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 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.

**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 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

(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 TAG SUMMARY 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 TAG SUMMARY 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 TAG SUMMARY 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 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 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 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 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 TAG SUMMARY 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 8)
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 9)
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 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 TAG SUMMARY 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 TAG SUMMARY 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 TAG SUMMARY 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 TAG SUMMARY 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 TAG SUMMARY 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 deflated; he/she would recheck the
connection and plug in the air mattress and if still not working would call the 500 number
to come and fix the resident’s LALM and would notify the charge nurse.
During an interview on 6/28/19 at 11:05 A.M., CMT D said:
-The resident with a low air loss mattress if the mattress was having problems a warning
sound would beep to notify you when there is a problem with the LALM and he/she would
check the function of the air loss mattress and if an issue with the mattress was found
he/she would notify the nursing staff and would continue to monitor and
-The charge nurse were also responsible for monitoring the air loss mattress to ensure it
is working properly.
During an interview on 6/28/19 at 11:20 A.M., CMT C said the resident’s LALM is checked
daily by the care staff and the care staff are to report any concern to the Charge Nurse.
During an interview on 6/28/19 at 2:54 P.M., the DON said:
-Expected the staff to monitor the LALM every shift.
-The staff will check the controls of the resident’s mattress if light are on, check 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 TAG SUMMARY 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 18)
mattress to ensure it has inflated fully and to monitor the resident for comfort levels.
-The nursing staff do have a mattress check off on the resident’s Treatment Admission
Record (TAR);
-He/she was not aware the resident had an issue with his/her LALM.
-When it is found that the LALM was not inflated properly, he/she would expect the nursing
staff not leave the resident in the deflated mattress even when resident is not feel well
and
-This can increase the risk of skin break down when left in a deflated mattress for long
period of time.
MO 028

F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

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

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to provide
monitoring and supervision to prevent a fall with an injury and to ensure the resident’s
safety with the gait belt transfer for one sampled resident (Resident #21); to maintain
hot water temperatures between 105 degrees Fahrenheit (ºF ) and 120 ºF; to ensure the
temperature gauges on the boilers were accurate; to provide oversight for six residents to
ensure safe monitoring of residents’ smoking behaviors and smoking materials; to ensure
residents’ smoking behaviors were assessed at least annually, and to include current
intervention and plans related to changes in safe smoking behaviors for sampled six
residents (Residents #56, #58, #20, #24, #12 and #79), and to ensure the safety of one
sampled resident (Resident #72) out of 29 sampled residents from wandering off the floor,
who was at risk for wandering. This deficient practice had the potential to affect all
residents residing with in the facility, the facility’s census was 86 residents.
Record review of the facility’s Fall Policy dated 3/20/19, showed:
-Resident safety is the on-going responsibility of all staff. In order to reduce the risk
of resident injuries as a result of a fall, the staff will assess and re-assess the
patient’s level of risk for falls and in conjunction with the care plan team institute
appropriate intervention procedures.
-To establish a consistent process to identify residents who are at risk for falls upon
admission utilizing the Fall Risk Assessment.
-To identify a resident who is at risk for falls that were not initially deemed a fall
risk on admission.
-To develop a comprehensive plan of care for the initiation of appropriate safety measures
and interventions.
-A fall is a witnessed or unwitnessed unplanned descent to the floor (or extension of the
floor) with or without injury to the resident. This includes assisted falls such as when a
staff member attempts to minimize the impact of the fall by easing the resident descent to
the floor.
-Every resident will be screened upon admission utilizing the Fall Risk Assessment form.
-Each resident will be reassessed not less than quarterly and
-Reassessment must also be completed if a resident has a fall and was not previously
considered a fall risk.

