Alta Skilled Nursing And Rehabilitation Center

F-F600

49557

Resident #455

Resident #455 was admitted to the facility on [DATE REDACTED], with diagnoses including end stage heart failure and anemia, unspecified.

A physician's order dated 05/24/2024, documented admit to Gentiva hospice, diagnosis heart failure with reduced ejection fraction.

Resident #455's care plan documented the following:

- Altered cardiovascular status related to permanent atrial fibrillation, congestive heart failure, pulmonary hypertension, hyperlipidemia and hypertension. The date initiated was 06/05/2024. Interventions included to administer medications as ordered. The date initiated was 06/05/2024.

-Potential for fluid and/or electrolyte imbalance related to diuretic use. The date initiated was 06/05/2024. Interventions included medications as ordered. The date initiated was 06/05/20204.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0849 On 06/12/2024 at 9:42 AM, the Licensed Practical Nurse (LPN) assigned to Resident #455 explained staff knew a resident's hospice plan of care (POC) by reviewing the resident's hospice binder and/or by speaking Level of Harm - Minimal harm or directly with hospice staff when hospice staff came to see the resident. The LPN explained changes in potential for actual harm condition, new medication orders, and any other concerns with the resident were communicated in the resident's hospice binder. The LPN located Resident #455's hospice binder and confirmed the binder lacked Residents Affected - Few a POC, orders, and communication between hospice and facility staff. The LPN denied hospice staff had communicated with the LPN regarding Resident #455.

A scanned document in Resident #455's clinical record, dated 06/04/2024, documented a physician's order to start Potassium Chloride Extended Release (ER), 10 milliequivalents (meq) ER tablet, give one tablet by mouth daily. Reason: Hypokalemia.

An Order Review History Report for Resident #455 lacked an order for Potassium Chloride ER.

On 06/12/2024 at 11:57 AM, the Director of Nursing (DON) explained facility staff communicated with hospice staff through the resident's hospice binder. The hospice binder typically contained contact information for the hospice provider, physician orders, and a POC.

The DON explained if a new order was received from hospice, the resident's nurse would notify the facility physician and if the physician agreed, the nurse would enter the order into the electronic medical record (EMR). The DON further explained if a new order was received on a weekday the nurse would also notify the Unit Manager (UM). The DON verbalized the expectation when a new order was received was the order would be entered into the EMR by the end of the shift.

During the interview, the DON reviewed Resident #455's clinical record. The DON confirmed a physician order dated 06/04/2024, with instruction to start Potassium Chloride ER, was scanned into the documents section of the resident's record. The DON confirmed Resident #455's clinical record lacked documented evidence the order for Potassium Chloride ER was communicated to the facility's physician, the facility's physician agreed with the order, and the order was entered into the EMR so it would reflect on the Medication Administration Record (MAR) as needing to be administered.

On 06/12/2024 at 12:18 PM, the DON contacted the facility physician via phone. The facility physician provided a telephone order to start Potassium Chloride ER per the faxed hospice order. The DON then entered the order into the EMR.

The DON explained the facility did not have one designated hospice coordinator, each unit's manager was responsible for coordinating with hospice.

On 06/12/2024 at 12:21 PM, the UM verbalized an order for Potassium Chloride ER was not in Resident #455's electronic orders and was not on the resident's MAR. The UM confirmed the Potassium Chloride ER had not been administered as ordered. The UM verbalized faxes from hospice typically came directly to the nurses' station so staff could review the faxes and enter any new orders in the EMR as appropriate. The UM verbalized the UM was not going to look in the resident's scanned documents after each hospice visit to determine if new orders had been received.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0849 On 06/12/2024 at 12:29 PM, the LPN verbalized a bubble pack containing the ordered Potassium Chloride ER for Resident #455 was located in the medication cart. The bubble pack did not have any missing doses. Level of Harm - Minimal harm or The DON explained when hospice delivered medications to the facility, hospice staff would communicate potential for actual harm with the facility nurse. The facility nurse would check the medication and the medication receipt. The DON verbalized the nurse who received the Potassium Chloride ER and placed the medication in the medication Residents Affected - Few cart should have noted there was not a current order on the resident's MAR and contacted the physician.

The facility document titled Nursing Facility Hospice Services Agreement, effective 09/25/2019, documented services to be provided by the nursing facility included coordination of services and administration of prescribed therapies. The nursing facility designee was responsible for collaborating with hospice representatives and coordinating nursing facility staff participation in the hospice care planning process, obtaining hospice medication information specific to each resident, and hospice physician and attending physician orders specific to reach resident.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 49557 potential for actual harm Based on observation, interview, clinical record review, and document review the facility failed to ensure Residents Affected - Few Enhanced Barrier Precautions (EBP) were implemented when providing care to a resident's jejunostomy tube (J-tube) for 1 of 33 sampled residents (Resident #109). Note: The nursing home is disputing this citation. Findings include:

Resident #109

Resident #109 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with a diagnosis of other artificial openings of gastrointestinal tract status.

On 06/10/2024 at 10:00 AM, a sign outside Resident #109's room indicated the resident was on EBP.

The sign instructed staff to wear a gown and gloves while providing high-contact care.

On 06/10/2024 at 10:05 AM, Resident #109 was receiving tube feeding via an enteral feeding pump. A Licensed Practical Nurse (LPN) entered Resident #109's room, stopped the pump, and disconnected the tube feeding from the resident's J-tube. The LPN was not wearing a gown or gloves.

On 06/10/2024 at 10:07 AM, while in the hallway outside the resident's room, the LPN explained the sign outside Resident #109's room indicated the resident was on EBP. The LPN confirmed the LPN was not wearing a gown or gloves when the LPN disconnected the resident's tube feeding and verbalized a gown and gloves should be worn when providing care to Resident #109's J-tube. The LPN explained EBP helped to prevent infections.

