discharge summary, dated 6/24/25, documented Resident #5 presented from the nursing home with abnormal twitching with unclear symptoms during the transport with emergency medical services (EMS) to the hospital. The discharge summary documented Resident #5’s symptoms escalated during transport to more generalized shaking, flexion and stiffness of her extremities. She was treated by EMS with 12.5 mg of Versed (a sedative that can treat seizures). Upon arrival to the emergency department at the hospital, Resident #5 was lethargic and appeared to be postictal (period immediately following a seizure). The discharge summary documented that she was treated with a Keppra (anticonvulsant medication) loading dose and neurology recommended a fosphenytoin (anticonvulsant medication) load since her level was low due to her missed doses of Dilantin. She was also given phenobarbital (anti-seizure medication) intravenously. The summary documented the resident's Dilantin level was 8.3 mcg/ml (micrograms/milliliter) which was considered low, upon her admission to the hospital. On day two of her hospital stay her focal status epilepticus resolved and she was restarted on her home medications, but she was still being monitored at the hospital. On day four she was discharged back to the nursing home. The physician progress note, dated 6/26/25, documented Resident #5 had been at her baseline since her return from the hospital. The note documented the physician went over Resident #5’s medications with the unit nurse that was onsite. VI. Staff interviewsThe pharmacist was interviewed on 7/15/25 at 12:37 p.m. The pharmacist said she was not notified of the three missed Dilantin doses for Resident #5. She said the therapeutic level for Dilantin was between 10 to 20 mcg/ml. She said the half-life (the time it takes the medication to decrease by half in the blood stream) of Dilantin varied depending on how the resident metabolized the medication. She said the half-life could go down to as low as seven hours, depending on how the resident metabolized and processed the medication. She said that she would expect the facility to administer the medications per the physician’s orders. LPN #1 was interviewed on 7/15/25 at 1:47 p.m. LPN #1 said she was really busy on 6/7/25 when the box was delivered from the pharmacy. She said she had only read the label on the outside of the box. She said she did not open the box and look inside. She said she was unaware that there was medication inside of the box. She said because of her mistake, Resident #5 had a seizure and went to the hospital. She said she tried to order the medication from the pharmacy before it ran out. She said when a medication ran out, she would let the pharmacy know as well as the physician. She said she thought she had let Resident #5’s physician know, but she could not remember if she did. She said that she should have documented that the medication was not given and if she had contacted the physician. She said there was a button in the electronic medical record (EMR) to reorder medications. She said the pharmacy would let the facility know if the reorder was too early, had been ordered already, or if there were any other issues with the medication order. She said there was a print out at the nurses’ station which would let the staff know the status of the reorder. She said when the medication was not available she documented on the MAR the code number 10, which meant the medication was on order. Registered nurse (RN) #1 was interviewed on 7/16/25 at 10:10 a.m. RN #1 said he was recently trained on receiving medication orders from the pharmacy. He said he could not remember the date that he received the education. He said when receiving a bag from the pharmacy, the contents should always be inventoried and put away in its proper area. He said a pharmacy order should never be left in the medication room unopened. He said if a medication was missing he would let the pharmacy know, the DON and the physician. He said if it was a medication that was needed right away, he would get authorization from the DON to open the emergency kit (E-kit) and use the medication from there. The DON was interviewed on 7/16/25 at 11:34 a.m. The DON said when the nurses received an order from the pharmacy they should open the box to make sure the medication was correct and put the medication in the correct place. The DON said when a medication was not in the medication cart, the nursing staff should be checking to see if the medication had been reordered and let the pharmacy know. She said that if the missing medication was one that could be found in the E-kit, they could open the E-kit and use it. She said that Dilantin was not in the E-kit and the physician should have been notified. She said Resident #5’s physician was not notified of the missed doses of medication but was notified when she was sent to the hospital. She said the nurses had to use their own discretion on when to notify the physician on missed doses of medication. The DON said LPN #1 might not have realized how important it was to let the physician know because Resident #5 was also on phenobarbital (another medication used to prevent seizures). She said the facility discovered the medication was in the medication room in a box on 6/22/25. She said when LPN #1 called the pharmacy, the pharmacy told her that the medication had been delivered and that was when they started searching the facility for the medication. She said they had missed the medication in the box on 6/20/25 when they did their medication room audit because they were looking for bags of medication, not boxes. She said that since 6/27/25, when all nursing staff had been educated, the facility had not had any missed doses of antiseizure medication.
Plan of correction
The state did not require a plan of correction for this citation.
3/10/2025Complaint Survey · ID 35QG11No deficiencies
0000INITIAL COMMENTSSurveyor note
Findings
A complaint survey, prompted by #CO39256 and Incident #39404 was conducted on 3/10/25. No deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
12/4/2024Revisit: Recertification Survey · ID EKNO22No deficiencies
0000INITIAL COMMENTSSurveyor note
Findings
A document revisit was completed with all deficiencies being corrected. No other deficiencies were cited and no response is needed.
Plan of correction
The state did not require a plan of correction for this citation.
11/6/2024Revisit: Recertification Survey · ID EKNO12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 11/6/24 for all previous deficiencies cited on 10/3/24. The facility is in compliance with all regulations surveyed.
Plan of correction
The state did not require a plan of correction for this citation.
10/30/2024Recertification Survey · ID EKNO212 deficiencies
0000INITIAL COMMENTSSurveyor note
Findings
This survey was conducted in accordance with the Federal Register at Section 42 CFR 483.70(a). The initial comments (ID Prefix Tag K-000) are informational only and are a representation of the facility's general characteristics. The facility consists of two (2), four story (4) Type 1 (222) structures licensed for two hundred one (201) beds, and the facility reports a census of sixty eight (68) at the time of the survey. Building A-1 (West Building) and building A-2 (East building) are both protected by a complete NFPA 13 fire sprinkler system. Each building contains their own sprinkler and fire alarm system and they are not interconnected. The two buildings are connected with a bridge on the third level and a tunnel on the basement level. The bridge and tunnel are separated with 2 hour fire rated construction and opening protectives on both sides of the East and West buildings. The facility was surveyed on October 30, 2024 for compliance to fire safety requirements using the National Fire Protection Association (NFPA) 2012 Life Safety Code, Chapter 19, Existing Facilities. The facility will meet these requirements when the following deficiencies are corrected. The deficiencies were discussed with the Maintenance Director during the walk-through inspection of the building and the survey concluded with a discussion of the deficiencies with the facility Maintenance Director during the exit conference.
Plan of correction
The state did not require a plan of correction for this citation.
0521HVACS/S F
Findings
Based on documentation review and staff interview, it was determined that the facility failed to maintain smoke dampers in accordance with Life Safety Code Section NFPA 105. This was evidenced by the following:1. The most recent fire damper inspection report from 4/26/2023 stated there were two fire dampers that failed inspection/testing. NFPA 105, 6.5.1 Smoke dampers for dedicated and non-dedicated smoke control systems shall be inspected and tested in accordance with NFPA 92A, Standard for Smoke-Control Systems Utilizing Barriers and Pressure Differences. 6.5.2* Each damper shall be tested and inspected one year after installation. The test and inspection frequency shall then be every 4 years, except in hospitals, where the frequency shallbe every 6 years. 6.5.3 Care shall be exercised that all tests are completed in a safe manner wearing the appropriate personal protective equipment. 6.5.4 Full unobstructed access to the damper shall be verified and corrected as required. This deficiency has the potential to affect occupants, who might include residents, staff, and visitors within the entire facility. Deficient items were discussed with the administrator and maintenance director at the exit conference.
Plan of correction · submitted by the facility
Corrective Action: On 11.14.24, Total Performance, evaluated the two "fire dampers" mentioned on the 04.26.23 that failed. The technician sated the sprinkler room damper is not a damper or a fire damper, it is a turning vain inside the duct. This is not a fire damper it is simply for airflow for lack of an elbow duct. The fire damper in the hallway at room 407, the technician stated there is a damper that supplies air for the room, however, it is pneumatic actuator, and it is not tied into any fire protection system. The pneumatics on the is building has been disabled a long time ago, approximately 15 years ago. Other residents who could be affection by the same deficient practice: 100% of all residents could be affected by the same deficient practice. Systemic Change: Complete fire damper inspections as required and ensure the follow up is complete. The Maintenance Director will maintain the records for the inspection. Monitoring: The Maintenance Director of designee will schedule the damper inspection/testing as required. The Maintenance Director or designee will ensure follow up from the inspection will be completed. The Maintenance Director or designee will maintain the records for inspection and follow up in our TELS system.
0923Gas Equipment - Cylinder and Container StoragS/S E
Findings
Based on observation during the course of the survey it was determined the facility failed to maintain a hazardous area in accordance with NFPA 99. This was evidenced by the following:1. CO2 cylinders are not properly secured (next to the soda machine in the basement). NFPA 99, Section 11.6.2.3 Cylinders shall be protected from damage by means of the following specific procedures:Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart. This deficiency can potentially affect occupants, including staff and visitors within the basement smoke compartment. Deficient items were identified during the survey and discussed with the Administrator at the exit conference.
Plan of correction · submitted by the facility
Corrective Action: On 10.30.24 the Maintenance Director secured the CO2 cylinders at the time the surveyor pointed this potential out to him. Other residents who could be affection by the same deficient practice: During the survey on 10.30.24 the surveyor and our team audited 100 % of the facility. No other deficient practice was noted. Systemic Change: The facility will properly chain or support freestanding CO2 cylinders in a stand. Monitoring: Maintenance Director or designee will audit free standing CO2 cylinders weekly for 30 days to ensure that they are secured and monthly thereafter for 90 days.
Plan of correction · submitted by the facility
Corrective Action: On 10.30.24 the Maintenance Director secured the CO2 cylinders at the time the surveyor pointed this potential out to him. Other residents who could be affection by the same deficient practice: During the survey on 10.30.24 the surveyor and our team audited 100 % of the facility. No other deficient practice was noted. Systemic Change: The facility will properly chain or support freestanding CO2 cylinders in a stand. Monitoring: Maintenance Director or designee will audit free standing CO2 cylinders weekly for 30 days to ensure that they are secured and monthly thereafter for 90 days.
10/3/2024Recertification Survey · ID EKNO114 deficiencies
0000Initial CommentsSurveyor note2 building records
Findings · record 1 of 2
A Recertification Emergency Preparedness Survey was conducted by Healthcare Management Solutions, LLC on behalf of the Colorado Department of Public Health and Environment (CDPHE) on 09/30/24 through 10/03/24. There were no deficiencies cited.
Findings · record 2 of 2
A Recertification survey was conducted by Healthcare Management Solutions, LLC on behalf of the Colorado Department of Public Health and Environment (CDPHE). Four deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
0550Resident Rights/Exercise of RightsS/S D
Findings
Based on observation, record review, interview, and review of facility policy, the facility failed to ensure two residents (Resident (R)51 and R72) out two residents observed with catheter bags out of 20 sampled residents reviewed had dignity bags for their use of a foley catheter. This failure had the potential to cause embarrassment and loss of dignity to the two residents. Findings include:Review of the facility's policy, provided by the facility, titled "Dignity" with an issued date of 05/06/19 and reviewed on 09/25/23 revealed "Each resident has the right to be treated with dignity and respect. "The procedure was to "promote resident independence and dignity while dining" and "refrain from practices demeaning to the resident, such as leaving urinary catheter bags uncovered."1. Review of R51's "Face Sheet" located in the electronic medical record (EMR) under the "Admission Record" revealed R51 was admitted to the facility on 04/28/23. Review of R51's annual "Minimum Data Set (MDS)" located in the EMR under the "MDS" tab with an Admission Reference Date (ARD) of 04/03/23 revealed a "Brief Interview of Mental Status (BIMS) score of three out of 15 which indicated severely impaired cognition. The "MDS" indicated R51 had an indwelling suprapubic catheter. During an observation on 10/01/24 at 10:19 AM revealed R51's foley catheter (indwelling urinary catheter) was attached to the bed frame on the side facing the door and there was a clear plastic bag over the catheter but you could still observe the bag and urine from the resident's doorway. 2. Review of R72's "Face Sheet" located in the EMR under the "Admission" tab revealed R72 was admitted to the facility on 08/14/24. Review of R72's significant change "MDS" located in the EMR under the "MDS" tab with an ARD of 08/16/24 revealed a "BIMS" of zero out of 15 which indicated he was unable to complete the cognition assessment. The "MDS"" revealed that R72 had an indwelling urinary catheter. During an interview on 10/01/24 at 12:01 PM Certified Nursing Assistant (CNA)1 confirmed the catheter bags were not covered yesterday or earlier today for R51 and R72. CNA1 stated they had the blue dignity bags today and she had placed them on R51's and 72's catheter bag. CNA1 stated the catheter bag should be covered for resident dignity and privacy. During an interview on 10/02/24 at 10:59 AM with Licensed Practical Nurse (LPN)1 revealed a catheter bag should be covered with a privacy bag to keep it private from others to maintain the dignity of a resident. LPN1 revealed there was a master key to the supply room, on the second floor, that staff had access to and could get a blue privacy bag anytime. During an interview with the Director of Nursing (DON) on 10/02/24 at 11:25 AM revealed catheter bags should be in a privacy bag to ensure the residents dignity. During an interview with the Administrator on 10/02/24 at 4:30 PM revealed the catheter bag should be covered with a dignity bag to ensure a resident maintained their dignity.
Plan of correction · submitted by the facility
F550 Residents Rights/Exercise of RightsCorrective Action:R #51 and R# 72 were provided with Privacy bags on 10/2/24. Identification of Others:Privacy bags on 10/5/24 all residents with foley catheters were audited for privacy bags - out of the 7 – two of the residents did not have privacy bags. The two residents were immediately given privacy bags. Systemic Measures:On 10/23/24 communication went to nursing staff via COVR regarding privacy bags need to be on the wheel chairs and beds at all times. (COVR is a communication application the facility uses for communication with staff that also can receive attachments; provides staff their schedules)Nursing staff will be educated on the use of privacy bags; importance of maintaining resident dignity thru the use of privacy bags - how to properly install privacy bags – and monitoring catheter with privacy bags in use. Nursing staff will be trained by 10/27/24 – nursing staff on vacation will be trained immediately upon return. New hire nursing staff will be trained during orientation. Monitoring: Charge nurse/Unit manager/SDC (staff development coordinator)/IP (infection preventionist) will conduct daily checks x 2 weeks for compliance and assuring all residents with foley catheter have privacy bags both on wheel chair and bed – monitoring will then be done weekly for the next 90 days or until substantial compliance achieved. Monitoring will be documented on paper audit tool. The audits are observation for privacy bags. The Director of Nursing (DON)/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review. This report will be done on paper and turned in to Qapi
0695Respiratory/Tracheostomy Care and SuctioningS/S D
Findings
Based on observation, interview, record review, and facility policy review, the facility failed to ensure four residents (Resident (R) 2, R6, R30, and R41) out of a total sample of 20 residents reviewed for respiratory services received appropriate care of their oxygen tubing. This created the potential for infection. Findings include:Review of the facility policy titled "Oxygen Administration (Safety, Storage, and Maintenance)", issued 12/03/18 and revised 02/27/24 and under the sub section titled "Infection Control" indicated " ...Change oxygen supplies weekly and when visibly soiled. Equipment should be labeled with patient name and dated when set-up or changed out ..."1. Review of R2's "Admission Record," located under the "Profile" tab of the electronic medical record (EMR), revealed R2 was admitted to the facility on 09/15/22 with diagnoses including chronic respiratory failure with hypoxia and dependence on supplemental oxygen. Review of R2's "Physician Orders" located under the "Orders" tab of the EMR revealed an order for oxygen at three liters per minute (lpm), continuously, per nasal cannula and an order to change the oxygen tubing every night shift, on every Sunday. During an observation on 10/01/24 at 1:25 PM revealed R2's oxygen tubing had no date to indicate when the tubing change was last changed. 2. Review of R6's "Admission Record," located under the "Profile" tab of the EMR, revealed R6 was admitted to the facility on 10/28/22 with a diagnosis of obstructive sleep apnea. Review of R6's "Physician Orders" located under the "Orders" tab revealed an order for the "titration of oxygen to keep her pulse ox (measurement of the oxygen content of the blood) over 90%, the use of Bi-pap (breathing assistance via a mask and oxygen) at night, and an order to change the oxygen tubing every night shift on every Sunday."During an observation on 10/01/24 at 2:00 PM revealed R6 had her oxygen on and there was no date on the tubing to indicate when it had last been changed. 3. Review of R30's "Admission Record," located under the EMR under the "Profile" tab, revealed R30 was admitted to the facility on 10/20/17. Review of R30's "Physician Orders"" revealed orders for oxygen at two liters continuously per nasal cannula and an order to change the oxygen tubing and nebulizer circuit every night shift on every Sunday as per the Physician order. During an observation on 09/30/24 at 2:46 PM and on 10/02/24 at 11:00 AM revealed R30's oxygen tubing was not dated to indicate when the last time it was changed. 4. Review of R41's "Admission Record," located in the EMR under the "Profile" tab, revealed R41 was admitted to the facility on 08/03/24 with a diagnosis which included chronic obstructive pulmonary disease (COPD). Review of R41's "Physician Orders" revealed an order for oxygen at three liters/minute continuously per nasal cannula and an order to change the oxygen tubing and nebulizer circuit every night shift every Sunday. During an observation on 10/01/24 at 1:50 PM indicated R41's oxygen tubing was not dated to indicate the last time it had been changed. During an interview with the Unit Manager on 10/02/24 at 1:00 PM, the Unit Manager confirmed that the oxygen tubing for R2, R6, R30, and R41 had not been changed on the night shift on Sunday per physician's orders.
Plan of correction · submitted by the facility
F695Respiratory Oxygen tubing Corrective Action:On 10/07/2024R #2;R#6;R#30 and R# 41 - immediately received new oxygen tubing and tubing was dated. 10/7/24: Audit completed on all residents with Oxygen, tubing was dated. Identification of Others:All residents with OxygenAudit was conducted on 10/7/24 am and 10/14/24 for oxygen tubing replaced – oxygen tubing was replaced and dated on Sunday night. No issues identifiedSystemic ChangesOxygen Policy and education regarding oxygen tubing changed and dated was sent out via COVR system to all nursing staff. (COVR is a communication application the facility uses for communication with staff that also can receive attachments; provides staff their schedules)Education was given to night shift nurses and c.n.a (certified nurse aide) with the understanding they have the responsibility of changing out the oxygen tubing and dating the tubing weekly on Sunday night. The night nurse will document the change in the TAR (treatment administration record). Should oxygen tubing need to be changed on a prn (as needed) basis – the nurse will document the change in the TAR and assure the new date is on the tubing. Education to the day and evening nursing staff to ensure understanding that they are responsible for monitoring residents and changing out oxygen tubing and dating the changed tubing as needed. Education to all nursing staff - Education to be complete by 10/27/24. MonitoringDON/designee will audit 10 residents weekly to ensure current oxygen tubing is dated beginning 10/14/24 for the next 90 days and or substantial compliance - Audits will include observation and this will be recorded on a paper audit sheet. The Director of Nursing/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0698DialysisS/S D
Findings
Based on record review, interview, and review of facility policy, the facility failed to ensure weights were documented for one (Resident (R) 31) of two residents reviewed for dialysis out of a sample of 20 residents. This had the potential for the resident to have unmet care needs. Findings include:Review of the facility policy titled "Hemodialysis Offsite Policy" effective 04/24/19 and last reviewed 09/06/24 indicated that under the "Procedure" section revealed, "the facility should weigh the resident." Under the "Day of Dialysis" section indicated, "the facility should observe the vascular access site prior to dialysis and initiate the "Pre/Post Dialysis Communication Form" to be sent to the dialysis with the resident." The "Day of Dialysis" section indicated "on return to the facility, facility staff should obtain vital signs and complete the "Pre/Post Dialysis Communication Form."Review of R31's "Admission Record," located in the EMR under the "Profile" tab, revealed R 31 was admitted to the facility on 06/25/17 with a diagnosis including, end stage renal disease (ESRD). Review of the "Physician Order" in R31's EMR revealed an order for R31 to have dialysis on Tuesdays, Thursdays, and Saturdays. Review of "Pre/post Dialysis Communication Form" located in the EMR under the "Documents" tab dated between 06/01/24 and 09/28/24 indicated R31's pre and post weights, which were to be done by the facility staff according to the "Pre/post Dialysis Communication Forms," were not completed as follows: 06/01/24-pre and post weights06/04/24-pre and post weights06/06/24-pre weight06/08/24-pre and post weights06/11/24-pre and post weights06/20/24-pre and post weights06/22/24-pre and post weights06/25/24-pre and post weights06/27/24-post weight07/02/24-pre weight07/08/24- pre and post weight07/11/24-pre and post weight07/13/24-pre and post weight07/18/24-pre and post weight 08/01/24-pre and post weight08/03/24-pre and post weight08/08/24-post weight08/10/24-pre and post weight08/13/24-pre and post weight08/15/24-pre and post weight08/17/24-pre and post weight08/20/24-pre and post weight08/22/24-pre and post weight08/24/24-pre and post weight08/31/24-pre and post weight09/03/24-pre and post weight09/05/24-pre and post weight09/07/24-pre weight09/10/24-pre and post weight09/12/24-pre and post weight09/14/24-pre weight09/17/24-pre and post weight09/21/24-pre and post weight09/24/24-pre and post weight09/26/24-pre and post weight09/28/24-pre and post weightDuring an interview on 10/03/24 at 2:37 PM with the Minimum Data Set Coordinator (MDSC) and the Director of Nursing (DON) both confirmed the "Pre/post Dialysis Communication Records," did not contain the pre and/or post weights as listed above for R31.
Plan of correction · submitted by the facility
F698Dialysis Corrective Action:10/4/24 - received dialysis treatment sheets from dialysis on R #31 to include pre/post weights and vitals. 10/4/24 - Audit conducted on all 3 residents who have dialysis -Identification of Others:3 residents have HD (hemodialysis)Systemic Changes: RN (registered nurse)/LPN (licensed practical nurse) will be educated on the importance of assuring the dialysis communication sheets are completed upon return from dialysis and if any missing information they are to call the dialysis center and obtain the information. Education will be done by 10/27/24RN/LPN will be educated on the process for addressing missed weights/information on communication sheets and document in progress note. - Education will be done by 10/27/24On October 20th Dialysis POC and Dialysis policy was sent to ALL LPN/RN via COVR system (COVR is a communication application the facility uses for communication with staff that also can receive attachments; provides staff their schedules)10/24/24 – Education on Dialysis communication sheets and process for lack of information given at All staff In-serviceMonitoring: Charge nurse/Unit Manager/SDC/IP will audit 3x a week to ensure completion of the communication sheet for each resident and any missing information will be addressed immediately with the dialysis unit for 90 days or substantial compliance. DON/designee will audit weekly to ensure dialysis communication sheets are filled out completely for the next 90 days or until substantial compliance.is audit will be done on a paper audit form. The Director of Nursing/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0919Resident Call SystemS/S D
Findings
Based on observation, record review, interview, and review of facility policy, the facility failed to ensure one resident (Resident (R)51) observed out of 20 sampled residents had their call light within reach. This failure had the potential to cause R51 needs to not be met .Findings include:Review of the facility's policy, provided by the facility, titled "Keeping a Resident Room in Order," issued :08/09/2019 and reviewed 06/02/24 revealed "The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and support for daily living safely, call lights must be within easy reach of the resident in bed and out of bed."Review of R51's "Face Sheet" located in the electronic medical record (EMR) under the "Admission Record" revealed R51 was admitted to the facility on 04/28/23 with diagnoses of cognitive communication deficit, muscle weakness, need for assistance with care, and schizophrenia. Review of R51's annual "Minimum Data Set (MDS)" assessment located in the EMR under the "MDS" tab with an Admission Reference Date (ARD) of 04/03/23 revealed a "Brief Interview of Mental Status (BIMS) score of three out of 15 which indicated severely impaired cognition..Review of R51's comprehensive "Care Plan" with a target date of 10/20/24 located in the EMR under the "Care Plan" tab revealed a problem for ADL (activities of daily living) self-care deficit and one of the interventions was to encourage R51 to use the bell to call for assistance. Review of the problem for impulsiveness and impaired memory revealed an intervention was for the call light to be in reach. During an observation on 09/30/24 at 1:20 PM revealed R51's in bed with his eyes closed and the call light was hanging on the drawers beside his bed and not in his reach. During an observation on 10/02/24 at 3:17 PM revealed R51s was in bed with his eyes closed and his call light was on the floor behind the bed and not in the resident's reach. During an interview on 10/02/24 at 3:17 PM with Licensed Practical Nurse (LPN)1 she confirmed the call light was on the floor and not within R51's reach. LPN1 revealed the call light should have a clip on it so it can be clipped to the blanket, and it did not have a clip. LPN1 stated R51 was able to utilize the call light. During an interview on 10/02/24 at 4:30 PM with the Administrator revealed the call light should be in reach of the resident and not on the floor. During an interview on 10/03/24 at 1:10 PM with the DON revealed call lights should be in reach of the residents for safety. The DON further revealed the call light should have a clip on it so it can be clipped to the bed so it would not fall on the floor. The DON stated the resident needed to be able to use the call light if he needed help.
