Mystic Healthcare & Rehabilitation Center, LLC

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, facility policy and interviews for 1 of 7 sampled residents (Resident #41) reviewed for medication administration, the facility failed to ensure a physician order for a subcutaneous injection was administered properly. The findings include: Resident #41's diagnoses included gastroenteritis (stomach/intestinal inflammation) and colitis (inflammation of the colon). The admission Minimum Data Set assessment dated [DATE] identified Resident #41 had a Brief Interview of Mental Status score of 15 indicating Resident #41 was cognitively intact and required maximal assistance with eating, bathing, and personal hygiene. The Resident Care Plan dated 12/17/25 identified that due to the gastrointestinal inflammation Resident #41 was on a tube feed 14 hours per day and received medication through a Gastrostomy Tube (tube that goes directly into the stomach). Physician orders in effect 12/17/25 to 1/13/26 directed to administer Octreotide Acetate Injection Solution 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 observations, interviews, review of the clinical record, and policy for the only sampled resident (Resident #73) reviewed for activities, the facility failed to ensure activities were offered to a dependent resident. The findings include:Resident #73 diagnoses included suspected adult neglect (from the hospital), anxiety, and neuropathy (nerve pain).The Resident Preferences Evaluation (completed upon admission) dated 1/29/25 identified Resident #73 found it very important to have books, newspapers and magazines to read, keep up with the news, and do his/her favorite activities (favorite activities were not specified).The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #73 had a Brief Interview of Mental Status (BIMS) score of 13 indicating no cognitive impairment, required set-up assistance for eating and partial/moderate assistance for dressing and transfers. Additionally, the MDS identified Resident #73 found it important to have books, newspapers and magazines to read,…

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 policy, observation and interviews for 1 of 3 sampled residents (Resident #98) reviewed for pressure ulcers, the facility failed to follow physician orders to offload the resident's heels and failed to follow physician orders for the appropriate treatment of a wound. The findings include: Resident #98's diagnoses included severe protein-calorie malnutrition, dementia and pressure ulcer to their left ischium. The Nursing admission assessment dated [DATE] identified Resident #98 was alert and oriented to person and presented as chronically disoriented and confused. The Resident Care Plan identified Resident #98 was at risk for alteration in skin integrity. Interventions included using pressure redistribution devices as ordered, and perform treatments as ordered.A. A physician's order dated 1/5/26 directed to elevate bilateral heels off the bed with pillows or use foam boots to prevent heel ulcers. Observation on 1/7/26 at 1:45 PM, and on 1/8/26 at 11:31 AM…

