Inspection Reports for St. Joseph Transitional Rehabilitation Center

The inspection was conducted as a result of a Complaint and Facility Reported Incident (FRI) Investigations in the facility on 05/02/2024.

Four complaints and three facility reported incidents were investigated. One complaint was substantiated without deficient practice, and the others were unsubstantiated. No regulatory deficiencies were identified and no further action was necessary.

Four complaints and three facility reported incidents were investigated: one complaint (NV00070929) was substantiated without deficient practice; the other complaints and FRIs were unsubstantiated with no regulatory deficiencies identified.

This inspection was conducted as a State Licensure Survey in conjunction with a Federal Recertification survey at the facility from 09/20/2023 through 09/22/2023 to assess compliance with Nevada Administrative Code Chapter 449 for Skilled Nursing Facilities.

The facility was found deficient for failing to timely notify the State Licensing agency of a change in administrator and for incomplete employee background screening and tuberculosis (TB) testing. Specifically, one employee's background check using the Nevada Automated Background check System (NABS) was not completed, and three employees lacked documented completion of the two-step baseline TB screening test.

The inspection was conducted as a result of a complaint investigation involving two complaints and three Facility Reported Incidents (FRIs) at the facility.

No regulatory deficiencies were identified during the investigation. All complaints and FRIs were unverified, and no further action was necessary.

Two complaints (#NV00068036 and #NV00068253) and three Facility Reported Incidents (#NV00067981, #NV00068266, #NV00068338) were investigated and found to be unverified with no regulatory deficiencies identified.

The inspection was conducted as a result of a facility reported incident and three complaints investigated, including allegations of employee to resident altercation, resident care concerns, and notification failures.

The investigation found that most allegations could not be substantiated, including repositioning, rehabilitation services, lost personal items, and timely staff response. One allegation of a resident choking on a pureed diet was substantiated. A significant deficiency was found related to failure to notify the provider of a resident's swallowing difficulty, delaying intervention.

Complaint #NV00067440 was substantiated regarding a resident choking on a pureed diet and failure to notify the provider of swallowing difficulties. Other complaints related to repositioning, rehabilitation, lost items, and staff responsiveness were not substantiated.

The inspection was conducted as a State Licensure Survey in conjunction with a Federal Recertification survey at the facility from 08/09/2022 through 08/12/2022 to assess compliance with Nevada Administrative Code (NAC) Chapter 449 for Skilled Nursing Facilities.

The facility failed to ensure that 7 of 11 employee records contained evidence of completed 2-step Tuberculosis (TB) screening, annual TB tests, or physical examinations as required by state regulations.

The inspection was conducted as a Medicare Recertification Survey, Complaint Survey, and Facility Reported Incident investigation from August 9 through August 12, 2022, investigating 14 complaints and 5 facility reported incidents.

The facility was found to have multiple deficiencies including substantiated complaints of insufficient staffing, delayed call light response, inadequate fall prevention, failure to provide timely showers and bed baths, untimely assessments, failure to properly secure residents during transport, and inadequate care related to suprapubic catheters and wound care. Some allegations of neglect and abuse were substantiated without regulatory deficiencies, while others were unsubstantiated.

The investigation included 14 complaints and 5 facility reported incidents. Several complaints were substantiated with no regulatory deficiencies, including allegations of neglect, insufficient staffing, and injury of unknown origin. Some complaints were unsubstantiated due to lack of evidence. The facility was found deficient in multiple areas related to care and safety.

Routine inspection of Saint Joseph Transitional Rehabilitation Center to assess compliance with healthcare regulations including medication consent, environment safety, resident assessments, care planning, and staffing adequacy.

The facility was found deficient in multiple areas including failure to obtain consent for psychotropic medication, maintain equipment, timely complete resident assessments, provide baseline care plans, ensure ADL care and wound care, maintain medication storage conditions, and provide adequate staffing.

The inspection was conducted as a Medicare Life Safety Code (LSC) recertification survey and Emergency Preparedness survey at the facility.

The facility was found deficient in multiple areas including emergency preparedness policies and training, egress door locking mechanisms, exit signage, hazardous area enclosures, sprinkler system installation and obstruction, HVAC system compliance, fire damper inspections, fire drill procedures, smoking regulations enforcement, and electrical equipment testing and maintenance.

Investigation of facility reported incidents and complaints including allegations of failure to notify public guardian after resident discharge, failure to provide podiatry services, and other resident care concerns.

The investigation substantiated complaints regarding failure to notify the public guardian after a resident left against medical advice and failure to provide timely podiatry services. Other allegations related to resident care, visitation, staffing, and facility practices were not substantiated. The facility provided education and corrective actions for identified deficiencies.

Complaint #NV00063564 substantiated failure to notify public guardian after resident discharge. Complaint #NV00064913 substantiated failure to provide podiatry services. Other complaints related to resident care, visitation, staffing, and facility practices were investigated with mixed substantiation results.

The inspection was conducted as a result of an investigation of facility reported incidents and complaints at the facility on 12/28/2021.

The investigation included review of multiple complaints and facility reported incidents. Two complaints were substantiated related to failure to notify the Public Guardian after a resident eloped and failure to follow a request for podiatry services. Other allegations including resident care, visitation, staffing, and facility conditions were not substantiated. Deficiencies were cited related to notification of changes and foot care.

Complaint #NV00063564 was substantiated for failure to notify the Public Guardian after a resident left the facility against medical advice. Complaint #NV00064913 was substantiated for failure to follow a request for podiatry services. Other complaints were investigated with some allegations not substantiated.

The inspection was a Centers for Medicare and Medicaid Services (CMS) Focused Infection Control survey conducted on 05/11/2021 and completed on 05/12/2021, to investigate regulatory compliance for Infection Control and Prevention.

The facility had three positive COVID-19 cases and 22 residents under observation. The investigation included review of infection control policies, staff screening, PPE usage, and cleaning practices. Deficiencies were identified related to baseline care plans for antibiotic therapy, N95 mask fit testing, disinfecting blood glucose monitors, proper use of PPE, and cleaning of toilet bowls.

An offsite follow-up survey was completed to verify correction of all deficiencies cited on January 15, 2021.

All deficiencies cited in the prior inspection have been corrected. The facility was found to be in substantial compliance with regulations surveyed.

