Amethyst Health Of Wausau

Penalty

59 days payment denial

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that residents were free from misappropriation and exploitation of their funds. Multiple instances were identified where resident payments intended for care and room charges were deposited into a bank account that only the Business Office Manager (BOM) had access to. This account was unknown to other facility leadership and was used for personal purchases, including cash withdrawals, restaurant, and store charges. The BOM was the sole authorized user of this account, and the facility administrator only became aware of its existence after reviewing a bank statement. The administrator's subsequent investigation revealed that resident checks and insurance payments were being deposited into this unauthorized account, and the BOM closed the account after being questioned. Several residents and their families reported ongoing issues with missing funds, unexplained billing, and inability to access or account for their money. For example, one resident's family continued to receive bills despite having made substantial payments, and another resident was at risk of losing their place at an assisted living facility due to missing Social Security payments. In some cases, checks written from residents' personal checkbooks had signatures that did not match the residents' handwriting, and funds were withdrawn from resident accounts after discharge. Facility staff, including the social worker and administrator, expressed concerns about the whereabouts of resident funds and suspected misappropriation, but these concerns were not promptly or thoroughly investigated or reported to the state agency or law enforcement as required. The facility did not have or could not provide policies related to accounts receivable or resident funds when requested by the surveyor. Interviews with staff and family members revealed a lack of communication and transparency regarding the handling of resident funds. The administrator and other leaders failed to notify affected residents or their representatives about the suspected misappropriation, and there was no evidence of a thorough internal investigation prior to the survey. The facility's failure to act on suspicions of misappropriation and to report these incidents in a timely manner left residents at continued risk of financial exploitation and resulted in a finding of immediate jeopardy.

Removal Plan

• The NHA and member of a governing body conducted an audit of past residents' funds. Credits will be made to families who are owed. The NHA and member of the governing body reviewed the petty cash policy and implemented it.
• The Director of Nursing (DON), Social Service Director (SSD) and Minimum Data Set (MDS) nurse/care plan nurse will review clinical documents to identify any negative outcome that may have resulted from the alleged deficiency. The following documents were reviewed: NAR report, 24-hour summary, order report listing, incident report portal, transfer/discharge log, concern log and resident council minutes.
• The DON/SSD/Nurses will complete assessment of all residents to identify any negative psychosocial outcomes or worsening of overall condition that may have resulted from the alleged deficiency. The attending physician/Nurse Practitioner (NP) of the resident will be notified of any negative findings.
• The NHA/SSD/DON will conduct interviews of interviewable residents to identify if they have any concern related to mishandling, misused and/or misappropriation of their funds. Any identified concern will be reported to the state agency and law enforcement, and investigation will be conducted. For residents who are not able to participate in the interviews, the NHA/SSD/DON will interview the resident representatives.
• The corporate BOM will also audit all residents' status of benefits (Medicaid and Managed Care) to identify any concern. An investigation will be conducted if any concern is identified.
• Any identified misappropriation of residents' funds and exploitation will be reported to the NHA, state agency and law enforcement.

Penalty

59 days payment denial

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to immediately report suspected misappropriation and exploitation of resident funds to the State Agency and local authorities upon discovery. The Nursing Home Administrator (NHA) identified concerns after reviewing a bank statement for an account under the facility's name, which was unknown to the NHA. The statement revealed significant cash withdrawals and a money order, and the bank confirmed that the Business Office Manager (BOM) had a checkbook and debit card for this account. The NHA suspected that resident payments intended for care and room fees were being deposited into this unauthorized account rather than the facility's Resident Fund Management System. Despite these findings, the NHA was instructed by the Director of Operations (DOO) not to report the concerns to the State Agency or police department. Multiple residents were affected by these actions. For example, one resident's family reported ongoing billing issues despite making substantial payments, and another resident's family was unable to determine the whereabouts of Social Security income. The Social Worker and NHA also expressed concerns about residents with significant funds who suddenly had negative balances or depleted accounts, and there were suspicions of forged signatures on personal checks. An insurance check was also deposited into the unauthorized account, with no clear indication of which resident it was intended for. These concerns were not reported to the appropriate authorities as required by facility policy and federal regulations. Interviews with staff and family members confirmed ongoing concerns about the handling of resident funds, lack of transparency, and the absence of timely reporting to authorities. The BOM resigned after a disciplinary meeting, and the NHA eventually contacted the police and State Agency only after being prompted by the surveyor. The facility was unable to provide policies for accounts receivable and payable when requested by the surveyor, and the failure to report the suspected misappropriation and exploitation of resident funds resulted in a finding of immediate jeopardy.