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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 19)
Record review of the facility’s Transferring Residents Policy dated 6/2008 showed:
-Gait Belt:
–A special belt that is placed around the resident’s waist and provide the nurse assist
with handle to hold on to when moving the resident.
–It enhances both the safety and comfort of the resident during the transfer procedure;
prevents injury to resident which could be caused by pulling on arms.
–Useful for ambulating residents and increases safety.
–Apply the belt snuggly but not tight that it causes discomfort or impairs the resident’s
ability to breathe.
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 (Is a disruption in how your brain works that causes a change in
behavior).
Record review of the resident’s Comprehensive Resident assessment dated [DATE] showed:
-He/she required two person assist with transfers.
-He/she was to ambulate with one person assist with wheelchair only and was full weight
bearing and
-On 3/23/19 the resident had a change in his/her functional status where he/she needed a
two person assist.
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, bathing,
grooming and transferring needs.
Record review of the resident’s Care Plan dated 4/4/19 showed:
-The resident’s bed was to kept in the lowest position and
-He/she was to have the call light within reach and instruct on usage if he/she
comprehends.
Record review of the resident’s Nurse’s Notes dated 5/15/19 showed the physician had
approved for the resident to use chair alarm to prevent further falls and to indicate to
staff when the resident was leaning out of range parameters while he/she was seated in
his/her wheelchair.
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, 5/23/19 showed
the resident had a Brief Interview Mental Status (BIMS) score of 00 which means the
resident was severely cognitively impaired, had difficulty focusing attention, was easily
distracted, and poor recall and memory.
Record review of the resident’s care plan dated, 5/23/19 showed:
-He/she had a fall due to weakness and
-Resident attempted to walk independently at times.
Record review of the resident’s Nurse’s Notes dated 5/29/19 showed:
-The resident had a fall which resulted in a laceration on his/her right forehead that
measured 2.0 centimeters (cm) x 1.0 cm.
-Was sent to the hospital for evaluation after his/her physician was notified and
-The nurses attempted neurological checks but were unsuccessful due to resident being
combative (hitting and grabbing) at staff.
Record review of the resident’s Post Fall Observation dated 5/29/19 showed:
-The resident was seated in a stationary chair in his/her room, the resident stood up and
was found on the floor bleeding with a laceration measuring 2.0 cm x 1.0 cm.
-The fall history of the resident showed he/she had five falls in the last 90 days.
-The fall investigation report concluded the resident had poor safety awareness and lost
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 20)
his/her balance when he/she stood up from his/her wheelchair.
-The staff had applied pressure and and bandage to the resident’s laceration.
-The resident’s physician and Durable Power of Attorney (DPOA A type of advance medical
directive in which legal documents provide the power of attorney to another person in the
case of an incapacitating medical condition) were notified of the resident’s injury and
-The resident was sent to the hospital.
Record review of the resident’s Post Fall Observation dated 6/9/19 showed:
-The resident was in his/her wheelchair and stood up and fell , and landed on his/her
buttocks. The fall was witnessed by nursing staff.
-He/she denied pain.
-The staff was to ensure the resident’s chair alarm was on and in use at all times and
-The staff was to ensure the resident’s wheelchair was locked for resident’s fall
prevention needs.
Record review of the resident’s Physician order [REDACTED].
Record review of the resident’s care plan dated, 6/20/19 showed the resident was at risk
for falls, and required the following interventions:
-Bed/chair alarm applied at all times.
-Staff were to monitor the resident every two hours and as needed.
-Floor mat at bedside.
-Bed in the lowest position.
-The resident was to have assistance from two or more staff when he/she was transferred,
especially if he/she exhibited behaviors.
-The resident was to have a call light within his/her reach and
-Staff was to encourage the resident to use call light for assistance.
Observation on 6/24/19 at 9:20 A.M., showed the resident seated in his/her wheelchair and
had bruise on the right side of his/her forehead area.
Observation on 6/25/19 at 2:40 P.M., showed:
-Certified Nursing Assistants (CNA) A, CNA B, and CNA C were transferring the resident
from his/her wheelchair to his/her bed in his/her room.
-CNA A stood in front of the resident and started to move the resident to his/her bed
without using a gait belt around his/her waist and
-CNA B and CNA C stood on either side of the resident and placed an arm under the
resident’s arm in the armpit area and lifted the resident from the wheelchair to the
his/her bed without using a gait belt.
During an interview on 6/25/19 at 11:00 A.M. the resident’s family said:
-The resident had suffered four to five falls since he/she had resided at the facility and
-He/she had a laceration on his/her forehead, scratches on his/her legs and bruises on
his/her cheek and temple, after he/she had a fall on 5/10/19.
During an interview on 6/27/19 at 12:30 P.M. the Physical Therapy (PT) Coordinator said:
-All staff should use a gait belt anytime a resident is being moved and
-He/she had provided training to the staff on transfers, gait belt usage and other body
mechanics tips.
During an interview on 6/28/19 at 12:20 P.M. CNA B said:
-He/she was provided three days of orientation training on how to transfer a resident
properly.
-He/she had been trained to wrap the gait belt around the resident and
-Generally two people are involved in a resident’s transfer.
During an interview on 6/28/19 at 12:30 P.M. Registered Nurse (RN) A said:
-Nurses were expected to check a resident’s vital signs and start neurological checks
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 21)
after a fall.
-Nurses were expected to complete a fall packet on any resident who had a fall in the
facility.
-Nurses were expected to notify the resident’s physician and his/her family after a fall.
-Nurses were expected to stabilize the resident after a fall and start post fall
neurological checks.
-The residents were assessed by PT.
-PT provided in-service training for staff to learn about how to provide proper transfers
for the residents.
-PT was to determine the number of staff needed to provide transfer assistance for the
residents and
-If staff do not use a gait belt while transferring a resident it has the potential to
cause bodily harm or fracture to the resident.
During an interview on 6/28/19 at 3:00 P.M., the Director of Nursing (DON) said:
-He/she expected the residents who were a high fall risk to have a completed fall
assessment on file.
-He/she expected the nursing staff to perform neurological checks for three days.
-He/she expected post fall investigations and put interventions in place to avoid further
or repeated falls.
-He/she expected staff to notify the resident’s family and his/her physician.
-He/she expected a resident who was identified as fall risk to not be left alone in a
stationary chair.
-He/she expected a resident had an order for [REDACTED].
-He/she expected staff to ensure the chair/bed alarm was working at all times on an
on-going basis.
-He/she expected the nursing staff to use his/her gait belt when transferring residents
and he/she expected two person assistance during all transfers.
-He/she expected residents who required a mechanical lift to have at least two staff
persons to assist with the transfer and
-He/she expected the nursing staff not to use the chicken wing method when transferring a
resident within the facility.
Record review of the Burn Foundation website, www.burnfoundation.org, showed the
following:
-Hot Water Causes Third [MEDICAL CONDITION](full [MEDICAL CONDITION] go through the skin
and affect deeper tissue resulting in white or blackened, charred skin):
-In 1 second at 156 degrees F.
-In 2 seconds at 149 degrees F.
-In 5 seconds at 140 degrees F and
-In 15 seconds at 133 degrees F.
** Note: All water temperatures were checked after letting the faucet run for 2 minutes or
more.
2. Observations of hot water temperatures on 6/24/19, showed the following hot water
temperatures, at the handwashing sinks, at the following locations and times on the 2nd
floor:
– At 1:59 P.M., the hot water temperature at the handwashing sink in room [ROOM NUMBER],
was 130.8 degrees ºF.
– At 2:02 P.M., the hot water temperature at the handwashing faucet in the shared restroom
of resident rooms 225/226, was 130.9 ºF.
– At 2:06 P.M., the hot water temperature at the handwashing faucet in the shared restroom
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 22)
of resident rooms 227/228, was 129.7 ºF.
– At 2:09 P.M., the hot water temperature at the handwashing faucet in the shared restroom
of resident rooms room [ROOM NUMBER]/230, was 129.6 ºF.
– At 2:14 P.M., the hot water temperature at the handwashing sink in vacant room [ROOM
NUMBER], was 128 ºF.
– At 2:17 P.M., the hot water temperature at the handwashing sink in vacant room [ROOM
NUMBER], was 127.8 ºF.
– At 2:19 P.M., the hot water temperature set at between 129-130 degrees F at the hot
water storage tank which served the 1st and 2nd floors.
– At 2:20 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER] was 121.0 ºF.
– At 2:22 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 127.0 degrees.
– At 2:51 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 129.6 ºF.
– At 2:52 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER] was 126.8 ºF.
– At 3:11 P.M., the temperature in the sink in the shared restroom of resident rooms
202/203, was 135.5 ºF.
– At 3:14 P.M., the temperature in the sink in the shared restroom of resident rooms
204/205, was 135.7 ºF.
– At 3:16 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 135.1 ºF and
– At 3:18 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 131.9 ºF.
Observations of hot water temperatures on 6/24/19, showed the following hot water
temperatures, at the handwashing sinks, at the following locations and times on the 1st
floor:
-At 2:31 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 125.2 ºF.
-At 2:37 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 125.4 ºF.
-At 2:38 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 118.0 ºF.
-At 2:39 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 126.5 ºF and
-At 2:42 P.M., the hot water temperature at the handwashing sink in resident room [ROOM
NUMBER], was 128.8 ºF.
During interviews on 6/25/19, the following was said:
-At 8:35 A.M., Maintenance Person A said the water temperatures were checked once per
week.
-At 8:47 A.M., Maintenance Person A said he/she (the Maintenance Department) should have
checked water temps on Monday 6/24/19, but he/she (Maintenance Person A) ended up walking
around with the state surveyor for Life Safety Code and environmental observations.
-The most recent time before 6/25/19, that hot water temperatures would have been
measured, was 6/17/19, and
– No employees or residents reported issues pertaining to hot water temperatures.
Observation with Maintenance Person A on 6/25/19 at 8:58 A.M., showed the temperature of
the boilers, was set between 121- 122 ºF.
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 23)
Record review of the most recent hot water temperature records dated 6/17/19, showed no
recorded temperatures were above 125 ºF.
During interviews on 6/25/19 at 8:31 A.M., Plumbers A and B, said:
– There was a calcium and lime (a hard, off-white, chalky deposit often found in kettles
and hot water boilers) buildup on the mixing valve.
– There was calcium buildup on both mixing valves (a device designed to blend hot water
with cold water to ensure a constant, safe outlet temperature, utilized in residential,
commercial, and institutional applications where controlling water temperature is critical
to avoid scalding).
-There was a storage tank that serves the domestic side.
– There were two boiler on the 4th floor that stored the water which served both resident
occupied floors.
– The thermostatic mixing valve was corroded and calcified, and
-They (Plumbers A and B) said they were installing a new one.
Observation with Plumbers A and B on 6/25/19 at 8:40 A.M., showed the 2nd thermostatic
mixing valve which operates on lower usage demand, was also calcified.
During interviews on 6/626/19 at 8:29 A.M. with Plumber A said:
-The aquastats (a device used in hydronic heating systems for controlling water
temperatures) were set too high at 140 ºF, and the setting should be closer to about 120
and
-He/she changed the setting, and he/she did not know if the gauges were as accurate as
they should be.
During an interview on 6/26/19 at 9:18 A.M., the Heat Ventilation Air Conditioning (HVAC)
Technician from the local mechanical services company said:
– At the time he/she saw the aquastats, he/she said they were set to where they need to
be.
-Three of the gauges have not worked accurately for years and
– When there was a change in the temperature settings on the aquastats, then the water
temperature for the facility, will be set.
**Note: All but three residents were able to temper water temperatures on their own, the
three residents needing assistance were completely dependent and received cares from
facility staff that would temper water temperatures for them.
Record review of the facility’s policy entitled Smoking, Alcohol and Illegal Drugs Policy
and dated 5/11/18, showed:
– Consumption of tobacco Products including but not limited to cigarettes, cigars, and
chewing tobacco, shall be restricted and controlled, in order to maintain a safe and
healthy environment for the residents and employees of the facility.
– The facility takes a hard stance against smoking in restricted areas.
– The only designated area in which smoking is permitted on the campus of the facility, is
the Incani Patio during designated times in which the patio is open.
– Smoking by residents employees or visitors in any other than the designated area of the
Incani Patio, will be subject to disciplinary action.
– Residents will face the following progressive disciplinary action:
– For the First offense, a 30 day discharge notice will be given to the residents.
– Arrangements will be made to find another facility that allows smoking.
– The 30-day discharge can be rescinded if a change in behavior is noted and agreed upon
by the resident and a responsible party.
– For the 2nd offense, an immediate Emergency Discharge.
– In the event, a second offense is noted an immediate emergency discharge will be given,
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 24)
utilizing that the resident has shown themselves to be a danger to themselves or others or
has endangered the health of others, meaning the residents is no longer a resident of the
facility, Appropriate law enforcement will be called to remove resident(s) from the
facility.
– Appropriate family and /or responsible parties will be notified in the event, this
occurs.
– Employees in violation of the policy will be subject to corrective and/or disciplinary
action, and
– Visitors in violation of the policy will be asked to refrain from violation or face
possible revocation of visitor privileges.
3. Record review of Resident #56’s Admission Face Sheet showed he/she was admitted to the
facility on [DATE] with following [DIAGNOSES REDACTED].>-[MEDICAL CONDITION] (A chronic
and severe mental disorder that affects how a person thinks, feels, and behaves).
-[MEDICAL CONDITION] ([MEDICAL CONDITION] disorder).
-[MEDICAL CONDITION] ([MEDICAL CONDITION] is a chronic [MEDICAL CONDITION] lung disease
that causes obstructed airflow).
-Under smoking status unknown if ever smoked and
-The report was ran on 5/13/19.
Record review of the resident’s Smoking Care Plan dated 1/14/19 reviewed 2/19/19 showed:
– He/she at risk of harm due to smoking.
– The goal was for the resident will only smoke in the designated smoking area.
– The approach intervention showed:
– The resident was to have a smoke detector in his/her room.
– The facility staff was to write a Smoking Concern Form if resident’s was found smoking
in his/her room.
– The resident was to be supervised while smoking for safety.
– The facility staff was to monitor for the resident smoking in his/her room and in
his/her bathroom.
– The resident was to be instructed on and monitored that he/she smokes in designed
smoking area under supervision, and
– Was to be monitored for his/her safety while smoking, not to hold cigarette too close to
himself/herself, too close to other resident’s or objects.
Record review of the resident’s Annual MDS dated [DATE] showed he/she:
– Was able to understand others and he/she was able to express ideas and wants.
– Requires supervision and oversight with bathing.
– Has a difficulty focusing attention, or difficulty tracking what has been said and
– Used tobacco daily.
Record review of the resident’s MDS care plan meeting dated 5/9/19 at 10:00 A.M. showed
the facility staff had concerns that the resident needed to have counseling on smoking in
his/her room.
Record review of the resident’s Social Service Note dated 6/17/19 at 2:59 P.M. showed:
– The facility Administrator met with the resident’s Public Administrator (PA) office
staff regarding the resident’s smoking behavior.
– The facility staff had to constantly redirect the resident for smoking in his/her room.
– The facility had given the resident a warning about smoking noncompliance and if he/she
had more smoking safety issue, it may lead to discharge from the facility to a more
restrictive facility.
– The resident’s PA and Administrator had agreed to give the resident more freedom in
hopes that it might settle him/her down.
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 25)
– The resident’s PA said the resident was allowed to walk to the store once a day and can
only be gone for 45 minutes at a time.
– The resident must sign out and sign back into the facility.
-The resident’s PA wants to be informed if the resident not following rules.
-If the resident did not follow rules the plan was to restrict him/her again, and
-The resident’s PA said the resident had come from a Residential Care Facility (RCF) and
had no behavioral issues in the community.
Record review of copy of the resident’s Safety Smoking Assessment from the thinned medical
record showed:
-The assessment was completed upon admission to the facility on [DATE].
-The resident was able to smoke unsupervised at that time and
-Did not have a current safety smoking assessment review date for the resident on the
form.
Observation on 6/25/19 at 12:19 P.M., showed the presence and odor of smoke in the
resident’s room.
During an interview on 6/25/19 at 12:21 P.M., the resident said:
-The cigarette was pretty good.
-Yes, he/she smoked in his/her room that day and
-The resident understood that he/she could had set a fire in his/her room.
Observation on 6/27/19 at 6:40 A.M., showed the resident:
-He/she was outside in the smoking area without supervision of staff.
-Three other residents were also in the smoking area smoking and
-The resident was holding a lit cigarette.
Observation on 6/28/19 at 10:00 A.M. of the resident’s room showed he/she shared bathroom
with other resident’s and bathroom had a smoke detector.
During an interview on 6/28/19 at 2:44 P.M., the DON said:
-The facility smoking policy has a concern form that will be completed if residents have
unhealthy smoking behaviors. -If smoking risk issues continues the resident will get a 30
day discharge notice.
– The resident has been given a discharge notice due to smoking in his/her room and he/she
is to be monitored by staff and
-The resident’s Public Administrator (PA) is working on finding new placement.
4. Record review of Resident #58’s quarterly MDS, dated [DATE], showed:
– The resident was usually able to make himself/herself understood and
– The resident usually understood others, with clear comprehension, and
– The resident had a Brief Interview for Mental Status (BIMS) score of 12 ( cognitively
intact).
Record review of the resident’s Care Plan initially dated 5/11/18, and reviewed on
10/18/19, 1/23/19 and 4/30/19, showed:
-Problem: The resident was a smoker.
– Goals: the resident will be safe while smoking in designated smoking areas, and
-Approaches which included showing the resident where the smoking patio was located, the
resident is able to go back and forth to the smoking area unassisted. The resident was not
to take oxygen to the smoking patio and to not smoke in his/her room. If found, the
resident will receive a 30 day notice.
Record review of the resident’s POS, dated 5/20/19 through 6/19/19, showed:
-[DIAGNOSES REDACTED].
-an order for [REDACTED].
Record review of the resident’s Safe Smoking Assessment Form, dated 10/1/18 and 1/23/19,
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 26)
showed:
The resident knew designated areas for smoking.
-The resident can light smoking materials independently when observed.
-The resident can extinguish smoking materials completely in an appropriate receptacle.
– The resident did not require supervision while smoking.
-All smoking materials will be kept at the nurse’s station.
– The resident was notified of restrictions.
-The resident’s family was notified of restrictions, and
– A smoking care plan is in place.
Observation on 6/25/19 at 12:21 P.M., showed the presence of ashes on the floor and the
presence of a cigarette butt in the restroom in Resident #58’s room.
During an interview on 6/28/19 at 11:36 A.M., Certified Medication Technicians (CMT) A and
B said:
– Resident #58 resides with another resident (Resident #20) in the same room.
– Both residents have been caught smoking their rooms.
– Both residents have cigarette/smoking materials in their rooms.
– Since 4/19, CMT A has smelled cigarette smoke or saw ashes in the resident’s room, and
-Resident #20 sometimes used oxygen and he/she has seen evidence of smoking by that
resident in the room.
During an interview on 6/28/19 at 12:27 P.M., the resident said
– He/she has been at the facility for 4-5 months.
– He/she has smoked in his/her room once before.
– He/she kept oxygen in his/her room.
– One of the nursing staff caught him/her smoking in his/her room, and
– They told him/her not to do it again.
Record review of the resident’s medical record showed no charting about smoking in his/her
room.
Observation on 6/28/19 at 1:33 P.M., showed the presence of an oxygen concentrator with 5
packs of cigarettes in the drawer in the resident’s room.
5. Record review of Resident #20’s quarterly MDS dated [DATE], showed:
– The resident was able to make himself/herself understood.
– The resident understood others, with clear comprehension, and
– The resident had a BIMS score of 9. (moderately cognitively impairment)
Record review of the resident’s Safe Smoking Assessment Form, dated 5/2/18, 7/1/18,
1/3/19, 3/28/19, and 6/12/19, showed:
– The resident knew designated areas for smoking.
– The resident can light smoking materials independently when observed.
– The resident can extinguish smoking materials completely in an appropriate receptacle.
– The resident did not require supervision while smoking.
– All smoking materials will be kept at the nurse’s station.
– The resident was notified of restrictions.
– The resident’s family was notified of restrictions, and
– A smoking care plan is in place.
Record review of the nurse’s notes dated 6/11/19 showed:
– The RN walked into the resident’s room and observed the resident in the bathroom smoking
a cigarette.
– The RN counseled the resident behavior was not acceptable.
– The resident put the cigarette out in the toilet and
-The RN confiscated the resident’s remaining cigarettes and lighters, 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 27)
-Both the cigarettes and both lighters were stored in the medication room.
Further record review showed the 6/11/19 incident was not documented in the section of the
Resident’s smoking assessment, which asked if the resident had any past
accidents/incidents with smoking materials, even though the assessment form was updated on
6/12/19.
During an interview on 6/28/19 at 11:36 A.M., CMTs A and B said:
– Resident #20 resides with another resident who smokes, in the same room.
– Both residents have been caught smoking their rooms.
– Both residents have cigarette/smoking materials in their rooms.
– Since 4/19, CMT A has smelled cigarette smoke or saw ashes in the resident’s room, and
– Resident #20 sometimes used oxygen and he/she has seen evidence of smoking by that
resident in the room.
During an interview on 6/28/19 at 1:35 P.M., the resident said:
– He/she has not been caught smoking in the room.
– He/she kept smoking supplies outside (Observation showed a lighter and 3 cigarette packs
in his/her drawer) and
– He/she did not remember the incident in regards to smoking (record review of the medical
record showed the resident was caught smoking on 6/11/19).
Observation on 6/28/19 at 1:37 P.M., showed the presence of a lighter and 3 packs of
cigarettes on the resident’s side of the room.
During an interview on 6/28/19 at 3:44 P.M., the DON said:
-If residents do not abide by the smoking policy, they get a 30 day notice.
– Resident #20 got a verbal warning.
– He/she had not been told about the resident smoking in the rooms and
-He/she has not spoken with Resident #20 and was not aware that Resident #58 smoked in
his/her room.
6. Record review of Resident #24’s Face Sheet showed he/she was admitted to the facility
originally on 3/13/13 with current admission date of [DATE], with the following [DIAGNOSES
REDACTED].>-Dementia.
-[MEDICAL CONDITION] and
-Smoker.
Record review of residents Quarterly MDS dated [DATE] showed:
-Was alert.
-Ability to make needs known.
-Current smoking use not marked and
-Requires assistance from staff for eating with set up, dressing, bathing and transfers.
Observation on 6/24/19 at 10:06 A.M., showed a cigarette butt was seen in resident trash
can next to resident bed.
During interview on 6/24/19 at 10:15 A.M., the resident said:
-Was a smoker for years.
-Goes outside to smoke.
-Occasionally will smoke in room.
-Resident did not remember when the cigarette butt was put in trash can and
-Resident does wear a smoking apron when smoking outside.
7. Record review of Resident #12 Admission Face Sheet showed he/she was admitted to the
facility on [DATE], and he/she had a [DIAGNOSES REDACTED].
Record review of the resident’s Quarterly MDS dated [DATE] showed;
-Was able to understand others and he/she was able to express ideas and wants.
-No documentation showing if the resident used tobacco 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0689