Resident #109's care plan documented a focus of EBP related to the presence and care of a J-tube. The date initiated was 01/10/2024. Interventions included EBP per facility policy. The date initiated was 01/10/2024.

On 06/12/2024 at 11:53 AM, the Director of Nursing (DON) explained a gown and gloves were required when providing care to a resident's feeding tube as residents with feeding tubes were on EBP. The reason for EBP was to help prevent the introduction of bacteria, which could cause infection, to residents with indwelling medical devices.

The facility policy titled Infection Prevention and Control Program (IPCP), undated, documented EBP served as an infection control intervention to lessen the transmission of multidrug-resistant organisms (MDRO). EBP applied to residents with any indwelling medical device. Staff were to wear a gown and gloves when performing high-contact resident care activities which included indwelling medical device care.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 29 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 49557 potential for actual harm Based on clinical record review, interview, and document review, the facility failed to ensure residents were Residents Affected - Some screened for eligibility to receive a pneumococcal vaccination, education regarding the vaccine was provided to the resident and/or the Resident Representative, and the vaccine was offered and either administered or declined for 28 of 163 residents in the facility (Resident #410, #158, #255, #163, #106, #112, #85, #17, #27, #124, #9, #83, #50, #156, #47, #155, #61, #8, #117, #81, #161, #310, #115, #55, #18, #122, #46 and #104).

Findings include:

Resident #410

Resident #410 was admitted to the facility on [DATE REDACTED], with diagnoses including moderate protein-calorie malnutrition and alcohol abuse with withdrawal, unspecified.

Resident #158

Resident #158 was admitted to the facility on [DATE REDACTED], with diagnoses including saddle embolus of pulmonary artery without acute cor pulmonale and tobacco use.

Resident #255

Resident #255 was admitted to the facility on [DATE REDACTED], with diagnoses including unspecified symptoms and signs involving cognitive functions following cerebral infarction and alcohol abuse, uncomplicated.

Resident #163

Resident #163 was admitted to the facility on [DATE REDACTED], with diagnoses including unspecified sequelae of cerebral infarction and tobacco use.

Resident #106

Resident #106 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including epilepsy, unspecified, intractable, with status epilepticus and type two diabetes mellitus with hypoglycemia with coma.

Resident #112

Resident #112 was admitted to the facility on [DATE REDACTED], with diagnoses including spinal stenosis, cervical region, and tobacco use.

Resident #85

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 30 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0883 Resident #85 was admitted to the facility on [DATE REDACTED], with diagnoses including nontraumatic intracerebral hemorrhage in hemisphere, subcortical and alcohol abuse, uncomplicated. Level of Harm - Minimal harm or potential for actual harm Resident #17

Residents Affected - Some Resident #17 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including chronic obstructive pulmonary disease, unspecified and type two diabetes mellitus without complications.

Resident #27

Resident #27 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including bipolar disorder, unspecified and alcohol abuse, uncomplicated.

Resident #124

Resident #124 was admitted to the facility on [DATE REDACTED], with diagnoses including encounter for surgical aftercare following surgery on the digestive system, nicotine dependence, unspecified, uncomplicated and tobacco use.

Resident #9

Resident #9 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including chronic respiratory failure with hypoxia and type two diabetes mellitus with diabetic neuropathy, unspecified.

Resident #83

Resident #83 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with a diagnosis of unspecified sequelae of cerebral infarction.

Resident #50

Resident #50 was admitted to the facility on [DATE REDACTED], with diagnoses including cardiomyopathy, unspecified and tobacco use.

Resident #156

Resident #156 was admitted to the facility on [DATE REDACTED], with diagnoses including encounter for surgical aftercare following surgery on the digestive system and alcohol use, unspecified with withdrawal delirium.

Resident #47

Resident #47 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including epileptic seizures related to external causes, not intractable, without status epilepticus and thyrotoxicosis, unspecified without thyrotoxic crisis or storm.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 31 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0883 Resident #155

Level of Harm - Minimal harm or Resident #155 was admitted to the facility on [DATE REDACTED], with diagnoses including encounter for other potential for actual harm orthopedic aftercare and atherosclerotic heart disease of native coronary artery without angina pectoris.

Residents Affected - Some Resident #61

Resident #61 was admitted to the facility on [DATE REDACTED], with diagnoses including polyneuropathy, unspecified and type two diabetes mellitus without complications.

Resident #8

Resident #8 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including unspecified sequelae of cerebral infarction and alcoholic cirrhosis of liver without ascites.

Resident #117

Resident #117 was admitted to the facility on [DATE REDACTED], with diagnoses including acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure and chronic kidney disease, stage three unspecified.

Resident #81

Resident #81 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including quadriplegia, unspecified and chronic respiratory failure with hypoxia.

Resident #161

Resident #161 was admitted to the facility on [DATE REDACTED], with diagnoses including encounter for other orthopedic aftercare and type two diabetes mellitus without complications.

Resident #310

Resident #310 was admitted to the facility on [DATE REDACTED], with diagnoses including parkinsonism, unspecified and chronic systolic (congestive) heart failure.

Resident #115

Resident #115 was admitted to the facility on [DATE REDACTED], with diagnoses including Wernicke's encephalopathy and type two diabetes mellitus with other circulatory complications.

Resident #55

Resident #55 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including unspecified sequelae of cerebral infarction and hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 32 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0883 Resident #18

Level of Harm - Minimal harm or Resident #18 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including potential for actual harm chronic obstructive pulmonary disease, unspecified and type two diabetes mellitus with diabetic neuropathy, unspecified. Residents Affected - Some Resident #122

Resident #122 was admitted to the facility on [DATE REDACTED], with diagnoses including traumatic hemorrhage of cerebrum, unspecified, without loss of consciousness, subsequent encounter and alcohol dependence, uncomplicated.

