Life Care Center Of Pueblo

F-F600 for failure to keep a resident free from abuse.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 0610 C. Facility investigation of incident between RN #1 and Resident #3

Level of Harm - Minimal harm or The [DATE REDACTED] facility investigation was provided by the nursing home administrator (NHA) on [DATE REDACTED] at 12:45 potential for actual harm p.m. The investigation was related to an allegation of sexual abuse in the early morning hours of [DATE REDACTED].

Residents Affected - Few The roommate of Resident #3 was interviewed by the facility on [DATE REDACTED] at 9:15 a.m. The roommate reported that RN #1 said she had come off of her break to deal with Resident #3. The roommate said Resident #3 had repeatedly yelled for RN #1 to stop. The roommate said RN #1 had hurt Resident #3 and she had heard her scream. The roommate said she had begun to pray for Resident #3.

RN #1 was interviewed by the facility on [DATE REDACTED] at 11:15 a.m. RN #1 said she administered a suppository

after digitally removing stool from the Resident #3's rectum. RN #1 said the care only lasted 15 to 20 seconds. RN #1 said Resident #3 never told her to stop.

On [DATE REDACTED] at approximately 3:00 p.m. the facility interviewed certified nurse aide (CNA) #5. CNA #5 said she helped RN #1 administer the suppository by rolling Resident #3 onto her side. CNA #5 said the nurse had to remove feces to get the suppository placed inside Resident #3. CNA #5 said RN #1 told Resident #3 I can't stop because I am trying to pull feces out so I can put the suppository in.

Resident #3 was interviewed by the facility on [DATE REDACTED] at 4:00 p.m. Resident #3 said she had been feeling constipated and had requested a suppository. Resident #3 said RN #1 had inserted more than three fingers inside her rectum, moving them around, during the medication administration. Resident #3 told RN #1 that it was hurting and to stop, but RN #1 did not stop. Resident #3 said she was told by RN #1 not to push her call light again after the incident. Resident #3 said she did not feel safe in the facility.

The investigation revealed the facility interviewed one additional staff member who was working the floor at

the time of the incident.

-However, the two additional staff members who were working at the time of the incident were not interviewed as part of the investigation.

According to review of the facility's investigation, three additional staff members from different shifts were interviewed and asked if they had ever witnessed staff members being sexually inappropriate with residents and if they had any concerns about the way staff members handled residents.

The facility interviewed five additional residents, asking each of them the following questions:

-Has a staff member ever been sexually inappropriate with you;

-Are you fearful of any staff members;

-Do you feel safe; and,

-Is there anything else you want the facility to know?

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 0610 -However, the facility failed to ask the residents any questions related to if any of them had ever experienced any care from staff that they felt had been provided in a forceful physical way. Level of Harm - Minimal harm or potential for actual harm The facility unsubstantiated Resident #3's sexual abuse related to the resident's emergency department (ED) visit had not noted trauma to the resident's rectal area. Residents Affected - Few -However, the facility failed to investigate the potential that physical abuse occurred due to the forceful way RN #1 administered the suppository to Resident #3, despite Resident #3 asking the nurse to stop.

D. Record Review

An emergency department (ED) visit progress note, dated [DATE REDACTED] at 3:23 p.m., documented Resident #3 appeared to be nervous. Resident #3 said she had been rectally assaulted, possibly for disimpaction, but against her will. The note documented the resident had a small external hemorrhoid at the 11 o'clock position of the rectum that was not bleeding and there were no overt tears, trauma, bleeding or bruising. The note further documented the rectum did not appear to be irritated but was mildly red inside.

III. Staff interviews

The NHA and the director of nursing (DON) were interviewed together on [DATE REDACTED] at 10:15 a.m. The NHA said he was the abuse coordinator for the facility. He said he was notified of a sexual abuse allegation on [DATE REDACTED]. The NHA said he followed the investigation procedure for a sexual abuse allegation.

The DON said the facility had not substantiated the sexual abuse allegation because the emergency room discharge stated no signs of trauma or assault.

The DON said RN #1 had been interviewed by a CNA who was helping out the social services department and was not a licensed social worker. The DON said she had not conducted the interviews because RN #1 was the DON's sister, so she had removed herself from the investigation. She said she did not think the assistant director of nursing (ADON) had conducted an interview with RN #1 in her place when she removed herself from the investigation.

