Kossuth Regional Health Center

“42 CFR 485.623(d) Kossuth Regional Health Center was found to be in compliance with the requirements for participation in Medicare/Medicaid at 42 CFR 485.623(d), Life Safety from Fire, and the related National Fire Protection Association (NFPA) Standard 101 - 2012 edition. Kossuth Regional Health Center is a three story building with a basement of Type II (000) construction that was built in 1948. The building is fully sprinklered and there is supervised smoke detection located in the corridors, resident rooms and the spaces open to the corridors. The facility has 25 certified beds. All 25 beds are certified for Medicare/Medicaid only. At the time of the survey the census was 12 with 3 in Labor. The requirement at 42 CFR 485.623(d) was MET.”

“NURSING SERVICES CFR(s): Nursing services must meet the needs of patients. (1) A registered nurse must provide (or assign to other personnel) the nursing care of each patient, including patients at a SNF level of care in a swing-bed CAH. The care must be provided in accordance with the patient’s needs and the specialized qualifications and competence of the staff available. This Standard is not met as evidenced by: 47335 Based on a review of the Critical Access Hospital (CAH)’s policies and procedures, medical records, and staff interviews, the hospital’s administrative staff failed to ensure nursing staff provided appropriate nursing care, including completing and documenting timely and appropriate postoperative vital sign (VS) measurements for 2 of 5 sampled patients (Patients #4 and #5) after having surgery at the CAH. The effects of these failures and deficient practices could have resulted in delayed detection of potential postoperative complications, such as infection or internal hemorrhage, thereby increasing patients’ risk of experiencing adverse health outcomes. Findings include: 1. Review of policy number 20385746, “ Vital Signs Post Op,” last approved 04/2026, revealed in part: a. “Purpose: To establish guidelines to identify and document the post-operative patient care to assure the same-day surgery patients’ readiness to be discharged from the hospital...” b. “ ...General Anesthesia and Spinal Anesthesia: Vital signs assessed upon return to [same-day surgery], again in 30 minutes and every 4 hours until discharge. Vital signs will be taken and recorded upon discharge. More frequent vital signs will be taken as necessary or as ordered by the physician...” 2. Review of policy number 20838253, “Pain Assessment and Management,” last revised 05/2026, revealed in part: a. “Purpose: To provide guidelines for the effective and safe management of pain across the continuum of care...” b. “Pain is assessed in all patients utilizing a pain rating scale that is consistent with the scope of care, treatment and services and the patient’s condition ...” 3. Review of Patient #4 (P4)’s medical record revealed the following: a. On 8/7/25 at 7:52 AM, P4 presented to the surgical department for an elective laparoscopic cholecystectomy (gallbladder removal surgery) for a diagnosis of symptomatic cholelithiasis (gallstones). b. On 8/7/25 at 9:35 AM, P4 entered the operating room (OR), and anesthesia was started. c. On 8/7/25 at 9:52 AM, Surgeon E started P4’s surgery. d. On 8/7/25 at 11:45 AM, P4’s surgery ended. e. On 8/7/25 at 11:50 AM, surgery staff transported P4 to the recovery room on a stretcher. Surgery staff assessed P4’s postoperative VS, which showed a blood pressure (BP) of 90/60 (Reference Range: 90-120/60-80), pulse (P) of 90 (Reference Range: 60-100), respiratory rate (RR) of 17 (Reference Range: 14-20), pulse oximetry (SpO2) of 99 (Reference Range: greater than 95) with oxygen (O2) on at 4 liters (L) per nasal cannula (NC), and a temperature (T) of 97.5 F (Reference Range: 97.9-100.6). Staff assessed P4 for pain using the “Face, Legs, Activity, Cry, Consolability” (FLACC) pain scale. f. On 8/7/25 at 3:05 PM, Surgery Nurse D documented Surgeon E evaluated P4 and made the decision to admit P4. g. On 8/7/25 at 