The Blossoms at Cumberland Rehab & Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to coordinate assessments with the PASARR (Preadmission Screening and Resident Review) program by obtaining a copy of the completed Level II PASARR, so any recommendations could be incorporated into the resident's assessment, care planning and transition of care for 1 (Resident #7) of 1sample resident reviewed for PASARR. These are the findings: 1. Resident #7 was admitted to the facility on [DATE] and had diagnoses of schizoaffective disorder, auditory hallucinations, delusional disorders, unspecified mood [affective] disorder and anxiety disorder. The quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) 12/17/2024, documented that the resident scored 15 (13-15 indicating cognitively intact). a. Resident #7 ' s Care Plan with an initiated date of 9/19/2024, documented, Focus: Resident expresses maladaptive behavioral symptoms related to: A diagnosis of chronic mental illness (schizophrenia). The resident's…

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, interviews, record review, and facility document review, it was determined the facility failed to ensure the resident received a bath/shower per the schedule to promote good hygiene for 1 (Resident #44) of 18 sampled residents reviewed for assisting residents to perform activities of daily living (ADLs). Findings include: The admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 12/06/2024, revealed Resident #44 had a Brief Interview for Mental Status (BIMS) score of 15 which indicated the resident was cognitively intact. Diagnoses on the MDS included diabetes (abnormal blood sugar), seizure disorder (neurological condition), obesity, and an ulcer on the lower extremity. The resident was observed, and records were reviewed, for ADLs being completed. 1) On 01/14/2025 at 9:35 AM, Resident #44 stated that some residents were not getting showers frequently enough. Resident #44 stated residents needed a shower three times per week and it was only carried out once or twice per week. Resident #44 stated [pronoun] needed minimal assistance but…

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, record review, and policy review, the facility failed to ensure staff monitored the skin and applied ointment as ordered by the physician for 1 (Resident #36) of 1 sampled resident reviewed for skin issues. The findings are: 1. Review of an Order Summary revealed Resident # 36 had diagnoses of spinal stenosis, coronary artery disease (CAD), neurogenic bladder, acute kidney failure. The quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 11/08/2024 documented that the resident scored 15 (13-15 indicates cognitively intact) on the Brief Interview for Mental Status (BIMS). a. On 01/15/2025 at 7:15 PM, review of a Physician's Order, dated 3/08/2024, stated: [brand name] external ointment (Emollient) Apply to bilateral lower extremities (BLE) topically one time a day for dry skin and apply to BLE topically as needed for dry skin. b. On 01/15/2025 at 7:30 PM, the Treatment Administration Record (TAR) report for January 2025 showed 3 missed days of [brand name] ointment not applied as ordered 01/7/2025, 01/11/2025 and 01/13/2025. c. On 01/16/25…

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, interviews, record review, and facility document review, it was determined the facility failed to provide safety during the process of medication administration for one (Resident #44) of 18 sampled residents reviewed for being free of Accident Hazards/Supervision/Devices. The findings include: Review of an admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 12/06/2024, revealed Resident #44 had a Brief Interview for Mental Status (BIMS) score of 15 which indicated the resident was cognitively intact. Diagnoses on the MDS included diabetes (abnormal blood sugar), seizure disorder (neurological condition), obesity, and an ulcer on the lower extremity. The resident was observed, and their record reviewed, for safe medication practices. 1) On 01/05/2025 at 7:50 AM the medication pass process was observed for Resident #44: a. Licensed Practical Nurse (LPN) #3 had a cup with two medications in the cup. LPN #3 stated the medicines were [name brand anticonvulsant and nerve pain treatment medication] 50 mg and [Name brand combination pain…

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, record review, and facility document review, it was determined the facility failed to have a medication as ordered for treatment available for 1 (Resident #36) of 1 sample resident who was reviewed for pain control. The findings are: 1.Review of an Order Summary revealed Resident #36 had diagnoses of spinal stenosis, coronary artery disease (CAD), and acute kidney failure. The quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 11/08/2024, indicated the resident scored 15 (13-15 indicates cognitively intact) on the Brief Interview for Mental Status (BIMS) and took opioid (pain) medications. a. On 01/15/25 at 2:15 PM, review of Progress Notes on 12/15/2024 10:33, - Medication Administration Note Text: [Narcotic pain medication] Oral Tablet 5-325 milligrams (MG) Give 1 tablet by mouth two times a day for pain awaiting delivery from pharmacy. On 12/14/2024 09:24, Medication Administration Note Text: [Narcotic pain medication] Oral Tablet 5-325 MG Give 1 tablet by mouth two times a day for pain awaiting delivery from pharmacy. On 12/12/2024…

