Country Drive Post Acute

Based on observation and interview, the facility failed to ensure dietary services followed proper sanitation for food service safety when: the three compartment sink was not maintained clean. This failure had the potential to cause cross contamination and an outbreak of food borne illness to 98 residents who received food from the kitchen. Findings: During a concurrent observation and interview, in the initial tour of the kitchen, on 5/15/23, at 10:03 a.m., with Dietary Supervisor (DS), observed the three compartment sink right counter with a green worn out sponge and a silvery mesh, a red bucket, an open box of traditional bakery cornbread mix, and surface of the counter was wet and dirty with brownish black and white food particles. The DS stated, they used the compartment sink for manual washing of dishes and pans and were currently using the dish machine. During a concurent observation and interview in a follow-up tour of the kitchen, on 5/17/23, at 10:17 a.m., there was a white residue on the side of the middle sink of the three compartment sink and vegetable food particles in…

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

Based on interview and record review, the facility failed to ensure dialysis (a treatment to remove extra fluid and waste products from the blood when the kidneys cannot) communication records were completed for three residents (Resident 201, Resident 54, and Resident 56) out of 5 sampled residents. This failure has the potential to miss signs of illness such as fever or bleeding, which could lead to hospitalization. Findings: A review of Resident 201's admission record indicated admission date of 5/14/23 with a diagnosis of end stage renal disease (the last stage of long-term kidney disease where the kidneys no longer work), with a dependence on renal dialysis. A review of Resident 54's admission record indicated an admission date of 04/08/23 with a diagnosis of end stage renal disease with a dependence on renal dialysis. A review of Resident 56's admission record indicated an admission date of 08/26/22 with a diagnosis of hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease and dependence on renal dialysis. During a record 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 observation, interview, and record review, the facility failed to ensure medication error rate of less than 5% when three errors were observed in 36 medication pass opportunities which resulted in 8.33 % medication error rate. The errors as follows: Dorzolamide HCl solution 2%, (used to lower high eye pressure), Fish Oil capsule (Omega -3 Fatty acids- supplements) and Multivitamin with minerals medications were omitted for Resident 43, during medication pass observation on 5/16/23. This failure had the potential to put resident (Resident 43) at risk for harm and/or adverse consequences. Findings: During medication pass observation and concurrent interview with LVN 1 on 5/16/23, at the beginning of 8:50 AM, at the doorway of Resident 43's room, Licensed Vocational Nurse (LVN) 1 was preparing Resident 43's medications with gloves on. LN 1 was observed administering the following medications via G-tube (Gastrostomy tube- a tube inserted through the wall of the abdomen directly into the stomach) to Resident 43: Amiodarone HCL (anti arrhythmic-a type of drug that is used to help…

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 develop a baseline care plan for one of six residents (Resident 351) within 48 hours of admission to the facility. This failure ha the potential to not providing an effective, person-centered and quality resident care. Findings: Resident 351 is a [AGE] year old, admitted [DATE], with diagnoses including Hypertension (high blood pressure), difficulty in walking and hyperlipidemia (cholesterol in the blood), Hemodialysis(treatment of filtering waste and water from your Blood). During the initial facility tour on 5/15/23 at 10:30 am, observed Resident 351 in bed with Oxygen at 2L/min, lying on a low air loss bed, turned to her left side facing the glass sliding door. A follow up visit with Resident 351, on 5/17/23, at 10:05 am, observed resident in bed turned to left side facing the glass sliding door. Resident 351 said ouch when surveyor introduced self to resident. Did not verbalize any words or response to questions asked by surveyor.…

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 review and revise a comprehensive plan of care for one of six residents, (Resident 27), when her wounds were healed and wanted to get out of bed and do more things outside the facility. This failure had the potential for Resident 27 to cause further decline of mobility and psychosocial issues. Findings: Resident 27 is a [AGE] year-old female admitted in December 2021 with diagnoses including protein-calorie malnutrition; type 2 diabetes mellitus (blood sugar disorder) and contracture (shortening or stiffening) of muscles. The minimum data set (MDS- assessment tool), brief interview for mental status (BIMS), dated 12/14/22, score 13, indicating intact cognition. During the initial tour of the facility, on 5/15/23 at 10:38 am, observed Resident 27 lying in bed. A follow up visit with Resident 27 on 5/17/23, at 11 am, observed Resident 27 is still in bed. When asked if she had been getting up, she stated ,I do not get up at all . I had a lot…

