Life Care Center Of Yuma

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on documentation, staff interviews, and the facility policy and procedures, the facility failed to ensure that one resident (#27) was not neglected and her basic needs were being met regarding assistance with bathing, nail clipping, hair washing, and monitoring the condition of her skin. The facility also failed to assess the resident's needs after falls and update the care plan with new interventions as needed. The deficient practice could result in further incidents of resident neglect. Findings include: Resident #27 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included Alzheimer's disease, depression, and osteoporosis. The functional goal care-plan initiated April 27, 2022 with a revision date of September 4, 2024 revealed that the resident has limited physical mobility related to Alzheimer's disease, dementia, osteoporosis, osteoarthritis, and weakness. Interventions included that staff will assist with activities of daily living (ADL's) with a 1-2 assist as…

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, staff interviews, and policy review, and review of current facility practice, the facility failed to ensure care plan was developed and implemented to meet the assessed need for one resident (#78). The deficient practice could result in the resident receiving the care they need. Findings include: Resident #78 was admitted on [DATE] with diagnoses of hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, type 2 diabetes mellitus, dysphagia, and unspecified protein-calorie malnutrition. The mini nutritional assessment signed and dated 05/29/2024 revealed that the resident had a score of 6 indicating the resident was malnourished. The Residents at Risk meeting notes dated 05/29/2024 revealed that resident was a new admission and was on a mechanically altered diet on 05/29/2024. The weight record on 05/29/2024 was 221.5 lbs. (pounds). A nutritional assessment dated on 05/31/2024 revealed the resident had a diet of regular mechanically altered texture and thin…

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 personnel file review, staff interviews, facility assessment and policy review, the facility failed to ensure one Certified Nursing Assistant (CNA /staff #64) had the cardiopulmonary resuscitation (CPR) certification to provide nursing and related services. The deficient practice could result in staff not able to to safely meet resident needs during an emergency. Sample size was one. Facility census was 81. Findings include: The Facility assessment dated [DATE] revealed the staffing plan included 13 licensed nurses, and 27 CNA's to provide direct care for an average of 86 residents every day including emergencies. The assessment also revealed the resources the facilities needed to provide competent support and care for their resident population every day and during emergencies. A review of the personnel record for CNA (staff #64) revealed a hire date of [DATE] and had no evidence of current CPR certification. An interview was conducted on [DATE] at approximately 8:35 AM with the business office manager…

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, staff interviews, and the facility policy and procedures, the facility failed to maintain a clean kitchen; and failed to ensure food items were dated when opened. The deficient practice could result in residents having food-borne illness. Findings include: An observation of the kitchen was conducted on June 24, 2024 at 11:25 a.m. with the cook (staff #92). The large walk-in refrigerator had a 5lb opened and undated bag of green leaf lettuce that was exposed; and, the lettuce heads were wilted and discolored. Inside the bag of lettuce was a white plate with food covered by a plastic film. Staff #92 stated that the food items on the white plate were turkey, chicken and potato salad; and, she did not know how the plate got in the lettuce bag or why the bag of lettuce was left open. There was also an opened and exposed three-pound box of cream cheese; and the end of the cream cheese had dried out and was left open in the box. The refrigerator floor had spilled milk. The walk-in freezer area had approximately two cups of frozen corn kernels on the freezer floor and…

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, staff interviews, and facility policy review and the Centers for Disease Control and Prevention (CDC), the facility failed to ensure infection control standards related to enhanced barrier precautions were followed for one resident (#78) with catheter and wound. The deficient practice could result in transmission of multi-drug resistant organisms. Findings include: Resident #78 was admitted on [DATE] with diagnoses of obstructive and reflux uropathy, type 2 diabetes mellitus, emphysema, dementia, anxiety, and benign prostatic hyperplasia with lower urinary tract symptom. The care plan dated May 28, 2024 revealed that an indwelling catheter was in place for uropathy. Interventions included enhanced barrier precautions (EBP), catheter care per shift, change catheter as needed a 16FR (French) 10cc (cubic centimeter) and checking tube for kinks each shift. A physician order dated May 29, 2024 revealed an order for an indwelling catheter size 16 French with a 10cc bulb. The minimum data set…

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 -Resident #337 was admitted to the facility on [DATE] with diagnoses that included digestive surgery, sepsis due to enterococcus, and encounter for surgical aftercare following surgery on the digestive system. Review of hospital records, dated February 11, 2022 included discharge instructions for wound care which noted that there was use of a wound vacuum (VAC) for the resident's surgical wound. The admission nursing note dated February 12, 2022 included that the resident was admitted with a diagnosis of small bowel obstruction related to hernia surgery and the resident had an extensive debridement hernia repair. The note included the resident was admitted with a wound VAC in place. The resident's skin integrity care plan, initiated on February 12, 2022, included that the resident had a break in skin integrity. Interventions included treatments as ordered and a pressure reducing mattress. Nursing notes dated February 14 and 16, 2022 indicated that the wound VAC was in place and was functioning properly. Review…

