Lutheran Home Of Southbury Inc

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews and record review for 1 of 1 resident (Resident #310) reviewed for positioning, the facility failed to offload heels for a resident at high risk for pressure ulcer development. The findings include: Resident #310's diagnoses included atrial fibrillation, essential hypertension and hearing loss. The admission Norton Scale Predicting Risk of Pressure Ulcer Assessment completed 5/30/25 identified Resident #310 was a high risk for pressure ulcer development. The Resident Care Plan dated 5/30/25 identified Resident #310 had the potential for pressure injury development related to incontinence, and decreased mobility. Interventions included to monitor dressing placement as ordered to ensure it was intact and adhering, educate the resident/family/caregivers as to causes of skin injury including repositioning/positioning requirements and offloading both feet with pillows while in bed starting at calves down to the heels. The admission Minimum Data Set (MDS) assessment dated [DATE]…

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 4 residents (Resident #64) reviewed for falls, the facility failed to prevent a fall for a resident at risk for falls who required assistance with ambulation. The findings include: Resident #64's diagnoses included dementia with agitation, anxiety, and rheumatoid arthritis. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #64 was severely cognitively impaired, required setup or clean-up assistance with eating, and supervision or touching assistance with transfers and ambulation. Additionally, the MDS identified Resident #64 had no falls since admission. The Resident Care Plan (RCP) in effect 1/29/25 identified Resident #64 was at risk for falls related to confusion, deconditioning, medications, decline in health on hospice, refusal of care at times, and Resident #64 was very self-determined to do what he/she wanted independently despite ongoing assistance. Interventions included…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, facility documentation, and policy review for medication storage , the facility failed to ensure bi-monthly audits of controlled medications were completed. Review of the facilities bi-monthly narcotic audit sheets for [NAME], C1 South, C2 South, and C2 North medication carts identified they were not completed for May 2025 and June 2025. Interview and facility documentation review with the Director of Nurses (DNS) on 6/16/25 at 12:34 PM identified that the bi-monthly audits of controlled medications for [NAME], C1 South, C2 South, and C2 North medication carts were not completed for May 2025 and June 2025. It was identified that it was the responsibility of the DNS to ensure they were completed and although she knew they should be completed, she had forgotten to complete. Review of the Controlled Substance Storage facility policy and procedures by Woodmark Pharmacy, revised November 2011, identified that medications included in the Drug Enforcement Administration (DEA) classification as…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, facility policy and interviews for 1 of 5 residents (Resident #64) reviewed for unnecessary medication, the facility failed to change or discontinue a psychotropic medication after extended nonuse of the medication, failed to document the duration and rationale for extension of an as needed (PRN) psychotropic medication extended beyond 14 days. The findings include: Resident #64's diagnoses included dementia with agitation, anxiety, and left femur fracture repair. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #64 was severely cognitively impaired, received hospice care, had no physical or behavioral symptoms directed towards others (hitting, kicking, grabbing, screaming/cursing at others, threatening others), had no behavior symptoms not directed towards others (pacing, rummaging, screaming or hitting/scratching self), and was receiving an antianxiety medication. The MDS assessment further identified Resident #64 required setup or…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, review of the clinical record, and facility policy for 1 of 5 residents reviewed for nutrition, the facility failed to provide adaptive equipment per the physician's order for a resident with dysphagia and malnutrition. The findings include: Resident #106's diagnosis included dysphagia (difficulty swallowing), protein-calorie malnutrition, and dementia. An Occupational Therapy progress note dated 5/14/25 identified Resident #106 was observed for breakfast and lunch and was made an assist of 1 for feeding and required a blue covered mug with a straw for all meals. A physician's order dated 5/14/25 directed to provide a blue handled cup with lid and straw for all meals. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #106 was severely cognitively impaired and was dependent with transfers, toileting, eating and bed mobility. The MDS indicated Resident #106 required a mechanically altered and therapeutic diet. A Nutrition Assessment written by 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 one (1) of two (2) residents (Resident #1) reviewed for behaviors, the facility failed to ensure the physician was notified when the resident was restless and agitated. The findings include: Resident #1 had diagnoses that included dementia with behavioral disturbance and adjustment disorder with disturbance of conduct. The nursing admission assessment dated [DATE] at 9:13 A.M. completed by RN #7 identified for Resident #1 restraints were not being used. The functional abilities and goals assessment dated [DATE] identified Resident #1 requires substantial assistance with ADLs and transfers, independent with bed mobility, and used a manual wheelchair. The initial social history assessment dated [DATE] at 2:25 P.M. identified Resident #1's family reports h/she has had increased confusion over the past few months. The social history assessment identified Resident #1 had a Brief Interview for Mental Status (BIMS) score…

