Rock Creek Care Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to implement infection prevention and control practices for one of 25 sampled residents (Resident 379) when the Certified Nursing Assistant (CNA 2) did not wear the proper Personal Protective Equipment (PPE-gown, eye protection or face shield and gloves) upon entering Resident 379's room with an isolation precaution sign. This failure put the residents at increased risk for the spread of infection. Findings: During a review of Resident 379's admission Record, the admission Record indicated, Resident 379 was admitted on [DATE], with diagnoses that included but is not limited to COVID-19 (a highly contagious respiratory disease caused by the SARS-CoV-2 virus), moderate protein-calorie malnutrition, and muscle weakness. During a review of Resident 379's Result Details, dated 10/2/24, the Result Details indicated a positive result for COVID-19. During a review of Resident 379's Order Summary Report (OSR), dated 10/10/24, the OSR indicated…

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 provide food that was palatable when three of seven sampled residents (Resident 3, Resident 4, and Resident 7) had food that was served cold. This failure had the potential for Resident 3, Resident 4, and Resident 7 to experience dissatisfaction with meals leading to decreased intake with possible weight loss. Findings: A review of Resident 3's admission Record indicated Resident 3 was admitted to the facility in March 2023 with multiple diagnoses including hemiparesis (weakness on one side of the body) and hemiplegia (paralysis on one side of the body) following cerebral infarction (stroke- lack of blood flow to the brain) and moderate protein calorie malnutrition (inadequate intake of protein, calories, and nutrients). A review of Resident 3's MDS (Minimum Data Set- a federally mandated assessement tool), Cognitive Patterns, dated 9/18/24, indicated Resident 3 had a Brief Interview for Mental Status (BIMS- tool to assess cognition) score of 13 out of 15 that indicated Resident 3 was cognitively intact. 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, interview, and record review, the facility failed to ensure resident needs were accommodated for one of six sampled residents (Resident 3), when Resident 3's call light was not within reach. The failure had the potential to result in the resident not attaining her highest practicable physical, psychosocial, and emotional well-being. Findings: Resident 3 was admitted to the facility in June 2024 with multiple diagnoses that included osteoarthritis (deterioration of tissue that lines the joints) and muscle weakness. A review of Minimum Data Set (MDS, and assessment tool), dated 6/11/23, indicated Resident 3 had moderately impaired cognition. During an interview on 7/3/24, at 11 a.m., with Resident 2, Resident 2 stated that her roommate, Resident 3 was unable to push the call light. Resident 2 further stated that she had to push the call light for Resident 3 on multiple occasions. Resident 2 further stated that Resident 3 also had to call out for help when she is unable to push the call light. During a concurrent observation and interview on 7/3/24, at 11:15 a.m.,…

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 follow physician orders to ensure professional standards of quality were maintained for one of six sampled residents (Resident 1), when Resident 1's surgical staples were not removed on the date ordered by the physician. This failure had the potential to cause an infection in Resident 1's wound. Findings: Resident 1 was admitted to the facility in April 2024 with multiple diagnoses that included a fracture of the right lower leg and rhabdomyolysis (a breakdown of muscle tissue). A review of the Minimum Data Set (MDS, and assessment tool), dated 4/24/24, indicated Resident 1 was cognitively intact. During a review of Resident 1's admission Summary Note dated 4/18/24, the admission Summary Note indicated, .Skin/Head to toe assessment .laceration to right side of forehead, 5 staples in place (Remove in 10-14 days, 4/24-4/28) . During a review of Resident 1's Order Summary dated 4/18/24, the Order Summary indicated, Laceration upper right forehead- 5 staples in place (Remove in 10-14 days, 4/24-4/28). During a review 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 interview and record review, the facility failed to ensure pharmacy services were maintained for one of six sampled residents (Resident 2), when Resident 2 did not receive chlordiazepoxide (a medication used to treat alcohol withdrawal symptoms) according to physician orders. This failure resulted in Resident 2 to have experienced uncomfortable symptoms and had the potential to cause Resident 2 to relapse during alcohol detoxification. Findings: Resident 2 was admitted to the facility June 2024 with multiple diagnoses that included fibromyalgia (a chronic condition involving widespread body pain and tiredness) and alcohol abuse. A review of Minimum Data Set (MDS, an assessment tool), dated 6/28/24, indicated Resident 2 was cognitively intact. During an interview on 7/3/24 at 11 a.m. with Resident 2, Resident 2 stated that chlordiazepoxide was ordered when she was admitted to the facility. Resident 2 further stated that she did not receive the medication until three days later. Resident 2 further stated, It was not cool; I had a concern there. I needed it (chlordiazepoxide)…