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 28)
-He/she was independent with cares and transfer.
Record review of the resident’s Smoking Care Plan reviewed on 6/13/19 showed:
-Facility staff are to ensure the resident smokes in designed smoking areas under
supervision of staff.
-He/she was to be monitored by staff to ensure the resident does not fall asleep while
smoking and
-Post smoking rules and safety and not to lit other resident’s cigarettes.
Record review of the resident’s Safety Smoking Assessment Form dated reviewed 6/12/19
showed the resident’s:
-Smoking materials was to be kept at the nurse’s station and
-Was able to smoke unsupervised and he/she smokes cigarettes.
Review of the resident’s MDS progress note dated 6/13/19 12:13 P.M. showed the resident
smokes cigarettes daily.
Observation on 6/24/19 in the afternoon showed the resident using his/her rolling walker
around the facility and was outside smoking during the 2:00 P.M. smoke break.
Observation on 6/25/19 at 10:21 A.M. showed the resident:
-Was using his/her rolling walker in the hallways.
-Wheeled himself/herself to the smoking area and around the facility and
-Was smoking in smoke area and he/she did not have supervision while smoking.
During the environmental tour on 6/25/19 at 11:00 A.M., of resident’s room showed:
-Cigarette butts were found in the resident’s trash can, and
-The both resident’s in who reside in the room do smoke cigarettes.
During an interview on 6/26/19 at 9:00 A.M., the resident

F 0692

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Provide enough food/fluids to maintain a resident’s health.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to notify the
resident’s physician and Registered Dietician (RD) in a timely manner when one sampled
resident (Resident #3) had significant weight loss over 30 days and to adequately monitor
and document the resident’s intake and nutritional interventions to try to prevent
continued weight loss 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 on [DATE], with
[DIAGNOSES REDACTED].
Record review of the resident’s Physician’s Telephone Order dated 10/25/18, showed
physician’s orders [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.
-Mobilized in a wheelchair and did not walk.
-Had upper range of motion limitations on one side and lower range of motion limitations
on both sides.
-Was at risk for skin breakdown, but did not have any wounds during the look back period.
-Had moisture associated skin damage and received application of ointments.
-Needed limited assistance with eating and received a mechanical diet (ground meat or
pureed).

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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0692

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 29)
-Did not have any swallowing problems and there were no issues with his/her teeth or
chewing identified and
-Did not have any significant weight loss during the look back period.
Record review of the resident’s Weight Record showed the resident’s monthly weights were:
-March 2019=104.2 pounds (lbs).
-April 2019=111 lbs.
-May 2019=104 lbs.
-June 2019=96.8 lbs.
-The resident’s documented weights showed a significant weight loss of 7.69% in 30 days,
(May to June), and a 13.5% weight loss in 3 months and
The resident’s weight record did not show the resident was placed on weekly weights at any
time during this period.
Record review of the resident’s Physician order [REDACTED].>-Mechanical soft diet with
fortified foods and
-Health shake supplement (very high protein) three times daily and at bedtime for weight
loss.
Record review of the resident’s Nutrition Note dated 3/21/19, showed the resident was
feeding himself/herself in the dining room and received a mechanically altered diet of
both pureed and mechanical soft foods. He/she documented the resident also received
vitamin C and a high protein health shake supplement three times daily and at bedtime for
skin integrity support and nutrition management. The RD documented the resident also
received medication for agitation and has had no significant changes. He/she documented
the resident’s ideal body weight (IBW) was 104 lbs. and the resident’s weight had
increased favorably. The RD documented he/she had no recommendations at the time and would
continue the resident’s current plan of care and monitor his/her nutritional status.
Record review of the resident’s Physician’s Notes dated 3/26/19, showed the resident’s
physician saw the resident in his/her room. The physician documented the resident’s
behaviors were as usual. He/she noted the resident was hospitalized in (MONTH) (YEAR) and
had been on Hospice (end of live care) services that were discontinued due to no continued
decline. The physician documented he/she completed a physical exam of the resident,
reviewed his/her medical record and labs. He/she reviewed the resident’s plan of care and
treatment and showed no changes in his/her medication orders. The documentation did not
show any nutritional or weight loss concerns.
Record review of the resident’s POS dated 4/20/19 to 5/19/19 showed physician’s orders
[REDACTED].>-Mechanical soft diet with fortified foods and
-Health shake supplement (very high protein) three times daily and at bedtime for weight
loss.
Record review of the resident’s Meal Intake records from (MONTH) 2019 to (MONTH) 2019,
showed the resident ate between zero and 100% at meals. The resident did not have a
pattern of eating more or less at any particular meal. The Meal Intake records also showed
some of the resident’s meal intake was not documented (left blank) and was not
consistently documented at every meal. There was no documentation showing the resident
received his/her health shakes or that/when he/she refused them. There was no
documentation showing the amount of supplements he/she consumed (if they were not
refused). There was no documentation showing if the resident received snacks or the type
and percentage of snacks that he/she consumed.
Record review of the resident’s Medication Administration Records (MAR) from (MONTH) 2019
to (MONTH) 2019, showed there was no documentation showing the resident received
nutritional supplements during his/her medication pass.
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0692

