| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0678 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** -These forms and related attachments should be placed in the front of the medical record |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0678 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 1) -admitted to the facility on [DATE]; -[DIAGNOSES REDACTED]. -Code status was DNR. Record review of the resident’s paper medical record, showed a signed DNR order dated [DATE]. Record review of resident’s social service notes, dated [DATE], showed the resident was full code. Record review of the resident’s EHR POS showed an order for [REDACTED].>Record review of the resident’s care plan, last revised on [DATE], showed the resident to have a DNR. Record review of the resident’s admission MDS, dated [DATE], showed the resident as cognitively intact. Record review of the resident’s paper face sheet, dated [DATE], did not list a code status. 3. Record review of Resident #96’s face sheet showed the following information: -Readmitted to the facility on [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s POS, dated (MONTH) 2019, showed the advance directive of DNR started on [DATE] and discontinued on [DATE]. Record review of the resident’s social services note dated [DATE], at 8:35 P.M., showed the resident had a signed DNR. Record review of the resident’s 5 day MDS assessment, dated [DATE], showed the following information: -Moderately impaired cognition; -[DIAGNOSES REDACTED]. Record review of the resident’s care plan, last revised on [DATE], did not include the advanced directive wishes for the resident. Record review of the resident’s paper chart, on [DATE], showed no signed DNR order. 4. Record review of Resident #39’s face sheet (basic resident information) showed the following information: -Original admission date of [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s social services note dated [DATE], at 10:33 P.M., showed the resident as a full code status at that time. Record review of the resident’s paper chart showed a signed DNR order dated [DATE]. Record review of the resident’s quarterly MDS, dated [DATE], showed the resident as moderately cognitively impaired. Record review of the resident’s care plan, last revised on [DATE], did not include the advanced directive for the resident. Record review of the resident’s POS, dated (MONTH) 2019, showed the advance directive DNR. 5. During an interview on [DATE], at 8:41 A.M., Certified Nursing Assistant (CNA) H said he/she would locate the code resident’s code status in the care plan or in the electronic chart where staff document the activities of daily living (ADL’s). 6. During an interview on [DATE], at 4:01 P.M., CNA L said the following: -He/she would check in the resident’s chartat the nurses’ station to see if the resident is DNR; -If the resident is a DNR code status, then there is a purple sheet put into the front of the chart; -If the purple sheet is not in the chart, then he/she is not certain what their code status is and would have to ask a nurse; |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0678 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 2) -There is no other place to check for code status that he/she is aware of; -When in doubt, he/she would perform CPR. 7. During an interview on [DATE], at 4:03 P.M., CNA C said the following: -If there is a resident in distress, he/she would immediately start CPR; -If there is time, he/she would check the chart for code status or send someone else to check the chart; -When in doubt, he/she will always perform CPR. 8. During an interview on [DATE], at 8:40 A.M., Certified Medication Technician (CMT) G said he/she would locate a resident’s code status in the Medication Administration Record [REDACTED] 9. During an interview on [DATE], at 10:14 A.M., Licensed Practical Nurse (LPN) I said full code and DNR status can be found in the electronic orders. The code status can also be found in the paper chart. 10. During an interview on [DATE], at 10:14 A.M., Registered Nurse (RN) E said the fastest way to find a code status is to look at the electronic orders. Full code status is not listed in the orders. 11. During an interview on [DATE], at 3:40 P.M., the Director of Nursing (DON) and Assistant Director of Nursing (ADON) said the following: -The code status is discussed with the resident upon entry into the facility at the 72 hour meeting; -It is discussed with the residents quarterly; -If a resident is a code status of DNR, then there is a purple sheet placed in their chart at the nurses’ station, they get a physician’s orders [REDACTED]. -Every resident is a full code unless they have a signed DNR paper and full code wishes are not addressed in the resident’s care plan, does not require a physician’s orders [REDACTED]. -When the resident leaves the facility for a hospital stay, the DNR order should go with the resident; -Once the resident returns from the hospital, the code status is discussed again and updated per the resident’s preference; -The first place to look for code status is in the physician’s orders [REDACTED].>-There is no code status listed on the resident’s face sheet; -A CNA should never look for a code status, they should get a nurse; -They did not know that the facility policy said to obtain a physician’s orders [REDACTED]. 12. During an interview on [DATE], at 3:40 P.M., the administrator said the following: -The code status DNR should be put in the resident’s care plan, have a physician’s orders [REDACTED]. -If the resident does not have a signed DNR, then by default they are considered a full code; -He/she did not know that the facility policy said to obtain a physician’s orders [REDACTED]. | |
