Original Inspection report

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY 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.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure beverages
during meals, were served in containers made of solid materials other than foam. This
practice potentially affected at least 80 residents who ate in the dining room. The
facility also failed to ensure that one dependent sampled resident (Resident #65) had
his/her face cleaned after breakfast out of 29 sampled residents. The facility census was
86 residents.
1. During the resident group interview on 6/26/19 at 9:23 A.M., six residents who attended
the group meeting said that all of their beverages at meals are always served in foam
cups.
Observations during meals on 6/25/19 at 8:20 A.M., 6/25/19 at 12:45 P.M., 6/26/19 at 12:49
P.M., and on 6/27/19 at 8:09 A.M., showed residents in different dining rooms, whose
beverages were served to them, in foam cups.
During an interview and observation on 6/25/19 at 12:45 P.M., Resident #21’s family member
said:
-The resident had been served liquids in foam cups since he/she resided at the facility on
(MONTH) 2019.
-The resident never used a plastic or real cup for his/her drinks and
-Certified Nursing Assistant (CNA) brought in a foam cup, filled with red drink in for the
resident.
During an interview on 6/27/19 at 9:37 A.M., Dietary Aide (DA) A said:
– The residents were not served in real cups anymore because some residents hoarded the
cups.
– That was about two Dietary Managers ago, they were told to give the residents foam cups
and
– The kitchen did not have enough regular cups for the residents.
During an interview on 6/27/19 at 9:50 A.M., the Dietary Manager said that serving the
resident’s drinks in foam cups was in place when he/she got there about two years ago.
2. Record review of Resident #65 Face Sheet showed he/she was admitted to the facility on
[DATE], with the following Diagnoses: [REDACTED].
-[MEDICAL CONDITION] (a progressive condition when protein and plaque build up in the
brain and block nerve signals and destroy nerve cells).
-Contractures (permanent shortening of muscles, tendons, or scar tissue producing
deformity or distortion).
-Incontinent of bladder and bowel.
-Abnormalities of gait and mobility.
-Age-related cognitive decline and
-Weakness.
Record review of resident’s admission Minimum Data Set (MDS-a federally mandated
assessment tool to be completed by facility staff or care planning) dated 5/12/19, showed
he/she:
-Was alert.
-Needed extensive assistance with bathing, dressing, toileting, transfers, mobility and
feeding and
-Did not walk and used a wheelchair assisted by staff for mobility.
Observation on 6/24/19 at 9:28 A.M., showed the resident:
-Was in his/her broda chair in his/her room with large amounts of food on his/her face

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY 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

(continued… from page 1)
following breakfast and
-He/she was incapable of wiping his/her face off due to hand contractures.
During an interview on 6/24/19 at 10:00 A.M., CNA A said someone should have wiped the
resident’s mouth before the resident was returned to his/her room.
During an interview on 6/27/19 at 9:00 A.M., Registered Nurse (RN) A said:
-No resident should leave the dining room with food on their face or clothing and
-Any food that may have fallen in their lap during meal time should have been removed
prior to being returned to their room.
During an interview on 6/28/19 at 2:54 P.M., the Director of Nursing (DON) said:
-He/she expected the staff to make sure no resident would ever be left with food on their
face or clothing and
-If clothing is soiled from meal/snack time, the resident should be cleaned up and
clothing changed.

F 0558

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Reasonably accommodate the needs and preferences of each resident.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to ensure proper
positioning for one sampled resident (Resident #65) while in the dining room out of 29
sampled residents. The facility census was 86 residents.
1. Record review of Resident #65’s face sheet showed he/she was admitting on 4/29/19 with
[DIAGNOSES REDACTED].
Record review of the resident’s care plan dated 5/16/19, showed:
– Problem: The resident had decreased mobility and at risk for falls.
– Goal: To be free from falls or injuries and to be free from pain and discomfort over the
next 90 days.
– Approach: Facility staff is to sit the resident up in the geriatric chair for comfort
and facility staff should assess for any signs of pain/discomfort.
Observations on 6/27/19 from 8:45 A.M. through 9:20 A.M., showed:
– Certified Nurse’s Assistant (CNA) A tried to install the foot rest to the resident’s
geriatric chair.
– Certified Medication Technician (CMT) B tried to assist in the placement of the foot
rest, but both CMT A and CNA A, were unable to install the foot rest on the geriatric
chair and
– The resident had to eat his/her breakfast meal with his/her feet not on the foot rest.
During an interview on 6/27/19 at 2:32 P.M., the Occupational Therapist (OT) said:
– The foot rest slipped out.
– The resident uses the foot rest to reposition himself/herself when he/she eats meals.
– If the foot rest was not there, then a staff member would have to help the resident with
repositioning.
– The foot rest was placed on the geriatric chair for facility staff to cue the resident
to move himself/herself up in the chair, and
– Without the foot rest the resident would require a higher amount of assistance in
sitting up.
During an interview on 6/27/19 at 2:46 P.M., CNA B said the foot rest for the resident’s
geriatric chair was already off when he/she got the resident up that morning on 6/27/19

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0558

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 2)
and he/she did not know how to place the foot rest back on.

F 0569

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Notify each resident of certain balances and convey resident funds upon discharge,
eviction, or death.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review and interview, the facility failed to submit a Third Party
Liability (TPL) form (a form which is sent to MO Health Net, which gives an accounting of
the remaining balance of that resident’s funds in the resident trust account), which is
required to be sent within 30 days after death, to Missouri (MO) Health Net after the
death of two residents (Residents #1000 and 1001). The facility census was 86 residents.
1. Record review of the Admit/Discharge report dated [DATE] showed:
– Resident #1000 died on [DATE] and
– Resident #1001 died on [DATE].
During an interview on [DATE] at 1:49 P.M., the Business Office Manager (BOM) said a TPL
form was not sent in for Resident #100 because he/she was on leave during the month of
(MONTH) 2019 and no TPL was sent after the death of Resident #1001.

