Highland Manor Of Elko Rehabilitation Llc
HIGHLAND MANOR OF ELKO REHABILITATION LLC in ELKO, NV — inspection on July 18, 2024.
Found 20 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
call light was not draped over an oxygen concentrator and out of reach of the resident for 1 of 18
Findings include: Resident #53 Resident #53 was admitted to the facility on [DATE], with diagnoses including unspecified dementia, unspecified severity, with agitation, muscle weakness, generalized, and anxiety disorder. Resident #53's Care Plan initiated on 04/18/2024, and revised on 07/15/2024, documented the resident was at risk for falls related to generalized muscle weakness, history of falls, incontinence, and dementia.
Interventions included to encourage the resident to call for assistance before getting out of bed or transferring and was an extensive one person assist with stand pivot transfers.
On 07/15/2024 at 1:25 PM, Resident #53 was in bed trying to straighten the bed blankets over the resident's legs with the call light draped over the running oxygen concentrator.
The resident was not able to reach the call light.
On 07/15/2024 at 1:30 PM, a Certified Nursing Assistant (CNA) entered the room and could not initially find the resident's call light device.
The CNA found the call light device draped over the oxygen concentrator and attached the call light device to the resident's blanket.
The CNA confirmed the resident could not reach the call light while it was draped over the oxygen concentrator and would have to yell for help.
The CNA explained Resident #53 knew how to use the call light device.
On 07/17/2024 at 3:29 PM, a Licensed Practical Nurse (LPN) explained Resident #53 was able to use the call light device when needed.
The LPN explained the resident would be unable to reach the call light if it were draped over the oxygen concentrator.
The facility policy titled Responding to Resident Needs, revised 10/2010, documented the primary means for a resident to communicate their need for staff assistance was via the call light.
When the resident was in bed or confined to a chair be sure the call light was within easy reach of the resident.
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agencies.
minimal harm Based on observation and interview, the facility failed to ensure the most recent survey results were made available in the facility's secured memory care unit to be readily accessible to residents and
Findings include: On 07/17/2024 at 9:19 AM, there was no evidence the survey results were available for visitors and residents within the facility's secured memory care unit to read.
On 07/17/2024 at 9:19 AM, a Registered Nurse (RN) in the memory care unit verbalized being unsure if or where the survey results were available.
On 07/18/2024 at 8:50 AM, the Administrator verbalized visitors could use the entrance to the secured memory care unit.
The Administrator confirmed the survey results were not posted in the secured memory care unit and residents in the secured memory care unit did not have access to the survey results.
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fractured femur and had to have surgery to repair the fracture.
Agency because there was no indication abuse or neglect had occurred on behalf of the facility.
The
Administrator had conducted a facility investigation as a result of the fall.
The facility policy titled Abuse Prohibition and Reporting (Elder Justice Act), last revised 07/13/2023, documented if a resident had an event resulting in serious bodily injury, a report would be made to the State Agency, the Ombudsman's office and law enforcement.
The report would be made the State Agency no later than two hours after the incident.
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-ensuring the resident was in the center of the bed.
-putting dolls on the bed so the resident did not need to reach for them. -putting pillows at the resident's back. -rounding on the resident more often.
On 07/17/2024 at 9:54 AM, a Registered Nurse (RN) verbalized Resident #31 tended to fall out of bed when napping around 2:00 PM to 4:00 PM.
The resident would get up without asking for assistance.
The RN explained the facility implemented interventions to prevent injury when the resident did fall.
These included floor mats, lower bed, waking the resident earlier, and rounding more often. Resident #31's Care Plan with a focus initiated 04/25/2024, and last revised on 07/02/2024, documented Resident #31 was at risk for falling and fall-related injuries relative to hypertension, diabetes, generalized muscle weakness, and medications.
The Care Plan did not include interventions related to floor mats or the bed in a low position.
On 07/17/2024 at 3:31 PM, the DON verbalized the DON was not familiar with the facility's fall protocol.
