Apple Rehab Shelton Lakes

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of facility documents and staff interviews, the facility failed to ensure the call bell system on the rehabilitation wing was functioning properly and relayed calls directly to the centralized nursing station. The findings include: A concern was received by the state agency on 1/5/2024. The concern indicated that when a call bell was pushed it would light up above the resident's door but would not ring at the nurse's station. The concern also indicated the person who had spoken to staff about the call bell issues without a resolution. On 12/4/24 at 10:30 AM the call bell system was tested with NA#15. The call light at the head of the bed for room [ROOM NUMBER] and room [ROOM NUMBER] were tested. On both observation with NA#15 the lights outside the rooms lit up, and there was no sound at the nurse's station. An observation with NA#15 identified that the call bell system at the nurse's station did not display the room number that was calling; instead, the call bell system displayed…

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, observations, facility documentation, facility policy and interviews for 2 of 3 sampled residents (Resident #28 and Resident #32) reviewed for resident rights, the facility failed to ensure a resident(s) with a urinary collection device was treated in a dignified manner. The findings include: 1. Resident #28's diagnoses included obstructive and reflux uropathy and other disorders of the prostate. The quarterly Minimum Data Set ( MDS) assessment dated [DATE] identified Resident #28 as moderately cognitively impaired and required (1) to (2) assist with Activities of Daily Living (ADL). The Resident Care Plan (RCP) dated 11/12/24 identified Resident #28 had an indwelling urinary device in place. Interventions directed provide catheter care as ordered, change drainage bag as ordered and provide privacy cover for drainage bag. The physician's orders dated 11/13/24 directed catheter care every shift and apply leg bag when out of bed. An observation with the Director of Nursing…

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 1 of 1 resident reviewed for Hospice/ End of Life ( Resident #154), the facility failed to ensure the care plan was revised when the resident elected Hospice/ End of Life services. The findings included: 1. Resident #154's diagnoses included dementia and arteriosclerotic heart disease. The annual Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #154 did not receive Hospice/ End of Life services and did not have a prognosis of 6 months or less. A nursing progress note dated 11/23/2024 at 12:21 PM indicated in part Resident #154 was admitted to hospice care effective 11/23/2024. An interview and record review on 12/6/2024 at 10:00AM with the MDS Coordinator (RN #3) identified the Social Worker (SW) is responsible for residents on Hospice, and if no care plan was noted when completing the Significant Change MDS assessment. RN #3 would initiate a hospice care plan at the time of the Significant Change MDS . An interview…

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 policy and staff interviews for 1 of 3 residents ( Resident #13) reviewed for Nutrition, the facility failed to ensure re-weights were obtained when the resident was noted with a 5-pound discrepancy in accordance to facility policy. The findings include: Resident #13 was admitted on [DATE]. The resident's diagnosis included dysphagia. A review of the weights documented in the Weights and Vitals Summary indicated the following: On 1/29/2024 at 3:02 PM Resident #13 was weighed via Hoyer lift on admission and weighed 116.6 pounds. On 2/5/2024 at 11:56 AM Resident #13 weighed 137.0 pounds standing, (a 20.4-pound weight gain in 7 days). On 2/8/2024 at 12:22 PM Resident #13 weighed 142.0 pounds standing, (a 5-pound weight gain in 3 days). The dietician note dated 2/8/2024 at 12:26 PM indicated in part the admission weight of 116.6 was inaccurate as the hospital discharge weight was 126 pounds. A review of weights documented in the Weights and Vitals Summary…

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 accidents, the facility failed to ensure appropriate interventions were implemented for a resident at risk for falls when the resident made multiple attempts to get up from the chair without assistance which resulted in a fall. The findings include: Resident #1 diagnoses that included history of falls, repeated falls, anxiety, and multiple fractures of ribs on right side status post fall. The nursing admission assessment dated [DATE] identified Resident #1 was at moderate risk for falls. The 5-day MDS dated [DATE] identified Resident #1 had a Brief Interview for Mental Status (BIMS) with a score of twelve (12) indicative of moderately impaired cognition, was always continent of bowel and bladder, required moderate assistance with dressing, toileting hygiene, personal hygiene, bed mobility, and transfers. The care plan dated 10/5/24 identified Resident #1 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.