3:08 PM, Surgeon E entered an order for nursing staff to notify the provider if P4 had an elevated T greater than 101 F, P greater than 140 or less than 50, RR less than 8, systolic BP (top number) greater than 180 or below 100, or a urine output less than 250 milliliters (mL) every 8 hours. h. On 8/7/25 at 3:09 PM, Surgeon E ordered P4’s VS to be assessed every one hour until 5:00 PM, then every two hours for two assessments, and then every four hours. i. On 8/7/25 at 3:30 PM, hospital staff assessed P4’s VS, which were BP: 114/86, P: 90, RR: 18, SpO2: 99, T: 96.5 F. j. On 8/7/25 at 4:30 PM, hospital staff failed to assess P4’s VS in accordance with the provider’s order. k. On 8/7/25 at 4:54 PM, hospital staff assessed P4’s BP, which was 125/87. Staff failed to obtain a full set of VS including a pulse, respiratory rate, SpO2, and temperature. l. On 8/7/25 at 5:49 PM, hospital staff assessed P4’s VS, which were BP: 129/84, P: 104, RR: 18, SpO2: 98, T: 97.9 F. m. On 8/7/25 at 7:49 PM, hospital staff failed to assess P4’s VS in accordance with the provider’s order. n. On 8/7/25 at 8:50 PM, hospital staff assessed P4’s VS, which were BP: 113/73, P: 110, RR: 18, SpO2: 96, T: 100.2 F. o. On 8/7/25 at 9:52 PM, hospital staff assessed P4’s T, which was 99 F. p. On 8/7/25 at 11:35 PM, hospital staff assessed P4’s VS, which were BP: 121/81, P: 102, RR: 12, SpO2: 98, T: 99.5 F. P4 rated their pain as 0/10 to the left upper abdomen. q. On 8/8/25 at 3:30 AM, hospital staff failed to assess P4’s VS in accordance with the provider’s order. r. On 8/8/25 at 4:18 AM, P4’s VS were BP: 126/84, P: 97, RR: 18, SpO2: 98, T: 98.8 F. s. On 8/8/25 at 7:35 AM, P4’s VS were BP: 124/85, P: 88, RR: 18, SpO2:98, T: 98.4 F. P4 rated their pain as 2/10 to the upper abdomen. t. On 8/8/25 at 10:40 AM, P4’s VS were BP: 131/86, P: 97, RR: 18, SpO2: 99, T: 98.4 F. u. On 8/8/25 at 1:50 PM, P4 discharged home. 4. During an interview on 7/7/26 at 1:00 PM, Nurse Manager S acknowledged nursing staff failed to assess P4’s VS in accordance with Surgeon E’s provider order. 5. Review of Patient #5 (P5)’s medical record revealed: a. On 7/10/25 at 7:00 AM, P5 presented to the surgical department for an elective surgery to remove an implanted contraceptive. b. On 8/7/25 at 7:37 AM, P5’s VS were assessed, but nursing staff failed to assess P5 for pain. c. On 8/7/25 at 9:25 AM, P5 entered the OR and anesthesia started. d. On 8/7/25 at 9:39 AM, Surgeon E started P5’s surgery. e. On 8/7/25 at 10:05 AM, Certified Registered Nurse Anesthetist (CRNA) C documented P5 transferred to recovery, report was given, and P5 was noted to be sleepy. f. On 8/7/25 at 10:36 AM, CRNA C documented a post-anesthesia assessment, which included VS and an assessment of P5’s condition, showing P5 was at their preoperative baseline. g. Nursing staff failed to complete any pain assessment during P5’s hospital visit. Nursing staff failed to document any postoperative assessment of P5’s condition, VS, or surgical incision. Staff failed to document P5’s discharge time, which resulted in the hospital’s computer system automatically discharging P5 on 7/10/25 at 11:59 PM. 6. During an interview on 7/7/26 at 1:00 PM, Nurse Manager R acknowledged nursing staff failed to complete appropriate documentation of P5’s discharge. Nurse Manager R acknowledged nursing staff failed to assess P5 for pain during the hospital visit. Nurse Manager R acknowledged nursing staff failed to assess P5’s surgical incision following surgery. Nurse Manager R reported nursing staff failed to complete their documentation. Nurse Manager R reported nursing staff should have assessed an Aldrete score (used to evaluate a patient’s recovery from anesthesia and readiness to transfer out of recovery and discharge home), VS, pain, surgical incision, for any nausea or vomiting, and the neurological system to assess for any drowsiness. Nurse Manager R acknowledged there was no discharge time and indicated the hospital’s computer system automatically discharged surgical outpatient patients at midnight.”