Alta Mesa Health and Rehabilitation

Based on facility documents, staff interviews and facility policy, the facility failed to ensure the Daily Staff Postings for nursing staff was accurate and completed for the number of staff hours scheduled and hours worked. Findings Include: A review of the 2024 Alta Mesa Health and Rehabilitation Facility Assessment addressed the staffing plan, charts, and assignments for the facility. According to the assessment, the facility utilized information collected in the resident profile to identify the care and services needed for the residents. The assessment included a sample staffing chart which calculated that the services of 1-2 registered nurses were appropriate for Long-Term Care and Short-Term Care (skilled) residents. The assessment further stated that staffing is ultimately is determined by the census, resident acuity and needs. A review of the PBJ Staffing Data Report for Fiscal Year Quarter 3, 2024 (April 1-June 30), identified the facility as having an excessively low weekend staffing finding. Review of the Daily Staff Posting dated July 6, 2024 revealed no evidence of the registered nurse assigned to the unit as a charge nurse. Further review of the posting revealed 3 Licensed Practical Nurses (LPN) worked the 6 am to 6 pm shift, with scheduled hours worked, and actual hours worked of 33.41 hours, after recalculation with the coordinator, it was determined the value was approximately 37.6 hours actually worked. The Daily Staff Postings dated from October 21, 2024 thru November 6, 2024 posting failed to include the actual hours worked by the licensed and unlicensed nursing staff directly responsible for resident care per shift. The hours reflected in the Time Tracking: Daily Punch Details, did not correspond to the postings The Daily Staff Postings dated November 13, 2024 during the 6 am to 6 pm shift revealed 4 RN's were scheduled to work 36 hours, with an actual worked hour of 35.95 hours. Punch details are listed below: -RN #1 total of 7.62 hours -RN #2 total of 12.18 hours -RN #3 total of 11.57 hours Cumulative Hours of 31.37. On this date there was a total of 3 RN's with an actual worked hour of approximately 31.37 ours. There is a 4.58-hour difference between the posting and punch details. According to the Center for Medicare Services (CMS website) as of November 20, 2024, the facility has a below average (two star) rating for staffing. The Registered Nurse hours per resident per day on the week average for the weekend was recorded at 23 minutes. The national average was 28 minutes. The Arizona average was 30 minutes. Observed with the staffing coordinator the miscalculations transcribed on the Daily Staff Posting dated July 6, 2024. Observed with the coordinator the Daily Staff Postings dated from October 21, 2024 - November 6, 2024, where the actual hours worked column were left blank. On November 18, 2024 during the initial pool screening, multiple alert and oriented residents complained of long wait times for care and voiced th

Based on resident and staff interviews, clinical record review, policy review and observations, the facility failed to ensure that one of one sampled resident (#510) was administered oxygen as ordered. Findings include: Resident #510 was admitted on November 15, 2024 with diagnoses that included influenza due to novel influenza A virus with other respiratory manifestations. A physician ' s order dated November 16, 2024 revealed an active order for oxygen at 2 liters per minute (LPM) via nasal cannula (NC) continuous, may titrate to 5 LPM to keep oxygen saturation above 90%. Review of the November 2024 Medication Administration Record (MAR) revealed evidence that oxygen had been administered via NC at 2LPM between November 16, 2024 to November 20, 2024. A care plan dated November 18, 2024 revealed a focus for oxygen therapy related to ineffective gas exchange, and the interventions included giving medications as ordered by the physician, and to monitor/document side effects and effectiveness. An admission Minimum Data Set (MDS) assessment dated November 20, 2024, revealed a Brief Mental Interview Assessment (BIMS) score of 15 which indicated no cognitive impairment. The MDS was in progress and there was no evidence of assessments in other areas. During an initial observation conducted on November 18, 2024 at 8:53 a.m. of resident #510 who was sitting up in bed and there was no evidence that the resident was being administered oxygen; nor was there evidence of oxygen related supplies in her room (ex. Nasal cannula, tubing, or oxygen tank and/or concentrator). A second observation of the resident was conducted on November 20, 2024 at 10:50 a.m. and the resident was observed to be sitting up in her bed and there was no evidence that she was being administered oxygen nor had oxygen related supplies in her room. A final observation of the resident was conducted on November 20, 2024 at 1:19 p.m. and there was no evidence that the resident was receiving oxygen. An interview was conducted on November 20, 2024 at 10:50 a.m. with Resident #510, who stated she had not been administered oxygen since admission An interview was conducted on November 20, 2024 at 11:06 a.m. with a Certified Nursing Assistant (CNA/Staff #61). Staff #61 revealed that the facility process for administering oxygen would be to ensure that the resident is being administered the right dosage and ensure that the system is functioning properly. The CNA stated she was familiar with the patient and did not recall ever seeing her on oxygen. The CNA then entered the room and confirmed the resident was not currently being administered oxygen. An interview was conducted on November 20, 2024 at 11:55 a.m. with a Licensed Practical Nurse (LPN/Staff #113), who stated that the process for administering oxygen would be to obtain a physician ' s order and administer as written, as this is the facilities expectation.The LPN stated the risks of not administering oxygen as ordered could result in low ox