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 two (2) residents, (Resident #2), reviewed for medication administration, the facility failed to notify the physician when medications were unavailable for administration. The findings include: Resident #2 was admitted to the facility on [DATE] with diagnoses that included chronic pain, hemiplegia and hemiparesis following cerebral infarction, Parkinson's disease, depression, and anxiety disorder. An admission progress note dated 12/29/23 at 10:30 PM identified that the resident was alert and oriented, and required assistance with activities of daily living. Physician orders dated 12/29/23 directed to administer the following medications: 1. Fentanyl ( a pain medication) 25 mcg/hr, transdermal patch, applied every three days, at 9:00 AM 2. Amantadine (treats Parkinson's disease) capsule, 100 mg, oral, given daily, at 9:00 AM. 3. Zolpidem (a sedative) tablet 5 mg, oral, given nightly, at 9:00 PM. 4.…

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 two (2) residents, (Resident #2), reviewed medication administration, the facility failed to ensure medications were administered in accordance with physician orders, and for one (1) of four (4) residents, (Resident #3), reviewed for elopement the facility failed to accurately complete an elopement risk assessment, obtain a physician's order for an elopement safety device, and to monitor an elopement safety device in accordance with facility policy. The findings include: 1) Resident #2 was admitted to the facility on [DATE] with diagnoses that included chronic pain, hemiplegia and hemiparesis following cerebral infarction, Parkinson's disease, depression, and anxiety disorder. An admission progress note dated 12/29/23 at 10:30 PM identified that the resident was alert and oriented, and required assistance with activities of daily living. Physician orders dated 12/29/23 directed to administer 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 review, observations, facility documentation, facility policy, and interviews for one (1) of three (3) residents, (Resident #3), reviewed for elopement, the facility failed to prevent a resident with a history of wandering from leaving the facility unattended. The findings include: Resident #3's diagnoses included dementia. The significant change Minimum Data Set (MDS) assessment dated [DATE] identified that Resident # 3 had a Brief Interview for Mental Status (BIMS) score of nine (9) out of fifteen (15) indicative of moderate cognitive impairment, ambulated with supervision and a device, and required assistance with activities of daily living. A Resident Care Plan (RCP) dated 8/4/22 identified that Resident #3 frequently wandered, could be confused and forgetful with interventions that directed to apply wander guard, check placement each shift, check wander guard every day as per facility policy and if resident was heading towards or lingering near an exit door to escort resident 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 observations, review of clinical records, facility documentation, facility policy, and interviews for 3 of 3 residents (Resident #31, #75, and #198) reviewed for Medication Administration, the facility failed to ensure medication were given in a timely manner per physician ' s orders. The findings include: 1. Resident #31 was admitted to the facility with diagnoses that included hypothyroidism, fibromyalgia, dementia, persistent asthma, post-polio syndrome and vitamin D deficiency. The care plan dated 5/23/22 identified a diagnosis of asthma. Interventions directed to give medications as ordered. The quarterly MDS assessment dated [DATE] identified Resident #31 ' s Brief Interview for Mental Status (BIMS) noted a score of 11 which noted impaired cognition. The assessment noted the resident required extensive assistance with personal hygiene and limited assistance with dressing, toileting, and transfers with one-person physical assist. A physician ' s order dated 8/10/22 directed to Ketotifen Fumarate…