F 0583

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Keep residents’ personal and medical records private and confidential.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure a
resident’s privacy was given during a wound observation for one sampled resident (Resident
#3); and to ensure that the door was closed during cares for one sampled resident
(Resident #65) out of 29 sampled residents. The facility census was 86 residents.
1. Record review of Resident #3’s Face Sheet showed he/she was admitted to the facility on
[DATE], with [DIAGNOSES REDACTED].
Record review of the resident’s Minimum Data Set (MDS-a federally mandated assessment tool
to be completed by facility staff for care planning) dated 3/14/19, showed he/she:
-Was alert with long and short-term memory loss.
-Needed total assistance with bed mobility, transfers, toileting, bathing and dressing.
– Was mobile in a wheelchair and did not walk.
-Had upper extremity range of motion limitations on one side of the body and lower
extremity range of motion limitations on both sides of the body.
-Did not have any wounds during the look back period and
-Had moisture associated skin damage and received application of ointments.
Record review of the resident’s Weekly Wound Flow Record showed weekly wound charting and
the resident had a wound to his/her left outer ankle that developed on 3/19/19, and
measured 1.5 centimeters (cm) x 1.0 cm x 0.0 cm, and it was resolved on 4/25/19.
Observation on 6/27/19 at 6:49 A.M., showed the resident was sitting in his/her wheelchair
in the common area by the nursing station. He/she was fully dressed for the weather.
Certified Medication Technician (CMT) B removed the resident’s left shoe and sock for
observation of the resident’s left ankle in front of other residents. He/she then took the

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0583

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 3)
resident to his/her room. The resident had a healed wound on his/her left ankle bone that
had pink skin and that was not open.
During an interview on 6/27/19 at 7:10 A.M., CMT B said he/she should have taken the
resident to his/her room first instead of taking his/her shoe and sock off in front of
other residents, to look at the resident’s wound.
During an interview on 6/28/19 at 11:18 A.M., Licensed Practical Nurse (LPN) C said:
-Anytime the nursing staff need to undress a resident, it should be done in the bathroom
or in the resident’s room for privacy even with socks and shoes and
-They have residents who will remove their own socks and shoes in a public area, but they
should put them back on the resident in their room.
During an interview on 6/28/19 at 2:54 P.M., the Director of Nursing (DON) said:
-He/She would not expect staff to remove the resident’s clothing, socks or shoes in front
of the nursing station, they should take the resident to their room and provide privacy
for the resident.
2. Record review of Resident #65’s Face Sheet showed he/she was admitted to the facility
on [DATE], with the following Diagnoses: [REDACTED].
-[MEDICAL CONDITION] (a progressive disease that destroys memory and other important
mental functions).
-Contractures (permanent shortening of muscles, tendons, or scar tissue producing
deformity or distortion).
-Incontinent of bladder and bowel.
-Abnormalities of gait and mobility.
-Age-related cognitive decline and
-Weakness.
Record review of resident’s admission MDS assessment dated [DATE], showed he/she:
-Was alert.
-Needed extensive assistance with bathing, dressing, toileting, transfers, mobility and
eating and
-Did not walk and used a wheelchair assisted by staff for mobility.
Observation on 6/24/19 at 9:28 A.M., showed the resident:
-Was in his/her broda chair (a specialized wheelchair that tilts back) in his/her room
with large amounts of food on his/her face following breakfast and
-He/she was incapable of wiping his/her face off due to hand contractures.
Observation on 6/27/19 at 6:27 A.M., showed the resident:
-Occupied the first bed in the room that was closest to the door and hallway.
-Was in bed, eyes closed, with only a brief and a shirt on.
-Blankets were off of the resident exposing him/her to the hallway and
-There was no privacy curtain in the resident’s room and and the door was open.
During an interview on 6/27/19 at 7:00 A.M., Certified Nurse Assistant (CNA) C said:
-It happens some times, the resident will kick off his/her covers.
-During rounds, everyone should check on the residents to make sure they are covered
properly.
-At shift change, the residents know we are coming to help get them up for breakfast and
sometimes the blankets are off and
-This resident does not have a privacy curtain to pull around the bed to keep him/her from
being exposed to the hallway.
During an interview on 6/27/19 at 8:00 A.M., CMT D said:
-The residents may get hot and kick off their covers and
-He/she did not realize there was not a privacy curtain available in the resident’s room.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0583

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 4)
During an interview on 6/27/19 at 9:00 A.M., with Registered Nurse (RN) A said:
-It is everyone’s responsibility to go around and check on the residents and
-He/she did not realize their was no privacy curtain for this resident’s bed.
During an interview on 6/28/19 at 2:54 P.M., the DON said:
-He/she expected the staff to make sure no resident would ever be left with food on their
face or clothing.
-If clothing is soiled from meal/snack time, the resident soul be cleaned up and clothing
changed.
-Expected the staff to ensure the residents are not exposed to the hallway.
-Every room should have a privacy curtain and
-Every shift should do rounds on the residents at least every two hours.

F 0584

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

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

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to properly stored
and wash out a resident’s saturated urine pajamas pants; to address the strong foul
smelling urine odors in his/her closet and room; to clean the grime on the floor area in
the resident’s room for one sampled resident (Resident #21) and to remove the presence of
grime and debris from the floors of the following resident use areas: resident rooms #113,
#115, and the floor of the shared restroom of resident rooms #117 and #118. This practice
potentially affected at least 8 residents who resided in those rooms out of 29 sampled
residents. The facility census was 86 residents.
Record review of the facility’s policy titled Resident Laundry dated 4/1/18, showed:
– A laundry bag should be placed in each resident’s closet for dirty items and
-Bags will be placed in the Soil Utility Room for laundry staff to pick up.
1. Record review of Resident’s #21 Face Sheet showed he/she was admitted to the facility
on [DATE], with the following Diagnoses: [REDACTED].
-Altered Mental Status – ( Is a disruption in how your brain works that causes a change in
behavior).
Record review of the resident’s Nurses’ Notes dated 4/4/19, showed he/she needed extensive
assistance with Activities of Daily Living (ADL’s) such as eating, dressing, grooming and
transferring needs.
Record review of the resident’s baseline Care Plans dated 4/4/19 showed he/she:
– Had a self care deficit regarding his/her current health status.
-Had Dementia.
– Had [MEDICAL CONDITION] (A disorder in which a person has difficulty recovering after
experiencing or witnessing a terrifying event).
-Had overall muscle weakness.
-Was to remain neat, clean, well groomed, free from odor and appropriately dressed per
nursing interventions.
-The staff was to provide on-going assistance with dressing, bathing, grooming and
-The staff was to explain what they were doing before starting care and erase any anxiety
he/she may had felt, or experienced while cares were performed by the nursing staff.
Record review of the resident’s quarterly Minimum Data Set (MDS – a federally mandated

