PARKLANE CARE AND REHABILITATION CENTER

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to protect one
resident’s (Resident #12) of twenty four sampled residents, dignity in a public area and
failed to create an environment that was respectful of the rights of six residents
(Resident #14, #69, #25, #62, #101 and #43) when staff did not assist Resident #12 with
provision of clothing that fit/repositioning of his/her clothing when the resident’s body
was exposed, including the resident’s peri-area, in the dining room and about the facility
hallways. The facility failed to treat resident (Resident # 39) with dignity and respect
by referring to the resident as being spoiled when the resident requested showers and the
bed made. The facility failed to ensure staff treated thirteen residents (Resident #1,
#12, #22, #27, #29, #39, #43, #69, #72, #95, #97, #101, and #111) of 24 sampled residents
and six additional residents (Resident #14, #25 #59, #62, #69 and #92) in a manner that
maintained their dignity when staff utilized paper plates and plastic silverware for meal
service. The facility census was 118.
1. Review of the Resident Rights Policy, dated as revised (MONTH) (YEAR), showed the
following:
-Employees shall treat all residents with kindness, respect, and dignity;
-Federal and state laws guarantee certain basic rights to all residents of this facility.
These rights include the residents right to a dignified existence.
2. Review of Resident #12’s care plan, date initiated 6/17/15, showed the following:
-[DIAGNOSES REDACTED].
-Requires minimal assistance due to weakness for many activities of daily living (ADLs)
and/or requiring supervision for completion for some ADL’s.
Review of the resident’s Minimum Data Set (MDS), a federally mandated assessment tool
required to be completed by facility staff, dated 3/15/19, showed the resident required
extensive assistance with dressing.
During an interview on 3/20/19 at 2:40 P.M. the resident said the following:
-His/Her pants were not on properly;
-His/Her pants would not stay up; the more he/she self-propelled the more they slipped
down;
-He/she had lost weight and his/her pants just would not stay up.
Observation of the lunch meal on 03/17/19 at 1:30 P.M. showed the following:
-The resident sat in the main dining room in a wheelchair with three resident tablemates;
-Thirty-six resident sat in the main dining room;
-The waistband of Resident #12’s pants was below the resident’s buttocks and the front
part of his/her pants pulled down, exposing his/her pubic hair;
-The resident wore neither underwear or incontinent briefs;
-The resident’s buttocks and peri-area were visible to any onlooker.
Observation of the supper meal on 03/17/19 at 6:05 P.M. showed the following:
-The resident sat in the main dining room in a wheelchair with three resident tablemates;
-The waistband of the resident’s pants was below the resident’s buttocks and the front
part of his/her pants pulled down, exposing his/her pubic hair;
-The resident wore neither underwear or incontinent briefs;
-The resident’s buttocks and peri-area were visible to any onlooker.
Observation of the breakfast meal on 03/18/19 at 8:24 A.M. showed the following:
-The resident sat in the main dining room in a wheelchair;
-The waistband of the resident’s pants was below the resident’s buttocks and the front

U4413
Class II*
Based on record review and interview, the facility failed to ensure each resident was
afforded the right to manage his/her financial affairs, when the facility failed to advise
residents of money held in the facility operating account that belonged to the resident.
The facility failed to deposit funds in excess of $100 in an interest bearing account that
was separate from any of the facility’s operating accounts, and credit all interest earned
on resident’s funds to that account. The deficient practice affected 13 residents

Based on interview and record review, the facility failed to provide the resident or
resident representative with a Notice of Medicare Provider Non-Coverage (NOMNC) when all
covered Medicare services were ending for two residents (Resident #101 and #61), who
remained in the facility after Medicare services ended; and failed to provide evidence
staff notified the individuals of the discharge from Medicare services at least two days
in advance of services ending for one resident (Resident #39). The facility census was
118.
1. Review of the undated facility Policy for the NOMNC Centers for Medicare and Medicaid
Services (CMS)- When to Deliver the NOMNC showed the following:
-A Medicare provider or health plan (Medicare Advantage plans and cost plans, collectively
referred to as plans) must deliver a completed copy of the NOMNC to
beneficiaries/enrollees receiving covered skilled nursing, home health, comprehensive
outpatient rehabilitation facility, and hospice services;
-The NOMNC must be delivered at least two calendar days before Medicare covered services
end of the second to last day of service if care is not being provided daily;
Plans only: In situations where the decision to terminate covered services is not
delegated to a provider by a health plan, but the provider is delivering the notice, the
health plan must provide the service termination date to the provider at least two
calendar days before Medicare covered services end;

