Stevens County Hospital Ltcu Dba Pioneer Manor
Inspection history, citations, penalties and survey trends for this long-term care facility in Hugoton, Kansas.
- Location
- 1711 S Main Street, Hugoton, Kansas 67951
- CMS Provider Number
- 17E546
- Inspections on file
- 15
- Latest survey
- February 4, 2026
- Citations (last 12 mo.)
- 1
Citation history
Health deficiencies cited at Stevens County Hospital Ltcu Dba Pioneer Manor during CMS and state inspections, most recent first.
Surveyors found that the facility did not complete or document required pre-employment criminal background checks for two CNAs before they were hired and allowed resident contact. Personnel file reviews showed no evidence of background screenings for these staff, and administrative staff confirmed they could not locate any such records or explain why the checks were not done, despite a written abuse, neglect, and exploitation policy requiring screening and documentation for all potential employees.
A facility failed to provide necessary ADL care for a resident, leading to prolonged exposure to soiled briefs and skin damage. Another resident experienced a significant weight loss of 10.75% over four months due to inadequate assistance with meals. Both residents had cognitive impairments and required substantial assistance, but the facility's care practices were insufficient, resulting in deficiencies in personal hygiene and nutritional management.
Two residents developed preventable pressure ulcers due to the facility's failure to implement effective prevention and treatment measures. One resident, with multiple medical conditions, developed a stage 3 ulcer due to inconsistent skin assessments and lack of treatment orders. Another resident, at risk for pressure ulcers, developed stage 2 injuries due to an inappropriate air mattress and inadequate skin monitoring. Staff interviews revealed a lack of wound care training and understanding of equipment use.
A resident with dementia experienced a 10.75% weight loss over four months without appropriate interventions. Despite being at high risk for weight loss, the care plan only included monitoring, and no dietary interventions were initiated. Observations showed inconsistencies in meal assistance, and staff interviews confirmed the weight loss was discussed but not addressed with new orders. The facility's weight policy requiring notification and referral for significant weight loss was not followed.
The facility failed to maintain an effective infection prevention and control program, with staff not consistently performing hand hygiene and failing to implement enhanced barrier precautions (EBP) for residents with open wounds. Additionally, the infection control surveillance program was ineffective, with incomplete and inaccurate documentation. These practices had the potential to affect all residents.
The facility failed to implement an effective antibiotic stewardship program, impacting their Infection Prevention and Control Program. The Infection Preventionist admitted the program was ineffective, with untrained staff completing incomplete Infection Control Surveillance Logs. Despite attempts to enforce McGeer criteria, more staff education was needed. The facility's policy outlined a mission for optimal antimicrobial therapy, but practices like prescribing prophylactic antibiotics after two UTIs did not align with guidelines, potentially affecting all 73 residents.
The facility failed to ensure the Infection Preventionist (IP) effectively managed the Infection Prevention and Control Program (IPCP), affecting 73 residents. Administrative Staff B, the designated IP, admitted the IPCP was ineffective, with floor nurses completing incomplete Infection Control Surveillance Logs. These logs lacked critical information and mapping for tracking infections. The nurses were not trained in infection control or Antibiotic Stewardship, contrary to the facility's policy requiring the IP to oversee infection surveillance and management.
The facility failed to provide the required annual in-service training for CNAs, including dementia care and abuse prevention. A review showed one CNA had less than the required 12 hours of training, and two CNAs lacked dementia care training. Administrative Staff A confirmed the absence of additional training records and the facility did not provide a policy on CNA continuing education.
The facility failed to verify valid advanced directives for three residents, leading to potential uncommunicated needs regarding end-of-life care. Despite indications of valid DNR orders in the EHR, necessary documentation was missing or incomplete, including lack of signatures from residents, representatives, or physicians. Staff interviews confirmed the deficiency, and the facility did not provide a policy on advanced directives when requested.
The facility failed to accurately complete MDS assessments for three residents, resulting in uncommunicated care needs. One resident's behaviors were not documented, another's oxygen use was omitted, and a third's need for total assistance with ADLs was inaccurately recorded. Staff interviews confirmed these discrepancies, highlighting lapses in the facility's assessment process.
The facility failed to update care plans for four residents after changes in psychotropic medications and the development of pressure ulcers. One resident's care plan was delayed by four months for a pressure ulcer update, and medication changes were not reflected. Another resident's care plan lacked updates for an open area on the back. Two other residents' care plans did not accurately reflect medication changes. Staff interviews indicated a lack of comfort in updating electronic health records, and no policy on care plan revisions was provided.
The facility failed to provide safe respiratory care for several residents, with observations showing improper handling and storage of oxygen equipment. Oxygen tubing was found on the floor, in baskets, and improperly stored, contrary to facility policy. Staff interviews revealed a lack of adherence to storage protocols, contributing to the deficiency.
The facility failed to maintain a medication error rate below 5%, resulting in a rate of 35.71%. Errors included incorrect water flush for a PEG tube, mixing medications without physician orders, and leaving medications unsupervised. Additionally, a resident's Prednisone was unavailable, and Metoprolol Succinate was not administered as extended-release. These actions violated facility policies and placed residents at risk.
The facility failed to ensure proper labeling and secure storage of medications, with observations of expired drugs in residents' rooms, unsecured medication drawers, and improper handling of narcotics by staff. Interviews confirmed non-compliance with policies requiring secure storage and proper administration of medications.
The facility failed to provide pneumococcal and influenza vaccines or obtain consent/declination forms for several residents, and did not document a required assessment before administering the influenza vaccine to another resident. The facility's Immunization Policy was not followed, as confirmed by an administrative nurse.
A resident with multiple health issues and intact cognition was discharged without active discharge planning. Despite being dependent on staff for most ADLs and having no initial plans for discharge, the resident was sent home with a spouse after the family notified the facility. The EHR lacked evidence of discharge planning, and administrative nurses confirmed its absence. The facility did not provide a discharge planning policy when requested.
The facility failed to remove accident hazards for a resident with impaired cognition, leaving a disposable razor within reach and the call light out of reach. Additionally, staff incorrectly used a mechanical lift for another resident, not following the facility's policy, which led to unsafe transfer practices.
A resident with dementia and depression was not provided with adequate behavioral health care, as the facility failed to monitor and document targeted behaviors and delayed referring the resident to a behavioral health provider. Despite being on antianxiety and antidepressant medications, the resident remained tearful and sad, with staff interviews revealing a lack of awareness and communication regarding the resident's mental health needs.
