Civita Care Bayview

Based on review of facility documentation, facility policy, and interview for water management, the facility failed to provide documentation of water sampling (for legionella and other waterborne pathogens), ice machine cleaning, and the facility failed to ensure the annual water management plan meeting was conducted with records maintained according to the facility's water management plan. The findings include: Review of facility documentation regarding monthly ice machine cleaning failed to identify the ice machines in the facility were cleaned from August 2024 through December 2024, 4 months. In addition, the records failed to identify any water sampling testing results for testing done on 1/29/24 and 1/27/25. Review of the Facility Water Management Plan with the Director of Maintenance and the Assistant Director of Maintenance on 9/18/25 at 2:23 PM identified the facility water management plan included flushing monthly, of water supply areas not frequently used, water sampling testing twice yearly for legionella, hot water temperature checks, and monthly ice machine cleaning. In…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the clinical record, review of facility documentation, review of facility policy/procedures and interviews for 3 of 3 sampled residents (Residents #1, 58 and 110) reviewed for advance directives, the facility failed to ensure the resident's choice for code status was honored. The findings include: 1. Resident #1 was admitted to the facility [DATE]. Diagnosis included dementia with agitation, Type II diabetes mellitus with hyperglycemia and difficulty in walking.The admission MDS dated [DATE] identified Resident #1 had severely impaired cognitive skills for daily decision making.Review of the Facility Advance Directives Declaration Code Status form dated [DATE] identified Resident #1 was a Do Not Resuscitate (DNR) and Do Not Intubate (DNI) as received by Resident #1's daughter by phone. The bottom of the form notes the physician must write an order and a progress note in the resident's chart.Physician's order dated [DATE] directed full code status (perform CPR if Resident #1's heart…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, review of facility policy and, interviews for three sampled residents residing on the first floor secure unit (Residents #58, #96 and #10) and for four sampled residents residing on the second floor (Residents #5, #7, #64, and #89) reviewed for involuntary seclusion, the facility failed to ensure the secured unit had established criteria for placement on the secured unit, failed to ensure the resident representative and/or resident was involved in the decision for placement on the secured/locked area, failed to ensure the resident's clinical record contained documentation of the clinical criteria met for placement, failed to indicate that the secured unit was the least restrictive setting, failed to include ongoing assessments of the continued appropriateness of the placement and failed to ensure that residents and visitors had access to the code for independent egress from the unit. The findings include: Observations on all days of the survey (9/15/25,…

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 secure the keys that opened the medication cart and medication room on the dementia unit. The findings include:Observation on 9/18/25 at 2:30 PM identified the DNS handed a set of keys to RN #3. RN #3 accompanied this Nurse Consultant (NC) to the med cart and opened it. After the observation of the medication cart, and narcotic count, RN #3 opened the medication room door with the same set of keys. Once the review/observations were completed, RN #3 was noted to place the keys into a plastic 3 draw bin which was located on top of the nurse's station desk. Interview on 9/18/25 at 2:31 PM with RN #3 indicated that he/she has always placed the keys in that bin since he/she has worked at the facility. Interview on 9/18/25 at 2:57 PM with the DNS indicated the keys for the medication cart/medication room should be kept on the nurse's person for the whole 8-hour shift and then given to the oncoming nurse after report, no exceptions. The DNS identified RN #3 should not have left the keys to the medication…

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 interviews, the facility failed to ensure the call bell system was functioning properly. The findings include:Observation on 9/15/25 at 9:45 AM identified the resident call bell system was not functioning on the second floor. There was no audible ring when activating the call bell. The light functioned outside of the resident rooms, however observation at this time identified no staff in the hall to see the light. Bells were located at the bedside of the residents, however not present in the residents' bathrooms. Interview on 9/15/25 at 10:00 AM with several residents identified the call system had not been functioning for a while and they were provided with bells as an alternative, however they did not always have the bells in reach and did not have the bells