Plan of correction · submitted by the facility
F 919Corrective Action:10/4/2024 R #51 - call light clip was placed on call light - call light then clipped to bed - Identification of OthersA whole house audit was completed on 10/21/24 to ensure call lights in place while in wheelchair and bed. Audit of call light clips completed on 10/21/24. Systemic Measures:Education for Call lights to be in reach while in bed or wheelchair and call lights must have clip on it was sent on 10/20/24 via COVR App – Policy sent on 10/20/24 via COVR app. to all staff. (COVR is a communication application the facility uses for communication with staff that also can receive attachments; provides staff their schedules)10/24/24 Education provided at the All Staff In-service regarding call lights in place with clips. On 10/24/24 – the maintenance team corrected all call lights needing clips. Monitoring:The facility shall complete the following actions:The NHA (nursing home administrator)/DON/Designee will audit of 10 Residents weekly to ensure that call lights are within Residents reach in bed or wheelchair for the next 90 days or when substantial compliance audits will include monitoring of call light placement. The audit form is paper. The NHA/DON will track and trend results of the audits weekly to include monitoring of call light placement for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review. This audit form is paper.
8/24/2023Revisit: Recertification Survey · ID 392O22No deficiencies
0000INITIAL COMMENTSSurveyor note
Findings
A document revisit was completed with all deficiencies being corrected. No other deficiencies were cited and no response is needed.
Plan of correction
The state did not require a plan of correction for this citation.
6/27/2023Revisit: Complaint, Recertification Survey · ID 392O12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 6/27/23 for all previous deficiencies cited on 5/9/23. The facility is in compliance with all regulations surveyed.
Plan of correction
The state did not require a plan of correction for this citation.
6/27/2023Revisit: State Licensure Survey · ID Q6SK12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 6/27/23 for all previous deficiencies cited on 5/9/23. The facility is in compliance with all regulations surveyed.
Plan of correction
The state did not require a plan of correction for this citation.
6/5/2023Recertification Survey · ID 392O2111 deficiencies
0000INITIAL COMMENTSSurveyor note
Findings
This survey was conducted in accordance with the Federal Register at Section 42 CFR 483.70(a). The initial comments (ID Prefix Tag K-000) are informational only and are a representation of the facility's general characteristics. The facility consists of two (2), four story (4) Type 1 (222) structures licensed for two hundred one (201) beds, and the facility reports a census of sixty eight (76) at the time of the survey. Building A-1 (AKA West Building) and building A-2 (AKA East building) are both protected by a complete NFPA 13 fire sprinkler system. Each building contains their own sprinkler and fire alarm system and they are not interconnected. The two buildings are connected with a bridge on the third level and a tunnel on the basement level. The bridge and tunnel are separated with 2 hour fire rated construction and opening protectives on both sides of the East and West buildings. The facility was surveyed on June 5, 2023 for compliance to fire safety requirements using the National Fire Protection Association (NFPA) 2012 Life Safety Code, Chapter 19, Existing Facilities. The facility will meet these requirements when the following deficiencies are corrected. The deficiencies were discussed with the Maintenance Director during the walk-through inspection of the building and the survey concluded with a discussion of the deficiencies with the facility Maintenance Director during the exit conference.
Plan of correction
The state did not require a plan of correction for this citation.
0293Exit SignageS/S D
Findings
Based on observation and staff interview, it was determined that the facility failed to arrange and maintain exit signage in accordance with Life Safety Code Section 7.10.1.2.1 and Chapter 19. This deficient practice could affect all residents, staff and visitors throughout the facility if an exit cannot be identified during an emergency. This was evidenced by the following: 1. Exit sign near 415 not working 2. Needs proper exit signage in courtyard. 3. Exit sign by rm#416, rm#418 needs to be replaced 4. Exit sign needs to be replaced near rm#3025. Needs proper exit signage in both courtyards indicating the exit is in through the buildingNFPA 101, 4.5.3.3 Awareness of Egress System. Every exit shall be clearly visible, or the route to reach every exit shall be conspicuously indicated. Each means of egress, in its entirety, shall be arranged or marked so that the way to a place of safety is indicated in a clear manner. NFPA 101, 7.10.1.2.1* Exits, other than main exterior exit doors that obviously and clearly are identifiable as exits, shall be marked by an approved sign that is readily visible from any direction of exit access. The exit sign deficiencies were during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:The Maintenance Director/Assistant replaced the exit sign near room 415 on June 19, 2023. The Maintenance Director/Assistant placed proper exit signage in courtyard on June 20, 2023. The Maintenance Director/Assistant replaced the exit sign by room #416/room #418 on June 20, 2023. On June 19, 2023 the exit sign was replaced by the Maintenance Director/Assistance near room #302. The Maintenance Director/Assistant placed proper exit signage in both courtyards indicating the exit is in through the building on June 20, 2023.2. IDENTIFICATION OF OTHERS:On June 5, 2023 the Maintenance Director/Assistant with the surveyors completed an audit of the entire facility. The findings are noted in the 2567.3. SYSTEMIC CHANGES:The facility will ensure exit signage is in place to identify during an emergency for resident's, staff and visitors. 4. MONITORING:The facility has no plans to install new exits. If the facility were to install one we will ensure that exit signage is in place to identify an exit during an emergency.
0321Hazardous Areas - EnclosureS/S E
Findings
Based on observation during the course of the survey it was determined the facility failed to maintain a hazardous area in accordance with NFPA 101, Section 19.3.2.4 and NFPA 99. This was evidenced by the following:1. Basement Excessive mattress in rehab storageNFPA 101 6.2.2.4* High Hazard Contents. High hazard contents shall be classified as those that are likely to burn with extreme rapidity or from which explosions are likely. (For means of egress requirements, see Section 7.11.)This deficiency has the potential to affect all occupants and staff within the smoke compartment. This deficiency was discussed during the survey and again during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:On June 20, 2023 the Maintenance Director removed the excess of mattresses in the rehab storage. 2. IDENTIFICATION OF OTHERS:On June 5, 2023 the Maintenance Director/Assistant with surveyors completed a 100% audit of the facility, no other areas noted of concern during walk through. 3. SYSTEMIC MEASURES:The facility will not store mattresses in excess. 4. MONITORING:The Maintenance Director/Assistant or designee will complete monthly audits of the rehab storage to ensure mattresses aren't stored in excess. The findings will be reported to the QAPI committee for review and input for 90 days and quarterly thereafter.
0324Cooking FacilitiesS/S E
Findings
Based on record review it was determined that the facility failed to maintain the kitchen hood suppression system as required by NFPA 96, (Chapter 11, Section 11.2.1). This deficient practice could affect all residents, and staff should a fire occur and the suppression system fails to operate effectively due to non-code compliant inspections and servicing. This was evidence by the following. 1. Kitchen stoves missing wheel blocking in both buildings. 2. Missing cable on kitchen appliances 3. Grease duct has not been cleaned since 2010The Director of Facility Operations acknowledged the lack of maintenance records. NFPA 96, 12.1.2.3.1 An approved method shall be provided that will ensure the appliance is returned to an approved design location. NFPA 54, 9.6.1.4 Restraint. Movement of appliances with casters shall be limited by a restraining device installed in accordance with the connector and appliance manufacturer's installation instructions. A.13.1.2.3.1 Wheel chocks that can be fastened to the floor should be installed to ensure that an appliance with casters is returned to its approved design location. NFPA 96, 11.2.1 Maintenance of the fire-extinguishing systems and listed exhaust hoods containing a constant or fire-activated water system that is listed to extinguish a fire in the grease removal devices, hood exhaust plenums, and exhaust ducts shall be made by properly trained, qualified, and certified person(s) acceptable to the authority having jurisdiction at least every 6 months. NFPA 96, 12.1.2.3.1 An approved method shall be provided that will ensure the appliance is returned to an approved design location. These deficiencies discussed during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:The Maintenance Director/Assistant ordered the missing wheel blocks for both of the kitchen stoves(one that is not being used in the East Tower and one in the West Tower kitchen) on June 20, 2023. Once the wheel blocks are received he will install the wheel blocking on both kitchen stoves immediately. The Maintenance Director/Assistant installed the missing cable on kitchen appliances on June 23,2023. Front Range Hood Cleaning, LLC cleaned the grease ducts on June 19, 2023.2. IDENTIFICATION OF OTHERS:On June 5, 2023 the Maintenance Director/Assistant and the surveyors completed an audit of the facility. The identified concerns are listed in the 2567.3. SYSTEMIC MEASURES:The facility will review and install appliances in accordance with the connector and appliance manufacturer's installation instructions to ensure the kitchen hood suppression system operates effectively. The facility will add the non functioning appliance in the East tower to the schedule to have the grease duct cleaned every 6 months. 4. MONITORING:If the facility plans to purchase/install appliances we will install to the manufacturers installation instructions to ensure the suppression system operates effectively. At this time we have no plans to purchase/install appliances. The Maintenance Director/Designee will report any concerns regarding the 6 month grease duct cleaning to the QAPI meeting for review and input.
0345Fire Alarm System - Testing and MaintenanceS/S D
Findings
Based record review it was determined that the facility failed to maintain the fire alarm system components and devices in accordance with the Life Safety Code Section 9.6 and NFPA 72. This was evidenced by the following: 1. Reprogram alarm needed 2. Did not test top of elevator west smoke detectorNFPA 10.10.2 When an alarm signal deactivation means is actuated, both audible and visible notification appliances shall be simultaneously deactivated. NFPA 101, Section 9.6.1.5* To ensure operational integrity, the fire alarm system shall have an approved maintenance and testing program complying with the applicable requirements of NFPA 70, National Electrical Code, and NFPA 72, National Fire Alarm and Signaling Code. NFPA 72, 14.2.1.1.2 Inspection, testing, and maintenance programs shall verify correct operation of the system. Failure to maintain the fire alarm system has the potential to harm all occupants, staff, and visitors within the building should a delay occur in locating a fire throughout the facility. The deficiency was discussed during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:The alarm didn't need reprogrammed as both the audible and visible notification does simultaneously deactivate.(This wasn't checked on survey and the Maintenance Director answered incorrectly) We also sent an email to Integrated Safety Services on 06.20.23 and they verified that the audible and visible notification does simultaneously deactivate in their return email on 06.21.23. Integrated Safety Services tested the west smoke detector on top of the elevator on August 16, 2022. During the August 16, 2022 test of the west smoke detector it was noted that it failed. At the time of the survey we didn't have documentation on site that is was corrected on 10.17.22-we have the documentation from Integrated Safety Services at this time on file as of June 21, 2023.2. IDENTIFICATION OF OTHERS:On June 5, 2023 Maintenance Director/Assistant and the Surveyors completed a walk through of the facility. Their findings are listed in the 2567.3. SYSTEMIC CHANGES:The facility will maintain the fire alarm system components and devices in accordance with Life Safety Codes. and maintain records. 4. MONITORING:The Maintenance Director/Designee will review the reports from the fire alarm system contractor and bring concerns to the QAPI committee for review and input.
0353Sprinkler System - Maintenance and TestingS/S D
Findings
Based on observation and staff interview during the survey, it was determined that the facility failed to maintain the automatic fire sprinkler system in accordance with National Fire Protection Association (NFPA) 13 and Life Safety Code Section 19.3.5. This was evidenced by the following:1. Rm#431Gap between ceiling escutcheon plate. 2. Room next to elevator paint on escutcheon plate.:3. Rm#331 Gap between ceiling escutcheon plate. 4. Ceiling tile gap on escutcheon plate near rm#426NFPA 13, 6.2.7.1 Plates, escutcheons, or other devices used to cover the annular space around a sprinkler shall be metallic or shall be listed for use around a sprinkler. The Plant Operations Manager acknowledged automatic sprinkler deficiency during the tour of the facility. This deficient practice could affect sprinkler coverage should a fire develop. This deficiency was discussed with the Plant Operations Manager during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:On June 20, 2023 the Maintenance Director/Assistant repaired the ceiling tiles so that there isn't a gap by room #431 and #331. Maintenance Director repaired the ceiling tile by room #426 on June 26, 2023. On June 23, 2023 the Maintenance Director/Assistant cleaned the paint from the escutcheon plate in the room next to the elevator.(Linen Room West Tower)2. IDENTIFICATION OF OTHERS:On June 5, 2023 the Maintenance Director/Assistant and the surveyors completed a walk through of the facility all areas of concern are noted in the 2567.3. SYSTEMIC CHANGES:The facility will ensure plates, escutcheons or other devices used to cover the annular space around a sprinkler are in place. 4. MONITORING:The Maintenance Director/Assistant or designee will complete random audits of the facility sprinklers and report findings to the QAPI committee meeting monthly for 90 days and quarterly thereafter for review and input.
0363Corridor - DoorsS/S E
Findings
Based on observation and staff interview during the course of the survey, it was determined that the facility failed to maintain corridor doors in accordance with the Life Safety Code Section 19.3.6.3This was evidenced by the following: 1. Rm 415 door will not close 2. Fire door near rm#419 not properly latching 3. Fire door near Rm#219 not properly latching. 4. Rm#219 Door not properly latching. Tight closure. 5. Door not properly latching near rm#2186. Rm 212 dr does not latch 7. Missing door closure near kitchenNFPA 101, 19.3.6.3.1 19.3.6.3.1* Doors protecting corridor openings in other than required enclosures of vertical openings, exits, or hazardous areas shall be doors constructed to resist the passage of smoke. NFPA 101, 19.3.6.3.2, (2) In smoke compartments protected throughout by an approved, supervised automatic sprinkler system in accordance with 19.3.5.7, the door construction materials requirements of 19.3.6.3.1 shall not be mandatory, but the doors shall be constructed to resist the passage of smoke. This deficient practice could affect all residents within the smoke compartments should the egress become untenable, due to smoke and heat transfer via the non-latching corridor doors and gaps in the door smoke seal. This was discussed during exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:On June 16, 2023 the Maintenance Director/Assistant replaced the hinges on the door to room 415. On June 16, 2023 Power Systems adjusted the door near room #419, #219 and room #218. On June 23, 2023 the Maintenance Director/Assistant adjusted room #212 and 219. All doors mentioned in the 2567 latch into frame. The kitchen door doesn't require a closure-an education was provided to all the dietary staff not to keep the door open with a chain by Maintenance Assistant on June 20, 2023.2. IDENTIFICATION OF OTHERS:On June 5, 2023 the Maintenance Director/Assistant and surveyors completed an audit of the facility. All areas noted are mentioned in the 2567.3. SYSTEMIC CHANGES:The facility will maintain corridor doors in accordance with the Life Safety Code Section 19.3.6.3.4. MONITORING:The Maintenance Director/Assistant or designee will use the TELS system to check facility doors monthly and report findings to QAPI committee meeting for review and input. Reports to the committee will be monthly for 90 days and then quarterly thereafter.
0372Subdivision of Building Spaces - Smoke BarrieS/S E
Findings
Based on observation and staff interview during the course of the survey it was determined the facility failed to maintain smoke barriers in accordance with NFPA 101, 8.5.1. This was evidenced by the following:1. Clean utility room on east side 4th floor penetration for tv 2. Chord running through door. Chord running through wall breaking penetration. 3. Biohazard room has an old shaft that needs to be sealed properly. Penetration in the ceiling. 4. Dry wall penetration needs top be replaced in the kitchen. 5. Open penetrations in fire riser room. 6. Ceiling tiles missing in sprinkler report 7. Ceiling tile needs to be replaced. NFPA 101, Section 8.5.1, in part, smoke barriers shall be provided to subdivide building spaces for the purpose of restricting the movement of smoke. The smoke barrier deficiency has the potential to affect all residents, visitors, and staff within those smoke compartments. The deficiencies were discussed during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:On June 21, 2023 Greiner Electric installed a receptacle so there isn't cords penetrating the wall on the 4th floor. The Maintenance Director/Assistant patched the wall where the penetration was on June 23, 2023 listed as #2. On June 13, 2023 the Maintenance Director/Assistant sealed the old shaft in the biohazard room. On June 19, 2023 the Maintenance Director/Assistant patched the penetration in the ceiling of the biohazardous room. The dry wall penetration was replaced in the kitchen on June 23, 2023 by the Maintenance Director. The penetration was repaired in the fire riser room on June 26, 2023 by the Maintenance Director/Assistant. The ceiling tiles in the sprinkler report have been replaced from June 16, 2023 through June 23, 2023 by the Maintenance Director/Assistant. The Maintenance Director/Assistant replaced the ceiling tile on 06.20.23 in room 431 #7 in the 2567.2. IDENTIFICATION OF OTHERS:The Maintenance Director/Assistant and surveyors on June 5, 2023 completed a facility audit and the findings are listed in the 2567. On 06.26.23 Greiner Electric removed the mounted tv on 3 West and assisted with installation of a new outlet. The Maintenance Director patched the penetration on 3 West on 06.26.23. Greiner Electric removed the mounted tablet on 2 West to assist with placement of an outlet on 06.26.26. Greiner Electric will complete the work by July 14, 2023. The other tablets that have been mounted in the East tower(4E, 3E & 2E)will be removed and have outlet installed by Greiner Electric by July 14, 2023. The walls will be patched and painted immediately following completion of outlet installation by the Maintenance Director/Assistant. 3. SYSTEMIC CHANGE:The Maintenance Director/Assistant will patch any penetrations and replace ceiling tiles as work has been completed to maintain smoke barriers. 4. MONITORING:The Maintenance Director/Assistant or designee will audit 25% of the building for penetrations monthly for 120 days. Results of the audits will be reported to the QAPI committee for review and input.
0511Utilities - Gas and ElectricS/S D
Findings
Based on observation during the survey, it was determined that the facility failed to maintain proper gas valve protection in accordance with Life Safety Section 9.1and NFPA 54, 7.9.2.1. This was evidenced by the following:1. Sheet metal screws used to connect dryer vent pipe in laundry room. 2. Excessive lint accumulation in the laundry room. NFPA 101, 9.1.1 Gas. Equipment using gas and related gas piping shall be in accordance with NFPA 54, National Fuel Gas Code. This deficiency was discussed during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:The Maintenance Director/Assistant removed the sheet metal screws and reconnected the dryer vent pipe in the laundry room with plumbers tape on June 23, 2023. The Maintenance Director/Assistant cleaned the excessive lint accumulation in the laundry June 13, 2023. 2. IDENTIFICATION OF OTHERS:The Maintenance Director/Assistant and surveyors completed a audit of the only laundry room during the survey on June 5, 2023. The areas of concern are noted in the 2567.3. SYSTEMIC CHANGES:The facility equipment using gas and related gas piping will be in accordance with Life Safety Code. The facility will increase its cleaning of lint in the laundry room so it doesn't accumulate. 4. MONIRORING:We have no plans to change the piping in the laundry room if we have plans it will be presented to the QAPI committee for review and input. The Maintenance Director/Assistant will clean the lint accumulation weekly and prn to prevent excess, it will be documented in TELS.
0521HVACS/S E
Findings
Based on record review and staff interview during the survey, the facility failed to perform and document the exercising of all fire and smoke dampers at least every four years, in accordance with NFPA 90A, Standard for the Installation of Air-Conditioning and Ventilation Systems; section 3-4.7 Maintenance. This was evidenced by the following: 1. West Building Damper FD-402 will not fully closeNFPA 90A, Chapter 3, Section 3-4.7 Maintenance. At least every 4 years, fusible links (where applicable) shall be removed; all dampers shall be operated to verify that they fully close; the latch, if provided, shall be checked; and moving parts shall be lubricated as necessary. This deficient practice could affect all residents, staff and visitors within those smoke compartments should the smoke dampers malfunction due to improper maintenance. This deficiency was discussed during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:On June 26, 2023 the facility contracted with Total performance to complete the work on the damper in the West Building. Total Performance plans to have the West Building Damper FD-402 damper fully closing by July 14, 2023.2. IDENTIFICATION OF OTHERS:On June 5, 2023 the Maintenance Director/Assistant completed a full facility walk through and all areas of concern are noted in the 2567.3. SYSTEMIC MEASURES:The facility will perform and document the exercising of all fire and smoke dampers every four years. 4: MONITORING:The facility will review the 4 year damper report in the QAPI meeting for review and input. Please note the fire and smoke dampers were completed in 04/2023.
0911Electrical Systems - OtherS/S E
Findings
Based on observation, it was determined that the facility failed to maintain proper electrical practices in accordance with NFPA 101, 9.1.2, and NFPA 70, National Electrical Code. This was evidenced by the following deficiencies:1. No gfci hook up in med room 2. Hood on roof has electoral cable that is abraided 3. Old floor mounted power box has exposed wire 4. Fire alarm control panel needs breaker lock. Box lock needs to be replaced. Missing proper label. NFPA 101, Section 9.1.2 Electrical Systems. Electrical wiring and equipment shall be in accordance with NFPA 70, National Electrical CodeNFPA 70, Section 110.12 Electrical equipment shall be installed in a neat and workmanlike manner. This deficient practice could affect all occupants and staff throughout the smoke compartment if improper maintenance of electrical equipment causes a fire. The deficiency was discussed during the exit conference
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:Greiner Electric has been contracted to install a gfci hook up in the 4 West med room. Greiner Electric is contracted to do quite a bit of work for the 2567 and plan to have a items taken care of by July 14,2023. On June 26, 2023 the facility contracted with Total Performance to work on #2 listed in the 2567-we are waiting on the bid for the work to be completed and we will move forward as soon as received. In the HR Office the Maintenance Director/Assistant replaced the old floor mounted power box with exposed wire on June 16, 2023. The facility has contracted with Greiner Electric on #4 in the 2567, plan to have work completed by July 14, 2023.2. IDENTIFICATION OF OTHERS:The surveyors and Maintenance Director/Assistant completed an audit of the facility on June 5, 2023. The findings are listed in the 2567. The facility completed an audit of all of the med rooms after the surveyor left and noted that 2 West Med room also needed a gfci-Grainer Electric has been contracted for this work and plan to have completed by July 14, 2023.3. SYSTEMIC CHANGE:The facility will maintain proper electrical practices. 4. MONITORING:The facility has no plans to have electrical work completed at this time other then what is listed in the 2567. If the facility needs electrical work they will make sure the electrical equipment is installed in a neat and workmanlike manner in accordance with electrical code.
0918Electrical Systems - Essential Electric SysteS/S D
Findings
Based on observation and record review during the survey, it was determined that the facility failed to maintain the back-up emergency generator in accordance with National Fire Protection Association (NFPA) Standard 110. This was evidence by the following: 1. No battery conductance testing on generators. NFPA 110, 8.3.7.1 The required monthly testing and recording of electrolyte specific gravity or conductance results (Reserve Capacity, "RC") of the lead acid batteries in connection with the emergency power supply system (generator) were not completed as required. The emergency power supply system provides power for emergency lighting. Ref: 2012 NFPA 101 Section 21.2.9, 7.9.2.4, 4.6.12.1 / 2010 NFPA 110 Section 8.3.7.1NFPA 110, 8.4.1 EPSS's, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly. These deficiencies have the potential to affect all occupants, which might include staff, residents, and visitors should the generator fail to start during an emergency. These deficiencies were discussed during the survey and again during the exit conference.
Plan of correction · submitted by the facility
1. CORRECTIVE ACTION:On June 21, 2023 Maintenance Director/Assistant with help from another Director performed the monthly test under load and completed the weekly inspection on both generators 2. IDENTIFICATION OF OTHERS:The Maintenance Director/Assistant and surveyors reviewed the records, the 2567 noted areas of concern. 3. SYSTEMIC CHANGES:The Maintenance Director/Assistant will perform the battery conductance testing on the generator as required with monthly and inspect generators weekly. 4. MONITORING:The Maintenance Director/Assistant or designee will review the TELS-weekly/monthly results with the Executive Director monthly to discuss results for 90 days, concerns will be reviewed with the QAPI committee for review and input.
5/9/2023Complaint, Recertification Survey · ID 392O1111 deficiencies
0000Initial CommentsSurveyor note2 building records
Findings · record 1 of 2
A recertification survey with complaint #CO31967 was completed from 5/3/23 to 5/9/23. Eleven deficiencies were cited.
Findings · record 2 of 2
An Emergency Preparedness survey was conducted from 5/3/23 to 5/9/23. No deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
0659Qualified PersonsS/S D
Findings
Based on record review and interviews the facility failed to ensure the nursing services were provided by individuals who had the skills, experience, knowledge and proper licensure to meet the residents' needs. Specifically, the facility failed to monitor unlicensed student nurses during medication administration with a resident. Findings include:I. Facility policyA request was made to the facility for a policy regarding the use of student nurses for resident care; no policy was provided during the survey. A signed contract agreement between a named educational institute for student nurses and the facility was provided by the director of nursing (DON) on 5/8/23 at 2:12 p.m. It read in the pertinent part:"The facility agrees to: permit (affiliate's name) students to perform services for facility patients only when under the direct supervision of a registered, licensed or certified facility caregiver licensed in the discipline in which supervision is to be provided."Retain ultimate responsibility for the provision of all services provided to patients or residents of the facility."II. ObservationsOn 5/8/23 at 12:40 p.m. licensed practical nurse (LPN) #1 permitted and assisted student nurses (SN #1 and SN #2) to prepare medications for Resident #19. The student nurse prepared oral medication (including a narcotic medication) for Resident #19. After the medications were prepared LPN #1 told the student nurses to administer the medication to the resident and return to the nurses station and sat down at the desk while two student nurses delivered a controlled medication to Resident #19 in the resident room and out of sight of LPN #1. The student nurse who handled the resident medication and passed the medication to the resident did not confirm the resident's name prior to giving the resident the cup of medications. III. InterviewsThe director of nursing (DON) was interviewed on 5/9/23 at 6:05 p.m. The DON said student nurses should be supervised by a nurse until they have completed the task enough to be checked off on it. The education institution's clinical instructor (CI) for the student nurses was interviewed on 5/9/23 at 11:25 a.m. The CI said student nurses were to perform the six rights of medication administration when preparing and giving a resident their prescribed medications; introduce themselves in the resident's room upon arrival to the resident's room, and confirm the resident's name prior to giving the resident the medication for consumption. The CI said it was required that the student nurses be supervised by a licensed nurse during every medication pass because the student nurses had not yet earned their license to practice nursing unsupervised.