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 maintain professional standards for food service safety when ready to use dishware was found dirty and in uncleanable condition. These failures had the potential to cause food-borne illnesses (an illness caused by food or water contaminated with bacteria, viruses, parasites or toxins) to all residents. Findings: During a concurrent observation and interview on 6/27/24 at 10:55 a.m. with the Activities Assistant (AA) in the main dining room, eight residents with beverage mugs were in the dining room playing a game and there was a cart with urns of coffee and mugs available for residents to use. The AA confirmed three of the mugs available for residents to use had brown and white residue stuck to the inside of the mugs. The AA stated the mugs were not clean, should not be used for residents, and she would take them back to the kitchen to be cleaned. During a concurrent observation and interview on 6/27/24 at 10:59 a.m. with the Certified Dietary Manager (CDM) in the kitchen, the CDM stated clean, ready to use…

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 interview and record review the facility failed to ensure appropriate treatment and services were provided to two of four sampled residents (Resident 1 and Resident 2) when the Restorative Nursing Assistant program (RNA program: provides residents with exercises to improve or maintain mobility and strength) services were not implemented per the physician's order. This deficient practice had the potential to result in Resident 1 and Resident 2 experiencing declines in range of motion and strength. Findings: A review of Resident 1's admission record indicated Resident 1 was admitted to the facility in September of 2023 with diagnoses which included muscular dystrophy (weakness and loss of muscle mass) and multiple sclerosis (causes muscle stiffness and weakness). A review of Resident 1's Minimum Data Set (MDS: an assessment tool), dated 3/28/24, indicated Resident 1 had moderate memory impairment and had no rejection of care behaviors. An interview on 6/27/24 at 11:41 a.m., Resident 1 stated he 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, interview, and record review, the facility failed to ensure the medication storage policy and procedures were followed, in a census of 75, when medications requiring storage in the refrigerator were kept at temperatures lower than the recommended range. This failure had the potential risk to decrease the effectiveness of the medications stored in the refrigerator. Findings: During a concurrent observation and interview of the medication room at maple station on 3/20/23, at 9:50 a.m., with Licensed Nurse 1 (LN 1), LN 1 indicated the medication refrigerator, in which vaccines and antibiotics were stored, was observed to be at 32 degrees F (Fahrenheit, a unit of measuring temperature). During an observation and interview of the same medication room on 3/21/23, at 9:51 a.m., with LN 1, LN 1 indicated the medication refrigerator was observed to be at 34 degrees F (Fahrenheit, a unit of temperature). LN 1 acknowledged that the temperature in the refrigerator was out of the acceptable range (36-46 F). During an interview on 3/21/23, at 2 p.m., with Director of Nursing…

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 cooks utilized standardized recipes for food preparation to ensure the nutritive value and palatability of the meals served. This failure had the potential to negatively impact the resident's nutritional status and not meet the residents' preferences. Findings: During a concurrent observation and interview on 3/20/23, at 11 a.m., with [NAME] 1 (CK 1), CK 1 poured a cup of water into a container of mashed potato granules. CK 1 was observed adding mashed potato granules, black pepper, and dry basil and did not use measuring tools. CK 1 indicated she did not have a recipe for mashed potatoes. During an interview on 3/20/23, at 12:51 p.m., with CK 1, CK 1 was asked about the recipe for the turkey for resident's lunch that day and about the recipe for the pasta salad dated 3/18/23. CK 1 indicated she followed the instructions on the turkey's package and that the package had been thrown away .she did not remember the instructions for cooking the turkey and she did not follow any standardized recipe…