in the restroom. Review of the resident council meeting minutes from July 2025 identified the call bell system does not have sound. The lights go on, but the bell system is not working. Hand bells had been handed out and in service had been given 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, facility policy review, and interviews for two of three sampled residents (Resident #13 and 126) reviewed for constipation, the facility failed to monitor bowel movements (BM) and administer the facility bowel regimen policy. The findings include: 1. Resident #13 's diagnoses included chronic kidney disease stage 3, hypertension, and venous thrombosis.The physician's order dated 8/29/25 directed to administer Senna 8.6 mg give 2 tablets by mouth at bedtime for constipation, administer Milk of Magnesia (MOM) (laxative) 400mg/5ml give 30ml as needed for constipation if no bowel movement for 3 days (a total of 9 shifts) on the 3-11 shift, give Bisacodyl suppository 10 mg insert 1 suppository rectally during the 11-7 shift as needed for constipation used for second step if MOM not effective, and give fleet enema insert 1 application rectally as needed for constipation during the 7-3 shift if Bisacodyl not effective, and call physician for further order if fleet enema was not…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, facility documentation, facility policy and interviews for 2 of 2 residents (Resident #23 and 114) reviewed for respiratory care, the facility failed to order BiPAP equipment timely for Resident #23 and failed to follow a physician's order to change the oxygen tubing weekly for Resident #114. The findings include:1. Resident #23's diagnoses included sleep apnea, heart failure and anxiety. A physician's order dated 3/30/22 directed BiPAP on at bedtime with oxygen at 2 - 3 liters per minute. The annual Minimum Data Set assessment dated [DATE] identified Resident #23 was cognitively intact, had sleep apnea and utilized oxygen. The care plan dated 7/9/25 identified Resident #23 used BiPAP with oxygen and the resident would maintain an effective breathing pattern during sleep and have restful sleep. Interventions included to keep BiPAP in the resident's room, monitoring for sleep and any complaints of insomnia or refusal's to wear BiPAP. Interview on 9/15/25 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 clinical record, facility policy, facility documentation, and interviews for one of five sampled residents (Resident #11) reviewed for immunizations, the facility failed to ensure that the pneumococcal vaccine was offered to the resident upon admission. The findings include: Resident #11 was admitted to the facility in May 2024 and had diagnoses of anxiety, dementia, and hypertension. The quarterly MDS assessment dated [DATE] identified Resident #11 had moderately impaired cognition. Review of Resident #11 immunization consents and records identified the resident had received the Prevnar 13 on 06/06/2017 at age [AGE] years of age, and Pneumococcal vaccine (PPV23) on 6/2/2016 at age [AGE] years of age prior to been admitted to the facility. However, the clinical records and consent records failed to identify Resident #11 was offered the pneumococcal vaccine as to complete pneumococcal vaccine series on admission. Review of Resident #11 immunization consents and records with the Infection…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, facility documentation, facility policy and interviews for one (1) of three (3) sampled residents (Resident #1) reviewed for medication administration, the facility failed to ensure a narcotic pain medication was refilled to prevent a delay in the administration and failed to obtain a physician's order to administer the medication the following day. The findings include:Resident #1's diagnoses included malignant neoplasms of the left breast, bone and lung and neoplasm related pain. The Nursing admission assessment dated [DATE] identified Resident #1 was alert and oriented and required assistance with activities of daily living. The pain evaluation dated 7/9/25 identified Resident #1 experienced continuous nagging, radiating and deep pain that effected Resident #1's sleep, day to day activities, and appetite. The evaluation indicated the medications Fentanyl and Dilaudid relieved the pain. The Resident Care Plan dated 7/10/25 identified that Resident #1 utilized pain medications…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, facility documentation, facility policy and interviews for one of two sampled residents (Resident #5) who were reviewed for a potential allegation of abuse, the facility failed to ensure a resident was treated with dignity and respect when a staff member conducted oneself unprofessionally and used profanity in front of a resident. The findings include: Resident #5's diagnoses included multiple pelvic fractures, generalized anxiety disorder, and Post-Traumatic Stress Disorder (PTSD). The admission Minimum Data Set assessment dated [DATE] identified Resident #5 made reasonable and consistent decisions regarding