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 facility documentation, interviews, and policy, the facility failed to ensure that staff were tested for COVID-19 at the required frequency. This deficient practice could lead to the spread of COVID-19. Findings include: Review of the COVID-19 log and line list for staff for November 25 through December 6, 2022 and the log and line list for residents for November 17, 2022 through November 30, 2022 revealed that the facility was in outbreak mode from November 17, 2022 through December 6, 2022. Review of the facility's COVID-19 documentation revealed no evidence that staff or residents had been tested for COVID-19 during the the facility outbreak of COVID-19. An interview was conducted on December 22, 2022 at 10:07 a.m. with the Assistant Director of Nursing (ADON/staff #2), who identified herself as the Infection Preventionist (IP). She stated that she couldn't find her COVID-19 log and line list for residents and staff, so she was not able to provide COVID-19 documentation for residents prior to November 17, 2022 and for staff prior to November 25, 2022. She stated that 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 clinical record reviews, facility documentation, interviews and policy, the facility failed to ensure that an allegation of resident to resident abuse was thoroughly investigated for two residents (#24 and #51). The deficient practice could result in other residents being abused. Findings include: -Resident #24 was admitted to the facility on [DATE] with diagnoses that included vascular dementia, psychotic disturbance, legal blindness, and anxiety disorder. The quarterly Minimum Data Set (MDS) assessment dated [DATE] included a Brief Interview for Mental Status (BIMS) score of 11 indicating mild cognitive impairment. The assessment also included that the resident required one-person extensive assist with ambulating in a wheelchair. Review of the progress notes did not reveal any documentation regarding an allegation that resident #24 was hit by resident #51. -Resident #51 was admitted to the facility on [DATE] with diagnoses that included hemiplegia and hemiparesis following cerebral infarction…

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 clinical record review, interviews, and policy, the facility failed to accurately complete the Preadmission Screening and Resident Review (PASARR) process for one resident (#3). The deficient practice could result in residents not receiving needed services. Findings include: Resident #3 was admitted to the facility on [DATE] with diagnoses that included panic disorder (episodic paroxysmal anxiety), unspecified dementia, psychotic disturbance, mood disturbance, major depressive disorder and Post Traumatic Stress Disorder (PTSD). Review of the clinical record revealed that the resident had a diagnosis of schizoaffective disorder added on January 20, 2021. The Minimum Data Set (MDS) assessment, dated December 12, 2021, included the resident had severe cognitive impairment. The assessment also included active diagnoses of anxiety disorder, depression, schizophrenia, and PTSD. Review of the undated PASARR Level I assessment revealed that dementia was not the primary diagnosis and no mental illness 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, interviews, and policy, the facility failed to develop a bowel care plan for one resident (#65). The deficient practice could result in residents not receiving needed care. Findings include: Resident #65 was admitted to the facility on [DATE] with diagnoses that included Diabetes Mellitus (DM) type 2 with diabetic neuropathy, hemiplegia and hemiparesis following a cerebral infarction, and dysphagia. Review of the physician's orders revealed the following bowel medication orders: -August 1, 2022 - Senna Tablet 8.6 milligrams (mg) (Sennosides) via Gastrostomy tube (G-tube) at bedtime for constipation -August 1, 2022 -Maalox plus suspension 30 milliliters via G-tube every 6 hours as needed for indigestion -August 1, 2022 - Loperamide capsule 2 mg via G-Tube every 12 hours as needed for diarrhea -August 26, 2022 -Imodium A-D Tablet 2 mg via G-tube every 6 hours as needed for diarrhea -September 7, 2022 - Questran light powder 4 grams (g) via G-tube every 7 days for diarrhea for 7…

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 clinical record review, interviews, and policy, the facility failed to administer pain medications within ordered parameters for one resident (#65). The deficient practice could result in residents' receiving too much pain medication. Findings include: Resident #65 was admitted to the facility on [DATE] with diagnoses that included Diabetes Mellitus (DM) type 2 with diabetic neuropathy, hemiplegia and hemiparesis following a cerebral infarction, dysphagia, and hypertension. The quarterly Minimum Data Set (MDS) assessment dated [DATE] included a Brief Interview for Mental Status (BIMS) score of 10 indicating moderate cognitive impairment. The resident's pain care plan include an intervention to administer pain medication as ordered. Review of the December 2022 recapitulation of physician's orders revealed the following orders: -Tramadol 50 milligrams (mg) via Gastrostomy tube (G-tube) every 12 hours as needed for pain levels 5 through 10 out of 10. -Acetaminophen 325 mg 2 tablets via G-tube every 4 hours…