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 3 residents (Residents #2, #31, and #75) reviewed for respiratory care and for (Resident #31 and #75), the facility failed to change the resident's oxygen tubing, nebulizer tubing, and nebulizer mask within accordance to facility policy, and failed to obtain a physician's order for oxygen and nebulizer care and for (Resident #2), the facility failed to obtain a physician's order prior to administering oxygen therapy. The findings included: 1. Resident #75 was admitted to the facility on [DATE] with diagnoses that included Chronic Obstructive Pulmonary (COPD) disease, and asthma. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #75 had intact cognition and required extensive assistance with personal hygiene. The care plan dated 9/1/22 identified a diagnosis of chronic obstructive pulmonary disease. Resident #75 at risk for respiratory distress, ineffective breathing…

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 reviewed for specialized treatment (Resident #67), the facility failed to ensure fluid intake and output was consistently monitored for a resident on a fluid restriction who received specialized services. The findings include: Resident #67 was admitted with diagnoses that include end stage renal disease, Type II diabetes mellitus and dependence on specialized treatment. A quarterly MDS assessment dated [DATE] identified Resident# 67 was moderately cognitive impairment, required assistance with personal care and received specialized services. The care plan dated 8/9/22 identified Resident #67 had chronic kidney disease and received hemodialysis. Interventions included to provide diet as ordered, monitor laboratory work and to monitor Intake and Output (I&O) as ordered per policy. The physician's orders directed Fluid Restriction of 1200ML/24 Hours (320 ml nursing and 880 ml dietary). A review of Resident…

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

Based on review of facility documentation, facility assessment, and interviews, the facility failed to ensure that staffing levels were adequate for (95) residents on 4 units within accordance with the plan of care. The findings include: A review of the staffing allocation sheet dated 9/11/22 identified the night shift had one (1) Registered Nurse, two (2) Licensed Practical Nurse, and two (2) Nurse Aides. A review of the census report on 9/11/22 identified the facility capacity was 106 beds and the census was 95 residents in the facility. A review of the census report dated 9/11/22 identified the Rehabilitation unit (consist of 2 units) which had a census of 41 residents. Review of the census report dated 9/11/22 identified the skilled nursing unit (consist of 2 units) had a census of 54 residents. A review of the daily staffing breakdown schedule dated 9/11/22 for the 11:00 PM - 7:00 AM shift identified the Rehabilitation units (consist of 2 units), the census was 41 and there was one (1) charge nurse and one (1) Nurse's Aide (NA) assigned to the unit. Review of the daily staffing…

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 #63) reviewed for unnecessary medications, the facility failed to respond to pharmacy irregularities. The findings include: Resident #63 was admitted with diagnoses that included atherosclerotic heart disease, atrial fibrillation, and congestive heart failure (CHF). A quarterly MDS assessment dated [DATE] identified Resident #63 had moderate cognitive impairment and required limited assist with personal care. The care plan dated 8/11/22 identified Resident #63 had a history of CHF. Interventions included the administration of medications as ordered, laboratory work as ordered and to follow up with cardiologist and pulmonologist as ordered. A physician's orders directed Amiodarone 100mg daily. The Pharmacy Consultation Reports dated 8/1/2021 through 8/30 2022 identified on 3/10/22 and 4/5/22 Resident #63 was prescribed Amiodarone 100 mg daily (used in the management of CHF)…