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, interview, and review of facility policy, for 1 of 5 sampled residents (Resident #74) reviewed for unnecessary medications, the facility failed to ensure that behavior monitoring was being performed with antipsychotic medication administration. The findings includeResident #74's diagnosis included dementia with behavioral disturbance, substance abuse, and diabetes.The Minimum Data Set assessment dated [DATE] identified a Brief Interview for Mental Status score of 12 indicating moderate cognitive impairment and required assistance with bed mobility and transfers. Further review of the MDS failed to identify a psychiatric diagnosis for the use of an antipsychotic medication.Review of the Resident Care Plan in effect from January 2025, through January 14, 2026, identified a behavioral disturbance. Interventions directed to conduct behavioral monitoring.A physician order dated 1/18/25 directed to administer Seroquel (an antipsychotic) 50 milligrams at bedtime for schizophrenia. 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 review of the clinical record, observations, interviews and facility policy for 2 of 3 sampled residents (Resident #11 and Resident #98) reviewed for Resident #11 reviewed for infection prevention practices, the facility failed to wear appropriate Personal Protective Equipment (PPE) for a resident on Enhanced Barrier Precautions (EBP), and for Resident #98 reviewed for pressure ulcers, the facility failed to follow appropriate hand hygiene practices. The findings include: 1.Resident #11 's diagnoses included Sepsis, Dysphagia (difficulty swallowing) and Dementia. A physician's order dated 12/20/25 directed to administer Ertapenem sodium injection solution reconstituted 1 gram intravenously once a day for Sepsis until 1/16/26 at 100 milliliters/hour over 30 minutes via a Peripherally Inserted Central Catheter. (PICC) The baseline Resident Care Plan dated 12/20/25 identified enhanced barrier precautions related to current antibiotic (intravenous) therapies. Interventions included handwashing between…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, clinical record review, facility documentation review, facility policy review, and interviews for one resident (Resident #1) reviewed for abuse, the facility failed to ensure the resident was free from verbal mistreatment. The findings include:Resident #1 was admitted with diagnoses that included stroke with resultant hemiplegia and hemiparesis (loss of movement on one side of the body), anxiety, and major depression. An admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had a Brief Interview for Mental Status (BIMS) score of 13 (was alert and oriented), and was dependent for toileting, transfers and bed mobility. The Resident Care Plan (RCP) dated 8/18/2025 identified Resident #1 was frequently incontinent of bowel and bladder was long term placement. The RCP directed to provide incontinent care upon request, toilet upon request and staff to provide emotional support. A facility investigation (A &I) report dated 8/28/2025 at 9:00 AM identified an allegation 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, clinical record review, facility documentation review, facility policy review, and interviews for one resident (Resident #1) reviewed for abuse and neglect, the facility failed to ensure staff reported an allegation of abuse timely. The findings include: Resident #1 was admitted with diagnoses that included stroke with resultant hemiplegia and hemiparesis (loss of movement on one side of the body), anxiety, and major depression. An admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had a Brief Interview for Mental Status (BIMS) score of 13 (was alert and oriented), and was dependent for toileting, transfers and bed mobility. The Resident Care Plan (RCP) dated 8/18/2025 identified Resident #1 was frequently incontinent of bowel and bladder was long term placement. The RCP directed to provide incontinent care upon request, toilet upon request and staff to provide emotional support. A facility investigation (A &I) report dated 8/28/2025 at 9:00 AM identified an…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility policy and interviews for one (1) of three (3) residents (Resident #1) reviewed for injuries of unknown origin, the facility failed to review and revise the plan of care timely following a newly discovered wound and failed to ensure the residents plan of care addressed frequent refusals of care. The findings include: Resident #1's diagnoses included dementia without behavioral disturbances, generalized muscle weakness and polyneuropathy (peripheral nerve disorder that causes multiple nerves throughout the body to malfunction at the same time which can cause numbness, pain, tingling or a burning sensation). The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had moderately impaired cognition (Brief Interview for Mental Status (BIMS) score of 10) and was independent with eating, bed mobility, transfers and ambulation. A. A nurse's note dated 3/17/25 at 12:51 PM identified Occupational Therapist (OT) #1 reported a 16 cm by 7 cm skin…

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 injuries of unknown origin, the facility failed to ensure a full body skin assessment was performed after the discovery of an injury of unknown origin and failed to document every shift on an injury of unknown origin per physician's orders. The findings include: Resident #1's diagnoses included dementia without behavioral disturbances, generalized muscle weakness and polyneuropathy (peripheral nerve disorder that causes multiple nerves throughout the body to malfunction at the same time which can cause numbness, pain, tingling or a burning sensation). The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had moderately impaired cognition (Brief Interview for Mental Status (BIMS) score of 10) and was independent with eating, bed mobility, transfers and ambulation. A nurse's note dated 3/17/25 at 12:51 PM identified Occupational…

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 four (4) of six (6) residents (Residents #3, 4, 5 and 6) reviewed for abuse, the facility failed to ensure that the grievance forms were filled out and responded to per policy and failed to ensure the residents were provided support timely after allegations of abuse/mistreatment were made within the facility. The findings include: 1. Resident #3's diagnoses included anxiety disorder and depression. The Resident Care Plan (RCP) dated 10/28/24 identified Resident #3 has the potential for impaired psychosocial wellbeing related to the loss of independence and the need for assistance with interventions that included encouraging the resident to verbalize feelings and make routine daily decisions. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #3 had a Brief Mental Interview for Mental Status (BIMS) of fifteen (15) indicative of intact cognition and was dependent on staff for personal…