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY 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 5)
assessment tool to be completed by facility staff for care planning) dated, 5/23/19 showed
he/she had a Brief Interview Mental Status (BIMS) score 00 which means he/she was severely
cognitively impaired, had difficulty focusing attention, was easily distracted and poor
recall and memory.
Observation on 6/28/19 at 11:10 A.M., showed:
-The resident’s family found a pair of navy blue plaid pajama pants in the resident’s
closet.
-The residents pajama pants were fount to have a large urine stain around the center
portion and down both leg portions of the resident’s pajama pants.
-The family said he/she finds almost daily soiled clothes and linen in his/her the
resident’s room.
-The staff will not pre-soaked the resident’s clothing or linen and will not bag the dirty
or soiled clothes or linen in a clear plastic bag or the facility mesh bags for their
Laundry Department.
-The family proceeded to place the resident’s soiled pajama pants in the a clear plastic
bag.
-The resident’s soiled pajama pants left a strong foul urine odor inside the resident’s
room and
-The resident navy mattress had a brown substance located on the mid-section area of the
mattress.
During an interview on 6/27/19 at 12:15 P.M., the Laundry Aide A said:
-The nurses were responsible for taking dirty linen and the resident’s dirty clothes to
the linen closet.
-The facility had recently started the bag system.
-He/she was responsible for washing and drying the resident’s clothing.
-He/she also hung up and delivered clean clothes to the residents and
-He/she had seen nursing staff throwing away the resident’s dirty or soiled linen that had
either urine or feces on the resident’s clothing articles.
During an interview on 6/27/19 at 12:15 P.M., the Certified Nurse Assistant (CNA) D said:
-The CNA’s are expected to wash out of the feces and urine from the resident’s clothing
before it goes to the Laundry Department.
-Soiled linen and clothing was to be washed out and stored in the facility’s utility room
and
-The CNA’s were expected to ring out the wet clothes or linen and placed the clothes in a
plastic or the mesh bag.
During an interview on 6/27/19 at 12:30 P.M., the Charge Nurse said:
-There was a separate barrel to store the soiled linen and clothing items within the
facility.
-CNA’s were responsible for washing the resident’s soil clothes or linen.
-The Laundry Department was responsible for picking up soiled clothes and linen and
-If specific laundry issues are not resolved he/she expected to contact the Director of
Nursing (DON) or Housekeeping Supervisor.
During an interview on 6/27/19 at 3:00 P.M., the DON)said:
-He/she expected the nursing staff to use a plastic bag to contain soiled sheets or
resident’s clothing items and
-The staff should not place the resident’s soiled clothes or the linens in a resident’s
closet without using a plastic bag.
2. Observation on 6/24/19 at 11:06 A.M., showed the wall base around the sink coming off
and black substance around the bathroom stool area had grime buildup on the wall floor in
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY 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 6)
resident room [ROOM NUMBER].
Observations with Maintenance Person A on 6/25/19, showed the following:
– At 11:17 A.M., there was a brownish grime on the floor of resident room [ROOM NUMBER].
– At 11:22 A.M., there was the presence of grime behind the bed and close to the wall in
resident room [ROOM NUMBER] and
– At 11:26 A.M., showed a heavy buildup of grime on the floor of the shared restroom of
resident rooms [ROOM NUMBERS].
During an interview on 6/25/19 at 11:27 A.M., Maintenance Person A said he/she noticed the
grime on the floors of different resident rooms.
MO 521

F 0656

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Develop and implement a complete care plan that meets all the resident’s needs, with
timetables and actions that can be measured.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to implement,
develop, maintain and update a care plan consistent with the resident’s specific needs,
and risks based on their comprehensive assessments for two sampled residents (Resident’s
#4 and #8) out of 29 sampled residents. The facility census was 86 residents.
1. Record review of Resident #4’s Face Sheet showed he/she was admitted to the facility on
[DATE] with [DIAGNOSES REDACTED].>-Urinary incontinence.
-Bowel incontinence and
-Protein calorie malnutrition (has low amount of protein in the body due to poor appetite
and not eating).
Record review of the resident’s quarterly Minimum Data Set (MDS- a federally mandated
assessment tool to be completed by facility staff for care planning) dated 12/28/19 showed
he/she:
-Was alert.
-Was dependent on staff for transfer per a mechanical lift.
-Required assistance with daily activities and
-Was incontinent of bowel and bladder.
Record review of the resident’s care plan dated 12/28/19 showed the staff did not develop
a care plan for the resident’s incontinence of bowel and bladder.
Observation on 6/27/19 at 8:18 A.M., showed there was a strong foul smelling odor of urine
coming from the resident’s room.
Record review of the resident’s dietary progress note dated 12/21/19 showed the resident:
-Receives bolus tube feedings of Fibersource HN, one can five times a day with water
flushes through his/her Gastrostomy Tube ([DEVICE]-is a tube placed into the stomach for
nutritional support).
-Was transitioning to a puree diet and had eaten 75% of his/her breakfast.
-May benefit from decreasing number of cans to tolerate more food and
-Has a new order to decrease the bolus tube feedings to one can of Fibersource HN to four
times a day with 250 cubic centimeters (cc) of water flushes.
Record review of resident’s Quarterly Dietary Progress notes dated 3/21/19 showed the
resident:
-Continues meals with pureed texture as tolerated.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0656