Resident #46

Resident #46 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including unspecified sequelae of cerebral infarction, chronic respiratory failure with hypoxia and atherosclerotic heart disease of native coronary artery without angina pectoris.

Resident #104

Resident #104 was admitted to the facility on [DATE REDACTED], with diagnoses including type two diabetes mellitus without complications and end stage renal disease.

Resident #104's clinical record included a Pneumococcal Vaccine Permission Statement dated 05/15/2024.

The Pneumococcal Vaccine Permission Statement documented Resident #104 was not eligible to receive a pneumococcal vaccine as the resident was less than [AGE] years old.

On 06/13/2024 at 11:44 AM, during an interview with the Infection Control Preventionist (ICP) and the [NAME] President of Clinical Services (VPCS), the ICP explained residents were screened for eligibility to receive a pneumococcal vaccine upon admission and annually using a flowchart. The ICP verbalized residents aged 65 and older were eligible for the vaccine.

The ICP confirmed the flowchart in the facility's policy titled Pneumococcal Vaccine was utilized to screen residents for eligibility to receive the pneumococcal vaccine. The ICP confirmed the first question on the flowchart asked if the resident was [AGE] years or older and confirmed if the resident was not [AGE] years or older the resident was determined to not be eligible for the pneumococcal vaccine.

When asked if certain conditions made a resident under the age of 65 eligible for the pneumococcal vaccine,

the ICP did not respond. The VPCS then verbalized there were conditions which made a resident eligible for

the vaccine when the resident was under the age of 65 such as diabetes and if the resident was immunocompromised. The VPCS confirmed the facility followed the Centers for Disease Control and Prevention (CDC) guidelines for determining vaccine eligibility.

On 06/13/2024 at 11:53 AM, the ICP and the VPCS reviewed Resident #104's clinical record and confirmed

the resident had type two diabetes mellitus which made the resident eligible for the pneumococcal vaccine.

The ICP and the VPCS confirmed Resident #104 should have been offered the pneumococcal vaccine.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 33 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0883 The ICP and VPCS confirmed residents #410, #158, #255, #163, #106. #112, #85, #17, #27, #124, #9, #83, #50, #156, #47, #155, #61, #8, #117, #81, #161, #310, #115, #55, #18, #122, #46 and #104 were Level of Harm - Minimal harm or determined to be not eligible for the pneumococcal vaccine based on age alone and the residents were not potential for actual harm screened for eligibility based on any additional criteria.

Residents Affected - Some The facility policy titled Pneumococcal Vaccine, adopted by the facility on 02/01/2019, documented all residents were to be offered pneumococcal vaccines to aid in preventing pneumonia/pneumococcal infections. Prior to or upon admission, residents would be assessed for eligibility to receive the pneumococcal vaccine series.

The facility document titled Let's Talk Vaccines - CDC Vaccine Information Statements, updated 01/2024, documented pneumococcal polysaccharide vaccine (PPSV23) was recommended for anyone two years old or older with certain medical conditions. Pneumococcal conjugate vaccine (PCV) was recommended for adults 19 through [AGE] years old with certain medical conditions or other risk factors.

The CDC document titled Pneumococcal Vaccination: Summary of Who and When to Vaccinate, last reviewed 09/22/2023, documented adults 19 through [AGE] years old with certain risk conditions were eligible to receive a pneumococcal vaccine.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 34 of 34 295077

F-F657

Resident #305

Resident #305 was admitted to the facility on [DATE REDACTED], and discharged [DATE REDACTED], with diagnoses including other pulmonary embolism without acute cor pulmonale, other specified peripheral vascular diseases, cognitive communication deficit, and disturbance, psychotic disturbance, mood disturbance, and anxiety.

A Skin/Wound Note, dated 04/30/2024, documented the Nurse noticed bluish discoloration to the resident's right lower extremity. The affected area was cold and clammy with positive pedal pulses. The resident was experiencing generalized pain due to contracture of the right leg. The Nurse called the Physician to relay the condition. The Physician ordered a bilateral leg arterial ultrasound.

A physician order, dated 04/30/2024, documented bilateral leg arterial ultrasound.

A Weekly Skin Check for Resident #305, dated 05/01/2024, documented the resident had bluish discoloration and cold, clammy skin to the resident's right lower leg and the leg was starting to be painful.

The Physician was notified on 04/30/2024, and a bilateral arterial ultrasound was ordered.

A Nursing Note, dated 05/03/2024, documented the resident was confused and crying out. The right lower extremity was cool to touch from mid-calf to toes and was tender to touch. The resident's lower extremity was purplish in color to the pads of the toes.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 24 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0849 A Monthly Nursing Summary for Resident #305, dated 05/04/2024, documented the resident had increased pain to bilateral lower extremities, cold, clammy skin, and bluish discoloration to the right lower extremity. Level of Harm - Minimal harm or The resident likely had some circulatory problem. The resident now had complaints of 10 out of 10 pain. The potential for actual harm physician had ordered an arterial ultrasound of bilateral lower extremities but there was no in house ultrasound available. Residents Affected - Few

A Nursing Note, dated 05/06/2024, documented the resident continued to cry out in pain when the resident's right lower extremity was touched or moved during care.

A Nursing Note, dated 05/06/2024, documented the facility's contracted diagnostics company was called to see if they still did not have an ultrasound technician and the company confirmed they did not have one. The resident right lower extremity had blue discoloration and was painful to touch. The Unit Manager advised the nurses to call the Physician if the resident's leg got worse.

A Behavior Note, dated 05/06/2024, documented the resident kept yelling and screaming.

A Transfer to Hospital Summary, dated 05/07/2024, documented the resident had an order for an arterial ultrasound of bilateral lower extremities related to swelling and discoloration. The ultrasound could not be completed in the facility. The Physician was notified and ordered the resident sent to the hospital. The resident's representative was notified of the situation. The resident was sent to the hospital via emergency transport.