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 clinical record review, resident and staff interviews, and policy reviews, the facility failed to ensure treatments were provided as ordered for one sampled resident (#7) with a pressure ulcer. The deficient practice resulted in the resident not receiving consistent treatment for a pressure ulcer. Findings include: Resident #7 was admitted on [DATE] with diagnoses that included stage 4 pressure ulcer of the sacral region, lymphedema, and history of vulvar cancer. A quarterly Minimum Data Set assessment dated [DATE] revealed the resident had one stage 4 pressure ulcer and was receiving pressure ulcer care. The assessment also revealed a score of 15 on the Brief Interview for Mental Status which indicated the resident had intact cognition. A physician's order dated February 1, 2021 included for wound care: wash with normal saline, pat dry, peri skin prep, drape, loosely pack wound with white vac foam, topped with black vac foam, drape then place [NAME] pad. Negative Pressure Wound Treatment (NPWT) at low…

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, clinical record review, staff interviews, and policy review, the facility failed to ensure physician's orders were followed regarding catheter size for one sample resident (#7). The deficient practice could result in residents not having the size catheter ordered by the physician. Findings include: Resident #7 was admitted on [DATE] with diagnoses of a stage 4 pressure ulcer to the sacral region, lymphedema, and history of vulvar cancer. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a score of 15 on the Brief Interview for Mental Status indicating the resident had intact cognition. The assessment included the resident had an indwelling urinary catheter. A physician's order dated April 4, 2021 included for an indwelling catheter to straight drainage, size 16 French, bulb 10 cc (cubic centimeter) and to change monthly for infection, obstruction or when the closed system is compromised related to the pressure ulcer of the sacral region, stage 4. The quarterly…

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 clinical record review, staff interviews, and policy and procedure review, the facility failed to ensure one of 22 residents' (#32) medical record was complete. The deficient practice could result in residents' clinical records not being complete. Findings include: Resident #32 was admitted to the facility on [DATE] with diagnoses that included unspecified atrial fibrillation, asthma, and Chronic Obstructive Pulmonary Disease (COPD). Review of the Medication Administration Record (MAR) for June 2021 revealed no documentation for the following multiple medications: -buspirone (anxiolytic) 5 milligrams (mg) on June 4, 5, 6, and 11, 2021 -aspirin enteric coated on June 5, 2021 -diltiazem hydrochloride (antihypertensive) 120 mg on June 11, 2021 -metoprolol tartrate (antihypertensive) 25 mg on June 11, 2021 -pravastatin sodium (lipid lowering agent) 40 mg on June 2, 11, 15, 20, and 21, 2021 -tiotropium bromide monohydrate (bronchodilator) on June 5, 2021. Review of the MAR revealed no documentation to…

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 clinical record review, staff interviews, and review of policy and procedure, the facility failed to ensure one of six sampled residents (#32) was informed of the risks and benefits of a psychotropic medication prior to the administration of the medication. The deficient practice could result in residents/representatives not being information of the risks and benefits of taking psychoactive medications. Findings include: Resident #32 was admitted to the facility on [DATE] with diagnoses that included unspecified atrial fibrillation, asthma, and Chronic Obstructive Pulmonary Disease (COPD). Physician's orders dated May 23, 2021 included for Alprazolam (anxiolytic) 0.25 milligrams (mg) one tablet by mouth every 8 hours as needed for sleep. An electronic MAR (eMAR) orders administration note dated May 24, 2021 at 10:00 a.m. revealed Alprazolam 0.25 mg was administered to the resident. The admission Minimum Data Set assessment dated [DATE] revealed the resident scored 14 on the Brief Interview for Mental…

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 -Resident #320 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis that included cellulitis of the left lower limb, type-2 diabetes mellitus, and peripheral vascular disease. An advance directive form dated [DATE] signed by the resident revealed the resident had chosen to be a Full Code. Review of the physician's order dated [DATE] revealed the following advance directive order: Do Not Resuscitate (DNR) with limited interventions. An interview was conducted with the Assistant Director of Nursing (ADON/staff #6) on [DATE] at 9:55 am. She stated the residents sign their code status on admission and the order will be entered in Point Click Care (PCC). The ADON stated the advance directive form has to be redone when the resident returns to the facility after hospitalization. She stated the code status in PCC should match the signed advance directive form in the resident's chart. Staff #6 further stated the resident chart should also include the orange DNR sheet if the resident chooses to…