The NHA said the interviews during the investigation should have been conducted by a qualified social worker or someone from the management team, and not the CNA who was not a licensed social worker.

During the interview, the NHA read aloud the interview that the facility had conducted with Resident #3's roommate. After reading the interview, the NHA said his first instinct would have been that there had been potential physical abuse, however, he said he did not recognize it at the time of the incident. The NHA said every staff member who was working on the shift when the incident occurred should have been interviewed.

51163

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 0660 Plan the resident's discharge to meet the resident's goals and needs.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 51160 potential for actual harm Based on record review and interviews, the facility failed to develop and implement an effective discharge Residents Affected - Few plan for one (#3) of three residents reviewed for discharge planning out of 13 sample residents.

Specifically the facility failed to assist Resident #3 in the development of a safe and appropriate discharge plan.

Findings include:

I. Facility policy and procedure

The Against Medical Advice (AMA) Discharges policy and procedure, August 2023, was provided by the nursing home administrator (NHA) on 8/7/24 at 2:30 p.m. It read in pertinent part, If a resident wishes to be discharged prior to the completion of medical treatment or against the advice of the attending physician to a setting that does not appear to meet their needs or appears unsafe, the facility will treat this a refusal of care.

The facility will complete the required documentation and provide written discharge instructions as with any discharge. If a discharge AMA cannot be prevented, a practitioner must evaluate the resident's mental capacity to be sure that the resident can understand the condition, the nature and effect of the proposed treatment, and the inherent risk/benefit in pursuing the treatment and not pursuing the treatment.

Documentation should include the resident's decision-making capacity, disclosed risks, and the resident's understanding of those risks. As with any discharge, the facility is required to provide written discharge instructions, including follow-up with practitioners, medication management, the need for continued therapy, and any durable medical equipment necessary. Notify the resident practitioner, the facility's social services department, and a facility administrator of the resident's desire to leave the facility AMA.

The AMA documentation includes: decision-making capacity, discussion of treatment goals (risks of not completing goals with resident understanding those risks), date and time the practitioner was notified of residents desire to discharge AMA, discharge arrangements made with caregiver/family member, written discharge instructions provided, person to whom resident was discharged , signed copy of the AMA form, physical assessment findings and education provided to resident and family (with understanding of that teaching).

II. Resident #3

A. Resident status

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 0660 Resident #3, age greater than 65, was admitted on [DATE REDACTED] and discharged to home on 6/7/24. According to

the June 2024 computerized physician orders (CPO), diagnoses included constipation, gastro-esophageal Level of Harm - Minimal harm or reflux disease (GERD), nausea, diabetes mellitus type 2, end stage renal disease and left leg below the knee potential for actual harm amputation.

Residents Affected - Few The 4/24/24 minimum data set (MDS) assessment revealed the resident was cognitively intact with a brief

interview for mental status (BIMS) score of 15 out of 15. She required a hoyer lift for transfers related to a recent left leg below the knee amputation.

The MDS assessment did not indicate the resident had an ongoing discharge plan.

B. Resident's representative interview

The resident's representative was interviewed on 8/7/24 at 12:55 p.m. The resident's representative said her mother had informed her of an incident which occurred in the early morning of 6/5/24. She said her mother had told her later in the morning (6/5/24) that she was scared and did not want to continue to live at the facility. The resident's representative said she spoke with the NHA to inform him of the abuse allegation. The resident's representative said Resident #3 went to dialysis on 6/5/24 and then to the hospital to be examined for a sexual assault allegation. The resident's representative said Resident #3 returned to the facility on [DATE REDACTED] so the family could have time to obtain a Hoyer lift (mechanical lift) and a medical bed in order to make preparations so Resident #3 could be discharged from the facility to live with her. The resident's representative was a certified nurse aide (CNA) and an emergency medical technician (EMT). The resident's representative said she had told the facility she wanted Resident #3 to discharge home with her, however,

she needed time to prepare.

The resident's representative said the NHA told her if she was taking Resident #3 out of the facility it would be AMA and he had forced her to sign the AMA paperwork on the discharge date of [DATE REDACTED]. The resident's representative said the facility did not send any discharge instructions, medications or a list of the current medications that Resident #3 was currently prescribed. She said Resident #3 went nearly two weeks without her blood thinner medication and other medications. The resident's representative said the facility did not send any paperwork with the resident. The resident's representative said the facility did not provide any assistance with the discharge planning process.

