Mcalester Nursing & Rehab

In the surveyor’s words

From the most serious findings on record at Mcalester Nursing & Rehab, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Nov 21, 2024

  An IJ was identified from 11/17/24 through 11/21/24. The deficient practice remained at isolated level of a potential for harm. On 11/21/24, an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to to provide adequate supervision to prevent elopement for a resident with severe cognitive impairment and elopement seeking behaviors, and to educate staff on how to identify residents at risk for elopement. On 11/17/24, Resident #1 was reported missing from the facility and found one block away from a driver passing by. Resident #1 stepped off the curb and fell to their knees and was transported to the ER. This resulted in Resident #1 acquiring a closed head injury, laceration of the face requiring sutures, and an abrasion of the knee. […]

• Actual harm, isolatedF600Dec 11, 2023

  Based on record review and interview, the facility failed to ensure a resident was free from abuse for one (#1) of three residents sampled for abuse. Two staff members witnessed CNA #1 slap and curse Res #1 on 12/06/23 evening shift. The facility had put measures in place to correct the deficiency on 12/06/23. The administrator identified 45 residents who resided in the facility. Findings: Res #1 had diagnoses which included dementia with agitation and metabolic encephalopathy. A quarterly MDS assessment, dated 10/06/23, documented the resident was cognitively impaired, required supervision to touch assistance with transfers, and independent with a manual wheelchair. […]

• No harm, potential for more than minimal, patternF921May 19, 2026

  Based on observation, record review, and interview, the facility failed to ensure the shower curtain was kept clean and ceiling tiles were in good repair for 1 (east hall shower room) of 2 shower rooms observed.The administrator identified 25 residents used the east hall shower room. Findings:On 05/19/26 at 12:39 p.m., the east hall shower room was observed to have a grey and white shower curtain hanging with spots of black discoloration (too numerous to count) and two ceiling tiles with brown rings and water damage.A Laundry and Bedding, Soiled policy, revised 11/2010, read in part, shower linen ie curtains .shall be laundered as needed.A Bathrooms_Showers policy, revised 02/2021, read in part, showers . […]

• No harm, potential for more than minimal, patternF641Jul 31, 2024

  Based on record review and interview, the facility failed to ensure Resident Assessments were accurately coded for two (#39 and #50) of 13 sampled residents reviewed for accurate assessments. The Administrator identified 43 residents resided in the facility. Findings: 1. Resident #39 had diagnoses which included hepatic encephalopathy, metabolic encephalopathy, and cirrhosis of the liver. Resident #39's physical therapy treatment notes documented they received services on 06/26/24, 06/27/24, and 07/01/24. A Quarterly Resident Assessment, dated 07/01/24, documented Resident #39 did not receive physical therapy services. On 07/30/24 at 3:22 p.m., MDS Coordinator #1 stated they would code a resident received therapy services in section O of the Resident Assessment. […]

• No harm, potential for more than minimal, patternF657Jul 31, 2024

  Based on record review and interview, the facility failed to ensure a care plan was updated related to an unstageable pressure ulcer for one (#152) of 12 sampled residents reviewed for care plans. The Administrator identified 43 residents resided in the facility. Findings: Resident #152 had diagnosis which included unstageable pressure ulcer. A nursing note, dated 07/18/24, documented Resident #152 had readmitted to the facility with a 5.0 cm in length by 3.0 cm in width by 0.1 cm in depth moisture associated wound to their right buttock. A Physician's order, dated 07/26/24, documented, clarification order clean unstageable area on buttock with wound wash, pat dry, apply hydrogel and collagen. […]