Removal Plan

• The DON/SSD/Nurses will complete assessment of all residents to identify any negative psychosocial outcomes or worsening of overall condition that may have resulted from the alleged deficiency. The attending physician/NP of the resident will be notified of any negative findings.
• The NHA/SSD/DON will conduct interviews of interviewable residents to identify if they have any concern related to mishandling, misused and/or misappropriation of their funds. Any identified concern will be reported to the state agency and law enforcement, and investigation will be conducted. For residents who are not able to participate in the interviews, the NHA/SSD/DON will interview the resident representatives.
• The corporate business office manager will audit all residents' status of benefits (Medicaid and Managed Care) to identify any concern. An investigation will be conducted if any concern is identified. Any identified misappropriation of residents' funds and exploitation will be reported to the NHA, state agency and law enforcement.
• The NHA/DON will provide training to the department heads (Activities, SSD, BOM, Dietary Manager, Therapy Director, Environmental Services and Maintenance staff) related to the intent of F609, facility policy related to Abuse, Neglect, Exploitation and Misappropriation, focusing on the reporting requirements and responsibility of the staff to misappropriation of resident property, and exploitation to the state agency and police department.
• The DON/NHA/trained department head will provide training to all staff about reporting allegations of abuse, neglect and misappropriation to the Administrator/DON. The staff members who are not available will receive their education prior to starting their shift upon return to work.

Penalty

59 days payment denial

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to thoroughly investigate multiple allegations of misappropriation and exploitation of resident funds, affecting at least five residents. The Nursing Home Administrator (NHA) discovered a bank account under the facility's name, which was unknown to them, containing suspicious withdrawals and transactions. The Business Office Manager (BOM) was identified as having access to this account, and there were indications that resident payments intended for care and room and board were deposited into this account and potentially used for personal purposes. Despite these findings, the NHA was directed by the Director of Operations (DOO) and the facility owner not to report the incident to the State Agency or law enforcement, and no thorough investigation was initiated at that time. Several residents and their families reported concerns about missing payments, uncredited funds, and unexplained depletion of resident accounts. For example, one resident's family received bills despite having made payments, another resident's Social Security checks were unaccounted for, and a resident with severe cognitive impairment had checks written from their account with signatures that did not match their handwriting. In each of these cases, the concerns were either not investigated or only minimally reviewed, with no follow-up to determine the extent of the misappropriation or to identify all affected residents. Interviews with staff, residents, and family members confirmed that concerns about financial discrepancies were raised but not addressed. The NHA acknowledged being aware of the issues and sharing them with upper management, but was instructed not to alert authorities or conduct a full investigation. The lack of action allowed the misappropriation and exploitation to continue, and the facility did not ensure that residents were protected or that a thorough analysis of the situation was conducted, as required by facility policy.

Removal Plan

• Provide training to the NHA, DON, new BOM and members of the governing body about the intent of F610 and their responsibility to identify and investigate allegations of misappropriation of residents' funds.
• Conduct interviews of interviewable residents to identify concerns related to mishandling, misused and/or misappropriation of their funds. Report any identified concern to the state agency and law enforcement, and conduct an investigation. For residents unable to participate, interview resident representatives.
• Audit all residents' status of benefits (Medicaid and Managed Care) to identify concerns. Conduct an investigation if any concern is identified. Report any identified misappropriation of residents' funds and exploitation to the NHA, state agency and law enforcement.
• Complete assessment of all residents to identify any negative outcome. Notify the attending physician/NP of any negative findings.
• Initiate investigations while ensuring residents are protected from further misappropriation of property and exploitation.
• Provide training to the RDO, NHA, DON, and members of the governing body related to the intent of F610, facility policy related to investigation of allegations of misappropriation of resident property and exploitation, and staff responsibility to assure thorough investigation and implement measures to prevent further mishandling of finances and/or exploitation and to safeguard residents' finances.
• Provide training to department heads (Activities, SSD, BOM, Dietary Manager, Therapy Director, Environmental Services and Maintenance staff) related to the intent of F610, facility policy related to investigation of allegations of misappropriation of resident property and exploitation, and staff responsibility to assure thorough investigation and implement measures to prevent further mishandling of finances and/or exploitation and to safeguard residents' finances.
• Provide staff with training about their responsibility to participate/cooperate with the administration when conducting an investigation. Staff who are not available will receive their education prior to starting their shift upon return to work.

