Apple Rehab Saybrook

Based on review of facility documentation, review of facility policies and procedures, and interviews, the facility failed to ensure that the infection prevention control program policies and procedures were reviewed annually, the facility failed to ensure that environmental rounds were conducted/completed quarterly, the facility failed to ensure Infection Control Surveillance data collection reports, analysis of infection trends within the facility were completed monthly, along with quarterly reports, and the facility failed to ensure documentation of quarterly water management plan meetings were conducted. The findings include: 1. Review of the facility's Infection Control Program Policies and Procedure manual for the period of August 2022 to December 2024 with the Regional Director of Nursing Services (RN #6) and the Infection Preventionist (IP) Nurse (LPN #4) on 1/7/25 at 11:41 AM identified that the policies and procedures manual was reviewed on 3/21/22 and 8/30/24 but failed to provide any documentation that the Infection Control Program Policies and Procedure manual 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, review of clinical records, review of facility documentation, review of facility policy/procedures and interviews for two sampled residents (Resident #24 and Resident #55) observed with medications at the bedside, the facility failed to ensure medications were administered as ordered and for one of three sampled residents (Resident #50) reviewed for choices, the facility failed to ensure medications were administered according to prescribed times. The findings include: 1. Resident #24's diagnoses included gastro-esophageal reflux disease without esophagitis (GERD), anemia, major depressive disorder and peripheral vascular disease. The quarterly MDS assessment dated [DATE] identified Resident #24 was cognitively intact, dependent on care for toileting hygiene, dressing and personal hygiene, was non-ambulatory and utilized a wheelchair for mobility. The monthly physician's orders for January 2025 directed Clopidogrel Bisulfate 75 milligram (mg) one tablet by mouth once a day 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 observations, clinical record review, review of facility documentation, review of facility policy, and interviews for one sampled resident (Resident #53) reviewed for foot care, the facility failed to ensure the resident was seen by a podiatrist. The findings include: Resident #53's diagnoses included type 2 diabetes mellitus. The Resident Care Plan (RCP) dated 8/14/23 identified Resident #53 was at risk for hypoglycemia related to type 2 diabetes mellitus. Care plan interventions directed to administer medications as ordered, wash and dry feet thoroughly, note any changes in skin condition, watch for sign and symptoms of hypoglycemia, and check blood glucose per physician order. The physician's orders for December 2024 directed for podiatry services as needed, the order's origination date was 8/14/23. The annual MDS assessment dated [DATE] identified Resident #53 had severe cognitive impairment, required extensive assistance with lower body dressing, toileting, and bathing. The nurse's note 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 review of facility documentation, facility policy and interviews, during a review of the facility antibiotic stewardship program, the facility failed to ensure that the facility's antibiotic surveillance tracking report of antibiotic use, patterns and resistant trends was completed and reviewed at the quarterly medical staff meetings for a multidisciplinary collaboration. The findings include: Review of the antibiotic stewardship program for the period of August 2022 to December 2024 with the Regional Director of Nursing Services (RN #6) and the Infection Preventionist (IP) Nurse (LPN #4) on 1/8/25 at 1:31 PM failed to identify any documentation related to monthly review of the antibiotic stewardship program for the period of August 2022 to September 2023. Review of the quarterly Medical Staff Meeting agendas and documentation provided for, the first, the second, and the third quarter of 2023, and first quarter of 2024, the facility failed to identify any documentation related to infection control and antibiotic usage/antibiotic stewardship program within the facility that…

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 clinical records, review of facility policy, review of facility documentation, and interviews for two of five sampled residents (Resident #20, and Resident #55) reviewed for immunizations, the facility failed to offer and/or assess for pneumococcal immunizations upon admission and when offered the pneumococcal vaccine the facility failed to administer the vaccine as requested. The findings include: 1. Resident #20 was admitted to the facility in March of 2023 with diagnoses that included anemia, acute respiratory failure with hypoxia, and heart failure. The quarterly MDS assessment dated [DATE] identified Resident #20 was cognitively intact. Review of the immunization records for Resident #20 on 1/7/25 at 2:25 PM failed to identify that the pneumococcal vaccine was offered to the resident on admission. Review of the Pneumococcal Vaccine Consent form identified Resident #20 gave the facility permission to administer the pneumococcal based on the guidance provided by the Centers for Disease…