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 #67) reviewed for abuse, the facility failed to ensure a resident was free from verbal mistreatment. The findings include: Resident #67 was admitted to the facility on [DATE] with diagnoses that included atrial fibrillation, hepatitis C, congestive heart failure, end stage renal disease. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #67 had intact cognition and required extensive assistance with personal hygiene. A nurse's note dated 6/20/22 at 7:51 PM identified documentation by the Director of Nursing Services (DNS) which identified staff observed Resident #67 being verbally threatened by his/her roommate (Resident #35) that s/he would punch Resident # 67. Resident #67 was moved out of the room by staff immediately. Resident #67 felt safe, denied any issues or concerns at this time, no pain, and no distress was noted. The state agency, Administrator, 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 of 2 residents (Resident #5) reviewed for abuse, the facility failed to report an allegation of verbal mistreatment to the overseeing state agency within required time frames. The findings include: Resident #5 was admitted with diagnoses that included chronic obstructive pulmonary disease and ileostomy. 5-day PPS MDS assessment dated [DATE] identified Resident #5 had no cognitive impairment, required extensive assist with bed mobility, transfers, toileting and personal care. The care plan dated 6/28/22 identified Resident #5 required assist with Activities of Daily Living (ADL) and had an ileostomy colon resection with interventions that included the provision of ileostomy care as needed. A Concern Form dated 8/7/22 identified Resident #5 did not want to make an official complaint but did not want to work with Nurse Aide (NA #8) stating s/he did not listen to Resident #5. All efforts would be made to ensure NA…

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 documentation, review of facility policy and interviews for one of three residents, (Resident #40), reviewed for accidents, the facility failed to ensure care was provided safely after a fall with injury and for one of four sampled residents (Resident #41) who required assistance with meal set-up or supervision, the facility failed to ensure the resident was not able to access the meal tray prior to being provided with set up assistance. The findings included: 1.Resident #40 was admitted to the facility with diagnoses that included dementia, anxiety, and depression. A quarterly MDS assessment dated [DATE] identified Resident #40 was severely cognitively impaired required extensive assistance with one staff for transfer, toileting, and personal hygiene. A care plan reviewed on 12/14/21 identified Resident #40 required assistance with ADL needing set up for oral care and limited assistance for daily washing, dressing, and grooming. Additionally, the care plan…

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, observation, facility policy, and interviews for 1 resident (Resident #73) reviewed for urinary catheter or UTI, the facility failed to ensure a urinary catheter tubing was free of obstruction to facilitate the resident's urine flow. The findings include: Resident #73 was admitted to the facility in February 2022 with diagnoses that included malignant neoplasm of bladder, gross hematuria, neuropathic bladder, and benign prostatic hyperplasia with lower urinary tract symptoms. The physician's order dated 7/9/22 directed to provide catheter care every shift and as needed. The physician's order dated 8/6/22 directed to change the indwelling foley catheter monthly and as needed for blockage or dislodgement every night shift every 30 days for foley management. The physician's order dated 8/6/22 directed to irrigate foley catheter for hematuria and to monitor for worsening symptoms, if worsens call Medical Doctor (MD)/APRN for hospital transfer out. The quarterly 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 on clinical record review, review of facility policy and interviews for 1 resident, (Resident #27) reviewed for pressure wounds, the facility failed to complete weekly weights as ordered and to have the dietician address a significant weight loss timely. These findings include: Resident # 27 was admitted with diagnoses that include Alzheimer's disease, dysphagia, and lupus. A Nursing admission assessment dated [DATE] identified Resident #27 weight was 111 pounds, required 1 staff to assist with transfers and bed mobility and noted the resident was independent for eating, A baseline care plan dated 6/3/22 identified Resident #27 had a nutritional goal to maintain current weight and to prevent weight loss. A physician's order dated 6/3/22 directs to weigh resident weekly times 4 weeks on Friday. An admission minimum data set (MDS) dated [DATE] identified that Resident # 27 was severely cognitively impaired requiring extensive assistance of 1 staff for bed mobility and supervision with 1 staff member 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 clinical record review, review of facility documentation, facility policy review and interview for one resident (Resident #348) reviewed for Intravenous (IV) therapy, the facility failed to ensure the parenteral fluid was administered consistently with professional standard of practice. The findings include: Resident #348 's diagnoses included sepsis, peritoneal abscess, hypomagnesemia, irritable bowel syndrome, convulsion, chronic kidney disease, hyperlipidemia, and type 2 diabetes mellitus. The admission MDS assessment dated [DATE] identified Resident #348 had intact cognition and required extensive assistance of 1 to 2 people for transfers, dressing, toileting, and hygiene. The physician's order dated 7/6/22 identified Resident #348 was directed to administered Vancomycin solution 750 MG intravenously daily and Ceftriaxone solution 2 gram intravenously at bedtime. The Resident Care Plan (RCP) dated 7/11/22 identified Resident #348 had received an IV antibiotic via peripherally inserted catheter 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, review of policy and staff interviews for1 resident, (Resident #80) reviewed for rehabilitation services, the facility failed to ensure the resident was evaluated by a physician every 60 days. The findings included: Resident #80 was admitted to the facility with diagnoses that included heart failure, generalized muscle weakness and arthritis. A quarterly MDS assessment dated [DATE]identified Resident #80 was moderately cognitively impaired and requires supervision for set up help for bed mobility and transfer and required supervision with 1 staff to walk in the room. Additionally, Resident #80 was independent with walking on the unit with a walker. A review of Resident #80 's clinical record identified a physician progress note last written on 6/21/22. Interview with Resident # 80 on 9/12/22 at 1:00 PM identified Resident #80 reported her/his physician had resigned from her/his case in June 2022 and the facility had not yet assigned another physician to her/his case. Interview…

