| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, interview, and record review, the facility failed to maintain and/or | |
| 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, |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 1) including but not limited to receiving treatment and supports for daily living safely. Based on observation and interview the facility failed to maintain the shower room on the | |
| F 0607 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Develop and implement policies and procedures to prevent abuse, neglect, and theft. Based on record review and interview, the facility staff failed to check, prior to hire, |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0607 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 2) – Applicants may not start work until the CBC has been completed and reviewed for eligibility, and the CNA Registry has been completed and found to be acceptable. Licensed Practical Nurses (LPN’s) and Registered Nurses (RN’s) must be checked with the State of Missouri Department of professional Registration. Review of the facility personnel records showed: – Housekeeping Staff (HSK) I hired on 2/8/18, with an EDL and CNA Registry check on 2/14/18, six days after hire. The facility did not provide evidence of a CBC; – HSK J hired on 3/6/18. The facility did not provide evidence of a CBC or CNA Registry check prior to hire; – Registered Nurse (RN) K hired on 6/6/18, with an EDL and CNA Registry check on 6/11/18, five days after hire. The facility did not provide evidence of a CBC; – HSK M hired on 7/27/18. The facility did not provide evidence of checking the CNA Registry; – CNA O hired on 9/26/18. The facility did not provide evidence of checking the CNA Registry; – CNA P hired on 10/2/18. The facility did not provide evidence of checking the CNA Registry; – CNA Q hired on 10/9/18. The facility did not provide evidence of checking the CBC or the CNA Registry; – CNA R hired on 10/9/18. The facility did not provide evidence of checking CNA Registry. During an interview on 12/7/18 at 1:15 P.M., the Administrator said: – Some of the CBC’s, EDL’s and CNA Registry check were just missed; – They are working to be sure that new staff do not start work until the required background checks are completed. | |
| F 0623 Level of harm – Potential for minimal harm Residents Affected – Many | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0623 Level of harm – Potential for minimal harm Residents Affected – Many | (continued… from page 3) the reason of Resident #50’s transfer to the hospital. 4. Record review of Resident #80’s nurses notes showed the resident transferred to the hospital on [DATE] and readmitted to the facility on [DATE]. Review of the resident’s record showed no documentation of notifying the resident, the resident’s representative or the local Office of Long-Term care Ombudsman in writing of the reason of Resident #80’s transfer to the hospital. 5. Record review of Resident #93’s nurses notes showed the resident transferred to the hospital on [DATE] and readmitted to the facility on [DATE]. Review of the resident’s record showed no documentation of notifying the resident, the resident’s representative or the local Office of Long-Term care Ombudsman in writing of the reason of Resident #93’s transfer to the hospital. 6. Record review of Resident #99’s nurse’s notes showed the resident discharged on [DATE] and did not return. Review of the resident’s record showed no documentation of notifying the resident, the resident’s representative or the local Office of Long-Term care Ombudsman in writing of the reason of Resident #99’s discharge. During an interview on 12/06/18 at 1:32 P.M., the Administrator said: – The facility has not been notifying the resident or the resident’s representative in writing of the reason of transfer and she was not aware that they were supposed to notify the ombudsman; – They will start to notify the resident or the resident’s representative in writing of the reason for transfer and notify the ombudsman. Record review of the Transfer to Hospital Policy, dated (MONTH) 6, (YEAR), showed: – Prior to discharge/transfer, the Social Service Director will notify the resident’s family, next of kin or legal representative regarding transfer/discharge; – Location of the transfer/discharge; – Reason for the transfer discharge. | |