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 allegations of neglect, the facility failed to report of an allegation of neglect timely. The findings include: Resident #1 was admitted to the facility with diagnoses that included asthma, severe obesity and anxiety. The care plan dated 6/13/23 identified Resident #1 was incontinent at times with interventions included to encourage and offer toileting as needed, to wear a brief for dignity, offer to assist Resident #1 to the bathroom and incontinent care per policy. The quarterly MDS dated [DATE] identified Resident #1 had no impairments in cognition, was always incontinent of bowel and bladder, required extensive assistance of two staff to bed mobility, personal hygiene, was totally dependent on two staff for toileting, and was at risk for developing pressure ulcers/injuries. A physician's order dated 10/4/23 directed total mechanical lift 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 review of the clinical record, facility documentation, facility policy, and interviews for 3 of 3 residents (Resident #1, #2 and #3) reviewed for incontinence, the facility failed to complete Braden scales per facility policy. The findings include: 1. Resident #1 was admitted to the facility with diagnoses that included asthma, severe obesity and anxiety. The quarterly Braden scale dated 8/26/22 identified Resident #1 was at risk for pressure injuries/ulcers. The care plan dated 6/13/23 identified Resident #1 was incontinent at times and was at risk for an UTI and/or skin breakdown with interventions that included to encourage and offer toileting as needed, wear a brief for dignity, offer to assist Resident #1 to the bathroom and incontinent care per policy. The quarterly MDS dated [DATE] identified Resident #1 had no impairments in cognition, was always incontinent of bowel and bladder, required extensive assistance of two staff to bed mobility, personal hygiene and was totally dependent on two 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 observations, interviews, review of facility documentation, and facility policy during a review of the environment, the facility failed to ensure fire and egress door alarms were audible and responded to timely, and the facility failed to ensure the environment was safe, secure and free from potential access to hazardous materials and equipment. The findings include: On 7/25/22 at approximately 12:45 PM, the Building Fire and Life Safety Inspectors (BFSI) surveyor informed this surveyor that although Northeast and Northwest Units were currently closed for occupancy by residents, the doors were not secured, and indicated there were potentially hazardous items in various areas on these two units. A.) An Observation on 7/25/22 at 1:00 PM identified the Northwest and Northeast Units of the facility were closed with no residents residing on these two units. The doors leading to the recreation/dining room which was located at the end of the resident occupied [NAME] Unit were closed, but not locked. The room…

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 1 of 5 residents (Resident #8) reviewed for unnecessary medications, the facility failed to ensure that fluid intake was monitored for a resident on a fluid restriction and that daily weights were obtained per the physician's order, and for 1 of 3 residents (Resident #50) reviewed for nutrition, the facility failed to ensure a reweight was obtained for a 5 pound weight change. The findings include: 1. Resident #8 was admitted to the facility on [DATE]. Diagnoses included chronic kidney disease stage 5, chronic obstructive pulmonary disease, type II diabetes mellitus and depression. A.) The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #8 was moderately cognitively impaired and was independent with eating after set-up. A physician's order dated 4/13/22 directed a fluid restriction of 1200 milliliters (ml) per day. A nurse's note dated 4/13/22 indicated that Resident #8 was on a fluid restriction (1500ml…

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 observations, interviews, and facility policy review, the facility failed to ensure that the cooking appliances, including the stove hood, flat top grill and ovens in the food preparation area, were clean and free of debris and failed to ensure clean beverage distribution during a mealtime. The findings included: 1. During an initial tour of the facility kitchen on 7/25/22 at 10:00 AM with the acting Director of Dietary, multiple appliances, including the flat top grill, 2 ovens and the vent range hood, were observed to have debris and did not appear clean. The flat top grill was observed to have what appeared to be food particles on the cooking surface, with a dried white substance observed on the metal external surfaces. The flat top grill was noted to have debris and a dried dark substance on the tabletop under where the grill was positioned. The ovens were observed to have a dried white substance on the exterior surfaces, and the glass oven doors were covered with a brown opaque substance on the interior glass, which did not allow observation into the oven without…

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 interviews during a review of the infection control task, the facility failed to identify at least one person who is designated as responsible for the facility's Infection Prevention and Control Program. The findings include: Interviews with RN#1 and RN#3 on 7/25/22 at 11:10 AM identified that the facility did not have an infection control nurse on staff and the last infection control nurse left employment in April 2022. RN#1 was presently overseeing the infection control program, however, did not have training in infection control, and was also designated as corporate staff. Interview with RN#3 on 7/27/22 at 10:15 AM identified that the facility was currently recruiting for an infection control nurse. RN #3 indicated that she was aware that the facility did not meet the requirement to designate one or more individual(s) as the infection preventionist(s) who are responsible for the facility's Infection Prevention and Control Program. Although requested, the facility did not provide a policy for surveyor review.

