St Martin's In The Pines

Based on observation, interview, record review, and facility policy review, the facility failed to ensure residents were provided baths/showers for 2 (Resident #70 and Resident #77) of 11 residents reviewed for activities of daily living (ADLs).Findings included:During an interview on 06/29/2025 at 5:53 PM, Director of Clinical Services (DCS) #12 stated they did not have a policy for ADL care; they only had a procedure. An undated form titled, CNA [Certified Nurse Aide] Bath & Shower Report, revealed, The following assessment is to be completed on all residents receiving a bath. The Charge Nurse will sign and verify each assessment for accuracy and completion. All wound and findings are to be addressed immediately by the Charge Nurse and forwarded to the Unit Manager and Treatment Nurse with follow up of a physician or Nurse Practitioner if needed. The bottom of the form included a place for the resident's name, the date, the name of the CNA who provided the bath or shower, and the name of licensed nurse who received the form.1. The admission Record revealed the facility admitted…

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 record review, interview, and facility policy review, the facility failed to have an effective pain management program for 1 (Resident #98) of 1 resident reviewed for pain management.Findings included:On 07/18/2025 at 6:03 PM, Corporate Director of Clinical Services (DCS) #12 stated the facility did not have a policy for pain management, but it was the resident's right to be free of pain.An admission Record indicated the facility admitted Resident #98 on 09/05/2024. According to the admission Record, the resident had a medical history that included orthopedic aftercare following surgical amputation of the right leg below the knee, peripheral vascular disease, chronic pain, and anxiety disorder. The admission record indicated the resident was discharged home with home health services on 09/25/2024.An admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 09/09/2024, revealed Resident #98 had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident had intact cognition. The MDS indicated the resident frequently experienced…

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, interviews and review of a facility policy titled Section: SANITATION AND INFECTION CONTROL Subject: HAND HYGIENE, the facility failed to ensure the Certified Nursing Assistant (CNA) in the 3rd floor kitchen of Cottage A washed her hands before returning to the kitchen after assisting a resident. This had the potential to affect all 9 residents residing on the 3rd floor of Cottage A. Findings Include: A review of a facility policy Section: SANITATION AND INFECTION CONTROL Subject: HAND HYGIENE, revised 1/15, revealed: Policies: In the Food & Nutritional Services Department: All associates associated with the handling of food shall wash hands. Hands are washed with soap and water at the following times: . Before putting on gloves . After taking a break/when returning to the kitchen . After any other activity that may contaminate the hands . On 10/02/19 at 8:45 AM the surveyor conducted a kitchen observation in Cottage A on the 3rd floor. The surveyor observed Employee Identifier (EI) #4, CNA, cooking bacon and sausage. EI #4 removed her gloves and left 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 observations, record review, interviews, and review of Fundamentals of Nursing, Ninth Edition, the facility failed to ensure Resident Identifier (RI) #4's tube feeding bottle was labeled. This affected one of one resident sampled for tube feeding. Findings Include: Review of Fundamentals of Nursing, Ninth Edition, copyright 2017, Chapter 45 Nutrition, page 1082, revealed: . SAFETY GUIDELINES FOR NURSING SKILLS . When performing the skills in this chapter, remember the following points to ensure safe, individualized patient care. * Label enteral equipment with patient name and room number; formula name, rate, and date and time of initiation; and nurse initials . RI #4 was readmitted to the facility on [DATE] with a diagnosis of Dysphagia, oropharyngeal phase. RI #4's [DATE] Physician Orders included an order for Glucerna 1.5 at 55 mL/hr (milliliters per hour) time 23 hours via Percutaneous Endoscopic Gastrostomy tube. On [DATE] at 11:09 a.m., the surveyor observed RI #4's tube feeding infusing. There was…

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 and interview, the facility failed to ensure Resident Indentifier (RI) # 104's hospice care plan was revised when he/she was discharged from Hospice services. This affected Resident Identifier (RI) #104, one of 26 sampled residents for whom care plans were reviewed. Findings Include: RI #104 was re-admitted to the facility on [DATE] with the diagnosis of Vascular Dementia Without Behavioral Disturbance. A review of RI #104's Discharge Summary from Hospice revealed that the hospice start date was 12/11/2017, and the end date was 08/03/2018. A review of RI #104's Physician Order dated 08/03/2018 revealed: Discharge from Hospice due to prolonged prognosis. On 09/26/18 at 03:10 p.m., the surveyor reviewed RI #104's care plans, including the hospice care plan. There was no revision indicating RI #104 had been discharged from hospice services. On 09/26/18 at 04:28 p.m., an interview was conducted with Employee Identifier (EI) #7, a Registered Nurse/Resident Assessment Coordinator. EI #7 was…

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, and review of the facility's policy titled, FOOD AND SUPPLY STORAGE PROCEDURES, the facility failed to ensure: 1. the kitchen staff air dried dishes, pots and pans; and 2. 17 four fluid ounce prune juice cups with a manufactured use by date of 09/07/2018 were not expired. These findings had the potential to affect all 9 residents living on the second floor in Cottage B and all ten residents living on the second floor in Cottage A. Findings Include: 1. On 9/25/18 at 9:55 a.m., Employee Identifier (EI) #5, Certified Nursing Assistant, hand dried with a paper towel three pots and pans, a metal bowl, a divided plate, four bowls and four plates, a serving tray, then placed them into the cabinets. On 9/26/18 at 1:32 PM EI #5 was interviewed. When asked how dishes, pots and pans were supposed to be dried after being washed, rinsed and sanitized, EI #5 said Air dried. EI #5 stated she had not air dried the dishes on 9/25/18. When asked what the potential for harm was in not allowing the dishes to air dry, EI #5 said, it Can cause bacteria. On 9/26/18 at 1:37…