The inspection was conducted as a CMS Focused Infection Control survey to evaluate the facility's compliance with infection prevention and control requirements, including COVID-19 related practices.

The facility had no COVID-19 positive residents at the time of inspection but had 26 residents under observation for COVID-19. Deficiencies were identified related to infection prevention and control practices, including improper hand hygiene, incorrect mask usage, and issues with N95 mask fit testing and usage.

The inspection was conducted as a result of a Centers for Medicare and Medicaid Services (CMS) Focused Infection Control survey and a Complaint Investigation from 09/29/2020 through 09/30/2020.

The facility was found to have multiple deficiencies including staffing shortages, improper infection control practices, failure to provide scheduled showers and bed baths, inadequate skin assessments, improper use of personal protective equipment (PPE), and delayed response to resident call lights.

Complaint #NV00061389 was substantiated with allegations including staffing shortages, improper infection control, and failure to respond to call lights. Complaint #NV00060474 was substantiated with allegations including failure to respond to call lights timely.

The inspection was a Centers for Medicare and Medicaid Services (CMS) Focused Infection Control survey conducted to evaluate the facility's infection control and prevention program, including COVID-19 related policies and practices.

The facility was found to have no regulatory deficiencies. The survey reviewed infection control policies, staff screening, PPE usage, and resident cohorting related to COVID-19. Staff education and facility documentation were also evaluated and found adequate.

This inspection was a Centers for Medicare and Medicaid Services (CMS) Focused Infection Control survey conducted to review the facility's compliance with infection prevention and control requirements, including COVID-19 related policies and practices.

The survey found that the facility had implemented comprehensive infection control measures including screening, PPE usage, isolation units, and staff education. No regulatory deficiencies were identified during the survey.

This inspection was a Centers for Medicare and Medicaid Services (CMS) COVID-19 Focused Infection Control survey initiated due to the COVID-19 pandemic to assess infection prevention and control practices at the facility.

The facility was found deficient in infection prevention and control practices, specifically failing to ensure all staff were fit tested for N95 masks. Multiple staff members across departments were not fit tested, and corrective actions were required to address this deficiency.

The investigation was conducted as a result of facility reported incidents and a complaint completed at the facility on January 28, 2020, to assess compliance with federal regulations for long term care facilities.

The investigation substantiated one complaint regarding call lights being away from residents' reach, identifying a deficiency in reasonable accommodations for residents. Several other allegations and incidents were substantiated with no regulatory deficiencies identified. The facility failed to ensure call lights were within reach for 3 out of 5 sampled residents.

Complaint #NV00059220 was substantiated regarding the call light being away from the resident's reach. Other allegations related to resident neglect and injury were not substantiated or had no regulatory deficiencies identified.

The inspection was conducted as a result of a complaint investigation completed on 10/15/19 in accordance with 42 CFR, Chapter IV, Part 483 - Requirements for Long Term Care Facilities. Two complaints were investigated during this visit.

The investigation found one complaint substantiated regarding residents being left wet with wet diapers and bedding and hair not washed or combed. Other allegations such as inappropriate discharge and call bell issues were unsubstantiated. Deficiencies were identified related to ADL care provided for dependent residents, including failure to provide necessary assistance with grooming, eating, and toileting for 3 of 8 sampled residents.

Two complaints were investigated: Complaint #NV00058545 was unsubstantiated; Complaint #NV00058411 was substantiated with findings related to residents left wet with wet diapers and bedding and hair not washed or combed.

The inspection was conducted as an Emergency Preparedness survey in conjunction with a Medicare recertification survey to evaluate compliance with federal, state, and local emergency preparedness requirements.

The facility failed to develop and maintain a comprehensive emergency preparedness program updated at least annually, including an emergency plan and communication plan. Specific deficiencies included outdated emergency plan last updated in 2015 and incomplete staff contact information in the emergency preparedness communication plan.

This Medicare Recertification survey was conducted from July 29, 2019 through July 31, 2019, to assess compliance with federal regulations for long term care facilities.

The survey identified multiple deficiencies including failure to ensure patient privacy, protect personal health information, develop comprehensive care plans, provide scheduled showers, follow physician orders for elevated blood sugar, provide podiatry services, secure medication carts, perform neurological assessments after falls, and maintain infection control practices including proper use of personal protective equipment and cleanliness of laundry equipment.

One complaint (#NV00057449) was investigated and found to be unsubstantiated.

This inspection was a Medicare Life Safety Code recertification survey conducted at the facility on 07/31/2019 to assess compliance with NFPA 101 and NFPA 99 Life Safety Codes.

The facility was found to have multiple deficiencies related to means of egress obstructions, self-closing smoke barrier doors not functioning properly, sprinkler system installation issues, and corridor doors that did not close or latch properly and were obstructed. Corrective actions and education were planned and initiated.

The inspection was conducted as a result of a complaint investigation completed on 10/31/2018 regarding allegations of medication not being administered and other resident care concerns.

The complaint investigation substantiated that a resident did not receive prescribed special compound cream medication as ordered by a physician. Multiple other allegations related to call light response, staff behavior, and communication were not substantiated. The facility failed to administer medication per physician orders and lacked proper documentation and notification to the physician when medication was unavailable.

Complaint #NV00054984 was substantiated regarding the resident not receiving prescribed special compound cream medication. Other allegations including call lights not working, staff sleeping, verbal abuse, and mixing of personal effects were not substantiated.

The inspection was conducted as a complaint investigation triggered by two complaints alleging issues such as pressure ulcers, unclean residents, and unanswered call lights.

The investigation included observations, interviews with staff and residents, and clinical record reviews. No regulatory deficiencies were identified and the complaints could not be substantiated.

Two complaints were investigated. Complaint #NV00053908 involved allegations of pressure ulcers, lack of care, and unanswered call lights. Complaint #NV00053893 involved allegations including feeding residents high salt foods, weight gain, bathing refusals, pain medication administration issues, blood pressure medication concerns, and resident monitoring. Both complaints could not be substantiated.

This Plan of Correction was generated as a result of an Emergency Preparedness survey conducted in conjunction with a Medicare recertification survey at the facility on 07/26/18 - 07/27/18.