tasks of daily life and required extensive assistance of one (1) staff person for dressing and personal hygiene. The Resident Care Plan dated 12/27/22 identified Resident #5 had anxiety and used anti-anxiety medication. Interventions directed to administer anti-anxiety medications as ordered by the physician, monitor for side effects and effectiveness, and monitor,…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, review of facility documentation and interviews for two of five sampled residents (Residents #7 and #12) who were reviewed for hospice services, the facility failed to notify the Responsible Party of a referral to hospice or failed to ensure the resident or Responsible party was provided a choice of hospice services to contract. The findings include: 1. Resident #7's diagnoses included dementia, dysphagia (difficulty swallowing, type 2 diabetes mellitus and failure to thrive. The admission record identified a family member was Resident #7's Responsible Party. The quarterly Minimum Data Set assessment dated [DATE] identified Resident #7 rarely or never made decisions regarding tasks of daily life, weighed 102 pounds, and received a mechanically altered diet. The Resident Care Plan dated 5/24/24 identified Resident #7 was a nutritional risk related to the diabetes mellitus, dysphagia and dementia. The care plan indicated Resident #7 had received hospice services that 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 clinical record reviews, review of facility documentation and interviews for one of three sampled residents (Resident #7) who required a specialized treatment, the facility failed to ensure the resident received the dialysis treatment on the scheduled day. The findings include: Resident #9's diagnoses included type 2 diabetes mellitus, end stage renal disease and status post left hip fracture. A physician's order dated 10/26/22 directed dialysis days Mondays, Wednesdays, and Fridays every day shift. The admission Minimum Data Set assessment dated [DATE] identified Resident #9 made reasonable and consistent decisions regarding tasks of daily life, was dependent on two (2) person assistance with getting in and out of the bed and chair, non-ambulatory and received dialysis treatments. The Resident Care Plan dated 11/7/22 identified Resident #9 required hemodialysis related to end stage renal failure. Interventions directed to monitor the access site, vital signs, and signs and symptoms of renal…

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 Basedonclinicalrecordreview reviewoffacilitypolicy andinterviewsfortwoofsixsampledresidents(Resident#39 & #97), reviewedforadvancedirectives thefacilityfailedtoensurethatadvancedirectiveswerereviewedwiththeresidentonadmissionandfailedtoensuretherewasasignedcopyoftheAdvanceDirectiveDeclarationCodeStatusformintheresidentsclinicalrecordtoindicatetheresidentsendoflifechoices Thefindingsinclude 1. Resident#39 wasreadmitted tothefacilityinJuneof2023 withdiagnosesthatincludedheartfailure type2 diabetesmellitus andbipolardisorder ThequarterlyMDSassessmentdated[DATE] identifiedResident#39 hadintactcognition requiredassistanceofonestaffmemberfordressing andpersonalhygiene ReviewofResident#39'sclinicalrecordon[DATE] at10:14 AMfailedtoidentifysigneddocumentationrelatedtoadvanceddirectives althoughthecurrentphysiciansordersidentifiedtheresidenthadacodestatusoffullcodewhichmeansthatifapersonsheartstopsbeatingandortheystopbreathing allresuscitationprocedureswillbeprovidedtokeepthemalive Thisprocesscanincludechestcompressions…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, and interviews for one sample resident (Resident #14) who was admitted to the facility within the past six months, the facility failed to ensure physician's orders were signed and dated in a timely manner. The findings include: Resident #14 was admitted to the facility on [DATE] with diagnoses that included ulcerative colitis, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, dysphagia, and hypertension. The admission MDS assessment dated [DATE] identified Resident #14 was moderately cognitively impaired and totally dependent on staff for bed mobility, hygiene, toileting, and transfers. Review of the physician's orders from October 2023 through 1/24/24 identified Resident #14 physician's orders were not signed on admission and not renewed every 30 days for 90 days. The physician's orders should have been signed on 11/1/23 (48 hours after admission) and renewed by 12/10/23 and again by 1/10/24. Interview with the Medical Director (MD #1) on…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, facility policy review, and interviews for one of three sampled residents (Resident #52) reviewed for psychotropic medication side effects, the facility failed to ensure that an as needed order for Olanzapine (antipsychotic medication) was limited to14 days. The findings include: Resident #52 was admitted to the facility on [DATE] with diagnoses that included periprosthetic fracture of left hip, depression, anxiety, insomnia, and mild cognitive impairment. The physician's order dated 11/10/23 directed to administer Olanzapine 5 milligrams (mg) by mouth every 12 hours as needed for agitation and/or anxiety. Review of the physician's admission orders failed to identify a stop or discontinue date was set at fourteen days (11/24/23) for the as needed Olanzapine order. The admission MDS assessment dated [DATE] identified Resident # 52 had moderate cognitive impairment, required extensive assistance for dressing, hygiene, toileting, and transfers and received antipsychotic medication…

