Apple Creek Health And Rehab, LLC

Based on observation, interview, and record review, the facility failed to ensure that received dates were labeled on all items, that items are not left open to air when stored, and that hand hygiene was not performed when needed for two meals observed in 1 of 1 facility kitchen. The Assistant Dietary Manager (ADM) stated that there was no facility policy they were aware of for handwashing. On 01/06/2025 at 12:10 PM, the Surveyor observed a half full bag of dry elbow pasta in a plastic bag was left unsealed. The ADM confirmed the findings. On 01/06/2025 at 12:15 PM, the Surveyor observed an unopened bag of spiral pasta with no received date. The ADM confirmed the findings. On 01/07/2025 at 11:07 AM, the ADM pureed ten bread pork chops in the food processor for lunch service. The Surveyor observed ADM ' s mask fell below their nose, they then touched the mask to adjust it. Without performing hand hygiene, the ADM added two cups of stock and three cups of water to the puree. The ADM rinsed the food processor and touched their mask to adjust it again. The ADM ran the food processor…

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 accurately assess a resident's dental status for one (Resident #199) of two residents sampled for dental concerns. The findings are: Review of Resident #199 ' s Physicians Orders revealed diagnoses of Alzheimer's disease and nontraumatic subdural hemorrhage. Resident #199's admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 12/30/2024 documented a Brief Interview of Mental Status (BIMS) of 01, indicating severe cognitive impairment. The MDS indicated that resident did not have any broken or loose fitting dentures. On 01/06/2025 at 1:00 PM, Resident #199 was observed in the doorway of their room, as the resident attempted to talk the bottom plate of their dentures kept rising up from their bottom gumline in their mouth. During a concurrent observation on 01/07/225 at 9:18 AM, Resident #199 ' s dentures were noted to be rising from their gumline to the middle of their mouth. The admission assessment dated [DATE] did…

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, record review, and interviews, it was determined that the facility failed to implement a resident's care plan to ensure visual devices were utilized for 1 (Resident #83) and to ensure staff followed a resident's closet care plan by placing straws in the drinks of a resident with orders for no straws due to the medical diagnosis of dysphagia with difficulty swallowing for one (Resident #300) resident and failed to implement the resident care plan to ensure visual devices were utilized for one (Resident #83) resident of two residents reviewed for care plan development and implementation. The findings are: 1. Review of Resident #83 ' s Medical Diagnosis revealed diagnoses of Parkinsonism and repeated falls. The quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 10/18/2024 indicated a Brief Interview of Mental Status (BIMS) score of 02, indicating severe cognitive impairment, had a visual impairment, and wore glasses. On 01/06/2025 at 12:30 PM and 3:30 PM, Resident # 83 was observed in the day room of secure unit sitting in chair 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to ensure resident's wheelchairs was in good useable condition for 1 (Resident #74) of 1 sampled resident; and failed to ensure bed linen was maintained and in good condition for 1 (Resident #45) of 1 sampled resident. The findings are: A review of an admission Record indicated the facility admitted Resident #74 with a diagnosis that included dementia. The Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #74 had a Brief Interview for Mental Status (BIMS) score of 6, which indicated the resident had severe cognitive impairment. The resident required partial/moderate assistance with activities of daily living (ADLs). A review of the maintenance logbook dated 9/27/2023 through 11/22/2023 revealed no work order for the replacement of Resident #74's padded wheelchair armrest. On 11/27/2023 at 11:33 AM and 01:09 PM; and on 11/28/2023 at 08:34 AM, Resident #74 was sitting in a wheelchair. The armrest pads on both sides of 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, record review, and interview, the facility failed to ensure the resident's environment was free of accident hazards as possible, as evidenced by failure to ensure potentially hazardous hygiene products were stored in a secure location on 1 (400 Hall/Secure Unit) of 4 Halls, to prevent potential access of hazardous items for 2 (Residents #49 and #82) of 2 sampled residents. The findings are: A review of the admission Record indicated the facility admitted Resident #49 with diagnosis that included dementia. The Quarterly Minimum Data Set (MDS) dated [DATE], revealed Resident #49 had a Brief Interview for Mental Status (BIMS) score of 5, which indicated the resident had severe cognitive impairment. The resident required supervision to limited assist with activities of daily living (ADLs). On 11/27/2023 at 11:24 AM, and at 01:04 PM, and again on 11/28/2023 at 03:18 PM, a package of 8 denture tablets was observed on the sink in Resident #49's bathroom and not contained. A pink basin with a clear…

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 expired medication were removed from the Medication Storage room [ROOM NUMBER] and the Medication Cart for the 100 and 200 Halls. The findings are: During observation of Medication Storage room [ROOM NUMBER] on 11/29/2023 at 10:27 A.M. with Licensed Practical Nurse (LPN) #2. The Surveyor observed Mucinex DM expiration date 7-2023. During observation of the Medication Cart for the 100 and 200 Halls on 11/29/23 at 11:30 A.M., there was a plastic bag with 6 blue tablets, with a name and 112 written on the front. The Surveyor asked LPN #3 if she knew what the medication was. LPN #3 stated, No, I have never seen it. On 11/29/23 at 10:33 A.M., the Surveyor asked LPN #2 what do you do with the expired medications? LPN #2 said, We take our meds [medications] to the 100/200 Hall, write in the blue book the name of the medications and quantity. The medication is then disposed of in a large, locked container. On 11/29/23 at 10:35 A.M., LPN #3…

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 food items stored in the refrigerator was covered and sealed to maintain freshness and prevent potential cross contamination; expired food items were promptly removed from stock; expired food packages were promptly removed from stock and discarded to prevent potential for bacteria growth and food borne illness for residents who received meals from 1 of 1 kitchen.; leftover food items were used properly to maintain food quality for residents who received meal trays from 1 of 1 kitchen; an ice machines was maintained in a clean and sanitary condition to prevent potential contamination of residents' beverages for residents who received meals from 1 of 1 kitchen and hot food item was maintained at or above 135 degrees Fahrenheit on the steam table while awaiting service, to prevent potential food borne illness for residents who received meals from 1 of 1 kitchen; These failed practices had the potential to affect 73 residents who received meals from the kitchen total ( Census : 74), as documented on the Diet List provided…

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 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 residents who required pureed diets for 2 of 2 meals observed. The failed practice had the potential to affect 2 resident who received a puree diet as documented on the Diet List provided by the Food Service Supervisor on 8/23/22. The findings are: a. On 8/22/22 at 11:22 AM, Dietary Employee #1 placed 4 dinner rolls into a blender, added a carton of warm whole milk, and pureed them. She added another carton of whole milk and pureed. b. On 8/22/22 at 11:25 AM, she placed one dinner roll into a blender, pureed it some more. At 11:27 AM, She poured the pureed bread in a pan and placed it in the oven. The consistency of the pureed bread was thick and was not smooth. 2. On 8/22/22 at 11:59 AM, The following observations were made on the steam table: a. A pan of pureed rice was on the steam table. The consistency of pureed rice…

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.