The facility failed to develop and maintain an emergency preparedness communication plan that included a method for sharing information from the emergency plan with residents and their families or representatives, as confirmed by documentation review and interview with the Administrator.

This report documents the results of a Medicare recertification Life Safety Code (LSC) Survey conducted at the facility from 07/26/18 to 07/27/18 to assess compliance with fire safety and life safety regulations.

The facility was found deficient in multiple areas related to fire safety, including maintenance of the rooftop, sprinkler system, fire extinguishers, fire doors, smoke barriers, electrical systems, and gas equipment. Several sprinkler heads were improperly installed or maintained, fire doors did not latch properly, and electrical receptacles were not tested annually. Corrective actions and monitoring plans were outlined for each deficiency.

A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of CMS. The facility was found not to be in substantial compliance with 42 CFR 483 subpart B.

The facility failed to implement individualized programs of activities, failed to provide interventions to prevent and treat pressure ulcers, failed to ensure appropriate psychotropic medication use, and failed to maintain medication error rates below 5%. Corrective actions and systemic changes were planned to address these deficiencies.

The inspection was initiated as a complaint investigation starting on April 19, 2018, and completed on April 25, 2018, to investigate multiple complaints regarding resident care and facility practices.

The investigation included observations, interviews, and record reviews related to allegations of unsubstantiated complaints and substantiated complaints involving unsafe discharge, inadequate cleaning, and dignity issues. Several deficiencies were identified related to resident rights, discharge planning, and care practices.

Five complaints were investigated. Three complaints (#NV00050069, #NV00051954, #NV00051380) were not substantiated. Two complaints (#NV00051077 and #NV00052510) were substantiated involving unsafe discharge and failure to address resident's cleaning needs and dignity.

This report documents a Medicare recertification Life Safety Code (LSC) Survey conducted at the facility on 7/28/17 to assess compliance with fire safety standards as part of the facility's license renewal process.

The facility was found deficient in maintaining the automatic fire sprinkler system, portable fire extinguishers, corridor doors, smoke barriers, utilities, electrical systems, and gas equipment. Multiple sprinkler heads were dirty, damaged, or improperly installed, fire extinguishers were improperly mounted, corridor doors failed to resist smoke passage, and electrical and gas equipment had safety issues. Corrective actions and audits were planned to address these deficiencies.

This inspection was conducted as a Medicare Recertification survey from July 25, 2017 through July 28, 2017, including one complaint investigation.

The survey identified multiple regulatory deficiencies related to comprehensive care plans, pain management, range of motion, accident hazards, treatment and care, special needs, drug records, food safety, and safe/functional environment. The complaint investigated was not substantiated.

One complaint (#NV00048675) was investigated with allegations including no air conditioning, loud roommate, broken toilet, unclean room, uninflated mattress, unappetizing food, cockroach presence, lack of medications due to no pharmacy on site, and improper discharge instructions. The complaint was not substantiated.

The inspection was conducted as a result of a complaint investigation regarding allegations of resident abuse, intimidation, fear of retaliation, and failure to maintain and report incident records in a timely manner.

The complaint investigation included interviews with staff and residents and review of records. The allegations could not be substantiated and no regulatory deficiencies were identified. No further action was necessary.

Complaint #NV00047577 involved allegations of resident abuse, intimidation, fear of retaliation, and failure to maintain incident records and timely reporting. The allegations were not substantiated.

The inspection was conducted as a result of a complaint investigation regarding allegations about resident bed size issues, lack of hot water for bathing, and low water pressure in the facility.

The investigation included observations, interviews with staff and residents, and review of records and policies. No regulatory deficiencies were identified and the complaint was not substantiated.

Complaint #NV00047242 was investigated and could not be substantiated. Allegations included issues with a resident's bed size, lack of hot water for two to three weeks, and low water pressure from a shower head.

The inspection was conducted as a result of a complaint investigation regarding allegations of resident neglect and quality of care issues at the facility.

One complaint was substantiated related to improper documentation of Foley catheter care. Three other allegations regarding resident neglect were not substantiated. The investigation included observations, record reviews, and staff interviews.

Complaint # NVN00046792 was substantiated for allegation #4, Quality of Care, improper documentation of Foley catheter care. Allegations #1, #2, and #3 regarding resident neglect were not substantiated.

The inspection was conducted as a Medicare Recertification Life Safety Code (LSC) survey to assess compliance with NFPA 101 Life Safety Code standards at the facility.

The facility was found deficient in multiple Life Safety Code standards including patient room door locking mechanisms, fire drill procedures, smoke detector maintenance, sprinkler coverage, sprinkler system maintenance, obstruction of sprinkler heads by cubicle curtains, and electrical wiring and equipment issues. Corrective actions and timelines were provided for each deficiency.

This inspection was conducted as a Medicare Recertification Life Safety Code survey to assess compliance with NFPA 101 Life Safety Code standards.

The facility was found deficient in multiple areas including patient room door locking mechanisms, fire drill timing, smoke detector maintenance, incomplete sprinkler coverage, sprinkler system maintenance, obstruction of sprinkler spray by cubicle curtains, and electrical wiring and equipment issues.

This inspection was conducted as a State Licensure survey of the facility from August 9, 2016 through August 12, 2016 in accordance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing.

The facility was found to have a regulatory deficiency related to personnel records, specifically the failure to ensure that three housekeeping employees completed pre-employment physicals including tuberculosis skin tests as required by state regulations.

The inspection was conducted as a State Licensure survey from August 9, 2016 through August 12, 2016 in accordance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing.

The facility was found deficient for failing to maintain current and accurate personnel records, specifically for not ensuring pre-employment physicals for 3 housekeeping employees as required by state regulations.

This document is a Medicare Recertification survey conducted from August 9, 2016 through August 12, 2016, including investigation of three complaints during the survey.

The survey identified multiple deficiencies related to resident care, medication administration, treatment of pressure ulcers, catheter care, medication errors, food safety, and facility maintenance. Three complaints were investigated with one substantiated and two unsubstantiated. The facility failed to notify a resident's family timely about a fall and room change, failed to ensure proper medication orders and administration, and failed to maintain a safe environment among other issues.

Three complaints were investigated. Complaint #NV 00045925 was substantiated regarding a resident stuck in the patio and failure to notify family timely about fall and room change. Complaint #NV 00046558 and #NV 00046543 were unsubstantiated.

