Camarillo Healthcare Center

Based on observation, interview, and record review, the facility failed to dispose of expired medications per policy and procedure. This failure had the potential for expired medications to be administered to residents. Findings: During a concurrent observation and interview, on 2/6/25, starting at 8:53 a.m., with licensed nurse (LN 4), three expired medications were found in medication cart two. One vial of Latanoprost 0.005% solution (a medication used to treat high eye pressure) one vial of Prednisolone Acetate 1% (a medication used to relieve symptoms such as swelling and redness) and one vial of Brinzolamide 1% (a medication used to treat high eye pressure). All three medications had an expiration date of 2/4/25. The LN 4 verbalized all three medications were expired and needed to be placed in the waste container in the medication room. During a review of the facility's policy and procedure titled Nursing Administration subject Storage of Medications undated, indicated in part Expired medications will be removed from use, for appropriate disposal.

Based on observation, interview and record review, the facility failed to ensure a physician order of renal diet no added salt (NAS) order did not have a salt packet on the lunch tray for one of one sampled resident (Resident 82) who was on dialysis treatment. This failure had the potential for Resident 82 to have fluid retention for an already compromised condition (dialysis). Findings: During an observation on 2/05/25 at 12:15 p.m. of the lunch tray check and distribution process, in the hallway outside of resident rooms, Resident 82's lunch tray had a packet of salt. Upon checking the tray card for Resident 82, the diet order indicated renal diet. During an interview on 2/06/25 at 9:40 a.m. with the Registered Dietician (RD), the RD acknowledged that Resident 82's diet order is renal, should be no added sodium (NAS) and should not have salt packets added to meals/on trays. During an interview on 2/06/25 at 11:30 a.m. with the Director of Staff Development (DSD) who was in charge of verifying the resident meal trays, the DSD stated the salt packet was not removed because the meal…

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 follow their cleaning policy and procedure (P&P) when: 1. A floor drain in the dry goods storage area and the floors were not maintained in a sanitary manner. 2. Two of two ice chests used to distribute ice to residents were not cleaned before and after use. These failures had the potential to cause food borne illness to a highly susceptible resident population. Findings: 1. During a concurrent observation and interview on 02/04/25 at 9:23 a.m., with the Registered Dietician (RD) and the Dietary Assistant Manager (DAM), extensive debris and grime was visible in and around the floor drain in the dry storage area. Produce (red tomatoes/a potato), food scraps, and trash debris were observed behind, and under, metal racks of the walk-in refrigerator in the dry storage area and behind the ice machine on the floor. DAM and RD acknowledged the drain was dirty and the floor in the walk-in refrigerator appeared like it had not been swept or mopped. During a review of the facility's policy and procedure (P&P) titled…

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 2. During an observation on 2/4/25 at 10:21 a.m. Resident 49 was observed to be sleeping in bed with head slightly elevated, with nasal cannula tubing without label connected to oygen concentrator running at 2 liters per minute. There was an intravenous fluid IV 5% Dextrose running by gravity at 10-15 drops per minute, lines was observed to have label but without date and nurse's initial. During an interview on 2/4/25 at 10:30 a.m., certified nurse assistant (CNA6) confirmed there was no label on the oxygen tubing , and the label on the IV fluid did not have nurse's initial and there was no date making it impossible to know who and when the fluid was started. During the interview on 2/6/25 at 2:45 p.m. with the assistant director of nursing (ADON), ADON stated the tubings and IV fluids needed to be labeled dated and signed per policy. During a review of facility's policy and procedure (P&P), titled Oygen Therapy, dated 11/2024, P&P indicated it is the facility policy to administer oxygen in a safe manner, with…