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, facility policy, and interviews for 2 of 3 Residents (Resident #31 and #75) reviewed for Medication Administration, the facility to ensure medications were administered within accordance to physician ' s orders and professional standards to ensure the facility had a medication error rate less than 5%. The findings included: 1. Resident #31 was admitted to the facility with diagnoses that included hypothyroidism, fibromyalgia, dementia, persistent asthma, post-polio syndrome and vitamin D deficiency. The care plan dated 5/23/22 identified a diagnosis of asthma. Interventions directed to give medications as ordered. The quarterly MDS assessment dated [DATE] identified Resident #31 ' s Brief Interview for Mental Status (BIMS) noted a score of 11 which noted impaired cognition. The assessment noted the resident required extensive assistance with personal hygiene and limited assistance with dressing, toileting, and transfers with one-person physical assist. 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, facility policy and interviews for 1 of 2 medication carts, the facility failed to ensure that insulins vials were labeled with residents name and dated when opened and inhalers were dated when opened. The findings include: Resident # 75 was admitted to the facility with diagnoses that included fractures of the lumbosacral spine and pelvis and fracture right clavicle. The care plan dated 8/19/22 identified osteoporosis. Interventions directed to administer medications as ordered by the physician. The admission MDS assessment dated [DATE] identified Resident #75 had intact cognition and required extensive assistance with transfers, dressing, toileting, and personal hygiene with one-person physical assist. A physician ' s order dated 8/25/22 directed to give Norvasc 5mg daily for high blood pressure, anoro ellipta aerosol powder 62.5/25 mcg inhaler daily for respiratory daily, Vitamin D(Cholecalciferol) give 25 mcg daily, and Tramadol 50 mg tablets…

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 interview for 2 residents (Resident #2 and # 73), the facility failed to ensure the resident's medical record was complete. The findings includes: 1. a. Resident #2's diagnoses included bronchitis, congestive heart failure, asthma, and chronic obstructive pulmonary disease. The physician's order dated 9/1/22 directed to administer Ipratropium-Albuterol Solution 0.5-2.5 mg/3 ml. 3 ml inhale orally every 6 hours as needed for shortness of breath. The admission MDS assessment dated [DATE] identified Resident #2 had intact cognition and required extensive assistance with personal hygiene. Review of the census list identified Resident #2 was transferred to the hospital on 9/7/22. The nurse's note dated 9/7/22 at 2:07 PM identified the ADNS was made aware at approximately 11:30 AM Resident #2 was complaining of abdominal pain with a rating of 8/10. During care the NA and the charge nurse observed a moderate amount of frank red blood in the stool. Resident…

