Apple Rehab Guilford

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, facility documentation, facility policy and interviews for 2 residents, (Resident #25 and 37) reviewed for infection control, the facility failed to develop and implement policies to ensure a resident with a history of colonized multidrug resistant organism (MDRO) and a surgical wound was provided care in accordance with infection control practices and failed to implement policies regarding the use of personal protective equipment (PPE) while providing direct care and for Resident #37 the facility failed to ensure enhanced barrier precautions (EBP) were initiated for a resident with an indwelling medical device. The findings include: 1. Resident #25 had diagnoses that included cutaneous abscess of the groin requiring aftercare following surgery. The care plan dated 1/21/25 identified Resident #25 had a surgical wound, and a history colonized Methicillin-resistant Staphylococcus aureus, MRSA (bacteria resistant to many antibiotics) requiring advanced barrier…

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 review of the clinical record, facility documentation, facility policy and interviews for one (1) of three (3) residents (Resident #1) reviewed for abuse, the facility failed to ensure that a resident was free from abuse when care was not stopped upon resident request. The findings include: Resident #1's diagnoses included chronic pain, muscle weakness, difficulty in walking and anxiety disorder. The annual Minimum Data Set assessment dated [DATE] identified Resident #1 was cognitively intact, exhibited no behaviors and required extensive assistance for bed mobility and total assistance for transfers. The Resident Care Plan dated 1/30/24 identified that Resident #1 required staff assistance with interventions that included to assist as needed to meet toileting needs, incontinent care per policy and side rails per policy to assist with bed mobility. Review of the Concern Form (grievance) dated 5/3/24 and signed by the Social Worker and Administrator, identified that Resident #1 complained about care and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility documentation, facility policy and interviews for two (2) of three (3) residents (Residents #1 and #2), reviewed for abuse, the facility failed to ensure the State Agency was notified timely of allegations of abuse or neglect. The findings include: 1. Resident #1's diagnoses included chronic pain, muscle weakness, difficulty in walking and anxiety disorder. The annual Minimum Data Set assessment dated [DATE] identified Resident #1 was cognitively intact, exhibited no behaviors and required extensive assistance for bed mobility and total assistance for transfers. The Resident Care Plan dated 1/30/24 identified that Resident #1 required staff assistance with interventions that included to assist as needed to meet toileting needs, incontinent care per policy and side rails per policy to assist with bed mobility. Review of the Concern Form (grievance) dated 5/3/24 and signed by the Social Worker and Administrator identified that Resident #1 complained about care and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility documentation, facility policy and interviews for two (2) of three (3) residents (Residents #1 and #2) reviewed for abuse, the facility failed to investigate allegations of abuse and neglect and failed to ensure an alleged accused staff member was removed from the schedule timely to ensure residents were protected from potential abuse. The findings include: 1. Resident #1's diagnoses included chronic pain, muscle weakness, difficulty in walking and anxiety disorder. The annual Minimum Data Set assessment dated [DATE] identified Resident #1 was cognitively intact, exhibited no behaviors and required extensive assistance for bed mobility and total assistance for transfers. The Resident Care Plan dated 1/30/24 identified that Resident #1 required staff assistance with interventions that included to assist as needed to meet toileting needs, incontinent care per policy and side rails per policy to assist with bed mobility. Review of the Concern Form (grievance) 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility documentation, facility policy and interviews for one of three residents (Residents #1) reviewed for abuse, the facility failed to follow a physician's order directing staff assistance of two (2) for care. The findings include: Resident #1's diagnoses included chronic pain, muscle weakness, difficulty in walking and anxiety disorder. The annual Minimum Data Set assessment dated [DATE] identified Resident #1 was cognitively intact, exhibited no behaviors and required extensive assistance for bed mobility and total assistance for transfers. The Resident Care Plan dated 1/30/24 identified that Resident #1 required staff assistance with Activities of Daily Living (ADL's). Interventions included to assist as needed to meet toileting needs, incontinent care per policy and side rails per policy to assist with bed mobility. Review of the Concern Form (grievance) dated 5/3/24 and signed by the Social Worker and Administrator, identified that Resident #1 complained about…