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 7)
-Receives Fibersource HN tube feeding bolus 5 x daily with 192 ml and water flushes 250
cc.
-Was tolerating tube feeding and no signs symptoms of infection at tube site and
-Weighed 140 pounds.
Record review of the resident (MONTH) 2019 physician’s orders [REDACTED].
Record review of the resident’s care plan on 6/27/19 showed the staff did not develop a
care plan regarding his/her nutrtional status and him/her transitioning from bolus tube
feedings to a pureed diet.
2. Record review of Resident #8’s Face Sheet, showed he/she was admitted to the facility
on [DATE] with Diagnoses: [REDACTED].
-Constipation and
-Neuromuscular dysfunction of bladder (caused by neurologic damage and symptoms include
overflow of incontinence, frequency, urgency, urge incontinence and retention).
Record review of the resident’s quarterly MDS dated [DATE], showed he/she:
-Was alert.
-Was dependent on staff for transfer per a mechanical lift.
-Required extensive assistance with daily activities.
-Was incontinent of bowel and
-Was incontinent of bladder and used a suprapubic catheter (is tube inserted into your
bladder through the lower abdominal area to drain urine).
Record review of the resident’s (MONTH) 2019 POS showed a physician’s orders [REDACTED].
Observation on 6/27/19 at 8:18 A.M., showed the resident did not have his/her hand splints
on. The hands splints were laying on his/her bedside table.
Record review of the resident’s comprehensive care plan updated on 6/6/19 showed the staff
did not develop a care plan for the specific needs of a resident’s who is a quadriplegic.
-The resident had a care plan for [MEDICAL CONDITION] but did not have a [DIAGNOSES
REDACTED].>-The resident had a care plan for decrease mobility related to a stroke but
did not have a stoke diagnosis.
During an interview on 6/25/19 12:27 P.M. the resident said:
-The hand splints were needed keep his/her hands from contracting further.
-His/her physician ordered an evaluation by PT/OT for new hand splints due to his/her
contractures have gotten worse and the old hand splints are very uncomfortable and
-Resident has not been evaluated by therapy and has not received any new hand splints as
of this time.
3. During an interview on 6/27/19 at 3:00 P.M., the Director of Nursing (DON) said the
resident’s care plan should be accurate and be specific to the needs of each resident.

F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

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

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure
physician’s orders for one sampled resident’s (Resident #52’s) pacemaker (a small device
implanted under the skin in the chest to help control the heartbeat) included the
frequency of the pacemaker interrogation (checking to ensure the batteries are working
properly and that the device is working as it should) and how the resident’s pacemaker was

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

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

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 8)
to be monitored (remotely or at a clinic) and by whom; to ensure the resident’s care plan
also included this information; to ensure monitoring was completed when the resident began
having chest pains and to provide physician’s orders for a resident to self-administered
his/her own medications for one sampled resident (Resident #286) out of 29 sampled
residents. The facility census was 86 residents.
Record review of the facility’s policy Resident Self- Administration of Medication dated
7/15/15 showed:
-Purpose: To established a protocol to ensure resident that self-administer medication are
able to do so safely and correctly. The facility only allows self-administration of
aerosol medications (inhalers) or topical ointments by residents.
-Procedure:
-There must be a Physicians Orders for Self – Administration by the resident. The order
must be clear and specific.
-The resident will be instructed on administering the ordered medication by the licensed
nurse.
-A professional (licensed) staff member will observe the resident administering all
self-administered medications when the order is initiated and monthly to ensure the
resident is giving the medication correctly utilizing the appropriate administering
technique.
-The staff member will document in the nurse’s notes their observation of resident
administering the medication/medications. If the resident is unable or unsafe to
administer the medication the physician will be notified of this information and should
give an order to discontinue the self-administration order.
1. Record Review of Resident #52’s Face Sheet showed he/she was admitted to the facility
on [DATE], with [DIAGNOSES REDACTED]. (a [MEDICAL CONDITION] brain disease that is the
most common form of dementia, that results in progressive memory loss, impaired thinking,
disorientation, and changes in personality and mood).
Record review of the resident’s quarterly Minimum Data Set (MDS-a federally mandated
assessment tool to be completed by facility staff for care planning) dated 2/14/19, showed
he/she:
-Had cognitive loss.
-Needed limited assistance with bathing, dressing and toileting.
-Was independent with transferring, walking and needed supervision (set up assistance)
with eating and-Did not have any cardiac or respiratory diagnoses.
Record review of the resident’s Cardiology Report dated 10/10/18, showed he/she as seen
for a six month follow up to complete an interrogation of his/her pacemaker. The
resident’s cardiology history was reviewed as were his/her medications. The report showed
the resident had no acute distress and the interrogation of the resident’s pacemaker
showed no events. Notes showed the resident was to have another follow up appointment in
six months or sooner if necessary.
Record review of the resident’s Radiology Report dated 3/2/19, showed he/she had an annual
[MEDICAL CONDITION] (TB-an infectious bacterial disease characterized by the growth of
nodules (tubercles) in the tissues, especially the lungs) test and it showed the
resident’s pacemaker was in place and the resident’s x-ray showed no signs of TB.
Record review of the resident’s Physician’s Notes showed on 3/27/19 the resident had
pacemaker placement in 2013 and it was last checked on 10/10/18. The note showed there was
to be a follow up in three months.
Record review of the resident’s Medical Record showed there were no further reports from
the resident’s Cardiologist showing the resident’s pacemaker had been interrogated since
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

