The Blossoms At Conway Rehab & Nursing Center

Based on observation, interview, and record review, the facility failed to ensure residents were showered/bathed as scheduled to promote good personal hygiene for 01 (Resident R #35); ensure residents fingernails were kept clean and free of debris for 01 (Resident #13) sample mix residents who require assistance with showering/bathing. The findings are: 1. On 03/04/24 at 10:27 AM, the Surveyor observed Resident #35 lying in bed with greasy hair. a. On 03/04/24 at 10:28 AM, Resident #35 was asked, How long has it been since you've had a shower/bath? Resident #35 stated, Last shower was last week. b. On 03/06/24 at 08:24 AM, Licensed Practical Nurse (LPN) #03 confirmed the resident's hair was greasy and that he needed a shower. c. The admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 11/23/2023 documented, Self-Care E. Shower/ bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair) . Partial/ moderate assistance . d. On 03/06/24 at 09:04 AM, the care plan dated 02/24/2024 documented, . Please…

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 record review, the facility failed to ensure thickened liquids were within reach and that the cooler was maintained with cold ice packs to promote adequate hydration for 01 (Resident #22) sample mix resident and the facility failed to provide services to maintain acceptable parameters of nutritional status for 01 (Resident #37) of 7 sampled residents who have a physician's order to receive fortified foods. The findings are: On 03/05/24 at 10:09 AM, the Surveyor observed no thickened liquid drinks in Resident #22 room's or the resident's cooler. The ice packs in the cooler were thawed. No fluids were present in the resident's room. On 03/05/24 at 02:30 PM, Licensed Practical Nurse (LPN) #03 confirmed there were no fluids at Resident #22's bedside or in the room. LPN #03 also confirmed the ice packs were thawed and no drinks were in the cooler. The Annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 01/02/2024 noted in section K- Swallowing/ Nutritional Status the resident is on a mechanically altered diet that required a…

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 record review, the facility failed to assure nursing staff possessed the skill sets necessary to provide nursing services to meet the resident's needs safely and in a manner that promoted each resident's physical well-being, as evidenced by hand hygiene not being performed before putting on gloves during wound care to prevent the spread of infection for 2 (Residents #5, and #18), and the use of a mechanical lift as a care plan documented to prevent accidents for 1 (Resident #22) sampled resident. The findings are: a. On 03/05/2024 at 10:35 AM, Licensed Practical Nurse (LPN) #1, who reported they filled the roles of Treatment Nurse and Infection Preventionist [IP], gathered supplies and placed on bedside table in Resident #5's room. The nurse pulled gloves from uniform pocket, donned (applied) them, and proceeded to clean a pressure ulcer. LPN #1 took a collagen sheet from bedside table, tore it into small pieces placing some inside the wound bed, then laid the remaining collagen sheet back on the bedside table. LPN #1 then touched a different…

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 record review, the facility failed to ensure all pharmaceuticals were available for the residents during medication administration. The findings are: 1. On 03/05/2024 at 08:13 AM, during observation of medication administration for 200 Hall with Licensed Practical Nurse (LPN) #03, Resident #24 did not receive their ordered dose of Lactulose Oral Solution. LPN #3 said she would obtain the lactulose and notify the Surveyor to come back and observe her administer it. a. The Physician Orders dated 03/05/2024 documented, Lactulose Oral Solution 10 GM [gram]/15 ML [milliliter] (Lactulose) 30 ML by mouth every 12 hours as needed for constipation. b. On 03/05/2024 at 11:36 AM, LPN #3 confirmed that the facility does not have Resident #24 ' s Lactulose Oral Solution. c. Resident #24 ' s Nursing Progress note dated 3/5/2024 documented, Medication Administration Note Text: Lactulose Oral Solution 10 GM/15ML Give 30 ml by mouth two times a day related to CONSTIPATION, UNSPECIFIED Give 30ml to =20gm med not available . d. On 03/06/2024 at 12:39 PM, Resident…

