Kewaunee Health Services

In the surveyor’s words

From the most serious findings on record at Kewaunee Health Services, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF851Mar 6, 2024

  Based on staff interview and record review, the facility did not ensure they completed mandatory electronic submission of staffing information based on payroll data in a uniformed format to the Centers for Medicare & Medicaid Services (CMS). This had the potential to affect all 27 residents residing in the facility. The facility's staffing information for Quarter 4 (July 1-September 30) of the Payroll Based Journal (PBJ) was not accurately submitted to CMS. Findings include: The Centers for Medicare & Medicaid Services (CMS) Electronic Staffing Data Submission Payroll-Based Journal (PBJ), Long-term Care Facility Policy Manual, dated June 2022, indicates: Chapter 1: Overview, 1.1 introduction .(U) mandatory submission of staffing information based on payroll data in a uniform format. […]

• No harm, potential for more than minimal, widespreadF812Jan 12, 2023

  Based on observation, staff interview, and record review, the facility did not ensure food was stored and prepared in a sanitary manner. The practice had the potential to affect 27 of 28 residents (one resident was exclusively tube fed). Staff did not test quaternary sanitizing solution per manufacturer's instructions. Staff did not wash hands when moving from dirty to clean activities. Dietary Cook (DC)-E touched ready to eat food with a bare hand. Staff did not date refrigerated items upon opening and did not discard expired beverages. Staff did not discard expired dry storage food. Dietary Manager (DM)-D did not wait two minutes to take microwave reheated food temperature to ensure food was heated evenly. […]

• No harm, potential for more than minimal, patternF880Jan 12, 2023

  Based on observation, staff interview, and record review, the facility did not ensure Centers for Disease Control and Prevention (CDC) respirator use standards were followed during Resident (R) care for 4 residents (R3, R8, R14, and R21). In addition, staff did not perform hand hygiene per standards during personal cares for R12 and did not ensure hand hygiene was offered to 6 (unidentified) of 8 residents prior to meal service. ~Staff bagged and reused N95 respirators while inside the rooms of R3, R8, R14, and R21 who were on droplet transmission-based precautions. ~Certified Nursing Assistant (CNA)-H did not remove gloves when moving from dirty to clean and did not wash hands when gloves were removed during personal cares for R12. […]

• No harm, potential for more than minimal, patternF880Jan 13, 2022

  Based on observation, interview, and record review, the facility did not establish and maintain an Infection Control Program designed to prevent the development and transmission of disease and infection which had the potential to affect 4 of 14 sampled residents (R) (R16, R22, R25, R26). R26 had a Clostridioides difficile infection (C. diff.) (infection resulting in severe diarrhea and inflammation of the colon) of the gastrointestinal tract upon readmission to the facility 12/21/21. […]

• No harm, potential for more than minimal, isolatedF684Mar 6, 2024

  Based on observation, staff interview, and record review, the facility did not ensure 1 Resident (R) (R5) of 2 sampled residents with non-pressure wounds received care and treatment in a timely manner. R5 had a skin tear on the left leg. R5's medical record did not indicate the origin of the wound, did not contain treatment orders or monitoring instructions, and did not indicate R5's Power of Attorney (POA), Hospice team or Physician was notified. Findings include: The facility's Pressure Injuries and Non-Pressure Injuries policy, revised on 7/20/22 indicates: This center will complete a comprehensive assessment to identify risk factors for the development of pressure injuries and put in place measures intended to achieve the goal of prevention of pressure injuries in our residents. […]