Original Inspection report

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0578

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Honor the resident’s right to request, refuse, and/or discontinue treatment, to
participate in or refuse to participate in experimental research, and to formulate an
advance directive.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review and interview, the facility failed to ensure the advanced directive
were correct and according to the choices of two sampled residents (Resident #92 and #91)
out of 44 sampled residents. The facility census was 93 residents.
1. Record review of Resident #92’s Face Sheet showed he/she was admitted to the facility
on [DATE], with [DIAGNOSES REDACTED].), [MEDICAL CONDITIONS] ([MEDICAL CONDITION]- a
progressive disease that is characterized by shortness of breath and difficulty
breathing), [MEDICAL CONDITION] (abnormal heart rhythm), kidney failure (a medical
condition in which the kidneys no longer function), abdominal pain, high blood pressure
and malnutrition.
Record review of the resident’s Minimum Data Set (MDS-a federally mandated assessment tool
to be completed by facility staff for care planning) dated [DATE] showed he/she:
-Was alert and oriented with minimal confusion and
-Needed limited assistance with bathing, dressing, transferring, and continence.
Record review of the resident’s Social Service Notes dated [DATE], showed he/she was
admitted to the facility and was oriented to person and place but was not oriented to the
month or day of the year. The note showed the resident was a Full Code (if a patient has a
cardiac or respiratory arrest, the healthcare provider is ethically and legally obliged to
perform life-saving measures).
Record review of the resident’s Code Status form, signed by the resident, and Social
Service Worker on [DATE], and by the resident’s physician on [DATE], showed the resident
was a Full Code.
Record review of the resident’s Physician Order Sheet (POS) showed:
-On 10 /,[DATE], the resident’s code status was Do Not Resuscitate (DNR-a medical order
written by a doctor. It instructs health care providers not to do cardiopulmonary
resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops
beating) and
-[DATE] to [DATE] showed the resident’s code status was DNR.
During an interview on [DATE] at 10:22 A.M., the Director of Nursing (DON) said:
– When the resident is admitted to the facility, if they come with physician’s orders the
code status will be on the orders;
-Then the resident or responsible party will meet with the Social Worker and if the code
status is changed at that time, the Social Worker will document that in the notes and it
will be changed on the resident’s POS;
-This morning before he/she sent the resident out to the hospital, he/she noticed that the
resident’s POS showed the resident’s code status was DNR and the resident is not a DNR;
-The resident’s signed code status form showed that he/she is a Full Code and the
resident’s physician signed it on [DATE], so it should have been changed on the POS to
show the resident was a Full Code and
-He/She changed the resident’s code status on the resident’s POS this morning.
2. Record review of the Resident’s #91 Face Sheet showed he/she was admitted to the
facility on [DATE] with the following Diagnoses: [REDACTED].
-Bacteremia – The presence of bacteria in the blood;
-Dysphagia – Is the medical term used to describe difficulty swallowing;
-Disorder of Brain – A broad term for any brain disease that alters brain function or
structure;

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0578

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 1)
-[MEDICAL CONDITION] Disorder, [MEDICAL CONDITION] type – A mental health condition
including [MEDICAL CONDITION] and mood disorder symptoms;
-Major [MEDICAL CONDITION] – Depressed mood or loss of interest in activity and
-Feeding Tube – Is a device that’s inserted into your stomach through your abdomen. It’s
used to supply nutrition when you have trouble eating.
Record review of the resident’s Care Plans dated on [DATE], showed the following:
-The resident had appointed his/her son as his/her Durable Power of Attorney (DPOA-takes
effect when you become incapacitated ad unable to handle matters on your own);
-The resident and the son had decided he/she will be a DNR;
-The resident had indicated he/she did not want any extensive assistance or CPR provided
in the event that he/she does not have any respirations and or pulse;
-Staff was not to provide any extensive care in the event that resident’s pulses and or
respirations stop;
-The facility was to ensure the resident’s medical chart was properly marked to notify
concerning staff of code status and
-Was to ensure that DNR form was signed by the medical doctor and place the code status in
the resident’s medical chart.
Record review of the resident’s Outside The Hospital Do Not Resuscitate (OHDNR) Order
dated [DATE] was signed by the resident himself/herself showed he/she had authorize
emergency medical personnel to withhold or withdraw cardiopulmonary resuscitation from the
resident in the event he/she suffered cardiac or respiratory arrest. [MEDICAL CONDITION]
means the heart stops beating and respiratory arrest means the resident has stop
breathing.
Record review of the resident’s medical record dated on [DATE] showed he/she was listed as
No Code (No CPR) which means all measure of resuscitation will be taken in the following
domains:
-No emergency I V’s or medication;
-No further hospitalization ;
-No incubation/ventilator;
-No feeding tube;
-No artificial hydration;
-Comfort measures only;
-Give pain medication (by mouth or rectal). Outside the Hospital Do-Not-Resuscitate
(OHDNR) order will take effect and no medical procedure to restart breathing or heart
functioning will be instituted and
-On [DATE] the Medical Doctor signed the OHDNR order and the statement reads on the above
document that I authorize Emergency Medical Services Personnel to withhold or withdraw
Cardiopulmonary resuscitation from the patient in the event of Cardiac Respiratory Arrest.
Record review of the resident’s POS dated on [DATE] showed the resident was a Full Code.
3. During an interview on [DATE] at 10:00 A.M., the Certified Nursing Assistant (CNA) D
said he/she had to ask the Charge Nurse on duty the code status of each resident on
his/her hall if there was an emergency situation on that hall.
During an interview on [DATE] at 10:50 A.M., the Licensed Practical Nurse (LPN) A said:
-Had been trained and instructed to always follow the resident’s physician’s orders
pertaining to the resident current code status and not the resident’s Advanced Directives;
-Must follow the doctor’s written signature related the resident’s code status;
-Was responsible for asking each resident on monthly basis the question what if your heart
stop beating what would you like for us to do?
-Was responsible for keeping the code status of each resident up to date in the resident’s
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0578

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 2)
medical chart;
-The resident’s doctor and the resident’s responsible party had to sign the appropriate
documents pertaining to the resident’s code status and
-The resident’s Power of Attorney will make the the decision regarding the resident’s
medical condition if the resident is no longer able or capable of making his/her medical
decisions.
During an interview on [DATE] at 1:00 P.M., the DON said:
-Had placed a black dot on the resident’s door and in the resident’s medical chart to
determine the resident’s code status was DNR;
-Provided training to nursing staff on code blue and said everyone in the facility is
expected to respond to the code blue ( emergency situation in the facility);
-Was responsible for checking the resident’s medical record code status and when the
resident is initially admitted to the facility;
-Would fix the resident’s code status if he/she found the resident’s advance directives
and physician’s orders did not match and
-He/she was planning to conduct on an audit on the 93 residents who resided in the
facility to ensure the accuracy of each resident’s code status or Advanced Directives are
current and reflects the resident’s rights and choices for their health care wishes or
needs.

F 0584

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Honor the resident’s right to a safe, clean, comfortable and homelike environment,
including but not limited to receiving treatment and supports for daily living safely.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation and interview, the facility failed to maintain the fans in resident
rooms 203, 206, 204, free of a heavy dust buildup; failed to maintain the mattress in
resident room [ROOM NUMBER] in good repair; failed to maintain the restroom ceiling vents
in resident rooms 102, 105, 303, and the 40 Hall shower room, free of a heavy dust buildup
inside the vents; failed to maintain the floors of resident rooms 201, 206, 205, 306, 32,
36, 37, 30, 404, 412, free of dust and grime; failed to maintain resident rooms 105, 36,
free of a buildup of cobwebs (tangles of the silken threads of a spider web usually
covered with accumulated dirt and dust); failed to maintain one stand up lift free of a
buildup of dust and food debris; failed to ensure the minimum square footage required (80
square feet) in residents rooms was maintained for three residents who shared room [ROOM
NUMBER]; and failed to ensure room [ROOM NUMBER] was free of excessive clutter
(wheelchairs, Hoyer lifts and Sit to Stand equipment were stored on one half of the room,
one of the closet’s door was broken, one high walker chair and one oxygen tank were also
stored in that room). This practice potentially affected at least 70 residents throughout
the facility. The facility census was 93 residents.
1. Observations with the Maintenance Director, the Administrator, and the Housekeeping
Supervisor on 11/20/18, showed:
– At 9:03 A.M., a buildup of dust was present in the restroom ceiling vent of resident
room [ROOM NUMBER],
– At 9:06 A.M., a buildup of dust was present in the ceiling vent of the shower room next
to resident room [ROOM NUMBER],
– At 9:16 A.M., there were two cracks that measured 28 inches (in.) and 22 in. in length

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0584

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 3)
on the mattress in resident room [ROOM NUMBER], and cobwebs hung from the ceiling and a
dusty ceiling vent in the restroom,
– At 9:22 A.M., a stand-up lift was present outside of resident room [ROOM NUMBER] with a
large buildup of dust, food crumbs and debris on the base of the lift,
– At 9:24 A.M., Certified Nurse’s Assistant (CNA) D said the lifts should be cleaned
during the night shift and there were two residents in that section (the Cherry Lane) who
required a stand up lift for transfers,
– At 9:38 A.M., a buildup of dust was present on the floor behind the furniture in
resident room [ROOM NUMBER],
– At 9:38 A.M., the Administrator said the housekeeping staff were not moving the
furniture,
– At 9:40 A.M., a buildup of dust was present on the fan in resident room [ROOM NUMBER],
– At 9:53 A.M., a buildup of food crumbs was present on the floor and a buildup of dust
was present on the fan in resident room [ROOM NUMBER],
– At 9:56 A.M., a large amount of dust was present on the floor next to the bed in
resident room [ROOM NUMBER],
– At 9:58 A.M., a buildup of dust was present on the fan in resident room [ROOM NUMBER],
– At 10:11 A.M., a buildup of food crumbs and assorted debris was present on the floor in
resident room [ROOM NUMBER],
– At 10:13 A.M., a buildup of dust was present in the restroom ceiling vent of resident
room [ROOM NUMBER],
– At 10:15 A.M., two torn pillows were present in resident room [ROOM NUMBER],
– At 10:16 A.M., the Administrator said that was not Ok,
– At 11:01 A.M., a buildup of dust was present on the floor of resident room [ROOM
NUMBER],
– At 11:02 A.M., the Housekeeping Supervisor agreed there was a lot of dust on that room
floor,
– At 11:03 A.M., a buildup of cobwebs was present in resident room [ROOM NUMBER],
– At 11:03 A.M., the Housekeeping Supervisor said the housekeepers should be in the rooms
daily,
– At 11:09 A.M., there was a presence of grime on the floor of resident room [ROOM
NUMBER],
– At 11:22 A.M., a buildup of dust was on the floor behind the dresser in resident room
[ROOM NUMBER],
-At 12:10 P.M., a buildup of dust was present in the ceiling vent of the 400 Hall shower
room,
– At 12:13 P.M., there was a presence of grime on the floor of resident room [ROOM
NUMBER], and
– At 12:16 P.M., there was a presence of grime with popcorn seeds, on the floor of
resident room [ROOM NUMBER].
During an interview on 11/27/18 at 12:27 P.M., the Housekeeping Supervisor said:
– When the housekeepers go in, they should move beds away from the walls, look up at the
ceilings and look in the corners both upper corners and lower corners,
– He/she felt that he/she did not have enough time to check behind the housekeepers,
– The housekeeping department got a full staff within the last month,
– He/she was short three people in the housekeeping department,
– The maintenance is supposed to clean the inside of the ceiling vents, and
– The department can clean the outside.
2. Observation on 11/19/18 at 9:00 A.M., 11/20/18 at 9:45 A.M., 11/28/18 at 3:00 P.M., and
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0584

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 4)
on 11/29/18 at 10:00 A.M., showed the resident’s room [ROOM NUMBER] had one white Hoyer
Lift, two black wheelchairs, one oxygen tank near a resident’s bed area, and one beige
closet door off its hinges stored in the southeast corner of the resident’s room.
Observation on 11/28/19 at 3:00 P.M. showed the resident’s room [ROOM NUMBER] was reduced
to 72.5 square foot (sq. ft.) of floor space for each the three residents residing in the
room.
During an interview on 11/29/18 at 10:00 A.M., the Certified Nursing Assistant CNA D said
he/she:
-Had four residents on Hall 100 that used stand up lifts/or Hoyer Lifts equipment.
-Had observed on several mornings while conducting her nursing rounds that some residents
had excessive equipment in their rooms as Hoyer Lifts, multiple wheelchairs, large
walkers, oxygen tanks and broken closet doors.
-Had informed the other nursing staff to these safety concerns and their was to much
equipment in the resident’s room and the extra equipment needed to be removed immediately
to ensure the resident’s safety.
-Had agreed the resident should remain safe, neat, clean and tidy without clutter and no
danger or harm to the residents.
During an interview on 11/29/18 at 10:50 A.M., Licensed Practical Nurse (LPN) A said
he/she:
-Had two residents on Hall 100 that used a stand up lifts/or Hoyer Lift equipment.
-Had expected the Certified Nurse Assistants (CNA’s) to keep the resident’s room safe at
all times, and to make sure the resident’s room remained free of clutter.
-Had wanted the Hoyer Lifts to be stored on Cherry and Applegate floor as it related to
storing medical equipment properly.
– Did not know what amount of square footage is required by state regulation for shared
resident rooms.
During an interview on 11/29/18 at 1:00 P.M., the Director of Nursing (DON) said:
-Two residents on Hall 100 used stand up lift and hoyer lift.
-The hoyer lifts were stored in the room that could be locked.
-He/she was unable to recall the correct square footage as it relates to there required
floor space for resident who share a shared space area when three to four resident resided
together in a designated room area.
-He/she believed that each resident should have enough floor space to ensure or protect
the resident’s dignity.
MO 409.

F 0645

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

PASARR screening for Mental disorders or Intellectual Disabilities

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, record review and interview the facility failed to ensure the
Initial and Pre-Admission Screening for Mental Illness/Mental [MEDICAL CONDITION] or
Condition (PASARR) Disorder was completed and obtained upon admission for one sample
resident (Resident #81) out of 44 sampled residents. The facility census was 93 residents.
Record review of the Missouri Department of Health and Senior Services Division of
Regulation and Licensure regarding Pre-Admission Screening for Mental [MEDICAL CONDITION]
or Related Condition (PASARR) Disorders Policy showed the following:

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0645

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 5)
-Pre- admission screening for individuals with Mental Disorder and Individuals with
Intellectual Disability
(1). A Nursing facility must not admit, on or after (MONTH) 1, 1989, any new resident
with:
-Mental disorder as defined in paragraph () (3) (i) or this section, unless the State
Mental Health Authority has determined, based on an independent physical mental evaluation
performed by a person or entity other than the state mental health authority, prior to
admission.
B. If the individual requires such level of services, whether the individual requires
specialized services or any specified rehabilitative services the nursing facility will
provide the result of PASARR recommendations. If a facility disagrees with the findings of
the PASARR, it must indicate its rationale in the resident’s medical chart,
1. Record review of the resident’s Face Sheet showed he/she was admitted to the facility
on [DATE] with the following Diagnoses: [REDACTED].
-Post Traumatic Disorder ( [MEDICAL CONDITION]) – A disorder in which a person had
difficulty recovering after experiencing or witnessing a terrifying event;
-Major [MEDICAL CONDITION] – Depressed mood or loss of interest in activities; and
-Anxiety Disorder – A mental health disorder characterized by feelings of worry, anxiety,
or fear that are strong enough to interfere with one’s daily activities.
Record review of the resident’s annual Minimum Data Set (MDS – a federally mandate
assessment tool be completed by facility staff for care planning dated, on 8/10/16 showed
the resident:
-Had a Brief Interview for Mental Status (BIMS) of 6 and needed cueing and prompting by
staff.
-Had limited ability to communicate his/her needs to others.
-Had poor decision making skills.
-Was totally dependent with the assistance of two staff persons for his/her Activities of
Daily Living (ADL’s) for eating, bathing, dressing, transferring and other mobility needs.
Record review of the resident’s cognitive Care Plan dated 8/10/16 showed the following:
-He/she had Dementia.
-He/she was not able to tell the year, day of the week or mouth and requires staff
assistance for decision making.
-He/she had a legal guardian to help make health and financial decisions.
-had poor insight and an occasional delayed response and may miss the intent of what you
are saying to him/her during conversations.
-Had poor insight and an occasional delayed response and may miss the intent of what your
are saying to him/her.
-The resident takes scheduled [MEDICATION NAME] (a medication used to treat [MEDICAL
CONDITION]- a progressive disease that destroys memory and other important mental
functions).
-He/she had expected to make simple daily decisions with the assistance from staff through
the next 90 days.
-The facility staff was expected to give the resident choices as often a s possible about
(ADL’s).
-He/she was expected to be oriented during his/her waking hours.
-He/she was to provided repeated questions and statements as needed to give him time to
respond to intended questions from staff.
-Was to call the resident by his/her name when he/she was approached by staff or if you
needed to get his/her attention.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0645