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 30)
Record review of the resident’s Nursing Notes from 4/1/19 to 6/13/19, the nursing staff
did not document any notes regarding the resident’s weight loss, how they were monitoring
the resident for continued loss, and nutritional interventions for preventing continued
weight loss. There were no notes showing nursing staff was consulting with the RD or the
resident’s physician about the resident’s weight loss. Documentation showed:
-From 4/1/19 to 4/30/19 the nursing staff did not document any information about the
resident’s dining or behaviors during dining that would affect the resident’s ability to
eat or chewing/swallowing problems. Documentation showed the resident was being treated
for [REDACTED]. Documentation also showed the resident had agitation and behaviors of
yelling and cussing while self-propelling around the unit.
-On 5/5/19 the resident was in the dining room at breakfast pushing trays off of the table
and bumping into other residents and tables, nursing staff redirected the resident and the
resident was given medication to manage his/her agitation. At 3:00 P.M., the nurse
documented during lunch, the resident was eating and left his/her plate to begin eating
from another resident’s plate. Nursing staff re-directed the resident and removed him/her
from the dining room. The resident grabbed a juice from the table and threw it. At 7:30
P.M., nursing staff documented the resident was in the dining room for dinner and as
he/she was going past the beverage and dessert trays, he/she began throwing ice cream and
juice. Staff removed the resident from the dining room and gave the resident medication
for increased agitation and
-On 5/29/19 the resident’s physician visited the resident and ordered additional
medication to assist with managing the resident’s agitation. There was no documentation
showing the nursing staff notified the resident’s physician of the resident’s significant
weight loss, continued weight loss or need for additional interventions to assist with the
resident’s appetite or eating status.
Record review of the resident’s POS dated 5/20/19 to 6/19/19 showed physician’s orders
[REDACTED].>-Mechanical soft diet with fortified foods and
-Health shake supplement (very high protein) three times daily and at bedtime for weight
loss (discontinued 6/13/19).
Record review of the resident’s Care Plan updated on 6/5/19, showed the resident had
behaviors related to dementia that included refusal of meals and personal cares, and was
at risk for decreased nutritional status due to a history of dysphagia. Risk factors
included dementia, agitation, and depression. The resident’s goal was to consume at least
75% of his/her meals and have a stable weight over 90 days. Interventions showed staff was
to:
-Honor the resident’s food preferences.
-Provide a mechanical soft diet/or as ordered with fortified foods.
-Liberalize his/her diet as necessary to benefit the resident.
-Supervise the resident at meals.
-Monitor the resident’s weight monthly and encourage fluids.
-Check the resident’s blood sugar levels per physician orders [REDACTED].
-Provide nutritional supplement four times daily for weight management.
-Give the resident a sandwich so he/she can roll around and eat.
-Praise him/her when he/she eats all of his/her meal and tell him/her it will keep his/her
strength up and
-Offer food from the alternate menu to increase his/her food consumption and offer
encouragement and support.
Record review of the resident’s Nutrition Note dated 6/13/19, showed the RD documented:
-The resident had significant weight loss involuntarily due to decreased appetite,
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0692

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 31)
refusing nutritional supplements, and an increase in agitation.
-The resident’s physician was aware of the resident’s nutritional status, behaviors and
the resident had medications in place to address the resident’s (behaviors).
-Continue with the resident’s current diet as appropriate.
-Shakes (nutritional supplement) were offered but the resident refused during this visit.
-Continue to encourage fluids and snacks, continue current plan of care.
-The resident’s labs were reviewed and there were no concerns noted and
-Recommendation was to start protein snacks twice daily in-between meals, discontinue
vitamin C and discontinue health shake supplements three times daily and at bedtime.
Record review of the resident’s Physician’s Telephone Order dated 6/13/19, showed a
physician’s orders [REDACTED].>-Start protein snacks twice daily in-between meals and
-Discontinue vitamin C and health shakes three times daily and at bedtime due to refusal.
Record review of the resident’s Physician’s Note dated 6/14/19, showed the physician was
unable to complete a physical assessment of the resident and noted the resident was
sitting up in his/her wheelchair and had been having behaviors of cussing, yelling and
self propelling around the facility. The physician documented he/she reviewed the
resident’s medical chart, [DIAGNOSES REDACTED].
Observation on 6/26/19 at 12:47 P.M., showed the resident was sitting in his/her
wheelchair in the dining room. He/she was dressed for the weather without odors. He/she
was quiet and did not have any agitation or aggressive behaviors. Nursing staff served the
resident a pureed (the food consistency is like pudding or mashed potatoes) diet of mashed
potatoes, carrots, bread and roast beef with apple sauce and a mighty shake, water and
orange drink. Nursing staff was feeding the resident. The resident would look up from time
to time and take bites of food and drink. He/she did not attempt to feed himself/herself
but he/she ate all of his/her food. When he/she did not want anymore (during the meal
time) he/she would say no and turn his/her head away. Nursing staff would then offer the
resident a drink or wait until the resident was ready to resume eating.
During an interview on 6/26/19 at 1:22 P.M., Certified Nursing Assistant (CNA) C said:
-The resident usually eats well even though he/she can sometimes be combative and yell
out.
-When they feed the resident he/she usually ate most of his/her meal.
-The resident had a bath today and that may have made him/her feel better (before the meal
time).
-The resident ate 100% and drank his/her beverages as long as staff gave them to him/her
and
-He/she was not aware the resident had weight loss.
During an interview on 6/28/19 at 12:14 P.M., Registered Nurse (RN) A said:
-They have care plan Medicare meetings every Thursday where they discuss those resident
who have upcoming care plans, but they can discuss other residents as needed.
-They don’t have a risk meeting to discuss those residents who were at risk for weight
loss (or who had significant weight loss).
-They discussed those resident’s with weight loss concerns as needed or when concerns
arise.
-They have discussed the resident’s weight loss several times and they have tried health
shakes, fortified foods, health supplement pudding cups, and the resident was refusing
them, so those interventions were discontinued.
-They resumed giving the resident health shakes to see if they can get him/her to drink
it.
-The resident was able to feed himself/herself, but when he/she was calm, 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0692

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 32)
would not feed himself/herself and staff would have to feed him/her.
-When the resident was agitated and having behaviors, he/she will feed himself/herself,
and will hold food in his/her mouth.
-They tried giving the resident pureed diet due to him/her holding food in his/her mouth
and found that the resident ate the pureed food much better.
-The resident’s eating varies vastly depending on the behavior of the resident.
-The resident was on Hospice once before but they discontinued services because the
resident did not continue to decline.
-The resident was not currently on hospice.
-Nursing staff has referred the resident to the RD for weight loss and the RD has looked
at the resident’s health status and made recommendations for the resident that they have
implemented.
-The RD comes every week to the facility, but does not see every resident every time
he/she comes in unless the nursing staff let him/her know that there is a concern that
he/she needs to follow up on.
-If there is a resident who has had weight loss the nursing staff can notify the
resident’s physician and RD immediately.
-Nursing staff should document the resident’s meal intake at every meal so they can see
how much the resident is eating and determine how he/she is eating over time, what meal
he/she is eating the most of and they would also need to see if the resident refused a
meal.
-He/She would expect the RD to document that he/she assessed the resident’s nutritional
status after being informed that the resident was not eating or had continual weight loss,
and determine interventions that would assist in maintaining or improving the resident’s
nutritional status.
-The nursing staff should also notify the resident’s physician and he/she would expect the
physician and RD to be notified when the resident loses 5 pounds in a week.
-The resident was not on weekly weights, so for this resident it would be 5 pounds in a
month’s time.
-He/She did not know why the resident has not been on weekly weights.
-The MDS Coordinator and the Director of Nursing (DON) usually monitor the resident
weights and if they notice a discrepancy they will have nursing staff re-weigh the
resident and
-The RD will make nutritional recommendations and the Physician will write orders for
implementation of weight loss interventions for residents that they see or are notified
about.
During an interview on 6/28/19 at 2:54 P.M., the DON said:
-When a resident is at risk for weight loss, a dietary consult should be done and any
recommendations should be followed.
-If the resident continues to lose weight, or has a significant weight loss, the
expectation is to continue to encourage eating, obtain a psychiatric consult (if needed),
notify the physician for orders for an appetite stimulant, review the resident’s food
preferences and provide more foods the resident will eat, notify families to see if they
can bring in food the resident enjoys, provide supplements and fortified foods, weigh the
resident more frequently-they can implement this whenever they notice a drop in weight or
if they continue to lose weight.
-They review most of the resident weights monthly, but they have weekly weight reviews on
some residents who have weight loss, are refusing to eat or don’t eat very well. These
residents are usually recommended for more frequent weights by the physician 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0692

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 33)
Registered Dietician.
-They would consult the Registered Dietician for a nutritional review as soon as they are
aware that there is a resident with weight loss.
-If a resident loses 5 pounds (lbs.) in a month, they begin implementing weight loss
interventions.
-Meal intake percentages are to be documented on everyone daily at each meal.
-The nurse should be reviewing the meal intake documentation to ensure its being
documented daily.
-The nutritional supplements should be documented on the MAR and given out by whomever is
completing the medication pass. They should document how much the resident drank.
-The RD is at the facility weekly and is supposed to see those residents with significant
weight loss and those at nutritional risk at every visit.
-They have quarterly reviews on those residents who are not as at risk for weight loss.
-All of the nutritional interventions should be on the resident’s comprehensive care plan
and updated as the resident’s condition or interventions change.
-The Interdisciplinary team reviews resident weights monthly and they discuss
interventions that are working, not working and recommendations for further interventions.
The meeting notes should be documented in the resident’s medical record when they are
discussing the resident’s weights.