Plan of correction · submitted by the facility
Corrective Action:On 5/31/2023 the facility educated the nursing instructor that unlicensed student nurses must be monitored during medication administration with a resident. Identification of Others:From 5/10/2023 to 5/29/20230 the Director of Nursing/Designee observed unlicensed student nurses during medication administration to ensure they were being monitored. No further issues identified. Systemic Measures:From 5/23/23 to 5/31/23 the Director of Nursing/Designee educated staff that unlicensed student nurses must be monitored during medication administration with a resident. New staff will be educated upon orientation that unlicensed student nurses must be monitored during medication administration with a resident. Nursing student instructors will be educated that unlicensed student nurses must be monitored during medication administration with a resident prior to the students participating in in clinical rotations. Monitoring:The Director of Nursing/Designee will observe a medication pass weekly to ensure unlicensed nurses are being monitored during medication administration with a resident for 90 days or until substantial compliance is achieved. The Director of Nursing/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0676Activities Daily Living (ADLs)/Mntn AbilitiesS/S D
Findings
Based on observation, record review and interviews, the facility failed to ensure one (#10) of one resident reviewed for activities of daily living of 44 sample residents were provided appropriate treatment and services to maintain or improve their abilities. Specifically, the facility failed to ensure strategies were in place to effectively communicate with Resident #10, who spoke a language other than English. Findings include:I. Facility policy and procedureThe Meaningful Communication with Persons with Limited English policy and procedure, revised 2022, was provided by the nursing home administrator (NHA) on 5/9/23 at 6:02 p.m. It documented in pertinent part,"Individuals who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English may be limited English proficient (LEP). The facility will take reasonable steps to ensure that LEP residents with have meaningful access and an equal opportunity to participate in our services, activities, programs and other benefits. The policy of the facility is to ensure meaningful communication (language assistance services, qualified sign language interpreters, or auxiliary aids if hearing is impaired) with LEP residents and their authorized representatives involving their medical conditions and treatment. "All interpreters, translators and other aids needed to comply with this policy shall be provided without cost to the LEP resident being served, and patients/clients and their families will be informed of the availability of such assistance will be provided free of charge. "Language assistance will be provided through use of staff interpreters, and through formal arrangements with interpretation or translation services, or technology and telephonic interpretation services."Some LEP residents may prefer or request to use a family member or friend as an interpreter. However, family members or friends of the LEP resident will not be used as interpreters unless specifically requested by that individual and after the LEP resident has understood that an offer of an interpreter at no charge to the person has been made by the facility. Such an offer and the response will be documented in the resident's medical record. If the LEP resident chooses to use a family member or friend as an interpreter, issues of competency of interpretation, confidentiality, privacy, and conflict of interest will be considered. If the family member or friend is not competent or appropriate for any of these reasons, competent interpreter services will be provided to the LEP resident."II. Resident #10A. Resident statusResident #10, age under 65, was admitted on 7/22/22. According to the May 2023 computerized physician orders (CPO), the resident's diagnoses included osteomyelitis (inflammation of bone or bone marrow, usually due to infection), cerebral infarction (ischemic stroke) and type two diabetes. According to the 3/16/23 minimum data set (MDS) assessment, the resident was cognitively intact with a brief interview for a mental status score of 15 out of 15. She required extensive assistance of two people with bed mobility and extensive assistance of one person for transfers, dressing and toileting. She preferred Spanish and required an interpreter. B. Resident interviewResident #10 was interviewed on 5/8/23 at 12:59 p.m. Resident #10 said most of the time staff did not use interpreters or other tools to communicate with her. Resident #10 said she did not feel like the staff was communicating with her or understanding her concerns. Resident #10 said the facility used a hotline but not often. Resident #10 said she felt frustrated and the staff did not try to communicate with her effectively which upset her. C. ObservationsOn 5/3/23 observations from 11:30 a.m. until 2:30 p.m. the resident's room did not have signs indicating communication needs or interventions staff could use. The staff were not observed using the communication hotline or any other communication tools. On 5/8/23 observations from 11:30 a.m. until 2:00 p.m. the resident's room did not have signs indicating communication needs or interventions staff could use. The staff were not observed using the communication hotline or any other communication tools. D. Record reviewThe communication care plan on 4/11/23, revealed the resident has a communication problem. Resident#10 primary language was Spanish and she understood very little English. Interventions include using the communication hotline 100% of the time. III. Staff interviews Certified nurse aide (CNA) #6 was interviewed on 5/9/23 at 9:08 a.m. CNA #6 said Resident #10 only spoke Spanish. CNA #6 said she thought there was a hotline number the staff could use to communicate with the residents that did not speak English; posted at the nursing station. CNA #6 said she would find another CNA that spoke Spanish if she needed to communicate with her. Registered nurse (RN) #4 was interviewed on 5/9/23 at 11:45 a.m. RN #4 said the staff used the Spanish speaking CNAs and there was a hotline number staff could use to communicate with Resident #10. The social worker (SW) was interviewed on 5/9/23 at 2:49 p.m. She said Resident #10 spoke Spanish and understood very little English. The SW said staff could use the language hotline or a Spanish speaking staff member. The SW said staff would know to use the hotline when they were oriented to the floor. The director of nursing (DON) was interviewed on 5/9/23 at 6:16 p.m. She said individuals who had a primary language other than English, should be provided with a communication hotline for translation purposes. The DON said the staff did use pictures for some residents and Spanish speaking CNAs. The DON said some residents refused to use the communication hotline. The DON said Resident #10 did not refuse to use the hotline.
Plan of correction · submitted by the facility
Corrective Action:On 05.26.23 strategies were placed to effectively communicate with resident #10 to include: Staff that are able to translate and/or understand Spanish are assigned to resident #10s care when possible, facility utilizes a translator phone service, staff was provided with communication boards for the resident on 05.8.23, and google translate is utilized as needed by staff as an alternate means of communicating for resident. Resident #10 understands English as evidenced by her non verbal and verbal responses in English. Resident # 10 utilizes google translate on personal cell phone when communicating to staff. Identification of Others:On 05.26.23 the Director of Social Services/Designee completed an audit of 100% of residents to identify residents who have a primary language other than English. Care plans were created with interventions in place for staff to effectively communicate with each resident. Systemic Measures:From 05.30.23 to 06.01.23 staff were educated that strategies must be in place to effectively communicate with residents. Education provided included: Use of the translator line, communication boards, and Google translate. New hires will be educated upon orientation that strategies must be in place to effectively communicate with residents. Education provided included: Use of the translator line, communication boards, and Google translate. Monitoring:When completing a care conference of one of the residents identified as having a primary language spoken other than English, the SSD will review the communication care plan with the IDT to ensure strategies in place are effective. Any concerns will be reported to the monthly QAPI committee.
0677ADL Care Provided for Dependent ResidentsS/S D
Findings
Based on observations, record review and staff interviews, the facility failed to provide appropriate care and services to maintain the activities of daily living for one (#54) of five residents who required extensive assistance out of 44 sample residents. Specifically, the facility failed to provide regular nail care for Resident #54. Findings include: I. Facility policyThe Nail Care policy, revised August 2022, was provided by the nursing home administrator (NHA) #1 on 5/9/23 at 5:00 p.m. The policy read in part: "The resident will receive assistance as needed to complete activities of daily living (ADLs). Any concerns with skin or nails identified during completion of nail care should be reported to the nurse who will document and report to the practitioner as needed. Ensure fingernails are clean and trimmed to avoid injury and infection. Report any abnormalities to the nurse."II. Resident #54 A. Resident statusResident #54, age 78, was admitted on 8/26/2020. According to the May 2023 computerized physician orders (CPO), the resident's diagnoses included chronic obstructive pulmonary disease, hemiplegia (one-sided paralysis) and encephalopathy (a disease in which the functioning of the brain is affected). According to the 3/7/23 minimum data set (MDS) assessment, Resident #54 was unable to participate in a brief interview for mental status. The MDS assessment further revealed Resident #54 required extensive assistance with one-person physical assistance for ADLs of transfers, bed mobility, toileting, dressing, eating and personal hygiene. B. ObservationsObservation on 5/3/23 at 2:30 p.m. the resident's nails were half an inch long and yellow. Observation on 5/4/23 at 1:36 p.m. the resident's nails were half an inch long and yellow. On 5/9/23 at 1:00 p.m. registered nurse (RN) #4 went into Resident #54's room and acknowledged that Resident #54's fingernails were very long and needed to be cut. RN #4 asked the resident if his nails could be cut. Resident #54 held up his hand and said too long and said thank you. RN #4 said the resident's nails would be cut right away. C. Record reviewThe care plan reviewed 4/6/23, documented that the resident has ADL self-care performance deficit and requires assistance with bathing and dressing. Encourage the resident to participate to the fullest extent possible with each interaction. III. Staff interviewsCertified nurse aide (CNA) #6 was interviewed on 5/9/23 at 9:08 a.m. CNA #6 said Resident #54 was easy to work with if the resident knew the staff that was working with him. CNA #6 said CNAs did not perform nail care and an outside service provided the residents' nail care. RN #4 was interviewed on 5/9/23 at 11:45 a.m. RN #4 said Resident #54 could be difficult to work with but he worked well with preferred staff. RN #4 said CNAs did resident nail care during their baths including bed baths. The director of nursing (DON) was interviewed on 5/9/23 at 6:16 p.m. The DON said all nursing staff were responsible for nail care. The DON said the residnet's nails should be checked anytime staff interacted with the residents. The DON said if a resident refused nail care they should ask another staff to try. The DON said resident nails should be trimmed as needed.
Plan of correction · submitted by the facility
Corrective Action:On 5/09/23 nail care was provided to resident #54. Identification of Others:From 5/30/23 to 5/31/23 an audit was conducted by the Director of Nursing/Designee to determine if any other residents were in need of nail care. Any problems identified were corrected at the time of discovery. Systemic Measures:From 5/29/23 to 5/31/23 staff were educated that regular nail care must be provided for dependent residents. New hires will be educated upon orientation that regular nail care must be provided for dependent residents. Monitoring:The Director of Nursing/Designee will observe 10 residents weekly ensure regular nail care is provided for the next 90 days or until substantial compliance is met. The Director of Nursing/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0679Activities Meet Interest/Needs Each ResidentS/S D
Findings
Based on observations, record review and staff interviews, the facility failed to provide an ongoing program to support residents in their choice activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for one (#9) out of three residents reviewed for activity programming out of 44 sample residents. Specifically, the facility failed to: -Provide meaningful activities for Resident #9 while the resident was alone in her room; and, -Update the resident activity's and social program care plan with individualized meaningful person centered interventions to meet Resident #9's recreational needs and preferences. Findings includeI. Facility policy and procedureThe Activities Program policy, revised on 4/1/22, was received by the director of nursing (DON) on 5/10/23 at 11:50 a.m. It read in pertinent part, "The facility should implement an ongoing resident centered activities program that incorporates the resident's interests, hobbies and cultural preferences which is integral to maintaining and/or improving a resident's physical, mental, and psychosocial well-being and independence. To create opportunities for each resident to have a meaningful life by supporting his/her domains of wellness (security, autonomy, growth, connectedness, identity, joy and meaning). It is important for residents to have a choice about which activities they participate in, whether they are part of the formal activities program or self-directed. "Additionally, a resident's needs and choices for how he or she spends time, both inside and outside the facility, should also be supported and accommodated, to the extent possible, including making transportation arrangements. Individual or independent programming ensures that all residents who are unable or unwilling to participate in group programs have consistent, goal-oriented and individualized recreation opportunities. All residents have a need for engagement in meaningful activities. "Residents who prefer not to participate in group programs and/or are independently involved in recreation pursuits will be identified through the assessment process. Individual interventions will be developed based on each resident's assessed needs and the family will be notified for any special requests. The individual program will be provided according to a consistent schedule identifying specific days of the week and the time frame in which the program will occur. Each resident's individual program will include interventions that meet the resident's assessed social, emotional, physical, spiritual and cognitive functioning needs. These approaches will reflect the resident's lifestyle and interests and will be incorporated into the interdisciplinary care plan. II. Resident #9A. Resident statusResident #9, age 86, was admitted on 10/28/22. According to the May 2023 computerized physician orders (CPO), the diagnoses included unspecified mood disorder, depression and altered mental status. The 3/30/23 minimum data set (MDS) assessment revealed the resident had severe cognitive impairment with a brief interview for mental status score of four out of 15. The resident required extensive assistance of two caregivers and a mechanical lift with transfers; extensive assistance of two caregivers with dressing; and, extensive assistance of one caregiver for toilet use and personal hygiene. It was very important for Resident #9 to have books, newspapers, and magazines to read; listen to music and attend religious services. B. Resident observations and interviewOn 5/3/23 at 11:55 a.m. Resident #9 was observed in her room, sitting up in a wheelchair. No meaningful activities were observed in the area, television was off and remote was not within reach. There were no books, newspapers, magazines or activity packets observed in the area. On 5/8/23 during a continuous observation beginning at 12:44 p.m. and ending at 5:24 p.m. Resident #9 was observed in her room, lying in bed, with no meaningful activities observed. The television was off for most of the observation and when staff did turn the television on the resident was not offered a choice of television programming. The television remote was not within reach of the resident throughout the entire observation. -At 12:44 p.m. staff delivered the resident lunch and left the room, the resident was not offered the opportunity to eat lunch in the dining room in the company of her peers. Resident #9 was observed lying in bed eating lunch by herself. -At 2:03 p.m. Resident #9 began moaning loudly, licensed practical nurse (LPN) #2 entered the room and inquired about pain. Resident #9 denied pain. LPN #2 turned on the television; there was no conversation regarding channel selection or to inquire if the resident wanted to do some other activity. After turning on the television, the nurse left the room. The television remote was observed to be out of the resident's reach if the resident wanted to change the station she was unable. Resident #9 was not engaged in the television program as she laid in bed with her eyes closed. From 2:05 p.m. to 5:29 p.m. no staff offered Resident #9 any type of recreational activities programming. -At 5:29 p.m. staff delivered the resident's dinner tray and left the room. Resident #9 was observed lying in bed eating dinner alone in the room. The resident was not offered the opportunity to eat dinner in the main dining room with her peers. The television remained on and the remote was not within the resident's reach. Resident #9 was interviewed on 5/8/23 at 5:45 p.m. Resident #9 said she enjoyed watching news programs and doing word puzzles. Resident #9 said she would like to get out of her room more often but was stuck in bed a lot.-The resident's activities care plan documented the resident was to be provided a computer tablet for social and sensory stimulation (see below); observations revealed the resident did not have a tablet in her room and no staff offered the resident a tablet for use. When interviewed the resident knew what a computer tablet was but was unaware if she had access to a computer tablet for her personal use. On 5/9/23 during a continuous observation beginning at 9:16 a.m. and ending at 12:30 p.m. Resident #9 was observed lying in bed with a breakfast tray within reach; the resident's eyes were closed and the resident was not eating. There were no meaningful activities items within the resident's reach or observed anywhere in the resident's room, the television was off and the remote was not within reach of the resident. The resident remained in bed during the observation and no staff offered the resident any type or recreational activity. C. Record reviewThe 10/29/22 activities evaluation revealed Resident #9 had a career as a nurse practitioner. Past and current activities enjoyed by Resident #9 included arts and crafts, Bingo, cards, current events/news, visits from family and friends, group discussions, television, music, reading, religious services, social gatherings and volunteering. The comprehensive care plan with a review date 2/11/23, revealed Resident #9 was dependent on staff for meeting emotional, intellectual, physical, and social needs related to physical limitations, with a goal for Resident #9 to maintain involvement in cognitive stimulation, social activities as desired. Interventions included: Resident #9 preferred activities were watching television and using her tablet to be online; invite Resident #9 to scheduled activities; and when Resident #9 chooses not to participate in organized activities, the resident prefers to be on her tablet for social and sensory stimulation. Progress note dated 5/2/23 revealed Resident #9 had been agreeable to being in a reclining chair more often; wanted to work on cognition using word puzzles and games, wanted to attend movies and other activities. Activity participation record for Resident #9 was received by activities director (AD) on 5/9/23 at 7:00 p.m. It revealed Resident #9 participated in the following: Current event/news on 5/3/23, 5/4/23, 5/8/23 and 5/9/23. Television was turned on by staff on 5/8/23 at 2:03 p.m. it was not a current event/news program and the television was observed to be off on all other days. -There were no other sources of current event/news activities observed in the area of Resident #9. Family/friend visits on 5/3/23 and 5/4/23. Resident #9 was observed to be out of bed and engaged in visit on these days. Participated in group discussion on 5/3/23 and 5/4/23. Resident #9 was involved with family/friend visits. Participated in music on 5/3/23 and 5/7/23 and refused participation in music and group discussion on 5/4/23 and 5/8/23. No activity involving music was observed or heard in vicinity of Resident #9. -No alternative activities to music were observed to be available for Resident #9. Participated in reading on 5/3/23, 5/4/23, 5/8/23, and was unavailable on 5/8/23. -Staff was not observed reading to Resident #9, nor was there any reading materials observed in her area on these days. It was unknown if alternative activities were offered. Engaged with television watching and independent leisure daily from 5/1/23 through 5/9/23. Television was observed being turned on by a staff member on 5/8/23 at 2:03 p.m. The television was off on 5/3/23, 5/4/23, and 5/9/23. Refused to participate in religious activities on 5/7/23. -It was unknown if alternative activities were offered on these days. Resident #9 refused to participate in Bingo on 5/4/23, 5/9/23 and refused to participate in an educational program on 5/8/23. -It was unknown if alternative activities were offered on these days. III. Staff interviewsThe activities director (AD) and activities assistant (AA) were interviewed on 5/9/23 at 6:00 p.m. The AD said Resident #9 used to enjoy listening to jazz music but longer did. The AD said Resident #9 has not used her tablet since she moved rooms months ago. The AD said activity preferences were supposed to be documented in the resident's care plan. The AD said she was behind on updating care plans to reflect current activity preferences. The AD said the activity department put together activity packets for residents to have in their rooms. The AA said Resident #9 enjoyed having company and visiting with people, but did not want to leave her room. The AA said Resident #9 liked to watch the news, children shows, old sitcoms or mystery television. The AA said she had not seen Resident #9 use her tablet for months. The AD said residents who prefer being in their rooms should still be offered activities. Resident #9 was not on a one-to-one program even though she preferred to stay in her room. The AD was interviewed on 9/9/23 at 7:00 p.m. The AD said participation for current events included watching television. She said participation for group discussion occurred independently by residents forming a group to talk or were facilitated by staff. She said participation in independent leisure was an activity assistant providing one-to-one activity. She said participation in a reading activity included a resident reading on their own or using an activity packet. She said activity staff were the only staff members who charted in the resident's participation log.
