Pleasant Manor Nursing & Rehab

Based on observation, record review and interview, the facility failed to ensure the ice machine and ice scoop were maintained in a clean and sanitary condition to prevent potential growth of harmful bacteria that could be transferred to the residents food, failed to ensure opened food items in the refrigerator, freezer and storage room were covered, sealed and dated to maintain freshness and prevent potential cross contamination, failed to ensure dietary staff practiced good hand washing techniques to potential cross contamination of food and clean dishes, failed to ensure hot food item was maintained at the required temperature on the stove and serving line to prevent potential foodborne illness. This failed practice had the potential to affect 69 residents who received meals from the kitchen. The findings are: 1. On 07/15/2024 at 9:17 AM, the area in the ice machine where ice forms before dropping into the ice collector had wet sage and brown colors on it. The Surveyor asked the Dietary Manager (DM) to wipe the area. The wet sage and brown residue easily transferred 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 record review, and interview the facility failed to notify the resident and/or resident representative of the facility policy for bed holds including reserve bed hold payments when the resident was transferred/ discharged to the hospital for 4 (Residents #15, #38, #61 and #67) sampled residents. The findings are: 1. The Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 05/22/2024 indicated that Resident #15 had diagnoses of end-stage renal disease (ESRD), Viral Hepatitis, and Non-Alzheimer's Dementia and scored 13 (13-15 indicates cognitively intact) on the Brief Interview for Mental Status (BIMS). a. A review of a Hospital Discharge Summary dated 06/25/2024 indicated Resident #15 was admitted to the hospital on [DATE] with the principal problem of acute renal failure and discharged back to the facility on [DATE]. b. On 07/17/2024 at 12:15 PM, the Administrator was asked for a copy of the bed hold notification that was given to Resident #15 and the resident's representative…

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 and interview, the facility failed to ensure pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for those residents who required pureed diets for 2 of 2 meals observed. The failed practice had the potential to affect 3 residents who received pureed diet, and only resident who received pureed meat only. The findings are: 1. On 07/15/2024 at 11:38 AM, Dietary [NAME] (DC) #1 used a spatula to place 5 servings of beef enchilada into a blender and pureed. At 11:39 AM, DC #1 poured the pureed beef enchilada into a pan and placed it on the steam table. The consistency of the pureed beef enchilada was lumpy and not smooth. 2. On 07/15/2024 at 11:47 AM, DC #1 used a #6 scoop to place 5 servings of Spanish rice into a blender and pureed. At 11:49 AM, DC #1 poured the pureed rice into a pan that had some loose rice in it. The consistency of the pureed Spanish rice was lumpy and was not smooth. The were rice grains visible in the mixture. 3. On 07/15/2024 at 12:21 PM, the surveyor asked the Dietary…

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, record review and interview, the facility failed to maintain an effective pest control program to ensure the kitchen service areas and the main dining room were free of pests. This failed practice had the potential to affect all residents who resided in the facility. The findings are: 1. Pest control invoices were reviewed and showed the following: a. An invoice dated 5/1/2024 showed target pests none. b. An Invoice dated 06/03/2024 showed general pest control service. c. An Invoice dated 06/14/2024 showed re-service inside flies. d. An Invoice dated 06/24/2024 showed re-service inside flies. 2. A Quality Assurance Action Plan provided by the Administrator in training on 07/16/2024 at 10:18 AM under intervention documented, Fly control. I. (Named) pest control x 2 fly spray for 1/5, 2/1, 3/4, 4/1, 5/1, 5/23, 5/25/5/29, 6/1, 6/3, and 7/2. An Invoice dated 07/04/2024 showed re-service inside flies. 3. An Invoice dated 5/29/2024 showed 6 feet lights installed results: ongoing fly treatment. 4. On 07/15/24 at 9:33 AM, the following observations were made 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 interviews and record review, it was determined the facility failed to ensure resident was provided with the opportunity to formulate advance directives other than code status, to enable resident to make advance decisions regarding which measures should be provided or withheld in the event of their incapacitation for 1 resident (Resident #54). The findings are: 1. Review of the Care Plan indicated the facility admitted Resident #54 with diagnoses that included Alzheimer's disease, chronic fatigue, hypertension, dementia, and anxiety a. The quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 04/11/2024 revealed Resident #54 had a Brief Interview for Mental Status [BIMS] score of 0, which indicated the resident has severe cognitive impairment. b. The clinical records for Resident #54 did not indicate the resident was provided with the opportunity to formulate an Advance Directive. c. On 07/16/2024 at 3:33 PM, the Administrator in Training (AIT) provided a copy of the Physician Orders for Life-Sustaining Treatment (POLST) for Resident #54 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.

