Missoula Health & Rehabilitation Center

The facility failed to trigger and complete the required staff assessment.

275035 03/26/2026

Missoula Health & Rehabilitation Center 3018 Rattlesnake Dr Missoula, MT 59802

until 3/24/26, despite identification of skin breakdown on 3/19/26.

This demonstrates a failure to

Policy Statement: It is the policy of this center that a resident who enters the center without pressure ulcer/injury does not develop pressure ulcer/injury unless the individual's clinical condition demonstrates that they were unavoidable and a resident having pressure ulcer/injury receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.

• For new skin impairment identified, the LN completes the following:

a.

Documents the skin impairment that includes measurements of location, size, color, presence of odor, exudate, and presence of pain associated with the skin impairment. [sic]

275035 03/26/2026

Missoula Health & Rehabilitation Center 3018 Rattlesnake Dr Missoula, MT 59802

Based on observation, interview, and record review, the facility failed to ensure temperatures were

placed residents who had or used refrigerated medications and vaccines at risk for experiencing adverse effects.

Findings include: During an observation and interview on 3/26/26 at 8:51 a.m., staff member Q stated the two refrigerators in the provider office were used to store medications and supplements.

Staff member Q stated the night shift nurse was supposed to check the refrigerator temperatures during their shift.

Staff member Q stated he could see some temperatures were missing from the log sheets with daily temperature monitoring displayed on both refrigerators.

The refrigerator had multiple types of medications and biologicals, including Tubersol (for tuberculin skin testing) boxes and influenza vaccine (FLUAD) boxes.Review of a facility document titled, Temperature Log for Refrigerator - Fahrenheit, dated 3/26, showed two pages of logs for temperatures for March 2026.

One page showed temperatures for days 1-15, and the second page had temperatures for days 16-31.

On the days of March 20 and 21 (2026), there were no staff initials, times, or temperatures noted on the log.Review of a facility policy titled, Storage of Medication, dated 1/25, showed: .

Medications and biologicals are stored properly. to keep their integrity and to support safe, effective drug administration. 11.

Medications requiring refrigeration or temperatures between . 36 F and . 46 F. are kept in a refrigerator with a thermometer to allow temperature monitoring. A temperature log or tracking mechanism is maintained to verify that temperature has remained within accepted limits.

The temperature of any refrigerator that stores vaccines should be monitored and recorded twice daily. If no vaccines are stored in the refrigerator, document temperature checks at least once daily.

275035 03/26/2026

Missoula Health & Rehabilitation Center 3018 Rattlesnake Dr Missoula, MT 59802

serve food in accordance with professional standards.

in the kitchen by ensuring staff with facial hair wore beard coverings while working in the kitchen.

facility's kitchen by increasing the risk of hair contamination in the food.

Findings include:During an observation on 3/23/26 at 1:56 p.m., staff member L was observed with facial hair and was not wearing a beard cover while working in the kitchen.

During an interview and observation on 3/25/26 at 11:51 a.m., staff member M was observed working in the kitchen with facial hair and was not wearing a beard cover.

Staff member M stated he should have been wearing a beard covering because of his facial hair.

During an interview on 3/25/26 at 11:53 a.m., staff member L stated staff with facial hair are required to wear beard coverings while working in the kitchen.

Review of the facility's policy titled, Personal Hygiene Standards, updated June 2021, showed, .2.

The following standards have been adopted by the FANS (Food and Nutrition Services) Departments:.k.

For those employees with beards, beard guards are worn.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

275035 03/26/2026

Missoula Health & Rehabilitation Center 3018 Rattlesnake Dr Missoula, MT 59802

During an interview on 3/25/26 at 7:59 a.m., staff member B stated that when a resident arrives at the facility, the ADON enters the medication orders, and the DON double-checks them.

Staff member B stated she did not know why the order showed hypertension and did not know how it was entered that way.

Staff member B stated she had done an audit and noticed it had the wrong diagnosis and changed it immediately.

During an observation and interview on 3/25/26 at 10:10 a.m., staff member N stated the rationale for resident #44's buspirone was hypertension, according to the label on the medication card.

Staff member N pulled out the medication card and showed this surveyor.

The medication card for resident #44's buspirone showed .for hypertension.

Staff member N stated the medication administration record is the same as the medication card from the pharmacy.

During an interview on 3/25/26 at 4:16 p.m., staff member O stated buspirone does not have any hypertensive agents but could be used to reduce anxiety and, as a result, reduce hypertension.

During an interview on 3/26/26 at 8:49 a.m., NF3 stated she was not sure how hypertension got attached to resident #44's buspirone order. NF3 stated, She (resident #44) has a history of depression and anxiety, but the medication is definitely not for hypertension. NF3 stated she (resident #44) does see psych services, and she came to the facility on that medication.

Review of a facility document titled Medication Administration General Guidelines dated 1/25, showed: Policy: Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices.3.

Prior to administration, review and confirm medication orders for each individual resident on the Medication Administration Record.

Compare the medication and dosage schedule on the resident's MAR with the medication label. If the label and MAR are different, and the container is not flagged indicating a change in directions, or if there is any other reason to question the dosage or directions, the prescriber's orders are checked for the correct dosage schedule.

Apply a direction change sticker to label if directions have changed from the current label.