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 four (4) of six (6) residents (Residents #3, 4, 5 and 6) reviewed for abuse, the facility failed to ensure the State Agency was notified of allegations of abuse/mistreatment timely. The findings include: 1. Resident #3's diagnoses included anxiety disorder and depression. The Resident Care Plan (RCP) dated 10/28/24 identified Resident #3 has the potential for impaired psychosocial wellbeing related to the loss of independence and the need for assistance. Interventions included encouraging the resident to verbalize feelings and make routine daily decisions. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #3 had a Brief Mental Interview for Mental Status (BIMS) of fifteen (15) indicative of intact cognition and was dependent on staff for personal hygiene, toileting, bed mobility and transfers. Interview with Resident #3 on 2/13/25 at 11:59 AM identified that on several occasions 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility documentation, facility policy and interviews for five (5) of six (6) residents (Residents #2, 3, 4, 5 and 6) reviewed for abuse, the facility failed to investigate allegations of abuse or neglect and failed to ensure a complete investigation was completed on Resident #1. The findings include: 1. Resident #1 's diagnoses included dementia with behavioral disturbances. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had a Brief Mental Interview for Mental Status (BIMS) of three (3) indicative of severely impaired cognition and required supervision assistance with personal hygiene, transfers and ambulation. The Resident Care Plan (RCP) dated 1/20/25 identified that Resident #1 has impaired cognition related to a diagnosis of dementia with behaviors including aggression and striking out with interventions that included to provide two (2) staff for all care during the 3:00 PM to 11:00 PM shift for sundowning behaviors, 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 review of the clinical record, facility documentation, facility policy and interviews for one (1) of six (6) residents (Resident #1) reviewed for abuse, the facility failed to ensure the resident was free from abuse when a staff member was observed pushing the resident into the wheelchair. The findings include: Resident #1 's diagnoses included dementia with behavioral disturbances. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had a Brief Mental Interview for Mental Status (BIMS) of three (3) indicative of severely impaired cognition and required supervision assistance with personal hygiene, transfers and ambulation. The Resident Care Plan (RCP) dated 1/20/25 identified that Resident #1 has impaired cognition related to a diagnosis of dementia with behaviors including aggression and striking out with interventions that included to provide two (2) staff for all care during the 3:00 PM to 11:00 PM shift for sundowning behaviors, staff to identify themselves 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 one (1) of six (6) residents (Resident #1) reviewed for abuse, the facility failed to ensure there was two (2) staff present for care of the 3:00 PM to 11:00 PM shift on 1/25/25 per the resident's plan of care. The findings include: Resident #1 's diagnoses included dementia with behavioral disturbances. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had a Brief Mental Interview for Mental Status (BIMS) of three (3) indicative of severely impaired cognition and required supervision assistance with personal hygiene, transfers and ambulation. The Resident Care Plan (RCP) dated 1/20/25 identified that Resident #1 has impaired cognition related to a diagnosis of dementia with behaviors including aggression and striking out with interventions included to provide two (2) staff for all care during the 3:00 PM to 11:00 PM shift for sundowning behaviors, staff to identify themselves and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, clinical record reviews, facility policy review, and interviews for two of six sampled residents (Resident #11 and #35) who received oxygen therapy, the facility failed to ensure a physician's order was in place for a resident who required the use of continuous oxygen and failed to change oxygen tubing according to physician's orders and to prevent nosocomial infections. findings include: 1. Resident #11's diagnoses included asthma, chronic diastolic congestive heart failure (CHF), morbid obesity, sleep apnea and chronic obstructive pulmonary disease (COPD). The clinical admission assessment dated [DATE] identified Resident #11was re-admitted to the facility with continuous oxygen at 2 liters per minute via nasal cannula. The care plan dated 7/12/23 identified Resident #11 had the potential for alteration in respiratory status with the potential for poor airway clearance, dyspnea, fatigue, and respiratory distress related to COPD, CHF, morbid obesity, sleep apnea and oxygen dependence.…