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 review of the clinical record, facility documentation, facility policy and interviews for two (2) of three (3) residents (Residents #1 and #2) reviewed for abuse and neglect, the facility failed to ensure the residents were provided social services support timely after an allegation of abuse/neglect. The findings include: 1. Resident #1's diagnoses included chronic pain, muscle weakness, difficulty in walking and anxiety disorder. The annual Minimum Data Set assessment dated [DATE] identified Resident #1 was cognitively intact, exhibited no behaviors and required extensive assistance for bed mobility and total assistance for transfers. The Resident Care Plan dated 1/30/24 identified that Resident #1 required staff assistance. Interventions included to assist as needed to meet toileting needs, incontinent care per policy and side rails per policy to assist with bed mobility. Review of the Concern Form (grievance) dated 5/3/24 and signed by the DNS and Administrator identified that Resident #1 complained…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff interview for one of three residents (Resident #7) reviewed for quality of care, the facility failed to ensure the medical record was complete and accurate to include vital signs and neurological assessments after an unwitnessed fall. The findings include: Resident #7 was admitted to the facility with diagnoses of dementia. The quarterly Minimum Data Set (MDS) dated [DATE] identified Resident #7 had severe cognitive impairment and required staff assistance with ADLs and transfers. The Resident Care Plan (RCP) dated 6/27/2024 identified Resident #7 required assistance with ADLs, transfers and was impulsive. Interventions directed to assist with ADLs, and transfers, and to avoid information overload. Facility incident report dated 7/12/2024 at 10:45 PM identified Resident #7 was found on the floor by the bed by the maintenance staff (unwitnessed fall), and stated he/she had tried to get up alone. Resident #7 was awake, alert, able to stand with assistance, had no bruises…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, facility documentation, facility policies and interviews for one (1) of three (3) sampled residents (Resident #1) who was on a modified diet consistency due to missing teeth causing increased difficulty with chewing, the facility failed to ensure the resident was not served the wrong diet consistency of fruit to prevent the resident from choking. The findings include: Resident #1's diagnoses included schizoaffective disorder. The admission Minimum Data Set assessment dated [DATE] identified Resident #1 required set up assistance for eating. The hospital Discharge summary dated [DATE] identified Resident #1 was discharged to the facility on a regular diet. The hospital occupational therapy evaluation dated 8/2/24 identified Resident #1 was alert and oriented to person, time, and situation but disoriented to place. The evaluation indicated Resident #1 was completely independent with eating. The diet slip presented to the kitchen dated 8/5/224 identified Resident #1 was on 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 observations, review of facility documentation, facility policy, and interviews the facility failed to ensure a clean and comfortable homelike environment. The findings include: Observations on 10/17/22 at 10:40 AM through 11:40 AM, and on 10/17/22 at 2:18 PM with the Maintenance Supervisor, and the Housekeeping Manager identified the following issues: a. Damaged, chipped and/or marred bedroom walls on [NAME] unit in rooms 5, and 16. [NAME] unit in rooms 21, 22, 24, 28, 29, 31, and 32. East River unit in rooms 35, 36, 38, and 49. b. Damaged, chipped, rusty, and/or marred door frames in the bathroom on [NAME] unit in rooms 1, shower room. [NAME] unit in rooms [ROOM NUMBER]. East River unit in room [ROOM NUMBER]. c. Damaged, holes, chipped and/or marred doors in the bathroom on [NAME] unit in room [ROOM NUMBER], and 29. d. Damaged, chipped and/or marred bedroom radiator on [NAME] unit in rooms 7, and 11. [NAME] unit in rooms [ROOM NUMBER]. e. Stains, discoloration, dirt, debris, and/or wax build up on…