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to provide a home
like environment for six residents (Resident #12, #39, #43, #53, #69,and #101) in a review
of 24 sampled residents and five additional residents (Resident #5, #14, #25, #28 and #62)
when the facility did not provide laundry services to provide clean clothing for the
residents or washcloths available for the staff to use to provide cares. The facility
failed to repair one sampled resident’s (Resident #46) and one additional resident’s
(Resident #58) wheelchairs. The facility census was 118.
1. Review of the facility policy Quality of Life, Homelike Environment last revised
(MONTH) (YEAR) showed the following:
– Residents are provided with a safe, clean comfortable and homelike environment and
encouraged to use their personal belongings to the extent possible;
-The facility staff and management shall maximize to the extent possible, the
characteristics of the facility that reflect a personalized, homelike setting;
– These characteristics include clean, sanitary and orderly environment and inviting
colors and décor.
2. Review of Resident #5’s care plan revised 12/31/18, showed the following:
-The resident had dementia, gets confused and needs direction;
-The resident will have all of his/her basic needs met by staff;
-Assist times one supervision with care needs and bathing; allow him/her to do as much for
him/herself with set up assistance as tolerated;
-Encourage the resident to perform or participate in ADL’s to extent possible;
-Extensive assistance with bathing;
-Staff may need to provide more ADL assistance in the mornings when the resident first

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to ensure two residents with a
mental disorder had a DA-124 Level I screen (used to evaluate for the presence of
psychiatric conditions to determine if a preadmission screening/resident review (PASARR)
level II screen is required) as required, for two residents (Resident #91 and Resident
#95) in a review of 24 sampled residents. The facility census was 118.
1. Record review of the Missouri Department of Health and Senior Services (DHSS) guide
titled, PASARR Desk Reference, dated 3/3/08, showed:
-The PASARR is a federally mandated screening process for any person for whom placement in
a Medicaid Title (XIX) certified bed is being sought. This is a Level I screening
(completion of the DA124C form).
-A Level II assessment is completed on those persons identified at Level I who are known
or suspected to have a serious mental illness (such as [MEDICAL CONDITION], dementia,
[MEDICAL CONDITION], etc., MR or related MR condition to determine the need for
specialized service (completion of the DA124A/B form). The facility responsible for
completing the DA124A/B and/or DA124C forms is also responsible for submitting completed
form(s) to DHSS, Division of Regulation and Licensure, Section for Long Term Care
Regulation, Central Office Medical Review Unit (COMRU);
-PASARR screening is required: To assure appropriate placement of persons known or
suspected of having a mental impairment;
-To assure that the individual needs of mentally impaired persons can be and are being met
in the appropriate placement environment;
-To be compliant with the OBRA/PASARR federal requirements, see 42 CFR 483.Subpart C; and
-To assure Title XIX funds are expended appropriately and in accordance with Legislative
intent.
2. Record review of resident #91’s face sheet showed his/her date of admission was
2/11/19.
Record review of the resident’s (MONTH) 2019 physician order [REDACTED].
-[DIAGNOSES REDACTED].
-[MEDICATION NAME] (antipsychotic) 10 milligrams (mg) daily in the morning for bi-polar
(mental illness);
-[MEDICATION NAME] order changed on 2/28/19 to 5 mg daily for [MEDICAL CONDITION] (mental
illness);

During interview on 3/22/19 at 3:53 P.M. the director of nursing (DON) said level one
screenings should be completed upon entrance or admission to the facility.
During interview on 3/22/19 9:10 A.M. and 11:37 A.M. the administrator said she had no
more PASARRs. She gave the state agency (SA) survey team all the PASARRs she had found.
The former/previous social services employee left her office in a mess. She didn’t think
the residents needed a PASARR because they had not had a psychiatric stay in the past two
years.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to meet acceptable
professional standards of practice for three residents (Resident #29, #71 and #97) in a