The facility failed to complete AIMS assessments for two residents receiving Seroquel and did not provide a rationale for not following pharmacy recommendations for a GDR. One resident received Seroquel for several months without an AIMS assessment, and another had incomplete assessments and unaddressed pharmacy recommendations. Staff interviews confirmed these deficiencies, which were identified during an onsite survey.
Failure to Complete and Document Required Pre-Employment Background Checks
Penalty
Summary
The facility failed to develop and implement a process to ensure required pre-employment criminal background checks were completed and documented for all staff prior to hire and resident contact. Review of personnel records for two certified nurse aides (one CMA and one CNA) showed hire dates in late 2023 and mid-2024, respectively, with no evidence that pre-employment criminal background checks had been completed. When surveyors requested documentation of these checks, the facility was unable to provide any proof that the screenings had been performed for either employee. Administrative staff confirmed they could not locate criminal background checks for these two employees and could not explain why the tasks were not completed. The facility’s written Abuse, Neglect and Exploitation policy, dated 06/25/24, stated that all potential employees would be screened for a history of abuse, neglect, exploitation, or misappropriation of resident property and that the facility would maintain documentation proving that such screening occurred. Despite this policy, the facility’s records and staff interviews demonstrated that the required background checks and corresponding documentation were not in place for these two staff members, resulting in noncompliance with the facility’s own procedures and regulatory expectations for preventing abuse, neglect, exploitation, and misappropriation.
Deficiencies in ADL Care and Weight Management
Penalty
Summary
The facility failed to provide necessary services to maintain good personal hygiene for Resident 20, who was at risk for poor personal hygiene and related complications. Resident 20 had multiple diagnoses, including idiopathic peripheral neuropathy, pressure ulcer, venous hypertension with ulceration, dementia, and other conditions. The resident was dependent on staff for assistance with activities of daily living (ADLs) and required substantial assistance with all cares except eating. On a specific day, Resident 20 was observed in a geri-recliner in the dining area, calling out for assistance to use the bathroom, which was ignored by staff for over an hour. This delay in care resulted in the resident soiling his brief and developing moisture-associated skin damage. The facility also failed to assist Resident 72 with meals, contributing to a significant weight loss of 10.75% over four months. Resident 72 had moderately impaired cognition and required maximum assistance with ADLs, including eating. Despite being at high risk for weight loss, the facility did not ensure that Resident 72 was assisted to the dining area for meals or provided assistance with meals in her room. Observations showed that Resident 72 was not consistently assisted to the dining room for meals, and there was a lack of documentation and intervention regarding her weight loss. The facility's policies on pressure ulcer treatment and prevention, as well as weight management, were not effectively implemented. The failure to provide prompt ADL care to Resident 20 and to initiate weight loss interventions for Resident 72 demonstrated deficiencies in the facility's care practices. These deficiencies placed both residents at risk for negative health outcomes, including skin breakdown and further weight loss.
Failure to Prevent and Treat Pressure Ulcers
Penalty
Summary
The facility failed to prevent the development of pressure ulcers and provide adequate treatment for two residents, leading to deficiencies in care. Resident 24, who had multiple medical conditions including fractures, lymphoma, and dementia, developed a stage 3 pressure ulcer on her back. Despite having a care plan that included interventions for pressure ulcer prevention, such as repositioning and the use of pressure-reducing devices, the facility did not document or implement effective measures to prevent the worsening of her condition. The resident's skin assessments were inconsistent, and there were no treatment orders for her wounds, indicating a lack of proper wound care management. Resident 14, diagnosed with diabetes and muscle weakness, was identified as at risk for pressure ulcers but developed multiple stage 2 pressure injuries. The facility's failure to provide an appropriate weight-based intervention, such as a suitable air mattress, contributed to the development of these injuries. The resident's air mattress was not functioning properly, and staff were unaware of the weight limit and settings required for effective use. Additionally, the facility did not consistently monitor, measure, or assess the resident's skin condition, leading to inadequate care and management of his pressure injuries. Interviews with staff revealed a lack of wound care training and understanding of equipment use, further contributing to the deficiencies. The facility did not have a dedicated wound nurse, and the household nurse was responsible for weekly skin assessments, which were not consistently performed. The facility's policies on pressure ulcer treatment and prevention were not effectively implemented, resulting in preventable pressure injuries for both residents.
Failure to Address Significant Weight Loss in Resident
Penalty
Summary
The facility failed to initiate weight loss interventions for a cognitively impaired resident, identified as R72, who experienced a significant weight loss of 10.75% over four months. R72, diagnosed with dementia and vitamin deficiency, required maximum assistance with activities of daily living, including eating. Despite being at high risk for weight loss due to a new admission and lifestyle changes, the care plan only included monitoring nutritional status and weight, without implementing specific interventions to address the weight loss. The resident's weight fluctuated significantly, with records showing a decrease from 93 pounds to 83 pounds over the specified period. Observations revealed inconsistencies in the resident's meal assistance, with R72 sometimes not being assisted to the dining room for meals and reporting thirst. Despite these fluctuations and the resident's decreased food intake, no dietary interventions or supplements were initiated following the risk meeting on December 5, 2024, where the weight loss was discussed. Interviews with facility staff, including a registered dietician and administrative nurses, confirmed that the weight loss was acknowledged but not addressed with new orders or interventions. The facility's weight policy required notification and referral to a registered dietitian for significant weight loss, which was not followed in this case. The lack of timely intervention and documentation of progress notes or orders for supplements contributed to the deficiency in care for R72.
Infection Control Deficiencies in LTC Facility
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by several observations and interviews. Staff did not consistently perform hand hygiene before and during care for multiple residents, including R20, R27, and R14. For instance, CNA S applied medicated creams to R14's buttock and groin area without changing gloves or washing hands between tasks. Similarly, LN H and CNA I did not wash their hands when applying PPE or handling dressing change supplies for R27, and LN H used the same gloves to perform multiple tasks without hand hygiene. The facility also failed to implement enhanced barrier precautions (EBP) for residents with open wounds, such as R24, R14, R27, and R20. During a dressing change for R24, LN BB did not wear a gown and was unaware of the need for EBP for open wounds. Interviews revealed that staff were not consistently applying EBP, and some were unaware of the policy requirements. Administrative Nurse B confirmed that residents with open areas should be on EBP, but this was not consistently practiced. Additionally, the infection control surveillance program was ineffective, as demonstrated by incomplete and inaccurate documentation. Surveillance logs for R12 and R48 lacked necessary details, such as culture results and causative organisms. Administrative Nurse B acknowledged the deficiencies in the infection control program, including the lack of proper tracking and trending of infections. These practices had the potential to affect all residents in the facility.