The clinical record for Resident #305 lacked documentation of pedal pulses assessed after 04/30/2024.

On 06/11/2024 at 10:04 AM, the Unit Manager (UM) verbalized the resident's nurse had reported to the UM

on 04/30/2024, the resident had discoloration of the resident's leg and the discoloration did not improve when the leg was elevated. The UM verbalized the Physician had ordered an ultrasound, but the facility's contracted ultrasound provider did not have an ultrasound technician. The UM verbalized the UM instructed

the nurse to send the resident to the hospital if the resident experienced increased pain or further discoloration of the extremity. The UM verbalized the facility should have sent the resident to the hospital earlier and there was a delay in the care provided to the resident. The UM confirmed the only documented pedal pulse was on 04/30/2024, and pedal pulses should have been monitored at least daily for a suspected DVT.

On 06/11/2024 at 10:46 AM, the Director of Nursing (DON) verbalized the resident had an order for an ultrasound on 04/30/2024, and the resident did not receive the ultrasound because the facility's contracted ultrasound provider did not have an ultrasound technician. The DON verbalized the resident should have been sent to the hospital for any changes in condition if the facility could not manage the issue. The DON verbalized continued assessment of the resident would have included assessing for pain and the perfusion to both lower extremities. The DON confirmed the assessment should have included checking pulses. The DON verbalized the resident should have been sent to the hospital when the skin checks on 05/01/2024, documented the resident had cold and clammy skin with bluish discoloration. The DON verbalized the DON did not see any documentation the Physician had been notified of the lack of an ultrasound technician and

the inability to have the ultrasound completed in the facility.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0849 On 06/11/2024 at 10:58 AM, the Physician verbalized the facility had not informed the Physician the resident was declining while awaiting an ultrasound. The Physician verbalized the Physician would expect pedal Level of Harm - Minimal harm or pulses to be assessed when a resident had a suspected DVT, and an ordered ultrasound was delayed. The potential for actual harm Physician verbalized if the Physician had been notified of the resident's clinical decline and the unavailability of a bedside ultrasound the Physician would have ordered for the resident to be sent to the hospital with no Residents Affected - Few delay.

The Mayo Clinic document titled Deep vein thrombosis (DVT), dated 06/11/2022, documented leg swelling, leg pain, and change in skin color as possible symptoms of a DVT.

The facility policy titled Licensed Nurses, Standard of Care, dated 07/2023, documented all Licensed Nurses would be expected to provide services including assessments, orders (receiving and transcribing), resident safety, cardiovascular conditions, and emergency and first aid. Licensed Nurses would perform an evaluation of diseases and conditions of the resident. Licensed Nurses would perform an evaluation of other pertinent information about the resident affecting the services the facility must provide.

The facility policy titled, Resident Examination and Assessment, adopted 02/01/2019, documented the physical exam included assessing peripheral pulses (brachial, radial, femoral, popliteal, and dorsalis pedis).

The Physician would be notified of any abnormalities.

Complaint #NV00071241

Cross reference with tags

F-F849

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 41848 potential for actual harm Based on observation, interview, clinical record review, and document review, the facility failed to ensure a Residents Affected - Few resident's medical record was complete for 3 of 33 sampled residents (Resident #143, #455 and #205). This deficient practice had the potential to result in the resident sustaining significant weight loss and unrecognized complications from a improperly cared for G-tube.

Findings include:

Resident #143

Resident #143 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including acute duodenal ulcer with hemorrhage and age-related cognitive decline.

A physician's order dated 04/06/2024, documented Resident #143 would have weekly weights for four weeks, if weights stable, then every month.

A physician's order dated 04/11/2024, document Resident #143 would have a weight obtained and documented in the electronic health record every day shift, every Thursday, for 30 days. May use the Hoyer lift scale.

A physician's order dated 04/20/2024, documented Resident #143 would have weekly weights for four weeks, if weights stable, then every month.

Resident #143's Weights and Vital Signs Summary Report documented weights for April 2024 and May 2024 as follows:

-04/08/2024: 200 lbs

-05/09/2024: 129 lbs

Resident #143's clinical record lacked a documented reason the resident was not weighed on 04/18/2024, 04/25/2024, 05/02/2024, 05/16/2024, 05/23/2024, and 05/30/2024.

On 06/11/2024 at 9:27 AM, Resident #143 could not recall the last time the facility had performed a weight measurement.

On 06/11/2024 at 1:49 PM, the Director of Nursing (DON) explained all residents were to be weighed upon admission. The DON communicated Resident #143 should have been weighed weekly for four weeks and then monthly if the weight was stable. The DON confirmed there was only one weight in the resident's clinical

record and there should have been at least four weights. The DON verbalized the expectation of the Registered Dietician (RD) to ask for a re-weigh and not use the previous facility's weight as a baseline weight. The DON explained the expectation of nursing to follow the physician's orders as written.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0684 On 06/11/2024 at 2:42 PM, the RD confirmed weekly weights had not occurred and the clinical record lacked weight measurements as ordered. Level of Harm - Minimal harm or potential for actual harm The facility policy titled Weight Assessment and Intervention, adopted 02/01/2019, documented the nursing staff would measure resident weights on admission, the next day, and weekly for two weeks thereafter. Residents Affected - Few Weights would be recorded in each unit's Weight Record or notebook and in the resident's medical record.

Cross reference with tag F 692

Resident #205

Resident #205 was admitted to the facility on [DATE REDACTED], with diagnoses including unspecified protein-calorie malnutrition, dysphagia following cerebral infarction, dysphagia, unspecified, pneumonitis due to inhalation of food and vomit.

A physician's order dated 05/30/2024, documented gastrostomy tube (G-Tube), flush before, after and between medication administration and after bolus. Every shift. Flush with 30 cubic centimeters (cc) water (H20) before medication administration. Flush with 10 cc H20 between each medication administration.