Medicare Recertification survey conducted from August 9, 2016 through August 12, 2016, including investigation of three complaints.

The survey identified multiple deficiencies including failure to notify family timely after a resident fall, medication administration errors, improper catheter care, inadequate supervision of residents, failure to maintain nutritional status documentation, improper IV line care, medication storage issues, and environmental safety hazards.

Three complaints investigated. Complaint #NV 00045925 substantiated regarding resident left stuck in patio for 30 minutes and failure to notify family timely. Complaint #NV 00046543 substantiated regarding medication administration. Complaint #NV 00046558 unsubstantiated.

The inspection was conducted as a complaint investigation survey triggered by Complaint #NV 00045215, which included allegations regarding the removal and replacement of a hospital bed and lack of shower assistance for a resident.

The investigation included observations, interviews with staff, residents, and family members, and clinical record reviews. No deficiencies were identified and the allegations were not substantiated.

Complaint #NV 00045215 alleged that a resident's hospital bed was replaced with an unsuitable bed and that the resident had not received proper shower assistance since 2012. Both allegations were investigated and found to be unsubstantiated.

This inspection was conducted as a result of a complaint investigation regarding allegations that a resident was not provided preventative services for a pressure sore and was not provided telephone access.

The investigation found that preventative care for pressure sores was provided, including use of specialized mattresses and cushions, repositioning, and wound care. Telephones were observed to be available in resident units. Interviews and record reviews supported these findings. No regulatory deficiencies were identified.

Complaint #NV00044015 was investigated with allegations of lack of preventative pressure sore services and telephone access. Both allegations were not substantiated.

The inspection was conducted as a Medicare/Medicaid Recertification survey at the facility from 9/1/15 through 9/3/15 to assess compliance with federal regulations for long term care facilities.

The survey identified multiple deficiencies across various areas including abuse prevention training, accommodation of resident needs, provision of medically-related social services, development of comprehensive care plans, medication administration, infection control, and emergency preparedness. The facility failed to meet several regulatory requirements as evidenced by missing documentation, inadequate staff training, and improper care practices.

The inspection was conducted as a Medicare/Medicaid Recertification survey from 9/1/15 through 9/3/15 to assess compliance with federal regulations for long term care facilities.

The facility was found deficient in multiple areas including failure to ensure abuse prevention training for employees, failure to accommodate resident preferences, incomplete social service evaluations, lack of individualized care plans, medication administration errors, infection control lapses, medication storage issues, incomplete clinical records, and inadequate emergency procedure training.

This document is a Statement of Deficiencies generated as a result of a Life Safety Code (LSC) survey conducted at the facility on 09/03/15 to assess compliance with fire safety and life safety standards.

The facility failed to meet several NFPA 101 Life Safety Code standards, including issues with fire-rated doors not self-closing and latching, fire drills not properly conducted, fire alarm control panel inaccuracies, inadequate sprinkler protection for storage areas, improper storage near sprinkler heads, and improper electrical receptacle testing and documentation. These deficiencies could affect residents, visitors, and staff safety.

The inspection was conducted as a Life Safety Code (LSC) survey to evaluate compliance with fire safety standards and related health care occupancy regulations.

The facility was found deficient in multiple areas related to fire safety, including failure to maintain self-closing corridor doors to hazardous areas, inadequate fire drill responses, inaccurate fire alarm control panel displays, lack of sprinkler protection for a storage shed, improper maintenance of sprinkler heads, improper storage of oxygen cylinders, and failure to document required testing of electrical receptacles in resident rooms.

The inspection was conducted as a complaint investigation survey triggered by an allegation that Certified Nursing Assistants (CNAs) were unable to provide appropriate care to residents during the night shift due to staff shortage.

The complaint was not substantiated as observations and interviews revealed the facility had sufficient staff to provide care during the night shift. No regulatory deficiencies were identified and no further action was necessary.

Complaint #NV00042358 alleged CNAs were unable to provide appropriate care during the night shift due to staff shortage; this allegation was not substantiated after investigation including observations, interviews, and record reviews.

The inspection was conducted as a result of a complaint investigation at the facility from March 4-5 and 24, 2015, finalized March 31, 2015, regarding multiple allegations of resident care concerns.

The investigation reviewed multiple allegations including respiratory care, medication administration, facility neglect, fall management, and wound care documentation. None of the complaints except one related to wound care documentation were substantiated. One regulatory deficiency was identified related to failure to document wound care treatment for a resident.

Complaint #41739 contained four allegations, all unsubstantiated. Complaint #41793 contained five allegations, all unsubstantiated. Complaint #NVS00041807 contained one allegation, unsubstantiated. Complaint #NV00042250 contained one allegation, which was substantiated related to wound care documentation.

The inspection was conducted as a complaint investigation initiated by the Division of Public and Behavioral Health on 12/16/14, addressing multiple allegations including failure to obtain timely ophthalmologist consult and antibiotic eye drops, malfunctioning call bells, undignified treatment by nurses, and delay in medication administration.

The investigation found no substantiated deficiencies related to the allegations. Observations, interviews, and record reviews showed timely ophthalmologist consults and medication administration, functional call bells, appropriate resident care, and no evidence of undignified treatment or medication delays. No deficiencies were identified.

Complaint #NV00041269 contained one allegation regarding failure to ensure timely ophthalmologist consult and antibiotic eye drops, which was not substantiated. Complaint #NV00041186 contained three allegations: malfunctioning call bells, undignified treatment by nurses, and delay in medication administration, none of which were substantiated.

The inspection was conducted as a result of a complaint investigation regarding allegations of falsification of records and a resident deceased for an extended period prior to paramedics' arrival.

The investigation substantiated the allegation of falsification of records related to medication administration documentation. The allegation regarding a resident deceased for an extended period prior to paramedics' arrival was not substantiated. A deficiency was cited for failure to ensure accurate documentation of enteral nutrition administration for one resident.

Complaint #NV00040882 contained two allegations: 1) Falsification of records, which was substantiated; 2) Resident deceased for an extended period prior to paramedics' arrival, which was not substantiated.