Based on interview, and record review the facility failed to ensure the minimum data set [MDS] accurately reflected on section A1500 the preadmission screening and assessment resident record [PASARR] a serious mental illness and/or intellectual disability affecting 2 Resident (Resident #14 and #45) with a level II PASRR. The findings are: 1. Review of the Medical Diagnosis portion of Resident #14's electronic health record revealed diagnoses of bipolar disorder, anxiety disorder, and major depressive disorder. a. The quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 04/04/2024 documented no in Section A1500 if the resident was currently considered by the Level 11 PASARR process to have serious mental illness. b. A letter from the State Designated Professional Associates dated 08/17/2022 states, The above-named client will require a PASRR/Level II Screening to be completed at your nursing facility per the Office of Long-Term Care. An Assessor from the State Designated Professional Associates will contact your facility to make arrangements for this…

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 and interview, the facility failed to ensure eggs were stored below other foods and cooked food items were maintained the proper temperatures to reduce the chances of food borne illness; dietary staff washed their hands before handling clean equipment or food items to prevent potential food borne illness for residents who received meals from 1 of 1 kitchen; 1 of 1 ice machine was maintained in clean condition; foods stored in the storage area refrigerator and freezer were sealed, labeled, and dated. These failed practices had the potential to 73 affect residents who received meals from the kitchen (Total Census:76), as documented on a list provided by the Dietary Supervisor on 09/20/23 at 2:15 PM. The findings are: 1. On 09/18/23 at 11:02 AM, in the refrigerator there was an opened carton of eggs on the third shelf from the bottom. Two eggs remained in the carton. Sealed containers of cooked food were immediately below the carton on the second shelf. 2. On 09/20/23 at 9:33 AM, Dietary Employee (DE) #1 pushed her glasses to her face. Without washing her hands,…

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 and interview, the facility failed to ensure that refrigerated scheduled II-V controlled medications were maintained within a locked permanently affixed compartment in the Medication Storage Room. The finding are: On 09/21/23 at 1:15 PM, during observation of the Medication Room with Licensed Practical Nurse (LPN) #1, the Surveyor asked LPN #1 to see the refrigerated controlled medications. LPN #1 removed a small black medal box from the unlocked refrigerator and unlocked the box containing controlled medications. On 09/22/23 at 8:45 AM, in the Medication Storage Room the small black box containing controlled medications continued to not be permanently affixed to the unlocked refrigerator. On 09/22/23 at 9:10 AM, the Surveyor accompanied LPN #2 to the Medication Storage Room. In the unlocked refrigerator was the small black medal box containing controlled medications in the door. The Surveyor asked if she had ever been told that the box should be permanently affixed to the refrigerator. LPN #2 stated, No. During an interview on 09/22/23 at 9:15 AM, the Director…

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, record review, and interview, the facility failed to ensure meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for 1 of 1 meal observed. This failed practice had the potential to affect 1 resident who received a pureed diet and 17 residents who received a mechanical soft diet, and 55 residents who received a regular diet from 1 of 1 kitchen, (Total Census:76), according to a list provided by the Dietary Supervisor on 09/20/23 at 2:15 PM. The findings are: 1. On 09/20/23, the menu for the lunch meal documented the resident who received a puree diet was to receive two #8 scoops (1 Cup) of pureed cheeseburger, ½ cup of vegetable juice, and residents on mechanical soft and regular diets were to receive one cheeseburger each. 2. On 09/20/23 at 11:22 AM, Dietary Employee (DE) #2 placed 5 servings of hamburger patties into a blender, ground and poured into a pan. At 11:24 AM, she placed 7 more servings of hamburger patties into a blender, ground and poured in the same pan total of 12 servings without…

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.