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure staff monitored catheters (a sterile tube inserted into the bladder to drain urine) according to acceptable standards of practice for two residents (Resident #9 and #34), with history of urinary tract infections [MEDICAL CONDITION], when the residents’ catheter collection bags laid on the floor. A sample of 21 residents was selected for review. The facility census was 102. Record review of the Center for Disease Control and Prevention’s (CDC) Guideline for Prevention of Catheter-Associated Urinary Tract Infections, last updated 2/15/17, showed the following: -Do not rest the catheter bag on the floor. Record review of the facility’s catheter care policy titled, Urinary Catheter Care, dated 11/10/14, showed the following information: -The urine drainage bag should be kept lower than the bladder or an anti-reflux bag should be used to prevent urine in the tubing and drainage bag from flowing back into the resident’s bladder; -Catheter tubing and drainage bags are to be kept off the floor to prevent contamination; -Secure the catheter with a leg bag or loop to the bed sheet in a comfortable position for the resident. 1. Record review of Resident #9’s face sheet (basic resident information) showed the following information: -Original admission date of [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated comprehensive assessment instrument, completed by facility staff, dated 11/23/18, showed the following information: -Cognitively intact; -Required limited assistance with bed mobility, transfers, and dressing; -Required supervision with toileting and hygiene; -Indwelling catheter not marked. Record review of the resident’s care plan, last revised on 3/1/19, showed the following information: -Foley (indwelling urinary) catheter; -Pericare after each incontinent episode; -Evaluate for medical necessity; -Observe for signs and symptoms of infections; -Observe for changes in consistency and color of urine; -Wear leg band as tolerated and Foley care per shift. Record review of the resident’s (MONTH) 2019 physician order [REDACTED]. -Foley catheter may use leg band; -Change catheter with insertion tray or bag and band as needed (PRN); -May flush Foley as needed for sediment; -Indwelling Foley catheter with routine catheter care every shift; -[MEDICATION NAME] (antibiotic) 100 milligram (mg) tablet for UTI prevention related to personal history of UTI. Observation on 3/11/19, at 10:23 A.M., showed the following information: -Resident laid in the bed on the right side; -Catheter bag attached to the lowest rail of the bed; -Catheter drain tubing and catheter bag lay on the floor. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 4) Observation on 3/13/19, at 10:11 A.M., showed the following information: -Resident sat up in the bed; -Catheter bag attached to the lowest rail of the bed; -Catheter tubing lay on the floor. Observation on 3/15/19, at 9:38 A.M., showed the following information: -Resident laid on his/her back in the bed; -Catheter bag clipped to the lowest rail of the bed; -Catheter bag touching the floor. Observation on 3/15/19, at 10:48 A.M., showed the following information: -Resident laid in the bed on his/her back; -Catheter bag clipped to the lowest rail of the bed; -Catheter bag touching the floor. 2. Record review of Resident #34’s face sheet showed the following information: -Original admission date of [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s quarterly MDS, dated [DATE], showed the following information: -Severely cognitively impaired; -Required extensive assistance with bed mobility, transfers, dressing, toileting, and hygiene; -Indwelling catheter marked. Record review of the resident’s care plan, last revised on 3/1/19, showed the following information: -Foley catheter; -Pericare after each incontinent episode; -Observe for signs and symptoms of infections; -Observe for changes in consistency and color of urine; -Foley catheter care every shift, use leg band as tolerated to secure catheter tubing. Record review of the resident’s (MONTH) 2019 POS showed the following information: -Foley catheter may use leg band; -Change catheter with insertion tray or bag and band as needed (PRN); -May flush Foley as needed for