Failure to Implement Effective Antibiotic Stewardship Program
Penalty
Summary
The facility failed to implement an effective antibiotic stewardship program, which is a critical component of their Infection Prevention and Control Program (IPCP). During an interview, Administrative Staff B, who was identified as the Infection Preventionist, admitted that the facility did not have an effective infection control program, including an Antibiotic Stewardship Program. The staff responsible for completing the Infection Control Surveillance Logs were not trained in infection control or antibiotic stewardship. The logs were found to be incomplete, lacking information such as the causative organism, site of infection, and further documentation after a culture was documented. Additionally, there was no mapping of infections within the facility. Administrative Nurse B attempted to enforce the McGeer criteria for documenting the appropriateness of antibiotics but acknowledged that more education was needed for the staff. The facility's policy, dated 12/28/17, outlined the mission to provide the best antimicrobial therapy and establish an Antibiotic Stewardship Program team to review infections and monitor antibiotic usage patterns. However, the facility did not adhere to these guidelines, as evidenced by the resident physician's practice of prescribing prophylactic antibiotics after a resident had two urinary tract infections, which did not align with the Antibiotic Stewardship Guidelines. This failure had the potential to affect all 73 residents in the facility.
Inadequate Infection Control Program Management
Penalty
Summary
The facility failed to ensure the Infection Preventionist (IP) effectively assessed, implemented, and monitored the Infection Prevention and Control Program (IPCP), potentially affecting all 73 residents. During an interview, Administrative Staff B, who was designated as the IP, admitted that the facility did not have an effective IPCP. The floor nurses, rather than the IP, completed the Infection Control Surveillance Logs, which were found to be lacking critical information such as causative organisms, sites of infection, and documentation of cultures. Additionally, the logs did not include mapping for tracking and trending infections. Administrative Staff B acknowledged that the nurses were not trained in infection control or Antibiotic Stewardship, which was necessary for the effective management of the IPCP. The facility's Infection Control Policy required the IP Nurse to oversee the program, including surveillance, tracking, and trending of infections, but these responsibilities were not adequately fulfilled.
Deficiency in CNA In-Service Training Program
Penalty
Summary
The facility failed to ensure that Certified Nurse Aides (CNAs) received the required annual in-service training, including specific topics such as dementia care and abuse prevention. A review of training records for five CNAs employed for over a year revealed deficiencies in the training program. One CNA had less than the mandated 12 hours of documented in-service training, with only eight hours and twelve minutes recorded. Additionally, two CNAs did not receive training on required topics, specifically lacking dementia care education. Administrative Staff A acknowledged the deficiencies, confirming the absence of additional training records for the CNAs in question. The facility did not provide a policy related to CNA continuing education and in-service training when requested. This lack of documentation and adherence to training requirements indicates a failure to develop, implement, and maintain a comprehensive in-service training program for CNAs, as mandated.
Failure to Verify Valid Advanced Directives
Penalty
Summary
The facility failed to verify valid advanced directives for three residents, which could lead to uncommunicated needs regarding end-of-life care. Resident 20 had a severely impaired cognition with a BIMS score of six, and although the EHR indicated a valid DNR order, the Physician's Orders tab and Resident Documents tab lacked a DNR order. A prescription pad signed by a physician was provided, but it was not valid as it lacked the resident's or representative's signature and a witness signature. Resident 62 also had severely impaired cognition, and while the EHR indicated a valid DNR order, the necessary documentation was missing in both the Physician's Orders tab and Resident Documents tab. Resident 72, with a BIMS score indicating severely impaired cognition, had a DNR form in the Resident Documents tab, but it was not signed by a physician, rendering it invalid. Interviews with staff revealed that the determination of full code versus DNR should be performed on admission, and the DNR paperwork should be signed by the resident or representative and witnessed by a physician. The facility did not provide a policy regarding advanced directives or DNR when requested, further highlighting the deficiency in verifying valid advanced directives for these residents.
Inaccurate MDS Assessments Lead to Uncommunicated Care Needs
Penalty
Summary
The facility failed to accurately complete the Minimum Data Set (MDS) assessments for three residents, leading to deficiencies in capturing essential care needs. For one resident, behaviors were not documented in the MDS despite being recorded in the medication administration record (MAR) during the look-back period. The administrative nurse admitted to not reviewing the targeted behaviors documented on the MAR, resulting in the omission. Another resident's use of oxygen was not captured in the annual MDS, which was confirmed by the administrative nurse during an interview. Additionally, a third resident's MDS inaccurately reflected their need for assistance with activities of daily living (ADLs). The admission MDS indicated substantial to maximal assistance, while the quarterly MDS showed total assistance was required. The administrative nurse acknowledged the error, stating she did not realize the need to capture the correct level of assistance. Interviews with staff confirmed that the resident had consistently required total assistance since admission. The facility's policy mandates accurate and comprehensive assessments, but these lapses placed residents at risk for uncommunicated care needs.
Failure to Update Care Plans Following Medication Changes and Pressure Ulcers
Penalty
Summary
The facility failed to accurately revise care plans for four residents following changes in psychotropic medications and the development of pressure ulcers. Specifically, the care plan for one resident was not updated in a timely manner after a pressure ulcer was discovered, with a delay of four months before the care plan was revised. Additionally, this resident's care plan did not reflect changes in psychotropic medications, including the addition of Seroquel and Buspirone. Another resident's care plan was not revised to include an open area on the back upon readmission to the facility. Further deficiencies were noted in the care plans of two other residents, where changes in psychotropic medications were not accurately reflected. One resident's care plan did not include updates for multiple medication orders and discontinuations, such as Prozac, Lorazepam, Seroquel, and Trazodone. Another resident's care plan failed to remove discontinued medications and did not include a new order for Lexapro. Interviews with facility staff revealed that care plan updates were expected to be completed within a few days, but there was a lack of comfort among household nurses in updating electronic health records. The facility did not provide a policy regarding care plan revisions.