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 review of the clinical record, facility documentation, facility policy, and interviews for 1 resident (Resident #20) reviewed for physician notification, the facility failed to notify the physician when the resident refused ordered bloodwork. The findings include: Resident #20 was admitted to the facility with diagnoses that included Alzheimer's disease, left ankle deformity, major depression, and anxiety. The quarterly MDS dated [DATE] identified Resident #20 had severely impaired cognition, was occasionally incontinent of bladder and continent of bowel and required supervision with dressing and personal hygiene. Resident #20 was independent with transfers, ambulation in the room and hallway with a rolling walker. The care plan dated 7/25/22 identified Resident #20 had dementia with physical and/or verbal aggression towards staff and other residents. Interventions included to provide a psychiatric evaluation. A physician's order dated 8/1/22 directed on the next lab day to draw a Valproic Acid level…

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 review of the clinical record, facility documentation, facility policy, and interviews for two (2) of five (5) residents reviewed for abuse, (Resident #15 and Resident #379), the facility failed to ensure that the residents from mistreatment. The findings include: 1. Resident #15 was admitted to the facility with diagnosis that included anxiety disorder, Post Traumatic Stress Disorder (PTSD), and depression. The Care Plan dated 7/26/22 identified Resident #15 had an impairment in mobility and weakness requiring assistance with his/her activities of daily living (ADL's) with interventions that included to encourage Resident #15 to complete as much of his/her care as possible, to offer assistance only after he/she had attempted to complete the task his/herself and offer to assist Resident #15 with tasks he/she is unable to complete. The admission MDS dated [DATE] identified Resident #15 had no impairment in cognition, no identified behaviors, was an extensive assist for bed mobility, and independent for…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility documentation, facility policy, and interviews for 1 resident (Resident #79) reviewed for discharge planning, the facility failed to communicate with the home care agency including providing the discharge packet information. The findings include: Resident #79 was admitted to the facility with diagnoses that included fracture of the right tibia, multiple sclerosis, neuromuscular dysfunction of the bladder, and stroke. The care plan, undated, identified included interventions to establish a discharge plan with Resident #79 and the family, evaluate progress and revise plan as needed. Additionally, social services will facilitate discharge planning when appropriate. A physician's order dated 6/29/22 directed to transfer using a mechanical lift. The admission MDS dated [DATE] identified Resident #79 had severely impaired cognition, had an indwelling catheter, was frequently incontinent of bowel, and required extensive assistance with bed mobility, dressing, toilet 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 review of the clinical record, facility documentation, facility policy, and interviews for 1 resident (Resident #70) reviewed for hospitalization, the facility failed to follow the bed hold policy. The findings include: Resident #70 was admitted to the facility with diagnoses that included malignant neoplasm of the lung and brain, chronic kidney disease, and heart disease. The baseline care plan dated 9/28/22 identified the resident had cancer with metastasis. Interventions included to assist with arranging oncology appointments. The admission MDS dated [DATE] identified Resident #70 had intact cognition and required supervision with dressing, toileting, personal hygiene, and transfers. The nurse's note dated 10/4/22 at 7:52AM identified that Resident #70's white blood count was 41.1mcL (normal range is between 3,500 and 10,500 mcL). Subsequent to APRN notification, the resident was sent to the emergency room. Interview with the DNS on 10/18/22 at 10:19 AM indicated there should be a packet for transfer…