sediment; -Indwelling Foley catheter with routine catheter care every shift. Observation on 3/11/19, at 10:23 A.M., showed the following information: -Resident laid in the bed on his/her back; -Bed in the lowest position; -Catheter bag attached to the lowest rail of the bed; -Catheter tubing and catheter bag rested on the floor. Observation on 3/12/19, at 9:15 A.M., showed the following information: -Resident laid in the bed on his/her left side; -Bed in the lowest position; -Catheter bag attached to the lowest rail of the bed; -Catheter bag rested on the fall mat. Observation on 3/12/19, at 4:24 P.M., showed the following information: -Resident laid on his/her left side in the bed; -Bed in the lowest position; -Catheter bag clipped to the lowest rail of the bed; -Catheter bag touching the fall mat on the floor. Observation on 3/13/19, at 9:38 A.M., showed the following information: |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 5) -Resident laid in the bed on his/her left side; -Bed in the lowest position; -Catheter bag clipped to the lowest rail of the bed; -Catheter bag touching the floor. Observation on 3/13/19, at 10:16 A.M., showed Certified Nursing Assistant (CNA) K lowered the resident’s bed, allowing the resident’s catheter collection bag to rest on the floor. CNA K placed the fall mat next to the bed, but did not reposition the catheter bag off the floor before leaving the room. 3. During an interview on 3/15/19, at 3:15 P.M., CNA J said the following: -The catheter bag should be clipped to the bed below the bladder; -The tubing and the bag should be off the floor at all times; -Even if the bed is in the lowest position, the catheter bag and tubing should not touch the floor; -He/she was told that it was acceptable to place a towel on the floor and then lay the catheter bag and tubing on top of the towel because it would not be touching the floor. 4. During an interview on 3/15/19, at 12:21 P.M., Registered Nurse (RN) F said the following: -He/she expects the CNAs to clip the bag to the bed below the bladder; -Even when using a high/low bed, the catheter bag and tubing should remain off the floor; -The CNAs should not use a towel on the floor and then place the catheter bag and tubing on top of the towel. The bag and tubing would still be considered lying on the floor. 5. During an interview on 3/15/19, at 12:23 P.M., the Assistant Director of Nursing (ADON) said the following: -The catheter bag should be clipped to the bed; -Catheter bags should be hung below the bladder; -When using high/low beds, the catheter bag should be clipped up higher but still be below the bladder; -The catheter bag and tubing should never touch the floor; -It is not acceptable to lay a towel down and then place the catheter bag and tubing on the floor on top of the towel, this would still be considered lying on the floor; -It is not acceptable for the catheter bag or tubing to lie on the fall mat; -When the CNAs walk by or are in the room, they should check the catheter bag and tubing and adjust it so that it is off the floor if needed. 6. During an interview on 3/15/19, at 3:40 P.M., the administrator and Director of Nursing (DON) said the following: -Catheter bags and tubing are expected to be kept off the floor; -The catheter bag should be hung below the bladder; -The CNAs should not use a towel on the floor and then place the catheter bag and tubing on top of it, that is the same as it lying directly on the floor; -Even when using high/low beds, the catheter bag and tubing should remain off the floor; -CNAs should check the bag and tubing every time they walk by or enter the resident’s room and adjust the bag and tubing if needed. | |
| F 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0700 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 complete a side rail evaluation form for four residents (Resident #4, #39, #51, and #79); failed to care plan the use of side rails for three residents (Resident #51, #79, and #212); failed to obtain physicians orders regarding side rails for four residents (Resident #4, #51, #79, and #212); and failed to obtain consent and complete safety check for side rails for five residents (Resident #4, #39, #51, #79, and #212). A sample of 21 residents was selected for review in a facility with a census of 102. Record review of the facility’s policy, dated 1/1/19, titled Bedrail Use showed the following information: -Bedrails are used to enable a resident/guest to become more functionally independent, and when the medical condition of the resident/guest requires the use of a bedrail; -Bedrails could be considered a form of physical restraint; therefore, the need for bedrails should be identified in the resident/guest assessment, and the care plan, per resident assessment instruction (RAI) guidelines and regulatory requirements; -Bedrails may be used to help a resident/guest position or turn him/herself. Provide instructions to resident/guest as needed. The interdisciplinary team should determine if the