Deficiency in Respiratory Care and Oxygen Handling
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for five residents, as observed during a survey. The deficiencies included improper handling, storage, and dispensing of oxygen equipment. For instance, one resident's oxygen tubing was found connected to the concentrator with the nasal cannula hanging off the humidifier bottle. Another resident's oxygen tubing was observed coiled on the floor behind the concentrator. Additionally, a resident's oxygen tubing was placed in a basket on the bedside table, and another unused tubing was shoved in a basket beside a recliner. Furthermore, a nonrebreather mask was draped over a concentrator, unplugged, with the mask touching the floor. Interviews with staff revealed inconsistencies in the handling of oxygen equipment. A CNA mentioned that oxygen tubing and nasal cannulas should be placed in a bag and off the ground when not in use. However, the facility had recently removed plastic bags used for storage, citing a non-home-like environment, without providing an alternative solution. The facility's policy required nasal cannulas and nebulizer masks to be stored in plastic bags when not in use and changed weekly, but this was not adhered to. These actions and inactions led to the deficiency in providing respiratory care consistent with professional standards of practice.
Medication Administration Errors and Policy Violations
Penalty
Summary
The facility failed to maintain a medication error rate below 5%, resulting in a rate of 35.71% during the survey. This was observed in two of the four households reviewed during the medication administration pass. A total of 42 medication opportunities were observed, with 15 medication errors identified. These errors placed residents at risk for adverse reactions from the medications. One specific incident involved a resident with a Percutaneous Endoscopic Gastrostomy (PEG) tube, where the physician's orders required the tube to be flushed with 150 milliliters of water before and after medication administration. However, a licensed nurse administered only 90 milliliters of water, citing the resident's tendency to become nauseous. Additionally, the nurse mixed the resident's medications together in water, contrary to the physician's orders and facility policy, which required medications to be administered separately unless otherwise directed by a physician. Another incident involved a resident whose medications were not administered correctly. The resident's Prednisone was unavailable, and the Metoprolol Succinate administered did not match the extended-release order. Furthermore, the nurse left the resident's medications unsupervised in the room, which was against facility policy. The resident's care plan and electronic health record lacked documentation regarding self-administration of medications, and the nurse was unsure if the resident's request to have medications left in the room was documented. These actions were contrary to the facility's policies on medication administration and security.
Medication Storage and Labeling Deficiencies
Penalty
Summary
The facility failed to ensure that drugs and biologicals were properly labeled and stored in locked compartments, allowing only authorized personnel access to the keys. During observations, it was noted that a resident had a medication cup with pills left unattended in her room, which she took without staff supervision. Additionally, expired medications were found in multiple residents' rooms, including Nystatin powders and saline nasal gel, which were not removed or disposed of as per policy. Further observations revealed that a licensed nurse left a medication drawer unlocked and unattended while preparing a resident's medication, and another nurse carried narcotic medications for multiple residents in a pill container in her pocket without proper labeling or documentation of administration times. The medication room contained expired and undated medications, including Novolog insulin and Miralax, which were not disposed of or labeled correctly. Interviews with staff confirmed that medications were sometimes left unsecured in residents' rooms, and there was a lack of adherence to the facility's policies regarding medication storage and administration. The facility's policies required that medications be stored securely, outdated medications be disposed of immediately, and that staff observe residents taking their medications, none of which were consistently followed, leading to the identified deficiencies.
Deficiencies in Vaccine Administration and Documentation
Penalty
Summary
The facility failed to provide the pneumococcal vaccine or obtain consent/declination forms for two residents, and similarly failed to provide the influenza vaccine or obtain consent/declination forms for three residents. Additionally, the facility did not complete and document a required assessment prior to administering the influenza vaccine to another resident. These deficiencies were identified through interviews and record reviews, which revealed a lack of documentation in the Electronic Health Records (EHR) for the involved residents. The facility's existing Immunization Policy, dated August 2017, mandates that all residents be offered the influenza vaccine annually and that new admissions be offered the pneumonia vaccine. The policy also requires that a resident's temperature be taken prior to vaccine administration. However, the facility did not adhere to these protocols, as confirmed by an administrative nurse during an interview, who acknowledged the absence of necessary documentation and assessments in the residents' EHRs.
Lack of Active Discharge Planning for Resident
Penalty
Summary
The facility failed to ensure active discharge planning for a resident, identified as R75, who was admitted with multiple diagnoses including abnormal weight loss, urinary tract infection, urosepsis, osteoarthritis, and chronic obstructive pulmonary disease. The resident had intact cognition, as indicated by a BIMS score of 15, and was dependent on staff for most activities of daily living (ADLs), using a wheelchair and having an indwelling urinary catheter. Despite these needs, the care plan did not include plans for discharge, and the family did not expect the resident to return home. However, on a later date, the family notified the facility that the resident would be going home, and the physician provided discharge orders. The resident was discharged home with a spouse, and a packet for community resources was provided. Despite this, the electronic health record lacked evidence of active discharge planning prior to the discharge, and during an interview, administrative nurses confirmed that no discharge planning had occurred. The facility also failed to provide a policy related to discharge planning when requested, indicating a deficiency in the discharge planning process.
Failure to Remove Accident Hazards and Incorrect Use of Mechanical Lift
Penalty
Summary
The facility failed to identify and remove accident hazards for three residents, leading to potential risks to their physical and psychosocial well-being. Resident 60, who had severely impaired cognition and was dependent on staff for assistance, was left unattended with a disposable razor within reach and his emergency call light out of reach. Despite his mental health conditions, including anxiety disorder, Alzheimer's disease, and dementia, staff did not ensure the removal of the razor or the accessibility of the call light, which was observed on multiple occasions. Resident 20, who had moderately to severely impaired cognition and was dependent on staff for most activities of daily living, was subjected to incorrect use of a mechanical lift. During a transfer from a geri-recliner to a bed, staff used the lift at an angle rather than directly in front of the resident, contrary to the facility's policy. This practice was observed during a transfer, where one staff member let go of the resident, allowing them to swing independently, which was not in line with the correct procedure. The facility's failure to adhere to its own policies and procedures regarding accident hazards and mechanical lift usage was evident in these incidents. The staff did not follow the correct protocols for ensuring resident safety, as outlined in the facility's policies, which contributed to the deficiencies observed during the survey.