Resident #205's Treatment Administration Record (TAR) dated 06/02/2024, lacked documented evidence

the G-Tube was flushed per the physician order.

A physician's order dated 06/07/2024, documented G-Tube, flush 65 milliliters (ml) H20 every hour, via pump, every shift.

Resident #205's Medication Administration Record (MAR) dated 06/08/2024, lacked documented evidence

the G-Tube was flushed per the physician order.

On 06/13/2024 at 10:41 AM, the DON confirmed Resident #205's TAR dated 06/02/2024, and MAR dated 06/08/2024, lacked documented evidence the G-Tube was flushed per the physician orders.

The facility policy titled, Charting and Documentation, adopted 02/01/2019, documented medications administered and treatments performed would be documented in the resident's clinical record.

49557

Resident #455

Resident #455 was admitted to the facility on [DATE REDACTED], with diagnoses including end stage heart failure and anemia, unspecified.

A physician's order dated 05/24/2024, documented admit to Gentiva hospice, diagnosis heart failure with reduced ejection fraction.

Resident #455's care plan documented the following:

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0684 - Altered cardiovascular status related to permanent atrial fibrillation, congestive heart failure, pulmonary hypertension, hyperlipidemia and hypertension. The date initiated was 06/05/2024. Interventions included to Level of Harm - Minimal harm or administer medications as ordered. The date initiated was 06/05/2024. potential for actual harm -Potential for fluid and/or electrolyte imbalance related to diuretic use. The date initiated was 06/05/2024. Residents Affected - Few Interventions included medications as ordered. The date initiated was 06/05/20204.

On 06/12/2024 at 9:42 AM, the Licensed Practical Nurse (LPN) assigned to Resident #455 explained staff knew a resident's hospice plan of care (POC) by reviewing the resident's hospice binder and/or by speaking directly with hospice staff when hospice staff came to see the resident. The LPN explained changes in condition, new medication orders, and any other concerns with the resident were communicated in the resident's hospice binder. The LPN located Resident #455's hospice binder and confirmed the binder lacked

a POC, orders, and communication between hospice and facility staff. The LPN denied hospice staff had communicated with the LPN regarding Resident #455.

A scanned document in Resident #455's clinical record, dated 06/04/2024, documented a physician's order to start Potassium Chloride Extended Release (ER), 10 milliequivalents (meq) ER tablet, give one tablet by mouth daily. Reason: Hypokalemia.

An Order Review History Report for Resident #455 lacked an order for Potassium Chloride ER.

On 06/12/2024 at 11:57 AM, the Director of Nursing (DON) explained facility staff communicated with hospice staff through the resident's hospice binder. The hospice binder typically contained contact information for the hospice provider, physician orders, and a POC.

The DON explained if a new order was received from hospice, the resident's nurse would notify the facility physician and if the physician agreed, the nurse would enter the order into the electronic medical record (EMR). The DON further explained if a new order was received on a weekday the nurse would also notify the Unit Manager (UM). The DON verbalized the expectation when a new order was received was the order would be entered into the EMR by the end of the shift.

During the interview, the DON reviewed Resident #455's clinical record. The DON confirmed a physician order dated 06/04/2024, with instruction to start Potassium Chloride ER, was scanned into the documents section of the resident's record. The DON confirmed Resident #455's clinical record lacked documented evidence the order for Potassium Chloride ER was communicated to the facility's physician, the facility's physician agreed with the order, and the order was entered into the EMR so it would reflect on the Medication Administration Record (MAR) as needing to be administered.

On 06/12/2024 at 12:18 PM, the DON contacted the facility physician via phone. The facility physician provided a telephone order to start Potassium Chloride ER per the faxed hospice order. The DON then entered the order into the EMR.

The DON explained the facility did not have one designated hospice coordinator, each unit's manager was responsible for coordinating with hospice.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0684 On 06/12/2024 at 12:21 PM, the UM verbalized an order for Potassium Chloride ER was not in Resident #455's electronic orders and was not on the resident's MAR. The UM confirmed the Potassium Chloride ER Level of Harm - Minimal harm or had not been administered as ordered. The UM verbalized faxes from hospice typically came directly to the potential for actual harm nurses' station so staff could review the faxes and enter any new orders in the EMR as appropriate. The UM verbalized the UM was not going to look in the resident's scanned documents after each hospice visit to Residents Affected - Few determine if new orders had been received.

On 06/12/2024 at 12:29 PM, the LPN verbalized a bubble pack containing the ordered Potassium Chloride ER for Resident #455 was located in the medication cart. The bubble pack did not have any missing doses.

The DON explained when hospice delivered medications to the facility, hospice staff would communicate with the facility nurse. The facility nurse would check the medication and the medication receipt. The DON verbalized the nurse who received the Potassium Chloride ER and placed the medication in the medication cart should have noted there was not a current order on the resident's MAR and contacted the physician.

The facility document titled Nursing Facility Hospice Services Agreement, effective 09/25/2019, documented services to be provided by the nursing facility included coordination of services and administration of prescribed therapies. The nursing facility designee was responsible for collaborating with hospice representatives and coordinating nursing facility staff participation in the hospice care planning process, obtaining hospice medication information specific to each resident, and hospice physician and attending physician orders specific to reach resident.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0692 Provide enough food/fluids to maintain a resident's health.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 43310 potential for actual harm Based on observation, clinical record review, interview, and document review the facility failed to ensure 2 of Residents Affected - Few 33 sampled residents (Resident #37 and #143) were weighed per facility policy.

Findings include:

Resident #37

Resident #37 was admitted to the facility on [DATE REDACTED], with diagnoses including type II diabetes mellitus, unspecified dementia, unspecified severity, with other behavioral disturbance, and adult failure to thrive.

Resident #37's Weights and Vital Signs Summary (Weight) report, documented an initial weight of 232.0 pounds (lbs) on 02/01/2019.