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 answer call lights per policy and procedure, for one of 25 sampled residents (Resident 104) and one unsampled Resident (Resident 54) when: 1. Staff turned off Resident 54's call light and left the room, without addressing Resident 54's concern. 2. Call light was turned off by staff without meeting the request/needs for Resident 104. These facility failures had the potential for Resident 54 and Resident 104's needs to go unmet and/or result in a delay in care. 1. During an observation on 2/6/25, starting at 8:37 a.m., Resident 54's call light was observed on. An unidentified staff member (USM 1) entered Resident 54's room, turned off the call light, and left the room. During a concurrent observation and interview, on 2/6/25, at 9:00 a.m., with Resident 54, Resident 54's call light was activated for a second time. Resident 54 was asked if USM 1 had addressed Resident 54's previous concern before leaving the room. Resident 54 verbalized no,…

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 safety of patients, staff and visitors when OXYGEN IN USE signs were not placed outside resident rooms per policy and procedure for 2 of 25 sampled residents (Resident 49 and Resident 57). This failure had the potential to result in an increase fire risk while oxygen is in use. Findings: During a review of facility policy and procedure titled, Oxygen Therapy, dated 11/2024, indicated, PROCEDURES: Equipment: . NO SMOKING/OXYGEN IN USE signs. During a concurrent observation and interview on 02/07/25 at 11:12 a.m. with Housekeeping/Maintenance/Central Supply Supervisor (HS) in hall outside room [ROOM NUMBER]C, there was not an OXYGEN IN USE sign outside room. HS stated that it is the nurses responsibility to make sure there is an OXYGEN IN USE sign is placed outside of resident rooms when they are on oxygen and stated that Resident 49 was on oxygen in room [ROOM NUMBER]C, and HS confirmed there was not an OXYGEN IN USE sign outside…

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 and necessary information was communicated to the receiving home health agency (HHA) for a safe ,effective transition/continuance of care when the HHA was not informed of Resident 1's pressure ulcers and moisture associated skin damage (MASD) in the groin, scrotal, and perirectal areas. This failure resulted in Resident 1's responsible party not knowing of the skin condition, delaying the necessary skin treatment until HHA came and did the assessment finding a stage 2 ( skin opening on the first layer of skin). Findings: During a review of Resident 1's, admission Record (AR), dated 01/15/25, the AR indicated Resident 1 was admitted on [DATE] with diagnoses including, pneumonia, acute respiratory failure with hypoxia, acute pulmonary edema, other abnormalities of gait and mobility, dysphagia, mild cognitive impairment, history of falling, and other diagnoses. Resident 1 was discharged to home on [DATE] at 18:39 with home health agency…

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 medical record review, the facility failed to communicate necessary information to a resident, the resident representative, and to the continuing care provider at the time of an anticipated discharge to one of one resident (Resident 1). This failure had the potential to result in provision of inappropriate and untimely care. Findings: During a review of Resident 1's, admission Record (AR), dated 01/15/25, the record indicated Resident 1 was admitted on [DATE] with diagnoses including, pneumonia, acute respiratory failure with hypoxia, acute pulmonary edema, other abnormalities of gait and mobility, dysphagia, mild cognitive impairment, history of falling, and other diagnoses. Resident 1 was discharged to home on [DATE] at 18:39. During a review of nursing notes for Resident 1, dated 1/09/25 at 09:20, titled Discharge Summary, indicated, Instructions for Ongoing Care: .Treatments: Facial redness/rash, apply clotrimazole cream 1% and monitor for progression. bilateral groin, scrotal, 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.

Based on interview and record review, the facility failed to ensure a Late Entry documentation policy and procedure (P&P) met professional standards of timely documentation when P&P titled Late Entry, indicated in part There is not a time limit to writing a late entry. This resulted in a twelve-day delay of discharge planning notes to be available in the medical record of one of one resident (Resident 1). This failure has the potential for staff to add late entries without regards to timeframe or validity on the source of information and compromise timely continuity of care to the residents. Findings: During an interview on 01/15/25 at 12:34 with Director of Nursing (DON), DON acknowledged Resident 1 did not receive discharge information and left facility without signing discharge paperwork. The DON deferred further questions to the staff, social services director (SSD) and licensed nurse (LN2), that handled the discharge process whom she said were not available for interviews. Requested facility Discharge policy, the discharge paperwork that should have been signed by R1 or R1'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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to maintain a complete medical record in accordance with accepted professional standards and practices for one of one sampled resident (Resident 1), when Resident 1's medical record did not have discharge planning notes. This failure had the potential to cause miscommunication and confusion amongst members of the healthcare team and not implementing discharge care planning affecting the resident's continuity of care. Findings: During a review of Resident 1's, admission Record (AR), dated 01/15/25, the record indicated Resident 1 was admitted on [DATE] with diagnoses including, pneumonia, acute respiratory failure with hypoxia, acute pulmonary edema, other abnormalities of gait and mobility, dysphagia, mild cognitive impairment, history of falling, and other diagnoses. Resident 1 was discharged to home on [DATE] at 18:39 with home health services. During an interview on 01/15/25 at 12:34 with Director of Nursing (DON), DON stated Resident 1 left with his…