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, record review, the facility failed to ensure one of 21 sampled residents (Resident 251), had clean and groomed fingernails. This failure had the potential to cause Resident 251 pain, injury, and infection. Finding: During a concurrent observation and interview on 5/16/23, at 10:04 a.m., Resident 251's fingernails were long, and dirty with black matter inside the nails. Resident stated,, they told staff about it and staff didn't do anything about it. Resident 251 stated it was upsetting. During a concurrent observation and interview on 5/17/23, at 1:02 p.m., with Director of Nursing (DON), Resident 251's fingernails were observed. DON stated Resident's 251's fingernails were long and dirty. During an interview on 5/17/23, at 1:25 p.m., with licensed vocational nurse (LVN) 3, LVN 3 stated Resident 251's long and dirty fingernails should have been identified on admission and were a risk for infection. During an interview on 5/18/23, at 11:01 a.m., with CNA 1, CNA 1 stated, they…

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 obtain a physician's order for oxygen administration for one of four sampled residents (Resident 150). This failure had the potential to place Resident 150 at risk for incorrect oxygen treatments and jeopardize Resident 150's health and wellbeing. Findings: Resident 150 was admitted to the facility on [DATE] with admitting diagnoses that included weakness and lack of coordination. During an observation on 5/15/23, at 11 am, Resident 150 was observed sitting in a chair by her bedside, with oxygen (O2) via nasal cannula (a two-pronged plastic tubing used to deliver oxygen therapy through the nose), attached through the long tubing to the oxygen concentrator ((a medical device for oxygen therapy, it takes in air from the room and filter out nitrogen). Resident 150's O2 was observed at 2 Liters per minute (L/min). During an observation on 5/17/23, at 11:05 am, Resident 150 was observed sitting in her wheelchair. Resident was waiting for 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, for one of three sampled residents (Resident 15), the facility failed to document an adequate indication and diagnosis for the use of Seroquel (a medication used to treat certain mental/mood condition). This failure placed Resident at unnecessary risk for adverse consequences related to the use of Seroquel. Findings: During a review of Resident's 15 face sheet, the face sheet indicated Resident 15 was admitted on [DATE] (originally admitted on [DATE]), with diagnoses that included Alzheimer's disease [a degenerative disease and is the most common cause of dementia (gradual loss of memory and decision-making capacity)]. During a review of Resident 15's Minimum Data Set (MDS- an assessment tool used to direct resident care dated 4/20/23 indicated a brief interview for mental status (BIMS, a brief scanner to help detect cognitive impairment) indicated score of 01 indicating Resident 15 had severe cognitive impairment. During a review of the physician order dated…

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 five sampled residents (Resident 43) was free of significant medication errors when the Amiodarone HCL ( anti arrhythmic-a type of drug that is used to help the heart stay in a normal rhythm) and Keppra (antiepileptics- a type of drug that is used to prevent or treat seizures) medications for Resident 43 were not entirely administered via gastrostomy tube (G-tube- a tube inserted through the wall of the abdomen directly into the stomach). This failure resulted for Resident 43 not to receive an accurate dosage and full therapeutic effect of the medications which could potentially lead to more serious medical complications. Findings: A Review of Resident 43's Order Summary Report active orders as of 5/16/23, indicated an order on 2/6/23 for Amiodarone HCL 50 milligram (mg- a measure of weight) once a day for Cardiac Arrythmia (irregular heartbeat) and Keppra tablet 500 mg twice a day to be administered via G-tube for Epilepsy (a brain disorder that causes seizure). During the medication…

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, for 4 of 46 sampled residents (Resident 76, 82, 112, and 105), facility failed to ensure residents were treated with dignity and respect when: 1. Facility staff assisted Residents 76, 105 and 112 with their meals while standing. 2. Facility staff who assisted Resident 82 with meals stood up two times, interrupting the resident's meal. This failure had the potential to result in undignified treatment. Findings: 1. During an observation and concurrent interview with Licensed Vocational Nurse (LVN) 4 on 3/18/19 at 8:55 a.m., LVN 7 was in Resident 105's room. LVN 7 stood by Resident 105's left side as Resident 105 was sitting up in bed and being assisted by LVN 7. LVN 7 stated she made sure to stand up while assisting Resident 105 with her meals because LVN 7 had already sat down doing paperwork. During an observation and concurrent interview with Director of Nursing (DON) on 3/19/19 at 8:36 a.m., Residents 112 and Resident 76 were assisted by two facility staff…