Based on review of facility documentation and interviews during a review of the Infection Prevention Program, the facility failed to notify residents, their representatives, and families of a COVID-19 outbreak per the requirement. The findings include: Interview with RN#3 on 7/27/22 at 10:15 AM identified that a staff member had tested positive for COVID-19 on 7/21/22. The staff member was subsequently taken off the schedule and remains out from work. Interview with the Administrator on 7/28/22 at 11:15 AM identified a facility staff member had tested positive for COVID-19 on 7/21/22. The Administrator indicated that she was the responsible staff member assigned to provide the notice per the requirement, (by 5:00 PM the following day), but that notices had not, as yet, been sent to residents, their families, or their representatives. The Administrator indicated that phone issues had prevented her from initially notifying the appropriate parties, however, once the phone issues had resolved she had still not made the required notification (7 days after the outbreak began) but should…

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 and interviews for one of three residents (Resident #35) reviewed for abuse, the facility failed to ensure a personal property inventory was completed upon admission. The findings include: Resident #35 was admitted on [DATE]. Diagnoses included diabetes, encephalopathy, adjustment disorder, mood disorder, conduct disorder and personality disorder. Physician's orders dated 6/6/22 directed behavior monitoring every shift, document: picking at skin, restlessness/agitation, hitting, spitting, use of profanity, use of racial slurs, delusions, hallucinations, stealing, psychosis and refusing care. The admission MDS dated [DATE] identified the resident had moderate cognitive impairment, felt it was very important to take care of his/her personal belongings and required supervision for transfers and dressing. The care plan dated 6/21/22 identified a focus of potential for exhibiting signs of depression, may exhibit accusatory behavior at time, interventions included to allow…

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, interviews, and review of facility policy for three of seven residents reviewed for advance directives (Resident #20, #35, and #50) the facility failed to ensure advance directive education, consents, and orders were appropriately addressed. The findings include: 1. Resident #20's medical record contained a designation of Conservator of Person dated 5/2/18, in the event of future incapacity. Resident #20 was admitted on [DATE]. Diagnoses included dysphagia and cerebral infarction. A facility advance directive document in the clinical record was signed and dated by both Resident #20 and the physician on 7/27/18, and identified the resident chose to be a full code. On top of the 7/27/18 document, another facility advance directive form dated 8/21/20 was signed by APRN #3 and directed the choice for Do Not Resuscitate (DNR). The form failed to identify APRN #3 had discussed the decision with the Resident #20 or their surrogate. The Quarterly Minimum Data Set (MDS) assessment…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based upon record review, review of facility policy, review of facility documentation, and interviews, for one of three residents reviewed for abuse (Resident #55) the facility failed to notify the State health agency of an injury of unknown origin within the required time frame. The findings include: Resident #55 ' s diagnoses included dementia, macular degeneration, and depressive disorder. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified that Resident #55 had a Brief Interview for Mental Status (BIMS) score of 10 out of 15, moderate cognitive impairment and required extensive assistance with bed mobility, transfers, and dressing. The nurse's note dated 12/6/2021 at 4:59 PM identified that Resident #55 complained of right shoulder pain and an x-ray was ordered. The results reported on 12/7/2021 indicated modest degenerative joint disease with mild subluxation/dislocation of right shoulder. A review of the Accident and Incident report dated 12/13/2021 identified that Resident #55 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 clinical record review, and interviews for the only sampled resident (Resident #25) reviewed for positioning, for the only sampled resident (Resident #48) reviewed for pressure ulcers, and for the only sampled resident (Resident #54) reviewed for abnormal vital signs, the facility failed to ensure implementation of practitioner's orders for Resident #25 and Resident #54 and failed to ensure weekly body audit assessments were completed for Resident #48. The findings included: 1. Resident #25's diagnoses included diabetes, vascular dementia, difficulty walking and abnormality of gait and movement. The significant change Minimum Data Set (MDS) assessment dated [DATE] identified Resident #25 had severely impaired cognition and required extensive assistance of two staff for dressing A Physician's order dated 4/25/22 directed Thrombo-Embolus Deterrent (TED) stockings (compression stockings), place on Resident #25 in the morning, and remove in the evening. The Resident Care Plan (RCP) dated 4/28/22 identified…