After discussing with the MDS Coordinator, the DON confirmed if a resident used floor mats and the bed was in low position, both should be documented as interventions on the care plan.
The facility policy titled Care Plan Policy, revised 06/01/2022, documented the facility would develop and implement a Comprehensive Person-Centered Care Plan appropriate for each resident and would include measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that were identified in the resident's comprehensive assessment.
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catheter care, and appropriate care to prevent urinary tract infections.
observation, clinical record review, interview, and document review, the facility failed to ensure the
resident's bladder to prevent the potential for urine in the tubing and draining bag from flowing back into the bladder for 1 of 18 sampled residents (Resident #58).
Findings include: Resident #58 Resident #58 was admitted to the facility on [DATE], with a diagnosis of neuromuscular dysfunction of bladder, unspecified.
A physician's order dated 09/13/2023, documented, 16 French, 10 cubic centimeters, Foley catheter as needed related to neuromuscular dysfunction of bladder, unspecified.
On 07/17/2024 at 2:36 PM, Resident #58 was sitting in a wheelchair in the resident's room facing the door. An opened walker was in front of the resident.
The resident's catheter drainage bag was hanging from the top rung of the walker in front of the resident.
The catheter drainage bag was suspended higher than the resident's bladder while the resident had been sitting in the wheelchair.
On 07/17/2024 at 3:14 PM, the Director of Nursing (DON) entered Resident #58's room. Resident #58 was still seated in the wheelchair.
The DON confirmed the catheter drainage bag had been placed on the top rung of the walker while the resident had been out of the room and should have been placed below the resident's wheelchair, once the resident had returned to the room, to ensure proper drainage of the catheter.
The DON verbalized a catheter drainage bag hung above the level of the bladder could have resulted in a backup of urine and a possible urinary tract infection (UTI) to the resident.
The DON verbalized having been unsure if Resident #58 had a previous UTI since admitting to the facility.
A physician's order dated 02/09/2024, documented uric acid, culture and sensitivity laboratory tests related to neuromuscular dysfunction of bladder, unspecified.
An Antimicrobial Susceptibility and Organism Identification Report, dated 02/11/2024, documented the culture and sensitivity laboratory result for Resident #58 was positive for Klebsiella aerogenes.
The facility policy titled, Catheter Care, Urinary, revised 09/2014, documented a urinary drainage bag must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and draining bag from flowing back into the urinary bladder.
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care.
The CNA recalled the CNA had provided ostomy care to two residents in the facility.
lacked documented evidence the CNA was trained or evaluated for competency to perform changes of
On 07/18/2024 at 8:24 AM, a Registered Nurse (RN) explained nurses and CNAs were allowed to change ostomy bags however only nurses were allowed to change an ostomy wafer as changing of an ostomy wafer was outside a CNA's scope of practice.
On 07/18/2024 at 9:15 AM, during an interview with the DON, and in the presence of the Assistant Director of Nursing (ADON) and the Regional Nurse Consultant, the DON explained the DON's expectation of staff when changing an ostomy wafer was to assess the resident's skin integrity as feces sitting on the skin could cause skin breakdown. It was important to ensure a good seal from the wafer to the stoma to avoid leaking.
The DON explained nurses were allowed to change ostomy wafers but the DON was not aware of this skill being within the CNA's scope of practice.
The DON denied CNAs in the facility had received training or had a competency/skills assessment completed for changing of ostomy wafers.
The DON reviewed the Competency-Nurse Aide checklist and confirmed changing of an ostomy wafer was not included in the list of nurse aide skills.
The DON explained the facility used Lippincott Manual of Nursing as the standard of practice.
The Lippincott Manual of Nursing Practice indicated standards of care guidelines for care of the patient with an ostomy included assessment of peristomal skin with each pouching system change.
The DON confirmed it was not within a CNA's scope of practice to perform an assessment.
The facility policy titled Nursing Home Job Description Certified Nurse's Aide, revised 11/2017, documented the nurse aide's job function was to provide direct resident care as trained and specified in the job training.
