Medicalodges Frontenac

In the surveyor’s words

From the most serious findings on record at Medicalodges Frontenac, in the surveyor’s own words.

• Immediate jeopardy, patternF689Apr 18, 2024

  The facility reported a census of 33 residents. The sample included three residents reviewed for transfers with mechanical lifts. Based on observation, interview, and record review, the facility failed to ensure adequate staff to safely transfer residents, in accordance with professional standards, Occupational Safety and Health Administration (OSHA) guidelines, Food and Drug Administration (FDA) guidelines, and manufacturers recommendations, with use of a mechanical lift. The facility identified eight residents who required a full body mechanical lift and four residents who required a sit-to-stand mechanical lift for transfers. […]

• Immediate jeopardy, isolatedF808Mar 6, 2023

  The facility reported a census of 37 residents, with eight residents identified with mechanically altered diets. Based on interview and record review, the facility failed to follow the physician ordered therapeutic diet for Resident (R)1, who required a mechanically altered diet of ground meat with gravy, and all other items pureed, with honey thick liquids. On [DATE] at 11:36 PM, staff gave the resident a peanut butter and jelly sandwich in her room and left the resident unsupervised. The resident choked and staff attempted the Heimlich maneuver (a first-aid procedure for dislodging an obstruction from a person's windpipe in which a sudden strong pressure is applied on the abdomen, between the navel and the rib cage) without success. The resident became unconscious and died . […]

• Actual harm, isolatedF689Jun 1, 2022

  The facility reported a census of 42 residents including four residents reviewed for accidents. Based on observation, record review, and interview, the facility failed to ensure Resident (R) 4 remained free from accident hazards when staff failed to maintain a safe room arrangement after a fall on 03/29/22, when the resident fell and sustained a forehead laceration on the night stand next to his bed requiring a trip to the emergency room . Administrative Nurse D re-arranged the resident's room after the fall on 03/29/22 and moved the nightstand away from his bed. […]

• No harm, potential for more than minimal, widespreadF730Nov 18, 2024

  The facility reported a census of 36 residents. Based on interview and record review, the facility failed to complete an annual performance review at least once every 12 months for three of the five Certified Nurse Aides (CNA) reviewed, CNA R, CNA MM, and CNA NN. Findings included: - Review of five employee personnel files, employed by the facility for greater than one year, revealed the following concerns: Certified Nurse Aide (CNA) R, hired 10/18/19, lacked an annual performance review in her personnel file. CNA MM, hired 12/15/22, lacked an annual performance review in her personnel file. CNA NN, hired 05/17/22, lacked an annual performance review in her personnel file. […]

• No harm, potential for more than minimal, widespreadF851Nov 18, 2024

  The facility reported a census of 36 residents. Based on interview, and record review the facility failed to electronically submit to the Centers for Medicare and Medicaid Services (CMS), accurate direct staffing information, based on payroll and other verifiable and auditable data in a uniform format according to specifications established by CMS (i.e. Payroll Base Journal (PBJ), related to licensed nursing staffing information, when the facility failed to accurately report weekend staffing for Quarters 1 2024 (October 1-December 31), Quarter 2 2024 (January 1-March 31) and Quarter 3 2024 (April 1- June 30). […]