Further review of the resident’s medical record, showed the following:
-No documentation/evidence the resident was going to [MEDICAL CONDITION] or [MEDICAL
CONDITION] therapy appointments;
-No documentation/evidence the resident was being assessed following the [MEDICAL
CONDITION] or [MEDICAL CONDITION] therapy appointments.
5. During an interview on 3/22/19 at 3:53 P.M., the Director of Nurses (DON) said the
following:
-She would expect staff to follow physician orders;
-She would expect staff to follow the resident care plans;
-She would expect staff to document after [MEDICAL CONDITION] and [MEDICAL CONDITION]
therapy any complications from either.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review the facility failed to provide
necessary services to maintain good personal hygiene and prevent body odors for 13
residents (Resident #12, #22, #27, #29, #53, #57, #71, #72, #97, #99, #109, #110 and #111)
in a review of 24 sampled residents and four additional residents (Resident #5, #9, #28
and #38). Staff failed to provide showers, nail care, oral care, and grooming to include
shaving. The facility census was 118.
1. Review of the facility policy titled Brushing and Combing Hair, dated (MONTH) 2007,
showed the following:
-The purpose of the policy was to provide hair and scalp care;
-The resident’s hair should be brushed and combed every morning before breakfast and when
necessary throughout the day.
2. Review of the facility policy titled Shower/tub bath, dated (MONTH) 2010, showed the
purposes of this procedure was to promote cleanliness, provide comfort to the resident and
to observe the condition of the resident’s skin.
3. Review of the facility policy titled Mouth Care, dated (MONTH) 2010, showed the
following:
-The purpose of this procedure was to keep the resident’s lips and oral tissues moist, to
cleanse and freshen the resident’s mouth and to prevent infections of the mouth;
-Review the resident’s care plan to assess for any special needs of the resident.
4. Review of the facility policy titled Care of Fingernails/toenails, dated (MONTH) 2010,
showed the following:
-The purposes of this procedure are to clean the nail bed, to keep nails trimmed and to
prevent infections;
-Review the resident’s care plan to assess for any special needs of the resident;
-Nail care includes daily cleaning and regular trimming;
-Proper nail care aides in the prevention of skin problems around the nail bed;
-Unless otherwise permitted, do not trim the nails of diabetic residents or residents with
circulatory impairments;
-Trimmed smooth nails prevent the resident from accidentally scratching and injuring
his/her skin.
5. Record review of Resident #27’s Annual Minimum Data Set (MDS) a federally mandated
assessment instrument, completed by facility staff, dated 1/3/19, showed the following:
-Cognitively intact for daily decision making;
-No rejection of care;
-Required limited assistance of one staff for transfers, dressing, and toileting;
-Required physical help in part of bathing activity with assist of one staff;
-Had an indwelling catheter;
-Was always continent of bowel.
Review of the resident’s care plan, dated as revised 2/1/19, showed the following:
-Problem: The resident requires staff assistance with grooming and bathing;
-Approaches: Extensive assist with bathing needs especially with washing and drying of
lower body. Limited assist with toileting needs. Staff does have to assist with catheter

8. Review of Resident #12’s updated care plan, dated 1/31/19, showed the following:
-Requires minimal assistance due to fluctuating weakness for many ADL’s and/or requiring
supervision for completion for ADL’s;
-Does need extensive assistance with bathing needs;
-Does refuse showers at times; approach at different times of day for showers;
-Supervise to ensure personal hygiene is met;
-Refuses to shave chin at times; continue to offer assistance in tasks until resident is
agreeable with completion.
Record review of the resident’s quarterly MDS, dated [DATE], showed the following:
-BIMS of 15 indicating intact cognition;
-Personal hygiene, including bathing, combing of hair and shaving, required limited
assistance; one person physical assist.
Record review of the facility’s shower assignment sheet showed the resident was to have a
shower on Monday and Thursday day shift.
Review of the resident’s comprehensive CNA shower review documentation provided by the
facility for (MONTH) 2019 through (MONTH) 2019, showed the following:
-The resident’s last documented shower was on 2/21/19;
-No documentation to show the resident had been shaved or that cares had been provided or
refused on 02/25/19, 02/28/19, 03/04/19, 03/07/19, 03/11/19, 03/14/19, 03/18/19 and
03/21/19.
Observation on 03/17/19 at 12:58 P.M. showed the following:

