Inspection Results » Lutheran Village at Wolfcreek

Health Inspection on October 18, 2018 ^[1]

1. Widespread: No actual harm with potential for more than minimal harm that is not immediate jeopardy

   • Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. (Corrected 2018-11-26)
   • Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. (Corrected 2018-11-26)
   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2018-11-26)

2. Pattern: No actual harm with potential for more than minimal harm that is not immediate jeopardy

   • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. (Corrected 2018-11-26)

3. Isolated: No actual harm with potential for more than minimal harm that is not immediate jeopardy

   • Ensure each resident receives an accurate assessment. (Corrected 2018-11-26)
   • Develop and implement policies and procedures to prevent abuse, neglect, and theft. (Corrected 2018-11-26)
   • Ensure meals and snacks are served at times in accordance with residentÂ’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of schedu (Corrected 2018-11-26)
   • Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. (Corrected 2018-11-26)
   • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (Corrected 2018-11-26)
   • Provide appropriate pressure ulcer care and prevent new ulcers from developing. (Corrected 2018-11-26)
   • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. (Corrected 2018-11-26)
   • Provide and implement an infection prevention and control program. (Corrected 2018-11-26)
   • Provide enough food/fluids to maintain a resident's health. (Corrected 2018-11-26)
   • Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. (Corrected 2018-11-26)
   • Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. (Corrected 2018-11-26)

4. Widespread: No actual harm with potential for minimal harm

   • Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. (Corrected 2018-11-26)