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 6)
-The resident preferred to be faced when the staff wanted to talk or interact with
him/her.
Record review of the resident’s Care Plan dated on 8/10/16 showed he/she used or was
prescribed Psychoactive Medication and had the following health care needs:
-The resident had [MEDICAL CONDITION], anxiety and depression.
-He/she was at high risk for complications related to having the these Diagnosis:
[REDACTED].
-The resident will not have adverse reactions related to the use of Psychoactive
Medication,
-He/she had scheduled medication as ordered by the doctor, obtain any labs ordered and
report abnormal results or behaviors to the resident’s medical doctor.
-He/she was to have a psych-social consults as needed to monitor for changes in behavior,
orient and reassure resident as needed.
During an interview on 11/29/18 at 10:50 A.M., the Licensed Practical Nurse (LPN) A said:
-He/she expected that all residents have an Initial and Pre-screening Assessment Screening
on file for each resident so the nursing staff can provide appropriate services an
assesses the resident for any problems or/behaviors during or prior to the facility’s
resident’s admission process.
-He/she expected all residents to have access to the highest practicable mental and
psychosocial well-being.
-He/she had expected each resident to have twenty-four hours protective oversight at the
facility.
-He/she expected the resident’s who qualified for a PASARR to have this information in
his/her Comprehensive Plan of Care and in the resident’s medical record.
During an interview on 11/29/18 at 1:00 P.M., the Director of Nursing (DON) said:
He/she had requested the electronic copy of the resident’s Initial and Pre-screening
PASARR for the resident several days ago.
-On the DON’s computer the DON had requested the Sunshine request for multiple residents
who needed a PASARR in their resident’s medical record on 11/28/18.
-Was going to contact the agency that does the PASARRs to request a copy of the resident’s
PASSAR.
-Acknowledged the Intial and Pre-screening Admission Records should had been filed in the
resident’s medical record or in the Social Services’s office prior to the annual survey
date.
-The Social Services department is responsible for tracking and monitoring the residents’
PAS[DIAGNOSES REDACTED].

F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Ensure services provided by the nursing facility meet professional standards of
quality.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to to contact or
notify the resident’s physician when the resident’s blood sugar was above 300 parameters
during the late evening/ and night hours for over a period of four days for one sample
resident (Resident #7) and failed to follow a physician’s orders [REDACTED].#75) out of 44
sampled residents. The facility census was 93 residents.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 7)
1. Record review of the Resident’s #7 Face Sheet showed he/she was re-admitted to the
facility on [DATE] with the following [DIAGNOSES REDACTED].
Record review of the resident’s physician’s orders [REDACTED].>-Check the resident’s
blood sugar three times per day at 7:00 A.M., 12 Noon and 7:00 P.M,
-At 6:00 A.M., 12 Noon and 6:00 P.M., administer [MEDICATION NAME]5 units subcutaneous
(sub-q) before meals and to hold the insulin if the resident’s blood sugar was less than
120.
-The resident is to have a meal within 10-15 minutes of his/her insulin injections.
-Notify the resident’s physician when the resident’s blood sugars 300 or greater and if
less than 120.
Record review of the resident’s Admission Minimum Data Set (MDS – a federally mandated
assessment tool to be completed by facility staff for care planning) dated 10/18/18
showed:
-Had a Brief Mental Interview Status of 6 which means he/she had trouble concentrating or
paying attention.
-He/she was able to complete simple tasks for activities of daily living such as eating.
-He/she was at risk for impaired thought processes.
-He/she had difficulty making decisions.
-Had Dementia ( Memory loss) with behavioral disturbance.
Record review of the resident’s quarterly diabetic Care Plans dated 10/18/18 showed:
-The resident had labile blood sugars.
-He/she blood sugars will be below 120 by 2/14/19.
-He/she will not require additional insulin for the period dated 2/14/19.
-He/she had high A1C will be below 6 dated for 2/14/19.
-Was to monitor the resident’s nutritional intake.
-Was to obtain finger stick blood sugars as ordered by the medical doctor.
-The resident was referred to a Dietician.
-The staff was to observed fro signs of Hypo/[MEDICAL CONDITION].
-The resident was on a regular diet.
-He/she eats all of his/her meals in the dining room.
-He/she is able to feed himself after set up is provided.
-He/she is noted for double portion of protein at meals.
Record review of the resident’s (MONTH) (YEAR) Medication Administration Record
[REDACTED].
Record review of the resident’s Nurse’s Notes dated on 11/19/18 at 6:10 P.M., showed:
-The resident was running a high abnormal blood sugar level.
-The resident’s medical doctor was contacted today while the doctor was in the facility.
Record review of the resident’s (MONTH) (YEAR) MAR, showed:
-On 11/20/18 at 12 noon the resident’s blood sugar reading was 400.
-On 11/21/18 at 12 noon the resident’s blood sugar reading was not recorded or noted by
the charge nurse.
-On 11/21/18 at 6:00 P.M. the resident’s blood sugar reading was 280.
-On 11/22/18 at 12 noon the the resident’s blood sugar reading was 290.
-On 11/23/18 at 12 noon the resident’s blood sugar reading was 396. (there was no
documentation that the resident’s physician was notified of the resident’s blood sugar
over 300.)
-On 11/24/18 at 12 noon the resident’s blood sugar reading was 398. (there was no
documentation that the resident’s physician was notified of the resident’s blood sugar
over 300.)
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 8)
-On 11/25/18 at 12 noon the resident’s blood sugar reading was 336. (there was no
documentation that the resident’s physician was notified of the resident’s blood sugar
over 300.)
During an observation on 11/26/18 at 11:45 A.M., the resident blood sugar level was
elevated to 422.
-Licensed Practical Nurse (LPN) A notified the resident’s physician of the resident’s high
blood sugar and the resident did not have a physician’s orders [REDACTED].
-The resident’s physician gave an order for [REDACTED].
Record review of the resident’s MAR indicated [REDACTED].
Observation on 11/26/18 at 11:45 A.M. the resident did not receive any meals to eat until
1:30 P.M.
-The resident’s physician’s orders [REDACTED]. The resident received his/her insulin at
12:00 P.M.
During an interview on 11/26/18 at 11:45 A.M., LPN A said:
-Had been off for four days and when he/she returned to work on 11/27/18 had noticed over
the four days that the resident had high blood sugar levels during the noontime and
evening/night hours.
-Did not find any nurse’s notes in the computer system by the noon or night time shift
nurses.
-The resident’s primary doctor was not notified of the resident’s high blood sugars during
that time frame and there were no nurses’s notes found in the computer that showed the
staff during that time notified the resident’s physician of the high blood sugars.
– The physician’s orders [REDACTED].
-Was to continue to monitor the resident over the next few hours for sweating and inform
the evening nurse on duty about the resident’s high blood sugars today.
Record review of the resident’s MAR indicated [REDACTED].M. showed the resident’s blood
sugar reading was 442.
During an interview on 11/28/18 at 10:00 A.M., the CNA A said all insulin injections are
done by the LPN on duty, CNA’s cannot perform this duty of providing insulin injections to
the residents.
During an interview on 11/28/18 at 11:45 A.M., the LPN A said:
-The resident had his/her regular scheduled 5 units of insulin at 12:00 P.M.
-The resident had not received his/her lunch meal until 1:00 P.M.
-According to physician’s orders [REDACTED].
During an interview on 11/28/18 at 10:50 A.M., LPN A said:
-If the resident does not have a sliding scale for his/her blood sugars levels the Charge
Nurse must contact the resident’s physician immediately.
-It was the charge nurses responsibility to notify the resident’s physician of any changes
in the resident’s blood sugars.
-Was to monitor the resident’s for any physical signs/symptoms as needed.
-Notify the other nursing staff on the next shift regarding the resident’s medical needs
at all times.
-Notify the Director of Nursing (DON) of any changes in the resident’s medical condition
and the administration of the resident’s insulin due to his/her blood sugar readings.
During an interview on 11/28/18 at 1:00 P.M., the DON said:
-Expected the nursing staff to follow all Physicians Orders for a resident who is
receiving regular scheduled insulin injections so that the resident can remain with the
doctors’ insulin parameters.
-Expected the Charge Nurse to notify the resident’s physician and for the resident’s
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 9)
physician to call the Charge Nurse back regarding the resident’s high blood sugar levels.
2. Record review of Resident #75’s Facility admission sheet date showed the resident was
admitted on [DATE] with the following Diagnoses: [REDACTED].
-Symbolic dysfunction (A communication disorder that affects an individual’s ability to
comprehend, or apply language and speech to effectively communicate with others) .
-Chronic [MEDICAL CONDITION] (A long [MEDICATION NAME] liver infection).
-Urinary Tract Infection (An infection of the kidney, ureter, bladder, or urethra).
-[MEDICAL CONDITION] (a benign overgrowth of prostate tissue that surrounds the urethra
constricting urine flow).
Record review of the resident’s Care Plan dated 7/10/18 showed the resident had
physician’s orders [REDACTED].
Record review of the resident’s Quarterly Minimum Data Set (MDS-a federally mandated
assessment tool completed by facility staff for care planning) dated 10/17/18 showed:
-The resident was cognitively intact;
-Was continent of bowel;
-Intermittent (occurring at intervals) catheterization (use of a thin flexible tube to
drain urine from the bladder)
Record review of the resident’s physician’s orders [REDACTED].
-The resident had an indwelling catheter (a flexible tube inserted into bladder that is
held in place by a balloon inflated with sterile water) that was discontinued on 11/22/18;
and
The resident’s physician ordered a straight catheter to be done four times a day and as
needed (PRN).
Record review of the resident’s Care Plans showed reinstatement of a plan for Straight
Catheterization by self with or without staff assistance was reinstated on 11/24/18.
During interview on 11/27/18 at 9:38 A.M. the resident said:
-The urinary catheter fell out; and
-When it fell out it didn’t hurt.
During an interview on 11/27/18 at 9:47 A.M. Certified Nursing Assistant (CNA) B said:
-The resident removed the urinary catheter;
– He/she had complained of pain; and
-The resident refuses to allow us to help him/her.
During an interview on 11/27/18 at 11:33 A.M. the Assistant Director of Nursing (ADON)
said:
-Nursing staff assists the resident in straight catheter use;
-The resident requires reminding to wash his hands and to use gloves; and
-The resident has had frequent Urinary Tract Infections.
During an interview on 11/28/18 at 10:12 A.M. Licensed Practical Nurse (LPN) D said:
-The resident had chronic urinary tract infections previously from doing his/her own
straight catheterization; and
-The physician’s orders [REDACTED].
During an interview on 11/28/18 at 12:58 p.m. the Director of Nursing (DON) said:
-A physician’s orders [REDACTED].
-The expectation is that the charge nurse would complete the straight catheterization as
ordered;
-The resident would not be permitted to do the straight catheterization.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Ensure that a nursing home area is free from accident hazards and provides adequate
supervision to prevent accidents.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, record review and interview, the facility failed to provide
oversight for one resident (Resident #35) to protect himself/herself and at least 10 other
residents who resided in that area from the risk of fire, because that resident smoked in
his/her room. The facility census was 93 residents.
Record review of the facility’s policy regarding Smoking Safety dated 4/6/17, showed:
– No smoking in resident rooms,
– The facility will ensure that all designated smoking areas will utilize a
non-combustible, self-closing container for the resident’s smoking to ensure cigarette and
ashes are disposed of properly,
– The facility will provide direct supervision for smoking by patients classified as not
responsible, and
– The facility metal containers will have self-closing cover devices into which the ash
trays can be emptied are readily available to all areas where smoking is permitted.
1. Record review of the Resident’s Care Plan dated 12/14/17, showed facility staff were to
monitor the resident’s room daily for signs of smoking in his/her room, document, and
report behavior to the nurse.
Record review of the resident’s smoking assessment dated [DATE], 6/24/18 and 9/4/18,
showed Resident #35 was:
-Alert and oriented times,
-Able to hold cigarettes, lighter/matches without assistance,
-Had been educated on the risks of smoking,
-Was not physically able to extinguish a lit cigarette/ash that has fallen on themselves
or others,
-had a history of [REDACTED].>-Was not compliant with facility rules.
Record review of the Resident quarterly Minimum Data Set (MDS- a federally mandated
assessment tool required to be completed by facility staff for care planning) dated
9/12/18, showed the resident scored a 15 on his/her BIMS assessment indicating that he/she
was alert and oriented, and understood others.
Observation with the Maintenance Director, the Housekeeping Supervisor and the
Administrator, on 11/20/18 at 9:48 A.M., showed:
– The presence of cigarette ashes on the floor,
– Numerous burn marks on the left side of the drawer and the television set, and
– No self-closing ash trays in the room.
During an interviews on 11/21/18 at 11:15 A.M., the Care Plan Coordinator said:
– He/she noticed smoking in the resident’s room about year and half ago,
The facility tried to place the resident on supervised smoking with a staff member
watching,
– That was only done for a couple of weeks, and
– As far as he/she knew, the Resident was doing well.
During an interviews on 11/21/18 at 11:17 A.M., Licensed Practical Nurse (LPN) A said:
– No one reported to him/her that the resident had smoked in his/her room,
– He/she had never heard from anyone that the resident smoked in his/her room,
– He/she had done one-hour checks and had never smelled smoke in the resident’s room, and
– He/she knew the resident went to his/her smoke break.
During an interviews on 11/21/18 at 11:23 A.M., Housekeeper B said the following after

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 11)
he/she saw the burn areas in the resident’s room:
– The [MEDICAL CONDITION] not that bad on the side of the dresser in the room,
– He/she saw cigarette ashes on the floor in the past, when he/she worked in this area in
the past,
– He/she had been working in this section of the facility for about three months
currently, and has not seen cigarette ashes in the resident’s room at that time, and
– If he/she saw cigarette ashes on the floor, he/she would report that occurrence to the
charge nurse because the residents are not supposed to have cigarettes or lighters in
their rooms.
During an interviews on 11/21/18 at 11:40 A.M., Certified Nurse’s Assistant (CNA) A said:
– The only times he/she worked with the residents was when there was an emergency,
– He/she had not noticed the [MEDICAL CONDITION] the dresser until that day, and
– In the past, he/she had seen other residents in the past smoke in their room.