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 record review, the facility failed to ensure physician orders were followed to maintain a medication rate of less than 5% to prevent complications for 2 (Residents #18 and #24) of 3 residents observed during medication pass resulting in medication errors. The findings are: 1. On 03/05/2024 at 08:13 AM, during observation of medication administration for the 200 Hall with Licensed Practical Nurse (LPN) #3, Resident #24 did not receive Lactulose (a medication used to treat constipation). LPN #3 said they would obtain the lactulose and notify the Surveyor to come back and observe its administration. a. The Physician Order dated 03/05/2024 documented, Lactulose Oral Solution 10 GM (gram)/15ML (milliliter) (Lactulose) 30 ml by mouth every 12 hours as needed for constipation. b. On 03/05/2024 at 11:36 AM, LPN #3 confirmed that the facility does not have Resident #24's Lactulose. c. A Nursing Progress note dated 03/05/2024 documented, Medication Administration Note Text: Lactulose Oral Solution 10 GM/15ML Give 30 ml by mouth two times a day related to CONSTIPATION,…

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 garbage receptacles were maintained in a manner to minimize pests. The failed practice had the ability to affect all 47 residents who reside in the facility. The findings are: On 03/04/2024 at 10:27 AM, the dumpster to the left of the back door which was designated for recycling is observed to have the lid open. To the far right, located on the edge of the back parking lot were two trash dumpsters. The lids/doors of each dumpster were open. The Dietary Manager (DM) stated, They must have emptied them this morning because they were overflowing yesterday. There have been some issues with getting someone to pick them up, like maybe we switched companies. On 03/06/2024 at 12:00 PM, the dumpster found to the left after exiting the back kitchen door is observed to have the lid open, exposing the contents and providing an opening for pests. To the right, the two dumpsters at the back of the parking lot are observed to have a lid and a sliding door open. On 03/07/2024 at 12:30 PM, the DM was asked how the dumpsters…

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 staff changed gloves/washed hands when contaminated before, during and after wound care in accordance with professional standards of nursing practice, to prevent the potential spread of infection for 3 (Resident #5, #15 and #18) of 4 (Residents #5, #15, #18 and #24) sampled residents who had Physicians Orders for wound dressings changes. This failed practice had the potential to affect 6 residents who received wound care treatment /dressings changes. The findings are: 1. Resident #5 had diagnoses of Paraplegia, Pressure ulcer of right buttock, stage 4 (a stage 4 pressure injury indicates the wound has extended to muscle, tendon, or bone), and Pressure ulcer of left hip, stage 4. An admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 09/11/23 documented a Brief Interview for Mental Status (BIMS) of 15 (13-15 indicates cognitively intact), and that the resident had pressure injuries to include a stage 4…

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 residents were provided consistent access to personal property for 1 (Resident #46) sampled resident. The findings are: Resident #46 was admitted on [DATE]. The admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 01/15/2024 documented a score of 14 (13-15 indicates cognitively intact) on the Brief Interview for Mental Status (BIMS) On 03/05/2024 at 08:43 AM, the Surveyor observed a cell phone in the narcotic box of 100 Hall cart. Complaint stated that Resident #46 had their cellphone taken away by the Director of Nursing (DON) and placed on the med cart. Licensed Practical Nurse (LPN) #2 stated was made aware by other staff that the DON removed the residents cell phone from them and put on the med cart. On 03/05/2024 at 01:30 PM, the DON was asked, On Friday February 23, 2024, did you remove Resident #46's cell phone and lock it up in the 100 hallway medication cart? The DON stated, No. The Surveyor took 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 observation, record review, and interview, the facility failed to ensure that before a resident was allowed to self-administer nasal spray, the Interdisciplinary Team (IDT) conducted an assessment to determine if this practice was safe, obtain a physician order for self-administration, and develop a care plan to address educating the resident on self-administration, to prevent potential errors in administration for 1 (Resident #35) sampled resident. The findings are: On 03/04/2024 at 10:17 AM, the Surveyor observed a bottle of nasal spray lying in Resident (R) #35's windowsill next to the bed. The Surveyor asked the resident how long he/she had the nasal spray and they stated, Long enough for it to be empty. When asked, Were you assessed to be able to self-administer your own medications? R #35 stated, I don't think so. The physician order dated 11/27/2023 noted saline nasal solution (Saline) 1 spray in both nostrils every 4 hours as needed for dry nares. There was no order related to the self-administration of medication. The care plan date 11/20/2023 does not document…