Failure to Provide Adequate Behavioral Health Care
Penalty
Summary
The facility failed to provide necessary behavioral health care and services to a resident, identified as R5, who had been sad and tearful since admission. R5 had diagnoses of dementia and depression, and was on routine antianxiety and antidepressant medications. Despite these medications, R5 continued to exhibit signs of sadness and tearfulness, which were not adequately addressed by the facility. The resident's care plan included monitoring for mood symptoms and providing one-on-one support, but these interventions were not effectively implemented. The facility's records revealed several deficiencies in the management of R5's mental health needs. There was a lack of targeted behavior monitoring and documentation, as the physician orders did not include instructions to monitor and document specific behaviors. Additionally, there was a delay in referring R5 to a behavioral health provider, despite a request made by the resident to see a therapist. The social service designee was unaware of the order for behavioral therapy, and the administrative nurse was not aware of the resident's ongoing tearfulness and the need for targeted behavior charting. Interviews with staff indicated a lack of awareness and communication regarding R5's mental health needs. The social service designee did not document the new behavioral health services in the resident's electronic health record, and the administrative nurse was unaware of the resident's request for therapy. The facility also lacked a policy for treatment and services for mental and psychosocial concerns, contributing to the inadequate care provided to R5, who remained tearful and sad since admission.
Failure to Complete AIMS Assessments and Address GDR Recommendations
Penalty
Summary
The facility failed to complete Abnormal Involuntary Movement Scale (AIMS) assessments for two residents, R62 and R20, who were receiving Seroquel, an antipsychotic medication. R62's electronic health record (EHR) showed that they received Seroquel for several months without an AIMS assessment being completed. Additionally, the facility did not provide a rationale for not following the pharmacy's recommendation for a gradual dose reduction (GDR) of R20's Seroquel. The lack of AIMS assessments and failure to address the pharmacy's recommendations were identified during an onsite annual survey. R62's EHR indicated that they received Seroquel for a diagnosis of dementia, which was later changed to restlessness and agitation. Despite receiving Seroquel routinely, no AIMS assessments were completed during the seven months of administration. The pharmacist did not make any recommendations regarding the Seroquel administration for R62 until later, when a GDR was suggested for other medications. Eventually, R62's medication regimen was adjusted following a behavioral health consult. R20's EHR revealed that they received Seroquel for dementia and had AIMS assessments completed earlier in the year, but none were done from August to December. The pharmacist recommended a GDR for Buspirone, another medication R20 was taking, but the provider disagreed without providing a rationale. Interviews with facility staff confirmed the lack of appropriate responses to pharmacy recommendations and the failure to complete required AIMS assessments. The facility's policy on psychotropic medication use emphasized the need for adequate indication and monitoring, which was not adhered to in these cases.
Latest citations in Kansas
Surveyors found that the facility failed to maintain sanitary food storage, handling, and dishwashing practices in the kitchen. Clean dishes were stored upright instead of inverted, and numerous food items in coolers, freezer, pantry, and spice racks were undated, missing the year, had unreadable dates, or showed visible mold, while some bags and containers were left open or unsealed. A dietary staff member handled ready-to-eat foods such as bread and butter with bare hands and repeatedly washed hands with water only, without soap or sanitizer, while preparing pureed meals for a resident. The low-heat dish machine repeatedly operated below the facility’s stated minimum wash temperature, as documented on the temperature log. These practices were inconsistent with the facility’s own food storage policy and staff’s stated expectations for glove use, labeling, sealing of food, dish storage, and dishwashing temperatures.
The facility did not employ a full-time Certified Dietary Manager (CDM) as required by its own Nutritional Services Policy, despite serving meals to 31 residents. A dietary staff member without CDM credentials was observed overseeing meal preparation, and both this staff member and an administrative nurse confirmed that the staff member was not certified, although enrolled in CDM classes. The policy specified that a CDM must oversee key functions such as menu planning, diet and diet manual with nutritional evaluations, office procedures for notifying the RD of new elders, food production, and food service, but no certified individual was fulfilling these responsibilities.
Surveyors found that the facility failed to follow professional standards for food storage and temperature monitoring. A freezer had significant ice buildup, and a refrigerator contained unlabeled, undated sliced cheese. Temperature logs for multiple freezers and refrigerators were incomplete over several days, despite policy requiring routine monitoring and documentation. The ice machine area contained extraneous items, including a plastic lid, a metal object on the floor, and a cup on the drain. In dry storage, several open food items, including pasta, noodles, gelatin, and pancake mix, were undated, unlabeled, or unsealed. Dietary staff confirmed these conditions, and the Dietary Manager later described expectations that all food be labeled, dated, and properly sealed per facility policy.
Surveyors found that staff did not consistently follow EBP, hand hygiene, and clean laundry handling practices. During tracheostomy care for a resident, a nurse wore gloves and a mask but did not don a gown or change gloves before placing clean gauze and the trach cannula. In a separate case, after completing wound care for another resident, the same nurse manipulated a suprapubic catheter tubing while still holding wound supplies and then left the room without performing hand hygiene. Additionally, a housekeeping/laundry staff member removed residents’ personal items from a covered cart and carried them over the shoulder between halls without keeping the items covered. These actions did not follow facility policies requiring targeted gown and glove use for high-contact care, proper hand hygiene around invasive devices and dressings, and keeping laundry carts covered between rooms.
A resident with hemiparesis, chronic osteomyelitis, and intervertebral disc disorder with radiculopathy experienced a fall in his room, was found on the floor near a heater with pain and bruising, and was later confirmed by mobile X-ray to have a nondisplaced fracture of the left superior pubic ramus. Despite this, the subsequent quarterly MDS documented no falls since the prior assessment and did not code the event as a fall with major injury, even though the care plan and progress notes described the fall and resulting fracture. An administrative nurse later acknowledged that the falls section of the MDS had been coded in error, contrary to facility policy and RAI manual requirements for accurate resident assessment.
A resident with severe morbid obesity, vascular dementia, anxiety, and a history of falls, but intact cognition per BIMS, was repeatedly assisted in a wheelchair by staff without foot pedals in place. On multiple observed occasions, staff pushed and turned the resident in the wheelchair while the resident held his feet off the floor and a sock was seen dragging on the floor. Interviews showed staff uncertainty and inconsistency regarding the requirement for foot pedals when assisting the resident, despite the resident’s documented fall risk and a facility falls policy requiring interventions to reduce fall risk.