Nurse aides were to participate in skills performance reviews as directed by the facility.
The facility standard of practice titled Lippincott Manual of Nursing Practice: 11th edition, documented standards of care guidelines - care of the patient with an ostomy included assessment of peristomal skin with each pouching system change, documentation of findings, and treatment of any abnormalities (skin breakdown because of leakage, allergy, or infection) as indicated.
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was turned off then something could happen to the resident's health and safety.
order from another nurse and carry it through unless the order was from a Physician Designee.
The facility policy titled Oxygen Therapy & Safety, last revised 04/09/2020, documented a Doctor would provide a physician order dictating when to use, how often to use, the liter flow and whether to use a cannula or mask.
Staff would be responsible to ensure safety of the resident during the use of oxygen therapy.
The facility policy titled Pharmaceutical Procedures, last revised 01/31/2024, documented all physician order's pertaining to resident medications were to be followed as written by the physician.
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(2006), updated October 2022, documented recommendations for MDRO prevention in long-term care
prevent transmission of infectious agents which were transmitted by direct or indirect contact with
residents with MDROs in single-resident rooms or cohorting residents with the same MDRO when a single room was not available. A single resident room was preferred for residents who require contact precautions.
The CDC document titled Frequently Asked Questions about Enhanced Barrier Precautions in Nursing Homes, dated 06/28/2024, documented EBP was recommended for residents with indwelling medical devices as indwelling medical devices placed residents at higher risk of carrying or acquiring an MDRO.
Indwelling medical devices were described as a direct pathway for pathogens to enter the body and cause infections.
Examples of indwelling medical devices included hemodialysis catheters.
Cross reference with tag F-F880
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facilities included using contact precautions in addition to standard precautions for those residents
prevent transmission of infectious agents which were transmitted by direct or indirect contact with the resident or the resident's environment.
Recommendations for resident placement included placing residents with MDROs in single-resident rooms or cohorting residents with the same MDRO when a single room was not available. A single resident room was preferred for residents who require contact precautions.
Healthcare personnel caring for residents on contact precautions should wear a gown and gloves for all interactions which may involve contact with the resident or potentially contaminated areas in the resident's environment.
Donning a gown and gloves upon room entry and discarding before exiting the resident room was done to contain pathogens.
The CDC document titled Transmission-Based Precautions, dated 04/03/2024, documented TBP was a second tier of basic infection control and was to be used in addition to standard precautions for residents who may be infected or colonized with certain infectious agents for which additional precautions were needed to prevent infection transmission.
Contact precautions were to be used for residents with known or suspected infections which represented an increased risk for contact transmission. In long-term care settings, room placement decisions were made while balancing risks to other residents. PPE was to be used appropriately including gloves and a gown. A gown and gloves were to be worn for all interactions which may involve contact with the resident or the resident's environment.
Donning PPE upon room entry and properly discarding before exiting the room was done to contain pathogens.
Cross reference with tag F-F880 On 07/17/2024 at 3:31 PM, during an interview with the DON and in the presence of the Regional Nurse Consultant, the DON verbalized the DON was not familiar with the facility's fall protocol to include the reference to interdisciplinary team minutes and did not know where to look to find them.
The DON left the interview to ask the Assistant DON.
Upon return, the DON verbalized being unsure how to access a resident's MAR.
Once the MAR was accessed, the DON was not sure how to interpret a checkmark on a resident's MAR for side effect monitoring.
The DON confirmed being unable to see whether side effects were exhibited for the resident per the MAR but did not know where to look for documentation of the side effects.
The DON left to ask the Assistant DON.
Upon return, the DON explained the DON's EMR training was informal and minimal.
The facility's DON job description signed by the DON on 06/21/2024, documented the DON was accountable for directing all clinical services of the facility and overseeing nursing staff training upon hire and ongoing in-service education programs.
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Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
minimal harm facility's secured memory care unit to be readily accessible to visitors and residents.
This restricted access to nursing hours had the potential to affect 27 residents.