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: 1. Document fluid intake accurately for 1 out of 2 sampled residents (Resident 1). 2. Document fluid intake accurately for 1 out of 2 sampled residents (Resident 2). This failure had potential to affect the hydration status of Resident 1 and may have contributed to Resident 1 being sent out to the emergency room (ER) for shortness of breath; and admitted to the hospital for sepsis and pneumonia. This failure had potential to affect the hydration status of Resident 2 and may have contributed to Resident 2 being sent out to the ER for altered mental status; and admitted to the hospital for pneumonia, urinary tract infection (UTI) and sepsis. Findings: 1. During a review of Resident 1 ' s Physician Orders dated 11/6/24-11/16/24, the physician orders indicated to record intake each shift and record the total daily intake in ml/cc (milliliters/cubic centimeters). The physician orders indicated to calculate the 24 hours intake on the night shift. During a review of Resident 1 ' s Intake Record and the Calculated 24-hours Intake…

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 the family representative was notified of a change in condition for one of three sampled residents (Resident 1). This failure resulted in Resident 1's family member verbalizing feelings of mistrust and doubting the care the facility staff provided. Findings: During a review of the facility's admission record, this indicated Resident 1 was readmitted to the facility on [DATE] and had conditions listed as urinary tract infection and chronic kidney disease (involving a gradual loss of kidney function). During an interview on 5/24/24 at 4:10 p.m. with Licensed Nurse 1 (LN1), LN1 stated on 5/6/24, Resident 1 was observed sluggish and lethargic, and the physician ordered urinalysis. During an interview on 6/3/24 at 2:30 p.m. with the Infection Preventionist Nurse (IPN), IPN stated urine test result on 5/8/24 showed blood in the urine indicating an infection. IPN confirmed there was no documentation of notification of the urine test and result to 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 record review and interview, the facility failed to ensure proper documentation of intake and output for one (resident 1) of two sampled residents, was completed as specified in the care plan. This failure could lead to facility staff being unaware of the resident 1's gastrointestinal functions, fluid balance, renal function, abnormal losses, and bowel movements that potentially contributed to resident 1's weight loss. Findings: During a review of resident 1's care plan (CP) indicated resident 1 is, At risk for weight loss, malnutrition, dehydration, and fluid and electrolyte imbalance due recent surgery. The interventions included, Monitor the intake and output every shift. Record total daily intake and output. Weekly average intake and output in ml. Document the quality, color, odor, and consistency of urine, patient's hydration status. Report to physician the discrepancy in fluid intake or fluid balance every shift. During a review of the Nutrition Evaluation dated 3/19/24, the Nutrition Evaluation indicated Resident 1's anticipated fluid needs were, 1500-1800…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to ensure staff were properly following isolation precautions to prevent the spread of disease for two of 10 Sampled residents (Residents 552 and 96) when: 1. Staff member removed their used personal protective equipment (PPE) outside the isolation room ( supposed to be inside prior to exiting ) and did not perform hand hygiene after removing their PPE. 2. Facility policy and procedure related to the separation of clean and soiled items in Utility Rooms was not followed. 3. Expired medical supplies were not identified and removed from medical supply cabinets. 4. Remove contaminated isolation gown before exiting the resident room. These failures had the potential to transmit infectious microorganisms and increase the risk of infection for residents, staff, and visitors. Findings: 1. During an observation on [DATE] at 10:52 a.m., a license nurse (LN 2) was observed removing contaminated (soiled ) PPEs (isolation gowns and gloves)) in 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 ensure ventilation covers/panels were clean and free of dust when : 1. The ventilation cover and window tracks in room [ROOM NUMBER] was found with thick dust and dirt. 2. The ventilation cover outside room [ROOM NUMBER] was dirty. This failure have the potential for unclean and dirty air from the ventilations to circulate around which could cause respiratory infections inside the facility (residents, staff and visitors ). Findings: 1.During the facility initial tour on 7/11/23 at 10:27 a.m. inside room [ROOM NUMBER], the ventilation cover was observed with thick dust and the window tracks with piled black dirt. During an interview and concurrent observation on 7/13/23 at 9:05 a.m. with the facility Housekeeping Manager (HM), the HM acknowledged the vent cover and windows were dusty and dirty and were not cleaned by the weekend housekeeper. Review of the Centers for Disease Control and Prevention (CDC) website,…