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, interview, and facility policy review, it was determined the facility failed to ensure that staff performed hand hygiene when changing gloves when contaminated during indwelling urinary irrigation catheter care for 1 (Resident #36) of 1 sampled resident reviewed for catheter care and failed to ensure staff performed hand hygiene when changing gloves during wound care for 1 (Resident #48) of 2 sampled residents observed for wound care. 1. Review of Resident # 36 ' s Order Summary revealed had diagnoses of coronary artery disease (CAD), neurogenic bladder, acute kidney failure. The quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 11/08/24, indicated that the resident scored 15 on the Brief Interview for Mental Status (BIMS) (13-15 indicates cognitively intact), and Resident #36 had a catheter (indwelling). a. On 01/15/2025 at 9:00 AM, this surveyor observed the Treatment Nurse irrigate indwelling urinary catheter with 60 cubic centimeters (cc) of normal saline. Gloves were changed correctly. Hand hygiene was not performed…

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 residents skin treatments were completed to promote healing per physician's orders for 3 (Residents #2, #3, and #4) of 4 sampled residents. The findings are: Review of an Order Summary Report revealed Resident #2 had a diagnosis of veinous insufficiency and chronic venous hypertension with ulcer of left lower extremity. An Annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 06/07/2024 documented a Brief Interview for Mental Status (BIMS) of 15 (13-15 indicates cognitive) and had two venous ulcers. Review of an Order Summary Report revealed Resident #2 had an order dated 08/02/2024 that indicated, Wound Care: wash all wounds on entire bi-lateral lower legs and feet with (antibacterial, antimicrobial skin cleanser), apply a thin layer of collagen gel to wounds, cover with pad and secure with woven gauze wrap, tape to secure and compression stockings to bilateral legs under (hook and loop) wrap every other day on Monday, Wednesday and Friday. Resident #2's Care Plan initiated…

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 nursing staff were completing treatments per physician's orders for 3 (Residents #2, #3, and #4) of 4 sampled residents. The findings are: 1. Review of an Order Summary Report revealed Resident #2 had diagnoses of veinous insufficiency and chronic venous hypertension with ulcer of left lower extremity. An Annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 06/07/2024 revealed a Brief Interview for Mental Status (BIMS) of 15 (13-15 indicates cognitive) and had 2 venous ulcers. Review of an Order Summary Report revealed Resident #2 had an August 2024 Physician's order that read, Wound Care: wash all wounds on entire bi-lateral lower legs and feet with (antibacterial, antimicrobial skin cleanser), apply a thin layer of collagen gel to wounds, cover with pad and secure with woven gauze wrap, tape to secure and compression stockings to bilateral legs under (hook and loop) wrap every other day on Monday, Wednesday and Friday. Resident #2's Care Plan, initiated 05/14/2024, documented…

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 provide a clean environment on 5 (100 Hall, 300 Hall, 500 Hall, 600 Hall, and 700 Hall) halls of 6 halls where residents resided. This failed practice had the potential to affect all 68 residents who reside in the facility. The findings are: On 04/30/2024 at 9:10 AM, during rounds the following observations were made in the resident rooms: A dark brown build up with a thick black substance was noted along the baseboards, and debris behind the door of resident rooms: 107, 109, 305, 508, 509, 601, 602, 607, 610, 707 and 711. The floors were sticky in Resident Rooms: 106, 108 and 712. Resident room [ROOM NUMBER] had a large amount of dark brown substance covering the bowl in the toilet and a wad of toilet tissue soaked in a yellow substance in the sink. Resident room [ROOM NUMBER] had a spot of dark brown substance on floor 1 inch in diameter and a one foot area of a smeared brown substance was noted next to where a resident was sitting in…