The inspection was conducted as a complaint investigation triggered by Complaint #NV00040882, which contained two allegations: falsification of records by nursing staff and a resident being deceased for an extended period prior to paramedics' arrival.

The investigation substantiated the allegation of falsification of records where nursing staff documented medication administration in advance for one resident. The allegation regarding the resident being deceased for an extended period prior to paramedics' arrival was not substantiated. The facility failed to ensure accurate documentation of enteral nutrition administration for one sampled resident.

Complaint #NV00040882 contained two allegations: 1) falsification of records by nursing staff documenting medication administration and medical procedures in advance, which was substantiated; 2) a resident was deceased for an extended period prior to paramedics' arrival, which was not substantiated.

The inspection was conducted as a Medicare recertification survey initiated on 8/8/14 in accordance with 42 CFR Chapter IV, Part 483 - Requirements for Long Term Care Facilities.

The facility was found deficient in multiple areas including personal privacy and confidentiality of records, provision of medically related social services, professional standards for services, catheter care, eating skills restoration, food procurement and sanitation, specialized rehab services, drug records and storage, infection control, and resident records accuracy and accessibility.

The inspection was a Medicare recertification survey conducted in accordance with 42 CFR Chapter IV, Part 483 - Requirements for Long Term Care Facilities.

The facility was found deficient in multiple areas including privacy violations during medication administration and wound care, failure to provide initial social service evaluations, improper documentation of TB skin test results, failure to irrigate Foley catheter as ordered, improper feeding tube medication administration, unsafe food storage practices, failure to provide ordered physical therapy, improper medication storage and disposal, infection control lapses, and incomplete clinical record documentation.

The facility underwent a Life Safety Code (LSC) survey to assess compliance with NFPA 101 standards related to health care occupancies, focusing on fire safety and emergency egress.

The survey identified deficiencies including obstructed exit corridors reducing aisle width below required standards, inadequate clearance between storage racks and sprinkler heads, and a fire extinguisher being obscured by an emergency responder's vest. Plans of correction were provided to address these issues.

The inspection was conducted as a Life Safety Code (LSC) survey to assess compliance with fire safety standards at the facility.

The facility was found to have multiple deficiencies related to life safety code standards, including obstructed exit corridors reducing aisle width, insufficient clearance between storage and sprinkler deflectors, and a fire extinguisher that was not conspicuously located.

The inspection was conducted as a result of a complaint investigation at the facility on 7/30/14, in accordance with federal regulations for long term care facilities.

Three complaints were investigated; one complaint was substantiated involving a resident acquiring a pressure ulcer for not being turned, while the other two complaints were not substantiated. The facility was found to have failed to properly assess the skin condition of a resident to prevent pressure sores.

Three complaints were investigated. Complaint #NV00039879 was substantiated involving a resident acquiring a pressure ulcer for not being turned. Complaints #NV00039568 and #NV00039928 were not substantiated. Allegations included verbal abuse, unsafe discharge, medication errors, rough handling by a physical therapist, pest infestation, inappropriate feeding assistance, employee working with open sores, and unvaccinated staff working with residents with active Herpes zoster.

The inspection was conducted as a result of a complaint investigation at St Joseph Transitional Rehabilitation Center on 7/30/2014, involving three complaints with multiple allegations regarding resident care and facility conditions.

One complaint was substantiated involving a resident acquiring a pressure ulcer due to inadequate skin assessment and treatment. Other allegations including verbal abuse, unsafe discharge, medication errors, rough handling, understaffing, pest infestation, feeding assistance, employee health, and vaccination compliance were not substantiated.

Three complaints were investigated. Complaint #NV00039879 was substantiated with one allegation regarding a resident acquiring a pressure ulcer. Complaints #NV00039568 and #NV00039928 were not substantiated. Allegations included verbal abuse, unsafe discharge, medication errors, rough handling, understaffing, pest infestation, feeding assistance, employee working with open sores, and unvaccinated healthcare personnel working with infected residents.

The inspection was conducted as a complaint investigation initiated by the Division of Public and Behavioral Health on 12/2/13 regarding allegations that the facility failed to assess a resident in a timely manner after a change in condition and that the resident was isolated and denied visitation.

The investigation found that the facility nursing staff documented ongoing assessments and referrals with timely notification of physicians and family. The resident was not isolated and participated in social activities and out-of-facility trips. Interviews and record reviews substantiated that the allegations were not substantiated.

Complaint #NV 00037630 alleged failure to assess a resident timely after a change in condition and isolation with denied visitation. Both allegations were not substantiated based on document review, clinical record review, interviews with staff and the resident.

This visit was conducted as a State Licensure construction standards survey in accordance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing, focusing on remodeled areas including showers and nurse call systems.

No deficiencies were identified during this life safety code survey. The remodeled areas met the applicable construction and safety standards.

The inspection was conducted as the annual Medicare re-certification survey in accordance with 42 CFR Chapter IV Part 483 Requirements for Long Term Care Facilities.

The survey identified multiple deficiencies related to residents' rights to refuse treatment and formulate advance directives, abuse/neglect policies, dignity and respect of individuality, provision of care and services for highest well-being, maintenance of nutrition status, treatment and care for special needs, infection control, and resident records completeness and accuracy. The facility failed to meet several regulatory requirements as evidenced by record reviews, interviews, and observations.

The inspection was conducted as the annual Medicare re-certification survey and state licensure survey for the facility, including an infection risk assessment and a Life Safety Code survey.

The facility was found to have multiple deficiencies including failure to provide information and education on advance directives, failure to ensure criminal background checks for employees, failure to respect resident dignity, failure to provide care and services for highest well-being, failure to maintain nutrition status, failure to provide proper treatment and care for special needs, failure to maintain infection control, and failure to maintain accurate and complete resident records. Life safety code deficiencies related to emergency lighting and exit signage were also identified.

The inspection was conducted as a complaint investigation initiated by the Nevada State Division of Public and Behavioral Health on July 18, 2013, regarding pressure ulcer prevention, identification and treatment, pain management, physical therapy orders, evaluation and treatment, and proper discharge.

The complaint investigation included review of ten resident files, interviews with nursing and therapy staff, and review of related policies. The complaint was found to be unsubstantiated with no deficiencies cited.