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 the only sampled resident (Resident #54) reviewed for oxygen therapy, the facility failed to ensure that the resident's oxygen tubing was changed timely per the physician's order and facility policy. The findings included: Resident # 54's diagnoses included Hypertensive heart and chronic kidney disease (CKD), Chronic Obstructive Pulmonary disease (COPD) and Cerebral infarction. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified that Resident #54 had a Brief Interview for Mental Status (BIMS) score of fifteen out of fifteen, indicating no cognitive impairment. The quarterly MDS identified that Resident #54 required extensive with bed mobility and was totally dependent on staff for transfers. The Resident Care Plan (RCP) dated 5/2/2022 identified Resident #54 was at risk for sleep apnea. Interventions directed oxygen via nasal cannula at bedtime as ordered, and oxygen tubing should be changed every week per facility policy. 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, observations, and interviews for one of two units reviewed for dining, for Resident #29, the facility failed to accommodate a food preference. The findings include: Resident #29's diagnoses included Parkinson's Disease, dysphagia, diabetes mellitus, and bladder cancer. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified that Resident #29 had a Brief Interview for Mental Status (BIMS) score of 13 out of 15, indicating no cognitive impairment. A physician's order dated 06/29/22 directed to provide a carbohydrate-controlled diet for dysphagia Level two. The Resident Care Plan (RCP) dated 7/14/22 identified that Resident #29 had a potential for nutritional problems related to Parkinson's Disease and received a diabetic diet. Interventions directed to encourage the intake of food and fluids, offer choices at meals, and provide diet as ordered by the physician, but respect choices. Observation on 7/25/22 at 12:10 PM identified Resident #29's dietary slip indicated…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Resident #13 FTag Initiation Based on review of the clinical record, facility policy, observations, and interviews for one of two units reviewed for dining, for Resident #13, the facility failed to provide the required adaptive dining equipment. The findings include: Resident #13's diagnoses included Alzheimer's Disease, vascular dementia, transient cerebral ischemic attack (stroke), and cataracts. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified that Resident #13 had a Brief Interview for Mental Status (BIMS) score of 3 out of 15, indicating severe cognitive impairment and required supervision after set-up with eating. The Resident Care Plan (RCP) dated 5/31/22 identified a need for assistance with meal set-up and supervision. Interventions directed to provide a lidded cup with all meals. The Occupational Therapy Screening form dated 6/28/22 identified that Resident #13 required assistance with self-feeding. The occupational therapist note dated 6/29/22 at 7:45 AM identified the need 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.

Based on review of facility documentation, facility policy and interviews, the facility failed to act promptly, including providing a resolution, to concerns and grievances raised during the resident council meetings. The findings include: Review of resident counsel minutes dated 2/25/19 identified a concern was raised regarding call bell response time over the previous weekend. The facility response included interviewing for new staff. Review of the resident counsel minutes dated 3/25/19 identified concerns were raised regarding; not being assisted out of bed in a timely manner, and call bells are not being answered timely. The minutes failed to reflect a response or resolution regarding the concerns. Review of the resident counsel minutes dated 4/29/19 identified call bell response was not timely during the night shift. The minutes failed to reflect a response or resolution regarding the concerns. Review of the resident counsel minutes dated 5/20/19 identified a resident felt frustrated because staff explain (they are running short and that is why it's taking longer for care). 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, facility documentation, facility policy and interviews, for 6 of 7 residents (Resident #8, 25, 30, 38, 41, and 56) who were dependent on staff for care, the facility failed to follow the plan of care regarding ADL's. The findings include: 1. Resident #8 was admitted to the facility on [DATE] with diagnoses that included aphasia, and intellectual disability. The quarterly MDS dated [DATE] identified Resident #8 had severely impaired cognition, was unable to speak and make needs known or understand others, was always incontinent of bowel and bladder and required total assistance with care. A physician's order dated 7/30/19 directed to transfer Resident #8 out of bed to a custom wheelchair with the assistance of 2 staff a mechanical lift for 6 - 8 hours daily. The care plan dated 10/21/19 identified Resident #8 is wheelchair bound and is dependent on staff for all activities of daily living. Interventions included to anticipate and meet the resident's needs, use short simple…