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

Based on observations, facility documentation, facility policy, and interviews, reviewed for infection control, the facility failed to ensure staff followed the facility employee handbook regarding hand/nail hygiene. The findings include: Observations on 9/12/22 and 9/14/22 identified the following staff with extremely long fingernails: a. Interview with LPN #1 on 9/12/22 at 11:08 AM identified she has been employed by the facility for approximately 9 months. She indicated that she was aware that her fingernails were too long, and she has not had a chance to go to the nail salon. She also indicated she will address the issue. b) Interview with NA #7 on 9/14/22 at 6:33 AM identified she has been employed by the facility for approximately 3 ½ months. NA #7 identified she was aware that her fingernails were too long. NA #7 indicated she will address the issue. Interview with the Administrator on 9/14/22 at 7:25 AM identified he was not aware that some of the staff had long fingernails. The Administrator indicated he will in-service the nursing staff regarding long fingernails. Review…

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, review of facility policy, and interviews, for seven of fifteen sampled resident rooms (Resident #'s 15, 40, 46, 60, 63, 69, and 83) reviewed for the environment, the facility failed to ensure appropriate storage of resident care equipment. The findings include: Observations of Resident bathrooms identified the following: 1. In Resident #15's bathroom, a bedpan and wash basin were being stored on the handicap rails. 2. In Resident #40's bathroom, a vinyl covered wheelchair cushion and an foam exposed wedge cushion were being stored. 3. In Resident #46's bathroom, an unlabeled empty denture cup lacking a lid and wash basin were being stored. 4. In Resident #60's bathroom, a urine measuring hat was stored in the handicap rail with the opening against the wall. 5. In Resident #63's bathroom, an unlabeled bedpan was stored on top of a closed commode. 6. In Resident #69's bathroom, a wash basin was stored on the back of the toilet. 7. In Resident #83's bathroom, two wash basins were being stored in back of the toilet on the handicap rail. Interview, observation,…

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 documentation, review of facility policy, and interviews, for two of five sampled residents (Resident #64 and Resident #91) reviewed for Preadmission Screening and Resident Review (PASRR), the facility failed to ensure completion of PASRR recommendations. The findings include: a. Resident #64's diagnoses included anxiety and hyperglycemia. The annual Minimum Data Set (MDS) assessment dated [DATE] identified Resident #64 was without cognitive impairment and required supervision with bed mobility and limited assistance with transfers. Review of the PASRR level II documentation dated 11/9/18 identified that Resident #64 was to have an evaluation for a diagnosis of dementia, Alzheimer's, or other organic mental disorder. Review of the clinical record failed to reflect this assessment. b. Resident #91's diagnoses included schizophrenia and intellectual disabilities. The annual Minimum Data Set (MDS) assessment dated [DATE] identified Resident #91 had long and short…

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, interviews, and review of facility policy, for one of eight residents reviewed for Dining, (Resident #303), the facility failed to provide supervision with meals as ordered. The findings include: Resident #303 was admitted on [DATE]. Diagnoses included dementia, dysphagia, hemiplegia, and dysarthria. The quarterly Minimum Data Set (MDS) dated [DATE] identified Resident #303 had moderate cognitive impairment and required extensive assistance of one staff for eating. A physician's order dated 10/30/19 directed diet of dysphagia level 3 advanced with nectar thick liquids, see also tube feeding orders, supervision when eating, check mouth for pocketing after meals, assist with meal set up, upright/out of bed for meals and approximately 20 minutes after. The care plan dated 10/31/19 identified Resident #303 was at risk for decreased nutritional status due to dysphagia and requiring a mechanically altered diet. Interventions included diet as ordered. Resident #303's…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, review of the clinical record, and review of facility documentation, for one sampled resident, (Resident #301), reviewed for Choices, the facility failed to ensure medication was administered as ordered and in a timely manner. The findings include: Resident #301 was admitted on [DATE]. Diagnoses included end stage renal disease and dependence on renal dialysis. The Nursing admission assessment dated [DATE] identified Resident #301 was oriented to person, place, and time and had clear speech. A physician's order dated 11/6/19 directed Renvela 800 mg by mouth before meals at 8:00 AM, 11:00 AM, and 5:00 PM. The care plan dated 11/8/19 identified Resident #301 was on a Renal diet. Interview with Resident #301 on 11/18/19 at 10:22 AM identified Resident #301 was not given the 11/18/19 morning dose of Renvela until 10:05 AM, and it was to be given one half hour before breakfast. Resident #301 identified that he/she had eaten breakfast at 8:20 AM and so he/she received the Renvela over…