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, review of the clinical record, facility documentation, facility policy, and interviews for 1 resident (Resident #20) reviewed for accidents, the facility failed to ensure elopement risk evaluation assessments were completed per the policy. The findings include: Resident #20 was admitted to the facility with diagnoses that included Alzheimer's disease, left ankle deformity, major depression, and anxiety. The nurse's note dated 2/7/21 at 4:55 AM identified Resident #20 was wandering the halls for a few hours during the night and was easily redirected. The annual MDS dated [DATE] identified Resident #20 had severely impaired cognition, required supervision for dressing and toilet use, was independent with transfers, ambulation in the room and hallway with a walker and wandering behavior was not exhibited. The Annual Elopement Risk Evaluation was not completed for 2/19/21. The annual MDS dated [DATE] identified Resident # 20 had severely impaired cognition, required supervision for dressing and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility documentation, facility policy, and interviews for 1 resident (Resident #79) reviewed for discharge, the facility failed to ensure the interdisciplinary team and Resident #79 were involved with the discharge planning process. The findings include: Resident #79 was admitted to the facility with diagnoses that included fracture of the right tibia, multiple sclerosis, neuromuscular dysfunction of the bladder, and stroke. The care plan, undated, identified included interventions to establish a discharge plan with Resident #79 and the family, evaluate progress and revise plan as needed. Additionally, social services will facilitate discharge planning when appropriate. A physician's order dated 6/29/22 directed to transfer using a mechanical lift. The admission MDS dated [DATE] identified Resident #79 had severely impaired cognition, had an indwelling catheter, was frequently incontinent of bowel, and required extensive assistance with bed mobility, dressing, toilet…

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, review of the clinical record, facility documentation, facility policy, and interviews for 2 of 5 residents (Resident #20 and 64) reviewed unnecessary medications, the facility failed to follow the physicians' orders regarding bloodwork and medications. The findings include: 1. Resident #20 was admitted to the facility with diagnoses that included Alzheimer's disease, dementia, left ankle deformity, major depression, and anxiety. The quarterly MDS dated [DATE] identified Resident #20 had severely impaired cognition, was occasionally incontinent of bladder and continent of bowel and required supervision with dressing and personal hygiene. Resident #20 was independent with transfers, ambulation in the room and hallway with a rolling walker. The care plan dated 7/25/22 identified Resident #20 had dementia with physical and/or verbal aggression towards staff and other residents. Interventions included to provide a psychiatric evaluation. The psychiatric APRN note dated 8/1/22 (follow up visit)…

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, review of the clinical record, facility policy and interviews, for 1 resident (Resident #47) reviewed for accidents, the facility failed ensure medications were not left at the resident ' s bedside unsecured. The findings include: Resident #47 was admitted on [DATE] with diagnoses that included chronic kidney disease and Parkinson's disease. The quarterly MDS dated [DATE] identified Resident #47 had intact cognition, required limited assistance for mobility utilizing a rolling walker or wheelchair. The care plan dated 9/19/22 identified Resident #47 was at risk for skin breakdown with interventions that included to keep the skin clean and dry and apply barrier cream with incontinent care. Physician orders dated 9/30/22 directed to apply Ammonium Lactate Lotion 12% to legs topically every day and evening shift, and Capsaicin Cream 0.1% apply to legs topically at bedtime for feet pain. Observation on 10/16/22 at 1:03 PM identified Resident #47 had the following medications at the bedside on…

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 review of facility documentation, the facility assessment, and interviews, the facility failed to ensure sufficient nurse aide staffing. The findings include: Review of facility documentation identified the total capacity of the facility is 86, thre was a census of 81 on 10/16/22 and the 3 units with the following capacity was provided. East River Capacity 32. [NAME] Capacity 26. [NAME] Capacity 28. Review of the facility assessment dated 6/2022 identified the facility requires 7 nurse aides on the 3:00 PM - 11:00 PM shift, and 4 nurse aides on the 11:00 PM - 7:00 AM shift. Staffing assignments are reviewed regularly in relation to resident needs and adjusted as needed, staff assignments are based on the resident acuity rather than numbers. Review of the staffing schedules dated 10/8/22 - 10/18/22 for the 3:00 PM - 11:00 PM shifts identified the following. Saturday 10/8/22; 3.5 nurse aides . Sunday 10/9/22; 5 nurse aides. 10/10/22; 4 nurse aides. 10/11/22; 4 nurse aides. 10/14/22; 6.5 nurse aides.…