C. Record review

The AMA form, dated 6/7/24, was signed by the resident's daughter, the ombudsman and a registered nurse (RN). The discharge form documented, in pertinent part, I am being discharged against the advice of the attending physician and the facility administration. I acknowledge that I have been informed of the risks involved and hereby release the attending physician and the facility from all responsibility for and from anything that may result from such discharge. I am also aware that I will be responsible for any costs incurred tha my insurance company refuses to cover.

-Review of Resident #3's electronic medical record (EMR) did not reveal documentation indicating the facility had assisted the resident with discharge goals.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 0660 -The EMR failed to document the reasons for the AMA discharge, who had made the decision for the AMA discharge or if the interdisciplinary team (IDT) was involved with the decision to discharge the resident AMA. Level of Harm - Minimal harm or potential for actual harm -The EMR failed to document if the resident's physician or the medical director (MD) was notified of Resident #3's AMA discharge. Residents Affected - Few -A review of Resident #3's June 2024 CPO did not reveal a physician's order for the resident's discharge.

-The EMR did not reveal documentation to indicate that a discharge summary or any discharge documentation was sent with the resident.

III. Staff interviews

The NHA and the director of nursing (DON) were interviewed together on 8/7/24 at 10:15 a.m. The DON said

it was not been safe for Resident #3 to discharge home with family. The DON said the family had told the facility they were unable to care for the resident at home. The DON said the resident did return to the facility

after dialysis and the emergency department on 6/5/24 and was not discharged AMA until 6/7/24. The DON said the facility had wondered why Resident #3 had come back to the facility after her emergency department visit if the family had not wanted her there.

The DON said when the resident was first admitted to the facility she had planned to return home with her family. The DON said the resident's representative and the resident had made the decision to stay at the facility, as it was going to be difficult for the resident's representative to care for the resident at home. The DON said the facility made the decision to discharge Resident #3 AMA due to the fact that the resident's representative had told them she could not take care of her at home but was insisting on taking the resident home anyway. The DON said the resident's physician had not been notified prior to Resident's #3's discharge or that the resident left AMA.

The DON said Resident #3's EMR should have included documentation that she had been discharged home.

The DON said it was standard practice for the facility to notify adult protective services (APS) when a resident was discharged AMA, however, the DON said APS had not been contacted by the facility regarding Resident #3's AMA discharge.

The social services director (SSD), and the DON were interviewed together on 8/7/24 at 2:45 p.m. The SSD said a discharge summary should have been written and given to the family upon discharge. The SSD said

she did not know why a physician's discharge order was not obtained.

The SSD said although she was newly employed and was not hired at the time of Resident #3's discharge,

she said the practice was for the social worker to lead the discharge planning process. She said the social worker was to offer services and make referrals when needed. The SSD said the IDT was to complete a summary of the resident's stay.

The SSD said she reviewed Resident #3's EMR and said there was not any documentation or evidence which showed the resident was offered any services or discharge planning assistance. She said pertinent phone numbers, such as advocacy contact numbers, were not provided.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 0660 The MD was interviewed on 8/7/24 at 3:19 p.m. via telephone. The MD said there should have been a physician's discharge order when Resident #3 was discharged from the facility. The MD said the attending Level of Harm - Minimal harm or physician should have been notified and participated in the AMA discharge process. The MD said he was not potential for actual harm notified that Resident #3 had been discharged AMA.

Residents Affected - Few The dialysis center social worker (DSW) was interviewed on 8/15/24 at 9:33 a.m. via telephone. The DSW said the facility had not completed a safe discharge for Resident #3. The DSW said the facility left the resident's representative on her own with the discharge. The DSW said the facility did not provide discharge instructions, a medication list or the necessary equipment for Resident #3 to successfully discharge. The DSW said she picked up oxygen supplies at a medical supply company for Resident #3.

51163

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 51160 potential for actual harm Based on record review and interviews, the facility failed to provide treatment and care in accordance with Residents Affected - Few professional standards of practice and the comprehensive person-centered care plan for one (#3) of three residents reviewed for quality of care out of 13 sample residents.