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 and interview, the facility failed to ensure licensed nursing staff demonstrated competency in the care of a resident who required weekly body audits, as evidenced by failure to accurately perform weekly body audits resulting in the resident developing gangrene in the 4th and 5th toes on the left foot, which resulted in surgical amputations of the 4th and 5th toes on the (L) foot for 1 (Resident #323) of 1 sampled resident. The findings are: 1. Resident #323 had diagnoses of Type 2 Diabetes Mellitus with Hyperglycemia and Need for Personal Care. a. An Annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 1/13/24 documented the resident had no venous or arterial ulcers, no other ulcers, wounds and skin problems, and no skin and ulcer/injury treatments. b. A Care Plan initiated on 02/15/22 documented the resident had a focus problem of Diabetes Mellitus and an approach was inspect feet daily for open areas, sores, pressure areas, blisters, edema or redness . Refer to podiatrist/foot care nurse to monitor/document foot care needs and to cut…

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 freezer had an open date to minimize the potential for food borne illness for residents who receive meals from the facility kitchen. This failed practice had the potential to affect 73 residents (total census: 74) who received meals from the kitchen. The findings are: 1. On 01/29/24 at 10:40 AM, the following observations were made in the three-door freezer in the kitchen area, referred to as the meat freezer: a. One half case (1 bag) of chicken breast nuggets that had been opened, did not have an open date. b. The Dietary Manager (DM) was asked how many nuggets were in the bag. The DM said, Approximately seventy. c. An opened bag of cheese manicotti with a received date of 12/18/23, did not have an open date. d. The DM was asked how many cheese manicotti were in the bag? The DM stated, About twenty.

Based on observation, interview and record review, the facility failed to ensure 2 (Residents #23 and #66) of 14 residents who were dependent or required assistance of staff to perform facial hair removal to promote good hygiene and cleanliness. The findings are: 1. On 01/29/24 at 10:32 AM, Resident #23 was sitting in a wheelchair. Resident #23 had facial hair one inch long. Resident #23 was asked if she liked facial hair. She replied, No. a. On 01/30/24 at 08:12 AM, Resident #23 was in bed with one-inch-long facial hair noted. b. On 01/30/24 at 03:14 PM, Resident #23 was sitting in the Dayroom, one inch long facial hair was noted to the chin area. c. A Care Plan with an initiated date of 04/25/22 noted Resident #23 required cueing and supervision with possible assistance by (1) staff with bathing, personal hygiene, and oral care. d. On 1/30/24 at 3:15 PM, Certified Nursing Assistant (CNA) #1 was asked to accompany the Surveyor to Resident #23's room and look at her face and explain what she sees. CNA #1 stated, Its hairy. That's embarrassing for her. CNA#1 was asked should facial…

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 controlled substances remaining count was accurate and drug records of controlled substances were maintained. The findings are: 1. On 01/30/2024 at 04:06 PM, during observation of the medication cart for the 500 Hall with Licensed Practical Nurse (LPN) #5, Page 56 of the Controlled Substance Logbook documented an ending balance of 16 tablets of Lacosamide 100 mg (milligram) for Resident #41. Resident #41's bubble pack card of Lacosamide 100 mg tablets showed a remaining balance of 14. There were 2 tablets not accounted for at that time. 2. On 01/30/2024 at 04:11 PM, Page #61 of the Controlled Substance Logbook documented an ending balance of 52 tablets of Clonazepam 0.5 mg for Resident #51. Resident #51's bubble pack card showed a remaining balance of 51. There was 1 tablet not accounted for at that time. 3. On 01/30/2024 at 04:07 PM, the Surveyor observed LPN #5 sign out Lacosamide 100 mg tablet on two different lines, correcting the count for Resident #41's Lacosamide. LPN # 5 stated, I did not sign…