A resident with Alzheimer’s disease, CKD, BPH, obstructive uropathy, and urinary retention had a suprapubic catheter that staff repeatedly secured incorrectly. During catheter care, two nurses cleaned the abdominal insertion site but attached the Stat-lock to the resident’s thigh, anchoring the tubing to the leg instead of the abdomen. Nursing leadership stated they expected leg anchoring and noted the catheter policy did not specify Stat-lock placement, even though the facility’s suprapubic catheter competency checklist explicitly directed that the tubing be secured to the abdomen.
A resident with dementia, severe cognitive impairment, and depression experienced unplanned weight loss after the RD documented a slow weight-loss trend and recommended house supplement shakes TID with added calories to meals. The facility entered and carried out the supplement order only once daily, and staff confirmed the resident received a shake only on second shift. Weight documentation showed a large, unverified increase followed by a re-weigh that demonstrated a 3.16% loss over a short period, and nursing staff did not promptly recognize or recheck the significant weight discrepancy. The RD was not informed that her TID recommendation had been effectively reduced to once daily, and the facility’s own weight-loss prevention processes were not followed.
A resident with chronic respiratory failure, a tracheostomy, and oxygen therapy orders did not have an Ambu bag or emergency tracheostomy kit readily available at the bedside, despite care plan directives for respiratory care, suctioning, and emergency response if the tracheostomy tube came out. Surveyors observed on multiple occasions that only oxygen and suction were present in the room, while the Ambu bag and emergency supplies were stored on a covered cart in the hallway under a Hoyer lift, requiring movement of equipment before use. Staff, including CNAs, an LN, and an administrative nurse, confirmed that emergency tracheostomy supplies were kept in the hallway or medication room and not at the bedside, and that they were instructed to call 911 rather than attempt reinsertion of the tracheostomy tube, even though the facility’s respiratory care policy required services in accordance with professional standards and the resident’s care plan.
A resident with diabetes, heart failure, muscle weakness, severe cognitive impairment, incontinence, and limited mobility was identified as at risk for pressure ulcers, with care plans calling for turning/repositioning, use of a pressure-reducing device, and extensive staff assistance for ADLs. Despite these documented risks and interventions, the resident, who preferred to remain in a recliner or wheelchair and became less mobile after a foot fracture requiring a walking boot, developed a facility-acquired Stage 2 pressure ulcer on the buttocks. Wound assessments showed the ulcer’s presence and progression over time, indicating that timely and effective preventive measures were not implemented in accordance with the facility’s wound assessment and prevention policy.
Unsanitary Food Storage, Handling, and Dishwashing Practices in Kitchen
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to maintain sanitary conditions for food storage and preparation in the kitchen. During an initial kitchen tour, they observed multiple clean containers and plates on the drying rack not inverted, leaving eating surfaces exposed. Numerous food items in the kitchen cooler, walk-in cooler, freezer, pantry, and spice rack were either undated, missing the year, had unreadable dates, or were past labeled use-by dates. Examples included cheese and ham slices with only month and day, multiple large containers of sauces, dressings, olives, cherries with visible black mold on the rim and lid, parmesan cheese, syrups, soy sauce, wing sauce, and green beans all lacking complete or legible dating. Additional findings included rusted and peeling cooler racks, open and unsealed bags of frozen foods and pantry items, and a rice bin with a handwritten prep date missing the year. Further observations showed improper food handling and hand hygiene practices by dietary staff. One dietary staff member handled ready-to-eat foods, including butter and bread for toast, with bare hands and then placed the toast on a tray for a resident. On another occasion, a partially wrapped package of cheese slices in the cooler was found without any date. The same dietary staff member was observed washing hands under running water without using soap or sanitizer on three separate occasions while pureeing food for lunch. The facility did not provide a hand hygiene policy specific to dietary staff when requested. Surveyors also reviewed the operation of the low-heat Ecolab dishwasher and its temperature logs. At the time of observation, the wash temperature was 102°F, and the April temperature log showed multiple days with wash temperatures below the documented minimum of 120°F at which the supervisor should be notified. Administrative and dietary staff later confirmed that gloves should be worn when handling ready-to-eat foods, all stored food should be sealed and labeled with month, day, and year, dishes should be inverted, and the dishwasher wash cycle should be at least 120°F. The facility’s existing Food Storage policy required staff to label all food items with the name and date opened or use-by date and to discard food past expiration, but survey findings showed these practices were not consistently followed in the kitchen.
Lack of Certified Dietary Manager Overseeing Food and Nutrition Services
Penalty
Summary
The facility failed to employ a full-time certified dietary manager (CDM) to oversee food and nutrition services for 31 residents receiving meals from the facility kitchen. On one observed noon meal, the menu consisted of shrimp, cornbread, cooked sliced squash, rice, and yellow cake with chocolate frosting, and dietary staff member BB was observed overseeing preparation of this meal in the kitchen. During an interview, dietary staff BB confirmed she was not a CDM, stating she had enrolled in but not completed the certification classes. Administrative Nurse D also verified that dietary staff BB did not have dietary manager certification, although she had started the dietary certification classes. The facility’s Nutritional Services Policy, revised 01/21/26, documented that a certified dietary manager would oversee all kitchen procedures, including menu planning, diets and the diet manual with nutritional evaluations, office procedures related to notifying the Registered Dietitian of new elders, food production, and food service, but no such certified individual was in place at the time of the survey.