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, review of facility policy, and interviews, the facility failed to provide documentation that environmental rounds were conducted on a quarterly basis, and failed to provide documentation that infection trends within the facility were monitored and analyzed monthly. The findings include: a. Review of the infection control environmental round documentation for the past two years with the Infection Preventionist (RN #6) on 1/25/24 at 1:00 PM identified that quarterly environmental rounds were not completed for the months of January 2022, October 2022, and January 2023. Interview with RN #6 on 1/29/24 at 1:55 PM identified that she was unable to locate the environmental rounds survey worksheets for the months of January 2022, October 2022, and January 2023. RN #6 further added that she started working at the facility in March of 2023 and it would have been the responsibility of the previous IP nurse. Interview with the DNS on 1/30/24 at 2:35 PM identified that she was not employed at the facility during the time when the environmental rounds…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, clinical record review, review of facility policy and interviews for two sampled resident (Residents #13 & #76) with medication left at the bedside, the facility failed to ensure the resident was assessed for self-administration of medications. The findings include: 1. Resident #13's diagnoses included dementia, paraplegia, and osteomyelitis. The annual MDS assessment dated [DATE] identified Resident #13 had moderately impaired cognition, required assistance of two staff members for transfers using a mechanical lift, dressing, and toileting hygiene. The assessment further identified Resident #13 required maximal assistance with oral hygiene and personal hygiene. Resident #13 shared a room with Resident #21 whose diagnoses included dementia, anxiety disorder, and multiple sclerosis. Resident #21's annual MDS assessment dated [DATE] identified Resident #21 had severe cognitive impairment and required partial assistance with upper body dressing and locomotion on unit using a manual wheelchair.…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, review of facility documentation, review of facility policy and interviews, for one sampled resident (Resident #67) reviewed for communication/sensory, the facility failed to ensure that that there was follow up when a hearing device was lost. The findings include: Resident #67's diagnoses included dementia, anxiety, and depression. A nurse's admission assessment dated [DATE], identified a left hearing aid. The significant change assessment dated [DATE] identified Resident #67 was severely cognitively impaired, had minimal difficulty with hearing, did not have hearing aids and required extensive assistance with bed mobility, transfers, and toilet use. The care plan dated 11/30/23 identified Resident #67 had communication difficulties related to a hearing impairment, dementia, and lost hearing aids. Care plan interventions included: offer a communication board, encourage head/hand gestures, and speak slowly and clearly when explaining all procedures. During 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, clinical record review, review of facility policy and interviews for one sampled resident (Resident #76) with medication left at the bedside, the facility failed to ensure a medication was appropriately secured. The findings include: Resident #76's diagnoses included alcohol dependence, bipolar disorder, and history of other mental and behavioral disorders. Observation on 1/22/24 at 11:20 AM identified a bottle of Peridex 0.12% (antiseptic mouthwash) mouthwash on Resident #76's bedside table. The monthly physician's orders for January/2024 directed to administer Peridex Solution 0.12% (antiseptic mouthwash) 15ml orally every day and evening shift preoperatively for dental extractions with directions to swish and spit the liquid out. Review of physician's orders for the month of January/2024 failed to identify an order for self-administration of medication and review of the clinical record failed to identify an assessment for self-administration of medication. Interview with LPN #6 on 1/22/24 at 11:39 AM identified she was aware of the Peridex at the bedside 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 observation, clinical record review, review of facility policy and procedures and interviews for 3 sampled residents (Resident #92) reviewed for specialized services, (Resident #285) reviewed