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 develop a care plan for pain for one of 46 sampled residents (Resident 74), which had the potential to cause Resident 74 to have unmet pain relief needs. Findings: Review of the admission record for Resident 74 indicated that he was admitted on [DATE] with multiple diagnoses including chronic pain. During an interview with Resident 74 on 3/18/19 at 10:51 a.m., he stated he was in a lot of pain most of the time. He stated he can get pain medication every six hours, but it was not enough. He stated he could also have Tylenol as needed, but that did not help. During an interview and concurrent record review with Director of Nursing (DON) on 3/21/19 at 10:05 a.m. of Resident 74's care plan, she stated there was no care plan for pain. She stated Resident 74 should have a care plan for pain since he was on pain medications and was assessed for pain. The facility policy and procedure titled,Care Plan, Baseline and Comprehensive, revised 11/2017, indicated, 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, for two of two (Residents 37 and 76) sampled residents who were dependent on dialysis (a treatment where a machine cleans and filters the blood of toxins when the kidneys are not healthy enough to do it adequately, will be used interchangeably with hemodialysis), the facility failed to ensure services were provided in accordance with professional practice and comprehensive person-centered plan of care when phosphate binders (medications that binds with dietary phosphorus in the gastrointestinal tract) were not administered as ordered by the physician. This failure had resulted in increased phosphorus level in Resident 37 and had potential to result in increased phosphorus level for Resident 76. Findings: 1. Review of the clinical record indicated Resident 37 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus (abnormal levels of blood sugar) and end stage kidney failure and required hemodialysis. The Order Summary Report as of…

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

Based on observation, interview and document review, the facility failed to provide adequate staff to aid 11 of 11 sampled residents who needed feeding assistance during lunch time. This deficient practice does not promote residents' physical, mental, and psychosocial well-being. Findings: During an observation on 3/18/19 at 12:10 p.m. in the dining room, eleven of eleven dependent dining residents had their meals placed in front of them and were waiting to be assisted by staff. There were two licensed vocational nurses (LVN 7 and 8) in the dining room assisting dependent residents with eating. During an observation on 3/18/19 at 12:32 p.m. in the dining room, six of eleven dependent dining residents (Residents 13, 22, 48, 105, 112, and 117) were still waiting for assistance with eating their lunch. Resident 22 attempted to drink his chocolate milk without assistance and started choking. He continued to cough for approximately three minutes. During an interview with LVN 7 on 3/18/19 at 12:39 p.m. in the dining room, she stated residents should not be waiting for assistance 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 ensure drugs and biologicals were labeled and stored in accordance with professional principles when: 1. multiple medications were expired and were not labeled; 2. controlled substance drugs were not accounted; 3. a medication cart was left unsecured and unattended. These failures had the potential to result in decreased medication efficacy, risk of unauthorized access, use and abuse of controlled substances. Findings: 1. During a medication room inspection on [DATE] at 10:21 a.m., the following medications and biologicals were observed: a. a bottle of Ativan (also know as Lorazepam, a sedative controlled substance used to treat seizure disorders, epilepsy and to relieve anxiety) with an expiration date of [DATE] was stored with the currently used medications in the medication refrigerator; b. a bottle of Ativan with unreadable expiration date was stored with the currently used medications in the refrigerator; c. a bottle containing 100…