F 0691

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who
requires such services.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to obtain a
physician’s order for the resident to provide his/her own [MEDICAL CONDITION] care and the
self monitoring of the [MEDICAL CONDITION] site, failed to have detail documentation of
the skin assessment including [MEDICAL CONDITION] site and ongoing monitoring of the
resident’s [MEDICAL CONDITION], and failed to have documentation of the resident’s ability
to provide [MEDICAL CONDITION] care, return demonstrations had been monitored for one
sampled residents (Resident #90) out of 44 sampled residents. The facility census was 93
residents.
1. Record review of Resident # 90 Admission Face Sheet showed the resident was admitted to
the facility on [DATE] with the following [DIAGNOSES REDACTED].>- [MEDICAL CONDITION]
([MEDICAL CONDITION], is a chronic disease involving the airways in the lungs), -[MEDICAL
CONDITION] (is an opening — called a stoma — that connects the colon to the surface of
the abdomen),
-Noncompliance with other medical treatment and regimen.
Record review of the resident’s [MEDICAL CONDITION] Care Plan dated 5/1/18 showed the
resident:
-Was content of bladder and toilets by self,
-Had a [MEDICAL CONDITION] bag on his/her left side of his/her abdomen,
-Able to care for himself/herself and for his/her [MEDICAL CONDITION] himself/herself
-Supplies are kept in his/her room,
-Had aerosol air fresheners in his/her room to control odors,
-At risk for altered skin related to [DIAGNOSES REDACTED].
-Goal include:
-Will be free of infection related to his/her [MEDICAL CONDITION],
-Will Maintain current ADL function and abilities
-Will shower at least once a week,
Intervention include;
–Encourage proper hand hygiene before and after [MEDICAL CONDITION] care,

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0691

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 12)
–Encourage proper disposal of [MEDICAL CONDITION] bag and content after each change,
–Nursing staff are to monitor the resident for changes in ability to complete normally
simple task and report to the doctor,
–Nursing staff are to educate the resident on proper [MEDICAL CONDITION] care,
–He/she will ask staff for assistance if needed,
–[MEDICAL CONDITION] supplies are provided by the facility and the staff are to obtain
ostomy supplies for the resident
–Will ask for assistant from staff as needed.
–Requires assist of one staff member with everyday personal care activities and shower
–Will have weekly skin assessment by the nursing staff,
–Will have his/her skin monitored during the shower and to document findings on the
resident’s shower sheet,
–Will voice or report all skin changes issues to the staff, Nursing staff will encourage
resident to report all skin issues.
Review of the resident’s (MONTH) (YEAR) Certified Nurse’s Assistant (CNA) Skin assessment
Sheet showed;
-On 10/2/18 and 10/5/18, had no documentation related to the resident’s [MEDICAL
CONDITION] or if he/she had a [MEDICAL CONDITION], no areas of concerns noted,
-On 10/16/18, had documentation on his/her body diagram showing placement of his/her
[MEDICAL CONDITION] on the right lower abdomen,
-On 10/19/18, had documentation on his/her body diagram showing placement of his/her
[MEDICAL CONDITION] on the right lower abdomen, had left calve area circled and written in
broken, and the resident had received a bed bath by the CNA,
-On 10/23/18, had no documentation related to the resident’s [MEDICAL CONDITION] or if
he/she had a [MEDICAL CONDITION], no areas of concerns noted, had documentation on his/her
body diagram showing placement of cast on the resident’s left lower leg.
Record review of the resident’s Quarterly Minimum Data Set (MDS a federally mandated
assessment tool completed by facility staff for care planning) dated 10/31/18 showed the
resident:
-Was not cognitively impaired and has a BIMs (brief interview for mental status) score of
15 and was able to make his/her own decision,
-Was independent for Activities of Daily Cares (ADL’s) , such as toileting , bathing,
ambulation and transfer,
-Required assistant of one staff member for setup for personal cares,
-The resident’s had an ostomy.
Record review of the resident’s hand written care plan dated 11/1/18 had been located on
the 400 hall unit care plan binder showed;
-A printed basic care plan with hand written documentation added to the resident’s care
plan;
-The resident’s due to his/her [MEDICAL CONDITION] , the resident kept cleaning supplies
of Oxygen stain remover in his/her room, and had Air freshener in his/her room related to
potential odor from his/her ostomy ( is an artificial opening in an organ of the body such
as [MEDICAL CONDITION]).
Observation on 11/19/18 at 9:40 A.M., showed the resident had a isolation cart (is a
portable cart the facility used to keep protective equipment for infection control
prevention such as disposable gowns, mask, hazard bags) outside his/her room.
During an interview on 11/19/18 at 9:45 A.M., Register Nurse (RN) A said the resident
[MEDICAL CONDITION] on his/her wound -foot under cast, and the resident also had a
[MEDICAL CONDITION].
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0691

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 13)
During an interview on 11/19/18 at 12: 45 P.M., the resident said:
-Had been providing his/her own [MEDICAL CONDITION] care for several years, and
-The nursing staff have not been regularly monitoring or assessing his/her ostomy site,
Record review of the resident’s (MONTH) (YEAR) Treatment Administration Record (TAR) on
11/19/18 at 12:47 P.M. showed physician’s orders for:
-Did not have physician’s orders related to documentation and/or assessing the resident’s
knowledge and ability to provide his/her own [MEDICAL CONDITION] care and to include
infection control prevention,
-Did not have a physician’s order for the resident to provide his/her own self-monitoring
and care of his/her ostomy site, such as monitoring for signs and symptoms of infections
at the stoma site, placement of the ostomy bag, and other ostomy needs (i.e.; burping of
the bag of air, color of the stool, frequency, and texture of the stools).
-[MEDICAL CONDITION] bag should be change on the day shift every three days and as needed

-[MEDICAL CONDITION] care to be done by he staff every shift and was documented by the
nurse’s initial.
Record review of the resident’s (MONTH) (YEAR) Physician’s Order Sheet (POS) showed
physician’s orders for:
-[MEDICAL CONDITION] Care was to done by facility staff on each shift,
-[MEDICAL CONDITION] bag was to be change by nursing staff every three days and as needed,
-Did not have a physician’s order for the resident to provide his/her own [MEDICAL
CONDITION],
-Did not have a physician’s order for the licensed nursing staff to assess the resident’s
knowledge and ability to care for his/her [MEDICAL CONDITION].
During an interview on 11/19/18 at 1:00 P.M., the resident’s Physician A said;
-The resident had been providing his/her own ostomy care for several years,
-He/she would expect to have a physician’s order for the facility nursing staff to assess
the resident’s ability provide his/her own ostomy cares on an annual bases
-The resident may have had a physician’s order in the past to provide his/her own [MEDICAL
CONDITION] care,
-Would expect the resident to have an ongoing physician’s order for the resident to
provide his/her own [MEDICAL CONDITION] care,
-The facility nursing staff are to monitor the resident ostomy site and stoma during the
weekly and monthly skin assessment.
During an interview on 11/21/18 at 6:30 A.M., Certified Nurse’s Assistant (CNA) E said:
-The CNAs do not have a CNA care card that shows how to care for the residents,
-Would talk with the charge nurse on how to care for the resident’s or if any changes in
the resident’s care,
-The resident’s ADL cares provided by the CNA staff are documented in the ADL cares book
and was not aware of a CNA care plan book,
-The resident had been providing his/her own [MEDICAL CONDITION] care,
-The CNA’s only obtain the resident’s ostomy bags, and other ostomy supplies when
requested by the resident,
-He/she would only assist the resident if asked,
-The charge nurses assess the resident’s skin and the resident [MEDICAL CONDITION] site.
Review of the resident’s CNA Skin assessment Sheet dated 11/23/18 showed;
-The resident had [MEDICAL CONDITION] on the right lower abdomen and there were no areas
of concerns documented.
During an interview on 11/27/18 at 2:20 P.M., the resident said:

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0691

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 14)
-His/her [MEDICAL CONDITION] site had been sore with some redness and irritation around
the stoma or ostomy site and the surrounding skin,
-He/she had not reported the changes of the [MEDICAL CONDITION] site to the facility
nurses or the CNAs,
-The CNA’s do not assist with the showers or cares,
-The Shower Aid assist the resident with his/her shower,
-The Licensed Nurses had not assessed his/her skin or ostomy site recently.
Record review of the resident’s Weekly Nursing Skin assessment dated [DATE] showed the
resident’s:
-Skin was not intact
-Had a [MEDICAL CONDITION] on his/her right side,
-Had been receiving treatment on his/her left foot,
-Did not have a detailed description of the resident’s [MEDICAL CONDITION] site to show if
the resident had any open areas or skin irritation around the stoma site,
Observation and interview on 11/28/18 at 11:25 P.M., of the resident’s [MEDICAL CONDITION]
with the Assistant Director of Nursing showed the resident:
-Was in his/her room,
-Provided his/her own [MEDICAL CONDITION] care, while ADON monitored the care,
-Was sitting on his/her bed, and had supplies ready to use, included a [MEDICAL CONDITION]
bag, skin prep wipes, personal wipes, and Kleenexes,
-Did not have any protective items such as gloves or hand sanitizer at the bedside,
-Had long polished finger nails,
-Did not wash his/her hands and did not use hand sanitizer on his/her hands prior to
his/her [MEDICAL CONDITION] care,
-Laid the ostomy supplies on the left side of the resident’s bed and on top of his/her
purse,
-Did not have a clean field or barrier for his/her supplies,
-Requested the trash can to be placed closer to his/her right side of the bed,
-Had laid back and began to remove his/her old [MEDICAL CONDITION] bag,
-The ostomy bag had brown loose stool inside the bag and a slight odor from the ostomy bag
as it was loosen,
-Did have a hard time removing the ostomy bag and had to use wipes to loosen the sticky
edges,
-When the resident had a hard time removing the [MEDICAL CONDITION] bag the ADON washed
his/her hands and put on gloves,
-The resident was able to remove the bag and placed it on the trash bag,
-The stoma site was beefy red, with a darker beefy red ring around the site and also the
area to the left lower corner of the ostomy was red,
-The resident had complaints of discomfort, and grimacing while removing the ostomy bag,
-With the resident’s soiled ungloved hands obtained a personal wipe and cleaned around
his/her stoma area,
-The resident removed the ostomy bag clip from end of the old soiled [MEDICAL CONDITION]
bag and had laid it on the bed to the right and the clip was dirty with some brown
substance,
-With soiled ungloved hands, obtained a skin prep and opened the packet,
-Used the wipe around on the skin and the resident complained again of burning when
cleaning the skin area,
-Obtain the new [MEDICAL CONDITION] bag and placed the ring over the stoma, and removed
the paper from underneath to secure in place by using his/her soiled hands,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0691

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 15)
-He/she then obtain the clip without cleaning with personal wipe back on the end of the
new bag to ensure it was securely sealed to prevent leakage,
-The resident did not wash his/her hands after the [MEDICAL CONDITION] was finished and
said he/she would wash hands before going to lunch,
-The resident said the nursing staff have not asked him/her about his/her bowels and if
they were loose or hard,
-The resident said he/she only has his/her short intestines and his/her stools are always
running or loose,
-The resident said the nursing staff do not normally assess his/her ability to change the
[MEDICAL CONDITION] bag,
-The resident said that he/she had been providing his/her own care for at least five
years,
-The ADON said he/she would expect the resident to have a care plan self-care and for the
nursing staff to assess as needed and did not think there as a need for a physician’s
order for the resident to perform his/her own [MEDICAL CONDITION] care.
-The resident’s care plan showed the resident’s [MEDICAL CONDITION] was on his/her left
side of his/her abdomen and the resident’s [MEDICAL CONDITION] was on his/her right side
of his/her abdomen.
During an interview on 11/28/18 at 11:45 A.M., Licensed Practical Nurse (LPN) D said:
-As a charge nurse had provided the resident’s [MEDICAL CONDITION] care, or the CNA’s
would provide care and assist the resident in providing care,
-Would assess the resident’s skin and include detail description of the resident’s
[MEDICAL CONDITION] site and stools,
-Would expect for the nursing staff to obtain a physician’s order for the resident to
provide his/her own [MEDICAL CONDITION] care,
-Would expect nursing staff to provide on going assessment of the resident’s ability to
provide his/her own care as needed and document in the resident nurses notes or medical
record.
During an interview on 11/28/18 at 12:52 P.M., LPN A said:
-The Nursing staff should have obtained a physician’s order for the resident to provide
his/her own ostomy care,
-The Nursing staff should have assessed the resident’s ability to provide his/her own care
as needed,
-The resident’s care plan should be updated with the current physician’s order for ostomy
care and monitoring to include if the residents able to provide his/her own care and how
often to re-assess the resident ability to provide his/her own [MEDICAL CONDITION] care.
-During the nursing assessment of the resident’s [MEDICAL CONDITION] should include any
signs and symptoms of infection, description of the ostomy site and of the resident’s
stools,
During an interview on 11/28/18 at 2:15 P.M., Director of Nursing (DON) said;
-The DON and the administration provide monthly training’s on a variety of training’s to
all the staff to include different subjects related to resident care, resident rights
abuse, professional standards and if there are concerns infection control and hazardous
waste,
-The resident [MEDICAL CONDITION] care the CNA or the charge nurse can assist the resident
during cares,
-Nursing staff are to provide skin assessments of the resident’s stoma site and skin
around the area,
-Had provided training on comprehensive assessment documentation related to include detail
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0691

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 16)
description such as color/drainage/area of concerns, what the tissue looks like and this
should be included in the documentation when the nursing staff assist in changing the
[MEDICAL CONDITION] bag,
-The resident [MEDICAL CONDITION] physician’s order was to change the [MEDICAL CONDITION]
bag every two to three days and he/she expected the nursing staff to assess the resident’s
ostomy site and surrounding skin at that time and to ensure to look at the resident’s
stoma or expected the nurses to at least assess the resident’s ostomy site at least weekly
during the resident’s weekly skin assessment;
-Training includes return demonstration on providing own self-care, but ultimately it is
the staff’s responsibility to ensure care had been done correctly,
-Should have a physician’s order for the resident to provide his/her own [MEDICAL
CONDITION] care,
-He/she expected to have an ongoing assessment of the resident’s ostomy site, and the
ability of the resident to provide his/her own care.

F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Ensure that feeding tubes are not used unless there is a medical reason and the
resident agrees; and provide appropriate care for a resident with a feeding tube.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure one
sampled resident remained on continuous tube feeding, failed to ensure the physician’s
orders included parameters for holding the resident’s tube feeding (a medical device used
to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow
safely, or need nutritional supplementation. The state of being fed by a feeding tube is
called enteral feeding or tube feeding), failed to ensure certified nursing staff
performed duties within their professional limitations for one sampled resident (Resident
#82) and failed to follow physician’s enteral feeding orders to ensure the resident was
recieving his/her caloric and water intake as recommended by the Registered Dietician (RD)
to prevent the resident from a gradual weight loss for the last three weeks and failed to
notify the RD of new physician order to change the continuous enteral feeding to 22 hours
of enteral feeding as this good affect the caloric and water intake the resident is
required to recieve in a 24 hour period as recommended by the RD for one sample resident
(Resident #91) out of 44 sampled residents. The facility census was 93 residents.
Record review of the facility’s policy according to Centers for Disease Control (CDC)
guidelines – New Regulations for Nutrition, Weight Loss, Adaptation and Tube Feeding.
-Enteral tube feeding should not be given to people unless they are malnourished or at
risk of malnutrition and have, inadequate or unsafe oral intake and functional, accessible
gastrointestinal tract or they are taking part in a clincial trial.
-Nutrition support intervention in patients identified by screening and assessment at risk
for malnutrition or malnourished may improve clinical outcomes for patients.
-At – risk patients should have a nutrition screen followed up by dietitian assessment,
care plan and follow-up.
-Nutritional assessment tools are generally comprised by the following sections, history,
physical examination, laboratory tests, calculations of calorie necessities; and
indication for nutritional therapy.
-Acutely ill patients under [MEDICATION NAME] nutrition receive infusions continuously,