Plan of correction · submitted by the facility
Corrective Action:On 05.27.23 resident #9 was offered meaningful activities while in her room. Activity Director offered resident #9 word searches, cards, arts, crafts, radio, cross word puzzle, TV assistance, library books and the plan of care for resident #9 was updated to include individualized meaningful person-centered interventions to meet her recreational needs and preferences. Resident #9 stated that she is happy with her own activity preferences and has what she needs. Resident #9 stated she has books in her drawer that she is currently reading and has her radio with her cd's in her closet. Resident #9 stated she doesn't need staff to offer as she will take the initiative and ask for assistance as needed. Identification of Others:From 05.09.23 thru 05.31.23 the Recreation Director/Designee conducted an audit of residents to determine if meaningful activities are being offered in resident rooms when they are in their room alone. From 05.09.23 thru 05.31.23 the Recreation Director/Designee conducted an audit of resident care plans to determine if they included individualized meaningful person-centered interventions to meet recreational needs and preferences. Any issues identified were corrected at the time of discovery. Systemic Measures:On 06.01.23 the Recreation Director/Designee educated activity staff that meaningful activities must be offered to residents when they are in their room alone and that the plan of care must include individualized meaningful person-centered interventions to meet recreational needs and preferences. Non Activity Department staff were educated from 05.31.23 to 06.01.23. New hires will be educated upon orientation that meaningful activities must be offered to residents when they are in their room alone and that the plan of care must include individualized meaningful person-centered interventions to meet recreational needs and preferences. Monitoring:The Recreation Director/Designee will observe 10 residents weekly to ensure that meaningful activities are being offered to residents when they are in their room alone for the next 90 days or until substantial compliance is met. The Recreation Director/Designee will review 10 resident care plans weekly to ensure they include individualized meaningful person-centered interventions to meet recreational needs and preferences. The Recreation Director/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0684Quality of CareS/S D
Findings
II. Ensure medical orders were followed A. Facility policy The Anti Embolism Stocking Application policy, reviewed 9/12/22, was provided by the director of nursing (DON) on 5/9/23 at 3:30 p.m. It read in the pertinent part: "the facility will provide anti embolism stocking application in accordance with professional standards of practice, as outlined by Lippencott through the procedure linked below." -The Lippincott link was not provided. B. Resident status Resident #28, age 74, was admitted to the facility on 10/28/22. According to the May 2023 CPO, diagnoses included major depressive disorder, delirium due to unknown physiological condition, and difficulty walking. The 3/22/23 MDS assessment revealed the resident had severely impaired cognition as evidenced by a BIMS score of three out of 15. The resident had inattention and disorganized thinking. The resident did not present with aggressive behaviors and did not reject care. The resident was able to walk with a walker without staff assistance. The resident needed physical assistance from one person when dressing, performing personal hygiene, bathing, and toileting. C. Resident observationsResident #28 was observed on 5/4/23 at 1:46 p.m. and did not have TED hose on. Resident #28 was observed at 3:52 p.m. and did not have TED hose on. Resident #28 was observed on 5/8/23 at 11:22 a.m. and did not have TED hose on. Resident #28 was observed at 1:52 p.m. and did not have TED hose on. Resident #28 was observed on 5/9/23 at 9:46 a.m. and did not have TED hose on. D. Record review 1. Treatment ordersA review of the resident's medication and treatment administration records (MAR and TAR) revealed the following treatment order related to TED hose to the resident's lower extremities:-Apply bilateral TED hose daily. Remove TED hose every night at bedtime. 2. Care planThe resident's comprehensive care plan initiated on 5/1/23 revealed the resident had a care focus for complaints of feet and leg pain and edema in lower extremities with a goal of the resident to express pain relief through the review date. Interventions included anticipating the resident's need for pain relief; respond immediately to any complaint of pain; evaluate the effectiveness of pain interventions; and provide pain medications as ordered.-However, there was no documentation for the application of TED hose to be used daily. E. Staff interviewsLPN #1 was interviewed on 5/9/23 at 9:44 a.m. LPN #1 stated she was responsible for applying the TED house for Resident #28. LPN #1 said she had already put the TED hose on Resident #28 this morning.-However, the observation of Resident #28 at 9:54 a.m. showed she was not wearing TED hose. The DON was interviewed on 5/9/23 at 6:05 p.m. The DON acknowledged doctor orders should be followed; either a nurse or a certified nurse aide (CNA) were able to apply TED hose to the residents who have orders for them. Based on record review, observations, and interviews, the facility failed to ensure two out of two residents (#2 and #28) of 44 sample residents received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan. Specifically, the facility failed to:-Provide positioning assistance and monitoring of air mattress for proper inflation for comfort and skin integrity for Resident #2; and, -Ensure medical orders were followed for thrombo-embolic deterrent (TED) hose for Resident #28. Findings include:I. Proper application of an air mattress and repositioningA. Facility policy and procedureThe Alignment and Pressure-reducing Device Application policy, with a revision date of 10/11/21, was received by the director of nursing (DON) on 5/10/23 at 12:00 p.m. it read in pertinent part,"The facility will provide alignment and pressure-reducing device application in accordance with professional standards of practice, as outlined by Lippincott through the procedure linked below (link was not made available). The services provided or arranged by the facility, as outlined by the comprehensive care plan, must meet the professional standards or care."B. Manufacturers manualThe Direct Supply Panacea Air Advance Alternating Pressure Air Mattress manufacturer manual was retrieved from: https://store.directsupply.com/Product/Family/panacea-air-advance-alternating-pressure-air-mattress-37346 on 5/10/23. It read in pertinent part, "Indications for use: The Panacea Air Advance Mattress is a flotation therapy mattress that provides pressure management to assist in the prevention and treatment of up to stage IV pressure injuries. The alternating-pressure and low air loss mode provided with the Panacea Air Advance Mattress is indicated for use as a preventive tool against further complications associated with critically ill residents or immobility. "Control unit: firmness button adjusts the pressure within the mattress; Static button allows for the alternating-pressure functionality to be turned off; alternating pressure provides 10-, 15-, 20-, 25-minute loading and unloading cycles designed to maintain low interface pressures throughout the mattress to redistribute peak interface pressures during the cycle. "This device is only a tool to assist with pressure reduction as part of an overall care plan. Failure to comply with all instructions, warnings and precautions or using the product for a purpose other than the recommended use could result in bodily injury or death. This product is not designed to replace good caregiving practices including, but not limited to: direct patient and resident supervision; adequate care plans and training for staff personnel for entrapment and fall prevention; inspection and testing before use. "This product is only one element of care in the prevention and treatment of pressure ulcers by medical professionals and skilled caregivers to assist in the treatment and prevention of up to stage IV decubitus ulcers for residents under their care. This product is not designed to and cannot replace good caregiving practices and treatment including, but not limited to: appropriate nutrition and hydration, frequent positioning, routine skin assessment, wound treatment, infection control, and other generally accepted standards of care and prevention. "Adequate training for and precautions by staff personnel for bed entrapment; selection of an appropriate bed system to use with the product and proper maintenance and use of the product; testing of the product before each use." C. Resident statusResident #2, age 88, was admitted on 9/15/22. According to the May 2023 computerized physician orders (CPO), the diagnoses included multiple sclerosis, morbid obesity and major depressive disorder. The 3/20/23 minimum data set (MDS) assessment revealed the resident was cognitively intact with a brief interview for mental status score of 15 out of 15. The resident required extensive assistance of two caregivers with bed mobility, transfers, dressing, and toilet use, and extensive assistance of one caregiver for eating. The resident was at risk for skin breakdown. D. Resident interviewResident #2 was interviewed on 5/3/23 at 3:11 p.m. She said she was unable to reposition herself because of multiple sclerosis (MS); and was dependent on staff for repositioning. The resident said she preferred to be in bed most of the day, but was often uncomfortable due to lack of regular positioning assistance; and the air mattress she laid on provided no extra comfort. Resident #2 said staff did not offer repositioning on any regular schedule and she had to call staff when she wanted to be repositioned; and she wanted to be repositioned more often than what was provided. E. Resident observations On 5/3/23 during continuous observation beginning at 11:30 a.m. and ending at 3:11 p.m. Resident #2 was observed lying in bed on an air mattress, positioned on her back, head of the bed was raised approximately 30 degrees. The resident was not provided any type of pillows or props to support off loading pressure points as she laid on her back. The resident's air mattress settings were observed to have an alternating cycle time of 20 minutes, but the mode was set to static (lacking in movement). Static mode deactivated the alternating-pressure function. There was no auditory evidence of air transfer to inflate or deflate the mattress (sound of pump, mattress rising or falling). The firmness indicator was one bar below maximum firmness. At 4:57 p.m. Resident #2 was observed lying in bed, in the same positioning as in the earlier observation (see above). The air mattress setting remained the same. On 5/4/23 p.m. at 2:30 p.m. Resident #2 was observed at scheduled group activity in a wheelchair. At 3:26 p.m. Resident #2 was assisted back to her room. At 5:38 p.m. Resident #2 remained in her wheelchair. Positioning remained the same from 3:26 p.m. to 5:38 p.m.-Observations of the resident's air mattress revealed the brand identification tag read direct supply Panacea air advanced mattress. The inflation device located at the foot of Resident #2's bed had a visible control panel that was set the same for all observations on 5/3/23, 5/4/23, 5/8/23 and 5/9/23. The settings indicated the air mattress was set on an alternating pressure cycle time for 20 minutes, the firmness was set one bar below max inflation; however the control panel static setting was set to on. Per the manufactures manual (see above) using the static mode deactivated the alternating-pressure function. -Facility staff were not able to explain during interviews (see below) acceptable settings for the resident's air mattress or how they would know if the mattress was functioning properly to maintain proper position for comfort and relief of pressure point to protect Resident #2 from developing pressure injuries related to poor positioning. The resident record failed to document that the mattress was assessed for proper fit and met condition to properly address the resident positioning needs see resident records above. F. Record reviewThe comprehensive care plan, last review 2/23/23, revealed Resident #2 had a care focus for mobility related to a diagnosis of multiple sclerosis. The goals of the care included Resident #2 would remain free of complications or discomfort. The interventions failed to include person centered approaches to help the resident achieve comfort and avoid skin related complications. -The use of the air mattress was care planned for risk of skin breakdown. Interventions included the mattress having alternating pressure. Staff were not provided with instructions to ensure the mattress was implemented per manufactures recommendations. -The resident records failed to provide an assessment for the use of the air mattress or guidance on appropriate control setting based on the residents individualized needs. The 4/29/23 Braden scale for predicting pressure sore risk and risk factors revealed Resident #2 was moderately at risk. It revealed Resident #2 had a slightly limited ability to respond meaningfully to pressure-related discomfort and could not always communicate discomfort or the need to be turned; and was unable to make frequent or significant changes independently because of limited mobility, requiring her to need moderate to maximum assistance with moving. G. Staff interviewsLicensed practical nurse (LPN) #2 was interviewed on 5/9/23 at 11:00 a.m. LPN #2 said residents with limited mobility should be repositioned and changed every two hours. LPN #2 said Resident #2 activated her call light when she wanted to be repositioned. LPN#2 said repositioning was not documented because staff verbally communicated to one another when a resident was last assisted with positioning. LPN #2 said Resident #2 was on an air mattress but she did not know what setting the air mattress should be on. Certified nurse aide (CNA) #5 was interviewed on 5/9/23 at 11:00 a.m. CNA #5 said residents who were dependent on staff for care were repositioned and checked for cleanliness every two hours was a standard of care. CNA #5 said she did not wake up Resident #2 for repositioning if she was asleep, and waited until Resident #2 asked to be changed or repositioned. CNA #5 said Resident #2 used an air mattress, but she did not know how to tell if it was inflated properly. The CNAs relied on the Resident #2 to tell them if she was uncomfortable and then staff would provide positioning assistance. The minimal data set coordinator (MDSC) was interviewed on 5/9/23 at 4:30 p.m. The MDSC said Resident #2 admitted to the facility with the air mattress she was using. The MDSC said the family brought in the resident's air mattress requesting it to be used for Resident #2. The settings were already in place so they did not assess or readjust the mattress settings. The MDSC said residents with limited mobility should be repositioned and changed every two hours; a resident's repositioning needs would not be care planned because it was considered a standard of care. The MDSC said pressure ulcers were avoidable if a resident admitted without an existing pressure injury. LPN #3 was interviewed on 5/9/23 at 6:00 p.m. LPN #3 said Resident #2 activated her call light when she wanted to be repositioned, therefore the resident was not on a repositioned schedule. LPN #2 said staff were in her room every 15 minutes checking bed inflation and repositioned Resident #2. LPN #3 confirmed the resident was on an air mattress with an electronic pump device, however the nurse did not know what settings the air mattress should be on. LPN #3 said if the mattress was inflated and not flat it was assumed to be functioning properly. The director of nursing (DON) was interviewed on 5/9/23 at 6:15 p.m. The DON said residents that were dependent on staff for care were repositioned and checked for incontinence every two hours. Repositioning and incontinence care were not care planned because it was a standard of care. The DON said nursing staff or the wound care doctors would initiate the order of an air mattress and its settings. However, Resident #2 did not need an order for the use or specific setting for the air mattress she was using because Resident #2 moved into the facility with the air mattress. The DON said Resident #2 was using an alternating air mattress which when set on alternating pressure would reduce the frequency of staff needing to reposition Resident #2. The DON said the mattress inflation could be tested for appropriate inflation by staff placing a hand between the resident and the mattress, if staff felt the bed frame there needed to be more air in the mattress.
Plan of correction · submitted by the facility
Quality of CareCorrective Action:On 05.30.23 resident #2’s air mattress was checked for proper inflation. Resident #2's air mattress was placed on static per her preference as she doesn't like the mattress to alternate. 6/13/23 - The physician was notified and new order was given to keep the air mattress setting between 3-4 and ok to keep the static button turned off. From 05.20.23 TED hose were placed on resident #28. However, resident #28 removes independently and doesn't wear throughout the day. On 05.31.23 the physician updated the order for TED hose to be on as resident tolerates and encourage to elevate lower extremities frequently when not wearing ted hose. On 05.31.23 the TED hose were replaced by the nurse. On 05.31.23 resident #28 removed the TED hose and on 06.02.23 resident #28 stated, "she will not wear and doesn't want to wear they are tight and I don't like." Identification of Others:From 05.30.23 thru 06.1.23 the Director of Nursing/Designee conducted an audit to determine if air mattresses in the facility were properly inflated. Any problems identified were corrected at the time of discovery. From 05.31.23 thru 06.01.23 the Director of Nursing/Designee conducted an audit to ensure that residents with orders for TED hose had them placed as ordered. Any problems identified were corrected at the time of discovery. System Measures:From 05.30.23 thru 06.02.23 the Director of Nursing/Designee educated staff that air mattresses in the facility must be properly inflated to promote comfort and maintain skin integrity. Repositioning of residents will continue every 2 hours and as needed for comfort. From 05.30.23 to 06.02.23 the Director of Nursing/Designee educated staff that residents with prescribed TED hose must have them placed per medical order. When a resident refuses to wear TED hose, the MD will be notified, the nurse will await further direction/order from MD and encourage resident to elevate bilateral lower extremities and encourage wearing of TED hose. New hires will be educated upon orientation will be educated that air mattresses in the facility must be properly inflated to promote comfort and maintain skin integrity; Repositioning of residents will continue every 2 hours and as needed for comfort and that residents with prescribed TED hose must have them placed per medical order; When a resident refuses to wear TED hose, the MD will be notified, the nurse will await further direction/order from MD and encourage resident to elevate bilateral lower extremities and encourage wearing of TED hose. Monitoring:The Director of Nursing/Designee will observe 3 air mattresses weekly to ensure they are properly inflated to promote comfort and maintain skin integrity for 90 days or until substantial compliance is achieved. The Director of Nursing/Designee will observe 3 residents with prescribed TED hose weekly to ensure that the TED hose are placed per medical order for 90 days or until substantial compliance is achieved. The Director of Nursing/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0688Increase/Prevent Decrease in ROM/MobilityS/S D
Findings
Based on observations, record review, and interviews, the facility failed to ensure one (#61) of two residents with limited mobility reviewed for range of motion (ROM) and splinting application receives consistent treatment and services to increase range of motion and/or to prevent further decrease in range of motion, out of 44 sample residents. Specifically, the facility failed to ensure Resident #61 received:-Consistent regular restorative services as prescribed in the computerized physician's orders (CPO) and restorative nursing referral (see record review below);-A plan for contracture management services for hand and wrist contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) to maintain the current level of function/mobility and prevent worsening of contractures; and,-Provide consistent daily care to the resident's contracted hand to prevent potential skin breakdown, including hand hygiene and application of prescribed hand splint. Findings include:I. Facility policyThe Restorative Nursing Services policy, revised September 2022, provided by the nursing home administrator (NHA) on 5/9/23 at 6:15 p.m., read in pertinent part: "Restorative nursing care refers to nursing interventions that promote the resident's ability to adapt and adjust to living as independently and safely as possible. This concept actively focuses on achieving and maintaining optimal physical, mental, and psychosocial functioning."Restorative nursing function and procedures included range of motion, splint or brace, assistance, bed mobility, transfers. -Providing resident/caregiver teaching regarding the restorative care plan.-The trained CNA (certified nurse aide) will document provided techniques per the restorative care plan in the medical record.-The licensed nurse will conduct an evaluation on a routine basis, to include progress towards goal and response to the program. Any changes will be documented in the medical record.-Restorative care plan and care directives will be reviewed/revised as indicated."II. Resident #61A. Resident statusResident #61, under the age of 65, was admitted on 6/8/21 and readmitted on 2/3/23. According to the May 2023 CPO, diagnoses included quadriplegia (paralysis of all four limbs), contracture of right ankle, left ankle, right hand, left hand, left and right elbow, muscle weakness and edema. The 3/30/23 minimum data set (MDS) assessment revealed the resident was cognitively intact with a brief interview for mental status (BIMS) score of 15 out of 15. He required extensive assistance from staff with bed mobility, dressing, personal hygiene, and toileting. There was no rejection of care documented. According to the MDS assessment, the resident was receiving restorative nursing services three to four times per week. B. Resident observations and interviewOn 5/4/23 at 9:37 a.m., Resident #61 was observed lying in bed with both arms on a pillow. The resident's hands appeared contracted as evidenced by both hands being bent forward at the wrist at an approximate 90-degree angle with the fingers curled inwards causing the resident's long fingernails to rest on each palm. The resident did not have any type of hand splint or cloth palm protector on either contracted hand. The resident was able to hold a conversation. The resident said he was not in pain and did not know where his splints were but knew he was supposed to be wearing hand splints. The resident then said even if he was in pain or needed something he was not going to call for assistance because he did not want to be a bother to the staff. At 2:22 p.m., Resident #61 was observed laying in his reclinable wheelchair with pil
Plan of correction · submitted by the facility
Corrective Action:On May 12, 2023 resident #61 was taken to the hospital and expired. Identification of Others:From 05.22.23 thru 06.02.23 the Director of Nursing/Designee conducted an audit of residents with restorative services ordered to ensure they are receiving regular restorative services as prescribed in the computerized physician’s orders and/or nursing referral. All issues identified were corrected at the time of discovery. From 05.29.23 thru 06.02.23 the Director of Nursing/Designee conducted an audit of residents with hand and wrist contractures to ensure the facility has a plan in place to maintain the current level of function/mobility and prevent worsening of contractures. All issues identified were corrected at the time of discovery. From 05.29.23 thru 06.02.23 the Director of Nursing/Designee conducted an audit of residents with hand and wrist contractures to ensure a plan is in place to provide consistent daily care to the resident’s contracted hand to prevent potential skin breakdown, including hand hygiene and application of prescribed hand splint. All issues identified were corrected at the time of discovery. Systemic Measures:From 05.30.23 thru 06.01.23 the Director of Nursing/Designee educated staff that: 1. residents with restorative services ordered must receive regular restorative services as prescribed in the computerized physician’s orders and/or nursing referral. 2. Residents with hand and wrist contractures must have a plan in place to maintain the current level of function/mobility and prevent worsening of contractures. 3. Residents with hand and wrist contractures must have a plan in place to provide consistent daily care to the resident’s contracted hand to prevent potential skin breakdown, including hand hygiene and application of prescribed hand splint. New hires will be educated upon orientation that: 1. residents with restorative services ordered must receive regular restorative services as prescribed in the computerized physician’s orders and/or nursing referral. 2. Residents with hand and wrist contractures must have a plan in place to maintain the current level of function/mobility and prevent worsening of contractures. 3. Residents with hand and wrist contractures must have a plan in place to provide consistent daily care to the resident’s contracted hand to prevent potential skin breakdown, including hand hygiene and application of prescribed hand splint. Monitoring:The Director of Nursing/Designee will audit 5 residents with restorative services ordered weekly to ensure they are receiving regular restorative services as prescribed in the computerized physician’s orders and/or nursing referral for 90 days or until substantial compliance is achieved. The Director of Nursing/Designee will audit 5 residents with hand and wrist contractures weekly to ensure the facility has a plan in place to maintain the current level of function/mobility and prevent worsening of contractures for 90 days or until substantial compliance is achieved. The Director of Nursing/Designee will 5 residents with hand and wrist contractures weekly to ensure a plan is in place to provide consistent daily care to the resident’s contracted hand to prevent potential skin breakdown, including hand hygiene and application of prescribed hand splint. The Director of Nursing/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0712Physician Visits-Frequency/Timeliness/Alt NPPS/S D
Findings
Based on record review and interviews, the facility failed to ensure timely physician visits for one (#55) of five residents reviewed out of 44 sample residents. Specifically, the facility failed to ensure Resident #55 was seen by the physician once every 30 days for the first 90 days following admission to the facility. Findings include:I. Facility policy The Physician Services policy, reviewed 2/2/23, was provided by the clinical nurse consultant (CNC) on 5/18/23 at 11:35 a.m. It read in pertinent part: "Each resident admitted to the facility is under the continuing supervision of a physician who evaluates as needed and as required by state, federal, and Joint Commission guidelines. "Every resident is visited and assessed at least once every 30 days for the first 90 days following admission, and no less than once every 60 days thereafter for the duration of their stay in the facility. Visits may be conducted by the physician or his or her alternate as often as medically necessary." II. Resident #55 A. Resident status Resident #55, under the age 65, was admitted on 11/10/22 and readmitted on 12/26/22 after a two-day visit with family for the holiday. According to the May 2023 computerized physician orders (CPO), diagnoses included multiple sclerosis, anxiety and depression. The 3/24/23 minimum data set (MDS) revealed the resident was cognitively intact with a brief interview for mental status (BIMS) with a score of 15 out of 15. The resident required extensive assistance of one person for transfers and toilet use; and limited assistance of one staff to complete bed mobility, walking, and personal hygiene. B. Record review Review of Resident #55's medical record on 5/8/23 revealed: On 11/11/22, the resident's physician spent "greater than 60 minutes total on E&M (evaluation and management a non-face to face evaluation and management services) away from FTF (face to face), reviewing hospital notes, medications, vitals, labs, social history, discussing with the RN (registered nurse) therapies and established plan of care."-There was no documentation of any in person medical exam/visit until 2/27/23 over two months after admission (see below). On 2/27/23, Resident #55 was seen in person by a physician's assistant due to diagnosed COVID-19 on 2/25/23, and the presence of ongoing COVID-19 symptoms. The visit was initial documentation as a health and physical visit but was later changed to designation of a follow-up visit. On 2/28/23, Resident #55 was seen in person by a physician in follow-up of hypokalemia, muscle spasms and mood. On 3/1/23, Resident #55 was seen in person by a physician in follow-up for hypokalemia, muscle spasms and mood. On 4/6/23, Resident #55 was seen in person by a physician in follow-up for multiple sclerosis, physical therapy, mobility and mood. On 5/1/23, Resident #55 was seen in person by a physician's assistant in follow-up after experiencing a fall. -The resident was admitted on 11/11/23, and was not seen by a physician until 2/28/23 which was greater than 90 days before the first medical visit by a physician.-A request was made to the facility for additional medical provider visits for the resident but no other documentation was provided. III. Interviews The director of nursing (DON) was interviewed on 5/9/23 at 6:05 p.m. The DON said when residents admitted to the facility they were supposed to see a medical provider every 30 days for the first 90 days. The first visit should occur within 72 hours of admission.
Plan of correction · submitted by the facility
Corrective Action:Resident #55 has been in the facility for over 90 days. HIM educated per systemic measure below. Identification of Others:From 05.30.23 thru 06.02.23 the Health Information Manager (HIM)/Designee audited resident records to ensure each received a physician visit within the first 72 hours after admission and at least once every 30 days for the first 90 days following admission to the facility. HIM identified that three other residents were identified to be effected during our audit. HIM/Designee has reached out to the providers on 06.01.23/06.02.23 and educated the physician on the regulation. Systemic Measures:On 06.01.23 the Executive Director educated the HIM that residents must receive a physician visit within the first 72 hours after admission and at least once every 30 days for the first 90 days following admission to the facility. New hires in the HIM department will be educated upon orientation that residents must receive a physician visit within the first 72 hours after admission and at least once every 30 days for the first 90 days following admission to the facility. Monitoring:The HIM/Designee will review new admissions weekly to ensure they receive a physician visit within the first 72 hours after admission and at least once every 30 days for the first 90 days following admission to the facility. The HIM/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0744Treatment/Service for DementiaS/S D
Findings
Based on observations, record review, and interviews, the facility failed to ensure a resident diagnosed with dementia, received the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being for one (#28) resident reviewed for dementia care out of 44 sample residents. Specifically, the facility failed to address Resident #28's wandering behavior, who had a diagnosis of dementia. Findings includeI. Facility policy and procedureThe Dementia policy, dated 8/29/22, was provided by the director of nursing (DON) on 5/10/23 at 11:50 a.m. It read in pertinent part, "The facility will provide dementia treatment and services which may include, but are not limited to the following: ensuring adequate medical care, diagnosis, and supports based on diagnosis; ensuring that the necessary care and services are person-centered and reflect the resident's goals, while maximizing the resident's dignity, autonomy, privacy, socialization, independence, choice, and safety; and utilizing individualized, non-pharmacological approaches to care (for example: purposeful and meaningful activities). Meaningful activities are those that address the resident's customary routines, interests, preferences, and choices to enhance the resident's well-being. Procedure: Identify, address, and/or obtain necessary services for the dementia care needs of residents; develop and implement person-centered care plans that include and support the dementia care needs, identified in the comprehensive assessment; develop individualized interventions related to the resident's symptomology and rate of progression (for example: providing verbal, behavioral, or environmental prompts to assist a resident with dementia in the completion of specific tasks); modify the environment to accommodate resident care needs."II. Resident #28A. Resident statusResident #28, age 78, was admitted on 5/2/23. According to the May 2023 computerized physician orders (CPO), the diagnoses included dementia without behavioral disturbances. The 5/4/23 minimum data set (MDS) assessment revealed the resident had severe cognitive impairment with a brief interview for mental status score of zero out of 15. She required supervision of one person with transfers, toilet use, personal hygiene, and was independent with dressing. She was independent with ambulation (walking) without an assistive device or staff assistance. She was identified to have behavioral symptoms not directed at others such as: hitting or scratching self, pacing, rummaging, public sexual acts, disrobing in public, throwing or smearing food or bodily wastes, or verbal/vocal symptoms like screaming, disruptive sounds. These behaviors were identified to significantly interfere with the resident's participation in activities or social interactions, and significantly disrupt care or living environment. B. ObservationsDuring a continuous observation on 5/3/23 beginning at 11:34 a.m. and ending at 12:06 p.m. Resident #28 was observed walking, unattended, throughout the unit. Resident #28 was observed stopping in the doorway of the dining room, an occupied and unoccupied resident room. At the occupied resident room, she was overheard asking where she could find a bathroom. No care staff were present. At 2:48 p.m. Resident #28 was observed walking into room 226 with bare feet, holding a pair of shoes. No care staff were present. At 3:25 p.m. Resident #28 was observed touching items located on a cart outside of room 230. Items included plastic see through bad with white bandage. The cart was unattended, with no care staff present. Resident #28 then walked into room 232 and closed the door. Room 232 was an unoccupied resident room. Resident #28 exited room 232 with a fake decorative plant and a package of disposable briefs. Resident #28 placed items on the couch in the common area and re-entered room 232. No staff members were present. At 3:47 p.m. a staff member located Resident #28 in room 232 and escorted her to the common area. . No meaningful activity was provided. -Resident #28 now resided in a different unit in the building. On 5/8/23 at 11:27 a.m. Resident #28 was observed at nurses station opening draws, looking through items on the desk and attempting to open cabinets. Certified nurse aide (CNA) #4 informed Resident #28 that she was not allowed to be in that area. No meaningful activity was provided. At 12:22 p.m. Resident #28 was observed at the medication cart touching a laptop computer mounted to the top of the cart. CNA #4 approached Resident #28 and offered to get a soda and walked away. Resident #28 then walked into a resident room that was not her own and asked a staff member about her daughter. Staff member redirected the resident back to the hallway and informed the resident he did not know where her daughter was. No meaningful activity was provided. At 12:30 p.m. the medication cart was observed to be unlocked and unattended by staff, staff returned to the medication cart at 12:40 p.m. and locked it. At 12:28 p.m. CNA #4 returned with a soda and approached Resident #28. Resident #28 declined soda and was adamant CNA #4 find her daughter. CNA #4 was unable to provide this information and walked away from Resident #28. Resident #28 was observed grabbing the arm of an empty wheelchair and shaking it back and forth, she then entered the room of another resident and took a wheelchair from the room. The owner of the wheelchair activated call light. No meaningful activity or staff engagement were observed. During a continuous observation beginning at 1:00 p.m. and ending at 2:10 p.m. Resident #28 was observed attempting to remove a fire extinguisher from the wall, while another resident was telling her to leave it alone. CNA #4 attempted to redirect Resident #28 with having her sit to eat lunch, Resident #28 declined the suggestion and entered another resident's room. Resident #28 was instructed by a resident to leave the room. There was no staff intervention observed, no meaningful activities offered. -At 1:37 p.m. Resident #28 was observed in the common area attempting to turn off the television. Residents who were engaged in television watching instructed Resident #28 to stop touching the television. No staff intervention was observed. Resident #28 was observed unplugging a laptop cord from the wall and was approached by activities assistant (AA) #1 and offered books. Resident #28 declined the offer of books, AA #1 walked away from Resident #28, no other staff intervened. Resident #28 was observed pulling on television cords. Resident #28 was approached by another resident and was instructed not to touch the television. Staff intervened and offered for Resident #28 to sit and eat lunch. Resident #28 declined and entered another resident's room at 1:58 p.m. and declined to exit until 2:10 p.m. No meaningful interaction or activities were provided throughout observation. -The medication cart was left unlocked and unattended from 1:00 p.m. to 1:20 p.m. C. Record reviewThe 5/2/23 elopement risk evaluation revealed Resident #28 had a diagnosis of dementia and was able to ambulate independently. The 5/3/23 activities evaluation revealed Resident #28 had a career as a school teacher and enjoyed music, dancing, parties and being outdoors. The 5/4/23 progress note revealed Resident #28 had a tendency to wander that led to difficulty with being cared for at home with family. The facility staff had reported Resident #28 was frequently observed wandering into other residents' rooms at the facility. The care plan dated, 5/2/23, revealed Resident #28 was dependent on staff for meeting emotional, intellectual, physical and social needs because of impaired mental processing. Interventions included providing activities that were compatible with physical and mental capabilities; compatible with known interests and preferences; and, compatible with individual needs and abilities.-The resident did not have a care plan to address her dementia and behaviors of wandering. III. InterviewsThe former roommate (Resident #2) of Resident #28 was interviewed on 5/3/23 at 3:11 p.m. She said Resident #28 entered her side of the room. She said because of her multiple sclerosis she could speak loudly enough to ask her to leave or move independent from the area. She said Resident #28 had approached her and covered her feet with blankets. She said she was not comfortable with Resident #28 as a roommate. Licensed practical nurse (LPN) #2 was interviewed 5/8/23 at 11:00 a.m. She said she was not provided dementia training. She said Resident #28 was new to the facility and had difficulty locating her room consistently. She said staff redirected Resident #28 as best they could. Certified nurse aide (CNA) #5 was interviewed on 5/8/23 at 11:00 a.m. She said she has not received dementia training at the current facility. She said Resident #28 spent most of the day walking within the unit and went into other rooms often. She said it was difficult to keep Resident #28 occupied with an activity (puzzles, books, coloring) because she preferred to walk around the unit. The director of nursing (DON) was interviewed on 5/9/23 at 5:00 p.m. She said prior to Resident #28 moving in the family had said she frequently wandered in the home. She said Resident #28 needed time to acclimate to her new environment at the facility. She said facility staff would continue to monitor Resident #28 and implement interventions to support her.