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

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 9)
10/10/18.
Record review of the resident’s Medication Administration Record [REDACTED]. The MAR
indicated [REDACTED]
-[MEDICATION NAME] 0.4 mg was administered on 4/10/19, 4/11/19 x 3 and 4/13/19 for
complaints of chest pain that was effective and
-[MEDICATION NAME] 1000 mg every 12 hours for [MEDICAL CONDITION] was administered daily
as ordered except on 4/1/19.
Record review of the resident’s Nursing Notes showed:
-On 4/10/19 the resident complained of sharp chest pains that increased when he/she
inhaled.
-Nursing staff administered [MEDICATION NAME] for chest pain and took his/her blood
pressure and pulse.
-The nurse also notified the resident’s physician and responsible party.
-The resident did not want to go to the hospital.
-The facility did not send the resident out but continued to monitor him/her with the
direction that if the resident’s pain continued, they would send the resident to the
hospital.
-The resident began to feel better and attended the activities and
-The nursing staff notified the resident’s physician of the resident’s condition.
Record review of the resident’s Physician’s Order Sheet (POS) dated 4/20/19 to 5/19/19,
showed physician’s orders for:
-[MEDICATION NAME] ([MEDICATION NAME]) 0.4 mg one tablet under the tongue every 5 minutes
x 3 doses, as needed for chest pain. The original order was dated 12/28/15.
-[MEDICATION NAME] 1000 mg every 12 hours daily for [MEDICAL CONDITION]. The original
order was dated 1/2/19 and
-There were no physician’s orders showing the schedule/frequency for the resident’s
pacemaker check (interrogation), how the pacemaker check was completed (by whom), nor how
the resident’s pacemaker was monitored and any adverse reactions the physician would need
to be notified of.
Record review of the resident’s MAR indicated [REDACTED].
Record review of the resident’s MDS Care Plan meeting form dated 5/9/19, showed staff was
investigating who placed the resident’s pacemaker and the schedule for checking it since
the resident had recent complaints of chest pains (that was resolved with medication and
rest).
Record review of the resident’s Care plan updated on 5/17/19, showed he/she had a
pacemaker and the goal was that the resident would have no complications through the next
review period. The interventions showed the facility staff was to:
-Follow up on the resident’s cardiac appointments.
-Take the resident’s pulse and blood pressure daily, and to notify the physician if the
resident’s pulse was less than 60.
-Notify the resident’s physician if the resident complained of chest pain, [MEDICAL
CONDITION] (swelling and fluid in the tissues), wheezing, light headedness, anxious
behavior or hiccups and
-There was no documentation showing where and how the resident’s pacemaker was
monitored/interrogated, who was to perform the interrogation and the frequency of the
resident’s pacemaker interrogations.
Record review of the resident’s POS dated 5/20/19 to 6/19/19, showed physician’s orders
for:
-[MEDICATION NAME] ([MEDICATION NAME]) 0.4 mg one tablet under the tongue every 5 minutes
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

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

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 10)
x 3 doses, as needed for chest pain. The original order was dated 12/28/15.
-[MEDICATION NAME] 1000 mg every 12 hours daily for [MEDICAL CONDITION]. The original
order was dated 1/2/19.
-There were no physician’s orders showing the schedule/frequency for the resident’s
pacemaker check (interrogation), how the pacemaker check was completed (by whom), nor how
the resident’s pacemaker was monitored and any adverse reactions the physician would need
to be notified of and There was no date showing when the resident’s pacemaker
interrogation was scheduled to be completed again.
Record review of the resident’s MAR indicated [REDACTED]. The resident’s pulse was
documented (and was above 60); [MEDICATION NAME] 1000 mg for [MEDICAL CONDITION] was
administered as ordered.
Record review of the resident’s Nursing Notes showed:
-On 5/28/19 the resident had chest pain while lying in bed. The nurse completed blood
pressure and pulse checks and administered [MEDICATION NAME] to the resident for chest
pain. The resident expressed relief.
-The nurse notified the resident’s physician and no additional treatment was needed.
Nursing staff continued to monitor the resident until 5/29/19 and the resident had no
further complaints of chest pain and
-There was no documentation showing the facility followed up with the resident’s
Cardiologist to find out when the resident would be scheduled for his/her next
interrogation or when the resident’s last interrogation was.
Record review of the resident’s POS dated 6/20/19 to 7/19/19, showed there were no
physician’s orders showing the schedule/frequency for the resident’s pacemaker check
(interrogation), how the pacemaker check was completed (by whom), nor how the resident’s
pacemaker was monitored and any adverse reactions the physician would need to be notified
of. There was no documentation showing when the resident’s pacemaker was last checked
and/or when the next interrogation was scheduled.
Observation and interview on 6/27/19 at 9:23 A.M., showed the resident was sitting in the
lobby area with another resident looking out the window and interacting with staff and
residents who passed by. He/she was dressed for the weather and was very friendly, with
some confusion noted. The resident said he/she felt good and had eaten breakfast this
morning and everything was good. He/she showed no signs or symptoms of respiratory
distress, pain, discomfort or shortness of breath.
During an interview on 6/28/19 at 11:18 A.M., Licensed Practical Nurse (LPN) C said:
-Documentation regarding monitoring of the resident’s pacemaker and cardiology reports
should be in the resident’s medical record.
-The cardiology reports should be in the labs section and the nurses notes should show
when the resident’s pacemaker was last checked.
-He/she did not know when the resident’s pacemaker had last been interrogated.
-He/she did not know when the resident was supposed to have his/her pacemaker interrogated
and did not know the schedule of the resident’s interrogations (every three months, six
months etc) and
-He/she did not know whether the resident had his/her pacemaker interrogated remotely or
if he/she went to the Cardiologist, but he/she thought the resident was sent to the
Cardiologist for follow up.
During an interview on 6/28/19 at 2:54 P.M., the Director of Nursing (DON) said:
-There should be a physician’s order that states who checks the pacemaker (the
Cardiologist, hospital or location the resident’s pacemaker checks are completed), the
frequency of the resident’s pacemaker checks and how nursing staff are to monitor the
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