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 review of facility documentation, the facility assessment, and interviews, the facility failed to ensure staff working as a nurse aide had current certification and competencies necessary to provide nursing and related services. The finding included: Review of the facility staff schedule dated 10/8/22 through 10/18/22 identified the facility had been utilizing a Certified Occupational Therapy Assistant (COTA #1) as a nurse aide on the 3:00 PM - 11:00 PM shift, and hospitality aides as nurse aides on the 3:00 PM - 11:00 PM and 11:00 PM - 7:00 AM shifts. Interview with the DNS on 10/19/22 at 7:40 AM identified she is aware that the facility did not have sufficient nurse aide staffing on the 3:00 PM - 11:00 PM and 11:00 PM - 7:00 AM shifts and they have been utilizing a COTA and hospitality aides on the floors as direct care nurse aides. The DNS indicated the facility does not have a scheduler and that she has been the doing the schedule. The DNS indicated she was not aware that she cannot utilized the COTA as a nurse aide on the unit and she was not aware that the hospitality…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, review of facility policy, and interviews for one sampled resident, (Resident #63) reviewed for pharmacy services, the facility failed to notify the physician when a medication was unavailable from the pharmacy and therefore not administered to Resident #63. The findings include: Resident #63 was admitted to the facility on [DATE] at 6:18 PM with diagnoses which included atrial fibrillation, congestive heart failure and chronic obstructive pulmonary disease. A Discharge Hospital After Visit Summary (medication list) dated 3/15/19 identified Lidocaine patch 3.6-1.25 % daily (last administered on 3/15/19 at 9:59 AM). The admission physician orders dated 3/15/19 directed Lidocaine Menthol 3.6-1.25% patch-one patch on skin every day. Review of the MAR dated 3/16/19 through 3/18/19 (date of Resident #63's discharge) failed to identify the Lidocaine patch was applied to Resident #63 (3 days). Interview with the DNS on 12/30/19 at 2:15 PM indicated the Lidocaine patch was out of stock…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and interview for one sampled resident (Resident #64), reviewed for an injury of unknown origin, the facility failed to report an injury of unknown origin to the State Agency. The findings include: Resident #64's diagnoses include dementia and Parkinson's disease. A quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #64 was severely cognitively impaired and required extensive assistance of two for bed mobility and toilet use. The Resident Care Plan that was initiated 1/3/18 and currently in effect indicated Resident #64 had a risk of bruising/bleeding and taking blood thinning medication. Nurse's notes dated 6/13/19 at 10:01 PM indicated Resident #64 was found in bed with a bruise to the back of the right hand measuring 6 (centimeters) cm by 5 cm, dark purple blue in color. Resident #64 was unable to state the cause, the Supervisor notified. Try to find reason, no blood draw as record. Accident/Incident report filed. Family member noticed. Leave note for…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and interview for one sampled resident (Resident #64), reviewed for an injury of unknown origin, the facility failed to investigate an injury of unknown origin. The findings include: Resident #64's diagnoses include dementia and Parkinson's disease. A quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #64 was severely cognitively impaired and required extensive assistance of two for bed mobility and toilet use. The Resident Care Plan that was initiated 1/3/18 and currently in effect indicated Resident #64 had a risk of bruising/bleeding and taking blood thinning medication. Nurse's notes dated 6/13/19 at 10:01 PM indicated Resident #64 was found in bed with a bruise to the back of the right hand measuring 6 (centimeters) cm by 5 cm, dark purple blue in color. Resident #64 was unable to state the cause, the Supervisor notified. Try to find reason, no blood draw as record. Accident/Incident report filed. Family member noticed. Leave note for APRN 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, review of the clinical record, facility documentation, facility policy, and interviews for 1 sampled resident (Resident #13) observed with medication at the bedside, the facility failed to administer medication according to professional standards of practice. The findings include: Resident #13 was admitted to the facility on [DATE] with diagnoses that included atrial fibrillation, heart failure, respiratory failure, pulmonary hypertension and diabetes mellitus. Physician's order dated 10/4/19 directed to administer Potassium Chloride 40 Milliequivelants (Meq) by mouth daily. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #13 had intact cognition and required extensive assistance of 1 for bed mobility, transfers, and mobility on/off unit. The Resident Care Plan (RCP) dated 10/9/19 identified Resident #13 was on medication therapy, with interventions that included to administer medications as ordered. Resident #13's December 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 observations, review of facility documentation, facility policy, and interviews for one resident (Resident #14) reviewed for activities of daily living, the facility failed to consistently ambulate a resident who was on an ambulation program and dependent on staff to walk. The findings include: Resident #14 diagnoses included chronic kidney disease, major depression, and above the knee amputation of the right leg. The Resident Care Plan (RCP) dated 1/18/18 and currently in effect (but not dated) identified Resident #14 required assistance with activities of daily living. Interventions included to ambulate Resident #14 daily with a gait belt and rolling walker, to the 1st annex out cove with modified independence and to set up a chair at the nurse's station for rest periods. A quarterly Physical Therapy Screening form dated 10/1/19 identified Resident #14 was seen for a functional maintenance ambulation screen and remained appropriate for the ambulation program and continued to participate. The quarterly…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and interviews for one sampled resident (Resident #63)reviewed for pharmacy services, the facility failed to ensure medications were obtained and administered timely. The findings include: Resident #63 was admitted to the facility on [DATE] at 6:18 PM with diagnoses which included atrial fibrillation, congestive heart failure and chronic obstructive pulmonary disease. A Discharge Hospital After Visit Summary (medication list) dated 3/15/19 identified your medications have changed and start taking Eliquis 5 milligrams (mg) every 12 hours (last administered on 3/15/19 at 9:50 AM and due to be administered in the evening on 3/15/19) , Cardizem 180 mg once daily (last administered on 3/15/19 at 9:50 AM), Famotidine 20 mg daily (last administered on 3/15/19 at 9:50 AM), Ferrous Sulfate 65 mg twice daily (last administered on 3/15/19 at 9:50 AM and due to be administered in the evening on 3/15/19), Furosemide 40 mg twice daily (last administered on 3/15/19 at 9:50 AM and due to be…