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 two of two unsampled residents (Residents 84 and 100) assessements were accurate when : 1.The Minimum Data Set Assessment ((MDS- residents assessement ) Section K (Nutrition) for Resident 84 was not answered accurately and with missing infromation. This failure have the potential for an inaccurate assessment of the resident's nutrional and dietary status which can affect the plan of care . 2. For Resident 100, the Section A (discharge infromation) in the MDS have an inaccurate information. This failure have the potential for inappropriate discharge plans or information that can affect the resident's rights to admission or discharge. Findings: 1. During a review of the facility's Resident Matrix ((RM) used to identify pertinent care categories for: all residents), dated 07/11/2023, the RM indicated Resident 84 was receiving tube feedings (any type of tube that can deliver food/nutritional substances/ fluids/medications directly 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 interview and record review, the facility failed to ensure one of three unsampled residents (Resident 23) had accurate documentation in their medical record. For Resident 23, this failure resulted in an inaccurate representation of a change in their physical condition. Findings: During a review of Resident 23's Progress Note (PN), dated 5/11/23 at 10 a.m., the PN indicated, Resident c/o [complains of] SOB [shortness of breath] . resident with productive cough, bil [both sides] lung wheezing . new orders to send resident to ER . called 911, resident left facility at 1020 with paramedics. During a review of Resident 23's PN, dated 5/11/23 at 1:59 p.m., the PN indicated, No respiratory changes observed. No Respiratory treatments. During an interview on 7/14/23 at 10:11 a.m. with a licensed nurse (LN3), LN3 stated, I wrote the progress note after the resident was discharged . LN 3 also stated, I did the assessment at about eight am and recorded it at one fifty-nine pm. LN3 further stated, There wasn't a way to change the time of the documentation. During a review of 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 interview and record review, the facility failed to document code status (type of emergency treatment) for six of 22 sampled residents (Resident 40, 53, 56, 85, 91 and 107). This facility failure had the potential for Resident 40, 53, 56, 85, 91 and 107 not to receive life saving measures in case of emergency as per the residents wishes. Findings: During a review of the clinical record for Resident 56, the document titled, POLST (Physician Orders for Life-Sustaining Treatment), dated [DATE], indicated, the choice for Cardiopulmonary Resuscitation (CPR) was, Do Not Attempt Resuscitation/DNR. The document titled, Order Summary Report, dated [DATE], did not contain an order for DNR. During a review of the clinical record for Resident 85, the document titled, POLST, dated [DATE], indicated, the choice for CPR was, Attempt Resuscitation/CPR. The document titled, Order Summary Report, dated [DATE], did not contain an order for Full Code. During a review of the clinical record for Resident 107, the document…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to maintain resident care equipment in a safe and clean manner for one of 22 sampled residents (Resident 214). This facility failure had the potential to cause injury/infection and unsafe environment for Resident 214. Findings: During an observation and concurrent interview on 1/27/2020, at 2:45 p.m. with the Director of Nursing (DON) in room [ROOM NUMBER]-B, a bedside commode was observed with rust on the metal framing, and a broken hinge on the lid. The DON indicated that this was not acceptable to have in a resident's room. During a review of the facility's policy and procedure titled, Equipment Maintenance, dated 05/2007, the policy and procedure indicated, It is the policy of this facility to establish policies and procedures for routine and non-routine care of equipment and to ensure that equipment remains in good working order for resident and staff safety.