accidents, (Resident #400) reviewed for a significant change in condition, the facility failed to ensure that emergency supplies were kept in the resident's room per the facility policy and failed to ensure neurological assessments were completed after unwitnessed falls and failed to ensure that the resident's significant change in mobility and level of alertness was assessed. The findings include: 1. Resident #92's diagnoses included osteomyelitis of the right ankle and foot, peripheral vascular disease, type 2 diabetes mellitus with diabetic chronic kidney disease, end stage renal disease and dependence on renal dialysis. The Resident Care plan dated [DATE] identified Resident #92 received hemodialysis related to renal failure and had an arteriovenous (AV) shunt. Interventions included; encourage resident to go…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, review of facility policy and interviews for 1 of 8 sampled residents (Resident #16) reviewed for advance directives the facility failed to ensure the facility's policy was followed related to documentation of code status. The findings include: Resident #16's diagnoses included chronic obstructive pulmonary disease, diabetes mellitus and dementia. The annual MDS assessment dated [DATE] identified resident was moderately cognitively impaired. The Care Plan dated [DATE] identified Resident #16 had an established advanced directive that expressed the resident's desire to have a code status of do not resuscitate (DNR), do not intubate (DNI), do not hospitalize (DNH) and no feeding tube. Interventions included; do not administer cardiopulmonary resuscitation (CPR) and RN may pronounce. The current monthly Physician's orders (October/2021) identified Resident #16's code status as DNR/DNI/DNH, no feeding tube and RN may pronounce. Review of the clinical record on [DATE] identified there…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, review of facility documentation, review of facility policy, and interviews for one of six sampled residents (Resident #285) reviewed for accidents, the facility failed to ensure the physician or advanced practice registered nurse was notified when the resident sustained a fall with injury. The findings include: Resident #285's diagnosis included dementia, atrial fibrillation requiring long term anticoagulants, congestive heart failure, and heart failure. The quarterly MDS assessment dated [DATE] identified Resident #285 had severe cognitive impairment, required extensive assistance of two staff members for bed mobility, transfers and toileting. The assessment further noted that the resident did not ambulate, utilized a wheelchair for mobility, was totally dependent on staff for locomotion and had a range of motion deficit of an upper extremity. Review of Resident #285's clinical record identified a lab result dated 12/4/20 that noted an INR (international normalized ratio) level…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of the clinical record, review of facility's documentation, and interviews for 1 of 3 sampled residents (Resident #72) reviewed for pressure ulcers, the facility failed to ensure the physician, dietician and responsible party were notified of resident's pressure injury. The findings include: Resident #72's diagnoses included end stage renal disease (ESRD), diabetes mellitus and urinary retention. An admission MDS assessment dated [DATE] identified Resident #72 had intact cognition, required extensive assistance with activities of daily life (ADL's), did not ambulate, had a Foley catheter in place, was incontinent of bowel, received dialysis treatments in the last 14 days and utilized a wheelchair for mobility The assessment further identified that the resident was at risk for pressure ulcer development but did not have any current wounds. A pressure injury evaluation dated 8/27/21 identified an initial evaluation of facility acquired deep tissue injury (DTI) to Resident #72's right…

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 and interviews conducted during a review of medication storage and labeling, the facility failed to remove medication/IV fluids before or on its expiration date. The findings include: Observation with the ADNS on [DATE] at 11:00 AM of the intravenous (IV) supplies located in a locked supply room located near the administrative offices identified twelve 1000 cc bags of IV fluids located in a bin. Six of twelve IV bags of fluids were expired. The expired IV fluids consisted of one bag of potassium chloride that had an expiration date of 9/2021, two bags of 5% dextrose that had an expiration date of 8/2021 and three bags of 5% dextrose with an expiration date of 5/202. Interview with the ADNS identified that the pharmacy usually checks IV supplies monthly but that the nurses were also responsible for checking for expired IV fluids. She further identified that when a resident is started on IV fluids, the facility's stored IV fluids are utilized at times. Subsequent to surveyor's inquiry, 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.