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 record review, the facility failed to ensure that residents who are care planned for mechanical lift transfers were transferred by the mechanical lift, and that they were assessed for usage of the mechanical lift in accordance with professional standards of practice for 1 (Resident # 22) sample mix resident. The finding are: On 03/04/24 at 02:34 PM, the Surveyor observed Certified Nursing Assistant (CNA) #01 and CNA #02 give the resident the option of standing or using the mechanical lift to transfer from the wheelchair to the bed. Resident #22 chose to stand and was grasping the grab bar multiple times and rocking trying to get into a standing position. Both CNAs grasped the back of the Resident ' s pants and their brief, no gait belt observed, and assisted the resident into bed by swinging them from wheelchair to bed. On 03/04/24 at 02:39 PM, CNA #01 was asked, Is the resident to be transferred with a [mechanical lift]? CNA #01 stated, Ya, but they've been allowing [the resident] to do [themselves]. When asked, Who instructed you that it 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 and interview, the facility failed to ensure a deep freezer was maintained in a manner to ensure frozen food was maintained at the appropriate temperature to minimize the potential for food borne illness who could affect all 47 residents who receive their meals from one of one kitchen. The findings are: On 03/04/2025 at 10:25 AM, a large deep freezer is observed in the emergency storage room. The lid of the freezer is observed to protrude up from the bottom, failing to seal around the top. The front edge of the freezer and the edge of the lid failed to join by 2-2.5 inches. The Dietary Manager (DM) raises the lid to display a thick layer of ice (2 inches), which extended down the inside of the freezer and over the top edge. Standing at the end of the freezer the lid can be seen to extend toward the back, as opposed to forming a closure against the bottom. The rubber seal around the top of the freezer is loose preventing the formation of a seal. On 03/06/2024 at 09:05 AM, the Maintenance Director was asked if he was aware of the issues related to the deep…

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 the comprehensive care plan addressed and individualized appropriate care and services for 2 (Residents #1 and #3) of 3 (Residents #1, #2 and #3) sampled residents. The findings are: 1. Review of the Order Summary Report dated 10/10/23 noted Resident #1 was admitted to the facility on [DATE]. a. On 10/10/2023 at 3:43 PM, a review of Resident #1's Care Plan with an initiated date of 09/09/23 did not document any Activity of Daily Living (ADL) assistance. 2. Review of the Order Summary Report dated 10/11/23 noted Resident #3 was admitted on [DATE]. a. On 10/10/23 at 4:13 PM, a review of Resident #3's Care Plan did not document any ADL assistance. 3. On 10/11/23 at 10:45 AM, during an interview Licensed Practical Nurse (LPN) #1 confirmed Resident #1's and Resident #3's care plans did not contain the ADL care plans. 4. On 10/11/23 at 10:56 AM, during an interview the Director of Nursing (DON), confirmed Resident #1 and Resident #3 should have their…

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 the call light was accessible to allow residents to summon for assistance to accommodate their individual needs for 1 (Residents #7) and failed to provide therapy recommended adaptive eating utensils to accommodate resident needs for 1 (Resident #13) of 23 (Residents #1, #7, #8, #12, #13, #14, #15, # 21, #22, #26, #27, #28, #30, #31, #32, #34, #37, #38, #41, #92, #192, #243 and #244) sampled residents who used the call light system to summon for assistance and 1 sampled resident who required adapted eating utensils. The findings are: 1.Resident #7 had diagnoses of Dementia with Agitation, Type 2 Diabetes Mellitus and Obesity. The Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 09/25/22 documented the resident scored 8 (8-12 indicates moderately cognitively impaired) on a Brief Interview for Mental Status (BIMS) and required extensive physical assistance of two plus persons for bed mobility, transfer, dressing and toilet use, and extensive physical assistance of one person…

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 the Minimum Data Set (MDS) assessment accurately reflected the resident's status to reflect current services for 2 (Residents #21 and #31) of 6 (Residents #7, #12, #15, #21, #26 and #31) sampled residents who had physician orders for oxygen therapy. The findings are: 1. Resident #21 had a diagnosis of Shortness of Breath. The Quarterly MDS with an Assessment Reference Date (ARD) of 10/03/22 documented the resident scored 12 (8-12 indicates moderately cognitively intact) on a Brief Interview for Mental Status (BIMS) and had no shortness of breath upon exertion, sitting at rest or lying flat and did not receive oxygen therapy. a. The December 2022 Physician Orders documented, .Keep O2 [oxygen] within reach of resident at all times. Keep O2 concentrator close to bed. Check every shift every shift related to SHORTNESS OF BREATH . Order Date 10/30/2022 . O2 @ [at] 2LPM [liters per minute] via Nasal Cannula for SOB [shortness of breath] as needed . Order Date 08/31/2022 .'' b. On 12/06/22 at 1:38 PM,…

