Pioneer Therapy And Living

Based on observation, interviews, and record review, the facility failed to follow proper hand hygiene while preparing food for the 76 residents who received food from the facility kitchen. The findings include: During an observation and interview on 10/30/2024 at 8:30 AM, Dietary Aide #1 was observed scratching her face then touching the resident breakfast trays. Dietary Aide #1 stated she should have performed hand hygiene after touching her face and before touching the resident food trays. During a concurrent observation and interview on 10/30/2024 at 11:30 AM, Dietary Aide #1 was observed placing cups from a cart onto a tray. Without washing her hands or putting on gloves, Dietary Aide #1 opened the food processor, removed the food processor blade and began scooping deserts from the food processor into serving cups to be served to the residents on puree diets for lunch. Dietary Aide #1 stated that hand hygiene should be performed when going from a dirty task to a clean task. During a concurrent observation and interview on 10/30/2024 at 11:40 AM, Dietary Aide #1 was observed…

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 revise the care plan interventions to include behavioral-emotional health for 1 (Resident #43) sampled resident. The findings include: Record review of Resident #43's Medical Diagnosis sheet reported the resident had diagnoses to include dementia and generalized anxiety disorder. The quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD of 09/03/2024 reported the resident had a Brief Interview for Mental Status (BIMS) score of 2, which indicated the resident was severely cognitively impaired. Review of Resident #43's Clinical Physician Orders reported admission to the secure unit on 06/26/2024. Review of Resident #43's care plan initiated 10/22/2024, reported that Resident #43 had been physically aggressive toward other residents. Intervention treatment for urinary tract infection (UTI) and separation from a resident. Review of facility provided Incident by Incident Type dated 10/29/2024, reported physical aggression initiated incident on 08/15/2024. Physical aggression initiated incidents…

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 the 74 residents living at the facility were provided a safe, clean, and comfortable homelike environment. The findings are: 1. On 10/23/23, during initial rounds the following was observed: a. On 10/23/23 @ 11:42 AM in room [ROOM NUMBER]A resident took surveyor into the bathroom to show her the toilet which was completely covered with black substance throughout the entire toilet bowl. The resident stated, they never come in and clean it. b. On 10/24/23 at 09:59 AM room [ROOM NUMBER]A, surveyor observed that the toilet had black substance throughout the entire toilet bowl. c. On 10/25/23 @ 08:14AM, room [ROOM NUMBER]A the surveyor observed that the toilet had large amount of black substance throughout the entire toilet bowl. d. On 10/25/23 at 11:37AM, the surveyor took the Certified Nursing Assistant (CNA#2) into room [ROOM NUMBER]A, Surveyor then asked (CNA) #2, Can you tell me what you see in this toilet bowl? CNA #2 stated, Dark…

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 2 residents (#17 and #22), of sampled residents had been shaved and nails cleaned and trimmed to promote good hygiene, cleanliness and sense of wellbeing. The findings are: 1. Resident #17 had a diagnoses of unspecified dementia, unspecified severity , with agitation. A Quarterly Minimum Data Set (MDS) with an Assessment Review Date (ARD) of 10/10/23 documented a Staff Assessment of Mental Status (SAMS) for Memory Problem, Severely Impaired Cognitive skills for daily decision making. A MDS with and ARD of 7/10/23 documented extensive assistance for toileting and personal hygiene with 1 person physical assist and limited assistance with 1 person support with eating. a. A Care Plan with an initiation date of 12/2/15 documented, .[name] has an Activities of Daily Living (ADL) self-care performance deficit r/t (related to) osteoarthritis . and .[name] preferred bedtime routine is to brush her teeth, wash her face, and change into…

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 medication error rate did not exceed 5%. This failed policy had the potential to effect 74 Residents according to the Resident Matrix provided by the Administrator on 10/23/2023 at 11:30 AM. The findings are: 1. As of 10/25/23 at 08:44 AM, The surveyor observed Medication Technician [MT] #1 administer Citracal Calcium 650 milligrams [mg] with Vitamin D 25 micrograms [mcg] x2 tablets to Resident #49. The physician's Order Summary dated 10/25/2023 showed an order for Citracal Maximum Tablet 315-250 MG-UNIT (Calcium Citrate-Vitamin D) Give 2 tablets by mouth one time a day Start Date 8/16/23. 2. As of 10/25/23 at 11:43 AM, The surveyor observed Licensed Practical Nurse [LPN] #2 administer 4 bottles of Osmolite 1.5, each bottle contained 237 milliliters [mL] for a total of 948 mL, to Resident #63. The physician's Order Summary dated 10/25/2023 showed an order for Enteral Feed Order every shift Osmolite 1.5 at 55 cubic centimeters [cc]/hour [hr] to equal 1320 cc/24 hrs start date: 8/30/23. 3. As 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 record review and interview, the facility failed to ensure the Quality Assurance and Performance Improvement program [QAPI] Committee implemented appropriate plans of action to prevent repeated deficiencies with Treatment/Services to prevent/heal pressure ulcers and Maintaining effective pest control. These failed practices had the potential to affect 8 residents who receive treatment for pressure ulcers as identified on a list provided by the Director of Nurses [DON] on 10/26/23 at 10:00 am and 74 residents who reside in the facility as identified on the Resident Matrix provided by the administrator on 10/23/23 at 11:30 am. The findings are: 1. A Recertification survey was conducted on 10/26/2023 at the facility. During this survey, the team identified concerns with providing correct treatment for wound care. a. The Plan of Correction for wound care with a completion date of 08/26/22 documented Corrective Action: On 8/4/22 Director of Nursing received order from MD to change treatment order on resident #42 to wound cleanser. On 8/5/22 Director of Nursing counseled RN…