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 #1) reviewed for restraints, the facility failed to ensure the resident was free of a physical restraint. The findings include: Resident #1 had diagnoses that included dementia with behavioral disturbance and adjustment disorder with disturbance of conduct. The nursing admission assessment dated [DATE] at 9:13 A.M. completed by RN #7 identified for Resident #1 restraints were not being used. The functional abilities and goals assessment dated [DATE] identified Resident #1 requires substantial assistance with ADLs and transfers, independent with bed mobility, and uses a manual wheelchair. The initial social history assessment dated [DATE] at 2:25 P.M. identified Resident #1's family reports h/she has had increased confusion over the past few months. The social history assessment identified Resident #1 had a Brief Interview for Mental Status (BIMS) score of two (2) indicative…

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, interviews and facility policy for one resident reviewed for abuse (Resident #1), the facility failed to ensure the resident was treated with dignity and respect. The findings include: Resident #1 was admitted with diagnoses that included dementia with behavioral disturbance, and anxiety. The RCP dated 8/13/2024 identified Resident #1 had impaired cognition, communication and impaired thought process due to dementia. Interventions directed to approach resident in a slower pace, and to stop and return if the resident was agitated or upset, when unable to redirect, have staff to sit with resident to provide emotional support, do not touch her/him, do not rush and report the behavior issues to the nurse. The quarterly MDS assessment dated [DATE] identified Resident #1 had severely impaired cognition and was supervision for self-care, moderate assist for toileting, transfer and walk with a walker. Resident #1 was independent for bed mobility. 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, interviews and facility policy for one resident reviewed for abuse (Resident #1), the facility failed to ensure staff reported an allegation of abuse timely. The findings include: Resident #1 was admitted with diagnoses that included dementia with behavioral disturbance, and anxiety. The RCP dated 8/13/2024 identified Resident #1 had impaired cognition, communication and impaired thought process due to dementia. Interventions directed to approach resident in a slower pace, and to stop and return if the resident was agitated or upset, when unable to redirect, have staff to sit with resident to provide emotional support, do not touch her/him, do not rush and report the behavior issues to the nurse. The quarterly MDS assessment dated [DATE] identified Resident #1 had severely impaired cognition and was supervision for self-care, moderate assist for toileting, transfer and walk with a walker. Resident #1 was independent for bed mobility. 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 record review, facility documentation review, interviews and facility policy review for one resident reviewed for abuse (Resident #1), the facility failed ensure care was provided in accordance with the plan of care. The findings include:. Resident #1 was admitted with diagnoses that included dementia with behavioral disturbance, and anxiety. The RCP dated 8/13/2024 identified Resident #1 had impaired cognition, communication and impaired thought process due to dementia. Interventions directed to approach resident in a slower pace, and to stop and return if the resident was agitated or upset, when unable to redirect, have staff to sit with resident to provide emotional support, do not touch her/him, do not rush and report the behavior issues to the nurse. The quarterly MDS assessment dated [DATE] identified Resident #1 had severely impaired cognition and was supervision for self-care, moderate assist for toileting, transfer and walk with a walker. Resident #1 was independent for bed mobility. 