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, and interviews for 1 of 2 residents (Resident #8) reviewed for vision and audiology, the facility failed to provide routine vision, audiology, and podiatry services. The findings include: Resident #8 was admitted to the facility on [DATE] with diagnoses that included aphasia, anxiety, cataracts, anxiety, and profound intellectual disabilities. A Nursing admission assessment dated on 1/11/17 identified Resident #8's hearing was adequate in both ears, and vision was impaired. A physician's order dated 1/13/17 directed to consult vision, dental, podiatry, and audiology, as needed. A Department of Developmental Services annual report dated 9/21/18 identified because the review was unable to find Resident #8 had consultations with podiatry, vision, dental and audiology, the facility was asked to follow up with Resident #8's primary physician to obtain the services. Additionally, the report indicated if the resident had not received these services,…

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 6 of 7 residents (Resident #8, 25, 30, 38, 41, and 56) who were dependent on staff for care, the facility failed to ensure sufficient staff to meet the needs of the residents according to the plan of care. The findings include: 1. Resident #8 was admitted to the facility on [DATE] with diagnoses that included aphasia, and intellectual disability. The quarterly MDS dated [DATE] identified Resident #8 had severely impaired cognition, was unable to speak and make needs known or understand others, was always incontinent of bowel and bladder and required total assistance with care. A physician's order dated 7/30/19 directed to transfer Resident #8 out of bed to a custom wheelchair with the assistance of 2 staff a mechanical lift for 6 - 8 hours daily. The care plan dated 10/21/19 identified Resident #8 is wheelchair bound and is dependent on staff for all activities of daily living. Interventions included to anticipate…

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 interview for 2 (Resident #4 and 8) reviewed for dental services, the facility failed to ensure dental services were provided in a timely manner. The findings include: 1. Resident #4 was admitted to the facility on [DATE] with diagnoses that included a stroke, heart failure and peripheral vascular disease. Review of a dental request for service form dated 1/9/19 and signed by resident's representative identified Resident #4 requested to be seen for dental services. The admission nutritional assessment dated [DATE] identified the resident was missing teeth and had teeth in poor condition, and was on a carbohydrate controlled regular consistency diet with thin liquids. The admission MDS dated [DATE] identified the resident was cognitively intact and was independent with eating after set up. The care plan dated 1/29/19 identified Resident #4 had a history of dental caries and was at risk for complications. Interventions…

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, review of facility documentation, facility policies and staff interviews, the facility failed to store food and/or remove expired food items according to professional standards. The findings include: a. A tour of the kitchen on 10/28/19 at 9:45 AM with the Food Service Director (FSD) identified the following: In the walk in refrigerator; a container of egg salad dated 10/16/19 (12 days ago) and a container of tuna salad dated 10/24/19, (4 days ago). The FSD identified she did not know who prepared the food items and indicated the items were good for 3 days after the date on the container. Additionally, the FSD identified the outdated food items should have been discarded. Further, the FSD indicated it was everyone's job to check for and discard outdated items in the refrigerator; however, the responsibility was not assigned to any one person. b. Observation of the freezer on 10/28/19 at 10:00 AM with the FSD identified 4 boxes that contained open unsealed bags of dinner rolls, sausage links, hamburger patties, dark meat chicken patties and a bag 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 and review of facility documentation and interview with the Director of Maintenance the facility failed to ensure that a water management plan was in place to Reduce Legionella Risk in the Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires' Disease (LD) as required by 42 CFR §483.80 for skilled nursing facilities. On 10/29/19 at 10:30 AM, the surveyor was provided with documentation by the Director of Maintenance to indicate the facility had a comprehensive water management plan in place as required. However, the facility failed to follow recommendations made in the plan to eliminate identified dead ends in the water system. The facility also did not supply documentation that the water was ran in the identified areas in the water system. The surveyor witnessed tubs with plywood over them and shelving installed negating the ability to run the water. The lack of initiating the recommended control measures did not reduce the risks for Legionella and other opportunistic waterborne pathogens; e.g., Pseudomonas, Acinetobacter,…

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 2 of 5 residents (Resident #46 and 58) reviewed for immunizations, the facility failed to ensure that the residents pneumococcal vaccination history was complete and that pneumococcal vaccinations were offered and administered per facility policy. The findings include: 1. Resident #46 was admitted to the facility on [DATE] with diagnoses that included Diabetes, anxiety and major depression. Review of the immunization tracking form identified Resident #46 had received one dose of pneumococcal polysaccharide vaccine (PPSV 23) on 10/1/05. Review of the clinical record on 10/29/19 failed to reflect Resident #46 had been offered or received the pneumococcal conjugate vaccine (PCV 13) between 7/19/19 - 10/29/19. Subsequent to surveyor inquiry the resident's immunizations record was updated on 10/30/19 and identified Resident #46 had received the (PVC 13) vaccine on 11/10/15. 2. Resident #58 was admitted to the facility…