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 17)
but administration may be discontinued abruptly once enteral nutriton accounts for least
60 % of caloric needs.
1. Record review of Resident #82’s Face Sheet showed the resident was admitted to the
facility on [DATE], with [DIAGNOSES REDACTED].
Record review of the resident’s Care Plan dated 10/2018, showed the resident did not eat
anything by mouth and was on continuous tube feeding with water flushes every four hours.
There were no parameters for holding the resident’s tube feeding documented. The care plan
showed the resident was at nutritional risk and staff was monitoring him/her for nutrition
and weight loss.
Record review of the resident’s Physician’s Order Sheet (POS) dated 10/15/18 to 11/14/18
and 11/15/18 to 12/14/18, showed physician’s orders for:
-[MEDICATION NAME] 1.5 (a calorically dense, fiber-fortified therapeutic nutrition that
provides complete, balanced nutrition for long- or short-term tube feeding) 45 cubic
centimeters (cc) per hour, continuous feeding.
-Flush feeding tube with 150 milliliters (ml) water every 4 hours.
-There were no physician’s orders showing the resident’s tube feeding was to be held for
any timeframe (parameters) or how long the resident was to be off continuous tube feeding
(for incontinence care, activities, or activities of daily living (bathing, dressing,
mobility).
Record review of the resident’s Weight Record showed monthly and weekly weights. It
showed:
-admitting weight July=121 pounds (lbs.); August=122 lbs.; Sept=117 lbs.; Oct=119 lbs.;
Weekly weights showed:
-Oct (YEAR) week 1=119 lbs., week 2=118 lbs., week 3=116 lbs., week 4=115 lbs.
Record review of the resident’s Nursing Notes from 10/1/18 to 10/31/18 showed:
-On 10/23/18, the resident went out to the hospital for an appointment at the
gastrointestinal lab and possible replacement of his/her feeding tube. At 12:00 P.M., the
nurse spoke with the hospital and the resident did not need to have his/her feeding tube
replaced. Physician’s orders showed the resident was to be on continuous tube feeding and
water flush every four hours. The physician’s orders did not show parameters for the
facility to take the resident off of/hold his/her continuous tube feeding.
-There were no nursing notes regarding the downward trend in the resident’s weight or
concerns about the resident’s nutritional status. There was no documentation showing the
nursing staff notified the resident’s physician or Registered Dietician for the resident’s
weight loss.
Record review of the resident’s Physician’s Notes dated 10/2018, showed the resident’s
physician completed an examination of the resident and medical record review, to include
his/her medications and labs. There were no notations showing the resident had a gradual
weight loss or fluctuation in weights showing any additional interventions were
implemented or recommended.
Record review of the resident’s Dietary Notes showed there was no documentation in the
notes showing the resident had lost gradual weight since admission and there were no
documented nutritional interventions implemented to try to prevent continued weight loss
before it became significant. Dietary notes did not show any parameters for holding the
resident’s tube feeding.
Record review of the resident’s Medical Record showed the resident had a wound and
received wound care treatments weekly, but there was no documentation of complications
with it (infection) or any other acute illness or cause for why the resident would be
losing weight.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 18)
Record review of the resident’s intake records showed there was little and inconsistent
documentation to show how many calories the resident was receiving daily (to know whether
the resident was receiving the needed/recommended daily caloric intake).
Record review of the resident’s Weight Record showed the monthly and weekly weights for
(MONTH) (YEAR). It showed:
-Monthly weight was 119 lbs.
-Nov. (YEAR) week 1=119 lbs., week 2=116 lbs., and week 3=112 lbs.
Observation on 11/19/18 at 9:09 A.M., showed the resident was laying down in his/her bed
with the head of his/her bed up at least 30 degrees. The resident was not verbal. His/her
tube feeding machine was on at 45 ml/hr. with 100 ml flush every 4 hours (automatic
flush). The tube feeding bottle ([MEDICATION NAME] 1.5) showed it was placed at 12:00 A.M.
on 11/18/18.
Observation on 11/19/18 at 12:16 P.M., showed the resident was in bed with his/her head of
bed up at least 30 degrees. The resident’s tube feeding bottle had been changed and the
bottle was full and was infusing at 45ml/hr. The resident’s eyes were closed and he/she
was resting comfortably.
Observation on 11/20/18 at 8:59 A.M., showed the resident was laying in his/her bed with
the head of his/her bed up at least 30 degrees. His/her tube feeding was infusing at
45cc/hr., and the [MEDICATION NAME] 1.5 bottle showed the nursing staff placed it at 6:00
A.M., on 11/20/18. The resident had his/her eyes closed and was resting comfortably.
During an observation and interview on 11/20/18 at 9:30 A.M., showed the resident was in
his/her bed and Certified Nursing Assistant (CNA) G, CNA H and CNA J were preparing to
complete incontinence care on the resident. CNA J placed the resident’s tube feeding
machine on hold while they provided care, and he/she said he/she was told the CNA’s could
put the resident’s tube feeding on hold, but the licensed nursing staff had to turn the
resident’s tube feeding machine back on. When they were finished completing the resident’s
cares, the CNA staff went to get the Director of Nursing (DON) to turn the resident’s tube
feeding machine back on.
During an interview on 11/20/18 at 9:59 A.M., the DON said:
-The resident was living at home with relatives before coming into the facility. He/she
began having [MEDICAL CONDITION] and the relatives could no longer care for him/her at
home.
-The resident initially had speech therapy because they were trying to remove the
resident’s feeding tube, (family wanted him/her to eat), but when they had the Speech
Therapist evaluate the resident and perform a swallow study, the resident did not pass it.
-The Speech Therapist concluded the resident was not safe eating by mouth, and recommended
that the resident should remain on the tube feeding.
-The resident had been gaining weight.
Observation on 11/20/18 at 10:45 A.M., showed CNA G, CNA H, and CNA J were preparing to
transfer the resident from his/her bed into his/her wheelchair. The resident was not
connected to his/her tube feeding. The CNA’s washed their hands, gloved and transferred
the resident into his/her wheelchair. They then wheeled the resident to the main dining
room for a large group bingo activity.
Observation on 11/20/18 from 11:21 A.M. to 12:00 P.M., showed the resident was up and
sitting in his/her specialized wheelchair (in a reclined position), dressed and groomed,
passively participating in a large group bingo activity. He/she was sitting at the table
by the activity personnel. The resident was not on continuous tube feeding during the
activity.
During an interview on 11/20/18 at 11:55 A.M., the Registered Dietician (RD) said:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 19)
-If the resident is on a continuous tube feeding, the resident could lose weight if there
was an acute issue with the resident such as uncontrolled diabetes.
-The resident’s weights and intake should be monitored because that was how they
determined what his/her nutritional needs were.
-Sometimes while monitoring the resident’s weight, they determine that they need to
increase the tube feeding amount because the resident is not receiving enough nutrition.
-They were monitoring the resident’s weights, and the resident is on weekly weights, but
he/she should not be losing weight.
-He/She said that she would evaluate the resident to see if his/her nutritional intake is
enough and if the resident has lost weight, will consider increasing the resident’s tube
feeding amount.
Observation on 11/20/18 at 1:29 P.M., showed the resident was sitting up in his/her
specialized wheelchair in his/her room. The resident’s tube feeding machine showed it was
infusing at 45 cc/hr. and there was a little under 900 cc in the bottle. The resident had
his/her eyes closed and was resting comfortably.
Record review of the resident’s Registered Dietician notes dated 11/22/18, showed:
-The resident remained nothing by mouth (NPO) and received [MEDICATION NAME] 1.5 at 45
cc/hr. with the same water flushes (100 cc every four hours).
-The resident was down 3 lbs. in one week and in 1 month, which was a 2.5% weight loss;
was down 4 lbs. in three months, which was a 3.3% weight loss; and down 5 lbs. in 4 months
since admission.
-The resident’s current body mass index (BMI, a measure of body fat based on height and
weight) was 19.3, which was within normal range.
-He/she recommended increasing [MEDICATION NAME] to 50 cc/hr., with a new order to hold
tube feeding for 2 hours for activities of daily living. Continue to monitor.
Record review of the resident’s POS dated 11/15/18 to 12/14/18, showed an updated
physician’s order dated 11/23/18, that showed the resident was to have [MEDICATION NAME]
increased to 50 ml/hr. The physician’s order showed the facility may hold tube feeding for
2 hours for completing activities of daily living.
Record review of the resident’s Nursing Notes dated 11/23/18, showed the resident had a
new physician’s order to increase his/her [MEDICATION NAME] to 50 cc/hr. continuous
feeding. It showed the facility staff may hold the feeding for 2 hours for activities of
daily living.
During an interview on 11/27/18 at 9:51 A.M., Licensed Practical Nurse (LPN) B said:
-The resident is supposed to be on a continuous tube feeding.
-If the nurse removed the resident from his/her tube feeding, it should only be for
completing bathing or activities of daily living.
-When the resident is out of bed and up in the dining area or for activities, nursing
staff should bring the tube feeding out with the resident so he/she continues to receive
tube feeding.
-The resident should have had a physician’s order stating that the resident can be off of
continuous tube feeding for activities of daily living/bathing.
-The nurse is the only person that can turn the resident’s tube feeding on and off.
-If there is fluctuation in the resident’s weight and it is not due to a physiological or
medical reason, it may be that the resident is not receiving his/her feeding as ordered.
-The nurse was supposed to document the resident’s input (cc) from the tube feeding in the
e-chart on every shift.
-If they noticed the resident losing weight, they should notify the dietician and the
resident’s physician so they can assess the resident.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 20)
During an interview on 11/28/18 at 10:34 A.M., the DON said:
-His/Her expectation is for the resident to be on continuous tube feeding at the rate the
physician ordered.
-The resident should not continue to lose weight if he/she is on a continuous tube
feeding.
-The licensed nurse should be the only persons turning the resident’s tube feeding off and
on.
-The resident should remain on continuous tube feeding except for when the nursing staff
is bathing, toileting and or dressing the resident.
-The resident should remain on continuous tube feeding while in activities.
-They should have had a physician’s order for holding the resident’s tube feeding with
parameters upon admission, but they only recently received this order, and now the order
says they can hold the tube feeding for two hours during personal cares.
-The nurses have not been keeping good records on the resident’s input so he/she has no
way of knowing what the resident’s caloric intake is daily.
-If the nurses were documenting the resident’s caloric intake daily, he/she would have
been able to track the resident’s intake and identify any problems with the resident and
notify the resident’s physician and the Registered Dietician so they could address it.
-He/she noticed that there was a problem with the nursing staff documenting the caloric
intake of the resident and provided an in-service to them about three weeks ago.
-The Registered Dietician recently increased the resident’s tube feeding to 50 cc/hr. due
to the resident’s weight loss.
-It was possible the resident’s weight loss may be due to the time the resident was not
receiving tube feeding continuously.
-The weight machine was supposed to be calibrated monthly, but he/she was not aware of
when it was last calibrated.
-He/she was not aware that the Restorative Aide had changed the lift that was used to
weigh residents which could have also affected the weights that they were recording.
2. Record review of the Resident #91 Face Sheet showed he/she was admitted to the facility
on [DATE] with the following Diagnoses: [REDACTED].
-Pneumonia due to inhalation of food and vomit- Inflammation of the walls of the the
alveoli ( any of the tiny air sacs of the lungs which allows for inflammation of the
walls), the lungs usually caused by [MEDICAL CONDITION].
-Gastrostomy- An opening into the stomach from the abdominal wall, made surgically for the
introduction of food; and
-Peg Tube/Gastrostomy tube/[DEVICE]-Mostly commonly to provide or means of feeding when
oral intake is not adequate.
Record review of the resident’s quarterly Minimum Data Set (MDS – a federally mandated
assessment tool to be completed by facility staff for care planning) dated 10/3/18 showed
he/she:
-Had a Brief Interview Mental Status (BIMS) score of 6, which describes the resident had
difficulty keeping track of what was said by others.
-Was moderately cognitive impaired and was at risk for impaired thought process.
-Had difficulties making decisions.
-Had required cueing and redirection from staff, and had some confusion.
-Had used short sentences or one word responses to others.
Record review of the resident’s Weekly Weights Log Sheet for the month of October, (YEAR)
showed:
-Week One the resident had no weights recorded.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 21)
-Week Two the resident weighed 173 pounds.
-Week Three the resident weighed 176 pounds.
-Week Four the resident weighed 174 pounds.
Record review of the resident’s quarterly Care Plans dated on 10/3/18 showed the
following;
-Required total care – full staff performance to meet the resident’s Activities of Daily
Living (ADL’s) Assistance.
-The nursing staff provided 100 % of the time to the resident to meet the his/her eating,
bed mobility, transfers, dressing, toilet use and personal hygiene needs.
-He/she was totally dependent on staff to complete his/her ADL’s.
-He/she was required to be on tube feeding and it was maintained by the nursing staff.
-The nursing staff was to ensure his/her feeding was running as ordered.
Record review of the resident’s Nurse’s Notes dated on 10/4/18 at 4:15 P.M, showed the
resident required total care of ADL’s and a [DEVICE] was in place due to difficulty
swallowing and aspiration.
Record review of the resident’s Utilization Review on 10/8/18 at 2:27 P.M. showed the
resident required medical services related to new [DIAGNOSES REDACTED].
Record review of the resident’s Utilization Review on 10/15/18 at 2:39 P.M. showed:
-The resident continued with continuous tube feeding of Glucerna 1.2 at 40 milliliters
(ml) per hour.
-No Food By Mouth (NPO) status.
-Was to monitor his/her surgical site gastrostomy site for complication and pain
management.
-He/she was on weekly weights and he/she had dropped 30 pounds from his/her (MONTH)
weight, pending on weekly weights for the new baseline today.
Record review of the resident’s Dietary Notes on 10/20/18 at 8:20 A.M. and documented by
the RD showed:
-The resident was sent out to the hospital on [DATE], was re-admitted on [DATE].
-The resident was sent out again on 9/10/18, readmitted again on 10/3/18, the resident is
now NPO, receiving continuous tube feeding of Glucerna 1.2 per [DEVICE] at 70 cc per hours
which provided the resident (YEAR) calories which equals to 101 grams of protein per day.
-Resident was receiving 100 ml of water flushes every 4 hours which equals 600 cc of water
per day.
Record review of the resident’s Intake and Output Record dated on 10/29/18 showed:
-There was no enteral intake for the day shift.
-During the night shift the resident received 840 cc of Glucerna and and 400 cc of water
which equals to 1240 cc.
-According to the resident’s physician’s orders and the Registered Dietician had
recommended a total caloric and water intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 10/30/18 showed:
-During the day shift the resident received 1230 cc of enteral feeding and water intake
-During the night shift the resident received 840 cc of enteral feeding and 400 cc of
water which equaled to 1240 cc for that shift.
-The staff documented the 24 hour intake was 1248 cc. The total enteral and water intake
for 10/30/18 was 2470 cc.
-According to the resident’s physician’s orders and the Registered Dietician had
recommended at total caloric and water intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 10/31/18 showed he/she:
-The day shift did not document the enteral intake
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 22)
-Had received at the night shift 840 cc and the water flush was not recorded on the above
date.
-According to the resident’s physician’s orders and the Registered Dietician had
recommended a total caloric and water intake of 2616 cc each day for the resident.
Record review of the resident’s Utilization Review dated on 10/26/18 showed the resident
began participating in therapy on 10/8/18.
Record review of the resident’s (MONTH) (YEAR) Weekly Weight Log Sheet showed:
-Week one the resident weighed 179 pounds.
-Week two the resident weighed 178 pounds.
-Week three the resident weighed 177 pounds.
– Week four the resident’s weight was not recorded.
-A three pound weight loss in one month, which equals to a 1.6% loss of body weight in one
month.
Record review of the resident’s Intake and Output Record Sheet on 11/1/18 showed:
-During the morning shift the resident received at total of enteral and water intake was
1260 cc
-During the night shift the resident received 799 cc of enteral intake and no water
flushes were recorded. The resident received 2059 cc of enteral and water intake in 24
hours .
-According to the resident’s physician’s orders and the Registered Dietician had
recommended a total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 11/2/18 showed:
-During the day shift the resident received at total of 400 cc of enteral and water
intake.
-During the night shift the resident received a total 840 cc of enteral and water intake.
-The total enteral intake and water flushes for 24 hours was 1240 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 11/3/18 showed:
-During the day shift the resident received a total enteral and water intake of 1280 cc.
-During the night shift the resident received 840 cc of enteral feeding and 400 cc of
water for a total of 1240 cc.
-The resident received a total of 2520 cc of enteral and water intake in 24 hours.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 11/4/18 showed:
-The day shift did not record the enteral and water intake for that shift.
-During the night shift the resident received a total of 1240 cc of enteral and water
intake.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 11/5/18 showed:
-The day shift did not record the enteral or the water intake for that shift.
-During the night shift the resident received 800 cc of enteral intake and 300 cc of water
intake for a total of 1100 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Nurse’s Notes dated 11/5/18 at 2:37 P.M. showed he/she:
-Was on Medicare Part A for a new [DEVICE] Placement.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 23)
-Had received Glucerna 1.2 at 70 ml per hour.
-Resident was NPO.
-Resident gets up in broda chair.
-Resident transfers with a two person assistance a medical lift.
Record review of the resident’s Intake and Output Record dated on 11/6/18 showed:
-During the day shift the resident received a total of 1400 cc of enteral and water
intake.
-During the night shift the resident received Had received 845 cc of enteral intake and
300 cc of water intake.
-The resident received a total caloric intake of 2545 cc in 24 hours.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 11/7/18 showed:
-During the day shift the resident received 1200 cc of enteral and water intake,
-During the night shift the resident received 840 cc of enteral intake.
-The resident received a total caloric intake of 2040 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated on 11/8/18 showed:
-During the day shift the resident received 1200 cc of enteral and water intake.
-During the night shift the resident received 840 cc of enteral intake and 300 cc of
water.
-The resident received a total caloric intake of 2040 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated 11/9/18 showed:
-During the day shift the staff did not record any intake for that shift.
-During the night shift the resident received 800 cc of enteral intake and 400 cc of
water.
-The resident received a total caloric intake of 1200 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated 11/10/18 showed:
-During the day shift the staff did not record any intake for that shift.
-During the night shift the resident received 840 cc of enteral intake and 300 cc of
water.
-The resident received a total caloric intake of 1140 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Nurse’s Notes dated 11/10/16 showed the resident:
-Continued to attend skilled Medicare Part A;
-Attended therapy standing balance and transfers.
-Continued with feeding tube with Glucerna at 70 cc and water flushes per physician’s
orders.
Record review of the resident’s Intake and Output Record dated 11/11/18 showed
-During the day shift the staff did not record any intake for that shift.
-During the night shift the resident received 850 cc of enteral intake and 300 cc of
water.
-The resident received a total caloric intake of 1150 cc.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 24)
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated 11/12/18 showed:
-During the day shift the resident received 420 cc of enteral feeding and 300 cc of water
intake
-During the night shift the resident received 420 cc of enteral intake.
-The resident received a total caloric intake of 1140 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated 11/13/18 showed:
-During the day shift the resident received 1200 cc of enteral and water intake
-During the night shift the resident received 840 cc of enteral intake and 400 cc of
water.
-The resident received a total caloric intake of 2440 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated 11/14/18 showed:
-During the day shift the resident received 1200 cc of enteral and water intake
-During the night shift the resident received 800 cc of enteral intake and 300 cc of
water.
-The resident received a total caloric intake of 2300 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated 11/15/18 showed:
-During the day shift the resident received 660 cc of enteral and water intake
-During the night shift the resident received 820 cc of enteral intake and 300 cc of
water.
-The resident received a total caloric intake of 1780 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident
Record review of the resident’s Utilization Review dated 11/15/18 at 2:21 P.M. showed the
resident:
-Continued on skilled Medicare Part A services for a new [DEVICE].
-Nursing staff was to monitor the [DEVICE] site for complications, administering the tube
feeding and flushes and medications via the [DEVICE].
Record review of the resident’s Intake and Output Record dated 11/16/18 showed:
-During the day shift the resident received 1240 cc of enteral and water intake
-During the night shift the resident received 840 cc of enteral intake and 400 cc of
water.
-The resident received a total caloric intake of 2480 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
Record review of the resident’s Intake and Output Record dated 11/17/18 showed:
-During the day shift the resident received 1280 cc of enteral and water intake
-During the night shift the resident received 840 cc of enteral intake and 400 cc of
water.
-The resident received a total caloric intake of 2520 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0693