Specifically the facility failed to:

-Follow the physician's standing orders for bowel management for Resident #3;

-Document the bowel medications that were administered to Resident #3;

-Document the nursing medication reassessment;

-Document the nursing abdominal and peri-rectal assessment; and,

-Document the digital fecal disimpaction (procedure of removing stool from the rectum with a finger) procedure for Resident #3.

Findings include:

I. Professional reference

Setya A, [NAME] G, Cagir B. (2023). Fecal Impaction. National Institutes of Health. Retrieved on [DATE REDACTED] from https://www.ncbi.nlm.nih.gov/books/NBK448094/. It read in pertinent part,

Fecal impaction is a significant but preventable problem in the elderly population within hospitals and other institutions. The best way to treat it is to prevent it from developing in the first place. The cause of constipation should be identified early and managed appropriately. The treatment options are the rectal administration of stool softening agents, usually enemas or suppositories or a digital evacuation of the impacted fecal mass. The procedure is best done using ample lubrication and gently removing the impacted stool with the index finger.

Treas, L.S., [NAME], K.L., & [NAME], M.H. (2022) Basic Nursing, Thinking, Doing and Caring, (Third edition), page 2065 was retrieved on [DATE REDACTED]. It read in pertinent part, A health record permanently documents: the care, in chronological order, performed by healthcare providers, responses to medications, interventions, and procedures.

Document the medication, time, dose, and route given, preadministration assessments, and your signature. Document all therapeutic and adverse effects of the medication. Also document your nursing interventions and teaching of potential adverse effects.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 Treas, L.S., [NAME], K.L., & [NAME], M.H. (2022) Basic Nursing, Thinking, Doing and Caring, (Third edition), pages ,d+[DATE REDACTED] was retrieved on [DATE REDACTED]. It read in pertinent part, Position patient on left side which helps Level of Harm - Minimal harm or with medication retention because the descending colon is on the left side, it also helps relax the external potential for actual harm anal sphincter (rectum). The patient should not experience pain during the administration of a suppository, but they will feel pressure. Encourage deep breathing to aid in relaxation of the sphincter. Pushing a Residents Affected - Few suppository through a constricted sphincter causes discomfort.

II. Facility policy and procedure

The Bowel Protocol policy and procedure, dated [DATE REDACTED], was provided by the NHA on [DATE REDACTED] at 8:44 a.m. It read in pertinent part, Provide effective interventions for signs and symptoms of constipation. Nursing staff will record, in the electronic health record (EHR), each time a resident has a bowel movement.

The Nursing Facility Standing Orders and Constipation policy and procedure, dated [DATE REDACTED], was provided by unit care coordinator (UCC) #1 on [DATE REDACTED] at 12:12 p.m. It read in pertinent part, The nurse may order the following if no bowel movement for three days: milk of magnesia; dulcolax suppository, fleets enema or senna. If standing orders are followed and not effective, report assessment of impaction, bowel sounds, vital signs, last BM (bowel movement) quality and quantity, presence of blood in stool, recent administration of narcotics and fluid intake.

III. Resident #3

A. Resident status

Resident #3, age greater than 65, was admitted on [DATE REDACTED] and discharged home on [DATE REDACTED]. According to

the [DATE REDACTED] computerized physician orders (CPO), diagnoses included constipation, gastro-esophageal reflux disease (GERD), nausea, diabetes mellitus type 2, end stage renal disease and left leg below the knee amputation.

The [DATE REDACTED] minimum data set (MDS) assessment revealed the resident was cognitively intact with a brief

interview for mental status (BIMS) score of 15 out of 15. The MDS assessment revealed dependent status required two staff assistance with hoyer for transfers.

B. Resident's representative interview

The resident's representative was interviewed on [DATE REDACTED] at 12:55 p.m. The representative said Resident #3's mother died at an early age from a bowel obstruction and therefore she was always concerned about her bowel regimen because she was fearful of an obstruction.