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 the comprehensive care plan was accurately developed to address current services for oxygen therapy for 2 (Residents #21 and #31) of 6 (Residents #7, #12, #15, #21, #26 and #31) sampled residents who had physician orders for oxygen therapy. The findings are: 1. Resident #21 had a diagnosis of Shortness of Breath. The Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 10/03/22 documented the resident scored 12 (8-12 indicates moderately cognitively intact) on a Brief Interview for Mental Status (BIMS) and had no shortness of breath upon exertion, sitting at rest or lying flat and did not receive oxygen therapy. a. The Care Plan with a revision date of 10/24/22 did not address oxygen therapy. b. The December 2022 Physician Orders documented, .Keep O2 [oxygen] within reach of resident at all times. Keep O2 concentrator close to bed. Check every shift related to SHORTNESS OF BREATH . Order Date 10/30/2022 . O2 @ [at] 2LPM [liters per minute] via Nasal Cannula for SOB [shortness of…

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 professional standards of care in the care and storage of respiratory and/or nebulizer equipment was maintained for 2 (Residents #8 and #26); oxygen was ordered and administered at prescribed flow rate for 1 (Resident #31) and signage indicating No Smoking was posted on the door for 2 (Residents #21and #31) of 6 (Residents #7, #12, #15, #21, #26 and #31) sampled residents who received oxygen therapy and 11 (Residents #7, #8, #13, #15, #21, #26, #27, #31, #32, #38 and #244) nebulizer treatments. The findings are: 1. Resident #8 had diagnoses of Hypoxia, Chronic Pulmonary Edema, Chronic Combined Systolic and Diastolic Congestive Heart Failure and Pneumonia. The Quarterly Minimum Data Set (MDS) with Assessment Reference Date (ARD) of 11/13/22 documented the resident scored 15 (13-15 indicates cognitively intact) on a Brief Interview for Mental Status (BIMS) and did not receive oxygen therapy. a. The Care Plan with an initiated date of 05/13/22 documented, .has altered respiratory status/difficulty…

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 5 residents who received pureed diets, 9 residents who received mechanical soft diets, 2 residents who received chopped diets and 20 residents who received regular diets (total census: 38) from1 of 1 kitchen according to a list provided by the Dietary Supervisor on 12/6/2022. The findings are: 1. On 12/6/2022, the menu for the supper meal documented residents who received regular diets were to receive 8 oz (ounces) of chicken stuffing casserole; residents who received mechanical soft diets were to receive ground chicken stuffing casserole and residents on pureed diets were to receive two # 8 scoops of pureed chicken stuffing casserole (1 cup). 2. On 12/6/2022 at 5:15 PM, the following observations were made during the supper meal service: a. Dietary Employee (DE) #1 used a #8 scoop which is equivalent ½ cup (4…

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 a meal tray was not left to sit in a resident's room while they were out of the facility for an appointment and a new meal tray was provided instead of the residents eating the food to prevent the potential for food borne illness for 2 (Residents #27 and #243) of 2 residents who received dialysis and failed to ensure meals were served at temperatures that were acceptable to the residents, to improve palatability and encourage good nutritional intake during 1 of 1 meal observed. The failed practice had the potential to affect 7 residents who received meal trays in their rooms on Hulan Hall as documented on a list provided by Dietary Supervisor on 12/6/2022 and 2 residents who received dialysis as documented on the Resident Matrix provided by the Minimum Data Set Coordinator on 12/6/22. The findings are: 1. Resident #27 had diagnoses of Depression, Diabetes Mellitus, Renal Failure (Dialysis) Congestive Heart Failure and Chronic…

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 residents who required pureed diets for 2 of 2 meals observed. The failed practice had the potential to affect 5 residents who received pureed diets as documented on the Diet List provided by the Food Service Supervisor on 12/6/2022. The findings are: 1. On 12/06/22 at 3:24 PM, DE #1 placed 12 slices of bread into a blender, added warm milk and pureed. She poured the pureed bread with milk into a pan, covered the pan with foil and placed it in the oven to be served to the residents on pureed diets for supper. The consistency of the pureed bread was thick, not smooth. 2. On 12/06/22 at 3:46 PM, DE #1 used a #8 scoop to placed 6 servings of chicken/corn stuffing into a blender. He added gravy and pureed. He poured the pureed chicken/corn stuffing in a pan. He covered the pan with foil and placed it in the oven to be served to the residents on pureed diets. The consistency of the pureed stuffing…