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 identify and prevent hazards at specific points of food handling in a census of 75, when: 1. Kitchen staff did not wash their hands before handling food; and 2. Food trays were found wet and were used to serve food. These failures had the potential to put vulnerable residents receiving food from the kitchen, at risk for foodborne illnesses. Findings: 1. During a concurrent observation and interview on 3/20/23, beginning at 12:54 p.m., [NAME] 1 (CK 1) stood in the food line and scooped and used tongs to put food on plates for lunch. CK 1 then pulled up her pants with both hands, no gloves, and no hand washing after pulling up her pants. CK 1 returned to scooping foods with the ladle and using tongs to put food on the plates. CK 1 indicated that she should have washed her hands after touching her pants. During a concurrent observation and interview on 3/21/23, at 8:00 a.m., while CK 1 was standing in the food line, CK 1 touched the top of her watch, then picked up a knife with the same hand and continued 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 observation, interview, and record review, the facility failed to provide 80 square feet of space per resident in rooms 1-8, 11, 12, 17-19, 21, and 23-36 for a census of 75. This failure increased the potential for inadequate personal space and the residents' ability to move freely in their rooms. Findings: During a review of the facility document addressed to the Department of Public Health dated 3/9/21, the facility document indicated the Administrator (ADM) requested a continuance of room size variance waiver to rooms 1-8, 11, 12, 17-19, 21, and 23-36. During observations and concurrent interviews on 3/20/23 which started at 8:10 a.m. through 10:30 a.m., the following rooms failed to meet the minimum space requirement for each resident: Room # Beds Actual Sq Ft 1 2 71.4 sq. ft./person 2 2 71.45 sq. ft./person 3 2 71.4 sq. ft./person 4 2 75.5 sq. ft./person 5 2 71.4 sq. ft./person 6 2 74.5 sq. ft./person 7 2 74.5 sq. ft./person 8 2 76.9 sq. ft./person 11 2 74.67 sq. ft./person 12 2 72.1 sq. ft./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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to maintain an effective pest control program to ensure the facility was free from pests for a census of 75, when rodent droppings were found, and scattered garbage and debris were found behind and between two garbage bins. This failure resulted in the presence of pests inside the facility and had the potential to result in the transmission of infection caused by rodents and pests. Findings: Resident 35 was admitted to the facility in the middle of 2019. During a review of Resident 35's Minimum Data Set (MDS, an assessment tool), dated 1/12/23, the MDS indicated Resident 35 had no memory impairment. Resident 9 was admitted to the facility in late 2021. During a review of Resident 9's MDS, dated [DATE], the MDS indicated Resident 9 had moderate memory impairment. During a review of the facility document titled, Service Request Log (SRL), the SRL indicated services for pest control were requested on 1/13/23, 2/8/23, and 3/8/23. During a 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure the resident needs and personal requests were accommodated for three of 24 sampled residents (Resident 27, Resident 14 and Resident 17), when: 1. An appropriate call light was not provided to Resident 27; 2. Wheelchair footrests were not provided to Resident 14; and 3. An appropriate adaptive equipment was not provided to Resident 17 according to physician's orders. These failures had the potential to result in the residents not attaining their highest practicable physical and psychosocial well-being. Findings: 1. Resident 27 was admitted to the facility in late 2020 with diagnoses which included quadriplegia (paralysis of bilateral upper and lower extremities). During a review of Resident 27's Minimum Data Set (MDS, an assessment tool), dated 3/17/23, the MDS indicated Resident 27 had moderate memory impairment and required extensive assistance with activities of daily living (ADLs). During a review of Resident 27's assessment…

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 policy and procedures were followed in accordance with professional standards of practice when licensed nurses did not verify a pain medication's dosage strength on an order for Resident 9, in a census of 75. This failure had the potential to affect Resident 9's health, pain and comfort level. Findings: During a medication administration reconciliation of Resident 9's clinical record on 3/20/23, at 1:15 p.m., Order Summary Report (OSR) indicated an order dated 12/11/22 for Lidocaine Patch [a pain medication] Apply to affected site topically in the morning for x pain management . Apply 1 patch 12 hours on and 12 hours off. During a concurrent interview and record review on 3/21/23, at 10:10 a.m., with Licensed Nurse 2 (LN 2), LN 2 was not able to locate lidocaine patch's dosage strength .LN 2 stated the [lidocaine] patch dosage strength should be a percentage 4 or 5 .there is no dose on this order. During a record review of Resident 9's March 2023 Medication Administration Record (MAR) on 3/20/23, at…

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 implement pharmaceutical services policies and processes related to reconciliation of narcotic medications (drugs that have potential for abuse or dependence) for Resident 20, in a census of 75. Findings: During a reconciliation audit of medication cart 2's narcotic drawer on 3/20/23, at 9:53 a.m., a random medication blister pack was selected for reconciliation accuracy. The random blister pack was for Resident 20's lacosamide (a medication given for seizures) 250 mg (milligram, a unit of measure), the number of pills in the blister packs did not match the count on the Controlled Drug Record (CDR). During a concurrent interview and record review with Licensed Nurse 3 (LN 3), LN 3 confirmed Resident 20's medical record indicated a Physician Order, dated 1/9/23, for lacosamide 250 mg by mouth two times a day. A review of Resident 20's Medication Administration Record (MAR) indicated a dose was last given on 3/20/23 at 8 a.m., however the CDR indicated last documented dose given was 3/19/23 at 8:19 p.m. LN 3…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, one of 24 sampled residents (Resident 24) failed to receive the correct dose of a psychotropic medication (drug prescribed to affect the mind, emotions, or behavior), when Resident 24's new physician's order for aripiprazole (antipsychotic, a type of psychotropic medication to treat mental health conditions such as depression) Gradual Dose Reduction (GDR) was not initiated as per physician's order. This failure had the potential for Resident 24 not attaining the desirable effect of the medication. Findings: Resident 24 was admitted to the facility in early of 2022 with diagnoses which included bipolar disorder (a disorder associated with episodes of mood swings) and major depressive disorder (the persistent feeling of sadness). During a review of Resident 24's Order Summary Report (OSR), dated 3/18/23, the OSR indicated, Give aripiprazole 0.5 mg (milligram, a unit of measure) by mouth one time a day every other day for depression. During a concurrent interview and record review on 3/22/23, at 9:45 a.m., with Licensed Nurse 4 (LN…