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 25)
Record review of the resident’s Intake and Output Record dated 11/18/18 showed:
-During the day shift the resident received 1240 cc of enteral and water intake
-During the night shift the resident received 1300 cc of enteral intake and water intake.
-The resident received a total caloric intake of 2540 cc.
-According to the resident’s physician’s orders and the Register Dietician had recommended
at total caloric intake of 2616 cc each day for the resident.
During an interview on 11/21/18 at 11:00 A.M., the Registered Dietician said:
-No one from the facility had notified him/her of the new physician’s order for the
resident’s tube feeding to be held for two hour for ADLs and therapy. He/she thought the
resident’s tube feeding has been infusing continuously.
-The calculations of the residents caloric intake the resident is supposed to recieve in a
24 hour period is based on the physician’s order on how long the resident is supposed to
be on his/her tube feeding.
-Was not aware the resident had a gradual weight loss every week for the last three weeks.

Record review of the resident’s Dietary Notes dated 11/22/18 at 9:00 A.M., showed the
resident:
-Was to continue on Medicare Part A services.
-[DEVICE] was patent and running at 70 cc hour and had water flushes.
Record review of the resident’s Dietary Notes 11/22/18 at 9:57 A.M. showed the resident:
-Was to remain NPO.
-Continued to receive Glucerna 1.2 at 70 cc per hour with the same water flushes.
-Had a new physician’s on 11/8/18 to hold the tube feeding for two hours for ADL’s and
therapy.
-Continued to receive Glucerna 1.2 at 70 cc per hour for 22 hours providing 1848 caloric
intake per day.
-100 % estimated caloric intake needs, and 92 grams of protein (126% estimated protein
needs per day)
-No new labs noted.
-Resident height is 68′
-Resident’s weight for (MONTH) (YEAR) is 179 pounds.
-Resident was up one pound in one month.
-Resident was down 25 pounds in three months, a 12.3 % weight loss, down 23 pounds in five
months since initial admitted .
-Continue to follow and be available as needed according to the Registered Dietician.
Record review of the resident’s Nurse’s Noted dated 11/26/18 at 3:40 P.M. showed the
resident :
-[DEVICE]s cares are provided every shift.
-Was reminded not to touch the [DEVICE]; the resident has Dementia and sometimes he/she is
forgetful and must be redirected by staff for total care.
During an interview on 11/28/18 at 10:00 A.M., the CNA C said he/she:
-The Restorative Aides (RA) were respo

F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Past noncompliance – remedy proposed

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 26)
coordination of care between the facility and the [MEDICAL TREATMENT] (a process for
removing waste and excess water from the blood, and is primarily used to provide an
artificial replacement for lost kidney function in people with [MEDICAL CONDITION]) center
was maintained to ensure the continuum of care for one sampled resident (Resident #79) and
failed to obtain a physician’s order to assess and document the resident’s [MEDICAL
TREATMENT] fistula shunt (is a place where blood is removed and returned to the body after
cleansing by [MEDICAL TREATMENT]-removal of toxic substances or metabolic wastes from the
blood stream) after a hospital stay for one sampled resident’s (Resident #1) out of 44
sampled residents. The facility census was 93 residents.
Record review of the facility’s [MEDICAL TREATMENT] policy and procedures dated 11/28/17,
showed the facility would ensure that residents who require [MEDICAL TREATMENT] receive
such services, consistent with professional standards of practice, the comprehensive
person-centered care plan, and the resident’s goals and preferences including:
-Ongoing assessment of the resident’s condition and monitoring for complications before
and after [MEDICAL TREATMENT] treatments received at a certified [MEDICAL TREATMENT]
facility.
-Provide transportation to and from an off-site certified [MEDICAL TREATMENT] facility for
[MEDICAL TREATMENT] treatments.
-Ongoing assessments and oversight of the resident before and after [MEDICAL TREATMENT]
treatments.
-Ongoing communication and collaboration with the [MEDICAL TREATMENT] clinic regarding
[MEDICAL TREATMENT] care and services.
1. Record review of Resident #79’s Face Sheet showed the resident was admitted to the
facility on [DATE], with [DIAGNOSES REDACTED].
Record review of the resident’s admission Minimum Data Set (MDS), a federally mandated
assessment tool to be completed by facility staff for care planning dated 10/16/18, showed
the resident:
-Was alert, oriented and cognitively intact and did not have any behaviors.
-Was independent with transfers and ambulated without using an assistive device.
-Was independent with bathing, dressing, toileting, and grooming.
-Received [MEDICAL TREATMENT] treatments.
Record review of the resident’s Physician’s Order Sheet (POS) dated 11/15/18 to 12/14/18,
showed physician’s orders for [MEDICAL TREATMENT] three times weekly on Monday, Wednesday
and Friday. There were no physician’s orders instructing the nursing staff to check the
resident’s shunt (a connection between a vein and an artery, usually in the forearm or
upper arm, that provides easy access to the vascular system for [MEDICAL TREATMENT]) site.
Record review of the resident’s Care Plan updated on 10/24/18 showed:
-The resident could be non-compliant with his/her diabetes regimen, medication and
nutrition.
-The resident went to [MEDICAL TREATMENT] treatments at the [MEDICAL TREATMENT] clinic
three times weekly on Monday, Wednesday and Friday.
– The resident’s shunt site was on his/her upper right arm, and it was noted to clot
frequently. It showed the [MEDICAL TREATMENT] nurses would reopen it while the resident
was at the [MEDICAL TREATMENT] center.
-The resident’s care plan did not show any interventions for caring for, checking or
monitoring the resident’s shunt site and there were no interventions showing the
coordination of services and communication between the facility and the [MEDICAL
TREATMENT] center to assist in maintaining the health of the resident.
Record review of the resident’s Nursing Notes showed the nursing documentation did not
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 27)
include routine updates on the resident’s [MEDICAL TREATMENT] care that would indicate
that there was ongoing weekly communication and coordination of services between [MEDICAL
TREATMENT] and the facility. Nursing notes showed only intermittent and periodic
communication with the [MEDICAL TREATMENT] center.
Observation and interview on 11/19/18 at 9:43 A.M., showed the resident was sitting in
his/room on his/her bed. He/she was alert and oriented and able to make his/her needs
known. Observation of the resident’s shunt site (on his/her upper right arm) showed there
was no bruising or redness on or around the area and there were no open areas. The skin at
the site was clean, without odor or sign and symptoms of infection. The resident said:
-He/she was a brittle diabetic, but his/her diabetes was under control.
-He/she was also on [MEDICAL TREATMENT] (for two years now) and went to the [MEDICAL
TREATMENT] clinic on Monday, Wednesday and Fridays.
-His/her [MEDICAL TREATMENT] treatments were going well now, but he/she currently had a
spinal infection and was receiving antibiotics at the [MEDICAL TREATMENT] center.
-He/she was currently on antibiotics for a spinal infection that he got while at the
[MEDICAL TREATMENT] center and he/she was going to the doctor for a follow up appointment
this week.
-He/she had previously had problems with blood clots (three) and he/she eventually had the
shunt replaced about seven months ago and has not had any further blood clots.
-He/She is very knowledgeable about his/her diet restrictions, but admitted to not always
following them.
-Sometimes the [MEDICAL TREATMENT] center sent him/her with paperwork for the facility and
they also communicated by telephone.
-The nurse at the facility looked at his/her shunt site sometimes, not daily.
-The nurses did not listen to the thrill (palpitation of the blood flow through the
vascular system) and bruit (audible sound of the blood flow through the vascular system)
daily, only on occasion.
Observation and interview on 11/21/18 at 7:59 A.M., Licensed Practical Nurse (LPN) A used
hand sanitizer and gloved. He/She knocked on the resident’s door and entered the
resident’s room. The resident’s curtain was pulled. LPN A said that he/she had just given
the resident his/her pain medication and was going to check his/her [MEDICAL TREATMENT]
shunt. The resident was laying down in his/her bed awake. He/she held his/her arm out,
exposing his/her shunt site. LPN A felt the resident’s shunt site and said that he/she was
feeling for the blood going through the shunt (thrill). LPN A then placed his/her
stethoscope on and listened at the shunt site. He/she said that he/she was listening for
the blood going through the shunt (bruit) and everything seemed to be okay. LPN A said:
-The resident had osteo[DIAGNOSES REDACTED] that was causing the resident pain in his/her
lower back and hip.
-He/She informed the [MEDICAL TREATMENT] center when the resident began running a
temperature. They gave the resident Tylenol and the resident continued to have a
temperature while at [MEDICAL TREATMENT], so he/she called the [MEDICAL TREATMENT] center
and recommended that they check the resident for infection. They [MEDICAL TREATMENT]
center followed up, found that the resident had osteo[DIAGNOSES REDACTED] and the
physician at the [MEDICAL TREATMENT] center started the resident on antibiotics.
-The resident received intravenous (IV) antibiotic on Monday, Wednesday and Friday while
he/she was at [MEDICAL TREATMENT] and was being followed by the vascular clinic.
-The resident had been receiving antibiotics for the past eight weeks.
-The [MEDICAL TREATMENT] center usually does not send the facility any paperwork regarding
how much fluid they pull off of the resident while he/she is at [MEDICAL TREATMENT], the
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 28)
resident’s weights or routine labs.
-The [MEDICAL TREATMENT] center will only send information to the facility about the
resident when there is a change in treatment or physician’s orders.
-The facility does not send the resident to the [MEDICAL TREATMENT] center with any
paperwork for the [MEDICAL TREATMENT] center to complete and send back (requesting routine
information from each [MEDICAL TREATMENT] visit).
-He/She documented in the resident’s medical record every time he/she checked the
resident’s shunt site.
-All of the nurses were expected to check and document when they check the resident’s
shunt site daily.
-He/She said she also documented any/all communication with the [MEDICAL TREATMENT] center
in the resident’s medical record.
-The resident was very good at letting them know about his/her treatment when he/she was
at [MEDICAL TREATMENT], but he/she did not know if all of the nurses asked the resident
for this feedback.
-He/She said he/she usually called the [MEDICAL TREATMENT] center with any new orders that
originated at the facility or medication changes.
-He/she did not routinely call to request information about the resident’s [MEDICAL
TREATMENT] treatments.
-The documentation for any communication with the [MEDICAL TREATMENT] center would be in
the resident’s nursing notes.
During an interview on 11/28/18 at 10:34 A.M., the Director of Nursing (DON) said:
-The [MEDICAL TREATMENT] center that the resident attends does not send them any
documentation unless it is on a need to know basis.
-The other [MEDICAL TREATMENT] vendor that they use routinely sends documentation showing
the resident’s weights, fluid drawn and summary of treatment.
-The [MEDICAL TREATMENT] center did not send reports of the resident’s [MEDICAL TREATMENT]
treatments that show how much fluid is pulled off during his appointments, if there were
any complications, his/her weights before and after treatment or labs unless they
requested it.
-The facility did not routinely request information for the resident’s [MEDICAL TREATMENT]
center about his/her [MEDICAL TREATMENT] treatment.
-The facility weighed the resident weekly so they know how much he/she weighs.
-They should have documentation from the [MEDICAL TREATMENT] center so they are
consistently aware of how the resident’s [MEDICAL TREATMENT] treatments are going and
his/her current status (to ensure coordination of care).
-He/she said he/she will call the resident’s [MEDICAL TREATMENT] center to request medical
status updates on a routine basis so they are informed of /about the resident’s [MEDICAL
TREATMENT] treatments and can coordinate his/her care.
2. Record review of the resident’s (Resident# 1’s) Admission Face sheet shows the resident
was admitted on [DATE] with the following Diagnoses: [REDACTED].
-[MEDICAL CONDITION] (a deficiency of red blood cells);
-[MEDICAL CONDITION] (a disorder characterized by distortions of reality and disturbances
of thoughts and language with withdrawal from social contact); and
-[MEDICAL CONDITION] (the muscular twitching involving individual muscle fibers of the
upper chambers of the heart, prevents the upper chambers of the heart to pump blood
correctly).
Record review of the residents [MEDICAL TREATMENT] care plan dated 12/18/17 showed:
-The resident went to [MEDICAL TREATMENT] three times a week;
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 29)
-[MEDICAL TREATMENT] shunt was to be monitored for patency;
-Fluid intake was to be monitored;
-Monitor it weights; and
-Transportation and escort to be provided for scheduled [MEDICAL TREATMENT] center visits.

Record review of the resident’s Quarterly MDS dated [DATE] showed:
-Was mildly cognitively (slight mental impairment of perception and reasoning) impaired;
-Was able of performing activities of daily living with occasional cueing; and
-Needed prompting and cueing to perform personal hygiene.
Record review of the resident’s Physician’s Order Sheet (POS) dated 10/12/18 to 10/26/18
showed the resident was to have his/her [MEDICAL TREATMENT] right upper extremity
(RUE)shunt fistula assessed for bruit and thrill every shift.
Record review of the resident’s Treatment Administration Record (TAR) for 10/15/18 to
11/14/2018 had a physician’s order for assessment of the resident’s [MEDICAL TREATMENT]
shunt fistula in the right upper extremity to be completed once per shift by the nursing
staff which showed:
-Assessment was completed on the TAR until night of 10/26/18;
-Had been transported to local hospital on [DATE]; and
-Was admitted to the hospital for evaluation and treatment on 10/26/18.
Record review of the resident’s nursing notes dated 10/26/18 written by Licensed Practical
Nurse (LPN) C showed:
-The resident’s Physician was notified of the resident’s low red blood cell count;
-Physician gave orders to send the resident to a local hospital for evaluation and
treatment; and
-Transportation was by ambulance to the local hospital.
Record review of the resident’s nurse notes of 11/8/18 showed:
-The resident returned from the hospital to the facility at 5:00 P.M.;
-All medications had been reviewed and verified by the resident’s physician;
-A head to toe assessment had been done; and
-A physician’s order to assess the [MEDICAL TREATMENT] shunt fistula was not obtained from
the resident’s physician.
Record review of the resident’s (MONTH) TAR showed the staff did not have a physician’s
order to assess the [MEDICAL TREATMENT] shunt from 11/8/18 to 11/ 28/18.
Observation on 11/21/18 at 9:45 A.M. the Assistant Director of Nursing (ADON) assessed the
resident’s bruit by auscultation (listening with a stethoscope) and felt the vibrations of
the thrill.
During interview on 11/21/18 at 9:48 A.M. the ADON said she would document her assessment
of the [MEDICAL TREATMENT] shunt in the nurse notes for the resident.
During an interview on 11/28/18 at 9:45 A.M. Licensed Practical Nurse (LPN) D said:
-The resident had gone to the hospital on [DATE];
-Returned to the facility on [DATE];
-Upon returning to the facility no order had been obtain for assessing the [MEDICAL
TREATMENT] shunt fistula;
-A physician’s order had been requested on 11/28/18;
-Assessment of the [MEDICAL TREATMENT]’s shunt fistula on the RUE was to be done by Bruit
and thrill; and
-Documentation would be on the TAR.
During an interview on 11/28/18 at 10:01 A.M. LPN C said:
-Assessing the Bruit and thrill is fast assessment; and

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 30)
-Nurses should make a nursing note of doing the assessment;
During interview on 11/28/18 at 12:58 P.M. the Director of Nursing said:
-A physician’s order should have been on the POS for the [MEDICAL TREATMENT] shunt
assessment;
-Orders for an assessment should have been found in the TAR;
-Assessments should have been done and documented; and
-Care Planning should have been done for the assessment.

