Cordova Health And Rehabilitation, LLC

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, medical record review, the facility's policy for Sanitation Principles, and the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code; the facility failed to prevent the potential for cross-contamination by allowing: 1. staff who were chewing gum to assist residents with meals, 2. clean pots and pans to be stored on a rusty wire shelving rack, 3. a dirty floor in the storeroom for thickened liquids and nutritional supplements and additionally allowing a delivery of nutritional supplements to be placed on the dirty floor, 4. wooden shelving with gaps along the floor line, which could not be cleaned beneath, in the thickened liquids and nutritional supplement storeroom, and 5. the double sink used for food preparation to have a direct connection to the sewer. Findings include: The facility's policy for Sanitation Principles, dated 08/10/2018, included the following: . PURPOSE: To prevent the spread of bacteria that may cause food borne illnesses. STANDARD: Food…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, the facility's policy for Sanitation Principles, and the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code; the facility failed to ensure the Three-compartment Pot and Pan Sink was in good repair for use. Two of three drain levers did not work, resulting in the rinse sink and the sanitizing sink being unable to hold water. This had the potential to affect 108 of 108 residents receiving meals from the kitchen. Findings include: The facility's policy for Sanitation Principles, dated 08/10/2018, included the following: . PURPOSE: To prevent the spread of bacteria that may cause food borne illnesses. STANDARD: Food service areas should be maintained . The current . Food Code should be utilized as guidelines for the department. PROCESS: . b. equipment should be . maintained in good repair . The U.S. FDA 2022 Food Code included the following: . 4-501.11 Good Repair and Proper Adjustment. (A) EQUIPMENT shall be maintained in a state of repair . During the initial kitchen tour on 11/12/2024 at 10:55 AM, the Three-compartment Pot and Pan…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, the facility's policy for Sanitation Principles, and the United States (U.S.) Food and Drug Administration (FDA) 2022 Food Code; the facility failed to ensure one large return vent in the Dining Room and seven of thirteen exit vents on C and D halls were clean. The facility also failed to ensure one of two clocks on C Hall was working. In addition, the facility failed to ensure five of six vinyl covered chairs in the front lobby and front hallway did not have torn or cracked upholstery. This affected two of four halls and one of one dining room. Findings include: The facility's policy for Sanitation Principles, dated 08/10/2018, included the following: . PURPOSE: To prevent the spread of bacteria . STANDARD: . areas should be maintained in a clean and sanitary manner. PROCESS: . b. equipment should be kept clean, maintained in good repair, and should be free from breaks, corrosion, open seams, cracks . The U.S. FDA 2022 Food Code included the following: . 6-501.11 Repairing.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interviews, documents titled Online Incident Reporting System Report and a facility policy titled Abuse, Neglect, Misappropriation of Resident/Guest Property, Suspicious Injuries of Unknown Source, Exploitation the facility failed to report allegations related to physical and verbal abuse within 2 hours to the state agency on 04/09/2024, 07/03/2024 and 10/27/2024. This affected Resident Identifiers (RI) #27, #43 and #91. This deficient practice affected three of eleven residents sampled for abuse. Findings Include: A review of a policy titled Abuse, Neglect, Misappropriation of Resident/Guest Property, Suspicious Injuries of Unknown Source, Exploitation with an effective date of May 01, 2023, documented the following: .b) Investigation and Reporting Steps .All allegations of abuse and instances that result in serious bodily injury must be reported with 2 hours. 1. A review of a document titled Online Incident Reporting System Report documented RI #91 reported an allegation of verbal abuse…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview, and review of the Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual, the facility failed to ensure Resident Identifier (RI) #2's completed Minimum Data Set (MDS) assessments was transmitted to the CMS system. This affected RI #2, one of 22 sampled residents whose MDS assessments were reviewed. Findings include: Review of the Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, dated October 2024, revealed the following: CHAPTER 5: SUBMISSION .OF THE MDS ASSESSMENTS Transmitting Data: Providers must transmit all sections of the MDS 3.0 required for their State-specific instrument, including the Care Area Assessment (CAA) Summary (Section V) and all tracking or correction information. Transmission requirements apply to all MDS 3.0 records used to meet both federal and state requirements. . Assessment Transmission: Comprehensive…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, record