Plan of correction · submitted by the facility
Corrective Action:On 05.31.23 the Director of Social Services updated the plan of care to include interventions to minimize any potential for negative consequences that may result from wandering behavior that is a symptom related to the diagnosis of dementia. Redirect resident #28 with activity of choice if she attempts to in another resident's room. Resident #28 enjoys music, dancing and children. Resident #28 was provided with a baby to care for and enjoys walking with staff and the baby. Identification of Others:On 05.31.23 the Director of Social Services completed an audit to identify other residents with dementia who have wandering behaviors. Care plans of the residents identified were reviewed and updated as needed to ensure interventions were in place to reduce the potential for negative consequences that may result from wandering behavior. Systemic Measures:On 05.31.23 thru 06.01.23 staff were educated that residents with dementia who have an identified wandering behavior must have interventions in their plan of care to reduce wandering. Staff were provided with 3 interventions that are used to help reduce the potential for negative consequences that may result from wandering behaviors which include: redirect away from restricted areas and be shown areas that are safe and permissible for the resident to go; distract with a positive activity of interest for the resident; when possible, walk around with the resident. New hires will be educated upon orientation that residents with dementia may have wandering behavior as part of their dementia symptoms. The wandering behavior can sometimes place the resident at risk for harm to self. When this happens, there will be interventions on the resident's Kardex, that is accessible to the CNA and charge nurses to view, that can be implemented when needed. The new hires will also be educated on the Kardex meetings and invited to attend. Monitoring:The Director of Social Services/Designee will review the interventions to reduce the potential for negative consequences that are identified on the resident care plans during the weekly Kardex meetings. Any interventions that are determined to be ineffective will be updated with a more effective intervention, based on the information and recommendations made by the core care team. The Kardex meeting minutes will be presented to the monthly QAPI for input and review.
0761Label/Store Drugs and BiologicalsS/S E
Findings
Based on observations and interviews the facility failed to ensure three out of four medication refrigerators stored narcotic, non-narcotic medications and biologicals in accordance with accepted professional standards and that only licensed staff had access to resident-prescribed medications. Specifically, the facility failed to:-Ensure controlled medications were in a locked storage area that was permanently secured to the refrigerator;-Ensure the medication cart was locked when the nurse was not at the cart; and, -Ensure food was not stored with medications. Findings include: I. Facility policy and procedure The Storage and Expiration Dating of Medications policy and procedure, last revised on 7/21/22, was provided by the director of nursing (DON). It read in the pertinent part, "Facility should ensure that only authorized facility staff, as defined by the facility, should have possession of the keys, access cards, electronic codes, or combinations which open medication storage areas. Authorized staff may include nursing supervisors, charge nurses, licensed nurses, and other personnel authorized to administer medications in compliance with applicable Law."Facility should store Schedule II - V Controlled substances, in a separate compartment within the locked medication carts and should have a different key or access device. -Store all drugs and biologicals in locked compartments, including the storage of Schedule II-V medications in separately locked, permanently affixed compartments, -Facility should ensure that Schedule II -V controlled substances are only accessible to licensed nursing, Pharmacy, and medical personnel designated by Facility."Facility should ensure that resident medication and biological storage areas are locked and do not contain non-medication/biological items."Facility should ensure that food is not to be stored in the refrigerator, freezer, or general storage areas where medications and biologicals are stored."III. ObservationsOn 5/8/23 from 12:30 p.m. to 1:20 p.m. during a continuous observation the medication cart on four West was unlocked and licensed practical nurse (LPN) #1 was not within direct line of sight or with the cart for at least eight minutes while she was sitting at the nurse's station working on the computer behind a half wall. Two nursing students were refilling the water pitcher for the medication cart at this time. The student nurses did not lock the cart. From 12:31 p.m. to 1:20 p.m. Resident #284, a resident with severe cognitive deficits and diagnosed with dementia with behavioral disturbance, was wandering on the unit during the times the mediation was observed to be unlocked. Resident #284 was going into other resident rooms, opening doors, opening drawers and was touching the items on the unlocked medication cart. This resident had an observed history of continuous wandering; touching items belonging to others; and unplugging electronic devices. The resident was not easily redirected by staff when staff attempted to redirect the resident from the room of other residents; upsetting other residents; or when touching items that did not belong to this resident. (Cross referenced to F744 failure to a resident diagnosed with dementia, received the appropriate treatment and services to attain or maintain their highest practicable physical, mental, and psychosocial well-being). At 12:38 p.m. LPN #1 returned to the medication cart, the cart was unlocked; LPN #1 began preparing medications with the two nursing students. The nurse and the student nurses left the cart to administer the medications and left the cart unlocked. At 12:40 p.m. LPN #1 returned to the medication cart and locked the medication cart. At 1:11 p.m. LPN #1 returned to the medication cart to prepare resident medications and walked away from the medication cart leaving the cart unlocked. LPN #1 continued to leave the medication cart unlocked while she followed a resident down the hall attempting to get the resident to take her medications. At 1:20 p.m. LPN #1 returned to the medication cart and locked the medication cart. At 4:04 p.m. the four East medication room medication refrigerator was observed with LPN #6. The refrigerator contained a locked box to hold controlled medications needing refrigeration. The narcotic locked box was not permanently affixed to the refrigerator. Additionally, there were containers of yogurt stored in the medication refrigerator on the same shelf as the controlled substance medication locked box. The nurse confirmed the locked controlled substance locked box inside of the refrigerator contained controlled substance medications. At 4:20 p.m. the two East medication room medication refrigerator was observed with LPN #2. The controlled medication box was not permanently affixed to the refrigerator. The nurse confirmed the locked controlled substance locked box inside of the refrigerator contained controlled substance medications. At 6:50 p.m. the four West medication room medication refrigerator was observed with RN #2. The controlled medication box was not permanently affixed to the refrigerator. The nurse confirmed the locked controlled substance locked box inside of the refrigerator contained controlled substance medications. IV. Staff interviewsLPN #6 was interviewed on 5/8/23 at 4:05 p.m. LPN #6 said the medication refrigerator should not have food stored in it and she removed the yogurt to take elsewhere. The director of nursing (DON) was interviewed on 5/9/23 at 6:05 p.m. The DON acknowledged medication carts should be locked at all times when the nurses stepped away from the medication cart. The DON said the narcotic boxes in the refrigerators were in a locked box in a locked room and was not aware that the boxes needed to be permanently affixed to the refrigerator itself.
Plan of correction · submitted by the facility
Corrective Action:On 06.01.23 the facility ensured that controlled medications were in a locked storage area that is permanently secured to the refrigerator. On 06.01.23 the medication cart was locked, and education was given to the nurse. On 05.08.23 Food was removed from medication storage. Identification of Others:From 05.30.23 to 06.01.23 the Director of Nursing/Designee did an audit of medication refrigerators to ensure controlled medications were in a locked storage area that is permanently secured to the refrigerator. All problems identified were corrected at the time of discovery. From 05.30.23 to 06.01.23 the Director of Nursing/Designee did an audit of med carts to ensure they were locked when the nurse was not at the cart. No further issues identified. From 05.30.23 to 06.01.23 the Director of Nursing/Designee did an audit of medication storage areas to ensure food was not stored with medications. All issues identified were corrected at the time of discovery. Systemic Measures:From 05/29/23 to 6/01/23 the Director of Nursing/Designee educated nursing staff that: 1. Controlled medications must be in a locked storage area that is permanently secured to the refrigerator. 2. Medication carts must be locked when the nurse is not at the cart. 3. Food can not be stored with medications. New nursing staff will be educated upon hire during orientation that: 1. Controlled medications must be in a locked storage area that is permanently secured to the refrigerator. 2. Medication carts must be locked when the nurse is not at the cart. 3. Food cannot be stored with medications. Monitoring:The Director of Nursing/Designee will audit medication refrigerators weekly for 90 days or until substantial compliance is achieved to ensure that controlled medications are stored in a locked storage area that is permanently secured to the refrigerator. The Director of Nursing/Designee will observe medication carts weekly for 90 days or until substantial compliance is achieved to ensure they are locked when the nurse is not at the cart. The Director of Nursing/Designee will observe medication storage areas weekly for the next 90 days or until substantial compliance is met to ensure food is not stored with medications. The Director of Nursing/Designee will track and trend results of the audits for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review.
0867QAPI/QAA Improvement ActivitiesS/S F
Findings
Based on interviews and record review, the facility failed to ensure an effective quality assurance program to identify and address facility compliance concerns was implemented, in order to facilitate improvement in the lives of nursing home residents, through continuous attention to quality of care, quality of life and resident safety. Specifically, the quality assurance performance improvement (QAPI) program committee failed to identify and address concerns related to infection control and shared glucometers, quality of care and activities to meet resident needs. Findings include: I. Facility policy The QAPI (Quality Assurance and Performance Improvement) Program Design and Scope policy, last reviewed on 10/24/22, was received from the nursing home administrator (NHA) on 5/9/23 at 6:45 p.m. The policy read in pertinent part: "The facility will have a QAPI program that is ongoing, comprehensive and capable of addressing the full range of care and services it provides. At a minimum, the QAPI program will:-Address all systems of care and management practices;-Include clinical care, quality of life and resident choice;-Utilize the best available evidence to define measure indicators of quality and facilitygoals that reflect processes of care and facility operations that have been shown to be predictiveof desired outcomes for residents; and-Reflect the complexities, unique care and services that the facility provides." II. Review of the facility's regulatory record revealed it failed to operate a QAPI program in a manner to prevent repeat deficiencies and initiate a plan to correct F880 Infection control During a recertification survey on 7/25/19 F880 (infection control) was cited at a "F" scope and severity. During a recertification survey on 1/14/21 F880 (infection control) was cited at an "E" scope and severity. During a recertification survey on 3/15/22 F880 (infection control) was cited at an "E" scope and severity. During a recertification survey on 5/9/23 F880 (infection control) was cited at an increased scope and severity for failure to maintain proper infection control procedures at a "J" (immediate jeopardy) level. F684 Quality of care During a recertification survey on 7/25/19 F684 (quality of care) was cited at a "D" scope and severity. During a recertification survey on 1/14/21 F684 (quality of care) was cited at a "G"scope and severity. During a recertification survey on 3/15/22 F684 (quality of care) was cited at an "E" scope and severity. During a recertification survey on 5/9/23 F684 (quality of care) was cited at a "D" scope and severity. F679 Activities to meet the interests, needs of a resident(s) During a recertification survey on 3/15/22 F679 (activities of interests) was cited at a "D" scope and severity. During a recertification survey on 5/9/23 F679 (activities of interests) was cited at a "D" scope and severity. III. Interview The NHA was interviewed on 5/9/23 at 6:14 p.m. The NHA said the QAPI committee met monthly with the interdisciplinary team (IDT) and the medical director in attendance. The QAPI had identified several areas of opportunity including improvements to the activities program and an area identified and an action plan had been developed to enhance programming for residents diagnosed with multiple sclerosis. The NHA said IDT/program managers presented trending concerns which could include infection control and resident care matters for QAPI review and from there the QAPI committee determined the need for performance improvement plans. The division director of clinical services (DDCS) was interviewed on 5/8/23 at 10:20 a.m. The DDCS said the regional and division directors were assisting the facility (QAPI committee) with an improvement plan related to infection control.
Plan of correction · submitted by the facility
Corrective Action:On 05.04.2023 the facility held an ad hoc QAPI meeting to address concerns related to infection control, shared glucometers, quality of care, and activities to meet resident needs. The facility had an action plan for F679 in our QAPI meeting and was already being reviewed as we kept the monitoring from the prior survey. The facility didn't receive a tag for the same area of F679. Identification of Others:On 05.23.23 thru 05.31.23 the Executive Director/Designee did a review of key facility systems including quality of care, quality of life, and resident safety to identify concerns. Any concern identified was taken through the QAPI process and a performance improvement plan was created. The facility met with Telligen on 5/31/23 reviewed tags received and came to a working consensus on the oversight Telligen will provide for the QAPI process and improvement. Telligen will meet with IDT on Tuesdays weekly which will provide enough time to review and submit feedback to present to QAPI - Systemic Measures:On 06.01.23 the Executive Director/Designee educated staff that identified facility concerns must be taken to the quality improvement program committee for review and development of a performance improvement plan if indicated. New hires will be educated upon orientation that identified facility concerns must be taken to the quality improvement program committee for review and development of a performance improvement plan if indicated. Monitoring:The Executive Director/Designee will review key facility systems daily utilizing the grand round process and worksheet (Grand Rounds is a process designed to identify facility clinical and compliance concerns. Members of the Performance Improvement Committee make rounds and meet with facility staff to identify concerns) for 90 days or until substantial compliance is achieved. The Executive Director/Designee will track and trend results of the Grand Rounds worksheets for the next 90 days or until substantial compliance is met and present it to the Performance Improvement Committee monthly for input and review. Will continue to work with Telligen - meeting every Tuesday morning at 10am for oversight and areas of improvement for the next 90 days or until substantial compliance is achieved.
0880Infection Prevention & ControlS/S J
Findings
Based on observations, record review and interviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Observations and interviews revealed the nursing staff lacked the knowledge, training, and equipment to manage the residents' routine and emergency blood glucose monitoring needs. The facility's failure to monitor the blood glucose meters (glucometer) according to standard practice, coupled with the staff's lack of knowledge to ensure blood glucose meters were cleaned, sanitized and stored properly in between each resident's use created the situation for serious harm likely to occur at a level of immediate jeopardy if the blood glucose meters continued to be shared among residents due to potential transmission of blood-borne pathogens. One resident who shared the glucometer with another had a diagnosis of chronic viral hepatitis C (HCV, a viral infection that is spread by contact with contaminated blood). In addition, nursing staff and student nurses failed to administer medication in a sanitary manner where hand hygiene was performed appropriately to prevent potential cross contamination during the procedure. Findings include:I. Immediate JeopardyA. Findings of Immediate JeopardyBlood glucose metersThe facility had six blood glucose meters, which were shared among 18 residents who required routine blood sugar checks. This included one resident who had a diagnosis of chronic viral hepatitis C.Resident #38 had an active diagnosis of methicillin-resistant staphylococcus aureus infection (MRSA) and had been placed on enhanced barrier precautions. Resident #38 had an order for blood sugar checks before each meal and at bedtime. ObservationDuring an observation on 5/4/23 beginning at 3:24 p.m. and ending at 3:50 p.m., the following was observed:-At 3:24 p.m. registered nurse (RN) #2 used hand sanitizer and then collected the blood glucose monitor from the top drawer of the medication cart along with an alcohol swab and a lancet. RN #2 carried the supplies to Resident #79 and without donning gloves proceeded to clean the resident's finger with the alcohol swab and then used the lancet to puncture the resident's finger for the blood sample. The sample was collected into the test strip on the blood glucose monitor and the previously used alcohol swab was then used to stop the bleeding on the resident's finger. RN #2 returned to the medication cart and disposed of the used lancet in the sharps container and placed the blood glucose monitor back in the top drawer of the medication cart without performing any cleaning or sanitation of the device and closed the drawer of the medication cart. A few minutes later RN #2 used hand sanitizer and began collecting supplies for another blood glucose check. RN #2 opened the top drawer and removed the blood glucose monitor, an alcohol swab and a lancet. RN #2 closed the drawer and locked the cart. RN #2 did not clean or disinfect the glucometer and proceed to Resident #38's room. RN #2 walked to the room of Resident #38 with the supplies, knocked on the door and entered the room. RN #2 asked for Resident #38's pain level; the resident expressed pain and a need for pain medications. RN #2 returned to the nurses' station to review the resident's medication orders for available pain medication orders. RN #2 consulted with RN #1(RN #1 was providing RN #2 supervision as RN #2 was a new employee and was still in orientation). After the consultation, RN #2 picked up a paper and a pen from the desk and walked over to the medication cart; RN #1 remained at the nurses station. RN #2 logged into the computer on the medication cart and began documenting in the resident's record. RN #2 retrieved the keys to the medication cart from his pocket, unlocked the cart and returned the keys to his pocket. RN #2 did not usehand sanitizer again to clean his hands before collecting medications for Resident #38. RN #2 opened the drawer on the medication cart and removed a card of pills for Resident #38, pushed the medication out of the back of the medicine card and directly into his contaminated bare hand and then put the pills in the medicine cup. Without any hand hygiene, RN #2 returned the pill card to the drawer in the medication cart and then closed the drawer and locked the cart. RN #2 walked back to the room of Resident #38, knocked on the door and entered the room. RN #2 gave the medication to Resident #38 and then removed the unsanitized blood glucose monitor, alcohol swab and lancet from his pocket where he had keys and other items stored. RN #2 had not performed hand hygiene as he began to perform the blood glucose check on Resident #38. The nurse began by cleaning the finger of Resident #38 and proceeded to puncture the resident's finger with the lancet and collect the blood sample onto the test strip into the device. RN #2 returned to the medication cart and placed the blood glucose monitor on the top of the cart while he disposed of the lancet in the sharps container. RN #2 did not clean and sanitize the blood glucose monitor at any point and began to look on the computer for the third resident that needed to have their blood sugar checked. RN #2 gathered the unsanitized blood glucose device and supplies for testing the third resident's blood glucose level and without attempts to sanitize the device started to the third resident's room. RN #2 was stopped from proceeding to the third resident's room for an interview about infection control practices and procedures (see below). InterviewsRegistered nurse (RN) #2 was interviewed on 5/4/23 at approximately 3:47 p.m. RN #2 said he was in orientation with RN #1 being his mentor today. There were four residents who had orders for evening blood sugars checked. RN #2 said there were normally two glucometers on the medication cart but one of them was missing so only one was available for use. RN #2 said the blood glucose monitor was shared between the four residents in that unit. RN #2 said infection control and prevention for the medication pass included for the nurse to use hand sanitizer to clean their hands between administering medications and treatments to each resident. RN #2 said it was not appropriate to touch medications with bare hands. RN #2 said the blood glucose monitor was supposed to be cleaned in the resident's room with an alcohol pad before the blood glucose check. RN #2 was not aware of the manufacturer's recommendations for cleaning and disinfecting the blood glucose devices provided for shared use with residents to test their blood glucose levels. RN #1 was interviewed on 5/4/23 at 3:48 p.m. RN #1 said she was training RN #2 on the facility's clinical procedure. RN #1 said the blood glucometer device should be cleaned with the foaming hand sanitizer after each use, being careful not to get the device too wet. RN #1 was not aware of the manufacturer's recommendations for the blood glucometer. The director of nurses (DON) was interviewed on 5/4/23 at approximately 4:05 p.m. The DON said the facility used shared glucometers and the nursing staff used Oxivir disinfectant to sanitize the glucometer devices in between each resident. The disinfectant contact time was one minute. Further interviews with nurses from each unit on 5/4/23 revealed each nurse had a different method of cleaning the shared glucometers in between resident use. RN #6 said the device was to be sanitized with Oxivir and ensure a contact time of one minute to kill pathogens. Licensed practical nurse (LPN) #5 said the device was to be disinfected with Kroger brand disinfecting wipes with a contact time of eight to 10 minutes. RN #5 said the device was to be disinfected with an alcohol wipe and no contact time wait. All glucometers were observed on 5/4/23 and they were all stored in the medication carts for eachunit. They were not in individual storage spaces. Each blood glucose monitor was in a space shared with alcohol pads and lancets. Facility policy and procedureThe Infection Prevention and Control Program (IPCP) and Plan, revised on 1/25/23, was provided by the nursing home administrator (NHA) on 53/23 at 11:15 a.m. The policy read in the pertinent part: "The facility administration, infection preventionist, and medical director should ensure that current infection control standards of practice are based on recognized guidelines and facility assessment. These standards should be incorporated in the Infection Prevention and Control Program (IPCP)."Ensure staff follow the IPCP's standards, policies and procedures (hand hygiene and appropriate use of PPE) while other needs are specific to particular roles, responsibilities, and situations (injection safety and point of care testing);"Methods to reduce the risks associated with procedures, medical equipment, and medical devices ... Appropriate storage, cleaning, disinfection, and/or disposal of supplies and equipment;"Applicable precautions, as appropriate, based on the following:a. The potential for transmissionb. The mechanism of transmission. c. The care, treatment, and services setting"The Cleaning and Disinfection of the Glucometer policy, revised 9/28/22, was provided by the DON on 5/4/23 at 5:45p.m. It read in pertinent part: "The meter should be cleaned and disinfected after use on each patient. The Assure Prism multi Blood Glucose Monitoring System may only be used for testing multiple patients when standard precautions and the manufacturer's disinfection procedures are followed. The cleaning procedure is needed to clean dirt, blood and other bodily fluids off the exterior of the meter before performing the disinfection procedure. The disinfecting procedure is needed to prevent the transmission of blood borne pathogens."B. Facility notice of immediate jeopardyOn 5/4/23 at 7:18 p.m. the NHA was notified of the immediate jeopardy. C. Facility plan to remove immediate jeopardyOn 5/4/23 at 8:12 p.m., the director of clinical services (DDCS) provided a plan to remove the immediate jeopardy. The plan read:"Divisional and Regional team members for (facility name) are on-site and assisting the facility with the corrective action and management of this plan. Super Sani-Cloth was obtained by the facility. The facility has placed an order for additional supply and anticipates increased stock by end of day tomorrow, 5/5/23. Based on the manufacturer's guideline and facility policy and procedure, this germicidal disposable wipe is approved for use in cleaning the facility glucometers. This is the only approved disinfectant that the facility will utilize for cleaning of glucometers. If there is ever a problem with availability of the Super Sani-Cloth, the Director of Nursing (DON)/designee will determine the correct disinfect ant to be used until the Super Sani-Cloth is available and education will be provided to nurses. A copy of the manual for the glucometer utilized in the facility was placed on each unit on 5/8/23 and nurses were informed. This manual includes cleaning and disinfecting instructions, along with approved disinfectants. On 5/4/23, education regarding proper cleaning procedures of the glucometers and return demonstration competency was initiated immediately, including for the RN #1. 100 percent nurses currently in the facility received this education and return-demonstration competency check and this was documented. Education was provided by the DON/IP (infection preventionist)/designee(s). As of 5/8/23, all nurses except one prn nurse who has not worked in greater than three (3) weeks and one nurse who is out on leave. Education regarding proper cleaning procedures of the glucometers and return demonstration will be done with those nurses upon their return, prior to the start of their shift. No finger stick blood glucose checks were performed until each glucometer was cleaned properly with the Super Sani -Cloth and each nurse received the education and return demonstration competency. Nurses will receive education regarding proper cleaning procedures of the glucometers and return demonstration competency prior to the start of their shift until completed for 100 percent of nurses. This will include any agency nurses. Education was provided by the DON/IP/designee(s). The facility Medical Director was notified of the concerns identified and of the plan of correction. A quality improvement (QAPI) meeting was held with the Medical Director via telephone on 5/4/23."Identification of Others:A list of residents that require finger stick blood glucose tests was created. Each glucometer in use in the facility was identified."Systemic Changes:Finger stick Blood Glucose Glucometers are cleaned between each use with an Environmental Protection Agency (EPA) approved product for the correct amount of time based on manufacturer's guidelines:-Treated surface must remain wet for recommended contact time.-For all other contact times, refer to wipe manufacturers' instructions. Do not wrap the meter in a wipe.