clinical benefits outweigh the risk of a device/bedrail; -Possible hazards and clinical benefits of the bedrail use should be explained to the resident/guest and his/her family/legal representative, during the admission process and upon initial implementation; -Continued use of bedrails requires documentation of the presence of a medical symptom, which would necessitate the use of bedrails, or that the bedrails assist the resident/guest with mobility and transfer abilities and that clinical benefits still outweigh the risks of use; -Complete the Enabler/Assistive Device/Side Rail Review upon admission/readmission, upon initially implementing side rail, with a significant change, and with OBRA assessments. Side rails should be addressed in the care plan; -This review includes evaluations for entrapment risk which should also be completed when mattress or bed type are changed; -The resident/guest and the resident/guest representative should give informed consent to the use of the device, prior to its use. Record review of the facility’s policy (no effective date, currently being reviewed), titled Resident Beds and Bed Safety Rails Program, showed the following information: -To establish mitigation and preventative requirements and activities that maintain a constant state of safety related to resident care beds and bed safety rails; -Maintain resident beds and to perform bed safety rail audits; -Preventative maintenance should be conducted on resident beds and bed safety rails on a monthly and annual basis; -Monthly resident room checks- each room is to be inspected once a quarter. Every month, the maintenance supervisor is to divide out the total rooms by three to split the work evenly across the whole quarter; -Beds, side rails, cranks, floor locks, bed frames, and mattresses (check for compatibility of all components to verify that there is no risk of entrapment); -Bed Safety Rails Audit is schedule to be performed when it is determined that the use of hand rails is an appropriate application for the resident or when a component/item (i.e. mattress, etc .) is changed during an existing utilization of the appropriate use of a hand rail; -Nursing is responsible for conducting bed audits on the full bed system (frame, mattress, |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 7) bed rails, and assist devices); -Audits will be conducted as needed with a change of bed or mattress using the Bed Safety Action Grid; -Documentation of audits will be maintained. 1. Record review of Resident #51’s face sheet (basic information sheet) showed the following information: -admitted to the facility on [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s admission Minimum Data Set (MDS – a federally mandated comprehensive assessment instrument completed by facility staff), dated 1/23/19, showed the following information: -Severe cognitive impairment; -Total dependence with transfers, toileting, hygiene, and dressing; -Side rails not used. Record review of the resident’s care plan, last revised on 02/14/19,showed staff did not indicate the use of side rails. Record review of the resident’s (MONTH) 2019 physician order [REDACTED]. Record review of the resident’s medical record, on 03/12/19, showed the record did not included the following: -Bed rail assessment/evaluation; -Bed rail consent form; -Bed rail safety check form or completion of a regular inspection of the bed frame or bed rails. Observation on 03/12/19, at 4:15 P.M., showed round grip rails on both sides of the resident’s bed in the up position. During an interview on 03/12/19, at 4:15 P.M., the resident’s responsible party said the resident cannot use the grip rails on the bed. 2. Record review of Resident #79’s face sheet showed the following information: -admitted to the facility on [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s care plan, last revised on 1/31/19, showed staff did not indicate the use of side rails. Record review of the resident’s admission MDS, dated [DATE], showed the following information: -Moderate cognitive impairment; -Required extensive assistance with transfers, toileting, hygiene, and dressing; -Resident used wheelchair; -One fall since admission; -Side rails not used. Record review of the resident’s (MONTH) 2019 POS showed there was no order for side rails. Record review of the resident’s medical record, on 03/12/19, showed the record did not include the following: -Bed rail assessment/evaluation; -Bed rail consent form; -Bed rail safety check form or completion of a regular inspection of the bed frame or bed rails. Observation on 03/13/19, at 11:24 A.M., showed the resident’s bed with rounded grip rails, in the up position, on both sides of the bed. During an interview on 03/15/19, at 1:19 P.M., Certified Nursing Assistant (CNA) D said |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 8) the resident is able to position him/her self, but has to have assistance to get out of bed. 3. Record review of Resident #212’s face sheet showed