F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Past noncompliance – remedy proposed

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure the
resident’s physician’s order Sheet (POS) showed where the resident attended [MEDICAL
TREATMENT] treatments, how nursing staff was to monitor and care for the resident’s
[MEDICAL TREATMENT] catheter (a flexible tube inserted through a narrow opening into the
vein for [MEDICAL TREATMENT] treatment); to document that they were checking the
resident’s [MEDICAL TREATMENT] site on every shift, and to include clarification of the
location of the [MEDICAL TREATMENT] site and treatment and monitoring orders on the
resident’s care plans for two sampled residents (Resident #83 and #34) who received
[MEDICAL TREATMENT] (the clinical purification of blood by [MEDICAL TREATMENT], as a
substitute for the normal function of the kidney), out of 29 sampled residents. The
facility census was 86 residents.
1. Record review of Resident 34’s Face Sheet showed he/she was admitted to the facility on
[DATE], with [DIAGNOSES REDACTED].
Record review of the resident’s Physician’s Telephone Order showed on 4/10/19 to monitor
the resident’s [MEDICAL TREATMENT] catheter to right thigh every shift for end stage
[MEDICAL CONDITION]. Change the dressing as needed. Use clear tape to right thigh [MEDICAL
TREATMENT] site.
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 4/18/19, showed the resident:
-Was alert and oriented with no memory loss.
-Needed no assistance with bed mobility, transfers and grooming.
-Needed limited assistance of one person with bathing, dressing.
-Had limited range of motion on one side of his/her lower extremity and mobilized in a

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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 34)
wheelchair and
-Needed supervision and set up for eating.
Record review of the resident’s Care Plan updated on 4/25/19, showed he/she had end stage
[MEDICAL CONDITION] and received [MEDICAL TREATMENT] three times weekly. The interventions
showed staff would:
-Ensure the resident was ready for [MEDICAL TREATMENT] on Tuesday/Thursday and Saturday
and make sure he/she was in the lobby by 6:00 A.M. for transportation to pick him/her up.
-Use a stethoscope to listen for thrill (the vibration felt as blood is flowing at the
site) and bruit (the sound of blood flowing at the site) at the resident’s [MEDICAL
TREATMENT] site and record the results.
-Notify the resident’s physician and [MEDICAL TREATMENT] center if the results of the
thrill and bruit were not positive.
-Ensure the resident’s labs were drawn as ordered and abnormal labs would be reported to
the resident’s physician.
-Provide nutritional supplements and fortified foods per physician’s order.
-Monitor and maintain the resident’s fluid restriction at 2000 calories (daily weight) and
notify the physician of any 2-3 pound weight gain daily and
-The care plan did not identify how the facility staff cared for the resident’s [MEDICAL
TREATMENT] catheter site.
Record review of the resident’s POS dated 4/20/19 to 5/19/19, and 5/20/19 to 6/19/19
showed the following physician’s orders:
-Diabetic Renal Diet-2 grams, low sodium.
-[MEDICAL TREATMENT] treatments three times weekly on Tues/Thurs/Sat.
-Monitor [MEDICAL TREATMENT] catheter to right thigh every shift for end stage [MEDICAL
CONDITION]. Change the dressing as needed. Use clear tape to right thigh [MEDICAL
TREATMENT] site. The original order was dated 4/10/19 and
-The physician’s orders did not show where the resident received [MEDICAL TREATMENT]
treatments, how the facility staff was to monitor the resident’s [MEDICAL TREATMENT] site,
frequency of monitoring, treatment orders for changing the resident’s dressing (how to
clean the site and surrounding skin etc), the extent of care the facility was to provide
for the resident’s [MEDICAL TREATMENT] site.
Record review of the resident’s Treatment Administration Record (TAR) showed a physician’s
order to monitor the resident’s [MEDICAL TREATMENT] catheter to his/her right thigh every
shift and to change the dressing as needed. Use clear tape to right thigh [MEDICAL
TREATMENT] site for end stage [MEDICAL CONDITION]. Documentation showed:
-4/20/19 to 5/19/19 showed the nursing staff showed inconsistent documentation that they
checked the resident’s [MEDICAL TREATMENT] site on every shift and
-5/20/19 to 6/19/19 showed documentation was inconsistent and nursing staff did not always
initial that they were monitoring the resident’s [MEDICAL TREATMENT] site on every shift.
Record review of the resident’s Physician’s Outside Clinician Visit ([MEDICAL TREATMENT])
review dated 5/1/19 to 6/28/19 showed:
-The name, location and contact information of the resident’s [MEDICAL TREATMENT]
treatment center.
-The resident had his/her [MEDICAL TREATMENT] catheter placed (on his/her thigh) on
5/11/19, with no adverse reaction. Documentation showed the resident had no concerns noted
regarding [MEDICAL TREATMENT] treatment or related cares.
-There was a communication sheet for each [MEDICAL TREATMENT] visit that the facility
documented on to inform the [MEDICAL TREATMENT] center of any concerns or information
about the resident that day to include labs, medication changes, pain, or any additional
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 35)
health concerns that the center should be aware of.
-Documentation also showed the [MEDICAL TREATMENT] clinic was communicating at each
appointment any issues at the [MEDICAL TREATMENT] center regarding pain, wound
treatment/care weight loss/gain, any labs completed, pre and post [MEDICAL TREATMENT]
weight and
-Notes from 5/1/19 to 6/13/19, showed the communication to and from [MEDICAL TREATMENT]
between the facility and [MEDICAL TREATMENT] center was completed and ongoing regarding
weight gain/loss, treatments, medications, and any changes in the resident’s [MEDICAL
TREATMENT] care. The resident had no adverse reactions or problems with his/her catheter
site or treatment and his/her weight and nutrition remained stable during the review
period.
Record review of the resident’s Physician’s Order Sheet dated 6/20/19 to 7/19/19, showed
physician’s orders for:
-Diabetic Renal Diet-2 grams, low sodium.
-[MEDICAL TREATMENT] treatments three times weekly on Tues/Thurs/Sat.
-Monitor [MEDICAL TREATMENT] catheter (a flexible tube inserted through a narrow opening
into the vein for [MEDICAL TREATMENT] treatment) to right thigh every shift for end stage
[MEDICAL CONDITION]. Change the dressing as needed. Use clear tape to right thigh [MEDICAL
TREATMENT] site. The original order was dated 4/10/19 and
-The physician’s orders did not show where the resident received [MEDICAL TREATMENT]
treatments, how the facility staff was to monitor the resident’s [MEDICAL TREATMENT] site,
frequency of monitoring, treatment orders for changing the resident’s dressing (how to
clean the site and surrounding skin etc), the extent of care the facility was to provide
for the resident’s [MEDICAL TREATMENT] site.
Record review of the resident’s TAR dated 6/20/19 to 7/19/19, showed a physician’s order
to monitor the resident’s [MEDICAL TREATMENT] catheter to his/her right thigh every shift
and to change the dressing as needed. Use clear tape to right thigh [MEDICAL TREATMENT]
site for end stage [MEDICAL CONDITION]. Documentation showed nursing staff was documenting
that they checked the resident’s site per physician’s orders.
Record review of the resident’s Care Plan did not show an update that showed the
resident’s [MEDICAL TREATMENT] site had changed and that the resident has a [MEDICAL
TREATMENT] catheter placed in his/her right thigh. There was no update to show how nursing
staff was to care for and monitor the resident’s [MEDICAL TREATMENT] catheter.
During an observation and interview on 6/26/19 at 1:45 P.M., showed the resident was
sitting in his/her wheelchair in his/her room watching television. He/she was dressed for
the weather and had an above the knee amputation to his right leg (placement of his/her
[MEDICAL TREATMENT] catheter). The resident said:
-He/she went to the [MEDICAL TREATMENT] center three days weekly on Tues./Thurs./Sat., and
so far everything had been going very well.
-His/Her [MEDICAL TREATMENT] catheter was placed in his/her thigh after it was removed
from his arm-he/she said periodically after he/she dialyzed for a while in the same
location, the vein will collapse and they have to place it somewhere else (which was why
it is now in his/her thigh).
-He/She has been on [MEDICAL TREATMENT] for years and does not allow anyone to touch his
[MEDICAL TREATMENT] site except the staff at the [MEDICAL TREATMENT] center.
-The nursing staff at the facility were not [MEDICAL TREATMENT] professionals and he/she
did not let them do anything but look at the site.
-The nursing staff at the [MEDICAL TREATMENT] center put clear tape over the catheter
site, so the facility staff could look to see that the site looked okay and was not
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 36)
clogged or infected and
-If there was an issue with the site he/she would notify the nurses so they could call the
[MEDICAL TREATMENT] center.
2. Record review of Resident #83’s Face Sheet showed he/she was admitted to the facility
on [DATE], with [DIAGNOSES REDACTED].
Record review of the resident’s Physician’s Telephone Order dated 4/11/19, showed a
physician’s order to monitor the resident’s right [MEDICATION NAME] (an artery or vein in
the neck and arm on the left or right side of the body) [MEDICAL TREATMENT] catheter every
shift for signs and symptoms of infection.
Record review of the resident’s POS dated 4/15/19, showed physician’s orders for:
-[MEDICAL TREATMENT] Monday, Wednesday and Friday.
-Monitor the resident’s right [MEDICATION NAME] (an artery or vein in the neck and arm on
the left or right side of the body) [MEDICAL TREATMENT] catheter every shift for signs and
symptoms of infection and
-The physician’s orders did not show where the resident received [MEDICAL TREATMENT]
treatments, clarification of how the facility staff was to monitor the resident’s [MEDICAL
TREATMENT] site, frequency of monitoring, treatment orders (how to clean the site and
surrounding skin, dressing changes if needed etc), or the extent of care the facility was
to provide for the resident’s [MEDICAL TREATMENT] site.
Record review of the resident’s admission MDS dated [DATE], showed the resident:
-Was alert and oriented and had no memory loss.
-Needed limited assistance with bathing, dressing, transfers, toileting and mobility and
-Mobilized in a wheelchair.
Record review of the resident’s TAR showed:
-A physician’s orders to to monitor the resident’s right [MEDICATION NAME] [MEDICAL
TREATMENT] catheter every shift for signs and symptoms of infection and
-The resident’s TARs 4/20/19 to 5/19/19 showed nursing documentation was not consistent
and monitoring was not done every shift as ordered.
Record review of the resident’s Care Plan dated 4/30/19 showed the resident had end stage
[MEDICAL CONDITION] and the resident received [MEDICAL TREATMENT] on Monday, Wednesday and
Friday. The interventions showed staff was to:
-Ensure the resident was ready for [MEDICAL TREATMENT] for an early morning pick up
between 5:50 A.M. to 6:00 A.M. pickup, returning from 10:30 A.M., to 11:00 A.M.
-Monitor the resident’s [MEDICAL TREATMENT] site on each shift and
-The care plan did not show where the resident’s [MEDICAL TREATMENT] site was located or
show clarification on how they were to monitor or care for the site.
Record review of the resident’s [MEDICAL TREATMENT] Communication Sheets from 4/2019 to
6/2019 showed the facility and [MEDICAL TREATMENT] center were communicating about the
resident’s [MEDICAL TREATMENT] treatments to include labs, treatment changes, medications
and nutritional status. The documentation showed the resident had not had any
complications or concerns with his/her treatments or nutrition.
Record review of the resident’s TAR showed:
-A physician’s orders to to monitor the resident’s right [MEDICATION NAME] [MEDICAL
TREATMENT] catheter every shift for signs and symptoms of infection.
-The resident’s TARs showed on 5/20/19 to 6/19/19 showed nursing documentation was not
consistent and monitoring was not done every shift as ordered.
Record review of the resident’s POS dated 6/20/19 to 7/19/19 showed physician’s orders
for:
-Renal Diet/diabetic diet.
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 37)
-[MEDICAL TREATMENT] on Mon./Wed./Fri.
-[MEDICATION NAME] Injection /milliliters (ml), inject 1 ml intravenously at noon on
Mon./Wed./Fri. (done at [MEDICAL TREATMENT]) and
-The physician’s orders did not show where the resident received [MEDICAL TREATMENT], how
the facility staff was supposed to monitor the resident’s [MEDICAL TREATMENT] site (or
location), and how the nursing staff was supposed to care for the site.
Observation and interview on 6/27/19 at 12:15 P.M., showed the resident was sitting in the
dining room on his/her walker seat. He/She was wearing glasses and agreed to interview at
this time. Observation of the resident’s [MEDICAL TREATMENT] catheter dressing showed the
catheter placement was in his/her upper right chest, above his/her breast area. The
dressing was dated 6/26/19 and it was clean with no indication of any concerns. The
resident said:
-He/she chose to come into the facility and was glad he/she did because he/she she could
do a lot for himself/herself, but staff provided assistance as needed and he/she was
satisfied with his/her care here.
-Regarding his/her [MEDICAL TREATMENT], he/she went to [MEDICAL TREATMENT] three days
weekly on Mon./Wed./Fri. and the staff at the [MEDICAL TREATMENT] center cared for his/her
[MEDICAL TREATMENT] shunt.
-He/She did not want the staff here to care for it and has told them that.
-If the shunt began to leak or if he/she had problems with it, he/she would let the nurse
know, but otherwise, he/she did not believe the nursing staff was qualified to do anything
with his/her shunt and he/she does not allow them to do anything to it.
-The staff at [MEDICAL TREATMENT] change the dressing and ensure the shunt is okay and the
blood is moving properly.
-At [MEDICAL TREATMENT] the medical staff were discussing moving the catheter to a
different location.
-He/She liked the food and his/her family will also bring food to him/her and
-He/she eats well and follows his/her renal diet.
During an interview on 6/28/19 at 11:18 A.M., Licensed Practical Nurse (LPN) C said:
-When monitoring the resident [MEDICAL TREATMENT] site, they check to see if the dressing
is clean, dry and intact without signs of infection.
-They check the thrill and bruit if there is an access site or follow the physician’s
orders.
-They usually check the [MEDICAL TREATMENT] site once on every shift and as needed and
document it in the nursing notes.
-He/she has not been documenting that he/she had checked the thrill and bruit, but he/she
had been documenting that the dressing is clean dry and with no signs of infection.
-They used to document this information on the resident’s TAR but he/she noticed that the
orders to check/monitor for signs and symptoms was not always documented on the TAR and
there was no documentation showing they should check the thrill and bruit.
-(After looking at the resident’s TARs) Staff had not been documenting that they are
checking the resident’s [MEDICAL TREATMENT] site consistently.
-The physician’s orders should be clarified to state exactly how they are to monitor both
resident’s [MEDICAL TREATMENT] site and whether they are to check the thrill and bruit or
if they are just to look for any changes.
-She said if the resident does not allow staff to check the site they should document it
and after three refusals, they should notify the physician and
-If they are not supposed to change the resident’s [MEDICAL TREATMENT] dressing or check
the site, it should be noted on the physician’s order.
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0698