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 review of the clinical record, facility documentation, facility policy, and interviews for 1 of 5 residents (Resident #36) reviewed for unnecessary medication, the facility failed to monitor orthostatic blood pressures as per physician orders. The findings include: Resident #36 was re-admitted to the facility on [DATE] with diagnoses that included hypertension, ischemic heart disease, major depressive disorder, anxiety disorder, anemia, embolism, thrombosis of superficial veins of lower extremity and intellectual disability. A significant change Minimum Data Set (MDS) assessment dated [DATE] identified Resident #36 had moderate cognitive impairment and required limited assistance of 1 for bed mobility, transfers, walking in room, and dressing. Additionally, the MDS identified Resident #36 required extensive assistance of one for toilet use and personal hygiene. A physician's re-admission order dated 11/2/19 directed to administer Hydralazine (a vasodilator) 25 milligrams (mg) by mouth every 8 hours. 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, review of the clinical record, facility documentation, facility policy, and interviews for 1 of 4 sampled residents (Resident #44) observed during medication administration, the facility failed to the ensure a medication administration error rate was less than 5%. The findings include: Resident #44 was admitted to the facility on [DATE] with diagnoses that included Parkinson's disease, bipolar disorder, and acute kidney failure. A physician's order dated 11/20/19 directed to administer Aspirin 81 milligrams (mg) enteric coated delayed release (EC) tablet by mouth once a day, Divalproex (Depakote) 250 mg Extended Release(ER) by mouth once daily, and may crush appropriate meds and place in food or fluid as needed. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #44 had moderately impaired cognition, required total dependence of two with activities of daily living (ADL), bed mobility and transfers, did not identify a swallowing disorder or dental disorder 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.