Penalty

59 days payment denial

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Facility administration failed to ensure effective and secure management of resident finances, resulting in a lack of oversight and accountability for resident accounts. The Business Office Manager (BOM) maintained a bank account in the facility's name, complete with a debit card and checkbook, which was unknown to the Nursing Home Administrator (NHA) and other management staff. This account was used for various cash withdrawals and purchases, with no effective system in place to determine the purpose or beneficiary of these transactions. Additionally, there was no tracking system for payments received from residents or their representatives, and the administration did not hold the BOM or third-party billing company accountable for the safe and accurate handling of resident funds. Multiple instances were identified where resident funds were mishandled. For example, a check from a resident was deposited into the undisclosed account after the resident had been discharged, and family members reported inaccurate statements, missing receipts, and unexplained balances. In one case, a resident's Social Security payments continued to be withdrawn for care costs after discharge, and the managed care organization (MCO) responsible for payment did not receive the funds, putting the resident at risk of losing benefits. The BOM was listed as the authorized user on the resident's account, preventing the MCO from making necessary changes without police involvement. These issues were compounded by poor communication with the third-party billing company and a lack of transparency with residents and their representatives. The administration did not follow regulations or facility policy regarding the reporting and investigation of suspected misappropriation or exploitation of resident finances. Despite being made aware of potential fraud and misappropriation, upper management advised against submitting a facility-initiated report to the State Agency or police, and a thorough investigation was not conducted. Policies and procedures for accounts payable and receivable were not provided when requested, and staff lacked the necessary education and tools to properly manage resident funds. These failures led to a finding of immediate jeopardy, as residents were placed at risk for misappropriation and exploitation of their funds.

Removal Plan

• The compliance consultant will provide the NHA, DON, new BOM and members of the governing body training about the intent of F835 and their responsibility to operate and manage the facility efficiently and effectively to ensure that the facility is administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The training will also include review of their responsibility to prevent abuse, including misappropriation of resident property and exploitation, identifying, investigating and protecting residents from allegations of abuse and exploitation that has the potential to cause serious injury, harm, impairment, or death. To identify any negative outcome, the DON/SSD/Nurses will complete assessment of all residents. The attending physician/NP of the resident will be notified of any negative findings.
• The NHA and members of the governing body, NHA and Regional Director of Clinical Services will discuss the alleged deficiency and the corrective actions which are described in this plan of removal. The Administrator will notify the Medical Director of the alleged deficiency and immediate actions described in this plan of removal.
• To prevent the recurrence of the alleged deficiency, safeguard and track resident financials to include accounts payable and accounts receivables, an updated process will be implemented. The NHA/corporate regional representative will provide training to the new BOM about the new process. NHA to review and initial/sign off on all new accounts.
• Deposit process will be reviewed and updated to include two signers to accept checks and provide receipt with signatures. Both signers then log receipt of check on the Facility Check Receipt Log. Log will be reviewed weekly by facility NHA.
• Resident fund requests will be reviewed and updated: BOM makes withdrawal from resident's RFMS account and puts the money into the facility's RFMS Petty Cash account. BOM provides resident with requested money at the facility out of the RFMS Petty Cash box. RFMS Petty Cash box will be counted by the NHA and BOM weekly to ensure accuracy. Once RFMS Petty Cash box reaches a certain threshold (set by the NHA based on facility needs), a replenishment check will be requested. RFMS Petty Cash box will be counted. Receipts, G/L log and count will be sent to third-party billing office. Replenishment check will be issued to facility. Replenishment check will then be cashed at local bank. Funds will be counted at facility by two employees. Funds will then be placed back into the RFMS Petty Cash box.
• The policies and procedures related to administration of the facility will be reviewed by the NHA, DON, Medical Director and a representative of the governing body. The compliance consultant will provide the NHA, DON and members of the governing body training about administration of the facility in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. It will be emphasized that the NHA and DON are accountable for all the programs and services in the facility to meet the needs of the residents who reside in the facility. The Administrator and DON are accountable for planning, coordinating and managing all services, including protection of residents from misappropriation of property and exploitation, meeting the reporting and thorough investigation requirements of any allegation related to misappropriation of resident property and exploitation, and are responsible for the overall direction, coordination and evaluation of all care and services provided to the residents in the facility.
• The NHA/DON will provide training to the department heads (Activities, SSD, BOM, Dietary Manager, Therapy Director, Environmental Services and Maintenance staff) about the intent of F835 and their responsibility to operate and manage the facility efficiently and effectively to ensure that the facility is administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The training will also include review of their responsibility to prevent abuse, including misappropriation of resident property and exploitation, identifying, investigating and protecting residents from allegations of abuse and exploitation that has the potential to cause serious injury, harm, impairment, or death.