Resident #37's Weight Report documented weights from June 2023 through November 2023 as follows:

-06/11/2023: 194.0 lbs.

-07/09/2023: 196.0 lbs.

-07/21/2023: 196.0 lbs.

-09/29/2023: 198.5 lbs.

-10/12/2023: 225.4 lbs.

-11/27/2023: 222.1 lbs.

Resident #37's Weight Report did not document a weight for August 2023. Resident #37's clinical record lacked documented evidence the resident was weighed between 11/28/2023 and 06/11/2024.

Resident #37's Order Summary Report did not include an order related to weighing the resident.

A Nutrition/Dietary note dated 10/15/2023, documented Resident #37's weight was 225 lbs, showing a questionable weight gain of 26 lbs in two weeks. Nursing was asked to re-weigh the resident.

A Nutrition/Dietary note dated 11/28/2023, documented Resident #37's weight stable at 222 lbs and the resident had an undesirable weight gain of 23 lbs during the previous two months.

A Nutrition/Dietary note dated 01/23/2024, documented Resident #37 was weighed on 11/27/2023, and weighed 222 lbs. No new weights were available for the evaluation.

A Nutrition/Dietary note dated 04/23/2024, documented Resident #37 was weighed on 11/27/2023 and weighed 222 lbs.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0692 On 06/11/2024 at 3:06 PM, a Licensed Practical Nurse (LPN) verbalized when a resident needed to be weighed, orders to weigh the resident were placed in the resident's clinical record. The LPN confirmed Level of Harm - Minimal harm or Resident #37's clinical record did not include an order to weigh the resident and the resident was last potential for actual harm weighed on 11/27/2023.

Residents Affected - Few On 06/12/2024 at 9:30 AM, a Registered Nurse (RN) explained most residents were weighed one time per month. Residents with special dietary needs or weight loss were usually weighed one time per week. The expectation was all weights would be entered into a resident's clinical record after the resident was weighed.

On 06/12/2024 at 10:26 AM, a Registered Dietician (RD) verbalized the RD's process included weekly review of weight reports. The RD explained when a resident was weighed the weight was entered in to the residents clinical record. Once the weight was entered into the clinical record, it populated to the weekly Weight Reports reviewed by the RD. The RD confirmed Resident #37 had not been weighed in over six months and should have been weighed monthly per the facility policy.

On 06/12/2024 at 1:43 PM, the Director of Nursing (DON) confirmed the resident had not been weighed for over 6 months and should have been weighed once a month per facility policy. It was important to ensure residents were weighed one time per month in order to assess for weight loss, weight gain, and to determine if there was a change in dietary needs, or medications.

On 06/12/2024 at 1:48 PM, the DON confirmed Resident #37's clinical record lacked documented evidence of a reason the resident could not be weighed, including if the resident refused to be weighed.

The facility policy titled Weight Assessment and Intervention, dated 02/01/2019, documented residents were weighed upon admission, the following day, and weekly for two weeks. If weight concerns were not identified, the resident was weighed one time per month thereafter. Any weight change of 5 percent (%) or more since the previous assessment required the resident to be re-weighed the following day for confirmation. The RD was notified immediately, in writing, when a weight change of 5% or more was verified. Verbal notifications were to be confirmed in writing.

43311

Resident #143

Resident #143 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including acute duodenal ulcer with hemorrhage, and age-related cognitive decline.

A physician's order dated 04/06/2024, documented Resident #143 would have weekly weights for four weeks, if weights stable, then every month.

A physician's order dated 04/11/2024, document Resident #143 would have a weight obtained and documented in the electronic health record every day shift, every Thursday, for 30 days. May use the Hoyer lift scale.

A physician's order dated 04/20/2024, documented Resident #143 would have weekly weights for four weeks, if weights stable, then every month.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0692 Resident #143's Weights and Vital Signs Summary Report documented weights for April 2024 through May 2024 as follows: Level of Harm - Minimal harm or potential for actual harm -04/08/2024: 200.0 lbs (hospital)

Residents Affected - Few -05/09/2024: 129.0 lbs (Chair Scale)

A Nutrition/Dietary Progress Note dated 04/30/2024, documented Resident #143 did not have a new admission weight for the re-admission on 04/20/2024, the resident was re-evaluated using the hospital weight of 200.0 lbs. The dietician would follow up with an admission weight and begin weekly weights for close monitoring.

A Weight Committee Progress Note dated 05/15/2024, documented Resident #143 was seen by the Weight Committee, a facility weight of 129 lbs. taken on 05/09/2024, and showed a drastic/questionable 71 lbs. weight loss in one month. Interventions included a prescription for an appetite stimulant and nutrition shakes added to lunch and dinner. Weekly weights recommended for close monitoring and to establish baseline weight.

A Mini Nutritional assessment dated [DATE REDACTED], documented Resident #143 scored a nine which categorized

the resident as at risk of malnutrition.

The assessment was scored as follows:

-12-14 points: Normal nutritional status

-8-11 points: At risk of malnutrition

-0-7 points: Malnourished

A care plan dated 04/20/2024, documented Resident #143 had a nutritional problem or potential nutritional problem related to gastrointestinal bleed, rheumatoid arthritis, obese, and variable intake.

Interventions dated 4/14/2024-5/15/2024, were as follows:

-monitor/document/report oral intake

-monitor/record/report weights

-provide and serve diet as ordered

-Remeron as ordered

-special food items with meals

-supplements as ordered

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0692 A care plan dated 04/16/2024, documented Resident #143 was at risk of malnutrition per dietician assessment with interventions to observe for poor appetite, weight loss, and notify Physician of any changes. Level of Harm - Minimal harm or potential for actual harm On 06/10/2024 at 8:23 AM, Resident #143 explained the resident did not feel like eating most of the time and thought there was weight loss. Residents Affected - Few

On 06/11/2024 at 9:27 AM, Resident #143 could not recall the last time the facility had performed a weight measurement.