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, review of the 2013 Food Code, review of the facility's policies for Cleaning of Food and Nonfood Contact Surfaces, and Sanitizing Food Contact Surfaces, and review of the manufacturer's instructions for Oasis 146 Multi-Quat Sanitizer; the facility failed to ensure: 1.) Food was frozen solid in the kitchenette freezer of Cottage A on the second floor, as observed on two of three days of the survey. This had the potential to affect 10 of 10 residents receiving meals from this kitchenette. 2.) The sanitizer concentration in the three-compartment pot and pan sink was verified on 8/23/17 per the manufacturer's instructions. This had the potential to affect all 116 residents receiving food from the main kitchen, 116 of 117 residents in the facility. 3.) The drain pipes of three food preparation sinks, one three-compartment pot and pan sink, and the dishwashing area were placed over floor drains with air gaps to prevent back-siphonage. This had the potential to affect all 116 residents receiving food from the main kitchen, 116 of 117 residents in 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.

Based on observations, staff interview, a review of the 2013 Food Code, and a review of the facility's policy for Solid Waste Disposal, the facility failed to ensure the lid to one of two dumpsters was closed on 8/23/2017, which could result in the harborage and feeding of pests. The facility further failed to ensure that food residue, food-related trash, clutter, weeds, pinestraw, foul odor, and flies were not present in the area surrounding the dumpsters and oil refuse container. In addition, three of four side doors on the two dumpsters had a build-up of food residue under the side doors on the exterior walls of the dumpsters. This had the potential to affect 117 of 117 residents residing at the facility. Findings Include: A review of the 2013 Food Code by the United States Public Health Services (USPHS) and the Food and Drug Association (FDA) included the following: . 5-501-110 Storing Refuse, Recyclables, and Returnables. Refuse . shall be stored in receptacles . so that they are inaccessible to insects and rodents. 5-501.113 Covering Receptacles. Receptacles and waste handling…

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, a facility policy titled, Baseline Care Plan, and interviews, the facility failed to ensure care plans were developed for: 1. incontinence care for RI (Resident Identifier) #s 4, 6, and 8. 2. the use of the Bi-pap machine for RI #s 1 and 4. 3. catheter care for RI #4. 4. the use of an antipsychotic medication for RI #6. 5. the managment of anxiety for RI #6. This affected RI #s 1, 4, 6, and 8, four of twenty four sampled residents. This was observed in three of four units of the facility that housed residents. Findings Include: A review of a facility policy titled, Baseline Care Plan, with a revision date of 2017, revealed: . Policy: The facility will develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. 1. A review of the medical record for RI #4 revealed an admission date of 6/9/17 with diagnoses to include Chronic Obstructive…

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, and record reviews, the facility failed to ensure a care plan was followed for a sippy cup as ordered by the physician. This affected RI (Resident Identifier) #8, one of fourteen sampled residents. Findings Include: RI #8 was readmitted to the facility on [DATE] with diagnoses including Hypertension, Diabetes Mellitus Type 2, Vascular Dementia, and Dysphagia. A review of RI #8's Annual MDS (Minimum Data Set), with an assessment reference date of 5/16/17, revealed RI #8 required extensive assistance with ADLs (Activities of Daily Living). RI #8 required limited assistance with eating. RI #8's Care Plan with a review date of 8/14/17 revealed, Nutrition/hydration risk related to chewing/swallowing difficulty, dx (diagnosis) of dysphagia, needs assistance/cueing at meals, dependence on staff for the provision of fluid intake and eating . Approaches * .Elder to use sippy cup with all liquids . A review of RI #8's July and August 2017 Physician Orders revealed, Elder is to use sippy…

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, and record reviews, including a facility policy titled, Section: RESIDENT FOOD SERVICES Subject: ADAPTIVE EATING EQUIPMENT, the facility failed to ensure an assistive device of a sippy cup ordered by the physician was provided for RI (Resident Identifier) #8. This was observed on 2 of 3 survey days. This affected RI #8, one of fourteen sampled residents. Findings Include: A facility policy with a revised date of 9/13 and titled, Section: RESIDENT FOOD SERVICES Subject: ADAPTIVE EATING EQUIPMENT, revealed, POLICY: Adaptive eating equipment will be available to any resident for whom the equipment would be beneficial in assisting the resident's ability to self-feed.Dining Services Department *Maintains a stock of adaptive equipment to include, but not be limited to, build-up flatware, scoop plates, no-spill cups, or as required by the community *Provide the adaptive equipment with meals and sanitizes them upon return. RI #8 was readmitted to the facility on [DATE] with diagnoses…

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, interviews, and a review of a the facility policy titled, Perineal Care, the facility failed to ensure staff removed soiled gloves and washed hands before placing a clean adult brief on RI (Resident Identifier) #12, opening blinds, and opening RI #12's door to leave RI #12's room. This affected RI #12, one of six residents observed for incontinence care. Findings Include: A review of the facility's policy titled, Perineal Care, with a REV. 6/02, 3/08, 7/12. POLICY Peri-Care is to be performed after each incontinent episode, EQUIPMENT . PROCEDURE . FEMALE ELDER . 3. Apply brief if needed. 4. Bag soiled items for laundry and place ., 5. Bag all throw-away items ., 6. Remove soiled gloves. 7. Reposition elder and re-open blinds, curtains, and door. NOTES: .Remember to remove gloves before touching linens, call light, or other items in the room. A review of RI #12's medical record revealed the resident was admitted to the facility on [DATE], with diagnoses including Parkinson's Disease;…

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.