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 physician orders were followed to maintain a medication error rate was less than 5%, for 3 (Resident #33 #69 and #323 ) of 7 (Residents #9, #12, #33, #49, #62, #63 and #323) sampled residents observed during the medication pass. The medication error rate was 21.43%, based on observations of 28 medications administered for a total of 6 errors detected. The findings are: 1. Resident #33 a. A Physicians Order dated 12/5/23 documented Resident #33 was to receive Albuterol Sulfate HFA (hydrofluoroalkane) Aerosol Solution 2 puffs, inhale orally three times/day. b. The Medication Administration Record (MAR) documented the Albuterol Inhaler was to be administered at 4:00 to 6:00 AM; 11:00 AM to 1:00 PM; and 8:00 PM to 10:00 PM. c. On 1/29/24 at 11:54 AM, Licensed Practical Nurse (LPN) #1 prepared Resident #33's medication. The Albuterol Sulfate Inhaler was omitted from the medication pass. d. On 2/1/24 at 09:13 AM, Licensed Practical Nurse (LPN) #2 was asked if she gave Albuterol Sulfate 2 puffs to 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure that expired insulin vials were removed from the medication cart once the expiration date has been reached, the facility failed to ensure that controlled substances were properly removed once the seal to the medication had been broke to prevent the possible misappropriation of medication, the facility failed to ensure that medications were stored on the medication cart in original packaging to show the medication identifiers and expiration date. The findings are: 1. On [DATE] at 03:52 PM, observed a medication cart for the 500 Hall with LPN #5. In the top drawer of the medication cart was a medication cup of 12 white tablets, circular in shape. The tablets had an imprint of 44 137 and the medication cup was labeled Gas X. LPN #5 was unable to verify the identity of the pills. The medications were discarded by the Administrator. 2. On [DATE] at 04:03 PM, during reconciliation of controlled substances on the 500 Hall medication cart…

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 multi-resident use glucometer was disinfected after use to prevent potential spread of infection for 17 residents who had physician orders for capillary blood glucose (CBG) monitoring. On 1/29/23 at 11:54 AM, LPN #1 performed a glucose finger stick to Resident # 33. LPN #1 took an alcohol wipe and cleaned the glucose machine for approximately 1 minute then placed the machine in the 600-medication cart drawer. LPN #1 performed a glucose finger stick on Resident #62, then cleaned the glucose machine with an alcohol wipe for approximately 25 seconds then returned the machine to the 700-medication cart drawer. On 1/29/24 at 12:24 PM, LPN #1 performed a glucose finger stick on Resident #9. LPN #1 cleaned the glucose machine for 8 seconds then returned the machine to the 700-medication cart drawer. Resident #33 had a Physicians order dated 12/5/23 documented accuchecks BID notify MD [Medical Doctor] if less than 60 or greater than 250 two times a day. Resident #62 had a Physicians Orders dated 8/7/23 for…

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 and interview, the facility failed to ensure residents were provided with the opportunity to formulate Advance Directives other than code status, to enable them to make advance decisions regarding which measures should be provided or withheld in the event of their incapacitation for 1 (Resident #34) sampled resident. The findings are: 1. On 01/30/24 at 3:54 PM, the clinical records for Resident #34 contained no documentation to indicate Advance Directive information was provided allowing Resident #34 the opportunity to formulate an advance directive other than making decisions regarding code status. 2. A Physician Orders for Life-Sustaining Treatment (POLST) dated 08/19/2023 noted a family member was Resident #34's legal representative, and an Advance Directive was discussed and available and reviewed with the legal representative. No date for the Advance Directive was documented on the POLST. 3. On 02/02/24 at 11:17 AM, the Surveyor asked the Administrator and the Regional Manager if they had an Advance Directive for Resident #34 as indicated on 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, interview, and record review, the facility failed to ensure the confidentiality of resident records on the secured unit, were kept private by not closing the electronic medication administration record when not in use. The findings are: 1. On 1/31/2024 at 08:46 AM, upon entering the 600 Hall a medication cart was in the hall. There was not a nurse around. The electronic Medication Administration Record was open on top of the medication cart with a resident's private information visible to anyone passing by. At 08:48 AM, Licensed Practical Nurse (LPN) #1 opened a door and walked out of a resident's room. 2. On 1/31/2024 at 08:53 AM, LPN #1 was asked, What should you do prior to leaving the medication cart? LPN #1 stated, Close the medication administration record. LPN #1 was asked, Why should the medication administration record be closed before leaving the medication cart? LPN #1 replied, The medication administration record should be closed because its HIPPA [Health Insurance Portability and Accountability Act]. LPN #1 was then asked, What could happen if 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 ensure the Ombudsman was notified in writing of the resident's transfer to the hospital and/or discharge as required for 1 (Resident #323) of 10 (Residents #5, #8, #19, #30, #33, #37, 47, #68, #66 and #323) sampled residents who were transferred to the hospital from [DATE] to 2/2/24. The findings are: 1. Resident #323 had diagnoses of Type 2 Diabetes Mellitus with Hyperglycemia and Need for Assistance with Personal Care. a. A Health Status note dated 1/12/24 at 12:32 PM documented, .Assessed left foot, top half of foot at an[sic] horizontal angle noted extremely dark in color, faint papable [palpable] pulses. The fourth, and fifth metatarsals are necrotic in color, scant amount of red drainage moted to 5th toe with less than an size opening at site. Provider nurse in facility . b. A Nursing Progress Note dated 1/12/24 at 13:28 (1:28) PM documented, .[Provider Name] in the facility, and made aware of, stated to send resident to ED [Emergency Department]…