On 06/11/2024 at 1:49 PM, the DON explained all residents were to be weighed upon admission. The DON communicated Resident #143 should have been weighed weekly for four weeks and then monthly if the weight was stable. The DON confirmed there was only one weight in the resident's clinical record since admission and there should have been at least four weights for the weekly weights. The DON verbalized the expectation of the RD to ask for a re-weigh and not use the previous facility's weight as a baseline weight.

The DON verbalized the expectation of nursing staff to take weekly weights as ordered.

On 06/11/2024 at 2:39 PM, the RD confirmed Resident #143 should have been weighed upon admission and weekly for four weeks thereafter. The RD was aware of the documented weight loss of 71 lbs and had used

the acute care hospital's weight of 200 lbs for a baseline weight rather than an actual physical weight performed by the facility. The RD confirmed the RD had asked the facility staff for weekly weights, but it was not done and only had the acute hospital's weight to use as a baseline weight. The RD confirmed the RD did not follow up on the weight monitoring.

On 06/11/2024 at 2:42 PM, the RD confirmed Resident #143's clinical record had a weight measurement of 129 lbs. taken by the facility on 05/09/2024, indicating a 35.5% weight loss since 04/08/2024. The RD confirmed a discussion with the provider at the weight meeting on 05/15/2024, and weekly weights were to be performed to monitor the resident's weight loss of 35.5%. The RD confirmed weekly weights had not occurred as ordered or recommended.

The facility policy titled, Weight Assessment and Intervention, dated 02/01/2019, documented the multidisciplinary team would strive to prevent, monitor, and intervene for undesirable weight loss for residents. The nursing staff would measure resident weights on admission, the next day, and weekly for two weeks thereafter. Any weight change of 5% or more since the last weight assessment would be taken the next day for confirmation. The Dietician would review the unit Weight Record by the 15th of the month to follow individual weight trends over time. Negative trends would be evaluated by the treatment team whether or not the criteria for significant weight change had been met. The threshold for significant unplanned and undesired weight loss would be based on the following: in 1 month-5% weight loss was significant; greater than 5% was severe.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0730 Observe each nurse aide's job performance and give regular training.

Level of Harm - Minimal harm or 46301 potential for actual harm Based on interview and personnel record review, the facility failed to ensure a Certified Nursing Assistant Residents Affected - Few (CNA) had an annual performance evaluation completed timely for 1 of 2 CNAs employed greater than one year, sampled for personnel record review (Employee #8).

Findings include:

On 06/11/2024 at 10:55 AM, the Human Resources Manager and Regional Human Resources participated

in an interview to confirm the accuracy of the Personnel Records Checklist completed by the facility for 20 employees.

Employee #8

Employee #8 was hired as a CNA with a start date of 05/18/2022. The CNA's last performance evaluation was documented as completed on 07/11/2023.

On 06/11/2024 at 1:53 PM, the Human Resources Manager provided Employee #8's date of last performance evaluation. The Human Resources Manager and Regional Human Resource were unable to provide evidence the CNA had an annual performance evaluation completed by 05/18/2023. The Human Resources Manager and Regional Human Resource confirmed the CNA annual performance evaluation was completed late.

The facility policy titled Annual Review Process for Supportive Employees, undated, documented an annual

review was to be performed on CNAs annually from the date of employment.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 34524

Residents Affected - Few Based on observation, interview, clinical record review, and document review the facility failed to ensure ordered medications were available and administered for 1 of 33 sampled residents (Resident #18).

Findings include:

Resident #18

Resident #18 was admitted to the facility on [DATE REDACTED], and readmitted on [DATE REDACTED], with diagnoses including other chronic pancreatitis, chronic pain, and other muscle spasms.

On 06/10/2024 at 3:04 PM, Resident #18 verbalized they were out of medication for their muscle spasms and pancreatitis sometime last month. The resident explained they have chronic pain and not having the medication for their muscle spasms made their pain worse.

A physician order dated 12/09/2022, documented Cyclobenzaprine HCl, 5 milligram tablet, give one tablet by mouth every six hours for muscle spasm.

A physician order dated 12/09/2022, documented Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis.

On 06/12/2024 at 1:56 PM, a Registered Nurse (RN) verbalized Resident #18 received Creon Capsule Delayed Release Particles for chronic pancreatitis and Cyclobenzaprine for muscle spasms. The RN reviewed Resident #18's Medication Administration Record (MAR) for May 2024 and confirmed Resident #18 had missed administrations of Creon and Cyclobenzaprine in May 2024. The RN explained the resident did not receive the medications on the following days:

Cyclobenzaprine;

05/19/2024 at 8:00 AM

05/19/2024 at 2:00 PM

05/20/2024 at 8:00 AM

Creon;

05/26/2024 at 6:59 AM

05/27/2024 at 7:30 AM

05/27/2024 at 12:00 PM

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0755 05/27/2024 at 5:00 PM

Level of Harm - Minimal harm or 05/28/2024 at 7:30 AM potential for actual harm 05/28/2024 at 12:00 PM Residents Affected - Few 05/28/2024 at 5:00 PM

The RN explained the resident ran out of the medications and the medications had to be reordered from the pharmacy. The process was to order medications from the pharmacy two to three days before the medication ran out. The RN was unable to provide evidence the medications had been reordered prior to the medication running out.

An Orders-Administration Note dated 05/19/2024 at 8:55 AM, documented Cyclobenzaprine HCl, 5 mg tablet, give one tablet by mouth every six hours for muscle spasm. Medication needed refill, medication on order.

An Orders-Administration Note dated 05/19/2024 at 1:07 PM, documented Cyclobenzaprine HCl, 5 mg tablet, give one tablet by mouth every six hours for muscle spasm. Medication needed refill, medication on order.