Penalty

59 days payment denial

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to implement its policies and procedures regarding the screening of employees for a prior history of abuse, neglect, exploitation, or misappropriation of resident property. Specifically, one of thirteen employee files reviewed, belonging to a registered nurse, did not contain a completed Background Information Disclosure (BID), Department of Justice (DOJ) response, or Government Findings report prior to the employee starting work. The facility's own policy requires that background checks be conducted and prohibits the employment of individuals with findings of abuse, neglect, exploitation, or misappropriation. During the survey, it was discovered that several personnel files were missing required documentation, and a facility-wide review was underway to identify which files were incomplete. However, as of the time of the survey, no missing documentation had been updated, and no list of affected employees was provided to the surveyor. The deficiency was identified through record review and staff interviews, confirming that the required background checks were not completed before the registered nurse began employment.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide care and treatment consistent with professional standards of practice for one resident who was re-admitted following a hospitalization and removal of an indwelling catheter. After the resident returned to the facility without the catheter, there was no documentation of comprehensive assessments or monitoring of the resident's ability to void or for potential complications, as required by the nursing process outlined in the Wisconsin Nurse Practice Act. Specifically, there was a lack of documentation from the day after re-admission through the following day, and the Director of Nursing acknowledged that the resident was not assessed or monitored appropriately after re-admission. Interviews with facility leadership revealed that there was no current policy on comprehensive assessments and nurse documentation at the time of the incident. The Director of Nursing and Regional Clinical staff reported that the facility had previously identified concerns with nursing assessments and documentation during a recent re-certification survey and were in the process of developing new policies, procedures, and documentation tools, but these were not yet implemented at the time of the deficiency.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that required infection control training was completed for two housekeeping staff members. Both staff, identified as HSK E and HSK D, reported during interviews that they had not received any infection control training since their respective hire dates. This lack of training was confirmed through record review and staff interviews, indicating that the facility did not have a policy in place for infection control training for housekeeping staff. The Nursing Home Administrator acknowledged that there was no existing policy or documentation of infection control training for these staff members and confirmed that the required training had not been provided. The absence of infection control training for housekeeping staff has the potential to affect all 33 residents in the facility, as these staff perform duties that could impact infection prevention and control.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to return funds from resident trust accounts to the residents or their representatives within 30 days after discharge or death, as required. Record review showed that three residents who were either discharged or had expired still had open accounts with remaining balances. Specifically, one resident with diabetes mellitus and multiple sclerosis was found deceased, yet their account remained open with a balance of $0.40. Another resident with hemiplegia following a cerebrovascular accident was discharged, but their account still showed a balance of $100.07. A third resident with heart failure was found unresponsive and deceased, and their account also remained open with a balance of $0.81. Interviews confirmed that the Nursing Home Administrator was aware of the open accounts and the unreturned funds, and acknowledged the lack of a policy for returning funds within the required timeframe. The Business Office Manager, who may have had further information, was unavailable due to being on FMLA. The failure to return funds in a timely manner was identified through both record review and staff interview, affecting three out of four residents reviewed for money due after discharge or death.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to properly assess and document the need for a Wander Guard alarm for a resident with chronic obstructive pulmonary disease and severe cognitive impairment. The resident was admitted with a Brief Interview for Mental Status (BIMS) score indicating severe cognitive impairment, but the most recent elopement risk evaluation documented the resident as not at risk for elopement. Despite this, the care plan identified the resident as an elopement risk and included the use of a Wander Guard device. The device was observed attached to the resident's left ankle, and staff confirmed its use. Interviews with facility staff revealed that there was no written consent or physician's order for the use of the Wander Guard, and no updated elopement risk assessment had been completed to justify its use. The Social Service Director had obtained only verbal consent from the resident's power of attorney after discussing the resident's behavior, but no written documentation of consent was present. The Interim Director of Nursing confirmed the absence of both a physician's order and written consent, as well as the lack of an updated risk assessment supporting the intervention.