Alta Skilled Nursing And Rehabilitation Center
ALTA SKILLED NURSING AND REHABILITATION CENTER in RENO, NV — inspection on June 13, 2024.
Found 15 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
arterial ultrasound of bilateral lower extremities related to swelling and discoloration.
The ultrasound
hospital via emergency transport.
On 06/11/2024 at 10:04 AM, the 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 confirmed the family was not notified of changes between 04/30/2024 and 05/07/2024.
On 06/11/2024 at 10:46 AM, the Director of Nursing (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.
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 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 delay.
The facility policy titled, Change in a Resident's Condition or Status, adopted 02/01/2019, documented, the facility would promptly notify the resident, the healthcare provider, and the resident representative of changes in the resident's medical condition and status.
The nurse would notify the Physician when there was a significant change in the resident's condition, the need to transfer the resident to a hospital, or when there were specific instructions to notify the Physician of changes in the resident's condition. A nurse would notify the resident's representative when there was a significant change in the resident's physical status.
Complaint #NV00071241 Cross reference with tags F-F600 and F-F849
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
the unit was fixed.
The Administrator verbalized it would be appropriate to offer the resident a fan and the front desk had desk fans available.
The Administrator acknowledged temperatures outside were in the 90's.
The Administrator verbalized the resident was not experiencing a comfortable, homelike environment due to the broken AC unit and the temperature in the resident's room.
A work order created 06/13/2024 at 11:14 AM, documented the AC unit in Resident #257's room was not working and was blowing warm air.
The work order was updated at 11:53 AM and documented the AC unit had been replaced.
The HOM was made aware the unit was not working and no work order had been created.
The facility did not have any units in inventory and one had to be ordered from the home office.
This was the soonest the unit could be installed.
On 06/13/2024 at 12:02 PM, the Administrator verbalized the work order for repair of the AC unit in Resident #257's room was not created until 06/13/2024.
The facility policy titled, Quality of Life - Homelike Environment, dated 02/01/2019, documented residents were provided with a safe, clean, comfortable, and homelike environment.
The facility staff and management should maximize, to the extent possible, the characteristics of the facility which reflect a personalized, homelike environment.
These characteristics included comfortable and safe temperatures.
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
to follow up on the room change.
The resident verbalized to the social worker the resident had slept
On 06/13/2024 at 10:51 AM, the DON confirmed Resident #83 had spit on and thrown a cup of water
to the altercation and the facility had not been able to implement any new interventions due to Resident #83's increased behaviors; Resident #83 was transferred to a behavioral health center for additional services, and Resident #122 was moved to another room.
The facility policy titled, Abuse Prevention Program, adopted 02/01/2019, documented as part of the resident abuse prevention program, the facility would protect residents from abuse by anyone, including other residents.
FRI #NV00070898
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
reports of misappropriation of resident property would be thoroughly investigated by facility
staff members (on all shifts) who had contact with the resident during the period of the alleged
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
the resident used to have a leg strap in place to attach the catheter tubing to the resident's leg with
was pulled out earlier in the day.
The LPN verbalized measures to help prevent the resident from
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, Care Plan, Comprehensive Person-Centered, adopted 02/01/2019, documented the identification of problem areas and their causes, and developing targeted and meaningful interventions for the resident were the endpoint of the interdisciplinary process.
Assessments of residents was ongoing and care plans were revised as information about the resident and the resident's condition changed.
Cross reference with tag F-F849
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
the medication in the medication cart should have noted there was not a current order on the
The facility document titled Nursing Facility Hospice Services Agreement, effective 09/25/2019,
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.
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
weight measurement.
DON communicated Resident #143 should have been weighed weekly for four weeks and then monthly
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.
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
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.
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
medication running out.
The DON explained staff should not wait until the day before or the day of the
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.
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
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.
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.
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
Resident #109 Resident #109 was admitted to the facility on [DATE], and readmitted on [DATE], 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.
pneumococcal vaccine.
#83, #50, #156, #47, #155, #61, #8, #117, #81, #161, #310, #115, #55, #18, #122, #46 and #104 were
not screened for eligibility based on any additional criteria.
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.
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Alta Skilled Nursing and Rehabilitation Center 555 Hammill Lane Reno, NV 89511
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.
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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 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
Resident #305
Resident #305 was admitted to the facility on [DATE], and discharged [DATE], 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.
295077
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 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
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.
295077
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 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
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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.