Centennial Post Acute

F 0641

Ensure each resident receives an accurate assessment.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** .Based on

record review and interview, the facility failed to ensure the MDS (Minimum Data Set, a federally required assessment) was accurately coded for venous ulcers for 1 resident (#5), out of 8 sampled residents. This failed practice placed the resident at risk for not receiving the necessary and/or appropriate care and services .Findings:Record review on 8/29/25, revealed Resident #5 was admitted to the facility with diagnoses that included dementia (a decline in intellectual functioning, including problems with memory, reasoning and thinking), Cerebrovascular Accident (CVA - also known as stroke, is when blood flow to a part of the brain is stopped either by a blockage or the rupture of a blood vessel) with left sided hemiparesis (partial paralysis of one side of the body), obesity, chronic pain, Diabetes Mellitus type II (disorder characterized by persistent high blood sugar levels and inability to use insulin properly), and neuropathy (nerve damage). Wound Review: Record review on 8/29/25 of SNF [Skilled Nursing Facility] Wound Care notes, dated 7/2/25, revealed: description of wound #2: left shin, diabetic wound. Further review of the SNF Wound Care notes dated 7/8/25 and 7/15/25 revealed wound #2 was now described as left shin, vascular wound. MDS Coding: Record review on 8/29/25 of the most recent MDS assessment, a quarterly assessment dated [DATE REDACTED], revealed the Resident was not coded for venous or arterial ulcers under section M1030: Number of Venous and Arterial Ulcers. Further review of the document revealed Look back period for all items is 7 days unless another time frame is indicated. Record review of the Center for Medicare & Medicaid Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual version 1.20.1 section M1030, dated 10/2025, revealed: Skin wounds and lesions affect quality of life for residents because they may limit activity, may be painful, and may require time-consuming treatments and dressing changes. The presence of venous and arterial ulcers should be accounted for in the interdisciplinary care plan. This information identifies residents at risk for further complications or skin injury . Review the medical record, including skin care flow sheet or other skin tracking form. Further review of the Center for Medicare & Medicaid Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual version 1.20.1, dated 10/2025, revealed: The results of the assessment, which must accurately reflect the resident's status and needs, are to be used to develop, review, and revise each resident's comprehensive plan of care.

During an interview on 8/29/25 at 4:29 PM Resident Care Manager (RCM) #8 stated that the facility had a contracted wound care provider who was classifying wounds. The RCM further stated that the facility discovered concerns regarding the incorrect classification of diabetic versus pressure. As a result, a different provider was utilized to classify the wounds correctly.

Residents Affected - Few

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Centennial Post Acute

9100 Centennial Drive Anchorage, AK 99504

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 0684

alert to be monitored by licensed nursing. Completed 6/14/2025.

Level of Harm - Minimal harm or potential for actual harm

Facility DON/designee provided re-education to licensed nurses on notification of provider for changes in condition and follow up on interventions implemented. Completed 6/14/2025. Facility DON/designee provided re-education to licensed nurses on facility neglect policy. Completed 6/14/2025.

Residents Affected - Few Facility DON/designee provided re-education to licensed nurses on resident assessment including: vital signs policy, identification of change in condition, what to do when there are changes in vital signs from resident baseline including retaking of the vital signs, asking the resident how they feel or if they feel different than baseline, notification of provider if nurse assessment indicates additional interventions, completing documentation of provider notification on changes in condition, follow up on changes in condition, and provider response. Once an acute change is addressed using provider orders, re-assess the resident at the end of treatment, notify the provider of current status for additional direction, and

On completing nursing charting on clinical alerts when a resident is having a change in condition and their assessment and follow up on their assessment.

The facility/DON provided re-education to the CNAs on notifying the licensed nurse on any changes they have noted on a resident for further assessment by the licensed nurse.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Centennial Post Acute

9100 Centennial Drive Anchorage, AK 99504

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 0760

Ensure that residents are free from significant medication errors.

Level of Harm - Minimal harm or potential for actual harm

.Based on record review, observation, and interview, the facility failed to discontinue a medication order when wound care orders had changed for 1 resident (#5) out of 8 sampled residents. Specifically, the facility continued administering Santyl (prescription enzymatic debriding agent used topically to remove dead tissue from chronic skin ulcers promoting healthy wound healing) ointment after the wound care plan was revised to discontinue its use. This failed practice led to thirteen administrations of a medication that was no longer required and further placed the resident at risk for unnecessary treatment, potential adverse effects, and harm .Findings:Record review on 8/29/25, revealed Resident #5 was admitted to the facility with diagnoses that included dementia (a decline in intellectual functioning, including problems with memory, reasoning and thinking), Cerebrovascular Accident (CVA - also known as stroke, is when blood flow to a part of the brain is stopped either by a blockage or the rupture of a blood vessel) with left sided hemiparesis (partial paralysis of one side of the body), obesity, chronic pain, Diabetes Mellitus type II (disorder characterized by persistent high blood sugar levels and inability to use insulin properly), and neuropathy (nerve damage). Review of Resident #5 physician's medication orders revealed: Santyl external ointment 250 unit/gm (collagenase). Apply to sacrum topically every day shift for wound care cleanse with wound cleanser, pat dry, apply Santyl to wound bed, cover with calcium alginate, and cover with foam dressing .Order Date 7/23/25. Start Date 7/24/25. End Date 8/29/25 Record review of Resident #5's physician's orders for wound care revealed: Sacral wound- Cleanse with wound cleanser, pat dry, apply barrier cream to peri wound, pack with CA [calcium] alginate ribbon, cover with foam Q2 [every 2] days and PRN [as needed]. One time a day every 2 day(s) for wound care.Order Date 8/11/25.Start Date 8/13/25