| F 0625 Level of harm – Potential for minimal harm Residents Affected – Many | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to inform the resident 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0625 Level of harm – Potential for minimal harm Residents Affected – Many | (continued… from page 4) transfer on 12/02/18. 3. Record review of Resident #50’s nurse’s notes showed the resident transferred to the hospital on [DATE] and readmitted to the facility on [DATE]. Review of the resident’s record showed no documentation the resident or the resident’s representative was informed in writing of the facility’s bed hold policy at the time of transfer on 9/17/18. 4. Record review of Resident # 80’s nurse’s notes showed the resident transferred to the hospital on [DATE] and readmitted to the facility on [DATE]. Review of the resident’s record showed no documentation the resident or the resident’s representative was informed in writing of the facility’s bed hold policy at the time of transfer on 8/15/18. 5. Record review of Resident # 93’s nurse’s notes showed the resident transferred to the hospital on [DATE] and readmitted to the facility on [DATE]. Review of the resident’s record showed no documentation the resident or the resident’s representative was informed in writing of the facility’s bed hold policy at the time of transfer on 11/13/18. During an interview on 12/06/18 at 1:38 P.M., the Administrator said the facility gives the bed hold policy on admission, and management has been working on implementing this but they just didn’t have it in place yet Record review of the Bed Hold Policy, Revised (MONTH) 27, (YEAR), showed: – When a resident is admitted to the facility, they receive a copy of the bed hold policy; – When a resident is discharged to the hospital, the facility will provide to the resident or their legal representative, a copy of the bed hold policy. | |
| 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, interview, and record review, the facility failed to have |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 5) remaining residents. 2. Record review of the facility’s undated orientation checklist policy showed the policy directed orientation be completed for new hires. It did not specify when the orientation should be completed. During an interview on 12/4/18 at 1:12 P.M., FSS D said he/she had been at the facility for two days (hire date of 12/2/18) and had no training. Observation on 12/5/15 at 9:45 A.M., after requests for orientation checklists, showed the CDM completing an orientation checklist for FSS D. During an interview on 12/5/18 at 9:45 A.M., the CDM said she normally completed orientation on an employee’s first day but she did not provide orientation to FSS D. The CDM was completing the orientation checklist after a request to see the checklist from SLCR. The CDM said the policy did not specify when orientation had to be done. During an interview, the Administrator said she expected orientation to be done before staff started working. 3. Record review of the facility’s consultant Registered Dietitian’s (RD) report, dated 10/25/18, showed the RD recommended the CDM conduct training on handwashing, glove use, menus, recipes, infection control, plating and presentation. Record review of a training sign in sheet, dated 10/30/18, showed the CDM conducted training on glove use and infection control. The CDM did not conduct training on all areas recommended. Record review of the RD’s report, dated 11/28/18, showed the RD recommended the CDM conduct training on handwashing, food temperatures, production time lines, and staff responsibility. The RD noted she would follow up the following week with trainings on menus and recipes and would reinforce the CDM trainings. During an interview on 12/5/18 at 10:45 A.M., the CDM said she thought she might have done the training the RD said to do on 10/25/18 but did not do any of the recommended training from the RD’s 11/28/18 recommendations. The CDM did not do the trainings because she did not have time. | |
| F 0803 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview and record review, the facility failed to follow approved |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0803 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 6) cake. Observation on 12/4/18 at 12:50 P.M. showed FSS B prepared cake with peaches. FSS B dished a scant four ounce scoop of undrained peaches on the cake. During an interview on 12/4/18 at 1:12 P.M., FSS D said he/she had been working at the facility for only two days and had no training. FSS D did not know scoops should have been full and level when serving and said he/she was not serving the full amount due to the juice. 