F 0759

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Ensure medication error rates are not 5 percent or greater.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to ensure
medications were administered with an error rate of less than 5 percent (%). Three
medication errors were detected out of 50 observed medication opportunities resulting in
an error rate of 6.0%,including failure to use correct technique when administering
insulin pen for one sampled resident (Resident #31) and eye drops for one sampled resident
(Resident #21). The facility census was 93 residents.
Review of the [MEDICATION NAME] Pen Manufactures Prescribing Guide information Sheet dated
(YEAR) showed to Perform Safety Test on the insulin pen by:
– Dial a test dose of 2 units.
-Hold pen with the needle pointing up and lightly tap the insulin reservoir so the air
bubbles rise to the top of the needle. This will help you get the most accurate dose.
-Press the injection button all the way in and check to see that insulin comes out of the
needle. The dial will automatically go back to zero after you perform the test.
– If no insulin comes out, repeat the test 2 more times. If there is still no insulin
coming out, use a new needle and do the safety test again.
-Always perform the safety test before each injection
Review of Humalog (is a registered trademark of(NAME)Lilly and Company) Insulin Pen
Instructions for Use revised: (MONTH) 13, (YEAR) showed Prime Insulin Pen before each
injection:
-Priming your Pen means removing the air from the Needle and Cartridge that may collect
during normal use and ensures that the Pen is working correctly.
-If you do not prime before each injection, you may get too much or too little insulin.
-To prime your Pen, turn the Dose Knob to select 2 units.
Record review of the State Operations Manual dated (YEAR) showed eye drops should be
placed into the conjunctiva (under eye portion if the eye lid) sac, and the tear duct
should be pressed for one minute or the eye closed for 3 to five minutes for optimal eye
drop absorption
1. Record review of Resident #31’s Face Sheet showed:
-He/she was admitted to the facility on [DATE] and
-He/she had [DIAGNOSES REDACTED].
Record review of the resident’s quarterly Minimum Data Set (MDS a federally mandated
assessment tool completed by facility staff for care planning) dated 8/30/18 showed he/she
was moderately cognitively impaired.
Record review of the resident’s (MONTH) (YEAR) Medication Administration Record [REDACTED]
Physician order [REDACTED].>-To receive [MEDICATION NAME]Pen U-100 to be given

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0759

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 31)
Subcutaneous (SQ or Sub-Q) injection (is a injection given in the fatty tissue,just under
the skin) of 65 units of insulin in the A.M. and 65 units of insulin in the P.M.,
-To Receive Humalog [MEDICATION NAME]U-100 to be given SQ injections of 30 units and if
needed sliding scale insulin,
-Had a physician ordered for sliding scale insulin for [MEDICATION NAME] U-100 Sub-Q to be
given with schedule insulin for a blood sugar in specific range;
-For the blood sugar of 251 to 350, give 11 units.
Observation of Insulin Pen Medication Administration on 11/21/18 at 8:25 A.M. showed;
-Licensed Practical Nurse (LPN) A completed an accucheck for the resident with results
that the resident’s blood sugar was 255;
-LPN A then sanitized his/her hands and obtained the resident’s [MEDICATION NAME] Pen and
[MEDICATION NAME];
-LPN A wiped off the top of the pen with an alcohol pad and attached a new needle to the
pen;
-LPN A then dialed the resident’s [MEDICATION NAME] Pen to 65 units and obtained
[MEDICATION NAME] to total of 41 units,
-Went to the resident washed his/her hands and gloves on hands,
-He/she then injected the [MEDICATION NAME] into the residents left abdomen and then the
Humalog into the resident’s right abdomen,
-LPN A failed to prime the insulin pens with two units before dialing the intended doses
for the resident.
During an interview on 11/21/18 at 8:30 A.M. ,LPN A said:
-The resident’s insulin pens do not need to be primed prior to regular dose of insulin,
-No air needed to be released or entered into the pen, so he/she do not have to waste of
two units of insulin prior to setup the resident’s insulin pen,
-Medication training are provided by the Director of Nursing (DON) and LPN D about every
two weeks, which would include any new changes in administrating insulin pens,
-The DON or LPN D would normally let the Nursing staff and the Certified Medication
Technician (CMT) know about any new guidelines or changes related to medications.
During an interview on 11/28/18 at 2:15 P.M., DON said;
-Licensed nursing provide the insulin to the residents,
-Had provided training on proper use of insulin pens and not to use another syringe to
draw out insulin from the insulin pen and how to dial up the correct dose of insulin,
-The insulin pen should be primed with the first time use only,
-Was not aware of the Manufactures guidance or had been instructed by the facility
pharmacy about the safety information and guidance related to priming of the resident’s
insulin pen, should be primed before every time used.
2. The resident (Resident# 21) was admitted to the facility on [DATE] with the following
Diagnoses: [REDACTED].
-Hypertension (High Blood pressure); and
-[MEDICAL CONDITION] (a chronic and severe mental disorder that affects how a person
thinks, feels, and behaves).
Record review of the residents Quarterly Minimum Data Set (A federally mandated assessment
tool used by the facility staff for care planning) dated 8/30/18 showed:
-The resident was cognitively intact;
-The resident had impaired vision;
-The resident was independent in activities of daily living; and
-He/she was continent of bowel and bladder.
Observation on 11/21/18 at 8:15 A.M. of eye drop administration by Certified Medication
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0759

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 32)
Technician (CMT) A showed:
-Proper hand hygiene was performed;
-That the patient was identified;
-The medication was confirmed;
-The eye drop was placed in the conjunctiva sac;
-CMT A then had the resident close his/her eye; and
-CMT A then massaged the outer lower eye corner of the resident’s eye.
During an interview on 11/21/18 at 8:20 A.M. CMT A said:
-I always do eye drops that way; and
-I massage the outer lower eye after I put the drop in the eye.
During an interview on 11/21/18 at 9:00 A.M. the Assistant Director of Nursing (ADON)
said:
-When a resident has eye drops administered the inner eye tear duct should be held closed
to allow the medication to be absorbed.
During an interview on 11/28/18 at 12:58 P.M., the Director of Nursing (DON) said:
-My expectation is that medications will be administered correctly;
-I expect that when an eye drop has been administered the tear duct would be held in to
allow the medication to be absorbed by the eye for a minimum of one minute.

F 0760

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Ensure that residents are free from significant medication errors.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to prevent a
significant medication error during insulin administration by not priming the insulin pen
prior to dialing the intended dose for one sampled resident’s (Resident #31) out of 44
sampled residents. The facility census was 93 residents.
Review of the [MEDICATION NAME] Pen Manufactures Prescribing Guide information Sheet dated
(YEAR) showed to Perform Safety Test on the insulin pen by:
– Dial a test dose of 2 units.
-Hold pen with the needle pointing up and lightly tap the insulin reservoir so the air
bubbles rise to the top of the needle. This will help you get the most accurate dose.
-Press the injection button all the way in and check to see that insulin comes out of the
needle. The dial will automatically go back to zero after you perform the test.
– If no insulin comes out, repeat the test 2 more times. If there is still no insulin
coming out, use a new needle and do the safety test again.
-Always perform the safety test before each injection
Review of Humalog (is a registered trademark of(NAME)Lilly and Company) Insulin Pen
Instructions for Use revised: (MONTH) 13, (YEAR) showed Prime Insulin Pen before each
injection:
-Priming your Pen means removing the air from the Needle and Cartridge that may collect
during normal use and ensures that the Pen is working correctly.
-If you do not prime before each injection, you may get too much or too little insulin.
-To prime your Pen, turn the Dose Knob to select 2 units.
1. Record review of Resident #31’s Face Sheet showed:
-He/she was admitted to the facility on [DATE] and
-He/she had [DIAGNOSES REDACTED].

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0760

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 33)
Record review of the resident’s quarterly Minimum Data Set (MDS a federally mandated
assessment tool completed by facility staff for care planning) dated 8/30/18 showed he/she
was moderately cognitively impaired.
Record review of the resident’s (MONTH) (YEAR) Medication Administration Record [REDACTED]
Physician order [REDACTED].>-To receive [MEDICATION NAME]Pen U-100 to be given
Subcutaneous (SQ or Sub-Q) injection (is a injection given in the fatty tissue,just under
the skin) of 65 units of insulin in the A.M. and 65 units of insulin in the P.M.,
-To Receive Humalog [MEDICATION NAME]U-100 to be given SQ injections of 30 units and if
needed sliding scale insulin,
-Had a physician ordered for sliding scale insulin for [MEDICATION NAME] U-100 Sub-Q to be
given with schedule insulin for a blood sugar in specific range;
-For the blood sugar of 251 to 350, give 11 units.
Observation of Insulin Pen Medication Administration on 11/21/18 at 8:25 A.M. showed;
-Licensed Practical Nurse (LPN) A completed an accucheck for the resident with results
that the resident’s blood sugar was 255;
-LPN A then sanitized his/her hands and obtained the resident’s [MEDICATION NAME] Pen and
[MEDICATION NAME];
-LPN A wiped off the top of the pen with an alcohol pad and attached a new needle to the
pen;
-LPN A then dialed the resident’s [MEDICATION NAME] Pen to 65 units and obtained
[MEDICATION NAME] to total of 41 units,
-Went to the resident washed his/her hands and gloves on hands,
-He/she then injected the [MEDICATION NAME] into the residents left abdomen and then the
Humalog into the resident’s right abdomen,
-LPN A failed to prime the insulin pens with two units before dialing the intended doses
for the resident.
During an interview on 11/21/18 at 8:30 A.M. ,LPN A said:
-The resident’s insulin pens do not need to be primed prior to regular dose of insulin,
-No air needed to be released or entered into the pen, so he/she do not have to waste of
two units of insulin prior to setup the resident’s insulin pen,
-Medication training are provided by the Director of Nursing (DON) and LPN D about every
two weeks, which would include any new changes in administrating insulin pens,
-The DON or LPN D would normally let the Nursing staff and the Certified Medication
Technician (CMT) know about any new guidelines or changes related to medications.
During an interview on 11/28/18 at 2:15 P.M., DON said;
-Licensed nursing provide the insulin to the residents,
-Had provided training on proper use of insulin pens and not to use another syringe to
draw out insulin from the insulin pen and how to dial up the correct dose of insulin,
-The insulin pen should be primed with the first time use only,
-Was not aware of the Manufactures guidance or had been instructed by the facility
pharmacy about the safety information and guidance related to priming of the resident’s
insulin pen, should be primed before every time used.

F 0761

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Ensure drugs and biologicals used in the facility are labeled in accordance with
currently accepted professional principles; and all drugs and biologicals must be stored
in locked compartments, separately locked, compartments for controlled drugs.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0761

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review the facility failed to store, and label
medications
in the Memory Lane unit’s refrigerator’s, nurse’s treatment supply carts and medication
supply carts.
The facility census was 9
Record review of federal regulations 483.45(g), Labeling of drugs and biologicals, and
federal regulation 483.45 (h) requires all drugs and biologicals are to be labeled in
accordance with professional standards, including expiration dates. In accordance with
professional standards, including expiration dates and with appropriate accessory and
cautionary instructions.
Record review of the U.S. government Food and Drug Administration (USFDA) site for
Biologicals/Bloodvaccines/Vaccines showed that multi use vials should be discarded at
expiration date.
Record review of the manufacture’s recommendations for [MEDICATION NAME] 23 multi use
vials is that the vials be stored in temperatures between 36 to 42 degrees. That once
opened a multi use vials should be used within 48 hours of opening, and that all vaccines
should be discarded by the expiration date.
Observation on 11/27/18 at 10:30 A.M. with the Assistant Director of Nursing (ADON) of the
Memory Lane unit’s medication refrigerator a plastic bag from the pharmacy labeled as
Pneumococcal vaccine dated 5/17/17 contained a previously opened for use multi use vial of
Pneumo Vac 23 with the expiration date of 4/8/18.
Observation on 11/27/18 at 10:45 A.M. with the ADON, of the medication cart in the Memory
Lane unit of the facility:
-Three and one half pills/tablets were found loose on the bottom of the third cart drawer;
-Two pill were found loose on the bottom of the second cart drawer;
– Sani-Wipes cleaning towels were found in middle of the third cart drawer with partially
used medication punch cards leaning upon the Sani-Wipe container.
Observation 11/27/18 at 11:00 A.M. with the ADON of the Memory Lane unit’s nurses
Treatment cart:
-Topical ointment showed a prescription label dated 1/13/17, Trimocoline cream 0.1% to the
affected area for a resident;
-Treatment with an topical ointment was not listed in the Treatment Administration Record
for the resident dated 11/15/18 to 12/14/18;.
-No order for the use of [REDACTED].
During interview on 11/27/18 at 11:05 A.M. the ADON said:
– Nursing staff are responsible for the contents of the refrigerator, it should have been
checked and expired medications should be pulled for destruction.
-He/she had never opened the refrigerator previously, and had not looked at the Pneumo vac
vial expiration date previously.
During interview on 11/28/18 at 12:58 P.M. the Director of Nursing said:
-Staff are to check the medications in the refrigerator’s for expiration dates and to
ensure open dates are on multi use vials;
-Expired medications or medications that are deemed questionable should be sent to him/her
for destruction; and
-Medication rooms, and carts should have been cleaned, and inspected for proper storage of
medications on a weekly basis.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0761

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

F 0791

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Provide or obtain dental services for each resident.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review the facility failed to identify and
provide timely dental services for replacement of dentures for one sampled resident
(Resident #75) out of 44 sampled residents. The facility census was 93 residents.
1. Record review of Resident #75’s Facility admission sheet date showed the resident was
admitted on [DATE] with the following Diagnoses: [REDACTED].
-Symbolic dysfunction (A communization disorder that affects an individual’s ability to
comprehend, or apply language and speech to effectively communicate with others) .
-Chronic [MEDICAL CONDITION] (A long [MEDICATION NAME] liver infection).
-Urinary Tract Infection (An infection of the kidney, ureter, bladder, or urethra).
-[MEDICAL CONDITION] (a benign overgrowth of prostate tissue that surrounds the urethra
constricting urine flow).
Record review of the resident’s Admission Minimum Data Set (MDS-a federally mandated
assessment tool completed by facility staff for care planning) dated 7/18/18 showed the
residents had no dental issues noted in section [MI] Oral/Dental Status.
Record review of the resident’s physician’s orders [REDACTED].
-The resident had standing physician’s orders [REDACTED].
Observation on 11/27/18 at 12:02 P.M. of the resident showed he/she had no teeth visible
in his/her mouth.
During interview on 11/27/18 at 12:05 P.M. with the resident said:
-Have not seen a Dentist.
-Lost my dentures when I was at the local hospital.
-Would like new dentures.
During a interview on 11/28/18 at 8:55 A.M., the Social Service Designee (SSD) said:
-The Dentist has been here much since September.
-The Dentist was busy in (MONTH) with people getting dentures.
-The Resident had not mention needing dentures to him/her.
-Have called the dentist, and have left a message to try to get a dental appointment at a
hospital.
-Is responsible for putting new residents on the dentist list, and the resident had not
been on the list to see the dentist.
During an interview on 11/28/18 at 10:32 A.M. the SSD said:
-The visiting dentist had returned his/her call.
-The dentist had made an appointed to see the resident later the same afternoon.
During an interview on 11/28/18 at 12:48 P.M. the Director of Nursing (DON) said my
expectations are that:
-The nursing staff should have done a head to toe assessment for a newly admitted
resident.
-The head to toe assessment should have included an oral/dental assessment.
-The oral/dental assessment should have included, documenting missing, broken, decayed or
chipped teeth.
-If a resident had no teeth and/or needed dentures that assessment should have been
documented.
-Staff should have scheduled the initial dental appointment for the resident within 24 to
48 hours after admission.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0791

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

F 0800

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Provide each resident with a nourishing, palatable, well-balanced diet that meets his
or her daily nutritional and special dietary needs.