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

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 11)
resident’s pacemaker.
-Physician’s orders for monitoring the resident’s pacemaker should be followed and they
should have the resident’s pacemaker schedule so that it can be checked (interrogated) per
the Cardiologist’s recommendation.
-Nursing staff are to monitor the resident by taking the resident’s vital signs daily, if
the pulse rate falls below 60 (or if there is a different set rate for the
resident-depending on the pacemaker check or cardiologist report dictates) they are to
notify the physician.
-They should also check for [MEDICAL CONDITION], complaints of chest pain and shortness of
breath and any additional cardiac symptoms.
-If there are any irregularities or symptoms present, then the physician needs to be
notified and the nurse should document this information in the resident’s nursing notes.
-Nursing staff should document on the MAR indicated [REDACTED]
-The resident’s care plan should also show where the resident’s pacemaker is checked and
the frequency of the pacemaker checks, what signs and symptoms to look for when monitoring
the resident and when to notify the physician.
2. Record review of Resident #286’s face sheet showed he/she was admitted to the facility
on [DATE], with the following Diagnoses: [REDACTED].
-Atrophy (A decrease in the mass of muscle).
Record review of the resident’s Baseline MDS dated [DATE], showed he/she did not have a
care plan to provide self-administration of his/her medications.
Record review of the resident’s quarterly MDS dated [DATE], showed:
-The resident had a Brief Interview Mental Status (BIMS) score of 00 indicating the
resident was cognitively impaired, had difficulty focusing attention, was easily
distracted and had poor recall and memory.
-He/she had altered perception of surroundings.
-He/she had a history of [REDACTED].
-The staff was to remind the resident of his/her room location and
-The staff was to introduce themselves and approach the resident calmly.
Record review of the resident’s quarterly Care Plan dated 5/28/19, showed:
-The resident had memory disturbances and sleep disorder.
-The staff was to observe the resident’s mood symptoms to improve and become less frequent
over the next 90 days and
-He/she had repetitive questioning and repetitive anxious complaints and concerns.
Record review of the resident’s MAR indicated [REDACTED].M., in the morning which were
prescribed or ordered by his/her medical doctor:
-[MEDICATION NAME] HCI 25 milligrams (mg) one half tablet once daily for depression (is
common but serious mood disorder. It causes severe symptoms that affect how you feel and
think).
-[MEDICATION NAME] 20 mg twice a day for [MEDICAL CONDITION] Reflux Disease (GERD
digestive disease in which stomach acid or bile irritates found in the pipe lining).
-Donepezil HCI 5 mg tablet once a day for Dementia ( A group of thinking and social
symptoms that interferes with daily functioning).
-[MEDICATION NAME] 20 mg give two tablets every four hours for hypertension (high blood
pressure).
-Tylenol 325 mg give two tablets every four hours for pain and
-[MEDICATION NAME] Bisulfate 5 mg one tablet once a day for hypertension.
Observation on 6/24/19 at 9:00 A.M., showed CMT C:
-Had his/her medication cart on the 100 hall going to each resident’s room to distribute
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

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

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 12)
the residents’ their medications.
-Knocked on the resident’s door and introduced himself/herself to the resident and said
he/she was there to give the resident his/her morning medications.
-Placed six pills in the resident’s left hand and provided the resident with water in a
white foam cup in his/her right hand and
-Did not observe the resident taking or swallowing the six pills.
During an interview on 6/28/19 at 12:50 P.M., CMT C said:
-The resident did not have a Self-Administration Medication form on file in his/her
medical record or a Physician’s Orders.
-The role of the CMT was to check the physician’s orders and the resident’s MAR prior to
the resident receiving his/her medication.
-He/she was to triple check the resident’s medication to ensure that there was no
discrepancy regarding the resident’s medication usage and
-The CMT was trained in school to observe the resident to take and swallow all of his/her
medications.
During an interview on 6/28/19 at 1:15 P.M., Registered Nurse (RN) B said:
-The resident should have a physician’s orders on his/her medical record if he/she is
planning to self-administer his/her medications.
-Only a licensed nurse will observe the resident administering all self-administered
medications when the order was initiated by the resident’s physician and
-The CMT and licensed nurse’s were expected to document in the nurse’s notes and the
resident’s MAR indicated [REDACTED].
During an interview on 6/28/19 at 3:00 P.M., the DON said:
-He/she expected a physician’s orders for self-administration of medication be placed in
the resident’s medical record.
-He/she expected the resident’s physician’s orders to be clear and specific for the
licensed nurses.
-He/she expected the nursing staff to document in the nursing notes their observations of
the resident taking their own medication.
-He/she expected the CMT to watch the resident take his/her medication to ensure the
resident had properly swallowed the medication and
-It was never acceptable for a CMT to not observe the resident taking his/her pills.
MO 028

F 0686

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview, and record review, the facility failed to monitor and
document one resident’s wound and to notify the contracted wound care company to treat,
stage, evaluate and measure the resident’s left heel wound since admission for one sampled
resident (Resident #21), and to maintain a Low Air Loss Mattress (LALM) for one sampled
resident (Resident #79) who was at high risk for pressure ulcers; out of 29 sampled
residents. The facility census was 86 residents.
Record review of the facility’s Wound Care Protocol/Policy dated (MONTH) 2012, showed:
Polices and Procedures:
-Policy: Assessment to be completed on all residents on admission and reviewed quarterly

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0686

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 13)
with Minimum Data Set (MDS-a federally mandated assessment tool to be completed by
facility staff for care planning) Coordinator.
-Purpose: To determine resident risk for developing pressure ulcers/sores and initiating
preventive measures.
-Only completed by Licensed Practical Nurse (LPN) or Registered Nurse (RN) staff.
-Fill out demographic at top of form completely.
-Circle the resident risk factors – place number of each risk factor box to right, i.e. if
good is circled the number in the box should be zero.
-Total all numbers on the right and write total score on the total score line.
-Scores of 12 and above place residents at risk for pressure ulcer development follow
instructions on the form. Place information on care plan and make sure the MDS reflects
preventative skin care.
-This assessment was to be completed on admission with quarterly reevaluation of pressure
ulcer risk.
-Wound Documentation Tips:
-Document the type of wound and location.
-Describe if the wound is partial or full thickness wound.
-Describe the stage if wound is pressure ulcer.
-Document size, measure in centimeters, always document the length X width X and depth.
-Document any undermining, tunneling and sinus tract; using the clock system.
-Describe any exudates (drainage); any type, amount or odor.
-Describe the various types/characteristics of tissue in wound bed.
-The wound report is completed and presented by the Director of Nursing (DON) or her/his
designee.
-Wound assessment will be documented weekly in the resident’s medical record on the
pressure ulcer flow sheet.
-Wound rounds will be weekly with the following persons: Dietician, Clinical Coordinators,
MDS Coordinator, DON and Physician when available.
-All pressure sores must be addressed on the MDS and the care plan and
-A copy of the wound care protocol will be sent to each physician whenever revisions are
done and
-The wound care protocol will be reviewed for needed revisions every two (2) years.
1. Record review of Resident #21’s Face Sheet showed he/she was admitted to the facility
on [DATE] with the following Diagnoses: [REDACTED].
-Altered Mental Status (a disruption in how the brain works that causes changes in
behavior) and
-Muscle Weakness.
Record review of the resident’s Care Plan dated 4/4/19 showed:
-The resident’s had the potential for breakdown.
-The resident’s skin integrity was to be maintained through nursing intervention over the
next 90 days.
-The staff was to keep the resident clean and dry.
-The staff was to apply moisture barrier cream as ordered.
-The staff was to check the resident for incontinence every two hours.
-The resident did require to be repositioned every two hours as tolerated.
-The Certified Nursing Assistants (CNAs) were to do a skin assessment during his/her
shower and was to notify the nurse of any changes in the resident’s skin.
-The licensed nurse was to change the wound dressing daily and
-The licensed nurse was to apply the boot to the resident’s left foot while the resident
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0686

