Muskogee Nursing Center

In the surveyor’s words

From the most serious findings on record at Muskogee Nursing Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Mar 10, 2026

  On [DATE] at 5:30 p.m., an IJ situation was determined to exist related to the facility's failure to ensure supervision was provided to prevent Resident #1 from elopement. A quarterly assessment, dated [DATE], showed the resident had moderate cognition impairment with a BIMS of 12. An undated face sheet showed Resident #1 had diagnoses which included dementia, diabetes, and psychosis. A care plan, dated [DATE], for Resident #1 showed the resident was at risk for wandering. A facility incident report, dated [DATE], showed Resident #1 had left the facility and was struck by a car and expired later. On [DATE] at 5:35 p.m., the administrator was notified of the existence of an IJ situation related to the facility's failure to provide supervision to prevent elopement. […]

• No harm, potential for more than minimal, widespreadF851Jan 8, 2025

  Based on record review and interview, the facility failed to ensure accurate staffing information for the PBJ reports was provided to CMS for the fourth quarter of 2024. A facility document titled All Residents, dated 01/06/25, documented 38 residents resided at the facility. Findings: A CMS PBJ Staffing Data Report dated 07/01/24 through 09/30/24, documented the facility had not provided the required RN coverage or licensed nurse coverage for the quarter of 2024. A review of the facility daily staffing reports for the fourth quarter of 2024 revealed the facility had been adequately staffed for RN coverage, licensed nurse coverage, and weekend staffing. […]

• No harm, potential for more than minimal, patternF582Jan 8, 2025

  Based on record review and interview, the facility failed to ensure SNF ABN forms included the required information for two (#43 and #48) of three sampled resident reviewed for skilled services beneficiary review. The DON identified 10 residents that had discharged from part A skilled services in the previous six months to the survey. Findings: 1. A SNF ABN form for Resident #43, dated 09/20/24, was reviewed and found not to have the reasons for non-coverage and estimated cost of those services documented on the form. 2. […]

• No harm, potential for more than minimal, patternF726Jan 8, 2025

  Based on record review and interview, the facility failed to ensure licensed nurses were competent to perform tasks of their position by conducting a skills check and documenting the results for each licensed nurse. A facility employee list provided by the DON documented eight licensed nurses worked at the facility. Findings: A review of LPN #1's employee file did not reveal a skills review. On 01/08/25 at 8:56 a.m. the DON stated they had looked at LPN #1's records and did not find a skills check. They stated the former DON had stopped performing skill checks at some point and they would be restarting that process. They stated it was their expectation each licensed nurse would possess the skills to perform their duties. […]

• No harm, potential for more than minimal, patternF880Jan 8, 2025

  Based on observation and interview, the facility failed to: a. implement an enhanced barrier precaution policy to prevent the spread of multidrug-resistant organisms; and b. ensure a licensed practical nurse performed hand hygiene during tracheostomy care for one (#36) of one sampled resident reviewed for tracheostomy care. The administrator reported the census in the facility was 38 and one resident had a tracheostomy. Findings: 1. On 01/06/25 at 8:45 a.m., a tour of the facility was conducted. […]