Based on observation, interview and record review, the facility failed to ensure a pressure relieving device was in place per the physician orders for one of two sampled residents (Resident 56) with a pressure injury. This facility failure had the potential for Resident 56 to experience worsening of a pressure injury. Findings: During a concurrent observation and interview on 1/28/2020, at 4:44 p.m. with a licensed nurse (LN5) and Resident 56, Resident 56 was observed to have a bandage on his right heel, and a Prevalon foam boot (a device to help minimize pressure, friction and shear on the feet, heels and ankles of non-ambulatory individuals by off-loading the heel, it delivers total, continuous heel pressure relief) was lying on the bed beside the resident. Resident 56 stated, I have a sore on my right heel. LN5 stated that the boot should be on Resident 56's foot. During a review of the clinical record for Resident 56, a document titled, Medication Administration Record indicates an order for, Sage Prevalon to both heels every shift, dated 12/11/19, and is documented 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.

Based on observation, interview, and record review, the facility failed to follow the menu for one out of 30 residents (Resident 79) on a consistent carbohydrate diet, when Resident 79 was served a dessert with sugar instead of the sugar-free dessert indicated on the menu. This deficient practice had the potential to result in an increased blood sugar level for Resident 79, which could lead to health complications and require avoidable medical treatment. Findings: During a review of Resident 79's clinical record, the clinical record indicted, Resident 79 was admitedd to the facility with diagnoses including, Type 2 Diabetes Mellitus (an inability of the body to control blood sugar); Chronic Kidney disease, Stage 3 (when the organs that filter the blood are damaged and can be worsened by untreated high blood sugar); and need for assistance with personal care. During a review of the History and Physical form for Resident 79, the form dated 2/27/19, indicated the resident does not have the capacity to understand and make decisions. During a review of the physician's orders for Resident…

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

Based on observation, interview and record review, the facility failed to ensure a sanitary environment was provided for one of 22 sampled residents (Resident 103) to help prevent the development of infection when the connection tip of Resident 103's bi-level positive airway pressure (BiPAP - a device that helps with breathing) oxygen tubing was observed uncovered on the floor next to a used urinal. This facility failure had the potential to result in contamination of the resident's oxygen equipment and placed Resident 103 at risk for infection. Findings During a review of the facility's policy and procedure titled, Oxygen Equipment, dated 5/2010, the policy and procedure indicated, It is the policy of this facility to maintain all oxygen therapy equipment in a clean and sanitary manner .temporarily not being used, it will be covered loosely to prevent contamination. During a review of the, Order Summary Report, dated 1/3/20, for Resident 103, the order summary report indicated, May use own BiPAP with current setting, w/O2 bleeder [an adapter connected to the oxygen tubing] at 3LPM…

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

Based on observation and record review, the facility failed to ensure education was provided, and an influenza consent/declination form was signed for one of five sampled residents (Resident 24). This facility failure violated Resident 24's right to be educated in regards to the risks and benefits of the vaccine, in order to make an informed choice to receive or not to receive influenza vaccination. Findings: During a review of the clinical record for Resident 24, a document titled, Informed Consent for Influenza, Pneumococcal Vaccines Immunizations, dated 6/29/19, indicated, The resident wishes to have the influenza immunization (seasonal flu vaccine that protects against the influenza viruses) annually, signed by responsible person (RP). Staff documented on the same form that the resident had, Refused, the vaccine on 10/4/19, 10/11/19, and 10/22/19. There was no annual form on the chart stating that Resident 24 or the RP declined in writing, or was aware of the risks/benefits of receiving or not receiving the annual flu vaccine. During an interview on 1/30/2020, at 10:42 a.m., 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.