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 hands were sanitized or washed between donning and doffing of gloves and to properly replace a piston syringe. This failed practice had the possibility of affecting 1 [Resident #13] Resident of 2 [Resident's #4 & 13] sample mixed residents with pressure ulcers and 1 [Resident #63] Resident of 2 [Resident's #13 & 63] sample mixed residents that receive tube feedings according to lists provided by the Director of Nursing [DON] on 10/26/23 at 9:29 am titled, List of residents with pressure ulcers and List of residents with tube feedings. The findings are: 1. Resident # 13's diagnosis showed, pressure ulcer of left buttock, stage 4. a. Physician's Order Summary dated 10/25/23 showed, Clean stage 4 PU to left ischial tuberosity with wound cleanser. Pat dry with 4x4 gauze. Apply [named medication] around peri wound. Sterile woven gauze sponge 2x2 soaked with betadine, pack loosely into wound. Cover with 3x3 hydrocelluar foam dressing every day shift and PRN Reassess in 14 days. every day shift for Stage…

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 provide effective pest control for the facility on a regular basis. This had the potential to affect all 74 residents listed on the Resident Matrix provided by the administrator on 10/23/23 at 11:30 am. The findings are: a. On 10/24/23 at 09:08 AM R#4 and R#5 were in room awake. R#5 was lying in bed, and stated there are roaches in both the room and the bathroom, at night especially. It's just gross, I mean what if you would sit on that. You can hear them [staff (nurses and CNA's (Certified Nurse Assistants)] come in and stomp them. When they come in and it's dark and they turn the light on, and they just scatter. They look like teenagers or baby roaches. The Surveyor asked R#5 if food was kept in the room. R#5 answered, No. just when they leave the trays in here. They usually gather right there (as she pointed to the floor next to her bed under the bedside table) and when the light comes on they just scatter The Surveyor asked R#5 if she had actually seen them, and how many. R#5 answered, Yes, there are 3-4 at the most that…

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 a Minimum Data Set [MDS] assessment was coded correctly for 1 (#124) sampled residents who was prescribed antipsychotic medications. The findings are: 1. Resident #124 had the diagnosis [dx] Major Depressive Disorder, Recurrent, Unspecified and Vascular Dementia, Mild, Without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance and Anxiety. The admission Minimum Data Set [MDS] with an Assessment Review Date [ARD] of 10/19/23 documented SECTION N - MEDICATIONS .N0415. High-Risk Drug Classes: Use and Indication A. Antipsychotic: No . a. A physician order [PO] dated 10/24/23 documented Abilify Oral Tablet 2 MG (Aripiprazole), Give 2 tablet by mouth at bedtime related to Major Depressive Disorder, Recurrent, Unspecified. b. A PO dated 10/09/23 documented Abilify Oral Tablet 2 MG (Aripiprazole), Give 1 tablet by mouth at bedtime related to Major Depressive Disorder, Recurrent, Unspecified. Discontinue 10/24/32. 2. On 10/26/23 at 11:54 am The MDS Coordinator was asked to look at resident's admission MDS,…

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 resident with a facility acquired deep tissue abscess to coccyx and left buttock had the correct medication per MD order applied to wound to promote healing for 1 (resident #275). This failed practice had the potential to affect 1 of 8 sample mix residents (#4,#13,#28,#33,#41,#47,#65,and #275 ) who had documented wound treatments on a list provided by the Director of Nurses (DON) on 10/26/23 at 10:00AM The findings are: 1. Resident #275 had diagnosis of Alzheimers and dementia, depression, hypertension. A Quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 10/09/23 documented the resident scored 2(0-7indicates severely impaired) on a Brief Interview for Mental Status (BIMS). Physician Order dated 10/17/2023 clean coccyx with wound cleanser. Pat dry with 4x4 gauze. Apply [Named ointment], then apply calcium alginate and cover with 4x4 foam dressing everyday and PRN (as needed). a. Care plan dated 10/12/23…

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.