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to review and revise the comprehensive person-centered care plan to include a resident's repeated refusals of pressure ulcer treatments and management. The care plan did not document the resident's refusals to have dressing changes performed, wound vac dressings assessed, or wet to dry dressings applied, despite multiple instances of such refusals being recorded in the nursing notes. The facility's policy required that the care plan describe services not provided due to the resident exercising their right to refuse treatment, but this was not reflected in the resident's care plan. The resident involved was cognitively intact, with a history of type two diabetes mellitus and an unstageable pressure ulcer of the sacral region. Nursing notes documented several occasions where the resident refused wound care, dressing changes, and interventions related to the wound vac, as well as non-compliance with turning and repositioning protocols. Despite these documented refusals and non-compliance, the care plan was not updated to reflect the resident's choices or the facility's response to these refusals.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide appropriate treatment and care according to physician orders, as well as the resident's preferences and goals. This deficiency was identified through surveyor observation and review of records, which showed that care provided did not align with the documented orders or the expressed wishes and care goals of the resident involved.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide pharmaceutical services to meet the needs of each resident and did not employ or obtain the services of a licensed pharmacist. This deficiency was identified during the survey process, indicating that the required pharmaceutical oversight and services were not in place for residents as mandated.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to follow infection control practices during a dressing change for one resident with stage four pressure injuries to both heels. During the dressing change, an LPN placed the resident's wrapped heels on a clean barrier on the bed, then removed the dressings and placed the heels back on the same area of the barrier where the soiled dressings had been. The LPN also brought the treatment cart into the resident's room, contrary to facility expectations. The LPN later acknowledged not keeping clean and dirty areas separate on the barrier and admitted to making mistakes due to nervousness. The Interim Infection Preventionist confirmed that the nurse is expected to keep clean and dirty areas separate and not bring the wound cart into the resident's room. Additionally, the facility failed to maintain proper infection control for a resident with a suprapubic catheter. Observations showed the resident's catheter drainage bag was hanging on the side of the bed and touching the floor on two occasions. Both a CNA and an LPN confirmed that the drainage bag should not touch the floor, and the Interim Director of Nursing also acknowledged this expectation. Review of the facility's urinary catheter policy indicated that catheter tubing and drainage bags must be kept off the floor.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency occurred when the facility failed to complete a comprehensive skin assessment upon admission for a female resident with multiple diagnoses, including diabetes mellitus type 2, severe obesity, and a stage 2 sacral pressure ulcer. The resident was admitted from the hospital with a documented stage 2 pressure injury, but the hospital discharge information did not include wound measurements. Upon admission, only a basic skin assessment was performed by an LPN, which noted bruising on the forearms but did not identify the sacral wound. A comprehensive skin assessment was not completed until two days after admission, at which point an RN documented the stage 2 sacral wound and its measurements. Due to the lack of an initial comprehensive assessment, there was no documentation to determine whether the pressure injury had worsened or improved since admission. The DON confirmed that a comprehensive skin assessment should have been completed upon admission, but this was not done, resulting in incomplete documentation and monitoring of the resident's pressure injury.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide the necessary supervision to prevent accidents for a resident, identified as R5, who required close supervision while eating due to aspiration precautions. On the morning of July 31, 2024, a surveyor observed R5 eating breakfast alone in his room without any staff present, despite his care plan and speech therapy recommendations indicating he needed supervision. R5's care plan, updated earlier in the month, specified that he should not be left alone with food and required assistance with eating. However, a Licensed Practical Nurse (LPN) left R5 unattended after administering medication, assuming a Certified Nursing Assistant (CNA) would arrive shortly to assist. The CNA, upon entering the room, expressed surprise that R5 had been given his plate without supervision, acknowledging that R5 was supposed to be monitored while eating. The CNA attributed the oversight to possible miscommunication or lack of awareness by the part-time LPN. Interviews with the LPN, Medical Director, and Speech Language Pathologist confirmed the requirement for supervision and the potential risk of choking if not adhered to. The incident highlighted a lapse in communication and adherence to care protocols, resulting in R5 being left unsupervised during a meal, contrary to his documented care needs.