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, for two of two (Residents 37 and 76) sampled residents who were dependent on dialysis, the facility failed to ensure pharmacist identified and reported irregularities in medication regimen when missed doses of phosphate binders (medications that binds with dietary phosphorus in the gastrointestinal tract) were not identified and evaluated. This failure had resulted in multiple missed doses of phosphate binders that were not addressed in a timely manner. Findings: 1. Review of the clinical record indicated Resident 37 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus (abnormal levels of blood sugar) and end stage kidney failure and required hemodialysis. The Order Summary Report as of 3/1/19 indicated an order dated 12/23/18 for Resident 37 to receive sevelamer carbonate 800 mg (a phosphate binder) one tablet by mouth with meals three times daily. During an interview and concurrent review of Resident 37's Medication Administration Record…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure that the medication error rate was not five percent (%) or greater. The facility's medication pass observation on 3/18/19 resulted in three errors out of 27 opportunities indicating a medication error rate of 11.11%. These failures placed both Resident 36 and 83 at risk for not getting the full therapeutic effect of their prescribed medications and could result in undesired health care outcomes. Findings: 1. Review of the admission Record showed Resident 35 was admitted to the facility with multiple diagnosis which included diabetes (high blood sugar). During a med pass observation on 3/18/19 at 12:30 p.m., Registered Nurse (RN2) drew up 10 milliliters (ml) of 100 unit/ml Admelog solution (a short-acting insulin indicated to improve control in blood sugar levels) that had an opened date of 2/9/19. RN2 entered Resident 36's room and was about to give the medication. In an interview on 3/18/19 at 12:35 p.m, RN2 stated that she 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 seven (Resident 115, 83, 44, 104, 73, 64, 56) out of 113 residents received food that was at an appetizing temperature. This failure had the potential to affect all the residents who received their meals from the kitchen. Findings: In an interview on 3/18/19 at 9:20 a.m., Resident 115 stated, Food is cold and I do not like that. During resident council meeting on 3/19/19 at 10:56 a.m., Resident 83, 44, 104, 73, 64 and 56 stated food was served cold at the facility. During observation and concurrent interview on 3/19/19 at 12:58 p.m., a Test Tray was prepared for Regular and Puree consistency meal. While accompanied by facility's Dietary Supervisor (DM), the following observations were made: a. A Regular tray contained Chicken, Red Pinto Beans, [NAME] Beans and Orange Juice. Chicken- lukewarm, at 138 degrees Fahrenheit (°F) Red Pinto Beans- lukewarm, at 131 °F Green Beans- cold, at 116 °F Orange Juice- at 50 °F b. A Puree tray contained Chicken, Red Pinto Beans, and Spinach. Chicken- lukewarm, at 132 °F…

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 offer therapeutic bedtime snacks to six (Residents 44, 56, 64, 73, 83 and 104) of 46 sampled residents. This failure had resulted in Residents 44, 56, 64, 73, 83 and 104 feeling very hungry due to long periods of time in between an early dinner and having late breakfast the following day. Additionally, for Resident 44 and 83, who had a diagnosis of Diabetes Mellitus, this failure placed them at risk for Hypoglycemia (low blood sugar level which could result in a potentially dangerous health outcome up to and including death). Findings: In a resident group interview on 3/19/19 at 10:00 a.m., Residents 44, 56, 64, 73, 83 and 104 stated they were not offered snacks at night. Residents 44, 56, 64, 73, 83 and 104 added that dinner was served daily around 5:00 p.m. and breakfast was served past 7:30 a.m. the following day. Resident 73 and 104 stated that sometimes breakfast was served late and they felt very hungry not having had anything since 5:00 p.m. the previous evening. Residents 44, 56, 64, 73, 83 and 104…

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, interviews, and document review, the facility failed to store, distribute and serve food in accordance with professional standards for food service safety when: 1. A bag of frozen diced egg in walk in refrigerator was open, not dated and not labeled. 2. Six out of Six chopping boards were worn out with deep cuts and brown colored stains. 3. Employees personal belongings were stored in emergency food storage area inside the Kitchen. 4. Three compartment sink did not have an air gap. 5. Dietary Aide (DA 1) did not cover beard in the food service area. 6. Nursing Station 2 Refrigerator (Ref 1) had residents' food that was open, but not dated and not labeled. discharged residents' food was kept in Ref 1. 7. Nursing Station 1 Refrigerator (Ref 2)'s thermometer was broken, frozen food was not frozen solid. discharged residents' food was kept in Ref 2. This failure placed the residents at risk for food borne illnesses. Findings: 1. During an initial tour of the Kitchen accompanied by Dietary…

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 3. Review of admission Record dated 3/20/19 showed Resident 14 was admitted to the facility on [DATE] with diagnosis of Diabetic foot ulcer and Acquired absence of Right toe(s). Review of Resident 14's Physician Order Summary Report dated 3/20/19 showed an order stating Right 3rd toe amputation site wound: Clean with normal saline, pat dry, Apply Santyl to wound bed, pack with hydrogel impregnated 1/4 packing strip every day shift. During an observation on 3/19/19 at 9:24 a.m., Licensed Vocational Nurse (LVN 2) was observed during wound treatment for Resident 14's Right 3rd toe amputation site wound. LVN 2 prepared the wound treatment supplies at Resident 14's bedside. While wearing Right hand glove, one glove fell on the floor at Resident 14's bedside. LVN 2 put on another glove on right hand and picked up the glove from the floor. LVN 2 removed the right hand glove and without washing her hand she put on another glove. LVN 2 then pulled the privacy curtain and without washing hands and without changing gloves…