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 38)
During an interview on 6/28/19 at 11:34 A.M., Registered Nurse (RN) A said:
-Usually the [MEDICAL TREATMENT] was on the resident’s arm and they would check the thrill
and bruit, but for both residents, they had catheter placements and they would not check
the thrill and bruit, but they would look at the catheter site to ensure there was no
bleeding.
-They monitor by looking at the skin around the site for signs and symptoms of infection.
-They should document in the nursing notes and on the TAR that they are monitoring the
[MEDICAL TREATMENT] catheter site and the documentation should be consistent and
-He/She will have the physician’s orders clarified to show where the residents attend
[MEDICAL TREATMENT], how they are to monitor the [MEDICAL TREATMENT] catheter site, when
to notify the physician and [MEDICAL TREATMENT] center, and the frequency of monitoring.
During an interview on 06/28/19 at 2:54 P.M., the Director of Nursing (DON) said:
-The physician’s order should show the frequency of the resident’s [MEDICAL TREATMENT]
treatments, where they receive [MEDICAL TREATMENT], how staff is to monitor the resident’s
[MEDICAL TREATMENT], to check for thrill and bruit (if needed), checking the site for
blood, swelling, and other signs of infection.
-If the resident has a [MEDICAL TREATMENT] catheter, the physician’s order should show the
nursing staff should check the site to ensure it is in place and secured (so it can’t be
dislodged), and to look for swelling, redness, and other signs and symptoms of infection
and to notify the physician.
-They should document that they are monitoring the [MEDICAL TREATMENT] site on the TAR and
-All of this information should also be in the resident’s care plan.

F 0803

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

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.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to follow the menu
by not providing pureed (food that was processed into a paste or thick liquid suspension
usually made from cooked food that was ground finely) coffee cake for six residents who
had physician’s orders [REDACTED].
1. Record review of the menu that was to be served on 6/27/19, showed residents were to
receive juice, choice of cereal, little smokies (small sausage links) (eggs were the
substituted that day), coffee cake, and milk.
Observation on 6/27/19 from 8:12 A.M. through 8:38 A.M., showed:
– Four residents in the 2nd floor south dining room who had pureed diets.
– Breakfast was served to all residents and all the residents with regular diets received
pieces of coffee cake.
– None of the resident with pureed diets, received pureed cake.
**Note: during the observations of the breakfast meal preparation, no coffee cake was
pureed.
– At 8:38 A.M., after the state surveyor asked Dietary Aide (DA) D about the pureed coffee
cake, Registered Nurse (RN) A said they usually get milk and pour milk over a cake, and
– At 8:41 A.M., DA D said the cake should have been pureed in advance.
During an interview on 6/28/19 at 7:39 A.M., the Dietary Manager (DM) said that he would
address that making of pureed coffee cake with the dietary staff to ensure they puree 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 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 – Some

(continued… from page 39)
desserts also.

F 0804

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

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

Based on observation, interview and record review, the facility failed to implement a
system with the Dietary Cooks (DCs) to taste the pureed (food that was processed into a
paste or thick liquid suspension usually made from cooked food that was ground finely)
foods (eggs) to find out if the pureed eggs were as palatable as the regular scrambled
eggs. This practice potentially affected six residents with pureed diets. The facility
census was 86 residents.
1. Record review of the facility’s recipe for 90 servings of regular eggs showed:
– 45 pasteurized shell eggs, 1 and 7/8 cup milk, ½ cup margarine, 2 quarts + 1 ¾ cup of
pasteurized liquid whole eggs.
– Combine liquid eggs, and milk with wire whip.
– Melt margarine and add egg mixture, cook while stirring occasionally, and
– Pour egg mixture into pans. Bake for 20 minutes at 350 degrees Fahrenheit (ºF ).
Record review of the facility’s recipe for six servings of scrambled eggs showed:
– Six servings of prepared scrambled eggs from the previous recipe.
– 6 ounces of milk, and
-1.5 tablespoons of food thickener.
Observations on 6/27/19 at 7:01 A.M., showed the flavor of the regular eggs were egg like.
Observations with DC A on 6/27/19 at 7:37 A.M., showed the pureed eggs had a bland taste.
After tasting both the regular and the pureed eggs, DC A said the regular eggs tasted like
eggs and the pureed eggs had a flavor of eggs. DC A also said the pureed eggs were made on
the previous day.
During an interview on 6/27/19 at 9:41 A.M., DC B said:
– He/she works about two days per week.
– They should puree the food the day they make it.
– He/she was trying to get ahead and making sure the morning person was not overwhelmed,
and
– He/she did not know if margarine was added to the eggs on the previous day.
During an interview on 6/28/19 at 7:40 A.M., the Dietary Manager said the following about
the pureed food:
– The cook and /or the DM should taste the pureed food.
– Sometimes placing thickener in the recipe, may take away from the flavor of the eggs.
– He/she will ensure the dietary staff taste the pureed food and
– Up until that time, he/she had not consulted with the Registered Dietitian (RD) on the
taste of the pureed foods.