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to accurately assess and manage the pain of a resident, identified as R22, who was reviewed for pain management. The facility's policy requires pain assessments upon admission, quarterly reviews, significant changes in condition, and onset of new or worsening pain. However, R22's pain assessments were inconsistent and did not accurately reflect the resident's pain experience. For instance, R22's pain was documented as sharp and stabbing in the groin prior to hospitalization, but subsequent assessments failed to consistently identify the location and intensity of pain, which varied from 2/10 to 8/10. Additionally, the care plan was not individualized, as it only mentioned migraines and did not address other pain areas such as the back and legs. R22's physician orders included PRN Tylenol #3 and Extra Strength Tylenol, but no non-pharmacological interventions were ordered, and there were no scheduled pain medications. The Medication Administration Record (MAR) showed that R22 experienced moderate to severe pain on numerous days, yet the care plan did not reflect these findings. During interviews, R22 reported significant pain in his legs and back, which limited his mobility and ability to get out of bed. Despite these complaints, the facility did not reassess or adjust the pain management plan to address the resident's needs adequately. Interviews with staff, including a CNA and an LPN, revealed that R22's pain was not consistently managed, and there was a lack of communication regarding the resident's pain levels and management strategies. The LPN acknowledged that R22 had pain most days and attempted to get a scheduled pain medication order, but the physician did not approve it. The Director of Nursing (DON) admitted that the assessments did not indicate the location of R22's pain and recognized the need for changes. The failure to conduct comprehensive pain assessments and provide individualized care resulted in unmet pain management needs for R22.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to implement enhanced barrier precautions (EBP) for a resident with a Kennedy terminal ulcer, which was in-house acquired and staged by hospice. The deficiency was identified when a surveyor observed a Certified Nursing Assistant (CNA) performing personal care for the resident without donning a gown, despite the presence of a yellow sign on the resident's door indicating that EBP was required. The CNA acknowledged the mistake, attributing it to a misunderstanding during the morning report, where she believed she was informed that EBP precautions were no longer necessary. The Director of Nursing (DON) confirmed that the EBP had been reinstated over the weekend after the resident's wound reopened, but this information was not communicated to the nursing staff on Monday. The facility's procedure for EBP involves the DON or Assistant Director of Nursing (ADON) determining the need for precautions, placing signage, and informing the floor nurse, who is then expected to relay the information to other nursing staff. The lack of proper communication led to the CNA not following the required EBP, resulting in the deficiency.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to establish a governing body responsible for implementing policies regarding management and operation, leading to significant financial arrears that directly affect resident care. The facility owes substantial amounts to various service providers, including pharmaceutical services, staffing agencies, and electronic healthcare software providers. These overdue balances have resulted in some vendors ceasing their services, which could impact the quality of care provided to the 25 residents in the facility. The Nursing Home Administrator (NHA) indicated that financial concerns are not regularly discussed in meetings with the governing body, and the NHA has limited control over financial matters, which are managed by an external service center and the owner. Interviews with various representatives from service providers confirmed the outstanding balances and the cessation of services due to nonpayment. For instance, Pharm America, which provides medications for residents, has not received payment in 122 days and is considering switching to a cash-in-advance model. Other vendors, such as staffing agencies and suppliers of personal and medical supplies, have also stopped providing services due to unpaid invoices. The facility's financial issues are further compounded by overdue rent payments and bed taxes owed to the state. The owner admitted to hiring and subsequently terminating a financial management company, Future Care Consultants, which disrupted the facility's cash flow. The owner claimed that all vendors have been paid, but surveyors found evidence to the contrary. The NHA and the owner both acknowledged that financial concerns are not adequately addressed in Quality Assurance Program Improvement meetings, and the facility is currently transitioning to a new financial management service, Wipfli, to handle accounts payable and receivable.