-Once contact time is complete, wipe the meter dry. Nurses will receive education and return-demonstration competency upon hire and as needed. Education regarding proper cleaning procedures of the glucometers and return demonstration competency will be done for nurses upon hire during the skills orientation. The education and competency will remain in their education file. This education will be provided by the DON/ IP/designee(s). Nurses will not use the glucometer until the education and competency is completed and documented."D. Removal of immediate jeopardyThe facility's plan to remove immediate jeopardy was accepted on 5/8/23 at 3:35 p.m. Record review and observations revealed the facility educated 14 nurses on the policy and proper procedure for performing cleaning and disinfection of a shared blood glucometer between use with multiple residents. On duty nurses (5/8/23) were able to provide verbal instruction on proper cleaning and disinfection with return demonstration of acceptable infection control practices when using a shared blood glucose device. However, deficient practice remained at an E scope and severity, a pattern with the potential for more than minimal harm. E. Additional interviews and observations LPN #1 was interviewed on 5/8/23 at 11:25 a.m. regarding the training received on blood glucose monitor cleaning and disinfection. LPN #1 said the training was completed on 5/4/23 and that the blood glucose monitor should be cleaned with a sani-cloth wipe by scrubbing vertically three times on each side then scrubbing horizontally three times on each side and allowing it to dry for two minutes before performing the blood sugar check. LPN #1 said the device should be cleaned after each resident. RN #3 was interviewed on 5/8/23 at 11:30 a.m. regarding the training received on blood glucose monitor cleaning and disinfection. RN #3 said the training was received and the device should be cleaned with the sani-cloth wipe by wiping three times horizontally and three times vertically on each side of the device. RN #3 said the device should be allowed to dry for two minutes before it is used on a resident. RN #3 said the device should be cleaned after each use. RN #2 was observed on 5/8/23 at 3:11 p.m. while he prepared to perform a blood sugar check for Resident #19. RN #2 wiped each side of the blood glucose monitor vertically and horizontally three times with a sani-cloth wipe and allowed the device to dry for two minutes. II. Failure to ensure blood glucose meters were cleaned, stored, and sanitized in a manner consistent with standards of practiceA. Professional referenceAccording to the Centers for Disease Control and Prevention (CDC) Injection Safety, Infection Prevention during Blood Glucose Monitoring and Insulin Administration, retrieved from https://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html (5/11/23):"The CDC has become increasingly concerned about the risks for transmitting hepatitis B virus (HBV) and other infectious diseases during assisted blood glucose monitoring and insulin administration. CDC is alerting all persons who assist others with blood glucose monitoring and/or insulin administration of the following infection control requirements: Finger stick devices should never be used for more than one person."Whenever possible, blood glucose meters should not be shared. If they must be shared, the device should be cleaned and disinfected after every use, per manufacturer's instructions. If the manufacturer does not specify how the device should be cleaned and disinfected then it should not be shared. Meters requiring preloading of the test strip may come in direct or close contact with the resident's finger stick wound. Subsequent residents can be exposed when the meter is used on them. Staff hands can become contaminated with blood that is transferred to the meter when they obtain the reading. Blood remaining on the meter can be transferred to subsequent residents through staff hands when they perform the next procedure."According to the CDC Infection Prevention during Blood Glucose Monitoring and Insulin Administration, retrieved from https://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html#anchor_1556215485 on 5/11/23,"Whenever possible, blood glucose meters should be assigned to an individual person and not be shared. If blood glucose meters must be shared, the device should be cleaned and disinfected after every use, per manufacturer's instructions to prevent carry-over of blood and infectious agents."B. Manufacturer instructionsAccording to Arkray USA Inc. Ark Care Technical Brief: Cleaning and Disinfecting the Assure Platinum Blood Glucose Monitoring System (BGMS) retrieved from:https://www.arkrayusa.com/english/upload/docs/Assure%20Prism%20multi%20Cleaning%20%26%20Disinfecting%20Guide.pdfon 5/11/23."To minimize the risk of transmitting bloodborne pathogens, the cleaning and disinfecting procedures should be performed as recommended in the instructions below. -The Assure Prism multi BGMS is intended to be used for testing multiple patients in a professional healthcare setting when standard precautions and the manufacturer's cleaning and disinfecting procedures are followed. -The meter should be cleaned and disinfected after use on each patient. "Cleaning and Disinfecting: The cleaning procedure is needed to clean dirt, blood and other bodily fluids off the exterior of the meter before performing the disinfecting procedure. The disinfecting procedure is needed to prevent the transmission of bloodborne pathogens. Only wipes with EPA registration numbers listed below have been validated for use in cleaning and disinfecting the meter. Any disinfectant product containing these EPA registration numbers may be used on this device."Manufacturer recommendations for the glucometer cleaning indicated only the following wipes for use: "Clorox healthcare bleach germicidal wipes, Dispatch hospital cleaner disinfectant towels with bleach, Super sani-cloth germicidal disposable wipes, and CaviWipes1. "Guidelines for cleaning and disinfecting the Assure Prism multi BGMS -Each time the cleaning and disinfecting procedure is performed, two wipes are needed; one wipe to clean the meter and a second wipe to disinfect the meter. -Always wear the appropriate protective gear, including disposable gloves. -Open the disinfectant package and pull out one towelette. -Squeeze any excess liquid out of the towelette. -Wipe the entire surface of the meter using the towelette at least three times vertically and three times horizontally to clean blood and other body fluids from the meter. -Dispose of the towelette. -Repeat the above steps with a new towelette to disinfect the meter. -Meter surfaces must remain wet according to contact times listed in the wipe manufacturer's instructions. Once complete, wipe the meter dry."C. Facility cleaning product after immediate jeopardyThe facility used a product by PDI manufacturer, Super Sani-Cloth germicidal disposable wipes, to clean all blood glucose meter devices after the immediate jeopardy. The wipe required a two minute surface disinfectant time and was documented to be effective against non-enveloped viruses, bacteria, tuberculosis, fungi, multidrug resistant organisms and blood borne pathogens. III. Hand hygiene failure when administering medicationsA. Professional reference According to the CDC Hand Hygiene in Healthcare Settings, last reviewed 1/30/2020, retrieved on from https://www.cdc.gov/handhygiene/providers/guideline.html on 5/11/23, "Healthcare facilities should: Require healthcare personnel to perform hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendation. "Use an alcohol-based hand sanitizer immediately before touching a patient, before performing an aseptic task or handling invasive medical devices, before moving from work on a soiled body site to a clean body site on the same patient, after touching a patient or the patient's immediate environment, after contact with blood, body fluids or contaminated surfaces, and immediately after glove removal." B. Facility policy and procedure The Infection Prevention and Control Program (IPCP) and Plan, revised 1/25/23, was provided by the NHA on 5/3/23 at 11:15 a.m. The policy read in the pertinent part: "Standard and transmission-based precautions to be followed to prevent the spread of infections. The hand hygiene procedures to be followed by staff involved in direct resident contact."Interventions implemented may include the following: A facility-wide hand hygiene program that complies with CDC hand hygiene guidelines and Joint Commission National Patient Safety Goals, as warranted." C. Observation On 5/4/23 at 3:24 p.m. RN #1 gathered supplies for a blood glucose check. RN #1 did not wear gloves prior to performing the fingerstick for Resident #19. At 3:31 p.m. RN #1 gathered supplies for a blood glucose check. RN #1 did not use hand sanitizer prior to collecting supplies and the RN had just finished performing a blood glucose check on a separate resident and touched the laptop and mouse prior. RN #1 did not put gloves on prior to performing the fingerstick for Resident #38 and the resident was on enhanced barrier precautions for MRSA. On 5/8/23 at 12:40 p.m. licensed practical nurse (LPN) #1 assisted student nurses (SN #1 and SN #2) to prepare medications for Resident #19, neither student nurses performed hand hygiene prior to preparing or administering oral medications for Resident #19. The supervising LPN did not prompt the student nurses to perform any hand hygiene for the procedure. At 2:17 p.m. LPN #1 was observed preparing medications for a resident without performing hand hygiene. Prior to gathering the medications, the LPN had been sitting at the nurses station typing on the computer and touching papers on the desk. On 5/9/23 at 9:52 a.m. LPN #1 was observed supervising SN #1 and SN #2 while they gathered medications for a resident. Neither of the student nurses performed hand hygiene prior to collecting the medications. The supervising LPN did not prompt the nurse to perform hand hygiene during the procedure. D. Staff interviewsThe student's clinical institution instructor was interviewed on 5/9/23 at 11:25 a.m. She said the student nurses were to perform hand hygiene prior to preparing medications. The DON was interviewed on 5/9/23 at 6:05 p.m. The DON said the student nurses were to wash their hands or use hand sanitizer prior to preparing medications and delivering resident medications, then they should wash their hands or use hand sanitizer again.
Plan of correction · submitted by the facility
1. Corrective ActionThe facility will hire an infection control consultant (ICC) that is a registered nurse, advanced practice nurse, physician assistant or physician (see requirements below) to provide consultation and oversight for infection prevention and control within the facility. The facility will immediately implement an appropriate infection prevention and intervention plan consistent with the requirements of §483.80 for the affected resident(s)/neighborhood(s) identified in the deficiency. The infection preventionist (IP), director of nursing (DON), applicable interdisciplinary team (IDT) members, in conjunction with the ICC, shall identify and implement a consistent system for:(1) Ensuring shared glucometers were properly disinfected and properly stored between uses to prevent the potential spread infections and blood borne pathogens, in accordance with Centers for Disease Control and Prevention (CDC) guidelines.(2) Ensuring staff select and utilize the correct personal protective equipment (PPE) when completing blood glucose testing, in accordance with standard and transmission-based precautions for residents with known infections.(3) Ensuring staff follow hand hygiene and/or hand washing procedures to minimize the spread of germs when preparing and administering medications. The DON, staff development coordinator (SDC), IP or designee, in conjunction with the ICC will:(1) Educate registered nurse (RN) #2, #1, #5, and licensed practical nurse (LPN) #5, on the correct procedure for properly disinfecting and storing shared glucometers between uses. To ensure this education was effective, each of these staff will complete a successful return demonstration of properly disinfecting and storing a glucometer between uses.(2) Offer each resident (either directly to the resident or via the resident's medical decision maker as applicable) who may have shared a glucometer blood borne pathogen (e.g., needle stick panel) panel testing. The testing should follow guidelines for needle stick exposures related to potential seroconversion of blood borne pathogens.(3) Contact the Colorado Department of Public Health and Environment Disease Control and Public Health Response Division to report the improper disinfection of shared glucometers used to test resident blood glucose.(4) Educate RN #1 on the correct procedure for selecting and using PPE when performing finger stick blood glucose testing on a resident with and without an active methicillin resistant staphylococcus aureus (MRSA) infection. To verify this staff understands the education, this staff will perform a successful return demonstration for selecting and using the correct PPE to perform a finger stick blood glucose test on a resident with and without an active MRSA infection.(5) Educate RN #1 and LPN #1 on timely completing hand hygiene or hand washing when preparing and administering medications. To verify these staff understand the education, these staff will complete a successful return demonstration of timely, correct hand hygiene or hand washing when preparing and administering medications. 2. Identification of Others The IP and DON, in conjunction with the applicable interdisciplinary team (IDT) members will conduct the following steps to identify other who may be affected by the deficient practice:(1) Observe nursing staff who measure and record blood glucose results with glucometers to ensure the staff member is correctly disinfecting and storing the glucometer and selecting and using PPE to prevent the spread of blood borne pathogens. Education will be provided for any observed deviations from expected practices.(2) Observe nursing staff that perform medication administration to ensure they are performing hand hygiene or hand washing where indicated to minimize the spread of germs. Education will be provided for any observed deviations from expected practices. 3. System ChangesOn or before 6/7/2023 the facility shall hire an infection control consultant (ICC)that is a registered nurse, advanced practice nurse, physician assistant, or physician with experience consulting or directing infection control and prevention programs within nursing facilities. The ICC shall exercise independent judgement in the performance of all duties under the consultant contract. The ICC shall meet the independent judgement requirement if the consultant is not presently and has not within a five (5) year period immediately preceding 6/7/2023 been directly or indirectly affiliated with the facility, facility's owner(s), agent(s), or employee(s). In performance of all services provided, the ICC's status shall be that of an independent contractor and not that of an agent, employee, or representative of the facility, applicant or owner. The ICC shall exercise professional, independent judgment in the performance of all such services and shall not be directly or indirectly instructed, guided, influenced or otherwise interfered with by facility, applicant or owners, agents, employees or assigns. No oral understandings, statements, promises, or inducements contrary to the terms of this plan of correction (POC) shall be entered into during the term of this contract. Infection Control Consultant QualificationsPrior to engagement, ICC shall be a registered nurse, advanced practice nurse, physician assistant or physician and possess current occupational license in good standing with the State, as approved by the Department [via Chad Fear at 303-815-8604]. The ICC shall have completed infection prevention and control training from a recognized source, such as the Centers for Disease Control and Prevention or American Health Care Association. The ICC must demonstrate recent (within the last five years) experience in providing consulting services within nursing facilities that includes consultation on infection prevention and control. Infection Control Nurse Consultant DutiesIn conjunction with the director of nursing (DON), facility infection preventionist (IP), and applicable interdisciplinary team (IDT) members, the ICC shall oversee the development and implementation of a COVID-19 infection control and prevention program. This should include but not be limited to:(1) DON, IP and applicable IDT members, in conjunction with the ICC, will conduct root-cause analysis to identify and address the reasons for non-compliance related to:a. Failure to manage glucometers in a manner that prevented the potential spread of blood borne pathogens.b. Failure to select and use the correct PPE when performing finger stick glucose testing.c. Failure to complete hand hygiene in accordance with CDC guidelines. Information about root cause analysis can be found at https://www.cms.gov/Medicare/Provider-Enrollment-and-certification/QAPI/downloads/GuidanceforRCA.pdf(2) The DON, SDC, IP or suitable designee, in conjunction with the ICC, will ensure the following:a. Educate all staff (agency and facility) whose job duties may include blood glucose monitoring on the correct procedure for disinfecting, and storing glucometers between uses to prevent the spread of blood borne pathogens.b. Educate all nursing staff on standard and transmission based precautions for finger stick blood glucose testing.c. All staff will receive education on keeping hands clean between glove changes, between tasks, between contacts with potentially contaminated surfaces, and between residents. This education will include the CDC's lesson on clean hands available at: https://www.cdc.gov/infectioncontrol/projectfirstline/videos/EP21-Hands-LowRes.mp4.(3) The facility leadership will contact the Colorado Quality Improvement Organization (QIO), Telligen, to inquire about the assistance and services available from the QIO in improving infection prevention and control within the facility through quality assurance process improvement (QAPI) methods. 4. MonitoringWeekly for no less than 12 weeks, the DON, IP, SDC or a designee will conduct on-going monitoring to ensure, via observation, the approaches to correct deficient practice related to infection control and prevention are consistently implemented and effective. Such monitoring will include:(1) Observations of nursing staff who measure and record blood glucose with glucometers to ensure the staff member is correctly disinfecting and storing the glucometer to prevent the spread of blood borne pathogens and using the correct PPE to minimize the spread of germs.(2) Observations of nursing staff to ensure performance of proper hand hygiene or hand washing, when indicated, in the course of their medication preparation and administration duties. Observations will be made across all shifts and neighborhoods/units. Observations of noncompliance with the above will result in ad hoc education for the involved staff. Such education will be documented on monitoring forms. After twelve weeks of monitoring, provided that such monitoring demonstrates expectations are consistently met, monitoring may be reduced to monthly. Monthly monitoring will continue for no less than three months. All monitoring will be reported to the quality assurance performance improvement (QAPI) committee as part of QAPI activities. Monitoring will not be discontinued until the facility completes three consecutive rounds of monthly monitoring that demonstrate sustained compliance as approved by the QAPI committee and medical director. The ICC shall make weekly written reports for the first twelve weeks to the Department on all plan implementation, education, training, and monitoring for infection prevention and control activities. Such reports shall be provided to the Department via email, [jo.tansey@state.co.us and chad.fear@state.co.us] beginning 6/9/2023 then each following Friday with the final weekly report being submitted on Friday 8/25/2023. After the first twelve weeks, with Department approval, reports shall be due on the 15th of each month. Reporting shall then continue to be due monthly on the 15th for a minimum of three months and shall only be discontinued when the facility has demonstrated consistent implementation of all requirements of §483.80.5. Correction Date6/7/2023
5/9/2023State Licensure Survey · ID Q6SK111 deficiency
0000Initial CommentsSurveyor note
Findings
A licensure survey was completed on 5/3/23 to 5/9/23. One deficiency was cited.
Plan of correction
The state did not require a plan of correction for this citation.
2606Inf Cntrl-Sanitation of Nrsng&Res Care Equipt
Findings
Based on observations, record review and interviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Observations and interviews revealed the nursing staff lacked the knowledge, training, and equipment to manage the residents' routine and emergency blood glucose monitoring needs. The facility's failure to monitor the blood glucose meters (glucometer) according to standard practice, coupled with the staff's lack of knowledge to ensure blood glucose meters were cleaned, sanitized and stored properly in between each resident's use created the situation for serious harm if the blood glucose meters continued to be shared among residents due to potential transmission of blood-borne pathogens. One resident who shared the glucometer with another had a diagnosis of chronic viral hepatitis C (HCV, a viral infection that is spread by contact with contaminated blood). In addition, nursing staff and student nurses failed to administer medication in a sanitary manner where hand hygiene was performed appropriately to prevent potential cross contamination during the procedure. Findings include:I. Failures with blood glucose metersBlood glucose metersThe facility had six blood glucose meters, which were shared among 18 residents who required routine blood sugar checks. This included one resident who had a diagnosis of chronic viral hepatitis C.Resident #38 had an active diagnosis of methicillin-resistant staphylococcus aureus infection (MRSA) and had been placed on enhanced barrier precautions. Resident #38 had an order for blood sugar checks before each meal and at bedtime. ObservationDuring an observation on 5/4/23 beginning at 3:24 p.m. and ending at 3:50 p.m., the following was observed:-At 3:24 p.m. registered nurse (RN) #2 used hand sanitizer and then collected the blood glucose monitor from the top drawer of the medication cart along with an alcohol swab and a lancet. RN #2 carried the supplies to Resident #79 and without donning gloves proceeded to clean the resident's finger with the alcohol swab and then used the lancet to puncture the resident's finger for the blood sample. The sample was collected into the test strip on the blood glucose monitor and the previously used alcohol swab was then used to stop the bleeding on the resident's finger. RN #2 returned to the medication cart and disposed of the used lancet in the sharps container and placed the blood glucose monitor back in the top drawer of the medication cart without performing any cleaning or sanitation of the device and closed the drawer of the medication cart. A few minutes later RN #2 used hand sanitizer and began collecting supplies for another blood glucose check. RN #2 opened the top drawer and removed the blood glucose monitor, an alcohol swab and a lancet. RN #2 closed the drawer and locked the cart. RN #2 did not clean or disinfect the glucometer and proceed to Resident #38's room. RN #2 walked to the room of Resident #38 with the supplies, knocked on the door and entered the room. RN #2 asked for Resident #38's pain level; the resident expressed pain and a need for pain medications. RN #2 returned to the nurses' station to review the resident's medication orders for available pain medication orders. RN #2 consulted with RN #1(RN #1 was providing RN #2 supervision as RN #2 was a new employee and was still in orientation). After the consultation, RN #2 picked up a paper and a pen from the desk and walked over to the medication cart; RN #1 remained at the nurses station. RN #2 logged into the computer on the medication cart and began documenting in the resident's record. RN #2 retrieved the keys to the medication cart from his pocket, unlocked the cart and returned the keys to his pocket. RN #2 did not use hand sanitizer again to clean his hands before collecting medications for Resident #38. RN #2 opened the drawer on the medication cart and removed a card of pills for Resident #38, pushed the medication out of the back of the medicine card and directly into his contaminated bare hand and then put the pills in the medicine cup. Without any hand hygiene, RN #2 returned the pill card to the drawer in the medication cart and then closed the drawer and locked the cart. RN #2 walked back to the room of Resident #38, knocked on the door and entered the room. RN #2 gave the medication to Resident #38 and then removed the unsanitized blood glucose monitor, alcohol swab and lancet from his pocket where he had keys and other items stored. RN #2 had not performed hand hygiene as he began to perform the blood glucose check on Resident #38. The nurse began by cleaning the finger of Resident #38 and proceeded to puncture the resident's finger with the lancet and collect the blood sample onto the test strip into the device. RN #2 returned to the medication cart and placed the blood glucose monitor on the top of the cart while he disposed of the lancet in the sharps container. RN #2 did not clean and sanitize the blood glucose monitor at any point and began to look on the computer for the third resident that needed to have their blood sugar checked. RN #2 gathered the unsanitized blood glucose device and supplies for testing the third resident's blood glucose level and without attempts to sanitize the device started to the third resident's room. RN #2 was stopped from proceeding to the third resident's room for an interview about infection control practices and procedures (see below). InterviewsRegistered nurse (RN) #2 was interviewed on 5/4/23 at approximately 3:47 p.m. RN #2 said he was in orientation with RN #1 being his mentor today. There were four residents who had orders for evening blood sugars checked. RN #2 said there were normally two glucometers on the medication cart but one of them was missing so only one was available for use. RN #2 said the blood glucose monitor was shared between the four residents in that unit. RN #2 said infection control and prevention for the medication pass included for the nurse to use hand sanitizer to clean their hands between administering medications and treatments to each resident. RN #2 said it was not appropriate to touch medications with bare hands. RN #2 said the blood glucose monitor was supposed to be cleaned in the resident's room with an alcohol pad before the blood glucose check. RN #2 was not aware of the manufacturer's recommendations for cleaning and disinfecting the blood glucose devices provided for shared use with residents to test their blood glucose levels. RN #1 was interviewed on 5/4/23 at 3:48 p.m. RN #1 said she was training RN #2 on the facility's clinical procedure. RN #1 said the blood glucometer device should be cleaned with the foaming hand sanitizer after each use, being careful not to get the device too wet. RN #1 was not aware of the manufacturer's recommendations for the blood glucometer. The director of nurses (DON) was interviewed on 5/4/23 at approximately 4:05 p.m. The DON said the facility used shared glucometers and the nursing staff used Oxivir disinfectant to sanitize the glucometer devices in between each resident. The disinfectant contact time was one minute. Further interviews with nurses from each unit on 5/4/23 revealed each nurse had a different method of cleaning the shared glucometers in between resident use. RN #6 said the device was to be sanitized with Oxivir and ensure a contact time of one minute to kill pathogens. Licensed practical nurse (LPN) #5 said the device was to be disinfected with Kroger brand disinfecting wipes with a contact time of eight to 10 minutes. RN #5 said the device was to be disinfected with an alcohol wipe and no contact time wait. All glucometers were observed on 5/4/23 and they were all stored in the medication carts for each unit. They were not in individual storage spaces. Each blood glucose monitor was in a space shared with alcohol pads and lancets. Facility policy and procedureThe Infection Prevention and Control Program (IPCP) and Plan, revised on 1/25/23, was provided by the nursing home administrator (NHA) on 53/23 at 11:15 a.m. The policy read in the pertinent part: "The facility administration, infection preventionist, and medical director should ensure that current infection control standards of practice are based on recognized guidelines and facility assessment. These standards should be incorporated in the Infection Prevention and Control Program (IPCP)."Ensure staff follow the IPCP's standards, policies and procedures (hand hygiene and appropriate use of PPE) while other needs are specific to particular roles, responsibilities, and situations (injection safety and point of care testing);"Methods to reduce the risks associated with procedures, medical equipment, and medical devices ... Appropriate storage, cleaning, disinfection, and/or disposal of supplies and equipment;"Applicable precautions, as appropriate, based on the following:a. The potential for transmissionb. The mechanism of transmission. c. The care, treatment, and services setting"The Cleaning and Disinfection of the Glucometer policy, revised 9/28/22, was provided by the DON on 5/4/23 at 5:45p.m. It read in pertinent part: "The meter should be cleaned and disinfected after use on each patient. The Assure Prism multi Blood Glucose Monitoring System may only be used for testing multiple patients when standard precautions and the manufacturer's disinfection procedures are followed. The cleaning procedure is needed to clean dirt, blood and other bodily fluids off the exterior of the meter before performing the disinfection procedure. The disinfecting procedure is needed to prevent the transmission of blood borne pathogens."B. Facility plan On 5/4/23 at 8:12 p.m., the director of clinical services (DDCS) provided a plan, it read:"Divisional and Regional team members for (facility name) are on-site and assisting the facility with the corrective action and management of this plan. Super Sani-Cloth was obtained by the facility. The facility has placed an order for additional supply and anticipates increased stock by end of day tomorrow, 5/5/23. Based on the manufacturer's guideline and facility policy and procedure, this germicidal disposable wipe is approved for use in cleaning the facility glucometers. This is the only approved disinfectant that the facility will utilize for cleaning of glucometers. If there is ever a problem with availability of the Super Sani-Cloth, the Director of Nursing (DON)/designee will determine the correct disinfect ant to be used until the Super Sani-Cloth is available and education will be provided to nurses. A copy of the manual for the glucometer utilized in the facility was placed on each unit on 5/8/23 and nurses were informed. This manual includes cleaning and disinfecting instructions, along with approved disinfectants. On 5/4/23, education regarding proper cleaning procedures of the glucometers and return demonstration competency was initiated immediately, including for the RN #1. 100 percent nurses currently in the facility received this education and return-demonstration competency check and this was documented. Education was provided by the DON/IP (infection preventionist)/designee(s). As of 5/8/23, all nurses except one prn nurse who has not worked in greater than three (3) weeks and one nurse who is out on leave. Education regarding proper cleaning procedures of the glucometers and return demonstration will be done with those nurses upon their return, prior to the start of their shift. No finger stick blood glucose checks were performed until each glucometer was cleaned properly with the Super Sani -Cloth and each nurse received the education and return demonstration competency. Nurses will receive education regarding proper cleaning procedures of the glucometers and return demonstration competency prior tothe start of their shift until completed for 100 percent of nurses. This will include any agency nurses. Education was provided by the DON/IP/designee(s). The facility Medical Director was notified of the concerns identified and of the plan of correction. A quality improvement (QAPI) meeting was held with the Medical Director via telephone on 5/4/23."Identification of Others:A list of residents that require finger stick blood glucose tests was created. Each glucometer in use in the facility was identified."Systemic Changes:Finger stick Blood Glucose Glucometers are cleaned between each use with an Environmental Protection Agency (EPA) approved product for the correct amount of time based on manufacturer's guidelines:-Treated surface must remain wet for recommended contact time.-For all other contact times, refer to wipe manufacturers' instructions. Do not wrap the meter in a wipe.