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 14)
was in bed.
Record review of the resident’s quarterly MDS dated [DATE], showed he/she had a Brief
Interview Mental Status (BIMS) score 00 which showed he/she was severely cognitively
impaired, had difficulty focusing attention, was easily distracted, had poor recall and
memory.
Record review of the resident’s Nurse’s Notes dated 5/23/19 showed:
-RN B tried to make contact with the wound care company to help evaluate and to provide
treatment for [REDACTED].
-RN B tried to fax a physician’s orders [REDACTED].
-The facility did not receive a fax receipt or documentation back from the wound care
company indicating they had received the physician’s orders [REDACTED].>Observation on
6/25/19 at 2:20 P.M., showed RN C provided wound care to the resident’s right heel.
During an interview on 6/25/19 at 2:40 P.M., RN C said the resident’s heel wound was a
Stage 2 (Partial thickness skin loss with exposed dermis (skin). The wound bed is viable,
pink or red, moist and may also present as and intact or ruptured serum-filled blister., )
or a Stage 3 ( a full thickness loss of skin, in which fat is visible in the ulcer and
granulation (good tissue) and epibole (rolled wound edges) are often present. Slough (dead
tissue, usually cream or yellow in color) and or eschar (dry, black, hard necrotic tissue)
may be visible. Depth of tissue varies by anatomical location. Undermining (occurs when
the tissue under the wound edges becomes eroded, resulting in a pocket beneath the skin at
the wounds edges) and tunneling (have channels that extend from a wound and through
subcutaneous tissue or muscle) pressure ulcer.
During an interview on 6/28/19 at 12:20 P.M., CNA C said:
-He/she was not responsible for caring or treating the resident’s wounds.
-The licensed nurses were responsible for caring and treating the resident’s wound and
-He/she was responsible to notify his/her charge nurse for any changes in the resident’s
skin when he/she completes a bath sheet skin assessment on the resident.
During an interview on 6/28/19 at 1:00 P.M., RN B said:
-He/she only had orders to provide wound care to the resident’s heel wound.
-The wound care company comes to the facility on ce a week and
-He/she was unable to recall the last time the wound care company had provided staging,
evaluation and/or treatment to the resident’s heel wound.
During an interview on 6/28/19 at 3:00 P.M., the DON said:
-RN C was recently hired and he/she was not trained yet on how to stage wounds.
-He/she and the MDS Coordinator were the only two licensed nurses who were trained in
staging residents’ wounds.
-He/she was planning to teach the RN C how to stage a resident’s wound.
-He/she said there was a mix up regarding the order for the resident to receive treatment
for [REDACTED].
-The resident’s medical record should have contained:
–Documentation to describe the wound type and location.
–Documentation to describe the stage of the wound.
–Documentation to describe the wound measurements in centimeters.
–A weekly wound assessment on the pressure ulcer flow sheet.
-He/she expected licensed nurse’s to be responsible for providing the wound care treatment
and services to the residents.
-He/she expected the wound care company to be responsible for staging, treating and
evaluating the resident’s wounds and
-He/she expected the wound care company to provide the documentation on all residents who
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0686

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 15)
have wounds in the facility.
2. Record review of Resident #79’s Admission Face Sheet showed he/she was admitted to the
facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED].>-Mild cognitive
impairment (to persistent deficits in the brain’s ability to function effectively.
-[MEDICAL CONDITION] ([MEDICAL CONDITION], is a chronic [MEDICAL CONDITION] lung disease
that causes obstructed airflow).
-Stroke and
-Diabetes Mellitus (is high blood sugar levels over a prolonged period).
Record review the resident’s wound documentation flow sheet dated 12/28/19 showed he/she
was being seen for a Stage II coccyx pressure ulcer.
Record review of the resident nursing notes dated 1/11/19 showed a change in wound care
for the resident’s Stage II coccyx wound for staff to cleanse the coccyx wound with normal
saline, apply hydrogel (supplies moisture to the wound) to wound bed, cover with border
dressing daily and as needed.
Record review of the resident’s Assessment of Pressure Ulcer Potential dated 5/30/19
showed:
-Had a score of 19 showing the resident is high risk for pressure ulcers.
-No current pressure ulcer noted and
-Preventative measure included a specialized mattress to reduce pressure point areas.
Record review of the resident’s Nursing Progress notes dated 6/9/19 (no time noted)
showed:
-The resident had complaints of his/her bed hurts and
-He/she uses a LALM and the setting was noted to have been checked and was set correctly.
Record review of the resident’s Physician order [REDACTED].
Observation on 6/26/19 at 9:15 A.M., showed the resident was laying on his/her LALM with
his/her eyes closed and the power cord to the mattress was plugged in and the green power
light on and there was not warning signals noted.
During an interview on 6/26/19 at 9:41 A.M., CNA E said:
-The resident normally sleeps in and will yell out when he/she is ready to get up out of
bed and
-The staff had not waken the resident up for breakfast.
Observation on 6/26/19 at 11:22 A.M., showed:
-The staff had a hard time waking up the resident this morning.
-CNA E had notified the charge nurse.
-The CNA had already change the resident to ensure he/she was clean.
-The resident was lying in bed on his/her LALM with his/her eyes closed and his/her face
was flushed and
-His/her bed was in a low position and a fall mat laying on the floor next to the bed.
Observation and interview on 6/26/19 at 11:25 A.M., showed:
-The resident had complained of pain in his/her lower back.
-He/she does get a pain patch to the back as needed.
-Was found that the resident’s LALM was not working properly.
-The LALM middle section had deflated.
-The resident said that the mattress had been that way for a while.
-The nurse checked the mattress setting and the LALM was set for weight at 230.
-The power light was on and the middle section of bed was deflated and the other part of
air mattress bed was inflated placing the resident bottom area and lower back less
protected from the bed frame.
-The resident said every night he/she had woken up in pain from his/her bed.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0686