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 review, facility documentation review, facility policy review, and interviews for one off three residents (Resident #1) reviewed for accidents, the facility failed to provide adequate supervision to prevent a resident from leaving the building unescorted. The findings include: Resident #1's diagnoses included dementia, syncope, metabolic encephalopathy, and major depressive disorder. The significant change in condition Minimum Data Set, dated [DATE] identified Resident #1 had severely impaired cognition and required supervision with an assistive device for locomotion. Review of the Elopement Evaluation performed on 8/14/2023 identified Resident #1's had a score of eight (8). Further review of the evaluation identified a score value of one (1) or higher indicates a resident is at risk for elopement. The Resident Care Plan dated 8/22/2023 identified Resident #1 was a wandering/elopement risk. Resident was exit seeking and stated he/she wanted to go home.…

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, observations and interviews for one sampled resident (Resident #65) who was reviewed for decline in Activities of Daily Living (ADL), the facility failed to ensure the resident did not experience a decline in transfer status . The findings include: Resident #65's diagnosis included, morbid obesity due to excess calories, Chronic Obstructive Pulmonary Disease (COPD), unspecified spinal stenosis, lumbar region with neurogenic claudication, muscle weakness, difficulty walking, epilepsy and anxiety disorder . A physician's order dated 1/11/2021 for the resident's activity level directed contact guard for mobility level. admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #65 with intact cognition, extensive assist with one person for bed mobility. Extensive assist, two-person physical assistance. Extensive assist with one person for locomotion on unit, toileting, and personal hygiene. Moving from seating to standing position the assessment identified the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, review of facility documentation, review of facility policy and interviews for one of two residents (Resident #19) reviewed for smoking, the facility failed to provide adequate supervision during smoking and for one of four residents (Resident #4) reviewed for Accidents, the facility failed to ensure Resident #4 had supervision during meals per the hospitals recommendations and for one resident (Resident # 44) reviewed for accidents, the facility failed to ensure a resident was transferred in a safe manner to prevent a fall. The findings included: 1. Resident #19 had diagnoses that included schizoaffective disorder, pulmonary embolism, bipolar disorder and anxiety disorder. The quarterly MDS assessment dated [DATE] identified Resident #19 was cognitively intact and required limited assistance with one-person physical support for personal hygiene. The care plan identified the resident is risk for potential injury related to smoking. Interventions include to ascertain 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, review of facility policy and interviews for two of five residents (Resident #24 and Resident #70) reviewed for respiratory care, the facility failed to change oxygen tubing per physician orders and for three out five residents who utilized respiratory equipment ( Residents # #4, 55 and 429), the facility failed to ensure the resident's oxygen tubing was dated and labeled . The findings include: 1 Resident #24 had diagnoses that included legal blindness, vascular dementia with behavioral disturbance, major depressive disorder, anxiety disorder and cerebral infarction. The quarterly MDS assessment dated [DATE] identified Resident #24 had severe cognitive impairment, required total assistance with two-person physical support for all ADL and identified the utilization of oxygen while being a resident. The physician's order dated 1/03/21 identified to change oxygen and nebulizer tubing as well as the humidifier bottle once a week. Physician's order dated 11/10/18 identified to apply…

