Great Plains Post Acute

F-F675 also constituted substandard quality of care at 42 CFR 483.24.

The facility submitted an acceptable plan for removal of the immediate jeopardy on 03/04/25 at 08:46 PM which included the following:

Identify those residents who have suffered, or are likely to suffer, a serious adverse outcome as a result of

the alleged noncompliance:

1. Resident R77 is currently at the hospital.

2. Clinical managers will interview interviewable residents for last BM, signs and symptoms of constipation, and fecal impaction.

3. CNAs will document BMs before the end of their shifts.

4. Nurses will assess non interviewable residents for signs and symptoms of constipation or fecal impaction.

5. If any residents are identified with constipation and fecal impaction, MD will be notified, and orders will be follow as needed.

Specify the action(s) the facility will take to alter the process or system failure to prevent serious adverse outcome from occurring or recurring, and when the action(s) will be complete.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 5 175168 Department of Health & Human Services Printed: 09/07/2025 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 175168 B. Wing 03/05/2025

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

Excel Healthcare and Rehab Wichita 7101 E 21st Street North Wichita, KS 67206

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 0675 1. DON/designee will educate clinical staff on proper BM documentation, urinary output, signs and symptoms of constipation and fecal impaction. Level of Harm - Immediate jeopardy to resident health or 2. DON/designee will educate CNAs to document BMs on POC before they leave their shift. safety 3. DON/designee will educate nurses to review POC documentation before end of the shift that CNA has Residents Affected - Few completed BM documentation.

4. DON/designee will educate nurses to review alerts on PCC before the end of the shift.

5. DON/designee will educate Nurses to assess residents with no BMs for 3 days, signs and symptoms of impaction, or abdominal pain; notify MD; and follow physician's orders.

6. DON/designee will educate (in-services mentioned above) clinical staff prior to their next scheduled shift.

7. Unit manager will review POC documentation on daily clinical meeting to ensure compliance with BM documentation, urinary output and necessarily follow up.

8. DON will perform random audit on POC documentation, progress notes, MD notification, and medication administration for residents identified with no BM for 3 days or signs and symptoms of constipation or fecal impaction.

9. If additional discrepancies are identified, they will be corrected immediately according to physician's orders. ?

The surveyor verified the above corrective actions were implemented while on-site on 03/05/25. This deficient practice remained at a scope and severity of a G (isolated, actual harm).

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 5 175168