SMP Health - St Catherine North

In the surveyor’s words

From the most serious findings on record at SMP Health - St Catherine North, in the surveyor’s own words.

• Actual harm, isolatedF689May 21, 2024

  Based on record review, review of facility investigation, review of the facility policy, and staff interview, the facility failed to ensure adequate supervision and assistance for 1 of 1 closed records (Resident #1) reviewed for an accident with subsequent injury. Failure to provide adequate assistance with a full-body mechanical lift transfer resulted in Resident #1's injury and placed all residents requiring full-body mechanical lifts at risk for injury. This citation is considered past non-compliance based on review of the corrective action the facility implemented immediately following the incident. Findings include: Review of the facility policy titled Safe Resident Handling/Transfers occurred on 05/21/24. This policy, revised 05/10/24, stated, . […]

• No harm, potential for more than minimal, patternF684Feb 11, 2026

  Based on observation, record review, review of professional reference, and staff interview, the facility failed to ensure physician's orders were followed for 3 of 24 sampled residents (Resident #71, #107, and #124). Failure to follow physician orders for medication administration, and application of compression socks and ace wraps, may result in adverse health effects for the residents. Findings include: Review of professional standards included: [NAME], [NAME], and Frandsen's Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice, 10th ed., Pearson Education, Inc., Massachusetts, page 68, states, . Carrying Out a Physician's Orders . If the order is neither ambiguous not apparently erroneous, the nurse is responsible for carrying it out. […]

• No harm, potential for more than minimal, patternF880Feb 11, 2026

  Based on observation, record review, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 3 of 17 sampled residents (Resident #11, #57, and #107) and 1 supplemental resident (Resident #81) observed during cares. Failure to practice infection control standards related to disinfecting shared equipment, glove changes, and hand hygiene has the potential to spread infection throughout the facility. Findings include: Review of the facility policy titled Hand Hygiene occurred on 02/11/26. This policy, dated 01/17/18, stated, . Hand hygiene is performed: . Before and after direct resident contact . Before and after assisting a resident with toileting . […]

• No harm, potential for more than minimal, patternF641Sep 21, 2023

  Based on record review, review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.17.1), and staff interview, the facility failed to ensure accurate coding of the Minimum Data Set (MDS) for 3 of 24 sampled residents (Resident #9, #19 and #24). Failure to accurately complete the MDS does not allow each resident's assessment to reflect their current status/needs and may affect the accurate development of a comprehensive care plan and the care provided to the residents. Findings include: SECTION K: SWALLOWING/NUTRITIONAL STATUS The Long-Term Care Facility RAI User's Manual, revised October 2019, pages K-5 through K-12, stated, . K0300: Weight Loss . Coding Instructions . […]

• No harm, potential for more than minimal, isolatedF605Feb 11, 2026

  Based on record review, review of facility policy, and staff interview, the facility failed to ensure a medication regimen free from unnecessary medications for 2 of 5 sampled residents (Resident #6 and #11) selected for medication review. Failure to attempt a gradual dose reduction (GDR) or identify contraindications for a GDR may result in residents receiving unnecessary medications and experiencing adverse consequences related to their use.Findings include: Review of the facility policy titled Drug Regimen Review occurred 02/11/26. This policy, dated 06/09/23, stated, . The consultant pharmacist will provide a written review for each resident on an antipsychotic . antidepressant . The review will evaluate dose, duration, continued need, and emergence of adverse side effects. […]