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to ensure staff were properly
trained in Cardiopulmonary Resuscitation (CPR-process of providing rescue ventilation and
chest compressions to maintain circulation of blood) and subject to accepted professional
guidelines, by allowing the staff to certify/recertify for CPR online. The facility also
failed to have a system in place to ensure CPR certified staff were available on all
shifts 24 hours a day/seven days a week. The facility identified 52 residents as full code
status (CPR required in the event of cardiac or respiratory arrest). The facility census
was 118.
1. Review of the facility policy Emergency Procedure-CPR revised (MONTH) (YEAR) showed the
following:
Policy statement: Personnel have completed training on the initiation of CPR and basic
life support (BLS), including defibrillation, for victims of sudden [MEDICAL CONDITION];
General guidelines:
3. Victims of [MEDICAL CONDITION] may initially have gasping respirations or may appear to
be having a [MEDICAL CONDITION]. Training in BLS includes recognizing presentations of
sudden [MEDICAL CONDITION] (SCA);
4. The chances of surviving SCA may be increased if CPR is initiated immediately upon
collapse;
5. Early delivery of a shock with a defibrillator plus CPR within ,[DATE] minutes of
collapse can further increase chances of survival;
6. If an individual (resident, visitor, or staff member) is found unresponsive and not
breathing normally, a licensed staff member who is certified in CPR/BLS shall initiate CPR
unless:
-It is known that a Do Not Resuscitate (DNR) order that specifically prohibits CPR and/or
external defibrillation exists for that individual or;
-There are obvious signs of irreversible death (e.g. rigor mortis);
7. If the resident’s DNR status is unclear, CPR will be initiated until it is determined
that there is a DNR or a physician’s order no to administer CPR;
Preparation for CPR:
1. Obtain and/or maintain American Red Cross or American Heart Association certification
in BLS/CPR for key clinical staff members who will direct resuscitative efforts, including
non-licensed personnel.
2. Review of Centers for Medicare and Medicaid Services Center for Clinical Standards and
Quality/Survey & Certification Group memorandum revised [DATE] showed the following:
-Subject: CPR in Nursing Homes;
-CPR Certification: Staff must maintain current CPR certification for healthcare providers
through CPR training that includes hands-on practice and in-person skills assessment.
Online-only certification is not acceptable.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review the facility failed to provide one
additional resident (Resident #463) the necessary care and services to maintain his/her
highest practicable well-being when staff did not verify the resident’s hospital discharge
orders and administered [MEDICATION NAME] (blood thinning medication) when hospital
discharge orders directed staff to hold the medication until 3/28/19 and did not properly
assess the resident’s skin, documenting the resident had healed wounds when in fact the
resident had an open vascular wound that required treatment. The facility census was 118.
1. Review of the facility policy titled Anticoagulation-Clinical Protocol, dated (MONTH)
2012, showed the following:
-As part of the initial assessment, the physician will help identify individuals who are
currently anticoagulated;
-Assess for any signs or symptoms related to adverse drug reactions due to the medication
alone or in combination with other medications;
-Assess for evidence of effects related to the subtherapeutic or greater than therapeutic
drug level related to that particular drug (for example, a resident with an above
therapeutic level of an anticoagulation medication should be assessed for bleeding);
-In addition, nurses shall assess and document/report current anticoagulation therapy,
including drug and current dosage, recent labs, including therapeutic dose monitoring,

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review the facility failed to provide necessary
treatment and services consistent with standards of practice to assess, identify and
promote healing of pressure ulcers (a localized injury to the skin and/or underlying
tissue usually over a bony prominence, as a result of pressure, or pressure in combination
with shear and /or friction) for one resident (Resident #110) of 24 sampled residents and
one additional resident (Resident #100), the facility identified at risk of developing new
pressure ulcers and had existing pressure ulcers. Staff failed to complete a dressing
change on Resident #110 to an existing ulcer per order, and failed to provide treatment as
ordered for one additional resident (Resident #100), resulting in the resident acquiring
an unstageable pressure ulcer. The facility census was 118.
1. Review of the facility’s Pressure Ulcer/Injury Risk Assessment policy, dated as revised
(MONTH) (YEAR), showed the following:
-Purpose: The purpose of this procedure is to provide guidelines for the structured
assessment and identification of residents at risk of developing pressure ulcers/injuries;
-The purpose of a structured risk assessment is to identify all risk factors and then to
determine which can be modified and which cannot, or which can be immediately addressed
and which will take time to modify;
-Risk factors that increase a resident’s susceptibility to develop or to not heal pressure
ulcers or pressure injuries include, but are not limited to: Under nutrition,
malnutrition, and hydration deficits. Impaired/decreased mobility and decreased functional
ability. The presence of previously healed pressure ulcers/injuries. Exposure to skin to
urinary and fecal incontinence. Impaired diffuse or localized blood flow, for example,
generalized [MEDICAL CONDITION] (hardening of the arteries) or lower extremity arterial
insufficiency. Co-morbid conditions, such as end stage [MEDICAL CONDITIONS] disease, or
diabetes mellitus. Drugs such as steroids that may affect healing. Cognitive impairment.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review the facility failed to provide
restorative services as ordered for four residents (Resident #12, #53, #71, and #101), in
a review of 24 sampled residents. The facility census was 118.
1. Review of the facility policy titled Restorative Nursing Services, dated (MONTH)
(YEAR), showed the following:
-Resident’s will receive restorative nursing care as needed to help promote optimal safety
and independence;
-Restorative nursing care consists of nursing interventions that may or may not be
accompanied by formalized rehabilitative services (physical, occupational or speech
therapy);
-Residents may be started on restorative nursing program upon admission, during the course
of stay or when discharged from rehabilitative care;
-Restorative goals and objectives are individualized and resident-centered, and are
outlined in the resident’s plan of care;
-Restorative goals may include, but are not limited to supporting and assisting the
resident in adjusting or adapting to changing abilities, developing maintaining or
strengthening his/her physiological and psychological recourses, maintaining his/her
dignity, independence and self-esteem and participating in the development and
implementation of his/her plan of care.
2. Review of the facility policy titled Staffing, dated (MONTH) 2007, showed the
following:
-Our facility policy provides adequate staffing to meet needed care and services for our
resident population;
-Other support services (dietary, activities/recreational, social, therapy, environmental,
etc) are adequately staffed to ensure that resident needs are met.
3. Review of Resident #12’s (MONTH) 2019 physician order sheets (POS) showed the
following:
-[DIAGNOSES REDACTED].
-Restorative Therapy Program one time a day (two to five times a week) until goals are
met.
Review of the resident’s Restorative Therapy Program orders, dated 1/03/19, showed the
following:
-Frequency: two to five times a week;