Complaint #NV00036017 was investigated focusing on pressure ulcer prevention and management, pain management, physical therapy, and discharge procedures. The complaint was unsubstantiated.

The inspection was conducted as a result of a complaint investigation initiated by the Nevada Division of Public and Behavioral Health regarding activities of daily living documentation, care-planning, and nursing documentation.

Ten medical records were reviewed along with interviews and policy reviews. The complaint was found to be unsubstantiated and no regulatory deficiencies were identified.

Complaint #NV00035715 involved review of ten medical records focusing on bowel monitoring, pain monitoring, and tube-feeding documentation. Interviews were conducted with a respiratory therapist and the administrator. The complaint was unsubstantiated.

The inspection was conducted as a complaint investigation based on allegations that the facility did not provide adequate activities, appropriate durable medical equipment, and appropriate incontinence care for sampled residents.

The allegation regarding inadequate activities was not substantiated, but the facility was found to have substantiated deficiencies related to durable medical equipment and incontinence care. Specifically, a wheelchair was too small for a resident and one resident was not properly cleaned after bowel movements.

The complaint alleged inadequate activities for 1 of 5 sampled residents (not substantiated), failure to provide appropriate durable medical equipment (substantiated), and failure to provide appropriate incontinence care and notify the physician of a change in condition (substantiated).

This inspection was conducted as a result of a complaint investigation regarding allegations that the facility did not provide adequate activities, appropriate durable medical equipment, and appropriate incontinence care for sampled residents.

The investigation found that the allegation of inadequate activities was not substantiated, but the facility did not provide appropriate durable medical equipment or incontinence care, and failed to notify the physician of a change in condition for one resident. Specific deficiencies included a wheelchair that was too small for a resident and improper cleaning after bowel movements for another resident.

The complaint alleged the facility did not provide adequate activities for one of five sampled residents (not substantiated), did not provide appropriate durable medical equipment (substantiated), and did not provide appropriate incontinence care or notify the physician of a change in condition for one resident (substantiated).

This inspection was conducted as a result of a complaint investigation at the facility from 02/07/2013 through 02/08/2013 regarding the timeliness of staff answering call bells.

The investigation found that the facility did not ensure call bells were answered in a timely manner for 5 of 10 resident interviews, with some residents reporting waits up to four hours. The allegation that call bells were not answered timely was substantiated.

The complaint alleged staff were slow to answer call bells. Interviews with ten residents revealed delays ranging from at least two hours to up to four hours. The allegation was substantiated based on the investigation findings.

The inspection was conducted as a result of a complaint investigation regarding the timeliness of staff response to call bells at the facility.

The investigation found that call bells were not answered in a timely manner for 5 of 10 residents interviewed, with some residents reporting wait times up to four hours. The allegation that call bells were not answered timely was substantiated.

The complaint involved allegations that staff were slow to answer call bells, with residents reporting wait times ranging from two hours to four hours or longer. The allegation was substantiated based on resident interviews and record reviews.

The inspection was conducted as a complaint investigation initiated on 11/16/12 regarding allegations of insufficient staffing and inadequate nursing staff in the ventilator unit, as well as insufficient linens necessary for residents.

The complaint regarding insufficient staffing and inadequate nursing staff in the ventilator unit was not substantiated based on observations, interviews, clinical record reviews, and document reviews. The allegation of insufficient linens was also not substantiated after observation, interviews, and document review. No regulatory deficiencies were identified.

Complaint #NV00033375 was investigated and found not substantiated after review of staffing, interviews with nursing staff and administrators, and observation of linen supplies.

The inspection was conducted as a result of a complaint investigation at the facility on 08/01/2012.

The investigation found that some allegations related to infection control and dignity were not substantiated, but one allegation regarding failure to follow up with physician orders for 1 of 5 residents was substantiated, specifically related to clinical record documentation and discontinuation of a catheter order.

The complaint alleged improper infection control, lack of dignity in treatment, and failure to prevent pressure ulcers and communication issues. Most allegations were unsubstantiated except the failure to follow up with physician orders for 1 resident, which was substantiated.

The inspection was conducted as a result of a complaint investigation at the facility on 08/01/2012.

The investigation found that several allegations including improper infection control, lack of dignity in care, and quality of care issues could not be substantiated. However, the allegation that the facility did not follow up with applicable physician orders for one resident was substantiated.

The complaint alleged improper infection control related to catheter care, lack of dignity for one resident, failure to prevent pressure ulcers, failure to facilitate communication for a non-verbal resident, and leaving a resident wet for extended periods. Most allegations were unsubstantiated except for failure to follow physician orders for one resident.

The inspection was conducted as a result of a complaint investigation triggered by three allegations concerning employee criminal history, harassment and domestic violence history of an employee, and a resident's safety concerns.

The complaint was not substantiated after observation, documentation review, policy review, and interviews with facility staff, residents, and an investigator with the Nevada State Board of Medical Examiners.

The complaint contained three allegations: 1) Flyers regarding an employee's criminal history found on cars in the parking lot, unsubstantiated; 2) An employee's history of harassment and domestic violence, unsubstantiated after review of personnel files, policies, court documents, and interviews; 3) A resident did not feel safe at the facility, unsubstantiated due to lack of identifying information and interviews with residents and staff.

The inspection was conducted as a complaint investigation from 10/06/2011 through 10/11/2011 regarding allegations that the facility did not appropriately care for one sampled patient's pressure ulcer and urinary catheter, and did not timely attend to resident needs.

The complaint could not be substantiated after review of three resident clinical records and interviews with residents and staff, including the Director of Nursing and the Administrator. No regulatory deficiencies were identified.

Complaint #NV00029415 was investigated and found to be unsubstantiated based on clinical record reviews and staff interviews.

The inspection was conducted as a Medicare complaint survey at Saint Joseph Transitional Rehabilitation Center from May 9 to May 10, 2011, to investigate complaint #NV00027761 which contained four allegations.

The complaint investigation found all four allegations unsubstantiated, including claims of isolation, verbal abuse, teasing, and abandonment by staff.

Complaint #NV00027761 contained four allegations: 1) Resident #1 was isolated outside on the patio for a long time; 2) Resident #2 was verbally abused and sexually harassed by a staff member; 3) Resident #3 was teased and laughed at by staff until she cried; 4) A staff member abandoned residents by not cleaning or assisting them. All allegations were unsubstantiated.

