Walker Methodist Westwood Ridge Ii

if a written notice of discharge had been provided before discharging from the facility.On 4/14/26 at

transfer but was verbally reviewed with the resident at a later date.

The DON stated she would

8:21 a.m., the DON stated that when someone was discharged , staff would complete a recapitulation of the resident's stay that was given to the resident and signed on discharge.

The DON stated that facility staff would also give the resident a Notice of Medicare Non-Coverage, but giving a written facility discharge notice as soon as a discharge date was known was not part of their process.The facility's Discharge and Transfer policy dated 4/1/26, indicated that discharge and transfers will comply with federal regulations, including providing the required written notice.

The policy indicated that the written notice would include the applicable appeal rights.

245618 04/15/2026

Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118

During an interview on 4/15/26 at 8:25 a.m., the director of nursing (DON) stated that when nursing completed their admission assessment, there were boxes that should have been checked to trigger the residents' baseline care plans, but that did not happen for some residents.

The DON stated additional education was needed for nursing staff, so she scheduled a meeting with the staff for tomorrow.

The DON stated that she expected the baseline care plan to be formed within 48 hours.

The DON stated she would expect this to include the resident's immediate care needs, safety risks, and preferences.

Care and Service Plans dated 3/1/26, indicated that baseline care plans would be developed within 48 hours of admission, which would identify the minimum necessary interventions to address immediate care needs, safety risks, and preferences.

The policy indicated the baseline care plan would address initial goals based on the admission assessment, identified risks and safety needs, orders and immediate interventions, resident preferences, and advance directives.

245618 04/15/2026

Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118

During continuous observation on 4/14/26 from 12:21 p.m. to 12:31 p.m., R42 received her lunch tray and was observed eating unsupervised.

During an interview on 4/14/26 at 12:45 p.m., nursing assistant (NA)-A stated staff had access to Kardex information directing resident care and acknowledged R42 required supervision due to pocketing of food.

However, NA-A described supervision as checking on the resident every hour or so.

During an interview on 4/14/25 at approximately 2:00p.m., clinical coordinator and licensed practical nurse (LPN)-A stated a referral for speech therapy was received from the nurse practitioner yesterday (4/13/26) and the speech therapy evaluation was completed the same day. LPN-A confirmed awareness of the supervision order but described it as periodic checks and was unable to define the frequency. LPN-A further stated the resident was not considered a choking risk despite documented pocketing.

During an interview on 4/14/26 at 3:18 p.m., the director of therapy stated the speech therapist (ST)-A was recommending full supervision with meals due to R42 holding solids in her mouth at all times, stating R42 had not only swallowing issues but cognition issues as well.

The DOT stated nursing staff may need more education on what supervision with meals meant and why it was implemented.

During an interview on 4/15/26 at 9:26 a.m., ST-A stated her order for R42 to be supervised with meals was intended to ensure staff were present during meals for R42's safety due to pocketing of foods. ST-A stated she would clarify the order to ensure R42 received adequate supervision.

245618 04/15/2026

Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118

During an interview on 4/14/26 at 10:03 a.m., registered nurse (RN)-B stated that medication side effect monitoring should show up on each residents' medication and treatment administration record to be documented on every shift.

During an interview on 4/14/26 at clinical coordinator and licensed practical nurse (LPN)-A confirmed R42 did not have any medication side effect monitoring in place and that it would be expected.

During an interview on 04/15/2026 at 8:36 AM, the director of nursing (DON) stated that side effect monitoring is focused more closely on high-risk medications.

This monitoring is incorporated into the care plan, with specific elements added to the kardex for aides to observe.

The DON explained that anticoagulants are monitored for signs of bleeding or bruising. A facility policy on side effect monitoring was requested and not received.

245618 04/15/2026

Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118

During an observation on 4/15/26 at 7:39 a.m., Licensed Practical Nurse (LPN)-B was present on the unit providing care and administering medications to R49 on contact precautions.

Isolation signage on R49's door directed staff and providers to don gloves and gown prior to room entry, use dedicated or disposable equipment and disinfect reusable equipment after use.

However, staff demonstrated inconsistent adherence to these precautions.

Certified Nursing Assistant (CNA)-B was observed entering the room without personal protective equipment (PPE) to obtain R49's weight.

LPN-B also entered R49's room to obtain vital signs, including applying a blood pressure cuff directly to the resident's arm without gloves, scanning the resident's forehead for temperature, and placing an oximeter on the resident's finger, all without use of PPE.

During conversation, CNA-B stated she believed PPE was only required during personal care activities and not for tasks such as vital signs or weights.

Additionally, LPN-B stated staff were unsure when to utilize gowns and gloves and expressed confusion regarding the difference between enhanced barrier precautions and contact precautions.During a subsequent observation on 4/15/26 at approximately 8:10 a.m., LPN-B was observed transporting a vital signs (VS) tower from R49's room, who was on contact precautions, directly into the room of R50, who was also on contact precautions, without cleaning or disinfecting the equipment between uses.

This was inconsistent with isolation signage and infection control practices requiring the use of dedicated equipment or appropriate disinfection of reusable equipment between residents.

During an interview on 4/15/26 at 8:36 a.m., the Director of Nursing (DON) and infection preventionist (IP) stated staff were expected to follow the isolation signage, which required the use of gown and gloves when entering a room for residents on contact precautions and cleaning of vital sign equipment with bleach between uses.

The DON acknowledged this had been identified as an area needing improvement during a recent mock survey and reported that staff had received retraining on these infection control practices.A facility policy titled Transmission-Based Precautions, dated 1/1/26, indicated when a resident was on contact precautions, staff should wear gloves and a gown upon room entry when contact with infectious material is anticipated and dedicate equipment when able or disinfect prior to use with other residents,