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 documentation, review of facility policy, and interviews, for one sampled resident (Resident #89) reviewed for vision, the facility failed to ensure a recommendation for a follow up ophthalmology appointment was scheduled. The findings include: Resident #89's diagnoses included anxiety and diabetic retinopathy. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #89 was without visual and cognitive impairment and required extensive assistance with personal hygiene. The Resident Care Plan (RCP) dated 10/11/19 identified Resident #89 with visual impairment related to retinopathy, diabetic moderate non-proliferative, and left and right with eye injections in both eyes with macular edema. Interventions directed to provide adequate lighting and provide with eye medications. The nurse's note dated 6/19/19 at 4:12 PM identified that Resident #89 had gone to an eye appointment, had findings that the right eye was worsening and that 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 observations, clinical record review, review of facility documentation, review of facility policy, and interviews, for one sampled resident (Resident #46) reviewed for limited Range of Motion (ROM), the facility failed to ensure placement of a hand splint. The findings include: Resident #46's diagnoses included dementia, cognitive communication deficit, and osteoporosis. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #46 had long and short term memory impairment and required extensive assistance with eating and personal hygiene. The Resident Care Plan (RCP) dated 9/24/19 identified Resident #46 required assistance with all of Activities of Daily Living (ADLs). Interventions directed to apply a left resting hand splint in the morning after morning care and remove prior to evening care with skin checks throughout the wearing time. A physician's order dated 10/29/19 directed apply the left hand resting splint, after morning care, remove prior to evening care, with 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 observation, review of the clinical record, interviews, and review of facility documentation, for one of two residents reviewed for accidents, (Resident #303), the facility failed to ensure the resident was transferred per physician's orders. The findings include: Resident #303 was admitted on [DATE] with diagnoses that included dementia, dysphagia, hemiplegia, and dysarthria. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #303 had moderate cognitive impairment, required extensive assistance of two staff for transfers, and had range of motion impairments on one side for upper and lower extremeties. The care plan dated 8/5/19 identified Resident #303 required assistance with all Activities of Daily Living (ADLs). Interventions included transfers per physician's orders, and an intervention initiated 9/5/19 directed two staff for care at all times. A physician's order dated 9/16/19 directed physical therapy to evaluate and treat. Physical therapy orders dated 9/21/19…

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, interviews, review of the clinical record, and review of facility policy, for two of four residents observed for Medication Administration, (Resident #54 and Resident #64), the facility failed to ensure physician's orders were signed. The findings include: a. Resident #54 was admitted on [DATE]. Diagnoses included Alzheimer's disease, atrial fibrillation, and anxiety disorder. Interview and record review with Licensed Practical Nurse (LPN) #2 on 11/20/19 at 10:00 AM identified Resident #54's record failed to reflect signed physician's order renewals since 7/28/19. LPN #2 identified this should have been done, nursing should alert the physician, but he/she did not know if any particular person/role was assigned to address this. Interview and record review with the Assistant Director of Nurses (ADNS) on 11/20/19 at 11:06 AM identified order renewals were not signed since 7/28/19. and this should have been done, the nurses and physicians are responsible, but there was currently no one assigned…