-Once contact time is complete, wipe the meter dry. Nurses will receive education and return-demonstration competency upon hire and as needed. Education regarding proper cleaning procedures of the glucometers and return demonstration competency will be done for nurses upon hire during the skills orientation. The education and competency will remain in their education file. This education will be provided by the DON/ IP/designee(s). Nurses will not use the glucometer until the education and competency is completed and documented."The facility's plan was accepted on 5/8/23 at 3:35 p.m. Record review and observations revealed the facility educated 14 nurses on the policy and proper procedure for performing cleaning and disinfection of a shared blood glucometer between use with multiple residents. On duty nurses (5/8/23) were able to provide verbal instruction on proper cleaning and disinfection with return demonstration of acceptable infection control practices when using a shared blood glucose device. C. Additional interviews and observations LPN #1 was interviewed on 5/8/23 at 11:25 a.m. regarding the training received on blood glucose monitor cleaning and disinfection. LPN #1 said the training was completed on 5/4/23 and that the blood glucose monitor should be cleaned with a sani-cloth wipe by scrubbing vertically three times on each side then scrubbing horizontally three times on each side and allowing it to dry for two minutes before performing the blood sugar check. LPN #1 said the device should be cleaned after each resident. RN #3 was interviewed on 5/8/23 at 11:30 a.m. regarding the training received on blood glucose monitor cleaning and disinfection. RN #3 said the training was received and the device should be cleaned with the sani-cloth wipe by wiping three times horizontally and three times vertically on each side of the device. RN #3 said the device should be allowed to dry for two minutes before it is used on a resident. RN #3 said the device should be cleaned after each use. RN #2 was observed on 5/8/23 at 3:11 p.m. while he prepared to perform a blood sugar check for Resident #19. RN #2 wiped each side of the blood glucose monitor vertically and horizontally three times with a sani-cloth wipe and allowed the device to dry for two minutes. II. Failure to ensure blood glucose meters were cleaned, stored, and sanitized in a manner consistent with standards of practiceA. Professional referenceAccording to the Centers for Disease Control and Prevention (CDC) Injection Safety, Infection Prevention during Blood Glucose Monitoring and Insulin Administration, retrieved from https://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html (5/11/23):"The CDC has become increasingly concerned about the risks for transmitting hepatitis B virus (HBV) and other infectious diseases during assisted blood glucose monitoring and insulin administration. CDC is alerting all persons who assist others with blood glucose monitoring and/or insulin administration of the following infection control requirements: Finger stick devices should never be used for more than one person."Whenever possible, blood glucose meters should not be shared. If they must be shared, the device should be cleaned and disinfected after every use, per manufacturer's instructions. If the manufacturer does not specify how the device should be cleaned and disinfected then it should not be shared. Meters requiring preloading of the test strip may come in direct or close contact with the resident's finger stick wound. Subsequent residents can be exposed when the meter is used on them. Staff hands can become contaminated with blood that is transferred to the meter when they obtain the reading. Blood remaining on the meter can be transferred to subsequent residents through staff hands when they perform the next procedure."According to the CDC Infection Prevention during Blood Glucose Monitoring and Insulin Administration, retrieved from https://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html#anchor_1556215485 on 5/11/23,"Whenever possible, blood glucose meters should be assigned to an individual person and not be shared. If blood glucose meters must be shared, the device should be cleaned and disinfected after every use, per manufacturer's instructions to prevent carry-over of blood and infectious agents."B. Manufacturer instructionsAccording to Arkray USA Inc. Ark Care Technical Brief: Cleaning and Disinfecting the Assure Platinum Blood Glucose Monitoring System (BGMS) retrieved from:https://www.arkrayusa.com/english/upload/docs/Assure%20Prism%20multi%20Cleaning%20%26%20Disinfecting%20Guide.pdfon 5/11/23."To minimize the risk of transmitting bloodborne pathogens, the cleaning and disinfecting procedures should be performed as recommended in the instructions below. -The Assure Prism multi BGMS is intended to be used for testing multiple patients in a professional healthcare setting when standard precautions and the manufacturer's cleaning and disinfecting procedures are followed. -The meter should be cleaned and disinfected after use on each patient. "Cleaning and Disinfecting: The cleaning procedure is needed to clean dirt, blood and other bodily fluids off the exterior of the meter before performing the disinfecting procedure. The disinfecting procedure is needed to prevent the transmission of bloodborne pathogens. Only wipes with EPA registration numbers listed below have been validated for use in cleaning and disinfecting the meter. Any disinfectant product containing these EPA registration numbers may be used on this device."Manufacturer recommendations for the glucometer cleaning indicated only the following wipes for use: "Clorox healthcare bleach germicidal wipes, Dispatch hospital cleaner disinfectant towels with bleach, Super sani-cloth germicidal disposable wipes, and CaviWipes1. "Guidelines for cleaning and disinfecting the Assure Prism multi BGMS -Each time the cleaning and disinfecting procedure is performed, two wipes are needed; one wipe to clean the meter and a second wipe to disinfect the meter. -Always wear the appropriate protective gear, including disposable gloves. -Open the disinfectant package and pull out one towelette. -Squeeze any excess liquid out of the towelette. -Wipe the entire surface of the meter using the towelette at least three times vertically and three times horizontally to clean blood and other body fluids from the meter. -Dispose of the towelette. -Repeat the above steps with a new towelette to disinfect the meter. -Meter surfaces must remain wet according to contact times listed in the wipe manufacturer's instructions. Once complete, wipe the meter dry."C. Facility cleaning product The facility used a product by PDI manufacturer, Super Sani-Cloth germicidal disposable wipes, to clean all blood glucose meter devices after 5/4/23. The wipe required a two minute surface disinfectant time and was documented to be effective against non-enveloped viruses, bacteria, tuberculosis, fungi, multidrug resistant organisms and blood borne pathogens. III. Hand hygiene failure when administering medicationsA. Professional reference According to the CDC Hand Hygiene in Healthcare Settings, last reviewed 1/30/2020, retrieved on from https://www.cdc.gov/handhygiene/providers/guideline.html on 5/11/23, "Healthcare facilities should: Require healthcare personnel to perform hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendation. "Use an alcohol-based hand sanitizer immediately before touching a patient, before performing an aseptic task or handling invasive medical devices, before moving from work on a soiled body site to a clean body site on the same patient, after touching a patient or the patient's immediate environment, after contact with blood, body fluids or contaminated surfaces, and immediately after glove removal." B. Facility policy and procedure The Infection Prevention and Control Program (IPCP) and Plan, revised 1/25/23, was provided by the NHA on 5/3/23 at 11:15 a.m. The policy read in the pertinent part: "Standard and transmission-based precautions to be followed to prevent the spread of infections. The hand hygiene procedures to be followed by staff involved in direct resident contact."Interventions implemented may include the following: A facility-wide hand hygiene program that complies with CDC hand hygiene guidelines and Joint Commission National Patient Safety Goals, as warranted." C. Observation On 5/4/23 at 3:24 p.m. RN #1 gathered supplies for a blood glucose check. RN #1 did not wear gloves prior to performing the fingerstick for Resident #19. At 3:31 p.m. RN #1 gathered supplies for a blood glucose check. RN #1 did not use hand sanitizer prior to collecting supplies and the RN had just finished performing a blood glucose check on a separate resident and touched the laptop and mouse prior. RN #1 did not put gloves on prior to performing the fingerstick for Resident #38 and the resident was on enhanced barrier precautions for MRSA. On 5/8/23 at 12:40 p.m. licensed practical nurse (LPN) #1 assisted student nurses (SN #1 and SN #2) to prepare medications for Resident #19, neither student nurses performed hand hygiene prior to preparing or administering oral medications for Resident #19. The supervising LPN did not prompt the student nurses to perform any hand hygiene for the procedure. At 2:17 p.m. LPN #1 was observed preparing medications for a resident without performing hand hygiene. Prior to gathering the medications, the LPN had been sitting at the nurses station typing on the computer and touching papers on the desk. On 5/9/23 at 9:52 a.m. LPN #1 was observed supervising SN #1 and SN #2 while they gathered medications for a resident. Neither of the student nurses performed hand hygiene prior to collecting the medications. The supervising LPN did not prompt the nurse to perform hand hygiene during the procedure. D. Staff interviewsThe student's clinical institution instructor was interviewed on 5/9/23 at 11:25 a.m. She said the student nurses were to perform hand hygiene prior to preparing medications. The DON was interviewed on 5/9/23 at 6:05 p.m. The DON said the student nurses were to wash their hands or use hand sanitizer prior to preparing medications and delivering resident medications, then they should wash their hands or use hand sanitizer again.
Plan of correction · submitted by the facility
AS DIRECTED BY THE FEDERAL TAG 8801. Corrective ActionThe facility will hire an infection control consultant (ICC) that is a registered nurse, advanced practice nurse, physician assistant or physician (see requirements below) to provide consultation and oversight for infection prevention and control within the facility. The facility will immediately implement an appropriate infection prevention and intervention plan consistent with the requirements of §483.80 for the affected resident(s)/neighborhood(s) identified in the deficiency. The infection preventionist (IP), director of nursing (DON), applicable interdisciplinary team (IDT) members, in conjunction with the ICC, shall identify and implement a consistent system for:(1) Ensuring shared glucometers were properly disinfected and properly stored between uses to prevent the potential spread infections and blood borne pathogens, in accordance with Centers for Disease Control and Prevention (CDC) guidelines.(2) Ensuring staff select and utilize the correct personal protective equipment (PPE) when completing blood glucose testing, in accordance with standard and transmission-based precautions for residents with known infections.(3) Ensuring staff follow hand hygiene and/or hand washing procedures to minimize the spread of germs when preparing and administering medications. The DON, staff development coordinator (SDC), IP or designee, in conjunction with the ICC will:(1) Educate registered nurse (RN) #2, #1, #5, and licensed practical nurse (LPN) #5, on the correct procedure for properly disinfecting and storing shared glucometers between uses. To ensure this education was effective, each of these staff will complete a successful return demonstration of properly disinfecting and storing a glucometer between uses.(2) Offer each resident (either directly to the resident or via the resident's medical decision maker as applicable) who may have shared a glucometer blood borne pathogen (e.g., needle stick panel) panel testing. The testing should follow guidelines for needle stick exposures related to potential seroconversion of blood borne pathogens.(3) Contact the Colorado Department of Public Health and Environment Disease Control and Public Health Response Division to report the improper disinfection of shared glucometers used to test resident blood glucose.(4) Educate RN #1 on the correct procedure for selecting and using PPE when performing finger stick blood glucose testing on a resident with and without an active methicillin resistant staphylococcus aureus (MRSA) infection. To verify this staff understands the education, this staff will perform a successful return demonstration for selecting and using the correct PPE to perform a finger stick blood glucose test on a resident with and without an active MRSA infection.(5) Educate RN #1 and LPN #1 on timely completing hand hygiene or hand washing when preparing and administering medications. To verify these staff understand the education, these staff will complete a successful return demonstration of timely, correct hand hygiene or hand washing when preparing and administering medications. 2. Identification of Others The IP and DON, in conjunction with the applicable interdisciplinary team (IDT) members will conduct the following steps to identify other who may be affected by the deficient practice:(1) Observe nursing staff who measure and record blood glucose results with glucometers to ensure the staff member is correctly disinfecting and storing the glucometer and selecting and using PPE to prevent the spread of blood borne pathogens. Education will be provided for any observed deviations from expected practices.(2) Observe nursing staff that perform medication administration to ensure they are performing hand hygiene or hand washing where indicated to minimize the spread of germs. Education will be provided for any observed deviations from expected practices. 3. System ChangesOn or before 6/7/2023 the facility shall hire aninfection control consultant (ICC) that is a registered nurse, advanced practice nurse, physician assistant, or physician with experience consulting or directing infection control and prevention programs within nursing facilities. The ICC shall exercise independent judgement in the performance of all duties under the consultant contract. The ICC shall meet the independent judgement requirement if the consultant is not presently and has not within a five (5) year period immediately preceding 6/7/2023 been directly or indirectly affiliated with the facility, facility's owner(s), agent(s), or employee(s). In performance of all services provided, the ICC's status shall be that of an independent contractor and not that of an agent, employee, or representative of the facility, applicant or owner. The ICC shall exercise professional, independent judgment in the performance of all such services and shall not be directly or indirectly instructed, guided, influenced or otherwise interfered with by facility, applicant or owners, agents, employees or assigns. No oral understandings, statements, promises, or inducements contrary to the terms of this plan of correction (POC) shall be entered into during the term of this contract. Infection Control Consultant QualificationsPrior to engagement, ICC shall be a registered nurse, advanced practice nurse, physician assistant or physician and possess current occupational license in good standing with the State, as approved by the Department [via Chad Fear at 303-815-8604]. The ICC shall have completed infection prevention and control training from a recognized source, such as the Centers for Disease Control and Prevention or American Health Care Association. The ICC must demonstrate recent (within the last five years) experience in providing consulting services within nursing facilities that includes consultation on infection prevention and control. Infection Control Nurse Consultant DutiesIn conjunction with the director of nursing (DON), facility infection preventionist (IP), and applicable interdisciplinary team (IDT) members, the ICC shall oversee the development and implementation of a COVID-19 infection control and prevention program. This should include but not be limited to:(1) DON, IP and applicable IDT members, in conjunction with the ICC, will conduct root-cause analysis to identify and address the reasons for non-compliance related to:a. Failure to manage glucometers in a manner that prevented the potential spread of blood borne pathogens.b. Failure to select and use the correct PPE when performing finger stick glucose testing.c. Failure to complete hand hygiene in accordance with CDC guidelines. Information about root cause analysis can be found at https://www.cms.gov/Medicare/Provider-Enrollment-and-certification/QAPI/downloads/GuidanceforRCA.pdf(2) The DON, SDC, IP or suitable designee, in conjunction with the ICC, will ensure the following:a. Educate all staff (agency and facility) whose job duties may include blood glucose monitoring on the correct procedure for disinfecting, and storing glucometers between uses to prevent the spread of blood borne pathogens.b. Educate all nursing staff on standard and transmission based precautions for finger stick blood glucose testing.c. All staff will receive education on keeping hands clean between glove changes, between tasks, between contacts with potentially contaminated surfaces, and between residents. This education will include the CDC's lesson on clean hands available at: https://www.cdc.gov/infectioncontrol/projectfirstline/videos/EP21-Hands-LowRes.mp4.(3) The facility leadership will contact the Colorado Quality Improvement Organization (QIO), Telligen, to inquire about the assistance and services available from the QIO in improving infection prevention and control within the facility through quality assurance process improvement (QAPI) methods. 4. MonitoringWeekly for no less than 12 weeks, the DON, IP, SDC or a designee will conduct on-going monitoring to ensure, via observation, the approaches to correct deficient practice related to infection control and prevention are consistently implemented and effective. Such monitoring will include:(1) Observations of nursing staff who measure and record blood glucose with glucometers to ensure the staff member is correctly disinfecting and storing the glucometer to prevent the spread of blood borne pathogens and using the correct PPE to minimize the spread of germs.(2) Observations of nursing staff to ensure performance of proper hand hygiene or hand washing, when indicated, in the course of their medication preparation and administration duties. Observations will be made across all shifts and neighborhoods/units. Observations of noncompliance with the above will result in ad hoc education for the involved staff. Such education will be documented on monitoring forms. After twelve weeks of monitoring, provided that such monitoring demonstrates expectations are consistently met, monitoring may be reduced to monthly. Monthly monitoring will continue for no less than three months. All monitoring will be reported to the quality assurance performance improvement (QAPI) committee as part of QAPI activities. Monitoring will not be discontinued until the facility completes three consecutive rounds of monthly monitoring that demonstrate sustained compliance as approved by the QAPI committee and medical director. The ICC shall make weekly written reports for the first twelve weeks to the Department on all plan implementation, education, training, and monitoring for infection prevention and control activities. Such reports shall be provided to the Department via email, [jo.tansey@state.co.us and chad.fear@state.co.us] beginning 6/9/2023 then each following Friday with the final weekly report being submitted on Friday 8/25/2023. After the first twelve weeks, with Department approval, reports shall be due on the 15th of each month. Reporting shall then continue to be due monthly on the 15th for a minimum of three months and shall only be discontinued when the facility has demonstrated consistent implementation of all requirements of §483.80.5. Correction Date6/7/2023

Reportable Occurrences

43 records
6/12/2026Misappropriation of Property · ID 26020470015Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 6/12/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (A) alleged $30 had been stolen. During the course of the investigation, the healthcare entity conducted a search and offered options to secure any valuables. Review of resident account activity revealed client (A) withdrew $58 two days earlier. Client (A) still had $28 in their possession. Staff indicated they witnessed client (A) getting snack items from the vending machine and that he might have forgotten to obtain the change. Staff planned to assist client (A) as needed. The facility could not corroborate client (A)'s allegation of theft. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/13/2026 · released to the public 7/20/2026.
5/16/2026Misappropriation of Property · ID 26020470013Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 5/18/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (A) alleged $50 was stolen from their purse, and they believed the money had been taken by staff (1). The money had not been secured. During the course of the investigation, the healthcare entity suspended staff (1), notified the police and conducted a search and interviews. A lockbox was offered and staff encouraged them to safeguard any additional valuables. Staff (1) denied the allegation and reported they opened client (A)'s drawers for incontinence supplies. The facility could not establish if client (A) had that amount of money in their possession or if it was deliberately taken. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/7/2026 · released to the public 7/14/2026.
5/15/2026Misappropriation of Property · ID 26020470011Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 5/15/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (A) alleged someone stole some clothing items from their closet. The alleged thefts started over three years ago to just as recently as one month ago. During the course of the investigation, the healthcare entity conducted searches, record reviews and interviews. One item was located, but the most recent item reported being taken could not be found. Management offered to replace clothing items and installed a lock on the client's closet door. The facility could not determine if the items were deliberately taken or if client (A) had those clothing items originally. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/31/2026 · released to the public 8/7/2026.
5/7/2026Misappropriation of Property · ID 26020470010Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 5/7/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (A) alleged a vape pen had been stolen from their purse about a month ago. During the course of the investigation, the healthcare entity conducted a search and interviews. A lockbox was provided. Management reported a vape pen had been found one month earlier, but client (A) denied that it belonged to them. The facility was not able to determine if someone deliberately took a vape pen. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/16/2026 · released to the public 7/23/2026.
4/14/2026Sexual Abuse · ID 26020470009Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 4/16/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a sexual abuse event. Client (A) alleged someone attempted to rape them. Client (A) provided descriptive details about the alleged perpetrator. During the course of the investigation, the healthcare entity conducted an assessment and interviews. Management attempted to identify the alleged assailant and notified the police. Client (A)'s care plan was updated to reflect staff should provide care in pairs. Education was provided to client (A) to keep the door open or cracked for staff monitoring. Staff said they did not witness any visitors, and no staff matched the description of the alleged perpetrator. Nursing indicated there were no signs of a physical struggle or external sexual trauma. The facility concluded client (A) experienced a hallucination/delusional episode along with increased confusion due to end-of-life care. Hospice staff re-evaluated client (A)'s medications and staff provided comfort. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/22/2026 · released to the public 7/29/2026.
4/8/2026Misappropriation of Property · ID 26020470008Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 4/8/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (A) alleged someone stole their coat. During the course of the investigation, the healthcare entity conducted a search, interviews and record reviews. Management provided a lock for client (A)'s closet door, and they were encouraged to secure their items. With further interviews, client (A)'s timeline changed, as now they have said it had been stolen several months ago. The facility could not establish if the client had that item in their possession. No other clients reported having any concerns about missing items. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 6/29/2026 · released to the public 7/6/2026.
3/18/2026Misappropriation of Property · ID 26020470005Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 3/18/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (A) reported several clothing items were missing and claimed they had been stolen. During the course of the investigation, the healthcare entity conducted a search, reviewed client (A)'s inventory list and conducted interviews. Management could not confirm if these items were present in the facility. A decision was made to reimburse client (A), and a lock was provided for the closet. Staff assisted client (A) update the inventory list. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 5/22/2026 · released to the public 5/29/2026.
1/23/2026Verbal Abuse · ID 26020470003Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 1/23/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a verbal abuse event. Client (A) alleged a group of individuals have been coming into his room at different times, making noises and gestures. Client (A) reported feeling afraid he was going to be harmed, and that this has been occurring for quite some time. During the course of the investigation, the healthcare entity suspended one staff member (only person out of the group to be identified), provided emotional support and notified the police. Management requested care in pairs. No one could corroborate client (A)’s allegation or timeline of events. Management requested a mental health referral for client (A), as the family member reported he might be experiencing delusions. Staff (1) returned to work and was reassigned. The event could not be substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 4/3/2026 · released to the public 4/10/2026.
1/16/2026Misappropriation of Property · ID 26020470002Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 1/16/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (A) alleged someone stole $200 and some shoes from their room. During the course of the investigation, the healthcare entity conducted a search and interviews. Management reminded client (A) to utilize the lockbox provided for securing any valuables. Staff discovered $132 in the room, but client (A) said the other amount was still missing. Shoes were present in the room, but client (A) indicated another pair was still missing. The facility could not establish what shoes were missing or how much money the client initially had in their possession, and client (A) had recently gone out on a shopping activity. No other staff or clients reported having any awareness of missing or taken items. Client (A)’s allegation could not be substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 3/25/2026 · released to the public 4/1/2026.
11/15/2025Physical Abuse · ID 25020470024Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 11/15/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a physical abuse event. Staff heard a commotion and observed client (B) pushing client (A)’s shoulder as they swatted at one another. After staff separated the clients, client (A) alleged client (B) had lifted him by the neck, held him up against the wall and was choking him. During the course of the investigation, the healthcare entity separated the clients, conducted assessments and interviews, notified the police and implemented a monitoring plan for peer safety. Client (A) reported having 6/10 pain initially to his neck but later told staff there was no pain. No visible injury was observed. A room change occurred to separate the clients. Staff’s observation of the incident did not align with client (A)’s account. With client (B)’s physical state, staff reported he lacked the strength to pick up or hold client (A) against the wall. The event could not be substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 1/22/2026 · released to the public 1/29/2026.
8/20/2025Misappropriation of Property · ID 25020470018Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 8/20/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (B) alleged someone stole money from her outside bank account. During the course of the investigation, the healthcare entity notified the police, Adult Protective Services and family. Staff assisted the client get another bank card and supported the client to obtain a new legal representative. Client (B) indicated her family had access to her bank account. At a facility level, client (B)’s allegation could not be substantiated or unsubstantiated. Client (B) had the option of securing money in a facility account, and the external investigation was ongoing for an allegation of theft. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 11/6/2025 · released to the public 11/13/2025.
8/16/2025Physical Abuse · ID 25020470017Reported on time: No
Occurrence summary
SUMMARY OF FINDINGS:On 8/16/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a physical abuse event. Reportedly, client (A) alleged a transport driver drove recklessly causing her to slide forward from the wheelchair onto the floor. The result caused injuries to her lower extremities. Client (A) did not think she had been properly secured in the wheelchair. Treatment was provided. During the course of the investigation, the healthcare entity conducted an assessment and interviews and notified the police and transport agency. The driver was removed from transporting the client. The driver reported they quickly acted to prevent an automobile collision, which was confirmed via video footage cam. The allegation of reckless driving or not being properly secured in the wheelchair could not be substantiated. Management ensured new transport staff securely fastened the client in the van prior to transport. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was not submitted within the required timeframe.
Publication
Sent to facility 10/29/2025 · released to the public 11/5/2025.
8/8/2025Misappropriation of Property · ID 25020470016Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 8/10/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (B) alleged someone took her wallet that contained $200. During the course of the investigation, the healthcare entity conducted a search and interviews. Client (B)’s family indicated client (B) did not have any money in her possession. The facility was unable to substantiate an allegation of theft. A lock box was offered to client (B) and she was encouraged to secure any valuables. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 10/3/2025 · released to the public 10/10/2025.
7/14/2025Misappropriation of Property · ID 25020470013Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 7/14/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (B) reported $20 was missing from his drawer. The money had not been secured. During the course of the investigation, the healthcare entity helped conduct a search and conducted interviews. A lockbox was provided for the client (B) along with a wallet. Staff indicated they did not see client (B) with a $20 bill but only smaller bills. Client (B) had a history of giving money to others, and there was no indication of a theft. An allegation of misappropriation of property could not be substantiated. Management reimbursed the client in good faith. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 10/16/2025 · released to the public 10/23/2025.
6/6/2025Misappropriation of Property · ID 25020470010Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 6/6/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (B) reported $240 was missing from his room. During the course of the investigation, the healthcare entity conducted a search and interviews, offered client (B) a lock box, educated him to safeguard his money and not to keep a large amount of money. The facility was unable to establish whether client (B) had that amount of money in his possession or what might have happened. No pattern of theft was identified in the facility. An allegation of deliberate theft could not be substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 8/26/2025 · released to the public 9/2/2025.