review, and the Centers for Medicare & Medicaid Services (CMS)Center) Long- Term Care Resident Assessment Instrument 3.0 Manual, the facility failed to 1) ensure Resident Identified (RI) #60's Annual Minimum Data Set (MDS) assessment dated [DATE] section A1500 was coded accurately to reflect RI #60's Preadmission Screening and Resident Review (PASRR) Level II. 2) ensure RI #82's Annual MDS assessment dated [DATE] section A1500 was coded accurately to reflect RI #82's PASRR Level II. This deficient practice affected two of 22 sampled residents whose MDS was reviewed. Findings include: Review of the Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, dated October 2024, revealed the following: A1500: Preadmission Screening and Resident Review (PASRR) . Code 1, yes: if PASRR Level II screening determined that the resident has a serious mental illness and/or ID/DD or related condition 1) RI #60 was admitted to the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure Employee Identifier (EI) #7, a Licensed Practical Nurse (LPN) washed her hands prior to putting gloves on. Without washing or sanitizing her hands, EI #7 put gloves on and administered an inhaler medication to Resident Identifier (RI) #45. This deficient practice affected RI #45, one of four residents observed for medication administration. Findings include: RI #45 was admitted to the facility on [DATE]. RI #45 has a medical history to include a diagnosis of Asthma. RI #45's Physician Orders for October 2019 included an order for . Flovent 100 MCG (microgram) DISKUS inhaled BID (twice a day) for asthma . During medication pass observation on 10/3/2019 at 8:09 AM, EI #7, a LPN put on gloves without washing or sanitizing her hands and administered an inhaler medication, Flovent, to RI #45. In an interview on 10/3/2019 at 12:00 PM, EI #7, a LPN was asked when should she wash her hands when wearing gloves. EI #7 answered, before putting…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, a test tray, interview, the 2017 Food Code, and the facility's policies for Tray Assembly and Food Preparation Guidelines, the facility failed to ensure hot food items were served hot and further failed to ensure equipment designed to maintain the cold temperature of individual cartons of skim milk was used during the lunch trayline on 9/5/2018. This affected Resident Identifier (RI) #28, RI #61, fifteen of fifteen residents attending Resident Council on 9/5/2018 at 1:00 PM, and had the potential to affect 108 residents receiving meals from the kitchen, 108 of 111 residents. Findings Include: The facility's policy for Tray Assembly, dated 2/1/2002, included: . Purpose: . provide foods that are at proper temperature . Process: . e. equipment designed to maintain temperature should be used. The facility's policy for Food Preparation Guidelines, dated 8/15/2009, included: . Purpose: . Food should be palatable, attractive, and at the proper temperature, as determined by the type of food, to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, the 2017 Food Code, and the facility's policies for Food Preparation Guidelines, Food Receipt and Storage, and Cleaning of Miscellaneous Equipment and Utensils, the facility failed to ensure the potential for cross-contamination did not occur due to food items and supplies being stored less than six inches off the floor and the accumulation of dust on the ceiling and walls of the walk-in cooler. The facility further failed to maintain the cold temperature of an individual carton of skim milk at 41 degrees F (Fahrenheit) or below during the resident lunch trayline on 9/5/2018. This had the potential to affect 108 residents receiving meals from the kitchen, 108 of 111 residents. Findings Include: The facility's policy for Food Preparation Guidelines, dated 8/15/2009, included the following: . Process: . g. Food should be protected from contamination, while being stored, prepared, and served to residents. To prevent growth of pathogenic organisms: 1. Refrigerated at or below 41 . (degrees) F, . The facility's policy for Food Receipt and Storage, dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, medical record reviews and review of facility policies titled, Hand Hygiene, Medication Administration and Contact Precautions, the facility failed to ensure: 1) a Licensed Practical Nurse (LPN) washed her hands and changed her gloves appropriately during the medication administration and also place a barrier between the over bed table and medication supplies for Resident Identifier (R) #110; 2) a sign was posted outside RI #1's room to notify staff, residents and visitors to check with the nurse prior to entering the room and 3) a Certified Nursing Assistant (CNA) placed on appropriate Personal Protective Equipment (PPE) prior to entering the room of RI #1. 1)This affected 1 of 5 residents and 1 of 5 nurses during the observations of medication administration. 2) This affected 1 of 1 sampled resident on contact isolation. Findings Include: The facility's policy titled, Hand Hygiene, effective date 9/1/17, included: . The following is a list of some situations that require hand…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.