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 two of six sampled residents (Resident #35 and Resident #71) reviewed for unnecessary medication, documentation was lacking to reflect the pharmacist reviewed or made recommendations regarding behavior monitoring for residents taking anti-psychotic medications. The findings include: a. Resident #35 was admitted on [DATE] with diagnoses that include unspecified dementia with behavioral disturbances and adjustment disorder. A physician's order dated 8/23/19 directed to administer Seroquel 25 milligrams (mg) by mouth twice per day. The Medication Administration Record (MAR) dated 8/23/19 through 9/19/19 identified Resident #35 was administered Seroquel 25 mg twice per day. The Resident Care Plan (RCP) dated 8/26/19 identified Resident #35 was prescribed anti-psychotic medication. Interventions directed to be aware of resident's interaction with other residents or others for appropriateness…

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 3 of 6 sampled resident (Resident #35, Resident #71 and Resident #302) reviewed for unnecessary medications, the facility failed to implement behavioral monitoring with the use of an antipsychotic. The findings include: a. Resident #35 was admitted on [DATE] with diagnoses that include unspecified dementia with behavioral disturbances and adjustment disorder. A physician's order dated 8/23/19 directed to administer Seroquel 25 milligrams (mg) by mouth twice per day. The Medication Administration Record (MAR) dated 8/23/19 through 9/19/19 identified Resident #35 was administered Seroquel 25 mg twice per day. The Resident Care Plan (RCP) dated 8/26/19 identified Resident #35 was prescribed anti-psychotic medication. Interventions directed to be aware of resident's interaction with other residents or others for appropriateness and be aware of mental status functioning on an ongoing basis.…

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 two of six sampled residents (Resident #56 and Resident #69) reviewed for medication administration, the facility failed to ensure that medications were administered according to physician's orders and professional standards. The facility failed to ensure a medication error rate less than 5%. The findings include: a. Resident #56 was admitted on [DATE]. Diagnoses included benign prostatic hyperplasia. The annual Minimum Data Set (MDS) assessment dated [DATE] identified Resident #56 had severe cognitive impairment. A physician's order dated 10/30/19 directed Finesteride 5 mg by mouth daily. Observation of medication administration by Licensed Practical Nurse (LPN) #3 on 11/20/19 at 8:29 AM identified the medication Finesteride (Proscar) 5 mg was not available for Resident #56. LPN #3 identified that he/she had given the medication yesterday (11/19/19), and reordered the medication from…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, review of the clinical record, and review of facility policy, for one of two medication carts reviewed, the facility failed to ensure a nasal spray medication was labeled. The findings include: Resident #64 was admitted on [DATE]. A physician's order for Resident #64, dated 7/28/19, and reviewed on 10/16/19, directed Fluticasone (Flonase) 50 mcg nasal spray suspension, one spray into each nostril every twelve hours. Observation and interview on 11/20/19 at 8:06 with Licensed Practical Nurse (LPN) #2, identified a bottle of Fluticasone (Flonase) 50 mcg nasal spray suspension was in the medication cart, it was opened and not in a box. The medication failed to reflect a resident's name and/or directions on the bottle and no pharmacy label was nnoted on the medication. No other fluticasone was in the medication cart. LPN #2 identified that the only resident for this cart with this medication was Resident #64. LPN #2 identified the medication would need to be disposed of because it…

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 #10) reviewed for the environment, the facility failed to ensure a comfortable, homelike environment. The findings include: Resident #10's diagnoses included dementia, non-traumatic subarachnoid hemorrhage, and schizophrenia. The annual Minimum Data Set (MDS) assessment dated [DATE] identified Resident #10 was without cognitive impairment and required extensive assistance with bed mobility and toilet use. Additionally, Resident #10 was noted to reject care one to three days per week. The Resident Care Plan (RCP) dated 11/9/19 identified Resident #10 could be physically and/or verbally aggressive toward staff members. Resident #10 often refused Activity of Daily Living (ADL) care. Interventions directed to not express staff anger or impatience verbally or with physical movement (i.e. shaking head) explain the importance of accepting care, housekeeping 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.