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, facility documentation, facility policy, and interviews for 1 resident (Resident #5) reviewed for change of condition, the facility failed to notify the resident representative when there was a change of condition and for 1 of 3 residents (Resident #261) reviewed for medication administration, the facility failed to notify the physician when medication was not available for administration. The findings: 1. Resident #5 was admitted to the facility with diagnoses that included constipation, ulcerative colitis, and gastrointestinal hemorrhage. The care plan dated 5/11/23 identified Resident #5 had self-care deficits due to confusion. Interventions included to discuss with the resident and resident representative and any concerns related to loss of independence. The quarterly MDS dated [DATE] identified Resident #5 had moderately impaired cognition and required extensive assistance with care. The nurse's note written by LPN #6 dated on 8/24/23 at 1:57 PM identified Resident #5…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, facility documentation, facility policy, and interviews for 1 of 4 residents (Resident #35) reviewed for abuse, the facility failed to report an abuse allegation in a timely manner. The findings include: Resident #35 was admitted to the facility on [DATE] with diagnoses that included COPD, epilepsy, and heart failure. The quarterly MDS dated [DATE] identified Resident #35 had moderately impaired cognition and required limited assistance with one person for transfers and toilet use. The care plan dated 3/9/23 identified Resident #35 had impaired cognitive function or impaired thought processes presenting with forgetfulness. Interventions included to keep a consistent routine and provide consistent care givers, to decrease confusion. The FLIS Reportable Event Report dated 3/10/23 identified that on 3/8/23 at 6:00 PM, NA #1 reported hearing alleged verbal abuse from NA #2 directed to Resident #35. The local law enforcement agency, physician, and family were…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, facility documentation, facility policy, and interviews for 1 of 4 residents (Resident #35) reviewed for abuse, the facility failed to complete a thorough investigation of an abuse allegation. The findings include: Resident #35 was admitted to the facility on [DATE] with diagnoses that included COPD, epilepsy, and heart failure. The quarterly MDS dated [DATE] identified Resident #35 had moderately impaired cognition and required limited assistance with one person for transfers and toilet use. The care plan dated 3/9/23 identified Resident #35 had impaired cognitive function or impaired thought processes presenting with forgetfulness. Interventions included to keep a consistent routine and provide consistent care givers, to decrease confusion. The FLIS Reportable Event Report dated 3/10/23 identified that on 3/8/23 at 6:00 PM, NA #1 reported hearing alleged verbal abuse from NA #2 directed to Resident #35. The local law enforcement agency, physician, and family…

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 1 resident's (Resident #7) reviewed for care planning, the facility failed to ensure the comprehensive care plan was in place. The findings: Resident #107 was admitted to the facility with diagnoses that included protein-calorie malnutrition, hyperlipidemia, and anemia. A physician's order dated 7/9/23 directed a regular diet with thin liquids. The care plan dated 7/9/23 identified desirable weight loss. Nutrition assessment dated [DATE] indicated Resident #107's usual weight was 120 lbs., and current weight was 104 lbs. Resident on Glucerna 120 ml twice a day and has a 5.0 lb. weight loss since admission possibly due to edema post op left hip ORIF from fall at home. A physician's progress note dated 7/14/23 indicated the resident had suboptimal intake and complaints of poor appetite. Weight was 104.2 lbs. Plan to start Glucerna and obtain labs. A physician's order dated 7/14/23 directed to give Glucerna 120…

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 3 residents (Resident #261) reviewed for medication administration, the facility failed to follow professional standards of practice by verifying the identity of the resident before administering medication. The findings: Resident #261 was admitted to the facility with diagnoses that included osteoporosis with pathological fracture and pubic ramus fracture, (TIA) transient ischemic attack, cerebral infarction, and neoplasm of the brain. The admission MDS dated [DATE] identified Resident #261 had intact cognition, required extensive assistance with care, had pain frequently and received scheduled and as needed pain medications 7 days a week. Medication observation with LPN #1 on 8/28/23 at 8:00 AM for Resident #261 identified LPN #1 prepared Oxycodone, Lactulose, Nadolol, MiraLAX, Senna Plus, Letrozole, Dexamethasone, and Aspirin for administration to Resident #261. LPN #1 knocked on the semi-private room door…

