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Complaint Investigation

Russell Regional Hospital Ltcu

September 16, 2025 · Russell, KS · 200 S Main Street
Citations 12
CMS Rating 1/5
Beds 23
Provider ID 17E619
Healthcare Facility
Russell Regional Hospital Ltcu
Russell, KS  ·  View full profile →
Inspection Summary

RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS — inspection on September 16, 2025.

Found 12 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0605
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Potential for More Than Minimal Harm

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0605 during a standard health inspection conducted on 2025-09-16.

Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies

The facility was found deficient in the following area: Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0606 during a standard health inspection conducted on 2025-09-16.

Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies

The facility was found deficient in the following area: Not hire anyone with a finding of abuse, neglect, exploitation, or theft.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

the facility Board Chair to approve the policy. An injury to the resident should be classified as an injury of unknown source when both of the following conditions are met: the source of the injury was not observed by any person, or the source of the injury could not be explained by the resident or staff, and the injury is suspicious because of the extent of the injury or the location of the injury (the injury is located I an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or incidents of injuries over time. At the time the injury is discovered, it is not known how the resident hurt themselves; caregiver misconduct cannot be ruled out.

All incidents of unknown source must be reported immediately to the director of the facility or the nurse on call.

The director or charge nurse on duty at the time must ensure that the resident/residents are not in danger of subsequent incidents of injury or misconduct.

The risk manager or social service staff would initiate an internal investigation and take whatever steps are necessary to ensure residents are protected while a determination of the matter is pending. An internal investigation would determine what, if anything, happened.

The resident's guardian or Durable Power of Attorney (DPOA) would be notified.

The risk manager or social service would document the results of the investigation and report the results within five working days of the incident, if deemed appropriate.

Any incident in which a crime may have occurred would be forwarded to the appropriate law enforcement agency.

Failure to report incidents may result in immediate termination of employment.

Facility ID:

17E619

IDENTIFICATION NUMBER:

17E619

A.

Building

COMPLETED

09/16/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Russell Regional Hospital Ltcu

200 S Main Street Russell, KS 67665

SUMMARY STATEMENT OF DEFICIENCIES

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0657 during a standard health inspection conducted on 2025-09-16.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

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Administrative Staff F stated she had sent this incident to the state agency and also to the State Board of Nursing.

Administrative Staff B further stated that the video was difficult to see what had happened, but could see that LN H did not assist CNA N.

Administrative Staff B further stated R3 did not appear to be in distress, and LN H no longer worked at the facility.

Administrative Staff B stated the investigation was closed.On 09/16/25 at 12:45 PM, LN G stated R3 required supervision and cuing with her meals. LN G further stated that she was not aware of any time R3 choked on her food or had concerns with drooling.On 09/16/25 at 02:30 PM, Administrative Nurse D stated that LN H had not reported the incident to her, and she no longer worked at the facility.

Administrative Nurse D stated she had seen the video, and she could see that LN N had not assisted CNA N to retrieve food from R3's mouth.

Administrative Nurse D stated both LN H and CNA N were wrong in how the situation was handled.

Administrative Nurse D stated that there were no assessments of R3's lungs completed by the nurse, except for her blood pressure and pulse, and the incident was not documented in the EMR or the follow-up of the incident in the EMR.

The facility's Condition Change of the Resident policy, dated 06/01/19, documents that staff are to observe, record, and report any condition change to the attending physician so proper treatment can be implemented.

After all resident falls, injuries, or changes in physical or mental function, monitor the following: alterations in consciousness, sensory weakness, generalized weakness, and speech disorder.

Staff are directed to take vital signs and include temperature, complete an incident, accident, or risk management report per facility policy.

The policy documents staff would notify the resident's responsible party and monitor the resident's condition frequently until stable.

Staff documents the date, time, and condition change was identified, observes the resident, notifies the physician, and responsible party.

Document observation of the resident at least every shift until the condition was stable.

Facility ID:

17E619

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0689 during a standard health inspection conducted on 2025-09-16.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0757 during a standard health inspection conducted on 2025-09-16.

Category: Pharmacy Service Deficiencies

The facility was found deficient in the following area: Ensure each resident’s drug regimen must be free from unnecessary drugs.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0761 during a standard health inspection conducted on 2025-09-16.

Category: Pharmacy Service Deficiencies

The facility was found deficient in the following area: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

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Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0851 during a standard health inspection conducted on 2025-09-16.

Category: Administration Deficiencies

The facility was found deficient in the following area: Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0868 during a standard health inspection conducted on 2025-09-16.

Category: Administration Deficiencies

The facility was found deficient in the following area: Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-09-16.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Provide and implement an infection prevention and control program.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

Federal health inspectors cited RUSSELL REGIONAL HOSPITAL LTCU in RUSSELL, KS for a deficiency under regulatory tag F-F0882 during a standard health inspection conducted on 2025-09-16.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RUSSELL REGIONAL HOSPITAL LTCU.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-29.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in RUSSELL, KS, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from RUSSELL REGIONAL HOSPITAL LTCU or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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