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, facility staff failed to safely
transfer one resident (Resident #71) who was unable to bear weight, in a review of 24
sampled residents, and failed to follow the facility smoking policy for one additional
resident (Resident #463). The facility census was 118.
1. Review of the facility’s Smoking Policy, undated, showed the following:
-Smoking risk assessments will be completed upon identification of a resident who
expresses a desire to smoke, any resident found to be smoking on facility property,
quarterly, and with any significant change in condition;
-All residents able to smoke will do so in the facility’s designated smoking area only.
Residents identified as being independent with smoking may do so without supervision,
however, must follow the facility safety rules;
-Smoking materials will be kept at the nurse’s station and held by nursing staff. No

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to provide
appropriate treatment and services consistent with acceptable standards of practice to
prevent a urinary tract infection [MEDICAL CONDITION] for one resident (Resident #29) who
had been hospitalized for [REDACTED].#27 and #97) and failed to provide catheter care
consistent with acceptable standards of practice for two residents (Resident #27 and
Resident #97), in a review of 24 sampled residents. The facility census was 118.
1. Review of the facility Indwelling Urinary Catheter Care Policy and Procedure, dated as
revised 11/24/15, showed the following:
-Change the catheter and drainage bags per physician order, using a sterile technique;
-Change the catheter and drainage bags on the basis of as needed when clinical indications
show such as infection, obstruction, or when a closed system has been compromised;

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to provide five
residents (Resident #71, #12, #22, #69 and #101) of 24 sampled residents and three
additional residents (Resident #43, #28 and #5) sufficient fluid intake to maintain proper
hydration and health. The facility census was 118.
1. Review of the facility’s policy and procedure for Preventing Dehydration/Promoting

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the facility failed to ensure one resident (Resident
#101) in a review of 24 sampled residents, who received [MEDICAL TREATMENT], had a
physician’s orders [REDACTED]. The facility census was 118.
1. Record review of the facility’s [MEDICAL TREATMENT] Policy, undated, showed the
following:
-Policy: The facility shall provide adequate management of [MEDICAL TREATMENT] Services to
ensure that residents attain or maintain the highest practicable physical, mental, and
psychosocial well-being;
-It is essential that a communication process be established between the nursing home and
the [MEDICAL TREATMENT] facility to be used 24-hours a day. The care of the resident
receiving [MEDICAL TREATMENT] services must reflect ongoing communication, coordination,
and collaboration between the nursing home and the [MEDICAL TREATMENT] staff. The
communication process should include how the communication will occur, who is responsible
for communicating, and where the communication and responses will be documented in the
medical record, including but not limited to: Timely medication administration by the
nursing home and/or [MEDICAL TREATMENT]. Physician/treatment orders, laboratory values,
and vital signs. Advance Directives and code status- specific directives about treatment
choices; and any changes or need further discussion with the resident/representative, and
practitioners. Nutritional/fluid management including documentation of weights, resident
compliance with food/fluid restrictions or the provision of meals before, during an/or
after [MEDICAL TREATMENT] and monitoring intake and output measurements as ordered.
[MEDICAL TREATMENT] treatment provided and resident’s response, including declines in
functional status, falls, the identification of symptoms such as anxiety, depression,