F 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

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

Based on observation, interview and record review, the facility failed to maintain the fan
vent cover in walk-in refrigerator #1 free of a dust buildup; to maintain the floors of
walk-in refrigerators #1 and #2, free of food debris; to maintain the floor under the
convection oven free of grime and debris; to label a green covered container with the
substance that was actually inside the container; to maintain the upper nozzle of the
automated dishwasher free of debris; and to have a foot operated cover lifting system for
a trash container in the cooking area. This practice potentially affected at least 80
residents who ate food from the kitchen. The facility census was 86 residents.
1. Observations during the initial kitchen observation on 6/24/19 from 9:08 A.M. through
9:30 A.M., showed:
– A buildup of dust and grime on the fan vent covers of walk-in refrigerator#1 and a spill
of dairy product on the floor of the walk-in.
– Food debris (a potato) on the floor of Walk-in refrigerator #2.
-The presence of debris and grime under the double decker convection oven.
– A white powdery substance that was stored in green covered container, that was on the
seasoning/spice shelves, that was not labeled with what it was, and
– The presence of debris in the upper nozzle of dish washer.
2. Observations during the breakfast meal preparation on 6/27/19 from 5:36 A.M., through
7:15 A.M., showed the following:
– The presence of food debris present in the upper nozzles.
– The presence of food debris under convection oven.
– At 5:55 A.M., Dietary Cook (DC) A said the person who placed the white powdery substance
in that container, forgot to label it.
– At 5:58 Dietary Aide DA A lifted up lid on trash container to place some trash in the
container and went back to handling foil to wrap pans with coffee cake pieces without
washing his/her hands.
– At 6:41 A.M., DAs B and C said the night shift person is to take off the top nozzles and
clean those (the top nozzles of the automated dishwasher) too, after seeing the food
hanging from the nozzles.
– The food debris including potatoes and onion peeling on the floor of walk-in
refrigerator #2.
– The presence of grime on the fan vent cover of walk-in refrigerator#1.
The front part of DC A’s hair was not covered by a hairnet.
– A buildup of dust on wall above spice rack.
– At 9:29 A.M., DA C said they should get the debris and the potatoes from under the
shelves in the walk-in refrigerator and they should remove the dust from over the dietary
area, and
– At 9:34 A.M.,DC A said there should have been a cleaning person that was supposed to get
the debris under the convection oven every night.
During an interview on 6/28/19 at 7:52 A.M., the Dietary Manager (DM) said the dietary
staff should clean under the convection oven and under the shelves of the walk-in
refrigerators, daily.
Record review of the 1999 and 2009 Food and Drug Administration (FDA) Food Code and
Missouri Food Codes, showed:
– In Chapter 2-402.11, (A) Except as provided in (B) of this section, food employees shall
wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing
that covers body hair, that are designed and worn to effectively keep their hair from
contacting exposed food.

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 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 – Some

(continued… from page 41)
In Chapter 3-602.11 Food Labels.
(A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including
21 CFR 101 -Food labeling, and 9 CFR 317 Labeling, marking devices, and containers.
(B) Label information shall include:
(1) The common name of the FOOD, or absent a common name, an adequately descriptive
identity statement;
In Chapter 4-501.11, showed Good Repair and Proper Adjustment.
A) EQUIPMENT shall be maintained in a state of repair and condition that meets the
requirements specified under Parts 4-1 and 4-2.
(B) EQUIPMENT components such as doors, seals, hinges, fasteners, and kick plates shall
be kept intact, tight, and adjusted in accordance with manufacturer’s specifications.
– In Chapter 4-602.13, non-FOOD-CONTACT SURFACES of EQUIPMENT shall be cleaned at a
frequency necessary to preclude accumulation of soil residues
– In Chapter 6-501.12, paragraph A, The physical facilities shall be cleaned as often as
necessary to keep them clean.
– In Chapter 6-501.14, part A, Intake and exhaust air ducts shall be cleaned and the
filters changed so they are not a source of contamination by dust, dirt, and other
materials.

F 0814

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Dispose of garbage and refuse properly.

Based on observation, interview and record review, the facility failed to ensure the lid
of the dumpster was closed for two days during the survey. The facility census was 86
residents.
1. Observations on 6/26/19 at 11:56 A.M., and 3:28 P.M., and on 6/27/19 at 6:01 A.M., 6:36
A.M., 6:57 A.M., 7:59 A.M., 9:14 A.M., and 9:29 A.M., showed the left lid of the dumpster
was open.
During an interview on 6/27/19 at 9:29 A.M., Dietary Aide (DA) C said they should close
the lid to the dumpster.
Record review of the 2009 Food and Drug Administration (FDA) Food Code
Chapter 5-501.110 entitled Storing Refuse, Recyclables, and Returnables, showed: Refuse,
recyclables, and returnables shall be stored in receptacles or waste handling units so
that they are inaccessible to insects and rodents.
Chapter 5-501.113 entitled Covering Receptacles, showed: Receptacles and waste handling
units for refuse, recyclables, and returnables shall be kept covered:
(A) Inside the food establishment if the receptacles and units: (1) Contain food residue
and are not in continuous use; or
(2) After they are filled; and
(B) With tight-fitting lids or doors if kept outside the food establishment.

F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

Provide and implement an infection prevention and control program.