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 #5) reviewed for change of condition, the facility failed to do an RN assessment with a change in condition and for 1 resident (Resident #78 ) reviewed for nutrition, the facility failed to follow physicians orders for daily weights and for 1 of 3 residents (Resident #261) reviewed for medication administration, the facility failed to administer medication per physicians order. The findings: 1. Resident #5 was admitted to the facility with diagnoses that included constipation, ulcerative colitis, and gastrointestinal hemorrhage. The care plan dated 5/11/23 identified Resident #5 had self-care deficits due to confusion. Interventions included to discuss with the resident and resident representative and any concerns related to loss of independence. The quarterly MDS dated [DATE] identified Resident #5 had moderately impaired cognition and required extensive assistance with care. The nurse's note…

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 2 residents (Resident #6 and 263) reviewed for respiratory care, the facility failed to ensure oxygen tubing and humidifier canisters were changed weekly and dated, and that a sign that oxygen was in use was posted on the resident's doors per policy. The findings: 1. Resident #6 was admitted to the facility with diagnoses that included metabolic encephalopathy and pneumonia. The physician's progress note dated 7/26/23 indicated Resident #6 had been sent to the hospital for lethargy and fever and was diagnosed with acute metabolic encephalopathy secondary to viral/bacterial pneumonia with acute hypoxia. Resident #6 has returned to the facility. A physician's order dated 7/30/23 directed to apply oxygen via nasal cannula titrate to keep saturation level above or equal to 93% every shift. A physician's order dated 8/10/23 directed to apply oxygen via nasal cannula 1 - 3 liters for comfort as needed. 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.

Based on observation, review of facility documentation, facility policy and interview for 2 of 3 medication storage rooms, the facility failed to maintain the rooms in a secure manner and according to policy. The findings include: Observation on 7/18/21 at 5:15 AM identified the C-2 North unit and C-2 South unit's medication rooms were open/unsecured. The C-2 North's medication room door was propped completely open with a wedge. NA #1 was noted near the Nurse's station at that time and LPN #1 was noted halfway down the C-2 North's hallway. RN #2 was noted off C-2 South unit in adjacent hallway. Subsequent observation of C-2 South's medication room with RN #1 identified the medication room was unlocked and slightly open. Interview with LPN #2 on 7/18/21 at 5:27 AM identified that although the medication room should be closed at all times for resident safety, she forgot to close it. Interview with RN #2 on 7/18/21 at 5:35 AM identified that the door was not secured because she was preparing to administer narcotic medications and that it was her usual practice to keep it locked. 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 observation, review of facility policy and interviews the facility failed to wear hair restraints while in the kitchen. The findings include: Observation on 7/18/21 at 7:05 AM identified there were 3 Dietary Aides (DA) and 1 cook in the kitchen. DA #1 had facial hair on the sides of his face, chin and neck. DA #1 was washing dishes in the kitchen while wearing a surgical mask but was without the benefit of a beard restraint. DA #2 was in the kitchen wearing a baseball cap but had hair covering his ears and around the back of his neck to top of the collar of the shirt and was without the benefit of a hair net. Interview with DA #1 on 7/18/21 at 7:10 AM indicted he started working in dietary a month ago and no one educated him or had given him a beard guard. DA #1 indicated the facial hair was at least 1 inch in length. Interview with DA #2 on 7/18/21 at 9:00 AM indicated he had been educated to wear a hair net with the baseball cap but forgot to put one on today. Interview with the Director of Dietary on 7/18/21 at 12:00 PM indicated she had not educated DA #1 about wearing…