Findings include: On 07/17/2024 at 9:19 AM, the secured memory care unit lacked nursing hours posted.
On 07/17/2024 at 9:19 AM, a Registered Nurse (RN) in the memory care unit verbalized nursing hours were not posted in the facility's secured memory care unit.
On 07/18/2024 at 8:50 AM, the Administrator verbalized visitors could use the entrance to the secured memory care unit.
On 07/18/2024 at 10:07 AM, the Administrator verbalized the nursing hours were not posted in the facility's secured memory care unit and confirmed the residents in the secured memory care unit did not have access to the nursing hours posted outside the memory care unit.
Based on observation, interview, and document review the facility failed to ensure expired
storage.
Findings include: On 07/17/2024 at 12:36 PM, during a review of a medication cart in the 600 hall and in the presence of a Registered Nurse (RN), the following items were found: -A bottle containing Fish Oil 1200 milligrams (mg) (360 mg Omega-3) capsules.
The expiration date on the bottle was January 2024. -A bubble pack containing 25 tablets of Tramadol 50 mg.
The expiration date on the bubble pack was 05/14/2024.
On 07/17/2024 at 12:41 PM, the RN explained facility staff did a monthly check of the medication cart for expired medications.
The RN explained the importance of removing expired medications from a medication cart was residents could get sick if an expired medication was administered.
On 07/17/2024 at 2:22 PM, the Director of Nursing (DON) explained failure to remove expired medications from a medication cart could result in a medication error and expired medications, if administered to a resident, may not have the same effect as prescribed.
The facility policy titled Pharmaceutical Procedures, revised 01/31/2024, documented all expired medications were to be returned to the pharmacy for proper disposition and crediting considerations.
The only exception was for controlled drugs, which would be disposed of on the premises by two licensed staff.
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soiled equipment, and after engaging in any activity which would contaminate hands.
Hand antiseptic
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Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
the administering nurse did not document in the EMR. If monitoring was not completed, an indication
Resident #20's June 2024 TAR for treatment, side effect monitoring, pain monitoring, COVID-19
On 07/17/2024 at 2:33 PM, a Licensed Practical Nurse (LPN) explained a blank space on the TAR could mean the time frame for administration passed.
For monitoring, administering nurses had the whole shift to observe and document.
The LPN verbalized even if the resident was not available or outside of the facility, the administering nurse should indicate it on the TAR.
On 07/17/2024 at 4:06 PM, the Director of Nursing (DON) confirmed blank spaces on the TAR for treatment, side effect monitoring, pain monitoring, COVID-19 symptom monitoring, and behavior monitoring on the days and times mentioned above.
The DON explained those blank spaces meant the administering nurses forgot to document on those days and times.
The facility policy titled Psychoactive Medication Use, Intervention and Monitoring, revised 12/2016, documented if the resident was treated for altered behavior, the interdisciplinary team would document any improvements or worsening in the individual's behavior, mood, and function. If the resident used psychoactive medications, the psychotropic committee would monitor for side effects and complications related to those medications.
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dated 07/12/2022, described EBP as an infection control intervention designed to reduce
increased risk of acquiring MDROs, such as residents with wounds or indwelling medical devices.
hygiene supplies at the point of care.
Cross reference with tag F-F698, F-F726, F-F881, and F-F882
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Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
-Action: Implement at least policy or practice to improve antibiotic use.
-Tracking: Monitor at least one process measure of antibiotic use and at least one outcome from antibiotic use in the facility. -Reporting: Provide regular feedback on antibiotic use and resistance to prescribing clinicians, nursing staff, and other relevant staff.
Cross-reference with tag F-F880 and F-F882
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Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
isolation/treatment of infections.
documented it was the policy of the facility to follow nationally recognized standards and guidelines
implemented, in addition to standard precautions, and were based upon the means of transmission in order to prevent or control infections.
Contact precautions were implemented for residents known to be infected or colonized with organisms which could be transmitted by direct contact with the resident or indirect contact with environmental surfaces or resident care items in the resident's environment.