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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 42)
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure infection
control practices to prevent cross contamination were implemented by failing to wash hands
and change gloves during resident cares for two sampled residents (Resident #3 and #25);
use proper hygienic practices prior to and after a resident was transferred to his/her
wheelchair and the nursing staff failed to wash hands and glove prior to starting peri
care for one sampled resident (Resident #21); to ensure proper placement of the resident’s
Foley catheter during wound care and transferring for one sampled resident (Resident #85);
to ensure paper towels were available at the handwashing stations of the soiled utility
room on the 2nd and 1st floor; and to develop a water management program that was specific
to the facility which included a facility based risk assessment, a facility based
Environmental Assessment which considers patients who are at risk, and reservoirs such as
patient care devices, medical devices and healthcare workers, identify areas where
waterborne illness/Legionella could grow and spread within the facility, and account for
changes in municipal or facility water quality out of 29 sampled residents. The facility
census was 86 residents.
Record review of the facility Handwashing policy and procedure dated 10/1990, showed to
promote good infection control, handwashing is the single most important means of
preventing the spread of infection. It showed:
-Personnel should always wash their hands, even when gloves are used, after taking care of
an infected resident. In addition, personnel shall wash their hands after touching
excretions or secretions from wounds, skin infections and before touching any other
resident.
-Hands shall also be washed before and after performing invasive procedures, or touching
residents who are susceptible to infection. Hands shall be washed between all resident
contacts.
-Hands shall be washed before beginning work; before and after giving treatment; before
and after handling used equipment; before and after eating; before and after using the
bathroom; before and after any resident contact; before donning gloves and after removing
gloves.
1. Record review of Resident #3’s Face Sheet showed he/she was admitted 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.
-Mobilized in a wheelchair and did not walk.
-Had upper range of motion limitations on one side and lower range of motion limitations
on both sides.
-Did not have any wounds during the look back period and
-Had moisture associated skin damage and received application of ointments.
Observation and interview 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. The following occurred:
-Without washing or sanitizing his/her hands or gloving, Certified Medication Technician
(CMT) B removed the resident’s left shoe and sock for observation of the resident’s left
ankle.
-He/she then took the resident to his/her room. The resident had a healed area on his/her
ankle bone that had pink skin that was not open.
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 43)
-CMT B lifted the resident’s foot to put the resident’s sock and shoe back on. He/she said
the area healed and they were no longer treating it.
-CMT B then went to the bathroom, came out and said that there were no paper towels.
He/she said that the resident’s roommate put the towels in the toilet and they did not
have towels in the resident’s bathroom and
-Without washing or sanitizing his/her hands, CMT B then took the resident out of the room
and went to the medication room.
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 her shoe
and sock off in front of other residents, to look at the resident’s wound.
-He/she should have washed his/her hands and gloved prior to removing the residents sock
and shoe and then he/she should have washed or sanitized his/her hands before leaving the
resident’s room and
-They have hand sanitizer, but he/she did not have any with him/her at the time he/she
removed the resident’s shoe and sock.
During an interview on 6/27/19 at 7:15 A.M., Licensed Practical Nurse (LPN) B said:
-There should always be paper towels in the resident bathrooms and he/she would call
housekeeping to ensure they were brought up.
-The nursing staff were supposed to wash their hands and glove prior to doing anything
with the residents and after they completed resident care and
-They can use hand sanitizer instead of handwashing, but he/she preferred that they washed
their hands with soap and water.
2. Record review of Resident #25’s Face Sheet showed he/she was admitted to the facility
on [DATE], with [DIAGNOSES REDACTED].
Record review of the resident’s quarterly MDS dated [DATE], showed he/she:
-Was alert and oriented.
-Required total assistance with bed mobility, transfers, bathing, dressing, toileting, and
grooming.
-Had functional limited range of motion in both upper and lower extremities and
-Did not walk and used a wheelchair for mobility.
Observation on 6/26/19 at 12:26 P.M., showed the resident was in his/her bed . The
resident was fully dressed and was laying on top of his/her transfer sling. Certified
Nursing Assistant (CNA) B and CNA C came into the resident’s room and the following
occurred:
-Without washing their hands, CNA B began to attach the sling to the mechanical lift and
CNA C put on gloves and began to assist in attaching the sling to the mechanical lift.
-CNA B then raised the resident while CNA C assisted with transferring the resident to
his/her wheelchair.
-CNA C kept the resident’s catheter bag below the resident’s waist during the transfer and
placed it into a privacy bag that was at the side of the resident’s wheelchair as the
resident was being lowered.
-CNA C and CNA B both assisted with positioning the resident in his/her wheelchair and
placed pillows under his/her feet and between his/her knees.
-Without washing or sanitizing his/her hands, CNA C then removed and discarded his/her
gloves and left the resident’s room and
-Without washing or sanitizing his/her hands, CNA B stepped outside of the resident’s room
to obtain clean linen from the linen cart.
During an interview on 6/26/19 at 12:35 P.M., CNA B said that they are supposed to wash
their hands:
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 44)
-Upon entering the resident’s room before providing care.
-Any time they go from a clean to dirty task.
-Anytime they change their gloves.
-Before leaving the resident’s room.
-They had not washed their hands when they came into the residents room or before they
left.
-He/she knew that he/she probably should have washed his/her hands upon entering the
resident’s room, but since he/she had just completed his/her care, he/she did not think
he/she needed to do so again and
-He/she forgot to put on gloves when transferring the resident.
During an interview on 6/28/19 at 11:18 A.M., LPN C said:
-Nursing staff is supposed to wash their hands upon entering a resident’s room and before
leaving (they are to wash their hands and put on gloves).
-They can use hand sanitizer in place of handwashing when hands are not obviously soiled.
-If they are transferring a resident, they should wash their hands and put on gloves
before and after the transfer.
-They should wash their hands after removing gloves.
-They should wash their hands whenever going from clean to dirty tasks.
-They should wash their hands before leaving the resident’s room.
During an interview on 6/28/19 at 2:54 P.M., the Director of Nursing (DON) said:
-Staff should wash their hands prior to entering the resident’s room, when providing
resident care.
-When using gloves, they should wash their hands prior to gloving.
-They should wash their hands after removing gloves.
-When they are done providing care, they should remove their gloves and wash their hands.
-They should wash their hands prior to leaving the resident’s room and
-They can use hand sanitizer in place of washing their hands-it is provided and available
to the nursing staff.
3. Observations on 6/24/19 at 1:49 P.M., showed the absence of paper towels from the hand
washing station in the 2nd floor soiled utility room, with bags of laundry in the sink and
Observation on 6/25/19 at 11:51 A.M., showed the absence of paper towels in from the hand
washing station on the 1st floor soiled utility room,
Observations with Registered Nurse (RN) A and Licensed Practical Nurse (LPN) A on 6/26/19
at 3:35 P.M., showed the absence of paper towels from 2nd floor soiled utility.
During an interview on 6/26/19 at 3:36 P.M., both the RN and the LPN agreed that the hand
washing sink in the 2nd floor soiled utility room needed paper towels and the sink should
not have all those laundry bags in it, which made the sink inaccessible.
4. Record review of the facility’s documentation, showed the absence of a Legionella
/waterborne illness plan which accounted for the following:
-A facility risk assessment for waterborne illness.
-The facility implemented a water management program that considered the American Society
of Heating Refrigerating and Air Conditioning Engineers (ASHRAE) standards.
-The facility established a water management program Identify areas where waterborne
illness/Legionella could grow and spread, and
-The facility accounted for changes in municipal or facility water quality, water main
breaks and construction (including renovations and installation of new equipment).
During interviews on 6/28/19 at 2:49 P.M., the Administrator and Maintenance Supervisor
said:
-They have not identified areas that waterborne illness could occur 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 45)
– At this time there was not a comprehensive waterborne illness prevention plan.
5. Record review of Resident #85’s Admission Face Sheet showed he/she was admitted on
[DATE] and readmitted [DATE] with following [DIAGNOSES REDACTED].>-[MEDICAL CONDITION]
with Septic Shock (is when the infection is severe enough to affect the function of your
organs, such as the heart, brain, and kidneys) and
-Acute Kidney Failure (occurs when your kidneys suddenly become unable to filter waste
products from your blood).
Record review of the resident’s significant change MDS dated [DATE] showed:
-He/she was not cognitively impaired and had recall mild loss problems.
-He/she was able to understand others and make his/her needs known.
-He/she requires extensive assist of two staff member for bed mobility, transfer and
dressing and
-He/she had a indwelling catheter.
Observation and interview on 6/24/19 at 12:23 P.M. the resident said:
-He/she had pressure sore on his/her bottom and it was getting better.
-He/she had a catheter due to the wound.
-He/she said the catheter had not been changed for over a month.
-He/she was in hospital when he/she remember when was change last.
-Observation of the resident catheter tubing noted to have cloudy substance inside and
-The catheter bag was hanging on the side of the bed below the bladder and had yellow
liquid substance inside and had no odors.
Record review of the resident’s POS dated 6/19/19 to 7/20/19 showed;
-Had physician order [REDACTED].
-The facility care staff are to provide catheter care every shift and
-The resident on [MEDICATION NAME] one tab by mouth daily for kidney function.
Observation on 6/28/19 at 11:40 A.M., of the resident showed:
-RN A and he/she was assisted of CNA A had just finishing placing a new indwelling Foley
catheter and drainage bag when enter the resident room.
-The privacy curtain was pulled by window and at bedside.
-The facility staff said the resident catheter bag was leaking.
-The resident’s urine was slow starting and had a lot thick white substance draining and
watery looking urine liquid substance.
-RN A ask resident if he/she was drinking a lot water and the resident said yes and also
drinking a lot of tea and
-The new catheter drainage bag remained on the bed after insertion and while CNA position
the resident and finish care.
Observation on 6/27/19 at 11:55 A.M. of the resident wound care by RN A showed during the
resident wound care, his/her catheter bag remained on the bed at level of the bladder.
Observation on 6/28/19 at 12:45 P.M. of resident’s transfer showed:
-He/she was transferred with a mechanical lift with assist of two staff members.
-CNA A had placed the catheter drainage bag in the resident lap during the transfer.
– Once he/she was transferred to wheelchair had placed the catheter drainage bag was
dragging on the floor.
-The resident was reposition in chair while catheter bag brushed back and forth on the
floor and
-CMT D picked up the catheter bag and the placed in the privacy bag without wiping the bag
off.
During interview on 6/28/19 at 11:05 A.M., CNA D said:
-The resident’s catheter bag should be kept below the bladder and should not be touching
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 46)
or laying on the floor and
-If found laying on the ground he/she would change the resident’s catheter bag.
During an interview on 6/28/19 at 11:05 A.M., CMT D said the catheter should not be
touching the floor and keep below the bladder at all times
During an interview on 6/28/19 at 11:20 A.M., CMT C said:
-The resident catheter bag are to be kept below the resident’s bladder and never lay on
the ground or left on bed during resident’s personal care and
-During an transfer of the resident, the catheter bag should be below bladder and not be
laying on the floor.
During an interview on 6/28/19 at 2:54 P.M., the DON said:
-The catheter bag should not be place above the bladder.
-He/she expect nursing staff should had place the catheter drainage bag below the bladder
after insert new tubing and
-Expect CNA and nursing staff to ensure when transferring of a resident with mechanical
lift the catheter drainage bag should be kept below bladder and not touching or dragged on
the ground;
6. 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 (Is a disruption in how your brain works that causes changes in
behavior).
Observation on 6/25/19 at 2:40 P.M. showed:
-Three CNA’s came into the resident’s room to transfer him/her from his/her wheelchair to
his/her bed;
-The CNA’s did not wash their hands prior to performing the resident’s transfer from
his/her wheelchair to his/her bed; and
-CNA C, CNA D, and CNA E assisted the resident to his/her bed and then proceeded to pull
down his/her pants while he/she was still standing in a upright position and CNA D and CNA
E did not wash hands and use new gloves prior to started the resident peri care.
During an interview on 6/28/19 at 12:20 P.M., CNA C said:
-He/she was expected to wash his/her hands before entering the resident’s room.
-He/she was expected to wash his/her hands after providing cares to the resident.
-He/she was expected to wash his/her hands when passing out lunch trays.
-He/she was expected to was his/her hands before and after the resident’s peri care needs.
-He/she was expected to wash his/her hands before and after transferring a resident.
-He/she was expected to wash his/her hands all day and
-He/she was was only allowed to use the sanitizer gel only three times a day and the
remaining care needs for the resident required the nursing staff to actually wash their
hands with soap and water.
During an interview on 6/28/19 at 12:30 P.M., Registered Nurse (RN) B said:
-He/she expected nursing staff to always wash his/her hands prior to and after providing
cares to a resident.
-He/she expected the nursing staff to follow the facility’s handwashing policy and
protocols; and
-He/she expected the nursing staff to wash their hands through out the day at all times
when entering and exiting the resident’s room, especially when cares are being provided to
the residents.
During an interview on 6/28/19 at 2:54 P.M., the Director of Nursing (DON) said:
-Staff should wash their hands prior to entering the resident’s room when providing
resident care.
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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0880

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 47)
-When using gloves they should wash their hands prior to gloving.
-When they are done providing care, they should remove their gloves and wash their hands.
-They should wash their hands prior to leaving the resident’s room and
-They can use hand sanitizer in place of hand handwashing if it is provided and available
to the nursing staff.

F 0921

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

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

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation and interview, the facility failed to ensure that handwashing faucets
in resident rooms [ROOM NUMBER], drained properly when the water was ran to check
temperatures, and to mitigate the presence of sewer gas (a complex mixture of toxic and
nontoxic gases produced and collected in sewage systems by the decomposition of organic
household or industrial wastes, typical components of sewage) in the basement area. This
practice potentially affected at least five residents who resided in those rooms and the
basement area which is used by an unknown number of residents who use the basement area
for therapy services. The facility census was 86 residents.
1. Observations on 6/24/19, showed:
– At 2:22 P.M., the handwashing sink in resident room [ROOM NUMBER], overflowed after the
water was allowed to run for two minutes for a temperature check.
– At 2:38 P.M., the handwashing sink in resident room [ROOM NUMBER], overflowed after the
water was allowed to run for two minutes for a temperature check, and
– At 2:39 P.M., the handwashing sink in resident room [ROOM NUMBER], overflowed after the
water was allowed to run for two minutes for a temperature check.
During an interview on 6/24/19 at 2:43 P.M., Maintenance Person A said some of the sinks
were clogged and needed to be cleaned.
2. Observation with Maintenance Person A and the Central Supply Coordinator on 6/25/19 at
1:58 P.M. and on 6/26/19 at 11:58 A.M., showed the presence of sewer gas in the garage bay
next to the oxygen storage room.
During an interview on 6/28/19 at 11:31 A.M., the Central Supply Coordinator said he/she
has smelled the sewer gas in the oxygen storage room for about a year and sometimes he/she
smelled the gas in the office which is on the basement level and in the past, he/she has
told the maintenance department.

F 0925

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

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

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation and interview, the facility failed to maintain the following areas
free of insect debris, insect pests, and/or evidence of mice: vacant resident rooms 403,
410, 413, 418, the medical record’s office towards the south end of the first floor,
occupied resident rooms 111, 121, 123, 127,1st floor employee breakroom, mechanical 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 TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)
F 0925

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Many

(continued… from page 48)
[ROOM NUMBER], the kitchen hot water heater room; the storage area on the financial
services hall, and the video screening room. This practice affected many areas around the
facility. The facility census was 86 residents.
1. Observations with Maintenance Person A on 6/24/19, showed:
– At 10:35 A.M., there were numerous dead flies on the floor of vacant resident room [ROOM
NUMBER].
– At 10:43 A.M., there were numerous dead flies on the floor of vacant resident room [ROOM
NUMBER].
– At 10:45 A.M., there were numerous dead flies on the floor of vacant resident room [ROOM
NUMBER].
– At 10:50 A.M., there were numerous dead insects on the floor of vacant resident room
[ROOM NUMBER], and
– At 11:06 A.M., there were dead insects in a bed in occupied resident room [ROOM NUMBER].
2. Observations with Maintenance Person A and interviews with staff on 6/25/19, showed:
– At 10:38 A.M., there were numerous dead insect and cobwebs in the corner of the medical
records office, located towards the south end of the 1st floor.
– At 10:49 A.M., there was a gathering of numerous ants next to the climate control unit
with food crumbs present.
– At 11:35 A.M., there were mouse droppings (the excrement of certain animals, such as
rodents) on the floor of Mechanical room [ROOM NUMBER] on the 1st floor.
– At 11:38 A.M., there were numerous mice droppings food debris and chewed up paper on the
floor behind the fridge in the 1st floor employee breakroom.
– At 11:47 A.M., the Assistant Housekeeping Director said the housekeepers do not get
behind the fridge often.
– At 11:34 A.M., there were mouse droppings on the floor on Mechanical room [ROOM NUMBER].
– At 11:35 A.M., Mainte