This revisit survey was conducted in response to findings from the annual Medicare re-certification survey conducted February 8, 2011 through February 16, 2011.

The survey findings found the facility in compliance with no deficiencies noted.

This follow-up survey was conducted on 8/18/10 in response to findings from a previous recertification survey conducted on 6/22/10.

The survey found the facility in compliance with 42 CFR Chapter IV Part 483 Requirements for Long Term Care Facilities. No regulatory deficiencies were identified and no further action is necessary.

The inspection was conducted as a complaint investigation from 07/14/10 through 07/15/10 regarding an allegation that the facility did not provide appropriate social services for a resident.

The complaint was substantiated with one deficiency cited. The facility failed to provide appropriate medically-related social services for 1 of 3 sampled residents, as the care plan did not address identified social service needs and social work progress notes were lacking.

Complaint #NV00025748 was substantiated. The allegation that the facility did not provide appropriate social services was substantiated based on interviews and record review. Resident #1's social service needs were not addressed in the care plan, and social work progress notes were not documented by the responsible staff. The resident's Durable Power of Attorney was described as difficult to work with and verbally abusive to staff, which impacted social service provision.

The inspection was conducted as a complaint investigation based on complaint #NV00025748, alleging the facility did not provide appropriate social services to a resident.

The complaint was substantiated with one deficiency cited related to the facility's failure to provide medically-related social services to Resident #1 as required. The facility did not address identified psychosocial needs in the resident's care plan, and social services documentation was inadequate.

Complaint #NV00025748 was substantiated with one deficiency cited related to inadequate social services provision for Resident #1.

This inspection was conducted as a Medicare Life Safety Code (LSC) survey to assess compliance with NFPA 101 Life Safety Code standards at the facility.

The facility failed to have all smoke detectors inspected and tested in accordance with NFPA 101 9.6.1.3. The smoke detector inspection report dated 3/25/10 lacked documented evidence of inspection and testing for all smoke detectors. On 6/22/10, the Director of Maintenance indicated there were 80 smoke detectors in the building, but only 15 had documented inspections.

The inspection was conducted as a Medicare Life Safety Code (LSC) survey to assess compliance with NFPA 101, Life Safety Code, specifically focusing on fire safety and smoke detector maintenance.

The facility failed to have all smoke detectors inspected and tested in accordance with NFPA 101 9.6.1.3. Inspection reports showed incomplete documentation, with only 15 of 80 smoke detectors inspected as of the latest records.

The survey was conducted as a Medicare recertification annual inspection from June 14, 2010 through June 21, 2010.

The facility was found to have multiple deficiencies including failure to obtain informed consent for psychopharmacological medications, failure to provide information on advance directives, failure to notify physicians of significant changes, failure to maintain confidentiality of medical records, failure to post survey results accessibly, failure to obtain discharge summaries, failure to complete abuse reference checks, failure to maintain resident dignity during transport and meal service, failure to develop and follow comprehensive care plans, failure to meet professional standards in medication management, medication errors, failure to provide immunization education, failure to post nurse staffing information, failure to maintain sanitary food storage and distribution, and failure to maintain infection control practices.

The inspection was a Medicare recertification survey conducted from June 14, 2010 through June 21, 2010, to assess compliance with federal regulations for long term care facilities.

The survey identified multiple deficiencies related to informed consent for psychotropic medications, notification of changes in condition, personal privacy and confidentiality of records, development and implementation of abuse and neglect policies, dignity and respect of residents, drug regimen management, prevention of pressure sores, infection control, and food procurement and storage. Immediate jeopardy was identified and subsequently abated.

The inspection was conducted as a result of a complaint investigation in the facility on February 25, 2010, related to compliance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing.

The facility was found deficient for failing to have a sufficient number of slings available to transfer residents out of bed with a Hoyer lift at the time of a resident's request. The deficiency was substantiated for complaint #NV00024422 and unsubstantiated for complaint #NV00024388. The facility conducted an immediate search and inventory of slings, purchased additional slings, and provided staff in-services regarding sling availability and procedures.

Complaint #NV00024422 was substantiated with a deficiency cited. Complaint #NV00024388 was unsubstantiated.

The inspection was conducted as a result of a complaint investigation triggered by Complaint #NV00024422, which was substantiated, and Complaint #NV00024388, which was unsubstantiated.

The facility failed to have a sufficient number of slings available to transfer residents out of bed with a Hoyer lift at the time of resident's request, specifically for Resident #1.

Complaint #NV00024422 was substantiated with a deficiency cited. Complaint #NV00024388 was unsubstantiated.

The inspection was conducted as a complaint investigation based on complaints #NV00024204 and #NV00024179 in accordance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing.

Complaint #NV00024204 was unsubstantiated, while complaint #NV00024179 was substantiated with a deficiency related to failure of the social service worker to provide timely assistance for obtaining a birth certificate and arranging meetings for 2 of 4 residents.

Complaint #NV00024204 was unsubstantiated. Complaint #NV00024179 was substantiated with a deficiency.

The inspection was conducted as a result of a complaint investigation at Saint Joseph Transitional Rehabilitation Center on 01/28/2010, in accordance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing.

Complaint #NV00024179 was substantiated with a deficiency related to social services. The social worker failed to provide timely assistance to obtain a birth certificate and to arrange a meeting with the family and physician for 2 of 4 residents (Residents #2 and #3). Complaint #NV00024204 was unsubstantiated.

Complaint #NV00024179 was substantiated with a deficiency; Complaint #NV00024204 was unsubstantiated.

The inspection was conducted as a result of a complaint investigation triggered by three complaints (#NV00020988, #NV00023344, #NV00023997) regarding the facility's compliance with Nevada Administrative Code for skilled nursing facilities.

The investigation substantiated two complaints, with one complaint found unsubstantiated. Deficiencies were cited related to medication administration errors, specifically a failure to ensure a resident received the correct medication on 12/18/09.

Complaint #NV00020988 was substantiated in part with no deficiencies cited. Complaint #NV00023344 was unsubstantiated. Complaint #NV00023997 was substantiated with deficiencies cited.

The inspection was conducted as a result of complaint investigations related to medication administration errors at the facility.