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 clinical record review, staff interviews and policy review, the facility failed to ensure the required discharge information was documented and a discharge order was entered for one of three sampled residents (#69). The deficient practice could result in discharge requirements not being completed. Findings include: Resident #69 was admitted to the facility on [DATE] with diagnoses that included displaced intertrochanteric fracture of the right femur, chronic obstructive pulmonary disease, history of falling, anxiety disorder, and dementia without behavioral disturbance. The discharge MDS (Minimum Data Set) assessment dated [DATE] revealed the resident had an unplanned discharge to the community on June 17, 2021. Further review of the clinical record revealed no documentation that the physician was notified of the discharge, a physician's order was obtained for discharge, and/or a discharge summary. After a request was made for the information regarding the resident discharge, a copy of an AMA (Against…

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 clinical record review, observation, resident and staff interviews, and policy review, the facility failed to ensure that a baseline care plan was developed for one sampled resident (#66) regarding the use of oxygen. The deficient practice may result in residents not being provided the services and person-centered care necessary to meet his/her needs. Findings include: Resident #66 was admitted to the facility on [DATE], with diagnosis that included Chronic Obstructive Pulmonary Disease (COPD), dependence on supplemental oxygen, type 2 diabetes mellitus without complications and sepsis due to enterococcus. Review of the Weights and Vital Summary revealed the resident was receiving oxygen via nasal cannula on admission [DATE]), and on July 8 and 13, 2021. A physician's order dated July 13, 2021 revealed an order for oxygen at 2 liters/minute as needed (PRN) for desaturation. Review of the skilled nursing documentation dated July 2, 6, 7, 14 and 15, 2021 revealed resident #66 was on PRN oxygen 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, clinical record review, staff interviews, and policy and procedures, the facility failed to ensure that a care plan was developed for hearing and the use of hearing aids for one resident (#20). The sample size was 16. The deficient practice could result in residents use of hearing aids not being reflected in the care plan. Findings include: Resident #20 was admitted on [DATE] with diagnosis that included encounter for surgical aftercare following surgery on the digestive system, type 2 diabetes mellitus with hyperglycemia, heart failure, repeated falls and major depressive disorder. A physician order dated May 7, 2021 included the resident may have dental, podiatry, audiology, optometry care as needed. The nursing admission/readmission collection tool dated May 7, 2021 included that resident #20 had minimal difficulty hearing. A review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status of 8, indicating the resident had moderate…

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, clinical record review, staff interviews, and policy review, the facility failed to ensure one of two sampled residents (#2) received the necessary services to maintain good grooming and hygiene. The deficient practice could result in grooming and hygiene needs of residents not being met. Findings include: Resident #2 was admitted to the facility on [DATE] with diagnoses that included quadriplegia, unspecified, encounter for attention to gastrostomy, and encounter for attention to tracheostomy. Review of the care plan revised on April 23, 2021 revealed the resident had an ADL (activities of daily living) self-care deficit related to cerebrovascular accident (CVA) and quadriplegia. Interventions included extensive assistance with bathing, and total assistance with personal hygiene and oral care. Review of the Point of Care (POC) Certified Nursing Assistant (CNA) bathing documentation dated June 19, 2021 through July 7, 2021 revealed the resident received bathing/showers on 5 occasions. 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, clinical record review, staff and resident interviews, and policy review, the facility failed to ensure one resident (#43) was served food that accommodated the resident's food allergies. The census was 62. The deficient practice could result in residents receiving food that they are allergic to. Findings include: Resident #43 was admitted on [DATE] with diagnoses that included Parkinson's disease, type II diabetes, and schizophrenic disorder. Review of the Order Summary Report for July 2021 stated at the top of the form that the resident's allergies included peppers. Review of the resident's face sheet revealed the resident had an allergy to peppers. Review of the resident's food/meal card listed bell peppers as an allergy. An observation of the resident's tray conducted on 7/14/21 at 1:45 PM. Small pieces of bell pepper were observed off to the side of the tray. Review of the meal card revealed allergies that included bell peppers. The resident stated that she had been given a food tray…

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, clinical record review, staff interviews, and policy review, the facility failed to ensure infection control standards were followed regarding tracheotomy care for one resident (#2) and catheter care for one resident (#7). The deficient practice could result in the spread of infection. Findings include: -Resident #7 was admitted on [DATE] with diagnoses of stage 4 pressure ulcer to the sacral region, lymphedema, and history of vulvar cancer. Review of the clinical record revealed a physician order dated April 4, 2021 for urinary catheter care every shift. A quarterly Minimum Data Set (MDS) assessment dated [DATE] included the resident had an indwelling catheter. An observation was conducted on July 15, 2021 at 9:43 AM of perineal and catheter care with a Certified Nursing Assistant (CNA/staff #7). The CNA announced herself, stated what care she would be providing to the resident, and obtained the resident's consent. Staff #7 was observed to wash her hands and don gloves. The CNA proceeded…

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.