2. Record review of the facility’s approved menu for lunch on 12/4/18 showed the menu directed staff to serve residents with orders for pureed diets a number (#) 10 scoop of pureed sponge cake with a #10 scoop of pureed fruit. Record review of the facility’s approved recipe for pureed sponge cake with fruit showed the recipe directed staff to puree the cake with whole milk, puree drained fruit separately, then serve a #10 scoop of pureed cake with a #10 scoop of pureed fruit on top. The recipe identified the appropriate consistency as smooth, pudding or soft mashed potatoes. Observation on 12/4/18 at 11:51 A.M. showed FSS C pureed sponge cake with peaches without referring to a recipe. FSS pureed seven pieces of cake and six #10 scoops of undrained peaches. The resulting product had a thin, gravy consistency. FSS C then served residents one #10 scoop of the combined product. 3. Record review of the facility’s approved menu for lunch on 12/4/18 showed the menu directed staff to serve residents three ounces of roast beef. Observation on 12/4/18 at 12:15 P.M. showed the Assistant Dietary Manager (ADM) served residents one slice of roast beef. Upon request of SLCR staff, the ADM weighed the sliced roast beef. The portion served to residents was two ounces. 4. Record review of the facility’s recipe for pureed roast beef showed the recipe directed staff to puree roast beef with sliced bread and prepared beef broth. Observation on 12/4/18 at 1:05 P.M. showed FSS B pureed an unmeasured amount of roast beef with beef broth prepared with an unmeasured amount of beef base. FSS B did not refer to the recipe or add slices of bread. The resulting product had a slightly lumpy, pudding consistency. 5. Record review of the facility’s undated standardized recipe policy showed the policy directed staff to use standardized recipes for all food prepared. The policy directed the CDM to monitor and check for recipe use. Record review of the facility’s consultant Registered Dietitian (RD) reports showed on 10/25/18 the RD recommended staff training on menu and recipe use. On 11/28/18, the RD noted he/she would follow up on training for recipe use. During an interview on 12/4/18 at 1:20 P.M., FSS C said staff had been directed to serve food using level scoops and to follow recipes. During an interview on 12/4/18 at 1:40 P.M., the ADM said staff had been directed to use recipes and serve serve food using level scoops. During an interview 12/4/18 on 1:45 P.M., the Certified Dietary Manager (CDM) said staff had been directed to follow recipes and serve portions as per spread sheets. During an interview on 12/5/18 at 10:45 A.M., the CDM said she thought she might have done the training the RD said to do on 10/25/18. Record review showed a sign in-sheet for training completed by the CDM, dated 10/30/18, showed the CDM did not provide training on recipes and menu use. Complaint # MO 0 |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0803 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | ||
| 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 8) touched the food contact surface of a clean pan. Observation on 12/4/18 at 11:42 A.M. showed FSS A washed hands, pulled up pants, scratched sides, and touched counters. FSS A then touched the food preparation area without washing hands. Observation on 12/4/18 at 11:47 A.M. showed FSS B touched counters, cans, the can opener, and other equipment with gloved hands. Without changing gloves and/or washing hands, FSS B touched prepared cake and the food contact surface of a clean scoop used to dish fruit. Observation on 12/4/18 at 12:00 P.M. showed FSS D touched his/her back, sides, clothing and coughed in hand. Without changing gloves and/or washing hands, FSS D touched the food contact surfaces of clean dishes. Observation on 12/4/18 at 12:01 P.M. showed the ADM touched counters and equipment. Without washing hands, the ADM touched the food contact surfaces of clean plates. Observation on 12/4/18 at 12:10 P.M. showed FSS D touched his/her clothing, the counter, equipment and a can of food. Without changing gloves and/or washing hands, FSS D touched the food contact surfaces of dishes and utensils. Observation on 12/4/18 at 12:20 P.M. showed FSS B washed hands and donned gloves before opening the refrigerator and obtaining a bag of chopped lettuce. Without changing gloves and/or washing hands, FSS B used his/her hands to dish lettuce. During an interview on 12/4/18 at 1:20 P.M., FSS C said staff had been directed to change gloves and wash hands when leaving the kitchen or station and from dirty to clean. Observation on 12/4/18 at 12:25 P.M. showed FSS C prepared sandwiches while wearing gloves. FSS C touched bags, utensils, equipment, and counters. Without changing gloves and/or washing hands, FSS C touched slices of bread. Observation