Baptist Health Care Center

F-F689 is considered past non-compliance. The facility implemented corrective actions as follows:

* Completed immediate education on gait belt use and transfer policy and procedure to staff working on the neighborhood where the resident resided.

* The provider and resident representative notified of the incident and the resident transferred to the emergency room .

* Placed CNA (#1) on administrative leave on 12/18/24 until further investigation and education provided.

* Completed written education through the facility notification system to all direct care staff regarding gait belt use, transfer safety, and referencing resident care plans for ordered transfer status on 12/20/24.

* Implemented required completion of skill competency for all direct care staff related to gait belt use and proper transfer technique in and out of wheelchairs.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 2 of 3 355058 Department of Health & Human Services Printed: 09/11/2025 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 355058 B. Wing 01/02/2025

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

Baptist Health & Rehab 3400 Nebraska Drive Bismarck, ND 58503

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 0689 * Updated the orientation competency checklist to include gait belt use and proper transfer technique for new hire and travel direct care staff. Level of Harm - Actual harm * An in-depth root cause analysis completed on 12/19/24. Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 3 355058