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 #24) reviewed for edeka, the facility failed to notify the physician when the resident refused an ordered treatment. The findings include: Resident #24 was admitted to the facility in August 2020 with diagnoses that included dementia with behavioral disturbances and intracranial hypertension. The quarterly MDS dated [DATE] identified Resident #24 had severely impaired cognition, was frequently incontinent of bowel and bladder and required supervision with walking in the hallway, and dressing, including putting on and removing ted stocking (extensive assistance with one person). Review of an APRN progress note, written by (APRN #1) dated 7/15/21 identified Resident #24 had peripheral edema, likely due to ace inhibitor, with no acute cardiopulmonary decompensation. The note indicated orders were written that included to give Lasix 20mg, one dose now, apply ted stockings to both…

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 #24) reviewed for edema, the facility failed to provide treatment for lower extremity edema. The findings include: Resident #24 was admitted to the facility in August 2020 with diagnoses that included dementia with behavioral disturbances and intracranial hypertension. The quarterly MDS dated [DATE] identified Resident #24 had severely impaired cognition, was frequently incontinent of bowel and bladder and required supervision with walking in the hallway, and dressing, including putting on and removing ted stocking (extensive assistance with one person). Review of an APRN progress note, written by (APRN #1) dated 7/15/21 identified Resident #24 had peripheral edema, likely due to ace inhibitor, with no acute cardiopulmonary decompensation. The note indicated orders were written that included to give Lasix 20mg, one dose now, apply ted stockings to both lower extremities (apply in morning 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 observation, review of the clinical record, facility documentation facility policy and interviews for 1 of 8 residents (Resident #37) reviewed for accidents, the facility failed to implement measures as documented in the plan of care to prevent falls. The findings include: Resident #37 was admitted to the facility in August 2020 with diagnoses that included dementia with behavioral disturbances and anxiety. The quarterly MDS dated [DATE] identified Resident #37 had moderately impaired cognition and required no assistance with activities of daily living. The care plan dated 5/8/21 identified Resident #37 was at risk for falls. Interventions included to place bright colored tape on the call light to encourage its use and reminder signs in Resident #37's room to call for assistance and to take/use walker placed close to resident. Observation on 7/18/21 at 10:00 AM and 2:00 PM and on 7/19/21 at 10:20 and 12:59 PM identified the call bell was without the benefit of the bright colored tape and the resident'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, review of facility documentation and interview the facility failed to maintain appropriate infection control related to hand washing. The findings include: 1. Observation on 7/18/21 at 5:57 AM on C-2 North unit identified NA #3, preparing to provide morning care, was noted to wet towelettes, located on the linen cart with blue colored peri-wash, donned gloves, removed a wet towelette and a dry one and then proceeded into Resident #64's bedroom. NA #3 provided incontinent care to Resident 64, who had just had a bowel movement. Subsequently, NA #3 picked up the soiled materials with both gloved hands, left the room, and walked in the hallway to the soiled hampers. NA #3 opened the lid to the soiled hamper and disposed of the materials, removed her gloves and put on a new pair without the benefit of washing her hands. NA #3 proceeded to Resident #67's bedroom, provided incontinent care and without the benefit of handwashing, changed gloves, picked up soiled materials and walked out of 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, review of facility documentation, facility policy and interviews for 1 of 5 residents (Resident #24), reviewed for immunizations, the facility failed to obtain Pneumococcal and Prevnar 13 vaccination history and failed to administer the Prevnar 13 vaccine. The findings include: Resident #24 was admitted to the on 8/5/20 with diagnoses included dementia and dysphagia and no known allergies. Review of an undated vaccination consent form, signed by the resident's representative did not identify yes or no for consent, or identify if the resident had already received a vaccination for Influenza, Pneumonia, or Prevnar 13. Additionally, the form had a note recommending checking with the community pharmacy. The admission MDS dated [DATE] identified Resident #24 had severely impaired cognition and had no information for pneumococcal vaccination status. Review of a vaccination consent form dated 3/5/21, signed by the resident's representative, consented to have Resident #24 receive…

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.