on 12/4/18 at 12:30 P.M. showed FSS D touched counters, a can of fruit, and his/her soiled apron. Without changing gloves and/or washing hands, FSS D touched pieces of cake. Observation on 12/4/18 at 12:50 P.M. showed FSS B touched cans of food and counters with gloved hands. Without changing gloves and/or washing hands, FSS B touched the food contact surfaces of plates and pieces of cake. During an interview on 12/4/18 at 1:25 P.M., FSS D said staff had been directed to wash hands after everything and to wear gloves when washing dishes and messing with food. During an interview on 12/4/18 at 1:30 P.M., FSS B said staff had been directed to wash hands after leaving station, touching self, when dirty, and when changing gloves. During an interview on 12/4/18 at 1:40 P.M., the ADM said staff had been directed to wash hands and change gloves after leaving their station. During an interview on 12/4/18 at 1:45 P.M., the CDM said staff d been directed to wash hands when entering the kitchen, changing work areas, and when changing gloves. The CDM said she talked to FSS A about scratching and FSS A said he/she had flea bites. FSS A showed the CDM hundreds of bites on his/her sides. Record review of the facility’s undated hand washing and glove use policy showed the policy directed staff to wash hands prior to beginning work, after using the restroom, after smoking, when working with different food substances, and following contact with any unsanitary surface; i.e. touching hair, sneezing, opening doors, etc. The policy also directed staff to change gloves as often as hands needed to be washed. Record review of the facility’s undated personal hygiene policy showed the policy directed staff to maintain clean hands. Record review of the facility’s consultant Registered Dietitian’s (RD) reports showed on 10/25/ and 11/28/18, the RD directed the CDM to train staff on handwashing and glove use. Record review of an inservice sign in sheet, dated 10/30/18, showed the CDM conducted |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 9) training on glove use and infection control. 3. Observation on 12418 at 10:50 A.M. showed the ADM washed pots and pans in the three compartment sink. The ADM did not have soapy water in the first (wash) compartment and used a wadded up towel as [MEDICATION NAME] in second (rinse) compartment. Observation on 12/4/18 at 11:12 A.M. showed FSS B dropped a wire whisk on the floor. FSS B picked up the whisk, swished it in the first (wash) compartment of the three compartment sinks, The first sink did not contain soapy water. FSS B swished the whisk in the second (rinse) compartment then dropped it in the third (sanitizing) compartment. During an interview on 12/4/18 at 1:30 P.M., FSS B said the first compartment of the three compartment sink should have contained hot, soapy water. During an interview on 12/4/18 at 1:40 P.M., the ADM said the first compartment of the three compartment sink should have contained soapy water but that the water was not always sudsy. During an interview on 12/4/18 at 1:45 P.M., the CDM said first compartment of the three compartment sink should have had soapy water but the dispenser was not working properly. Record review of the facility’s undated pot and pan washing policy showed the policy directed staff to fill the first tank with water between 110 to 120 degrees Fahrenheit and an effective concentration of detergent. 4. Observation on 12/4/18 at 11:10 A.M. showed Maintenance Staff (MS) E entered the kitchen without a hair or beard restraint. Observation on 12/4/18 at 11:15 A.M. showed Licensed Practical Nurse (LPN) F in the hallway of the kitchen next to the upright refrigerator, paper products and entry into the dry food storage area. LPN F had not donned a hair restraint. During an interview on 12/4/18 at 11:15 A.M., LPN F said staff had been directed to wear hair restraints when in the kitchen. LPN F said he/she did not know he/she was in the kitchen. Observation on 12/4/18 at 11:20 A.M. showed MS F entered the kitchen without a beard restraint. During an interview on 12/4/18 at 1:20 P.M., FSS C said everyone who entered the kitchen had to wear a hair restraint. During an interview on 12/4/18 at 1:30 P.M., FSS B said everyone had to wear a hair restraint when in the kitchen. During an interview on 12/4/18 at 1:45 P.M., the CDM said anyone who entered the kitchen had to wear hair and beard restraints. The CDM said the the area between the kitchen and dry storage area was considered part of the kitchen. Record review of the facility’s undated personal hygiene policy showed it directed staff to cover hair and beards. 5. Observation on 12/4/18 from, 12:03 P.M. through 12:22 P.M. showed staff placed food for lunch service on three soiled carts. The carts had dried food and spills on the interior and exterior surfaces. During an interview on 12/4/18 at 12:03 P.M., FSS D said the carts were supposed to be wiped out before meals. During an interview on 12/4/18 at 1:45 P.M., the CDM said the carts should be cleaned before use. | |