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 Surveyor: [NAME], [NAME] Based on observation and interview, the facility failed to ensure that chipped areas in the kitchen floors tiles were not covered with a black residue; failed to ensure food items stored in the refrigerator were covered, sealed and dated; ceiling vents were maintained in clean, sanitary conditions for food preparation to prevent the potential food borne illnesses for residents who received meals from 1 of 1 kitchen; expired food items were promptly removed/discarded by the expiration or use by dates; foods were dated when received to assure first in, first out usage to prevent the potential for food bone illness; and dietary staff washed their hands before handling clean equipment or food items; and hot foods were 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 36 residents who received meals from 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 interview and record review, the facility failed to ensure the Binding Arbitration Agreement was explained in a manner understood by residents and representatives, explicitly granted the right to rescind the agreement within 30 days of signing, allowed the resident or representative to communicate with federal, state or local officials or Office of Long Term Care (LTC) Ombudsman, and was not required as part of the admission process for 3 (Residents #14, #38 and #192) of 3 sampled residents who signed Binding Arbitration Agreements upon admission since September 16, 2019. This failed practice had the potential to affect 121 residents admitted since the facility's last annual survey on 9/3/21. The findings are: 1. On 12/06/22 at 2:38 PM, the Administrator provided a copy of the facility's Arbitration Agreement. 2. On 12/06/22 at 9:38 PM, there was no reference to the 30-day right to rescind the agreement or allow residents/representatives to speak to federal, state, or local officials or the LTC (Long Term Care) Ombudsman. 3. On 12/08/22 at 9:28 AM, Resident #38's family…

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 Binding Arbitration Agreement provided for the selection of a neutral arbitrator or a venue was convenient to both parties for 3 (Residents #14, #38 and #192) of 3 sampled residents who signed Binding Arbitration Agreements upon admission since September 16, 2019. This failed practice had the potential to affect 121 residents admitted since the facility's last annual survey on 09/03/21. The findings are: 1. On 12/06/22 at 2:38 PM, the Administrator provided a copy of the facility's Arbitration Agreement. 2. On 12/06/22 at 9:38 PM, there was no reference to venue selection or neutral arbitrator. 3. On 12/08/22 at 10:03AM, the Surveyor asked the Social Service Director (SSD), Are you responsible for the Arbitration Agreements? The SSD stated, Yes. The Surveyor asked, Does your facility's arbitration agreement state the venue must be agreeable to both parties? The SSD stated, No, it doesn't. The Surveyor asked, Does the facility's arbitration agreement state the neutral arbitrator must be agreed upon by both…

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 a resident rights to visual privacy were maintained for 1 (Resident #38) of 23 (Residents #1, #7, #8, #12, #13, #14, #15, #21, #22, #26, #27, #28, #30, #31, #32, #34, #37, #38, #41, #92, #192, #243 and #244) sampled residents who was dressed in a hospital gown and the door was open. The findings are: 1. Resident #38 had diagnoses of Cerebrovascular Accident Affecting Left Dominant Side, Type 2 Diabetes Mellitus, Paroxysmal Atrial Fibrillation and Hemiplegia and Hemiparesis following Cerebrovascular Disease Affecting Left Dominant Side. The 5 Day Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 11/26/22 documented the resident was severely impaired in cognitive skills for daily decision making per a Staff Assessment for Mental Status (SAMS) and was totally dependent of two plus persons physical assistance for bed mobility, transfer, dressing, and toilet use and one person for personal hygiene and eating. a. The Care Plan with a revision date of 11/29/22 does not address behaviors. b. On…

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 the resident's environment was as free from accident hazards as possible, as evidenced by failure to ensure a heating pad was not used by a resident without supervision and/or facility knowledge for 1 (Resident#244) of 1 sampled resident. The findings are: 1. Resident #244 had diagnoses of Age-Related Physical Debility and Muscle Wasting and Atrophy. The Admissions Minimum Data Set (MDS) with an Assessment Reference Date (ARD) documented the resident scored 15 (13-15 indicates cognitively intact) on a Brief Interview for Mental Status (BIMS) and required extensive physical assistance of two plus persons with transfers, extensive physical assistance of one person with dressing, toilet use and personal hygiene. a. On 12/06/22 at 3:05 PM, Resident #244 was lying in bed with eyes closed. A heating pad was over her chest area. b. On 12/07/22 at 10:38 AM, Resident #244 was in her room, sitting up in a wheelchair. The heating pad was draped over the headboard of her bed. c. On 12/07/22 at 3:45 PM, 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.