Mulder Health Care Facility

According to the National Library of Medicine, phantom limb pain is the perception of pain or discomfort in a limb that is no longer there.

This pain most commonly presents as a result of amputation.

While the cause of the pain is not completely understood, it is thought to originate with the trauma to the nerves surrounding the amputation site and involve neurons in both the spinal cord and brain as well.

This pain is often described as tingling, throbbing, sharp, pins/needles in the limb that is no longer there.

Pain severity varies and tends to be intermittent in frequency.

Treatment has not been proven to be very effective for phantom limb pain and focuses on symptomatic control.

Medication options include acetaminophen (Tylenol), ibuprofen, opioids, antidepressants, anticonvulsants (anti-seizure medications), beta blockers, topical anesthetics like Capsaicin, botulinum toxin injections, and local anesthetics.

Phantom limb pain is very complex and difficult to treat and is best managed by an interprofessional team involving mental health professionals, pharmacists, and pain management physicians.

R11's most recent Quarterly Minimum Data Set (MDS), with Assessment Reference Date of 1/9/25, states that R11 has a BIMS (Brief Interview for Mental Status) of 15 out of 15, indicating that R11 is cognitively intact.

Section D indicates that R11 never has self-isolating behavior.

Section J indicates R11 experiences pain frequently, the pain frequently interferes with his sleep and day-to-day activities.

525209

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 525209 B.

Wing 04/14/2025

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

Mulder Health Care Facility 713 Leonard St N West Salem, WI 54669

F-F741)

The facility did not utilize the QAPI process to identify this high-risk resident population, identify risk factors related to the care for residents with suicidal ideations, monitor the care provided for these residents, ensure staff had the needed competencies and skillsets to care for these residents.

Example 3

Nutrition/hydration Status Maintenance

The facility has been cited at

During outbreak, frequent hand hygiene after providing care or having contact with residents suspected or confirmed with norovirus gastroenteritis. 5.

Transfers may be limited to Contact Precautions are not able to be maintained; or transfers may be postponed until residents no longer require Contact Precautions. 6.

Perform additional cleaning and disinfection of frequently touched environmental surfaces and equipment in resident care areas, resident with isolation and cohorted areas, as well as high-traffic clinical areas.

Frequently touched surfaces include, but not limited to, commodes, toilets, faucets, hand/bed railing, telephones, door handles, computer equipment, and kitchen preparation surfaces.

Clean and disinfect shared equipment between residents using EPA-registered products with label claims for use in healthcare which lists activity against norovirus.

Follow the manufacturer's recommendations for application and contact times. 7.

Clean and disinfect surfaces starting from the areas with a lower likelihood of norovirus (e.g., toilets, bathroom fixtures).

Change mop heads when a new bucket of cleaning solution is prepared or after cleaning large spills of emesis or fecal material. 8.

During outbreaks, change privacy curtains when they are visibly soiled and upon resident discharge or transfer. 9.

Handle soiled linens carefully, without agitating them, to avoid dispersal of virus.

Use Standard Precautions, including the use of appropriate PPE (e.g., gloves and gowns), to minimize the likelihood of cross-contamination. 10.

Staff who work with, prepare or distribute food will be excluded from duty immediately if they develop symptoms of acute gastroenteritis.

Any staff presenting with norovirus symptoms will be off work and not to return until a minimum of 48 hours after the resolution of symptoms or longer upon recommendation from Infection Control Preventionist or Infection Control Committee.

The facility policy titled, Infection Control Program Introduction, last reviewed 1/2025, states in part .

Introduction: Infections are among the most frequent and significant problems facing nursing facility residents today.

They account for a large proportion of morbidity and mortality, and for many hospital transfers.

This Infection Control Manual will provide information for the essential functions and practices of the facility and also be flexible enough to fit a facility's specific environment and able to accommodate new issues or requirements.

Purpose of Infection Control Program: The major purposes of Infection Control Programs in the nursing facility are to minimize the effects of infections on residents and employees, and to educate the staff. A successful Infection Control Program requires an underlying commitment and facility-wide participation. It should not just be seen as a way to meet paperwork requirements but as a way to analyze and use information effectively to improve and prevent problems.

525209

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 525209 B.

Wing 04/14/2025

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

Mulder Health Care Facility 713 Leonard St N West Salem, WI 54669

F-F880)

The facility did not utilize the QAPI process during or after the outbreak to gain feedback, collect data, and monitor the infection prevention and control process.

There was no evidence the facility identified deficient practices during or after the GI outbreak or analyzed the data to implement a process improvement for infection control/GI outbreaks.

Example 2

Sufficient/competent Staff-Behavioral Health Needs

The facility has been cited at