Based on observation, interview and record review, the facility failed to maintain the
temperature of cheesy broccoli and baked chicken at or above 135 ºF (degrees Fahrenheit)
throughout the meal service on Applegate Lane. This practice potentially affected eight
residents who may have selected the alternate that day. The facility census was 93
residents.
1. Observation on 11/19/18 at 2:26 P.M., showed the temperature of the baked chicken was
122 ºF and at 2:31 P.M., the temperature of the cheesy broccoli was 125 ºF on the steam
table.
During an interview on 11/19/18 at 2:32 P.M., Dietary Aide (DA) A said he/she was not able
to monitor the temperatures because he/she did not have a thermometer with him/her at the
steam table.
Record review of the 2013 FDA Food Code
– Chapter 501.16 Time/Temperature Control for Safety Food, Hot and Cold Holding.
(A) Except during preparation, cooking, or cooling, or when time is used as the public
health control as specified under section 3-501.19, and except as specified under
paragraphs B) and C) of this section, TIME/TEMPERATURE CONTROL FOR SAFETY FOOD shall be
maintained:
(1) At 135 ºF or above, except that roasts cooked to a temperature and for a time
specified in 3-401.11(B) or reheated as specified in paragraph 3-403.11(E) may be held at
a temperature of 130 ºF above.

F 0802

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Provide sufficient support personnel to safely and effectively carry out the functions
of the food and nutrition service.

Based on observation, record review and interview, the facility failed to have enough
dietary staff on the schedule on 11/19/18 to ensure that food that was delivered to the
facility was put away in a timely manner after delivery; and to ensure the lunch meal was
served to the Cherry Lane, Applegate and Memory Lane Units within a timely manner of the
listed times for lunch service. This practice potentially affected at least 85 residents.
The facility census was 93 residents.
1. Observations and interviews during meal preperation and service on 11/19/18 showed:
– At 9:06 A.M., two dietary staff (the Dietary Manager (DM) and one aide Dietary Aide (DA)
A) were on duty,
– At 9:06 A.M., the DM said there was just him/her and one DA on duty and there will be a
prep cook coming in around 10:00 A.M., maybe a little earlier,
– At 9:36 A.M., there were numerous items in the stock room which needed to be
refrigerated which were not put away yet, which included:
– Items that should be frozen include the following: one 30 pounds (lbs.) box of
margarine, one 50 lbs. box of frozen egg product, one 40 lbs. box of pollock fillets, one

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0802

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 37)
12 lbs. box of whipped topping, two boxes of turkey, one 30 lbs. box of chicken, one 11
lbs. box of waffles,
– Items to be refrigerated included, one box of celery, five boxes of 48 eight ounce (oz.)
containers of milk, 2 boxes of cabbage, and three nine lbs. boxes of strawberries,
– At 9:39 A.M., the DM said the reason why those items were not put away was because
he/she did not have enough dietary staff working with him/her today.
– At 9:59 A.M., DA A said the truck came in at around 7:00 A.M., that day.
– At 9:59 A.M. the DM said the regular cook had that day (11/19/18) off and he/she did not
have enough people on the schedule,
– At 10:06 A.M., Preparation Cook (PC) B started to put away the packages of food,
– At 11:32 A.M., PC A said that the food delivery the truck comes every Monday and Friday.
– Food is always waiting for him/her to put away,
– He/she always scheduled to come in at 10:00 A.M.
– At 12:06 P.M., the DM said to really make a go of it, he/she needed one cook and two
dietary aides in the morning shift and he/she also may need to schedule more people on the
days the truck delivers food,
– At 12:11 P.M., the DM said a DA was terminated on 11/13/18, which left him/her short,
he/she would like to get the food packed away into the freezer or fridge within an hour
half after the truck leaves.
2. Record review of the meal time schedules, showed the lunch meals should be served
between 12:30 P.M. and 12:45 P.M., in the Cherry Lane and Memory Lane areas and between
12:45 P.M. and 1:00 P.M., in the Applegate area.
Observations on 11/19/18, during the meal preparation showed the following:
– At 12:44 P.M., the DM was still cooking the main meal and DA A worked on getting the
dishes cleaned up from the breakfast meal.
– At 1:00 P.M., PC A just started to place fruit in bowls,
– At 1:34 P.M., the food was initially ready to leave the kitchen, but did not leave
kitchen until 1:44 P.M., because the DM said silverware was needed
**Note the meals should be served between 12:30 P.M. and 12:45 P.M., in the Cherry Lane
and Memory Lane areas and between 12:45 P.M. and 1:00 P.M., in the Applegate area.
Observations on 11/19/18, showed:
-At 1:29 P.M., showed the meals still had not arrived at Cherry Lane, 44 minutes after the
start time for that area,
– At 1:48 P.M., the lunch meal was brought to Cherry Lane by dietary staff, 63 minutes
after the start time for that area.
– At 1:56 P.M., the lunch meal was brought to the Applegate area by dietary staff, 56
minutes after the start time for that area, and
– At 2:01 P.M, the lunch meal was brought to the Memory Lane area, 75 minutes after the
start time for that area.
During an interview on 11/19/18 at 3:06 P.M., the Corporate Dietary Manager said he/she
was called over to assist because they were short of staff for that day and he/she helped,
just to get them caught up.
During an interview on 11/19/18 at 3:31 P.M., the Administrator said:
– He/she has been employed at the facility for two months,
– No one told him/her the dietary department was short,
– In all fairness there was a person who was terminated form the dietary department last
week.,
– He/she acknowledged the food was delivered late that day, and
– He/she said it was unacceptable.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0802

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 38)
During an interview on11/20/18 at 10:20 A.M., the Registered Dietitian ( RD) said:
– The DM can contact him/her when there are questions,
– He/she (the DM) goes to the facility on ce per month,
– He/she does a walk through watches the dietary department do the meal preparation, and
watched them keeping temps,
– He/she ( the RD) was not involved in the scheduling ,
– The current DM should not be the DM right now because he/she ( the DM) serves, cooks,
and worked generally in the kitchen, and
– The dietary department were always kind of short by at least one person.

F 0804

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Ensure food and drink is palatable, attractive, and at a safe and appetizing
temperature.

Based on observation and interview, the facility failed to ensure the carrots on a test
tray in the Cherry Lane area was maintained at or close to 120 ºF (degrees Fahrenheit).
This practice potentially affected at least seven residents who received their trays
closer to the end of the lunch meal. The facility census was 93 residents.
1. Observation on 11/19/18 at 2:02 P.M., of the test tray with Certified Nurse’s Assistant
(CNA) D, showed the temperature of the carrots was 106 ºF, 14 degrees below the
recommended serving temperature.
During an interview on 11/19/18 at 2:03 P.M., CNA D said he/she has not seen anyone from
the dietary department at the unit measuring temperatures of room trays.
During an interview on 11/21/18 at 8:40 A.M, Dietary Aide (DA) C said he/she checked the
food temperatures in the kitchen but does not check temperatures in the serving areas.

F 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Procure food from sources approved or considered satisfactory and store, prepare,
distribute and serve food in accordance with professional standards.

Based on observation, interview and record review, the facility failed to prevent or
maintain the following: a buildup of debris in the knife holder; maintain the oven mits
without rips, maintain the floor under the dishwasher area and the six burner stove free
of dishes and food debris, maintain the top of the six burner stove free from burnt on
grease, maintain the ice machine free from grime inside the machine, maintain Refrigerator
three free from a ripped gasket (a piece of rubber or some other material that is used to
make a tight seal between two parts that are joined together), maintain four cutting
boards free from numerous nicks which rendered those cutting boards as not easily
cleanable. This practice potentially affected all residents. The facility census was 93
residents.
1. Observations on 11/19/18 from 9:08 A.M. through 1:40 P.M., showed:
– At 9:08 A.M., there was a buildup of debris inside the knife holder,
– At 9:11 A.M., the oven mit that was used by the Dietary Manager (DM) while cooking, had

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 39)
a 1.5 inch (in.) rip in it,
– At 9:14 A.M., one glass, one plate cover, and other debris under the six burner stove,
– At 9:30 A.M. a nine inch tear and a 15 inch tear in the gaskets in refrigerator unit
three,
– At 9:30 A.M., the cover to the chest freezer was damaged with part of the cover held
together by tape,
– At 9:35 A.M. a yellow, red, white and two green cutting boards with stains/ numerous
nicks
– At 9:36 A.M, the DM said he/she needed to replace the cutting boards,
– At 10:04 A.M., a layer of grime was present on the white upper plastic part of the ice
machine,
– At 1:36 A.M., Preparation Cook (PC) A said he/she did not pay attention to the ice
machine in the past, but agreed the ice machine needed to be cleaned, and
– At 3:08 P.M., the Corporate DM, noticed the grime and debris under the stove.
During an interview on 11/19/18 at 3:16 P.M., the DM said the night shift dietary crew
should sweep and mop under the six burner stove.
Record review of the 1999 and 2009 Food and Drug Administration (FDA) Food Code and
Missouri Food Codes, showed:
-In Chapter 3-305.14, showed: During preparation, unpackaged food shall be protected from
environmental sources of contamination.
-Chapter 4-101.11, showed: Materials that are used in the construction of utensils and
food-contact surfaces of equipment may not allow the migration of deleterious substances
or impart colors, odors, or tastes to food and under normal use conditions shall be: (A)
Safe; (B) Durable, corrosion-resistant, and nonabsorbent; (C) Sufficient in weight and
thickness to withstand repeated warewashing; (D) Finished to have a smooth, easily
cleanable surface; and (E) Resistant to pitting, chipping, crazing, scratching, scoring,
distortion, and decomposition.
In Chapter 4-501.11, showed Good Repair and Proper Adjustment.
A) EQUIPMENT shall be maintained in a state of repair and condition that meets the
requirements specified under Parts 4-1 and 4-2.
(B) EQUIPMENT components such as doors, seals, hinges, fasteners, and kick plates shall
be kept intact, tight, and adjusted in accordance with manufacturer’s specifications.
– In Chapter 4-601.11, EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to
sight and touch.
– In Chapter 6-501.12, paragraph A, The physical facilities shall be cleaned as often as
necessary to keep them clean.
– In Chapter 4-602.13, nonFOOD-CONTACT SURFACES of EQUIPMENT shall be cleaned at a
frequency necessary to preclude accumulation of soil residues.

F 0813

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Have a policy regarding use and storage of foods brought to residents by family and
other visitors.

Based on record review, observation and interview, the facility failed to ensure that food
stored in the resident use refrigerator in Memory Lane, was labeled with someone’s name
and a date it was stored. This practice potentially affected at least 20 residents in the

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0813

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 40)
Memory Lane unit. The facility census was 93 residents.
Record review of the facility’s policy entitled Resident Food Storage dated 11/16/16,
showed:
– Food items will be dated after opening.
– Prepared food that is dated three days after it is placed in the refrigerator will be
discarded,
– Visitors are allowed to bring food items into the facility for residents.
– Resident’s and their visitors will be encouraged to follow the resident’s physician
ordered diet,
– Any variance in diet compliance will prompt education to be provided by the nursing
staff,
– Food brought into the facility by visitors will be stored in the resident’s refrigerator
if temperature maintenance is required.
– If the resident does not have a refrigerator, the facility will store the food in the
snack room refrigerator for three days.
– Food that does not require temperature regulation may be stored in the snack room, and
– No guideline for labeling the food with the resident’s name to whom it belonged.
1. Observation with Resident Care Coordinator (RCC) A on 11/27/18 at 10:17 A.M., showed
four containers with food in fridge without a date or a name of who the food belonged to.
During an interview on 11/27/18 at 10:21 A.M., RCC A said he/she did not know how long the
food had been in that refrigerator and if food were brought in to visitors, it would be
stored in that refrigerator.

F 0814

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Dispose of garbage and refuse properly.

Based on observation, interview and record review, the facility failed to keep the lid of
the outdoor dumpster closed over two days. The facility census was 93 residents.
1. Observations on 11/21/18 at 5:59 A.M., 7:41 A.M., 10:14 A.M, and 11:56 A.M, showed the
dumpster lid open continually.
2. Observations on 11/27/18 at 8:16 A.M., 9:18 A.M., 1:27 P.M. and 3:28 P.M., showed the
dumpster lid open continually.
During an interview on 11/27/18 at 3:28 P.M., the Dietary Manager said he/she had stressed
keeping the lid closed to his/her people and employees throughout the facility time and
time again.

F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Provide and implement an infection prevention and control program.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure infection
control practices to prevent cross contamination were implemented by failing to properly
store oxygen supplies for one sampled resident (Resident 92) , failed to ensure proper
placement of the resident’s catheter bag during cares and transfer for one sampled