C. Record review

The [DATE REDACTED] CPO revealed the following physician's order for bowel management:

-Standing order/protocols, ordered on [DATE REDACTED];

-Colace 100 mg (milligrams) (laxative) oral capsule as needed, ordered on [DATE REDACTED];

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 -Fleet enema ,d+[DATE REDACTED] grams (g) per 118 milliliter (ml) enema as needed, ordered on [DATE REDACTED];

Level of Harm - Minimal harm or -Miralax (3350 powder) 17 g with 120 to 240 ounces (oz) of fluid as needed, ordered on [DATE REDACTED]; potential for actual harm -Bisacodyl 10 mg suppository as needed, ordered on [DATE REDACTED]; Residents Affected - Few -Miralax (1450 powder) 17 g with eight oz ounces of fluid was ordered daily, ordered on [DATE REDACTED] (started after

the disimpaction procedure on [DATE REDACTED]); and,

-Senna-docusate sodium 8XXX,d+[DATE REDACTED] mg oral tablet was ordered nightly, ordered on [DATE REDACTED] (started

after the disimpaction procedure on [DATE REDACTED]).

The bowel and bladder elimination tracking record ([DATE REDACTED] to [DATE REDACTED]) revealed the following:

On [DATE REDACTED], the resident had a large bowel movement.

On [DATE REDACTED], it was documented a response was not required.

On [DATE REDACTED], it was documented a response was not required

On [DATE REDACTED], there was no documentation.

On [DATE REDACTED], it was documented a response was not required.

On [DATE REDACTED] at 12:55 a.m., it was documented a response was not required

On [DATE REDACTED] at 5:39 p.m., it was documented the resident had a small bowel movement.

On [DATE REDACTED], it was documented a response was not required.

On [DATE REDACTED] at 12:51 a.m., it was documented the resident had a medium bowel movement.

-According to the [DATE REDACTED] medication administration record (MAR) the resident did not receive any as needed laxatives, softeners or enemas after she had gone four days ([DATE REDACTED] to [DATE REDACTED]) without any bowel movement.

-The facility failed to follow the standing physician's orders for bowel management.

-Review of Resident #3's electronic medical record (EMR) did not reveal documentation regarding RN #1's assessment of the resident's bowel status or the procedure for the fecal disimpaction and suppository administration in the early morning hours of [DATE REDACTED] (see interviews below).

IV. Staff interviews

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 21 065269 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 065269 B. Wing 08/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Pueblo 2118 Chatalet LN Pueblo, CO 81005

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 Unit care coordinator (UCC) #1 was interviewed on [DATE REDACTED] at 12:00 p.m. UCC #1 said all medications that were administered needed to be documented as administered in the resident's EMR. UCC #1 said there was Level of Harm - Minimal harm or a standing order list (a list of common medical issues with steps and medications for the nurses to utilize). potential for actual harm UCC #1 said constipation was one of the common issues that occurred with residents that was included on

the standing physician's orders. Residents Affected - Few

The director of nursing (DON) was interviewed on [DATE REDACTED] at 3:48 p.m. The DON said residents' bowel movements were charted by the certified nurse aides (CNA). The DON said the standing physician's orders for bowel protocol began with the most gentle laxative and increased in strength if it was found to be unsuccessful. The DON said the nurses would give a stool softener, then milk of magnesia (laxative), then a suppository or enema. The DON said registered nurse (RN) #1 did not document in Resident #3's EMR that

she performed a fecal disimpaction or administered the suppository on [DATE REDACTED].

RN #1 was interviewed on [DATE REDACTED] at 7:24 p.m. RN #1 said Resident #3 had complained of constipation on

the previous day ([DATE REDACTED]). RN #1 said she had given Resident #3 milk of magnesia (laxative) and miralax (laxative) which helped the resident have a few small bowel movements. RN #1 said the resident had requested a Bisacodyl suppository (laxative).

-However, RN #1 did not document that she had administered the resident milk of magnesia, miralax or the suppository (see record review above).

RN #1 said as part of her assessment, she had listened to bowel sounds, palpated her stomach and verified that the resident was able to pass gas. RN #1 said she had explained to the resident that there was a need for digital fecal disimpaction. RN #1 said the resident was educated that stool needed to be removed for the suppository to work properly.

RN #1 said she lubricated her finger and massaged the lubrication around the edge of the rectum. She said some small stool exited the rectum with the lubrication and palpation around the resident's rectum. RN #1 said there were many little, hard, shaped balls of stool in different sizes from small to quarter sized. RN #1 said she may have forgotten to chart the administration of the suppository and the fecal disimpaction.

The DON was interviewed a second time on [DATE REDACTED] at 10:15 a.m. The DON said RN #1 should have documented the abdominal and rectal assessment, digital stool removal and the fecal disimpaction. The DON said all medications and treatments given to residents should be documented on the MAR when given.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 21 065269