Failure to Properly Label, Store, and Monitor Food and Equipment Temperatures
Penalty
Summary
Surveyors identified a deficiency in the facility’s food storage, distribution, and service practices based on observations, record review, and staff interviews. In the kitchen, a white upright freezer had approximately one-quarter inch of ice buildup along the inside and shelves, and the kitchen refrigerator contained a plastic bag of sliced yellow cheese that was unlabeled and undated. Review of March temperature logs showed missing morning and evening temperature documentation for multiple units, including a chest freezer in dry storage on numerous dates, a white stand-up freezer on several dates, a double-door refrigerator on several dates, and a single-door refrigerator on multiple dates. April logs also lacked documentation of readings for a double-door freezer on specified dates. The facility’s policies required that frozen foods be stored at 0 to -10°F, produce at 38-44°F, dairy at 35-40°F, and that temperature logs be completed and monitored by the Certified Dietary Manager or designee. Additional observations showed sanitation and labeling issues in and around the kitchen and dry storage areas. The ice machine between the kitchen and storage room had a plastic lid and a metal object on the floor behind it, and a plastic green drinking cup sitting on top of the drain underneath it. Eight 15.5-lb plastic jugs of used cooking grease were observed with numerous grayish-black substances on their tops. In dry storage, surveyors found an approximately one-quarter full 5-lb package of undated pasta Labello egg noodles, an approximately one-quarter full 4.5-lb package of unlabeled, undated, unsealed noodles, approximately three-quarters of a full package of undated strawberry gelatin, and an approximately three-quarters full bag of unsealed buttermilk pancake mix. A dietary staff member verified these findings during the survey, and the Dietary Manager later stated that staff were expected to label and date all food placed in dry storage, refrigerators, or freezers when received and when opened, and ensure items were sealed, labeled, and dated with the open date, as outlined in the facility’s written policies.
Failure to Follow Enhanced Barrier Precautions, Hand Hygiene, and Laundry Handling Practices
Penalty
Summary
The deficiency involves the facility’s failure to maintain an effective infection prevention and control program, specifically related to Enhanced Barrier Precautions (EBP), hand hygiene, and handling of clean laundry. During tracheostomy care for Resident 2, a licensed nurse performed hand hygiene, donned gloves, and wore a mask but did not don a gown as required under EBP and did not change gloves before placing clean gauze or the tracheostomy cannula. In a separate wound care observation for Resident 6, the same nurse performed hand hygiene and applied a gown and gloves before care, but after completing the wound care and while holding gauze and wound cleanser, the nurse inspected and manipulated the resident’s suprapubic catheter tubing and then left the room without performing hand hygiene. Additional deficiencies were observed in the handling of clean laundry. A housekeeping/laundry staff member placed a covered cart with residents’ personal items in one hall, then removed items from the cart and carried them over the shoulder to another hall without using the cart and without keeping the items covered between rooms. Interviews with nursing and administrative staff confirmed that wound care supplies should be kept in residents’ rooms or bagged and taken to the wound nurse, that hand sanitizing should be performed before and after wound care and after contact with catheters or tubing, and that staff are expected to wear gown, gloves, and mask at minimum for EBP. The housekeeping supervisor also stated that laundry staff are expected to keep the cart covered between rooms. These practices did not align with the facility’s written policies on EBP and hand hygiene, which require targeted gown and glove use during high-contact care and hand cleansing before and after resident contact, after contact with blood or body fluids, after removing PPE, and before procedures involving invasive devices or dressing care.
Inaccurate MDS Coding of Fall With Major Injury
Penalty
Summary
The deficiency involves the facility’s failure to accurately complete the Minimum Data Set (MDS) assessment for Resident 13, resulting in an incorrect coding of the resident’s fall history and injury status. Resident 13’s electronic medical record documented multiple diagnoses, including hemiparesis/hemiplegia, chronic osteomyelitis, and intervertebral disc disorder with radiculopathy. The quarterly MDS dated 03/24/26 recorded a Brief Interview for Mental Status (BIMS) score of 15, indicated the resident required supervision for walking 10 feet and partial assistance for walking 50 feet, and documented that the resident had no falls since the previous MDS assessment. However, this conflicted with clinical documentation and the resident’s care plan and progress notes. On 01/16/26, progress notes showed that staff responded to the resident’s call light and found him on the floor next to his heater, lying on boxes, papers, and his bedside table. The resident complained of back and left hip pain, had swelling behind his left ear from hitting the heater, redness on his left cheek, and reported tenderness with weight-bearing on his leg. A mobile X-ray later confirmed a nondisplaced fracture of the left superior pubic ramus, and the provider assessed the resident the same day. The care plan documented that the resident continued to act independently despite education to use the call light, and the resident later reported to therapy staff that he had falls and was working to get stronger after his last fall. During interviews, an administrative nurse acknowledged that the resident had a fall resulting in a hip fracture that should have been coded on the MDS as a fall with major injury, and that the falls section of the MDS had been coded in error, contrary to the facility’s policy to complete the MDS according to federal regulations and the RAI manual.
Failure to Use Wheelchair Foot Pedals When Assisting a Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide an environment free of accident hazards by not ensuring the use of wheelchair foot pedals when staff assisted a resident in a wheelchair. The resident had diagnoses including severe morbid obesity, vascular dementia, anxiety, and noncompliance, and had a BIMS score of 15 on multiple MDS assessments, indicating intact cognition. The resident’s assessments and Falls Care Area Assessment documented a history of falls within the previous months and identified the resident as being at risk for falls. The care plan documented that the resident was at risk for falls, had experienced a fall, and that his back locked up at times requiring the use of a wheelchair. On one observed occasion, a CNA pushed the resident in a wheelchair without foot pedals attached as he was brought from outside smoking back to his room, during which the resident crossed and held his feet off the floor. On another observed occasion, a nurse turned the resident in his wheelchair and assisted him to the dining room without foot pedals, during which the resident’s sock was half off and dragged on the floor, and the resident again held his foot off the floor. During interviews, one nurse expressed uncertainty about whether the resident should be assisted in the wheelchair without foot pedals, while a CMA stated the resident used foot pedals when being assisted but not when self-propelling. Administrative nursing staff confirmed that staff should not assist the resident in the wheelchair without foot pedals. The facility’s falls policy stated that residents would be assessed for fall risks and interventions implemented to reduce those risks.
Improper Securing of Suprapubic Catheter Tubing
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate care and treatment for a resident with a suprapubic catheter by not securing the catheter tubing according to current standards of practice and the facility’s own competency checklist. The resident had multiple urologic and cognitive conditions, including Alzheimer’s disease with severely impaired cognition (BIMS score of four), chronic kidney disease stage three, benign prostatic hyperplasia, obstructive uropathy, and urinary retention, and was documented as having an indwelling catheter. The care plan included an order from the resident’s urologist directing staff not to remove the catheter and directed staff to apply Skin-prep prior to attaching a Stat-lock for the suprapubic catheter. On two separate observations, licensed nurses assessed and cleaned the suprapubic catheter site on the resident’s abdomen but attached the Stat-lock to the resident’s left upper thigh, securing the tubing from the abdomen to the leg. One nurse confirmed the Stat-lock was attached to the thigh and stated they were unaware that a Stat-lock could be adhered to the abdomen. The administrative nurse stated she expected the Stat-lock to be anchored to the leg and acknowledged that the facility catheter policy did not specify Stat-lock placement for a suprapubic catheter. However, she also stated that the facility’s suprapubic catheter replacement competency checklist, which she had previously reviewed, directed that the catheter tubing should be anchored to the abdomen. The competency checklist documented that the catheter tubing should be secured to the abdomen, but this was not followed in practice.