Review of the eTAR (electronic Treatment and Administration Record) revealed thirteen documented administrations of Santyl from the period of 8/14-29/25. An observation on 8/29/25 at 3:39 PM, revealed LN #3 applied Santyl ointment to a cotton tipped applicator and then applied Santyl to the skin surrounding the sacral wound bed (periwound) during Resident #5's wound care. During an interview on 8/29/25 at 4:29 PM Resident Care Manager (RCM) #8 stated Resident #5's wound care orders were changed on 8/13/25 and no longer required Santyl. RCM further stated the Santyl should have been discontinued.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Centennial Post Acute

9100 Centennial Drive Anchorage, AK 99504

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

checked by the nurses once daily and the out-of-range temperatures should have been reported to the maintenance department. The RCM further stated he/she would file a work order ticket. During an interview

on 8/29/25 at 1:49 PM, IP and RCM #1 stated the emergency kits found in the refrigerator were sent back to Pharmerica for replacement. Review of the facility's policy, Storage of Medication, dated 1/2023, revealed: Medications and biologicals are store properly, following manufacturers or provider pharmacy recommendations, to maintain their integrity and to support safe effective drug administration. Medications requiring refrigeration or temperatures between 2oC (Celsius) (36oF) and 8oC (46oF) are kept in a refrigerator with a thermometer to allow temperature monitoring . A temperature log or tracking mechanism is maintained to verify that temperature has remained within accepted limits. Insulin products should be stored in the refrigerator until opened. Review of the Food and Drug Administration (FDA) drug storage recommendation, accessed at https://www.accessdata.fda.gov/drugsatfda_docs, undated, revealed the medications in the emergency kit [listed above], should be stored in a refrigerator (36 to 46 F [2 to 8 C]).

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Centennial Post Acute

9100 Centennial Drive Anchorage, AK 99504

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 - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

clean technique and proper setup to reduce the potential for microbial contamination.Review of Resident #1's Progress Note, on 5/10/25 at 8:00 AM, revealed the G-Tube was replaced later that day: .orders received by on call.to insert new G-Tube. 15Fr [French - unit of measurement] tube placed using sterile technique added 15 cc to fill balloon. Tube auscultated for proper placement. Residual return present. Site cleaned, Ointment applied and T Drain [drainage tube] to cover. Resident tolerated well. 300 cc water administrated at this time.Review of Resident #1's Care Plan, last revised 3/3/25, revealed: Goal: The resident will remain free of side effects or complications related to tube feeding through review date.

Interventions: . G Tube Placement Check: After two weeks, if unable to verify tube placement by tube marking, you may measure the gastric residual.G Tube Site Check: G tube site will be checked for signs of skin irritation, discomfort, leakage, s/s [signs and symptoms] infection or skin ulceration. Monitoring of signs of complications shall occur prior to each feeding, tube flush or medication administration.Provide water flushes as ordered before and after medication administrations, tube feeds, and free water flushes. Tube site care Q [every] shift.During an interview with LN #4, on 8/29/25 at 9:17 AM, when asked if there were any infection control concerns with his/her makeshift dressing, LN #4 answered: I used the resident's clean room tape; the rubber band functioned as a clamp. The rip was internal to the tubing; meds were delivered past the tear. At the time I did not identify additional risks beyond leakage, but I recognize the ad-hoc (something improvised or temporary) nature isn't ideal and should involve provider notification and replacement as soon as possible.During an interview on 8/29/25 at 11:00 AM, Infection Preventionist (IP) stated that using tape or rubber bands to manage a leaking tube was not acceptable. A medical grade clamp should have been used to prevent leakage and electrolyte imbalance. When asked how LN #4 should have correctly fixed Resident #1's defective G-Tube, the IP stated that the correct action would have been to clamp the tube and replace it in-house, as G-Tubes can be replaced on-site if supplies were available. She further stated that using rubber bands poses infection control risks, though tape itself was less risky if clean, as G-tube care uses clean technique, reaffirming that staff were not trained to use rubber bands, as proper clamps were available.During an interview on 8/29/25 at 4:45 PM, the Director of Nursing (DON), when asked about clamping the G-Tube, he/she stated that most facilities have standard medical grade clamps available. The DON further addressed infection control practices, stating that audits were not consistently conducted and needed to be revamped. When asked about LN #4's makeshift G-Tube dressing and rubber band clamp, the DON acknowledged that no specific follow-up was done at that time and the use of rubber bands was not the standard practice promoted by the facility.Review of the facility's adopted Lippincott procedures 2009, accessed at: https://www.wolterskluwer.com/en/solutions/[NAME]-solutions/[NAME]-procedures Enteral nutritional practice recommendations: when troubleshooting a leaking gastrostomy tube, the nurse must follow aseptic technique and manufacturer-specific guidelines. Key steps include: verify placement and condition of tube; check balloon integrity, assess connections and ports, secure and protect the site, keep the site and tubing clean and dry. Use only medical-grade devices (such as clamps or securement devices; escalate for replacement then indicated. [NAME] emphasizes that the nurse should not improvise with non-sterile or non-medical materials to patch the tube.Review of the facility's policy Gastrostomy Feeding Tube, last reviewed March 2019, revealed: .6. Staff should monitor the enteral tube site for s/s leakage at tube entrance site, s/s infection, or skin irritation. 8. Whenever possible, a closed system will be used for the administration of tube feedings.10. Clean technique (including the use of gloves) will be used by staff when stopping, starting, flushing or administering medications per gastric tube.

Event ID:

Facility ID:

If continuation sheet