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 16)
-The RN E had finished the resident’s assessment.
-The RN said he/she would check back on the resident and left the resident’s room at 11:35
A.M. and
-The resident remain laying in the same position on the partly deflated mattress.
During an interview on 6/26/19 at 11:37A.M., RN B said:
-He/she was going to call the LALM Company to come and look at the resident’s bed.
-He/she would see if the facility had a another bed available for the resident to use
until his/her bed was fixed.
-He/she was not aware of the resident currently having any pressure sore issues or redness
on his/her coccyx or sacral area.
-He/she did not assess the resident back prior to leaving the resident’s room.
-Would have to check with the resident’s physician to report the resident’s change in
condition before he/she would let the CNA get the resident out bed.
-The resident not feeling well and could not be transfer to chair at this time and
-RN B left the resident room with the resident lying in the partially deflated bed.
Observation on 6/26/19 at 11:43 A.M., showed the resident:
-Was yelling out saying Can I get up and CNA E had inform the resident that after his/her
lunch break they would get the resident up if he/she was feeling better.
-At 11:46 A.M. Certified Medication Technician (CMT) C said he/she informed the resident
that he/she was not able to get the resident up out of bed until he/she was feeling
better.
-At 11:48 A.M. RN D entered the resident’s room and was the settings on the resident’s
C-PAP machine (Continuous Positive Airway Pressure machine is used to treat sleep apnea
(this is when a person stops breathing for short period of time while sleeping) and RN B
told the resident that he/she was working on getting someone to come to fix the resident’s
LALM.
-At 12:02 P.M., the resident was yelling out, hello I am wanting to get up out of bed and
–The resident was still in the same position and the resident’s LALM was still deflated
in the middle.
Observation on 6/26/19 at 12:03 P.M., showed Physical therapy (PT) entered the resident’s
room:
-Asking the resident if having trouble breathing or a headache and
-PT staff said the resident was different today and had something going on but did not
address the resident’s deflated mattress.
During an interview on 6/26/19 at 12:09 P.M., CNA E said:
-He/she was not aware the resident having issue with his/her bed.
-CNA E had turned the air mattress control on and off, and it did not make a difference
with the low air loss mattress and
-The resident did have call light in place.
Observation on 6/26/19 at 12:18 P.M., the resident in his/her room laying in bed on
his/her LALM:
-The resident’s was laying on his/her back with his/her head of the bed slightly tilted
and the middle section of his/her low air loss mattress remained deflated.
-At 12:20 P.M., the RN B walked by the resident room.
-At 12:21 P.M., the RN B stop looked in on the resident; did not address the bed issue.
-At 12:23 P.M., the resident was yelling out help.
-At 12:24 P.M. CNA E was concerned about the resident’s face being flushed and the
resident said he/she was hot and maybe they should leave the resident bed and notified the
RN and
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 9/25/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265145

(X2) MULTIPLE CONSTRUCTION
A. BUILDING___________
B. WING___________
(X3) DATE SURVEY COMPLETED

NAME OF PROVIDER OF SUPPLIER

SWOPE RIDGE GERIATRIC CENTER

STREET ADDRESS, CITY, STATE, ZIP

5900 SWOPE PARKWAY
KANSAS CITY, MO 64130

For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAGSUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0686

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 17)
At 12:40 P.M., the resident was in the same position laying on his/her back and the LALM
was still deflated in the middle.
During interview on 6/26/19 at 1:37 P.M. the resident said he/she:
-Was feeling better and was wanting to get up out of bed.
-The middle section of the air mattress remained deflated.
-Was not able to reposition or turn himself/herself in bed and required assistance of
staff for bed mobility and
-The call light was on the floor out of reach of the resident.
Observation on 6/26/19 at 1:39 P.M. the resident was yelling out get me up, the facility
staff did not respond to the resident’s request and
-He/she remained laying on his/her back in bed with the middle section of the air loss
mattress partially deflated.
During an interview on 6/27/19 at 6:30 A.M. CMT E, CNA H and CNA G (evening staff) said:
-1st floor did not have a licensed nurse during the night shift, the LPN would float to
both floors.
-CMTs pass medication and charge the unit.
-The night staff were not aware the resident had any issue with his/her bed.
-The mattress control has a alarm when not working and they had not heard the bed alarm go
off.
-CNA G said normally if there was a concern with the mattress or bed, he/she would call
the facility 500 number to report to maintenance staff and tell the charge nurse.
-CNA G said the resident has complained of discomfort related to his/her bed several times
and
-CMT E had looked in resident’s medical record yesterday and they had notified the medical
equipment company on 6/25/19 at 1:49 P.M.
During an interview on 6/27/19 at 6:37 A.M. LPN B said:
-He/she was not informed of the resident having issue with LALM during nursing report.
-Last week the resident had issue with his/her bed being deflated.
-Would expect facility staff should had replaced the resident bed until able to fix it.
-Should not leave the resident in a partly deflated bed for any length of time and
-The resident has complained of his/her bed causing pain or discomfort to his/her lower
back and bottom area.
During an interview on 6/28/19 at 11:05 A.M., CNA D said:
–The LAL mattress are checked daily by the facility’s care staff and
-If an issue was found regarding the mattress being deflat