Failure to Implement Dietitian’s TID Supplement Order and Validate Significant Weight Changes
Penalty
Summary
The deficiency involves the facility’s failure to ensure adequate nutritional maintenance for Resident 27 by not implementing the registered dietitian’s recommendation for house supplement shakes three times daily and by not appropriately monitoring and validating significant weight changes. Resident 27 had dementia with severe cognitive impairment, chronic pain, unspecified intellectual disabilities, and major depressive disorder, used a wheelchair, and required set-up or clean-up assistance for eating. The MDS documented a weight of 123 lbs with no weight loss or gain at that time, and the care plan included nutrition-focused interventions such as providing diet as ordered, snacks between meals, monitoring for loss of appetite while on Remeron, and providing supplements as ordered. On 03/03/26, the dietitian documented that the resident had slow, unplanned weight loss related to a decline in energy and recommended offering a house supplement three times a day and adding extra sugar, cream, and butter to foods and fluids to increase energy intake and promote weight stability. Despite this recommendation, the electronic task list from 03/16/26 to 04/13/26 showed the resident was only offered and received a supplement drink once daily in the afternoon. Staff interviews confirmed that the resident received a supplement only on second shift around 2:00 PM, and an administrative nurse acknowledged she had missed the dietitian’s TID recommendation and entered the order for only once daily. Weight records showed a documented weight of 123.4 lbs on 04/01/26 and an implausible weight of 168.0 lbs on 04/10/26, which was not recognized or rechecked at the time by nursing staff. A subsequent re-weigh on 04/15/26, using the wheelchair tare method, yielded a resident weight of 119.5 lbs, reflecting a 3.9 lb (3.16%) loss from 04/01/26. Administrative staff later stated that the 168 lb weight should have been immediately reported and rechecked, and that whoever weighed the resident should have reviewed the previous weight and performed a re-weight if there was a significant change. The facility’s weight loss prevention policy required nutritional interventions and RD consultation for residents with poor or declining intake or weight loss, but the RD was not informed that her TID supplement recommendation had been effectively reduced to once daily.
Emergency Tracheostomy Equipment Not Readily Available at Bedside
Penalty
Summary
The deficiency involves the facility’s failure to ensure that emergency respiratory equipment, specifically an Ambu bag, was readily available at the bedside for a resident with a tracheostomy in the event of accidental extubation or respiratory distress. The resident had diagnoses including sleep apnea, chronic respiratory failure with hypoxia, obesity, dysphagia, malignant neoplasm of the nasopharynx, and required oxygen therapy and tracheostomy care. The resident was cognitively intact, used a wheelchair, and required varying levels of assistance with ADLs. The care plan documented that the resident received breathing treatments, required staff reminders to notify them when treatments were finished, and that staff were to provide oxygen via tracheostomy mask and suction as indicated. The care plan and physician orders also directed staff to call 911 and send the resident to the ER if the entire tracheostomy tube came out, and to follow the facility’s Emergency Protocol Health policy. Surveyor observations on multiple occasions showed that while oxygen and suction were available at the bedside, there was no Ambu bag in the resident’s room. Instead, the Ambu bag and emergency supplies were stored on a covered cart in the hallway under a Hoyer lift, with a battery charger on top, requiring staff to move equipment and wheel the cart into the room before use. Staff interviews confirmed that the emergency tracheostomy supplies and Ambu bag were not kept at the bedside and were instead located in the hallway or medication room. Nursing staff stated that all nurses were CPR-qualified and that hospice residents with tracheostomies had bedside emergency kits because hospice provided them. An administrative nurse reported that tracheostomy care competencies were done annually and explained that there was no emergency kit or Ambu bag at the bedside because the physician had instructed staff not to reinsert the tracheostomy if it came out, but to call 911 immediately. The facility’s Respiratory Care policy stated that necessary respiratory care and services would be provided in accordance with professional standards of practice, the resident’s care plan, and resident choice.
Failure to Implement Timely Interventions to Prevent Facility-Acquired Pressure Ulcer
Penalty
Summary
The deficiency involves the facility’s failure to initiate timely and adequate interventions to prevent the development and progression of a pressure ulcer for Resident 27, who was identified as at risk for pressure ulcer development. The resident had multiple diagnoses including diabetes mellitus, osteoarthritis, heart failure, and muscle weakness, and had a BIMS score of five indicating severely impaired cognition. Assessments documented that the resident required extensive assistance of one to two staff for bed mobility, personal hygiene, dressing, repositioning, and transfers, and that she had a urinary catheter for constant urinary retention and incontinence. The MDS and care plans identified the resident as at risk for skin impairment, with a history of refusing to lie down to relieve pressure from the buttocks, and indicated she was on a turning/repositioning program with nutritional or hydration interventions and a pressure-reducing device in her chair. A Braden Scale score of 16 further indicated risk for pressure ulcer development. Despite these identified risks and care plan directives, the resident developed a facility-acquired Stage 2 pressure ulcer on the left buttocks. Weekly wound assessments documented the presence and progression of an open area on the left buttocks, with measurements changing over time, including a lateral opening measuring 2.0 cm by 1.0 cm and later a left inner buttocks wound measuring 3.0 cm by 2.0 cm by 0.5 cm depth, and then 2.0 cm by 3.5 cm by 0.8 cm depth. The record noted that the resident became less mobile after sustaining a left 5th metatarsal fracture requiring a walking boot, and that she was incontinent and preferred to sit in a recliner and wheelchair rather than sleep in bed. The facility’s own Wound Assessment, Prevention and Treatment policy required timely skin assessments, Braden evaluations, and immediate implementation of plans to reduce pressure ulcer risk, but the development of a facility-acquired pressure ulcer under these known risk conditions demonstrated that timely preventive interventions were not effectively implemented.
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release May 27, 2026) and official state health department websites — never guesswork.
Trusted by long-term care providers and associations.