An Orders-Administration Note dated 05/20/2024 at 7:19 AM, documented Cyclobenzaprine HCl, 5 mg tablet, give one tablet by mouth every six hours for muscle spasm. On order.

An Orders-Administration Note dated 05/26/2024 at 6:59 AM, documented Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis. Medication needed refill. Ordered refill to pharmacy.

An Orders-Administration Note dated 05/27/2024 at 8:08 AM, documented Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis. Medication needed refill. Ordered refill to pharmacy. On order.

An Orders-Administration Note dated 05/27/2024 at 11:56 AM, documented Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis. Medication needed refill. Not available.

An Orders-Administration Note dated 05/27/2024 at 4:58 PM, document Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis. Medication needed refill. On order.

An Orders-Administration Note dated 05/28/2024 at 7:16 AM, documented Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis. Medication needed refill. On order.

An Orders-Administration Note dated 05/28/2024 at 12:00 PM, documented Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis. Medication needed refill. Not available.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0755 An Orders-Administration Note dated 05/28/2024 at 4:50 PM, documented Creon Capsule Delayed Release Particles, 12000-38000 unit. Give one capsule by mouth with meals related to other chronic pancreatitis. Level of Harm - Minimal harm or Medication needed refill. On order. potential for actual harm

On 06/12/2024 at 3:59 PM, the Director of Nursing (DON) verbalized the expectation was the medication to Residents Affected - Few be reordered from the pharmacy within seven days, no less than three days, prior to the medication running out. The DON explained staff should not wait until the day before or the day of the medication running out to reorder from the pharmacy as the policy states the medication needed to be reordered three days prior to the medication running out.

The DON confirmed the resident missed medication administrations of Cyclobenzaprine and Creon in May 2024. The DON confirmed there was not documentation the medication was reordered in the three day time frame required by policy.

The facility policy titled, Medication and Treatment Orders, 02/01/2019, documented drugs and biologicals must be reordered from the issuing pharmacy not less than three days prior to the last dosage being administered to ensure refills were readily available.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0849 Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 41848

Residents Affected - Few Based on observation, interview, clinical record review, and document review, the facility failed to ensure 1)a resident with a urinary catheter and the behavior of pulling out the urinary catheter had interventions in place to reduce the risk of the resident continuing the behavior and prevent further physical trauma related to the behavior for 1 of 33 sampled residents (Resident #98), 2) the facility provided care according to the facilities standard of practice to a resident with a deep vein thrombosis (DVT) (a blood clot in one or more of the deep veins in the body) for 1 of 3 residents reviewed for closed records (Resident #305) and 3) a physician's order from hospice was communicated to the facility's physician and the resident received an ordered medication for 1 of 33 sampled residents (Resident #455). This deficient practice had the potential to result in the resident sustaining further injury to the resident's lower urinary tract and residents having significant adverse health outcomes from delayed treatment for a DVT.

Findings include:

Resident #98

Resident #98 was admitted to the facility on [DATE REDACTED], with diagnoses including benign prostatic hyperplasia with lower urinary tract symptoms, urinary tract infection, site not specified, and retention of urine, unspecified.

On 06/10/2024 at 9:36 AM, Resident #98 was lying in bed and the resident had a urinary catheter draining to

a collection bag at the bedside.

On 06/10/2024 at 11:11 AM, the resident's representative verbalized the resident had a urinary catheter and

the resident had pulled the catheter out twice since admission to the facility and had to return to the hospital to have a new catheter inserted each time.

An Order Review History Report for Resident #98 documented the following:

- An order dated 05/23/2024, documented send to emergency room to reinsert Foley (urinary catheter), resident combative.

- An order dated 05/27/2024, documented send out to hospital for persistent hematuria (blood in urine) due to catheter with intact balloon pulled out.

- An order dated 05/22/2024, documented the resident would be seen for Physical Therapy five to seven times a week for 12 weeks.

A Progress Note dated, 05/23/2024, documented the resident had pulled out the resident's Foley. The resident was having gross (large amount) hematuria due to traumatization to the resident's penis.

A Progress Note dated, 05/27/2024, documented the resident's catheter came out with the balloon still intact. Bleeding was noted and the resident complained of pain to the resident's penis.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 34 295077 Department of Health & Human Services Printed: 09/23/2025 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 295077 B. Wing 06/13/2024

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

Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511

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 0849 A Progress Note dated, 06/12/2024, documented the resident had pulled out the resident Foley and was urinating bright red urine. Level of Harm - Minimal harm or potential for actual harm The indwelling catheter care plan for Resident #98, initiated 06/03/2024, lacked documentation of interventions to address the resident's behavior of repeatedly pulling out the indwelling catheter. Residents Affected - Few

On 06/12/2024 at 3:23 PM, the Licensed Practical Nurse (LPN) for Resident #98 verbalized the resident had pulled the resident's catheter out for the third time earlier in the day. The LPN verbalized the resident used to have a leg strap in place to attach the catheter tubing to the resident's leg with the goal of preventing the resident from pulling the catheter out. The LPN confirmed the resident did not have a leg strap or a StatLock (a stabilization device for catheters) in place when the catheter was pulled out earlier in the day. The LPN verbalized measures to help prevent the resident from repeating the behavior of pulling out the catheter would be documented in the care plan.

On 06/12/2024 at 3:54 PM, the Director of Nursing (DON) verbalized Resident #98 had pulled out the resident's indwelling catheter for the third time earlier in the day. The DON verbalized the resident would need interventions documented to try and prevent the resident from repeatedly pulling out the urinary catheter. The DON confirmed the catheter tubing could be anchored to the resident's leg and a StatLock would be used for a resident who was working with physical therapy.

The facility policy titled Catheter Care, Urinary, adopted 02/01/2019, documented the catheter would be secured with a leg strap to reduce friction and movement at the insertion site. Catheter tubing would be strapped to the resident's inner thigh.

Cross reference with tag