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 and interview, the facility failed to ensure Resident #66 had an order for a treatment to the left wrist area and the bandage was changed to prevent infection. This failed practice had the potential to affect 14 residents who resided on 600 Hall. The findings are: 1. On 01/29/24 at 02:43 PM, Resident #66 had a bandage to the left lower arm dated 1/24 with initials. The bandage had a dark red substance the size of a half dollar dried on it. On 01/30/24 at 08:08 AM, Resident #66 was in the Dayroom, the bandage was still on left arm dated 1/24. On 01/31/24 at 08:53 AM, the Surveyor accompanied Licensed Practical Nurse (LPN) #1 room. LPN #1 was asked to look at the bandage on Resident #66's left wrist. LPN #1 stated, We had a treatment nurse yesterday and it was changed. The Surveyor asked about the date of 1/24 on the bandage. The LPN #1 stated, That is letting you know that it was done in January of 24. LPN #1 was asked how often the dressing is changed. LPN #1 stated, Every shift and when soiled. On 1/31/24 at 10:08 AM, LPN #3 was asked if she performed…

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 and interview, the facility failed to ensure a Physician Ordered nutritional diet was served and the interdisciplinary team met timely for appropriate interventions and initiated new interventions when the resident's weight continued to decline in order to minimize further weight loss and maintain nutritional status to the extent possible for 1 (Resident #62) sampled resident. The findings are: 1.Resident #62 was admitted on [DATE] weighing 181.3 lbs (pounds). 2. On 10/20/2022, a Physicians Order documented general diet, regular texture, thin liquids consistency and fortified oatmeal. 3. On 01/29/24 at 12:17 PM, Resident #62 did not have any fortified foods or milk on his lunch tray. The tray card called for both. 4. 01/30/24 08:42 AM, Resident #62 received a pancake, oatmeal, and sausage. Certified Nursing Assistants (CNA) #2 and #3 were asked what the fortified food was for this meal. Neither CNA knew. CNA #3 went to the kitchen, came back and stated, It was oatmeal.…

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 medication and flushes via percutaneous endoscopic gastrostomy (PEG) were given via gravity for 1 (Resident #12) sampled resident who had a PEG tube. The findings are: 1. On 01/31/24 at 08:16 AM, Licensed Practical Nurse (LPN) #2 prepared the following medications for Resident #12: Citalopram 20 milligrams (MG) 1 tablet, Gabapentin capsule 300 mg 1 capsule, ASA (aspirin) 81 mg chewable 1 tablet, Carboxymethyl cellulose sodium 0.5% 1 drop both eyes, Docusate Sodium Liquid 50 mg/5 ml (milliliters) give 10 millimeters, flush with 50 ml water AC (before meals) & PC (after meals). LPN #2 took the syringe and drew up 50 milliliters. LPN #2 used a syringe and pushed the water through the tube. LPN #2 drew up the diluted medications and pushed the medications through the tube. LPN #2 drew up 50 ml of water in the syringe and pushed the water through the tube. a. A Physicians order dated 6/6/2003 documented, Celexa Oral Tablet 20 MG (Citalopram Hydrobromide) Give 1 tablet via PEG-Tube in the morning. b. 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.