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, review of facility documentation, review of facility policy and interviews for 2 of 2 residents (Resident #5 and Resident #57) reviewed for choices, the facility failed to provide care per resident's preferences. The findings included: 1. Resident #5 diagnoses included dementia, spinal stenosis, abdominal aortic aneurysm and chronic inflammatory demyelinating polyneuritis. The quarterly Minimum Data Set ( MDS) assessment dated [DATE] identified Resident #5 was cognitively intact and required supervision with one-person physical support for personal hygiene. The Resident Care Plan (RCP)7/23/21 identified the resident has an ADL self-care performance deficit related to fatigue, impaired balance, limited mobility and pain. Interventions include: to provide the resident with showers twice weekly with assistance., to provide assistance with ADL. Resident #5 prefers to have a basin of hot water and personal care items at bedside at 6:30 A.M. The resident is able to perform waist…

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, review of facility policy and interviews for eight of ten residents (Resident #12, #16, #17, #29, #32, #61, #64, and #72) reviewed for Medication Administration, the facility failed to ensure medications were given timely and for one resident (Resident # 12) reviewed for edema, the facility failed to ensure anti-embolism compression stockings were applied per the physician order. The findings included: 1. Resident #12 was admitted to the facility in April 2017 with diagnoses that included cerebrovascular disease, atrial fibrillation, diabetics mellitus, and dementia. Review of the Medication Administration Record on 7/28/21 directed the glipizide 2.5 Milligrams (MG) for diabetes scheduled at 7:30 A.M. in the morning before breakfast was given at 12:55 PM. The Humalog 5 units subcutaneous before meals for diabetes scheduled at 8:00 A.M. was given at 12:55 P.M. The Pradaxa 75 MG two times a day for atrial fibrillation scheduled at 9:00 A.M. was not given until 12:55 P.M. There…

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 one resident (Resident #51) reviewed for Medication Administration, the facility failed to ensure the medication error rate was less than 5%. The findings include: Resident #51 's diagnoses included pulmonary embolism, hypertension, atrial fibrillation, and chronic obstruction pulmonary disease. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #51 had a Brief Interview for Mental Status (BIMS) score of 11 out of fifteen, indicative of moderate cognitive impairment. The Resident Care Plan (RCP) dated 6/16/21 identified a potential for cardiac output secondary to chronic heart failure, dyslipidemia, hypertension, bilateral lower extremity edema, and history of Deep Vein Thrombus (DVT) / Pulmonary Embolism (PE). Interventions included to administer any medications and treatments as ordered. Observations and interview with RN #5 on 7/28/21 at 12:15 P.M. identified RN #5 in the process of starting…

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 one resident (Resident # 12) reviewed for edema, the facility failed to ensure an accurate medical record. The findings include: Resident #12 was admitted to the facility in April 2017 with diagnoses that included diabetes mellitus, left anterior fascicular block, chronic atrial fibrillation, and dementia. The quarterly MDS assessment dated [DATE] identified Resident #12 had severely impaired cognition, was frequently incontinent of bowel and bladder and required extensive assistance with activities of daily living. The care plan dated 5/11/21 identified an alteration in cardiac/circulatory status related to atrial fibrillation, hypertension, left anterior fascicular block, and hyperlipidemia. Interventions directed to monitor for pain, edema, cyanosis or dyspnea and report to physician. The physician's progress note dated 6/16/21 identified Resident #12 had Chronic heart failure and the plan was to apply [NAME] stockings 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 observation, interview and facility documentation facility, review of facility policy, the failed to appropriately sanitize a medical device and the facility failed to ensure that staff sign off on water management procedures per facility practice . The findings included: 1. During observation of medication administration on 7/26/2021 at 11:50 A.M., Registered Nurse (RN #7) was observed preparing materials to assess Resident # 35's blood sugar. RN# 7 was observed to have two (2) glucometers on her medication cart. She was observed to remove a germicidal disposable wipe identified as a bleach product from its container and briefly wipe one of the devices and place on a paper towel. RN# 7 then proceeded to gather materials including gloves, 2 x 2 gauze, alcohol wipes, lancet and test strip. RN# 7 proceeded into room and placed the materials directly onto Resident # 35's overbed table without the benefit of any field (barrier). She then proceeded to obtain blood sample from the resident's finger applied to the test strip in the glucometer. With gloved hands she was then noted…

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.