Examples of infections requiring contact precautions included but were not limited to skin or wound infections or colonization with MDROs.
Residents were to be placed in a private room or placed with a resident with the same infection with the same microorganism.
The CDC document titled Management of Multidrug-Resistant Organisms in Healthcare Settings (2006), updated 10/2022, documented recommendations for MDRO prevention in long-term care facilities included using contact precautions in addition to standard precautions for those residents whose infected secretions or drainage could not be contained.
Recommendations for resident placement included placing residents with MDROs in single-resident rooms or cohorting residents with the same MDRO when a single room was not available. A single resident room was preferred for residents who require contact precautions.
Healthcare personnel caring for residents on contact precautions should wear a gown and gloves for all interactions which may involve contact with the resident or potentially contaminated areas in the resident's environment.
Donning a gown and gloves upon room entry and discarding before exiting the resident room was done to contain pathogens.
The CDC document titled Transmission-Based Precautions, dated 04/03/2024, documented contact precautions were to be used for residents with known or suspected infections which represented an increased risk for contact transmission.
The CDC document titled Frequently Asked Questions about Enhanced Barrier Precautions in Nursing Homes, dated 06/28/2024, documented EBP differed from contact precautions as contact precautions required the use of a gown and gloves on every entry into a resident's room, regardless of the level of care being provided to the resident.
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administering the vaccine.
aged 65 years or more and all residents determined to be at high risk would be offered the
contraindications prior to administering the pneumococcal vaccine.
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Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
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Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 295078 B.
Wing 07/18/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
295078
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 295078 B.
Wing 07/18/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
Contact Precautions
On 07/15/2024 at 1:12 PM, room [ROOM NUMBER] had a CDC sign on the door indicating contact precautions were in place.
The sign stated everyone must perform hand hygiene before entering and when leaving the room, providers/staff must put on gloves and a gown before entering the room. A Personal Protective Equipment (PPE) cart was located outside the door, in the hallway.
The placard on the wall outside the room indicated the room belonged to Resident #40 and Resident #26.
Resident #40
Resident #40 was admitted to the facility on [DATE], with diagnoses including Parkinson's disease without dyskinesia, without mention of fluctuations, and pressure ulcer of right buttock, unstageable.
Resident #26
Resident #26 was admitted to the facility on [DATE], and readmitted on [DATE], with diagnoses including chronic kidney disease, stage five and type two diabetes mellitus with diabetic chronic kidney disease.
On 07/16/2024 at 8:31 AM, Resident #26 explained the contact precaution sign on the resident's door was intended for Resident #40 due to wounds on Resident #40's legs. Resident #26 denied staff regularly wore a gown or gloves while providing care to Resident #26.
On 07/16/2024 at 3:15 PM, the IP/ADON explained the IP/ADON and/or the physician were able to make decisions on when to place residents on TBP or EBP.
The IP used resident symptoms to guide the decision on which precautions were appropriate and if a resident had a wound the facility was culturing it would be more of a contact thing.
The IP/ADON verbalized the facility used and followed CDC signage when placing a resident on TBP.
The IP/ADON explained if a resident was on contact precautions due to a wound, and the wound was covered with a dressing, staff were not required to wear PPE if the care being provided did not include contact with the resident.
The IP/ADON verbalized contact precautions and EBP were similar and it depended on if the infected area was covered or not.
On 07/16/2024 at 3:21 PM, the IP/ADON retrieved a copy of the CDC signage the facility used for EBP and contact precautions and placed them side by side.
The IP/ADON confirmed the sign for EBP instructed staff to don a gown and gloves prior to high-contact care activities.
The IP/ADON confirmed the contact precautions sign instructed staff to don a gown and gloves prior to room entering the room and sign did not specify PPE was only required for direct contact with the resident.
295078
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 295078 B.
Wing 07/18/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Highland Manor of Elko Rehabilitation LLC 2850 Ruby Vista Drive Elko, NV 89801
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.