the following information: -admitted to the facility on [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s admission MDS, dated [DATE], showed the following information: -Severe cognitive impairment; -Required extensive assistance with transfers, toileting, hygiene, and dressing; -Total dependence on staff for transfers; -Resident used wheelchair; -No falls since admission; -Side rails not used. Observation on 03/12/19, at 11:15 A.M., showed half bed rails in the up position on both sides of the resident’s bed. During an interview on 03/12/19, at 11:15 A.M., the resident said he/she uses the side rails to position him/her self. He/she did not request the rails, they were already on the bed when the resident came to the room. Record review of the resident’s care plan, dated 03/15/19, showed side rails added as a care plan goal with interventions on 03/15/19. Prior to 3/15/19, the care plan did not address side rails. Record review of the resident’s (MONTH) POS showed an order for [REDACTED]. Record review of the resident’s medical record, on 3/15/19, showed an enabler/assistive device/side rail review form completed on 03/15/19. Staff did not complete a bed rail consent form, bed rail safety check form, or completion of a regular inspection of the bed frame or bed rails. 4. Record review of Resident #4’s face sheet showed the following information: -Original admission date of [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s quarterly MDS, dated [DATE], showed the following information: -Moderately cognitively impaired; -Required extensive assistance with bed mobility, transferring, toileting, and bathing. -Side rails not used. Record review of the resident’s care plan, last revised on 3/11/19, showed the following information: -Inform resident or responsible party of risk of using enabler; -Observe for change in ability to release the enabler on command; -Review need for enabler quarterly as needed; -Ask family or responsible party for additional approaches as alternative for enabler use; -Therapy consult as needed. Record review of the resident’s (MONTH) 2019 POS did not include an order for [REDACTED].>Observation on 3/11/19, at 10:23 A.M., showed the resident’s bed had one-fourth side rails attached to the bed on both sides and were in the raised position. During an interview on 3/13/19, at 2:43 P.M., the resident’s responsible party said due to the resident’s decline, the resident cannot use the side rails on the bed. Record review of the resident’s medical record, on 3/14/19, showed staff did not have the following in the record: -Quarterly bed rail assessment/evaluation; |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 9) -Bed rail consent form; -Bed rail safety check form; -Monthly inspection/evaluation of the bed frame or bed rails. 5. Record review of Resident #39’s face sheet showed the following information: -Original admission date of [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s quarterly MDS, dated [DATE], showed the following information: -Moderately cognitively impaired; -Required extensive assistance with bed mobility, transferring, toileting, hygiene, and dressing. -Side rails not used. Record review of the resident’s care plan, last revised on 11/29/18, showed the following information: -Inform resident or responsible party of risk of using enabler; -Observe for change in ability to release the enabler on command; -Review need for enabler quarterly as needed; -Ask family or responsible party for additional approaches as alternative for enabler use; -Therapy consult as needed. Observation on 3/11/19, at 10:23 A.M., showed the resident’s bed had one-fourth side rails attached to the bed on both sides and were in the raised position. Record review of the resident’s medical record, on 3/14/19, showed the record did not include the following: -Quarterly bed rail assessment/evaluation; -Bed rail consent form; -Bed rail safety check form; -Monthly inspection/evaluation of the bed frame or bed rails. 6. During an interview on 03/15/19, at 10:14 A.M., Registered Nurse (RN) E said when a resident is admitted , they use the bed that is in the room, unless the resident needs a special bed like a bariatric or air mattress. 7. During an interview on 3/15/19, at 9:29 A.M., the Assistant Director of Nursing said the side rail assessments, are located in the computer for the initial assessment under enabler assessments. The side rails are not considered restraints and are only considered enablers to allow residents to assist with turning and bed mobility. The facility obtains an order for [REDACTED]. 8. During an interview on 3/15/19, at 9:29 A.M., the Director of Nursing said the side rails are only used as enablers and because they are only enablers they do not obtain a signed consent form for them. The enabler assessment is completed, they obtain an order from the physician, and then add them to the care plan. He/she did not know where the bed measurement sheets were kept. 9. During an interview on 3/15/19, at 9:31 A.M., the administrator said they do not do measurements on beds that use enablers, they only do measurements for side rails and there is only one resident who utilizes side rails in the facility. 10. During an interview on 3/15/19, at 3:40 P.M., the administrator said the staff should have taken the following steps: -Completed the initial assessment and quarterly assessments; -Completed the measurement sheets; -Obtained a signed consent form signed by the resident or the resident’s representative; -Received a physician’s orders [REDACTED].>-Added the enablers to the care plan for all |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 10) residents who have enablers or side rails on their beds. | |