The facility was found to have substantiated deficiencies related to medication administration errors, specifically failing to ensure a resident received the correct medication on the evening of 12/18/09.

Complaint #NV00020988 was substantiated in part with no deficiencies cited. Complaint #NV00023344 was unsubstantiated. Complaint #NV00023997 was substantiated with deficiencies cited.

The inspection was conducted as a result of a complaint investigation at the facility on 11/03/2009 in accordance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing.

The complaint #NV00022880 was unsubstantiated and no regulatory deficiencies were identified during the investigation.

Complaint #NV00022880 was unsubstantiated.

This Statement of Deficiencies was generated as a result of the follow-up survey to the annual Medicare recertification conducted 8/5/09 - 8/6/09.

The facility was found to be in substantial compliance with the regulations regarding this survey. No further action is necessary concerning this report.

The follow-up survey was conducted on August 5 and 6, 2009, following a State licensure and complaint investigation survey conducted on June 10, 2009.

The facility was found to be in substantial compliance with the State licensure regulations regarding this survey. No further action is necessary concerning this report.

This document is a follow-up survey to the annual Medicare recertification conducted from 8/5/09 to 8/6/09 to verify compliance with regulations.

The facility was found to be in substantial compliance with the regulations regarding this survey, and no further action was necessary.

This Statement of Deficiencies was generated as a result of the annual Medicare recertification survey conducted at the facility from 6/2/09 through 6/10/09.

The facility was found to have multiple deficiencies including failure to properly assess and document the use of physical restraints, failure to prevent abuse, failure to ensure dignity and respect for residents, failure to provide appropriate accommodations, failure to provide adequate social services, failure to develop comprehensive care plans, medication errors, inadequate supervision to prevent accidents and falls, pressure sore management issues, inadequate infection control, and deficiencies in pharmacy services and quality assurance.

Annual Medicare recertification survey conducted from 2009-06-02 through 2009-06-10 to assess compliance with federal regulations.

The facility was found deficient in multiple areas including physical restraints, abuse prevention, dignity and respect, accommodation of needs, social services, comprehensive care plans, pressure sore prevention, range of motion treatments, medication errors, sanitary conditions, pharmacy services, infection control, and quality assessment and assurance.

The inspection was conducted as a Life Safety Code (LSC) survey of the St Joseph Transitional Rehabilitation Center on 06/10/2009 to assess compliance with fire safety and life safety standards.

The facility was found to have multiple deficiencies related to fire safety code standards including corridor doors not closing properly, improper fire-rated windows, exit access obstructions, inadequate emergency lighting testing, incomplete fire safety plans, failure to conduct required fire drills, malfunctioning fire alarm system components, inadequate smoke detection coverage, incomplete fire sprinkler coverage, electrical system issues, and deficiencies in fire watch policies.

This report documents a Life Safety Code (LSC) survey conducted at the facility on June 10, 2009, to assess compliance with NFPA 101 Life Safety Code standards for existing health care occupancies.

The facility was found deficient in multiple areas related to fire safety and life safety code compliance, including corridor door closures, fire-rated windows, exit access, corridor widths, emergency lighting, fire safety plans, fire drills, fire alarm systems, smoke detection coverage, sprinkler system coverage, medical gas system compliance, electrical system safety, and fire watch policies.

This Statement of Deficiencies was generated as a result of a State Licensure survey and complaint investigation conducted in the facility from June 2, 2009 through June 10, 2009, including substantiated complaints related to falls, care planning, social services, and physical environment.

The facility failed to ensure comprehensive and updated care plans for 7 of 26 residents related to falls and behavioral issues. Several residents incurred multiple falls with inadequate post-fall assessments and interventions. The facility also failed to provide adequate social services assessments and interventions for residents with behavioral issues and family conflicts. Additionally, the facility did not ensure adequate supervision and assistive devices to prevent accidents and falls for 8 residents. Smoking safety and related incidents were inadequately managed. The facility's fall prevention program and incident management were found deficient in implementation and documentation.

Complaint #NV00022009, #NV00021962, and #NV00021805 were substantiated with deficiencies cited related to falls, care planning, social services, and physical environment.

This document is a Statement of Deficiencies generated as a result of a State Licensure survey and complaint investigation conducted from June 2, 2009 through June 10, 2009, including substantiated complaints #NV00022009, #NV00021962, and #NV00021805.

The facility was found deficient in multiple areas including failure to update care plans after falls for 7 of 26 residents, failure to prevent development of pressure sores in 1 resident, failure to provide adequate social services for 3 residents with behavioral and family issues, and failure to ensure adequate supervision and assistive devices to prevent accidents and falls for 8 residents. Multiple falls were documented with inadequate follow-up and interventions.

Complaint #NV00022009, #NV00021962, and #NV00021805 were substantiated with deficiencies cited.

This Statement of Deficiencies was generated as a result of a State Licensure resurvey conducted on June 10, 2009, to assess compliance with Nevada Administrative Code, Chapter 449, Facilities for Skilled Nursing.

The facility was found deficient in multiple areas including infection control, inadequate dining and activity space, non-compliance with medical gas and electrical system installation and approvals, emergency nurse call system accessibility, backflow protection for potable water supply, and lack of required approvals from state and local authorities for construction and system expansions.

The Bureau conducted a survey at St Joseph Transitional Rehabilitation Center on June 10, 2009, which resulted in findings of deficiencies leading to the intent to impose sanctions and monetary penalties.

The Health Division found deficiencies at the facility with severity levels leading to monetary penalties totaling $800. The Plan of Correction submitted was reviewed and deemed acceptable.

This report was generated as a result of the annual Medicare recertification survey conducted at the facility from June 2, 2009 through June 10, 2009.

The facility was found deficient in multiple areas including physical restraints, abuse, dignity, accommodation of needs, social services, comprehensive care plans, pressure sores, range of motion, medication errors, sanitary conditions, pharmacy services, infection control, and quality assessment and assurance. Several residents were specifically cited for issues related to care and treatment.

This Statement of Deficiencies was generated as a result of the complaint investigation conducted at the facility on 12/8/08.

Complaint #NV19859 was unsubstantiated. There were no regulatory deficiencies identified during the investigation.

Complaint #NV19859 was unsubstantiated.