Walker Methodist Westwood Ridge Ii

resident's response, adverse effects, and effectiveness in the medical record.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 245618 Page 3 of 1 0 Department of Health & Human Services Printed: 06/12/2026 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 245618 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118 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)

if a written notice of discharge had been provided before discharging from the facility.On 4/14/26 at Level of Harm - Minimal harm 12:45 p.m., a call was attempted to Resident R35 with no answer.During an interview on 4/14/26 at 2:27 p.m., or potential for actual harm the DON stated that she had talked with facility staff, and Resident R35's notice of transfer was not given on transfer but was verbally reviewed with the resident at a later date. The DON stated she would Residents Affected - Few expect staff to provide the form to the resident or resident representative on transfer. On 4/15/26 at 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.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 245618 Page 5 of 1 0 Department of Health & Human Services Printed: 06/12/2026 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 245618 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118 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)

stated that the facility's electronic health record (EHR) had recently had an upgrade that changed the Level of Harm - Minimal harm way care plans were activated. LPN-A stated on the survey entrance, that they had noticed that some or potential for actual harm residents did not have baseline care plans completed. LPN-A stated that when nursing completed their admission assessment, this should have also triggered the baseline care plan to be formed, but it Residents Affected - Few didn't look like this information from the assessment had been pulled over to the baseline care plan.

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.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 245618 Page 7 of 1 0 Department of Health & Human Services Printed: 06/12/2026 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 245618 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118 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)

prevent accidents.

Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure adequate supervision

during meals for 1 of 1 residents (Resident R42) with a known swallowing impairment who had a physician Residents Affected - Few order for supervision related to holding food in the oral cavity (pocketing), and who was left unsupervised during meals despite documented risks. Findings include:Resident R42's face sheet indicated Resident R42 was admitted to the care facility on 4/6/26 with a primary diagnosis of pleural effusion. Resident R42's nutrition screen, dated 4/8/26, indicated Resident R42 was on a regular diet with regular textured foods and thin liquids. The screening further indicated that Resident R42 could not use a straw because of a past stroke and would self-select soft foods.Resident R42's progress note, dated 4/8/26 indicated Resident R42 was noted to have food resident in her mouth at 7:22 p.m., and Resident R42 required help eating due to spilling food on the floor. Resident R42's diet order, dated 4/13/26, indicated Resident R24 was to receive a minced and moist texture diet and required supervision while eating. Resident R42's orders also directed staff to perform oral care after oral intake and speech therapy to eval and treat swallow and cognition, also dated 4/13/26. Resident R42's speech therapy orders, dated 4/13/26, indicated Resident R42's diet change to minced and moist and for supervision with meals d/t [due to] food remaining in oral cavity.Kardex, printed 4/14/26, indicated Resident R42 required supervision with eating.During observation on 4/13/2026 at 12:21 p.m., Resident R42 was eating lunch alone in her room. Resident R42 demonstrated prolonged chewing with delayed swallow and was noted to hold food in oral cavity (pocketing). Drooling was observed throughout meal. During continuous observation on 4/14/26 from 12:21 p.m. to 12:31 p.m., Resident 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 Resident 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 Resident R42 holding solids in her mouth at all times, stating Resident 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 Resident R42 to be supervised with meals was intended to ensure staff were present during meals for Resident R42's safety due to pocketing of foods. ST-A stated she would clarify the order to ensure Resident R42 received adequate supervision.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 245618 Page 8 of 1 0 Department of Health & Human Services Printed: 06/12/2026 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 245618 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118 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)

Level of Harm - Minimal harm Based on interview and record review, the facility failed to ensure implementation of medication side or potential for actual harm effect monitoring for 1 of 1 resident (Resident R42) reviewed for anticoagulant use with a known risk of bleeding. Findings include: Resident R42's face sheet, printed 4/15/26, indicated Resident R42 was admitted to the care Residents Affected - Few facility on 4/6/26. Resident R42's Diagnoses, dated 1/31/25, indicated Resident R42 had a diagnosis of unspecified atrial fibrillation. Resident R42's Orders, indicated an order, dated 4/6/26, for Eliquis (a blood thinning/anticoagulant medication) 2.5 milligram (MG) two times a day. The most common serious side effect is bleeding (i.e., gum, nose, urine, or stools). Resident R42's electronic medical record (EMR), to include the medication and treatment administration record, active orders and care plan lacked evidence that Resident R42's was being monitored for side effects of anticoagulation medication. 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 Resident 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.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 245618 Page 9 of 1 0 Department of Health & Human Services Printed: 06/12/2026 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 245618 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Walker Methodist Westwood Ridge II 61 Thompson Avenue West West Saint Paul, MN 55118 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)

Level of Harm - Minimal harm Based on observation, interview, and document review, the facility failed to implement and ensure or potential for actual harm adherence to infection prevention and control practices, including appropriate use of personal protective equipment (PPE) and proper cleaning and disinfection of shared equipment for residents on Residents Affected - Few contact precautions. This deficient practice placed 2 of 2 residents (Resident R49 and Resident R50) observed on contact precautions at increased risk for the transmission of infectious organisms. Findings include:Resident R49's face sheet, printed 4/15/26, indicated Resident R49 was admitted to the care facility on 4/8/26, and was on contact precautions for a history of Extended-Spectrum Beta-Lactamases (ESBL) (enzymes produced by certain bacteria that make them resistant to a variety of commonly used antibiotics).Resident R50's face sheet, printed 4/15/26, indicated Resident R50 was admitted to the care facility on 4/9/26, and was on contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) (a type of staph bacteria that's become resistant to many of the antibiotics used to treat ordinary staph infections). 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 Resident R49 on contact precautions.

Isolation signage on Resident 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 Resident R49's weight.

LPN-B also entered Resident 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 Resident R49's room, who was on contact precautions, directly into the room of Resident 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, FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 245618 Page 1 0 of 1 0