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 #278) reviewed for rehabilitation, the facility failed to ensure a functional maintenance program was followed according to the plan of care. The findings include: Resident #278 was admitted to the facility on [DATE] with diagnoses that included recent surgery, generalized muscle weakness, unspecified abnormalities of gait and mobility. The 5-day MDS dated [DATE] identified Resident #278 had severely impaired cognition, was totally dependent for eating, and required extensive assistance for bed mobility, walking in the corridor, dressing, toilet use and personal hygiene. Additionally, the MDS identified Resident #278 had potential for increased independence related to activities of daily living. The care plan dated 10/3/19 identified Resident #278 was weak following a hospitalization and required assistance with activities of daily living, with a goal to achieve the highest 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 observation, review of the clinical record, facility documentation, and interviews for 1 resident (Resident #279) reviewed for respiratory care, the facility failed to ensure a newly admitted resident was assessed and monitored by nursing and by the physician for 2 days after admission, and failed to document care according to physician's orders. Hospital documentation dated 10/27/19 identified that Resident #279 had been admitted to the hospital for 7 days with a respiratory infection. Resident #279 was admitted to the facility on [DATE] with diagnoses that included acute on chronic respiratory failure with hypoxia. An APRN order dated 10/27/19 directed to check the resident's bowel sounds each shift, to check vital signs every shift for 3 days, to obtain an admission height and weight, and to monitor intake and output for 72 hours. Interview with Resident #279 on 10/28/19 at 12:25 PM identified that he/she had been admitted to the facility the previous day and indicated that although the nursing 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 observation, review of the clinical record, facility documentation, and interviews for 1 resident (Resident #2) reviewed for range of motion, the facility failed to provide care according to professional standards to re-evaluate a splint, used to treat a contracture, after the resident's continuous refusals. The findings include: Resident #2 was admitted to the facility on [DATE] with diagnoses that included osteoarthritis, contracture to left hand, and dementia. An orthopedic consultation dated 4/18/19 indicated Resident #2 was recommended for tendon lengthening procedure to address chronic contracture to left hand. Review of a Nursing to Therapy Communication form dated 5/26/19 indicated per orthopedic recommendation, please evaluate left hand, question need for a splint. A splinting consultation dated 6/5/19 identified Resident #2 has a severe degree of contracture to the left hand. The consultation indicated a left hand splint was provided. An Occupation Therapy Plan of Care dated 6/5/19 indicated…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility documentation, facility policy and staff interviews for 1 resident (Resident #61) reviewed for medication errors, the facility failed to ensure a resident was free from a significant medication error. The findings include: Resident #61 was admitted to the facility on [DATE] with diagnoses that included major depression, bipolar disorder, and anxiety. The quarterly MDS dated [DATE] identified Resident #61 had mild cognitive impairment, required extensive assistance with transfers and did not walk. Additionally the MDS identified Resident #61 had no behaviors and required an antipsychotic medication 7 days a week. The physician's order dated 9/4/19 directed to administer Lithium Carbonate (a medication used to treat bipolar disorder, which requires blood tests to monitor blood levels to ensure the correct dose is prescribed) 300 mg every morning and at bedtime. Review of the September 2019 MAR identified that Lithium Carbonate 300 mg was not administered on 9/28/19…

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 and staff interviews for 1 resident (Resident #328), reviewed for medication storage, the facility failed to ensure a medication was stored in an appropriate container with approved labeling according to current acceptable professional standards. The findings include: Resident #328 was admitted to the facility on [DATE] with diagnosis that included diabetes, obstructive sleep apnea, anxiety and morbid obesity. The physician's orders dated 10/25/19 directed to administer Sudafed 10 mg every 4 hours as needed for cold symptoms, not to exceed 6 tabs in 24 hours. Review of the October 2019 MAR identified Sudafed 10mg was administered once on 10/27/19 and 2 times on 10/28/19. Interview and observation of the medication cart on the North East Wing on 10/28/19 at 12:23 PM with LPN #3 identified a brown medicine container with 12 red pills located in the top drawer of the cart. Additionally, the bottle had a makeshift label cut from a Sudafed box that read (Sudafed PE…

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.