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

Based on observation, interview and record review, the facility failed to ensure that two of two dryers were in safe operating condition when the lint screens were observed full of lint. This deficient practice has the potential to cause overheating of the dryer and fire related consequences. Findings: During an observation and concurrent interview on 3/20/19 at 8:30 a.m. in the laundry room, the lint screens on both dryers were observed full of lint with excess lint in the bottom compartments of the dryers. The housekeeping supervisor (HS) stated the lint screens should be cleaned every two hours and documented on the lint clean out log. The housekeeping aide (HA) stated she did not clean the lint screens on her shift and did not document on the lint clean out log. Review of the Dryer Lint Clean Out Schedule, revised 10/7/16, indicated no initials for cleaning lint screens on 3/20/19 at 6:00 a.m. and 8:00 a.m. The facility policy and procedure titled, Description of Steps in the Laundry Process dated 10/7/16, indicated, These lint screens must be brushed and cleaned after every…

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, for three of three residents (Residents 36, 98 and 172) who received Medicare benefits, the facility failed to inform residents of charges for services that would not be covered under Medicare or the facility's per diem rates should residents opted to stay in the facility after Medicare services were discontinued when: 1. For Resident 36, Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN) Form issued was not completely filled out. 2. For Resident 98, SNFABN form did not have the resident or resident representative's signature. 3. For Resident 172, SNFABN form was not completely filled out and did not have resident's or resident representative's signature. This failure had the potential to result in uninformed healthcare decisions. Findings: 1. Review of the clinical record indicated Resident 36 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus (abnormal levels of blood sugar) and left leg amputation. The Order…

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 Range Of Motion (ROM) exercises to three (Resident 69, 75 and 13) of 33 sampled residents for limited ROM in extremities. This failure had the potential for Resident 69, 75 and 13 to suffer from worsening of limitation in ROM in extremities. Findings: 1. Review of admission Record dated 3/21/19 showed Resident 69 was initially admitted to the facility on [DATE]. During an observation on 3/19/19 at 7:51 a.m., Resident 69 was lying in bed with left arm and left leg covered under the bed sheet. When asked if she was able to move left arm and left leg, Resident 69 nodded her head as no. Review of Initial History and Physical dated 1/22/19 showed Resident 69 had an active diagnosis of left hemiplegia (paralysis of left side). During a concurrent interview and record review on 3/21/19 at 9:29 a.m., Registered Nurse (RN 2) confirmed Resident 69 did not receive ROM exercises for left side weakness. During a concurrent interview and record…

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 manage pain for two (Resident 120 and 26) of 46 sampled residents, when: 1. Resident 120 did not receive pain medication as desired prior to therapy session. 2. Resident 26 did not receive scheduled pain medication in a timely manner. This failure had the potential for Resident 120 and 26 to suffer from complications of pain such as limited mobility, and decreased participation in therapy. Findings: 1. Review of admission Record showed Resident 120 was admitted to the facility on [DATE] with active diagnosis of fracture of neck of Right femur (hip bone) and fracture of left acetabulum (socket of hip bone). Review of Resident 120's Physicians Order Summary Report dated 3/18/19 showed Resident 120 to receive: Morphine Sulphate Solution 20 mg/ml Give 10 mg by mouth every 6 hours as needed for severe pain. During an observation and interview with Resident 120 on 3/18/19 at 9:20 a.m., Resident 120 was lying in bed. Resident 120 stated severe…

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, facility failed to have sufficient nursing staff with appropriate competencies and skill sets to provide nursing and related services as determined by the acuity and diagnoses of resident population in accordance with the facility assessment when three of three licensed staff did not have skills competency skills check. This failure had the potential to result in poorly trained and incompetent staff providing substandard care to residents. Findings: During an interview and concurrent review of the employee files with Director of Staff Development (DSD) on 3/21/19 at 11:55 a.m., DSD stated RN 2 did not have skills check for infection control, RN 6 (hired in 2017) and LVN 4 (hired in 2016) both did not have any skills performance checklist. All three licensed staff did not have annual performance evaluations done. Review of the Facility Assessment provided by the facility at time of survey indicated facility admits and provide care that may present common diseases that included renal failure, end stage kidney disease, and infectious…

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.