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 41)
resident (Resident #78), failed to prevent infection spreading to the resident due to the
resident’s urinary catheter bag tubing was touching the floor on multiple occasions for
one sampled resident (Resident #86) out of 44 sampled residents and failed to wash hands
in-between residents during the medication pass on Memory Land and this could affect all
the residents who reside on Memory Lane. The facility census was 93 residents.
1. Record review of Resident #92’s Face Sheet showed the resident was admitted to the
facility on [DATE], with [DIAGNOSES REDACTED].), [MEDICAL CONDITIONS] ([MEDICAL
CONDITION]- a progressive disease that is characterized by shortness of breath and
difficulty breathing), [MEDICAL CONDITION] (abnormal heart rhythm), kidney failure (a
medical condition in which the kidneys no longer function), abdominal pain, high blood
pressure and malnutrition.
Record review of the resident’s Minimum Data Set (MDS), a federally mandated assessment
tool to be completed by facility staff for care planning dated 11/14/18 showed the
resident:
-Was alert and oriented with minimal confusion.
-Needed limited assistance with bathing, dressing, transferring, and continence.
-The MDS did not show the resident used oxygen or any breathing treatments.
Observation on 11/19/18 at 8:43 A.M., showed the resident was not in his/her room. The
resident’s oxygen concentrator (a medical device used to deliver oxygen to those who
require it) was sitting on the floor beside his/her bed and was on and running. The
resident’s nasal cannula (a lightweight tube which on one end splits into two prongs which
are placed in the nostrils and from which a mixture of air and oxygen flows -it is used to
deliver supplemental oxygen or increased airflow to a patient or person in need of
respiratory help) and tubing was uncovered and draped on top of a plastic bag that was on
top of the concentrator. There was a breathing treatment machine on the resident’s bedside
table. The mask and tubing was uncovered and sitting on top of a plastic bag and a
nightgown that was also lying on the bedside table.
Observation on 11/20/18 at 8:30 A.M., showed the resident was not in his/her room. His/her
oxygen concentrator was on and running and his/her nasal cannula and tubing was draped
over the oxygen concentrator, uncovered. The resident’s breathing treatment machine was no
longer on his/her bedside table.
During an interview on 11/28/18 at 10:43 A.M., the Director of Nursing (DON) said:
-He/She expected the resident’s oxygen equipment, to include nasal cannulas, oxygen masks
and tubing, to be kept covered in the plastic bags provided when not in use.
-If the resident takes the nasal cannula or mask off themselves, the nursing staff should
be monitoring for that and place the masks and nasal cannulas in the plastic bags.
-Oxygen equipment should not sit on top of the plastic storage bags provided to keep the
supplies covered.
Record review of Resident #78 Admission Face Sheet showed the resident was admitted to the
facility on [DATE] and readmitted to the facility on ,[DATE], with the following
[DIAGNOSES REDACTED].>-[MEDICAL CONDITION]
-Dementia,
-Pressure Ulcer unstagble (is Full thickness tissue loss in which the base of the ulcer is
covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black)
in the wound bed),
-Chronic oste[DIAGNOSES REDACTED] (is a severe, persistent, and sometimes incapacitating
infection of bone and bone marrow).
Record review of the resident’s Quarterly MDS dated [DATE] showed the resident’s;
-Was alert and oriented with minimal confusion,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 42)
-Had been on Hospice services,
-Had an Indwelling catheter (or a Foley catheter, is the tube that carries urine from the
bladder to the outside of the body and into a urinary/catheter drainage bag),
-Required total assistant of two staff member for transfer,
-Required total assistant of one staff member for personal care ,bathing and eating
assistance.
Record review of the resident’s Care Plan dated 7/19/18 showed the resident;
-Required total assistance from facility staff for all Activities of daily living (ADL’s),
-Requires to be transferred with a Hoyer lift (mechanical lift, used to assist staff in
safely transfer a dependent resident) and the assistance of two staff members,
-Has a indwelling catheter
Interventions included;
-To have catheter care every shift,
Record review of the resident’s Paper Hand written Care Plan had been updated on 10/4/18
showed the resident had a catheter replaced on 10/4/18, due to a wound on his/her bottom.
Record review of the resident’s POS dated 11/15/18 to 12/14/18 showed:
-Under the treatment order section had phsyician’s order for the resident’s Foley
catheter;
-Care staff to provide catheter care every shift,
-The foley catheter size was a 12 French (fr, is the size of tube to insert ) with 30
cubic centimeter (cc) balloon (amount fluid needed to inflate the balloon),
During observation on 11/20/18 at 12:05 P.M. of the resident’s peri care, catheter care by
Certified Nursing Assistant (CNA) A, CNA F; and Registered Nurse (RN) A showed;
-CNA A, CNA F and RN A had washed their hands with soap and water when they entered the
resident’s room,
-The resident room door closed and curtain pulled by staff,
-Staff had provided a sheet for privacy of the resident during cares,
-The resident was soiled with stool and staff had to use several wipes to clean the
resident,
-The CNA’s had to call RN A in for assist with cares,
– CNA F gloves became soiled trying to assist the CNA B with provided peri care,
-CNA F wipe his/her gloves off with the resident’s peri wipes and continue to use gloves
hands in provide care for the resident,
-CNA F had also touch the resident’s sheets and assisted the resident to side position to
provide peri care,
-CNA F with the same gloved hands, had to obtain several clean wipes out of the package
with soiled gloves hands,
-RN A came to assist: in care of the resident back side of stool and a new pad was applied
by RN A,
-CNA A suggested to CNA F to remove his/her gloves, before providing or assisting in
cares,
-CNA F removed gloves and used the foaming hand sanitizer on his/her hands, then applied
clean gloves,
-The resident’s catheter bag had been at the foot of the bed during cares, and above the
resident’s bladder,
-The nursing Staff and care staff reposition the resident and provided frontal peri care
and catheter care,
-CNA A had removed his/her gloves and washed his/her hands prior to applyng clean gloves,
-CNA A had provided catheter care for the resident,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 43)
-CNA A cleaned down the on tube first , with one wipe and then another wipe, then repeated
the process for the inner area,
-Resident’s care had been completed and CNA A removed his/her gloves and then washed
his/her hands with soap and water,
-CNA F had removed his/her gloves and obtain the foam hand sanitizer,
-With CNA A and CNA F applied clean gloves and finished dressing the resident and applied
the resident’s heel boots with gloved hands,
-CNA F did not wash his/her hands after providing personal care to the resident.
During an observation on 11/20/18 at 12:25 P.M., of the resident’s Hoyer lift transfer
showed:
-The resident being transferred from his/her bed to his/her broda chair by CNA A and CNA
F:
-With same gloved hands, they placed the hoyer sling under the resident,
-CNA A had left the resident’s room to get the Hoyer lift and he/she had reentered the
resident’s room and washed his/her hands with soap and water
-With clean gloves CNA A prepared the resident to be transferred,
-CNA F also left and reentered the resident room, washed his/her hands with hand sanitizer
applied clean gloves,
-CNA F had hooked the resident’s catheter bag on the sling loop and attached it to the
Hoyer lift
-While lifting the resident, CNA A had removed the catheter bag and went ahead replaced
the resident’s catheter bag on a loop at the height of the resident’s head,
-CNA A then transferred the resident safely to his/her broda chair while the catheter
foley bag was above the resident bladder,
-During resident’s care process and transfer of the resident, CNA F did not wash his/her
hands with soap and water peri care was completed and the resident had a large incontinent
stool,
-CNA F had left the resident’s room two times and only used the foam hand sanitizer after
his/her initial enter into the resident’s room and never washed his/her hands with soap
and water.
During interview on 11/28/18 at 10:33 A.M., with CNA F said:
-When you transfer a resident with a catheter, he/she had been taught to hook the catheter
bag on to the sling loop that was connected to the Hoyer lift, to prevent the resident’s
catheter bag from touching the floor, dragging or catching of the catheter bag,
-Catheter bag should be placed in a privacy bag on hooked onto the side if the resident’s
bed during care,
-He/she was not aware about keeping the catheter bag below the bladder during care and
reason why,
-He/she was aware the urine can flow back up the catheter tube,
-Had not been taught different while in orientation at the facility.
During an interview on 11/28/18 at 12:52 P.M., LPN A said :
-The resident catheter bag should be below the resident’s bladder and never above or at
the same hight of resident’s head,
During an interview on 11/28/18 at 2:15 P.M., DON said;
-It is not a facility practice for CNA’s and nursing staff to place the resident’s
catheter bag above the the resident’s bladder or at height of resident head during
transfer or care of the resident,
-Would expect nursing and care staff to ensure the resident’s catheter bag be kept below
the resident’s bladder at all times and not laying at the foot of resident’s bed during
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 44)
care,
-Catheter bag should not be touching the floor and should be in a covered bag for privacy,

-While CNA’s or nursing staff providing personal care, he/she would expect staff ensure
infection control preventin guidlines. If the CNA’s or nursing staff gloves soilded should
have changed his/her gloves and not to wipe them off with resident personal wipes,
-Would expect CNAs/and Nursing staf should not continuee resident care with soiled
clothes,
-When CNA’s and nursing staff should have changed their gloves and wash their hands with
soap and water, or use foam hand sanitizer wash during peri care,
-The staff should always wash thier hands with soap and water before leaving the resident
room.
-The facility had recently had in-serviced the staff on the proper way to wash their hands
and on the proper glove use prior to the survey.
Record review of the federally policy statement dated 12/3/18, showed the facility will
ensure any resident with a urinary catheter will be maintained to prevent infection and to
follow the Catheter Care procedures as follows:
-To make sure the urinary catheter bag tubing does not touch the floor to avoid or prevent
the spreading of communicable diseases to the resident.
3. Record review of the Resident’s Face Sheet #86 showed he/she was admitted to the
facility on [DATE] with the following Diagnoses: [REDACTED].
-Pain
Record review of the resident’s annual Minimum Data Set (MDS – a federally mandated
assessment too to be completed by facility staff for care planning ) dated 10/20/18 showed
he/she:
-Had a Brief Interview for Mental Status (BIMS) score of 10, which describes the resident
was cognitive alert and oriented.
-Was able to express ideas and wants to others in a consistent and reason manner.
-Was a one person assist with Activities of Daily Living (ADL) for eating , bathing,
dressing , transferring, personal hygiene and mobility needs.
-Was able to eat independently with set up help only and needed some assistance with
clothing items after daily toilet use.
Record review of the resident’s Care Plan dated, 10/20/18 showed the resident:
-Had a #16 french Foley Catheter.
-The resident was sent to the hospital after a mental status change.
-admitted to the hospital with [REDACTED].
-Had returned to the facility with a Foley Catheter to assist with monitoring of the
Hemiuria,
-Was to be free of infection related to his/her Catheter bag through the next review date
1/21/18.
-Was to provide catheter care every shift.
-Was to ensure his/her dignity is kept intact at all times by keeping the catheter bag
covered at all times.
-Was to empty his/her Catheter bag routinely.
-Was to wash his/her hands before and after providing catheter care.
-Was to monitor for changes in the resident’s urine such as color, smell, consistency and
report any changes to the resident’sdoctor.
Record review of the resident’s Care Plan dated on 10/20/18 showed he went to the hospital
due to breaking the catheter off into bladder.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 45)
Record review of the resident’s Treatment Administration Record (TAR) showed dated on
10/26/18 showed the resident was treated for [REDACTED].>-Catheter Care every shift for
the A.M. and P.M. hours.
-Had a #16 French Foley Catheter.
-Had to replace the Foley Catheter every mouth or as needed.
-Nursing staff had to provide or conduct skin assessments for the resident on a weekly
basis.
Record review of the resident’s Weekly Skin assessment dated on 10/31/18 resident had
[MEDICATION NAME] to the groin area.
Observation on 11/19/18 at 9:30 A.M. showed the resident had transferred himself/herself
to the bathroom and he had struggled with pulling up his/her pants.
-The LPN A walked in the room to assist the resident in the wheelchair with his clothing.
-The LPN A assisted the resident with his/her wheelchair and while he/she was pushing the
wheelchair it was noticed the Catheter tubing was dragging across the floor as LPN A
pushed the resident to his appropriate space in his/her room.
Observation on 11/20/18 at 1:30 P.M. showed the resident catheter tubing wrapped around
his/her left leg and was tangled around his/her pants.
-The catheter tubing was noticed floor area while he/she was seated in his/her wheelchair.
During an interview on 11/29/18 at 10:00 A.M.; the CNA D said:
-He/she was expected to clean Resident’s #86 Catheter tubing since it is like caring for
some one who requires Peri Care.
-He/she was expected to keep the Catheter bag below the resident’s bladder to ensure
proper positioning techniques and to avoid bacteria flowing back into the catheter tube to
the resident.
During an interview on 11/29/18 at 10:50 A.M. LPN A said:
-He/she expected to keep the resident catheter tubing in a bag to avoid any dignity
issues.
-He/she expected the catheter tubing or bag not to touch the floor.
-He/she expected the catheter tubing or bag be placed or position below the resident’s
bladder area.
-He/she expected nursing staff to report to him/her any changes in the resident’s urinary
discoloration.
During an interview on 11/29/18 at 1:00 P.M. with the DON said the resident’s catheter
tubing and/or bag should never be on the floor or touching the floor.
.
Record review of the Missouri state Certified Medication Technician Training Manual
Revised in 2008 showed that hand hygiene was the most effective method to prevent the
spread of infections. The hands should be washed or sanitized before and after contact
with each resident. That hand hygiene should be performed before gloving and after the use
of gloves.
4. Observation on 11/21/18 at 7:05 A.M of Certified Medication Technician (CMT) A showed:
-He/She did not wash or sanitize her hands prior to gloving for a Blood Glucose Level
test;
-He/she removed the gloves, and did not wash or sanitize his/her hands;
-Oral medications were given to the resident.
Observation on 11/21/18 at 7:19 A.M. of CMT A showed:
-He/she did not sanitize or wash his/her hands;
-Oral medications were prepared and administered to a second resident on the Memory Care
Unit; and
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 46)
-He/she did not sanitize or wash his/her hands after the administration of the
medications.
Observation on 11/21/18 at 8:15 A.M. of CMT A showed:
-He/She did not sanitize or wash his/her hands prior to doing a blood pressure check and
touching the residents bare skin;
-Oral medications were prepared and administered to the resident;
-He/she washed his/her hands and put on gloves for eye drop administration;
-He/she did not sanitize or wash hands after removing gloves.
During an interview on 11/21/18 at 8:30 A.M. CMT A said:
-I always do my medication administration passes the same way; and
-I do not have sanitizing gel on my medication cart.
During an interview on 11/18/18 at 8:49 A.M. LPN C said:
-Sanitizing Gel should to be kept in our uniform pockets;
-Hand washing should be done when working with the residents; and
-Hands should be washed before and after using gloves.
During an interview on 11/28/18 at 12:58 A.M. the DON said:
-He/she expected the staff to do proper hand hygiene;
-Prior to gloving hand hygiene should be done; and
-After removing gloves hand hygiene should be completed.

F 0921

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Make sure that the nursing home area is safe, easy to use, clean and comfortable for
residents, staff and the public.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation and interview, the facility failed to maintain a pipe next to the
automated dishwasher in the kitchen free of a leak which contributed to standing water and
failed to notify the maintenance department about that leak, maintain the floor in
resident room [ROOM NUMBER] free of a large damaged area and failed to maintain the pipe
under the sink in the Memory Lane Men’s Unit. This practice potentially affected at least
three residents who resided in resident room [ROOM NUMBER].
1. Observation on 11/19/18 at 9:01 A.M., and 10:40 A.M., showed the presence of standing
water on the floor next to where there food trays were stored on the shelf.
During an interview on 11/19/18 at 10:40 A.M., the Dietary Manager said the water came
from a leak on a pipe that was close to the automated dishwasher
During an interview on 11/20/18 at 8:38 A.M., the Maintenance Director said that time was
his/her first time he/she saw the leak under the sink.
2. Observation on 11/19/18 at 9:49 A.M., showed:
– A damaged section of floor in resident room [ROOM NUMBER] that was 15 inches (in.) long
by 12 in. wide,
– A a piece of the floor tile that exposed the floor base that was oblong and about the
size of a medium sized box,
– A resident who happened to be in the room at the time which said that he/she sometimes
tripped over the area when walking due to the uneven surface and that area was not
cleanable,
– The resident said the floor had been that way for almost a year, and
– He/She said he/she spoke to the maintenance personnel some time ago about that issue.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0921

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 47)
Observation with the Maintenance Director, the Housekeeping Supervisor and the
Administrator on 11/20/18 at 9:50 A.M., showed a damaged section of floor in resident room
[ROOM NUMBER] that was 15 in. long by 12 in. wide.
During an interview on 11/20/18 at 9:51 A.M., the Maintenance Director acknowledged the
existence of the damaged floor and it needed to be repaired.
3. Observation on 11/27/18 at 10:45 A.M., showed a leaky pipe and the presence of a black
grimy substance in the cabinet under the sink in the Memory lane medication room.
During an interview on 11/27/18 at 10:50 A.M., the Assistant Director of Nursing (ADON)
said he/she did not know how long that leak existed and had not informed the maintenance
department about that leak.
MO 409.

F 0925

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Make sure there is a pest control program to prevent/deal with mice, insects, or other
pests.

Based on observation, interview and record review, the facility failed to maintain the
kitchen free of gnats (small flies) and failed to maintain the window sill of the Memory
lane clean utility room free of a heavy buildup of dead insects. The facility census was
93 residents.
1. Observations on 11/19/18 at 8:52 A.M., 9:23 A.M., and 12:45 P.M., showed gnats flying
around in kitchen, four gnats on a napkin, and several gnats on the ceiling above the
dishwasher area.
During interviews on 11/19/18, the following was said:
– At 3:14 P.M., Preparation Cook (PC) A said he/she noticed the gnats, and
– At 3:15 P.M, the Dietary Manager (DM) said he/she had noticed the gnats as well and had
contacted maintenance.
2. Observation with the Maintenance Director and the Administrator on 11/20/18 at 11:25
A.M, showed a heavy buildup of dead insects in the window sill of the Memory Lane clean
utility room.
During an interview on 11/20/18 at 11:26 A.M., the Maintenance Director noticed the dead
insects.
3. Observation with the Maintenance Director on 11/21/18 at 6:39 .M, showed two openings
in the window in the attic area above Cherry Lane.
Record review of the following chapters of the 2013 Food and Drug Administration (FDA),
showed:
6-202.15 Outer Openings, Protected.
(A) Except as specified in paragraphs B, C, and E, and under paragraph D of this section,
outer openings of a FOOD ESTABLISHMENT shall be protected against the entry of insects and
rodents by:
(1) Filling or closing holes and other gaps along floors, walls, and ceilings;
(2 Closed, tight-fitting windows;
6-501.111 Controlling Pests.
The PREMISES shall be maintained free of insects, rodents, and other pests. The presence
of insects, rodents, and other pests shall be controlled to eliminate their presence on
the PREMISES by:

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/3/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265532

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

PARKWAY HEALTH CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

2323 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0925

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 48)
Routinely inspecting incoming shipments of FOOD and supplies;
Routinely inspecting the PREMISES for evidence of pests;
Using methods, if pests are found, such as trapping devices or other means of pest control
as specified under and
(D) Eliminating harborage conditions.
6-501.112 Removing Dead or Trapped Birds, Insects, Rodents, and Other Pests. Dead or
trapped birds, insects, rodents, and other pests shall be removed from control devices and
the PREMISES at a frequency that prevents their accumulation, decomposition, or the
attraction of pests.
MO 409.