| F 0883 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Develop and implement policies and procedures for flu and pneumonia vaccinations. |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0883 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Based on interview and record review the facility failed to ensure the residents were offered the influenza vaccination. This practice affected seven residents (Resident #37, #40, #46, #47, #72, #80, and #87) of the 12 sampled residents. The facility census was 108. 1. Record review of the facility’s policy on Influenza Immunizations, dated (MONTH) 12, (YEAR) showed: – The resident or legal representative will be told the Influenza Immunizations are provided yearly (between (MONTH) 1 and (MONTH) 31) unless the immunization is medically contraindicated, the facility has evidence that the resident has already been immunized during this time period, or the resident or resident’s legal representative has refused the immunization; – The resident or their legal representative will be asked to sign the revolving consent form and will be told this form provides consent for annual influenza immunizations; – The Customer Service Consultant/designee or the Social Services Director will provide education information on the immunizations and ensure the consent form is filled out, placed in the resident’s chart and updated (if needed) before the immunization is given to the resident; – The resident’s clinical record will document the resident either received the influenza immunization or did not receive them due to medical contraindications or refusal. 2. Record review of Resident #37’s medical record showed: – Consent form for the influenza immunization dated and signed on 10/22/18; – No documentation of the immunization given. 3. Record review of Resident #40’s medical record showed: – Consent form for the influenza immunization dated and signed on 10/23/18; – No documentation of the immunization given. 4. Record review of Resident #46’s medical record showed: – Consent form for the influenza immunization dated and signed on 10/23/18; – No documentation of the immunization given. 5. Record review of Resident #47’s medical record showed: – Consent form for the influenza immunization dated and signed on 10/23/18; – No documentation of the immunization given. 6. Record review of Resident #72’s medical record showed: – Consent form for the influenza immunization dated and signed on 10/22/18; – No documentation of the immunization given. 7. Record review of Resident #80’s medical record showed: – Consent form for the influenza immunization dated and signed on 10/23/18; – No documentation of the immunization given. 8. Record review of Resident #87’s medical record showed: – Consent form for the influenza immunization dated and signed on 10/22/18; – No documentation of the immunization given. During an interview on 12/7/18 at 10:45 A.M. Licensed Practical Nurse (LPN) S said the immunizations requested have not been not given. During an interview on 12/7/18 at 11:05 A.M. the Social Worker said it was her responsibility to obtain the consents from the resident or family representative. She said when the consents are returned, she relays the message to the nursing department. Interview on 12/7/18 at 11:10 A.M. the Director of Nursing (DON) said the influenza vaccination was back ordered in (MONTH) and when they got the immunization in stock, they gave some. Interview on 12/7/18 at 11:20 A.M. the Corporate Consultant said the nursing department |
| 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: 265388 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER SENATH HEALTH CARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 300 EAST HORNBECK 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 0883 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 11) was not aware of any consents being returned. She said the nursing department had asked the social worker several times about the returned consent forms and was told the social worker did not know which residents forms had been returned. Telephone interview on 12/13/18 at 11:15 A.M. the DON said the influenza immunization had been received in the facility on 10/25/18. | |