6/2/2025Missing Person · ID 25020470009Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 6/2/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a missing person event. Client (B) signed out on a community pass and did not return when expected, which compromised his medical needs. His whereabouts were unknown for over eight hours. During the course of the investigation, the healthcare entity attempted to contact client (B) by phone and notified the police. Over 24 hours later, client (B) returned. There was no reported adverse outcome noted. Client (B)’s pass privileges were revoked until the interdisciplinary team reviewed his safety needs. The event was substantiated. Four days later, the facility reported client (B) left the facility against medical advice to another community setting. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 9/11/2025 · released to the public 9/18/2025.
3/19/2025Misappropriation of Property · ID 25020470007Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 3/19/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Reportedly, a family member discovered $50 missing from client (B)’s possession and felt the money was stolen. Later, the amount changed to $70. During the course of the investigation, the healthcare entity conducted a search and offered a lock box. Staff had been unaware of the client having money in her possession. No other clients reported having any concerns of missing money. The facility was unable to determine if the client had money in her possession as reported or what might have happened. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/23/2025 · released to the public 7/30/2025.
3/9/2025Physical Abuse · ID 25020470006Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 3/12/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a physical abuse event. After client (B)’s discharge, there was an allegation of staff mistreatment at the facility due to findings of bruises and wounds. During the course of the investigation, the healthcare entity conducted a chart review, interviews and notified the police. Client (B) had been admitted to the facility for a short-term respite stay. Review of records showed client (B) had been admitted with bruises and wounds and treatments were provided. There were no falls at the facility, but he did have a history of falls prior to admission. The facility concluded the skin issues were present upon admission and there were no findings of abuse. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/23/2025 · released to the public 7/30/2025.
3/1/2025Missing Person · ID 25020470005Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 3/1/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a missing person event. Reportedly, at-risk client (B) eloped during the morning hours. Staff heard the alarm and conducted a search of the immediate grounds. When he could not be initially located on premises, additional staff joined in the search. During the course of the investigation, the healthcare entity extended the search area and located him two blocks away at a busy intersection. Staff helped him return and provided first aid treatment to a new skin tear. Client (B) was moved to a different unit and his care plan was revised to reflect him as an elopement risk. The event was substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 7/17/2025 · released to the public 7/24/2025.
2/22/2025Physical Abuse · ID 25020470004Reported on time: No
Occurrence summary
SUMMARY OF FINDINGS: On 2/22/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported a physical abuse event. Reportedly, staff (1) reported they observed staff (2) providing rough care to client (B) causing the client pain. Staff (1) asked staff (2) to stop and helped client (B). During the course of the investigation, the healthcare entity suspended staff (2) and conducted an assessment and interviews. Nursing noted client (B) had excoriation to her buttocks area, which contributed to the area being sensitive to touch. Client (B) did not voice any concerns with her care. Staff reported the client typically voices pain with peri-care due to the excoriation, which was being treated. No other clients or staff reported concerns with staff (2). Management discovered some personal issues between staff in the unit, which created a hostile work environment. With the findings, the facility concluded staff (1)’s concerns appeared to be retaliatory against staff (2). The event of abuse was not substantiated. A decision was made to terminate staff (1)’s employment and coaching was provided to staff (2) regarding professional interactions. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was not submitted within the required timeframe.
Publication
Sent to facility 5/31/2025 · released to the public 6/7/2025.
2/14/2025Misappropriation of Property · ID 25020470003Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS: On 2/14/25, the healthcare entity investigated a reportable event of misappropriation of property. Reportedly, client (B) owed money to the facility for his care and stay. Due to non-payment, he was issued a 30-day discharge notice. Client (B) indicated he gave money to a person, whom he identified as his “wife.” The wife used the funds for their needs. During the course of the investigation, the healthcare entity identified client (B) was a potential victim of an email scam and financial exploitation by the "wife" for the past several years. Management notified the police and provided education to the client about the email scam. The facility concluded due to client (B)’s age and diagnoses, he was an at-risk vulnerable person. Actions were taken to help safeguard client (B)’s funds. The allegation of financial exploitation was substantiated. A police investigation was ongoing. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. The department review of the occurrence investigation was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe. In addition, this event has been identified for further investigation by the Department. An onsite investigation was conducted by a representative from the State agency. For results of that on-site investigation, please reference https://cdphe.colorado.gov/find-and-compare-facilities, specifically the inspection dated 3/10/25, Event ID 35QG11.
Publication
Sent to facility 5/28/2025 · released to the public 6/4/2025.
12/10/2024Diverted Drugs · ID 24020470019Reported on time: No
Occurrence summary
SUMMARY OF FINDINGS: On 12/10/24, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported a potential diverted drug event. During the course of the investigation, the healthcare entity identified staff (#1) mishandled discontinued narcotics and there was a suspicion of drug diversion. The medications had been prescribed to clients no longer residing in the facility. Management suspended staff #1 and reviewed associated documents. Interviews with current clients revealed no issues with pain management. Review of nursing documentation showed gaps in nursing entries. Staff #1 admitted to taking narcotics. The facility terminated staff #1’s employment and notified the police and licensing oversight board. Staff educated on revised drug destruction protocol. The event was substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was notsubmitted within the required timeframe.
Publication
Sent to facility 2/26/2025 · released to the public 3/5/2025.
11/5/2024Misappropriation of Property · ID 25020470008Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 5/5/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a misappropriation of property event. Client (B) reported two pairs of shoes were taken some time back in November 2024 and money. During the course of the investigation, the healthcare entity conducted a search and interviews. The facility could not establish that she had these items or money in her possession. Staff reported she was experiencing active delusions during this time that contributed to her confusion. Client (B)’s allegation could not be substantiated. Staff requested a mental health evaluation to help address her mental health needs. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 6/24/2025 · released to the public 7/1/2025.
9/30/2024Misappropriation of Property · ID 24020470015Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 9/30/24, a resident alleged a nurse (1) stole his inhaler. The resident had requested his inhaler, which was secured in the locked medication cart. However, it could not be located. Staff was managing the resident’s medications. The facility replaced the inhaler. The facility was unable to determine what happened to the inhaler, but it was missing from the cart. Education was provided to staff regarding the management of an as needed inhaler for the resident. Management decided to reassign Nurse (1) to another unit due to some negative comments made by the resident and their feelings towards the staff member. DEPARTMENT FINDINGS:In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site review of this reportable event submitted by the agency/facility. This public summary is based on investigative findings provided by the licensed entity to the Occurrence section of the Department. The provider reports the information submitted to the Department is accurate and complete. Prior to the next onsite investigation of the agency/facility, this occurrence event will be reviewed by the State Agency. The occurrence report was submitted within the required timeframe. The facility/agency complied with licensing standards for conducting an internal investigation of this occurrence event and submitting a report of the findings to the Department.
Publication
Sent to facility 1/31/2025 · released to the public 2/10/2025.
9/25/2024Brain Injury · ID 24020470013Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 9/25/24, the healthcare entity investigated a reportable event. The entity acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported a brain injury event involving client (A) post-fall. During the course of the investigation, the healthcare entity provided first aid treatment and initiated neurological monitoring. The client was transferred to the hospital for further evaluation and treatment of a head laceration. Diagnostic imaging showed a brain bleed. The client received sutures to close the laceration and returned in stable condition. Fall safety measures were reviewed and additional interventions were implemented. The event was substantiated that the client experienced an unwitnessed, accidental fall with injury. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 2/8/2025 · released to the public 2/15/2025.
9/2/2024Diverted Drugs · ID 24020470012Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS: On 9/2/24, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported a potential diverted drug event. During the course of the investigation, the healthcare entity identified discrepancies in the medical records, narcotic sign out book for six clients, and there was a suspicion of agency staff (#1) diverting pain medications. Management suspended staff (#1). Client interviews revealed they did not receive pain medications and had no issues with pain management. Review of nursing documentation showed gaps in nursing entries. The facility ceased the work contract with staff #1, notified their staffing agency, and licensing oversight board. The event was substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 2/26/2025 · released to the public 3/5/2025.
5/17/2024Misappropriation of Property · ID 24020470009Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS:On 5/17/24, a resident reported a $100 bill was missing from her wallet and alleged it had been stolen. Staff assisted in a search but it was not located. The police and management recommended she secure the remaining money located in her wallet, but staff reported she initially refused. No other residents reported having any concerns with missing money or items. The resident’s family member reported the resident did not have $100 in her possession. The allegation of misappropriation of property could not be substantiated. A new plan was established for family and the resident to utilize the resident fund account within the facility. DEPARTMENT FINDINGS:In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site review of this reportable event submitted by the agency/facility. This public summary is based on investigative findings provided by the licensed entity to the Occurrence section of the Department. The provider reports the information submitted to the Department is accurate and complete. Prior to the next onsite investigation of the agency/facility, this occurrence event will be reviewed by the State Agency. The occurrence report was submitted within the required timeframe. The facility/agency complied with licensing standards for conducting an internal investigation of this occurrence event and submitting a report of the findings to the Department.
Publication
Sent to facility 12/26/2024 · released to the public 1/2/2025.
5/5/2024Sexual Abuse · ID 24020470008Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS: On 5/8/24, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported an alleged sexual abuse event involving client (A). During the course of the investigation, the healthcare entity reported client (A)’s family member alleged client (A) had been inappropriately touched in a sexual manner by staff #1 when providing personal care. The alleged staff assailant was interviewed and suspended. Management implemented female care providers and conducted an assessment. From interviews with other staff, staff #1 had not provided personal care to the client. Staff #1 was allowed to return to work and was reassigned to another unit. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 2/13/2025 · released to the public 2/20/2025.
4/2/2024Neglect · ID 24020470007Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS: On 4/2/24, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported a neglect event involving client (A). During the course of the investigation, the healthcare entity reported an incident of a client partially falling out of the wheelchair when being transported in a van. Allegedly, the client had not been secured appropriately with the seat belt. There were no reported injuries. Re-training occurred with drivers regarding securing clients and wheelchairs. The facility identified the staff member did not secure the client with the nine out of 10 secure points and determined it was human error. No other clients reported being secured inappropriately. Management planned to conduct random audits for staff compliance. The facility concluded the event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.
Publication
Sent to facility 2/17/2025 · released to the public 2/24/2025.
3/8/2024Misappropriation of Property · ID 24020470005Reported on time: Yes
Occurrence summary
SUMMARY OF FINDINGS: On 03/09/2024, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported misappropriation of client property. During the course of the investigation, the police were called by the client’s bank. Reportedly, funds were withdrawn from the client’s account without the client’s consent. The client and staff were interviewed, and documentation was reviewed. The client’s bank card was cancelled, and the bank account was closed. A new account was opened, and a new debit card was issued. To prevent a recurrence the client’s social security check will go directly to the healthcare entity. The event was substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity’s occurrence report was submitted within the required timeframe.
Publication
Sent to facility 5/2/2025 · released to the public 5/9/2025.
2/24/2024Sexual Abuse · ID 24020470004Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, physician, families/guardians and ombudsman. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The agency/facility's response to this occurrence violated licensing standards by failing to report the occurrence within the required timeframes.
Publication
Sent to facility 3/10/2025 · released to the public 3/17/2025.
1/23/2024Misappropriation of Property · ID 24020470001Reported on time: Yes
Occurrence summary
SUMMARY FINDINGS: On 1/24/24, reportedly, the facility staff identified a resident’s financial power of attorney (FPOA) spent the resident’s money without his permission in lieu of paying his payment owed to the facility for his stay. The facility sent the FPOA a bill for the amount due for the resident’s stay at the facility. The FPOA did not pay the bill. During a phone call with the FPOA on 1/24/24, the FPOA admitted to spending the money for her own personal use, such as a new car, without the resident’s permission. The resident expressed distress during the call and anger towards the FPOA. From the facility’s investigation, it was found, the allegation of misappropriation of property and financial exploitation did occur. On 1/27/24, the FPOA removed the resident from the facility and took him to live with her out of state. The resident was discharged from the facility. Management notified the police and Adult Protective Services regarding the substantiated findings. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site review of this reportable event submitted by the facility. This public summary is based on investigative findings provided by the licensed entity to the Occurrence section of the Department. The provider reports the information submitted to the Department is accurate and complete. Prior to the next onsite investigation of the facility, this occurrence event will be reviewed by the State Agency. The occurrence report was submitted within the required timeframe. The facility complied with licensing standards for conducting an internal investigation of this occurrence event and submitting a report of the findings to the Department.
Publication
Sent to facility 9/5/2024 · released to the public 9/6/2024.
12/4/2023Neglect · ID 23020470046Reported on time: Yes
Occurrence summary
Summary of Findings:On 12/4/23, hospital staff filed a report of alleged facility neglect regarding the care of resident (B)’s wounds. Resident (B) was identified to be dependent on staff to help meet his care needs. The resident had been hospitalized between 11/21 and 11/28. Upon his return, the facility indicated care plan interventions for wound management resumed, supplements provided and wound care dressings occurred per physician orders. The facility indicated the status of his wounds deteriorated post hospitalization. Upon review of the allegation, the facility reported the resident developed unavoidable wounds despite care measures put in place. Documentation showed care had been provided per orders and assessments were completed. The resident’s nutritional status was compromised and recommendations for further supplementation through a feeding tube had been declined. The allegation of staff neglect was not substantiated. Care continued per his individualized plans of care. Department Findings:In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site review of this reportable event submitted by the agency/facility. This public summary is based on investigative findings provided by the licensed entity to the Occurrence section of the Department. The provider reports the information submitted to the Department is accurate and complete. The occurrence report was submitted within the required timeframe. The facility/agency complied with licensing standards for conducting an internal investigation of this occurrence event and submitting a report of the findings to the Department. Prior to the next onsite investigation of the agency/facility, this occurrence event will be reviewed by the State Agency.
Publication
Sent to facility 10/23/2024 · released to the public 11/7/2024.
10/4/2023Missing Person · ID 23020470036Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 10/4/23, a resident notified staff he was leaving to meet a family member. Staff followed and lost sight of the resident at the bank. He was his own responsible person with a diagnosis of mental illness. He was identified to be an at-risk person due to his medical diagnoses and medical needs. He did not have his medications. FACILITY / AGENCY ACTION: The resident called the facility stating he was not coming back and would stop by later to pick up his belongings. The facility reported the resident left against medical advice and was discharged from the facility. The facility notified the police, ombudsman, and physician. Nineteen hours later, he returned. It appeared he fell out in the community and suffered several abrasions. The resident was transferred to the hospital for an evaluation and admitted. He did not return. With the pass program, families are asked to come to the facility to get the resident and sign them out. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence section of the Department. The provider reports the information submitted to the Department is accurate and complete. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed by the State Agency. The occurrence report was submitted within the required timeframe. The facility/agency complied with licensing standards for conducting an internal investigation of this occurrence event and submitting a report of the findings to the Department.
Publication
Sent to facility 7/8/2024 · released to the public 7/15/2024.
8/9/2023Misappropriation of Property · ID 23020470028Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 8/9/23, a resident, in her 50s, alleged someone took $650. She reported last seeing the money on 8/4/23. During different interviews, she said the money had been stored in her lockbox and then said she had it on person. Management reported the resident’s story about where the money came from or how she got the money varied as well. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, family/guardian, and ombudsman. Staff said they did not see the resident with a large sum of cash; two - $20 bills. No one reported having any awareness of a theft to support her allegation. After she made the allegation, she was hospitalized and then transferred to rehabilitation. The facility reported the resident has made this same allegation twice before. Back in January and May 2023, she alleged someone took $650. With the previous reports, the facility was unable to substantiate her allegations of stolen money. Staff reported the resident had a lock box and kept the key on person. The resident had agreed to alert a manager when she brought large sums of cash into the facility. She agreed to store the money in the lock box. However, the facility reported she has not complied with the agreed plan. From the findings, the facility was unable to substantiate the resident’s allegation of misappropriation. When she returned, management planned to re-discuss the safety plan and request she put her money in the facility safe. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the facility/agency acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 10/20/2023 · released to the public 10/27/2023.
8/8/2023Misappropriation of Property · ID 23020470027Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 8/8/23, a resident, in her 80s, alleged someone pried her lock box open and took a $10 bill. She reported seeing the money one day earlier. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, ombudsman, and physician. A manager observed the lock box and did not see any pry marks. The box was locked, and the key was kept close to person. Management educated the resident about the facility safe being available to safeguard items. None of the staff interviewed reported knowing the resident had money in her possession. No staff reported seeing anyone looking or rummaging through the resident’s belongings. No other residents reported having any money missing. There were reports of the resident experiencing increased confusion and paranoid delusions. The facility was unable to determine if the resident had money in her possession or what might have happened. The physician adjusted the resident’s medications to help manage her paranoid delusions. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the facility/agency acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 10/20/2023 · released to the public 10/27/2023.
6/16/2023Misappropriation of Property · ID 23020470021Reported on time: No
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 6/18/23, there was an allegation of a resident, in his 70s, being a potential victim of financial exploitation by a friend. Allegedly, the friend convinced the resident to give them money in excess of $9000. As a result, the resident was unable to make his payment portion owed to the facility. The resident was experiencing a cognitive decline and was identified as an at-risk adult. FACILITY / AGENCY ACTION: The friend took the resident out on pass to his bank on 6/15/23. Per a verbal plan with the facility, the friend was going to help the resident obtain bank statements and withdraw funds to pay his facility bill. Sufficient funds were present in the bank account on 6/14/23, which had been verified by phone in the presence of a staff member and resident. The patient payment was due on 6/16/23, and if not paid, the facility planned to discharge the resident for non-payment. On 6/16/23, when the facility became aware of the resident’s inability to pay, the resident voluntarily discharged himself from the facility. Review of the withdrawal slips showed a large withdrawal occurred on 6/15/23, which left insufficient funds to pay his bill. Staff reported the resident had diminished cognitive capacity and impaired judgment, which could affect his ability to understand the consequences of his actions. Both the friend and resident had been aware of money being owed to the facility when they visited the bank on 6/15/23. The friend denied taking money from the resident but offered no explanation as to the location of the withdrawn funds. From the facility findings, the facility was unable to substantiate with tangible evidence that the friend took the funds from the resident. The friend was present when the withdrawal took place and the resident did not pay his outstanding bill. The facility notified the police and Adult Protective Services regarding the allegation of financial exploitation and misappropriation. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The agency/facility's response to this occurrence violated licensing standards by failing to report the occurrence within the required timeframes. The Department reviewed and accepted the agency/facility plan to address timely reporting requirements.
Publication
Sent to facility 12/19/2023 · released to the public 12/20/2023.
5/28/2023Physical Abuse · ID 23020470018Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 5/28/23, a resident, in his 70s, alleged a staff member punched him in the eye. A new scratch was observed under his eye. The facility reported his story changed when speaking with different staff. He also claimed being kicked in the eye, being pistol-whipped and being held at gunpoint. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, family/guardian, ombudsman, physician and Adult Protective Services. Management suspended the staff member pending investigation. A nurse provided first aid treatment to his eye along with emotional support. Staff increased monitoring on the unit. The staff member reported s/he entered the room in response to the call light, and when reaching over to turn off the light, the staff member reported losing their balance, which startled the resident. The resident responded by getting up out of bed and started to approach the staff member in an alleged aggressive manner. In a rush to leave, the staff member said his/her hand made physical contact with the resident accidentally. Upon leaving the room, the staff member notified the nurse regarding the incident. No other residents or staff interviewed reported having any concerns with the staff member. Due to the conflicting statements, the facility was unable to substantiate the resident’s allegation that the staff member punched the resident intentionally. Education was provided to staff regarding customer service approaches. Staff was asked to make sure the resident was aware of their presence and physical actions because of his fear and irritability. Following the investigation and education, the staff member returned to work. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 12/4/2023 · released to the public 12/11/2023.
5/8/2023Misappropriation of Property · ID 23020470014Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 5/8/23, a resident, in her 50s, reported $680 was missing from her lock box. She said the key was placed in her purse, which was left on the bed. She left the room, and upon returning, she said the money was gone. She alleged her roommate took the money. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, ombudsman, and family. Prior to this event, management reported education had been provided regarding keeping her money secure through either a facility account or her lock box. The resident had a pattern of reporting missing money. She recalled receiving $700 recently and only spent $40. The roommate denied taking any money. The facility was unable to verify if the resident received money or how much if she did. The resident’s allegation of misappropriation of property could not be substantiated. Education was provided again to the resident to keep her money and key secured. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 7/27/2023 · released to the public 8/3/2023.
4/13/2023Misappropriation of Property · ID 23020470007Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 4/13/23, a resident, in his 70s, reported $124 was missing. He said he had that amount of money in his possession at admission. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, family/guardian, ombudsman, and physician. A manager helped search for the money, but it was not found. The facility reported a lock box was offered to the resident upon his admission, but he declined. Staff said he chose to keep the money in his shirt pocket. One staff member reported s/he conducted a count of the money with the resident upon admission, but did not follow through with placing the amount of money on the resident’s inventory sheet. The amount of money was not verified with a second staff member, which was part of the facility protocol. No other residents reported having any current issues about missing belongings. The facility concluded nursing staff did not follow admission policies for verifying a resident’s money upon admission. The facility was unable to determine what happened to the resident’s money. Re-education was provided to the staff regarding the admission process, verifying money and noting personal property on the inventory list. The facility offers several options to residents to help safeguard their valuables upon admission. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 7/27/2023 · released to the public 8/3/2023.
3/15/2023Physical Abuse · ID 23020470005Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 3/15/23, a resident, in his 60s, alleged a staff member grabbed his wrist causing him pain. He also said the staff member bumped his feet (toe amputation) during a shower and it hurt. There was also a comment that the staff member was rude and unprofessional with her comments. He alleged this staff member was the reason his toes were amputated (however, she did not work in the facility at that time). He suffered from extremity contractures, and per staff, he exhibited challenging behaviors. Two staff members should be present during any interactions with the resident. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, family/guardian, ombudsman, and physician. Management suspended the staff member pending investigation. A nurse assessed him and found no visible injuries. He had no current complaint of pain related to the alleged incident. The staff member reported that he calls staff vulgar names and attempts to hit them. The staff member acknowledged using his/her hand gently to hold his wrist so s/he did not get hit. Staff witness reports seeing no one handle the resident in a rough manner. With his diagnoses, he frequently reports having pain during care provisions. No other residents or staff reported having any issues with the staff member’s care or handling. From the findings, the facility did not substantiate an allegation of abuse or rough handling. However, the staff member did not follow his plan of care by having a second staff member present during a recent shower. Staff education was provided to follow his plan of care and to continue being gentle when working with him. Due to a history of making unsubstantiated allegations, management recommended staff continue providing care in pairs. The staff member returned to work, but s/he was reassigned not to work with this resident. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the facility/agency acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 9/29/2023 · released to the public 10/5/2023.
1/23/2023Misappropriation of Property · ID 23020470003Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 1/23/23, a resident, in her 50s, reported she was missing between $180 and $215. Two days earlier, a lock box was installed in her room, but she had not secured her money. She reported last seeing the money eight days earlier. Currently, she had other money secured inside the lockbox. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, family/guardian, and ombudsman. Per the facility, the resident handled her own finances and had a history of not wanting to pay her patient portion owed to the facility. Staff reported she was not always truthful about her money situation. From what the resident disclosed regarding denominations of cash she had in her possession and recent withdrawals from her bank account, the business transactions could not be verified. The business office manager stated the resident typically puts the patient payment portion on her card and did not pay with cash. No staff reported having any awareness of wandering residents going through other belongings. The facility was unable to substantiate her allegation of misappropriation of property. A manager encouraged the resident to use her lockbox. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 6/12/2023 · released to the public 6/19/2023.
1/21/2023Neglect · ID 23020470002Reported on time: Yes
Occurrence summary
DESCRIPTION OF OCCURRENCE: On 1/21/23, there was a report of a resident, in her 80s, falling during the evening shift on 1/20/23. She suffered a fracture. Management discovered that an agency nurse did not call the physician after receiving the results of the fracture per the x-ray findings. The agency nurse did not follow facility protocols for notifying the physician with a potential for a delay in care and management of her fracture. When the morning shift arrived, a nurse manager instructed staff to call the physician and she was transferred to the hospital. She underwent surgical repair. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, family/guardian, ombudsman, and physician. An audit was conducted on resident charts and no other residents were identified regarding timeliness of emergency treatment. The facility reported physician numbers are posted at the nurses’ station. Review of the records showed that after the fall, the resident complained of groin pain. Tylenol was provided for pain management through the night. The agency nurse said she did not call the physician due to family instruction not to send her to the hospital until the morning. The nurse said the family wanted the resident to sleep. The agency nurse said she was also not aware of the physician call process and confirmed she did not call the physician. Immediate education was provided to this nurse regarding protocol and nursing expectations with standards of practice. The off-going nurse working the evening shift reported she instructed the agency nurse to watch for the x-ray results and call the physician and family. From the findings, the facility concluded the agency nurse did not follow facility policy that night and should have alerted the physician of the fracture results. However, the allegation of staff neglect was unsubstantiated as staff attended to the resident’s change of condition that night and honored family wishes. Once she was medically cleared, she returned from the hospital. Per the family and resident report, the surgeon stated the resident had weak bones causing a fracture, which most likely contributed to the cause of her fall. Therapy services was ordered to assist with her rehabilitation. Contact numbers for triage, physicians and nurse managers are posted for all staff at the nurses’ station. In addition, easy read instructions on processes are available for nursing staff. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.
Publication
Sent to facility 8/16/2023 · released to the public 8/23/2023.