| 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 protect food |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 11) -Gloves are a one use item and should be discarded and another set of gloves applied after the task is completed. 2. Record review of the 2013 Food and Drug Administration (FDA) Food Code showed the following: -An employee shall eat, drink, or use any form of tobacco only in designated areas where the contamination of exposed food; clean equipment, utensils, and lines; unwrapped single-service and single-use artciles; or other items needing protection can not result. Observation of the kitchen on 3/14/19, at 10:28 A.M., showed the dietary manager prepared food in the kitchen with a Slim(NAME)hanging out of his/her mouth. Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following: -Dietary Manager completed several tasks in the kitchen, including food preparation and overseeing staff, with a Slim(NAME)hanging out of his/her mouth and while occasionally chewing on the Slim Jim. During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary Manager, and the Registered Dietitian said staff should not eat food in the kitchen area; there is a small break area right outside of the kitchen for this purpose. 3. Record review of the 2013 FDA Food Code showed the following: -Food shall be protected from contamination by storing the food in a clean, dry location; where it is not exposed to splash, dust, or other contamination; and at least 15 cm (6 inches) above the floor; -Food in packages and working containers may be stored less than 15 cm (6 inches) above the floor on case lot handling equipment; -Pressurized beverage containers, cased food in waterproof containers such as bottles or cans, and milk containers in plastic crates may be stored on a floor that is clean and not exposed to floor moisture. Record review of the facility’s policy titled Food Receipt and Storage, dated 8/23/17, showed foods should be checked for freshness when received and stored in accordance with Food and Drug Administration (FDA) Food Code recommendations. Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following: -Five stacks of milk crates stacked three high with assorted milk in them, stored directly on the floor in the walk-in cooler; -One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored directly on the floor under a shelf in the walk-in freezer. Observation of the kitchen on 3/13/19, beginning at 10:44 A.M., showed the following: -Five stacks of milk crates stacked five high with assorted milk in them stored directly on the floor in the walk-in cooler; -One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored directly on the floor under a shelf in the walk-in freezer. Observation of the kitchen on 3/14/19, at 10:28 A.M., showed the following: -Five stacks of milk crates stacked five high with assorted milk in them stored directly on the floor in the walk-in cooler; -One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored directly on the floor under a shelf in the walk-in freezer. Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following: -Five stacks of milk crates stacked five high with assorted milk in them stored directly on the floor in the walk-in cooler; |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 12) -One milk crate of tortilla shells and one crate of a bag of diced potatoes, a bag of diced green peppers, a bag of diced onions, and a bag of cheddar cheese were stored directly on the floor under a shelf in the walk-in freezer. During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary Manager, and the Registered Dietitian said the following: -Milk stored in milk crates in the walk-in cooler should be stored on top of an empty crate that has been flipped upside down; -Food items stored in the walk-in freezer should never be stored in milk crates on the floor. 4. Record review of the 2013 FDA Food Code showed food shall be protected from cross contamination by storing the food in packages, covered containers, or wrappings. Record review of the facility’s policy titled Food Receipt and Storage, dated 8/23/17, showed the following information: -Foods should be checked for freshness when received and stored in accordance with Food and Drug Administration (FDA) Food Code recommendations; -Open food items should be covered, labeled, and dated. Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following: -Five trays of 40 cups of assorted liquids including water, milk, and juice, were stored in the cooler, uncovered and with trays stacked directly on top of open cups; -Fourty-eight Styrofoam bowls of white cake with cherries and whipped topping and a full sheet pan of white cake sat on a tiered food cart uncovered. Observation of the kitchen on 3/13/19, beginning at 10:44 A.M., showed the following: -Four trays of 38 cups of assorted liquids including water, milk, and juice, were stored in the cooler, uncovered and with trays stacked directly on top of open cups. Observation of the kitchen on 3/14/19, beginning at 11:11 A.M., showed the following: -Four trays of 39 cups of assorted liquids including water, milk, and juice, were stored in the cooler, uncovered and with trays stacked directly on top of open cups; -Three trays, each containing 35 Styrofoam bowls of apple crisp and one tray of 12 Styrofoam bowls of apple crisp were stored on the food storage cart uncovered. Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following: -Three trays of 31 plastic cups of assorted liquids including water, juice, and milk were stored in the cooler uncovered and with trays stacked on top of open cups. During an interview on 3/15/19, at 2:11 P.M., DA K said the following: -Open drinks stored in the cooler for lunch should be covered; -All prepared food on the food storage cart should be kept covered. During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary Manager, and the Registered Dietitian said the following: -Prepared cups of assorted liquids should always be covered with paper sheets and trays should never be stacked on top of open cups; -Prepared food items should be covered at all times with paper sheets. 5. Record review of the 2013 FDA Food Code showed items must be allowed to drain and to air-dry before being stacked or stored. Stacking wet items such as pans prevents them from drying and may allow an environment where microorganisms can begin to grow. Record review of the facility’s policy titled, Cleaning of Miscellaneous Equipment and Utensils, dated 8/23/17, showed staff to air dry dishes. Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following: -Four 1/8 size steam pan and three half size steam pans stacked wet; -Three gallon plastic pitchers placed in the cabinet still wet. Observation of the kitchen on 3/14/19, beginning at 11:45 A.M., showed the following: |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265309 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER JOPLIN HEALTH AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 2218 W 32ND STREET | |||||||||
| 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 13) -DA M placed one plastic gallon pitcher in the cabinet, two butcher knives in the knife holder, and serving spoons in the drawer wet. During an interview on 3/15/19, at 2:11 P.M., DA K said dishes should be completely dry before being put away. During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary Manager, and the Registered Dietitian said dishes should be completely dry prior to being put away. 6. Record review of the 2013 FDA Food Code showed non food-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris. Observation of the kitchen on 3/11/19, beginning at 9:59 A.M., showed the following: -Three washed full steam table pans stored with food particles still on them; -One hundred plastic bowls stacked on serving trays on a tiered shelf, the bowls had been washed, dried, and covered. Staff stored the bowls with food particles still on them; -Utensil storage drawers contained small food particles and crumbs. Observation of the kitchen on 3/13/19, beginning at 10:44 A.M., showed the following: -Three washed plastic bowls, ready to use for lunch, were covered in food particles. Observation of the kitchen on 3/14/19, beginning at 11:45 A.M., showed the following: -DA M placed one metal spatula in the drawer with food debris still on it; -Black plastic cart used to store clean dishes covered in food debris and dust. Observation of the kitchen on 3/15/19, beginning at 1:47 P.M., showed the following: -Six bowls ready to be used for dinner covered in food debris; -Black plastic cart used to store clean dishes covered in food debris and dust; -Utensil storage drawers contained small food particles and crumbs. During an interview on 3/15/19, at 2:11 P.M., DA K said if something is dirty the expectation is to clean it. During an interview on 3/15/19, at 2:21 P.M., the Dietary Manager, Corporate Dietary Manager, and the Registered Dietitian said the following: -Dishes should be spot checked for residual food particles after being washed; -The dietary manager checks the daily and weekly staff cleaning schedules, the expectation is that if something is dirty, the staff will clean it every time even if it has already been completed for the day or week. | |