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 had a 6.9 % error rate, when two medication errors out of 29 opportunities were observed during a medication pass for two residents (Residents 1 and Resident 9). This failure resulted in medications not being given in accordance with the prescriber's orders, which resulted in residents not receiving the intended therapeutic effect of the medications. Findings: 1. During a medication pass observation on 3/20/22, at 8:24 a.m., with Licensed Nurse 1 (LN 1), LN 1 prepared and administered seven medications for Resident 1, which included a folic acid tablet. During a review of Resident 1's Order Summary Report (OSR), dated 2/26/23, the OSR indicated, Folic acid Tablet 1 milligrams [mg, a unit of measurement], give 1 tablet by mouth one time a day for supplement. During a concurrent interview and record review on 3/23/23, at 9:38 a.m., with LN 1, LN 1 confirmed she gave Resident 1 folic acid 400 micrograms (mcg, a unit of measurement) with calcium (a supplement to prevent low blood calcium) 100 mg on 3/20/23. During an…

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 one of 24 sampled residents (Resident 17) was provided with necessary adaptive equipment for meals, as ordered by the physician. This failure had the potential to negatively impact the resident's well-being and contribute to lower meal intake. Findings: Resident 17 was admitted to the facility in late 2021 with diagnoses which included heart failure, rheumatoid osteoarthritis (bone and joint pain), depression, and anxiety. During a review of Resident 17's Minimum Data Set (MDS, an assessment tool), dated 2/28/23, the MDS indicated Resident 17 had no memory impairment and required extensive assistance with bathing, toilet use, and other activities of daily living. During a review of Resident 17's Order Summary Report (OSR), dated 10/11/22, the OSR indicated, Built-up utensils [adaptive utensils that have larger handles that help people with grasping difficulties eat meals more independently] with all meals. During a review of Resident 17's Nursing Care Plan (NCP), dated 3/15/23, the NCP indicated,…

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 outside garbage dumpster area was clean and litter free for a census of 75. This failure had the potential to attract rodents that carry diseases and create an unsanitary environment for facility residents. Findings: During a concurrent observation and interview on 3/20/23, at 9 a.m., with the Assistant Dietary Supervisor (ADS), two dumpsters in the back of the building for kitchen and facility use, revealed trash on the ground surrounding the dumpsters included plastic bottles, plastic cups, soda cans, disposable gloves, disposable utensils, food fragments, and a plastic bag containing incontinence briefs. The ADS indicated the garbage needed to be bagged better and scattered garbage could attract critters and pests .the expectation was for the dumpster area to be picked up, monitored, and made sure it's cleaned .the scattered trash was not acceptable. During an interview with Registered Dietitian (RD), on 3/21/23, at 8:55 a.m., the RD indicated pests could be attracted to garbage and garbage…

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 maintain the walk-in freezer in safe operating condition in a census of 75, when the walk-in freezer had ice buildup and a damaged gasket (a rubber seal that keeps the door tight to maintain the temperature). This failure had the potential to cause the freezer to not operate efficiently, which would result in thawing and possible contamination of food. Findings: During a concurrent observation and interview with [NAME] 1 (CK 1), on 3/20/23, at 8:15 a.m., the walk-in freezer revealed ice build-up on two separate shelves, on the floor, and around the door frame. The gasket on the door frame was damaged and missing in multiple areas. CK 1 indicated she did not know how long the gasket had been damaged, and stated, The [Certified Dietary Manager, CDM] usually does that .gasket was fairly new. During a concurrent observation and interview on 3/20/23, at 9:05 a.m., with the Assistant Dietary Supervisor (ADS), the ADS confirmed the ice build-up, and stated, There is a seal problem, gasket needs to be replaced. 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, interview, and record review, the facility failed to provide a safe and sanitary environment for one of 24 sampled residents (Resident 9), when a mouse trap with mouse droppings were found in the resident's room. This failure resulted in Resident 9's decreased sense of emotional well-being and had the potential for the transmission of diseases. Findings: Resident 9 was admitted to the facility in late 2021. During a review of Resident 9's Minimum Data Set (MDS, an assessment tool), dated 3/17/23, the MDS indicated Resident 9 had moderate memory impairment. During a review of the facility document titled, [Pest Control Service Provider] (PCSD), dated 3/8/23, the PCSD indicated, Performed exterior rodent service. Checked accessible bait stations and replaced bait as needed .Performed interior rodent service, checked and reset all traps. Placed glueboards [traps for mice and rats] on each side of doors in six rooms closest to bathroom due to patient stating she saw a mouse. During a concurrent…

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.