Forest Hills Of Dc

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, the facility failed to ensure a resident's Medication Administration Record included the correct formulary for a medication used to treat elevated blood pressure for one (1) of three (3) sampled residents. (Resident #1) The findings included: Resident #1 was admitted to the facility on [DATE] with a history of Acute Pulmonary Embolism and Hypertension. A review of Resident #1's medical record revealed that the resident was discharged from an out-of-town nursing home on [DATE]. The discharge summary documented that the resident was prescribed . Metoprolol Succinate [Toprol XL] Extended Release 50 mg one (1) tablet by mouth at bedtime. A physician order dated 12/19/24 instructed, Metoprolol Tartrate [Lopressor] 50 mg one (1) tablet by mouth at bedtime for elevated blood pressure. The December 2024 Medication Administration Record (MAR) showed an order for Metoprolol Tartrate [Lopressor] 50 mg one (1) tablet by mouth at bedtime for elevated blood pressure. According 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.

Based on observations and staff interview, facility staff failed to distribute and serve foods under sanitary conditions. These findings have the potential to affect all residents. The findings included: 1. An open pack of provolone cheese and a pan with chunks of grapefruit were stored in a refrigerator undated, in the kitchen on unit Healthcare 1. 2. Two (2) of 14 white cutting boards, and two (2) of 14 green cutting boards in the main kitchen were soiled and discolored. 3. Food temperature logs from the main kitchen, and the kitchen on healthcare 1 and 2, were missing several entries throughout the month of October 2024. 4. One (1) of two (2) convection ovens in the main kitchen (bottom), was soiled. 5. Two (2) of eight (8) fire suppression nozzles, located above the grease fryer and the gas stove were soiled with grease deposits, and one (1) of eight (8) was corroded. 6. One (1) of two (2) fire sprinkler heads in the walk-in refrigerator was soiled and rusty. Employee #5 (Director of Dietary Services) acknowledged the findings during a face-to-face interview on 12/5/2024, 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 record reviews and staff interviews, for two (2) out of 19 sampled residents, facility staff failed to accurately code their Minimum Data Set (MDS) assessments. (Residents #11 and #57) The findings included: 1. Resident #11 was admitted to the facility on [DATE] with multiple diagnoses that included Chronic Obstructive Pulmonary Disease (COPD), Type 2 Diabetes Mellitus and Hypothyroidism. Review of the resident's medical record revealed the following: A physician's order dated 01/04/23 that directed, Aripiprazole 5 mg (milligrams) by mouth every night for Depression. A physician's order dated 03/23/23 that directed, Remeron Oral Tablet 15 MG, give 1 tablet by mouth at bedtime for Depression. A physician's order dated 10/02/23 that directed, Fetzima Oral Capsule Extended Release 24 Hour 120 MG, give 1 capsule by mouth one time a day for Depression. Physician's order dated 03/12/24 that directed, Abilify Oral Tablet 5 MG (Aripiprazole), give 1 tablet by mouth one time a day for Depression. In addition,…

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 and staff interview, for one (1) out of 19 sampled residents, facility staff failed to develop a care plan with goals and interventions to address Resident #11's use of antibiotics. The findings included: Review of the facility's Care plans, Comprehensive Person-Centered policy (not dated) documented: - A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Resident #11 was admitted to the facility on [DATE] with multiple diagnoses that included: Chronic Obstructive Pulmonary Disease (COPD), Type 2 Diabetes Mellitus and Hypothyroidism. Review of the resident's medical record revealed a physician's order dated 03/14/24 that directed, Trimethoprim (type of antibiotic) oral tablet 100 MG (milligrams), give 1 tablet by mouth at bedtime for UTI (urinary tract infection) prophylaxis. A Quarterly 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 record reviews and staff interviews, for one (1) of 19 sampled residents, the facility staff failed to update and revise the care plan with resident-centered goals for Resident #55 following a fall that occurred on 07/13/24. The findings included: A review of the facility's policy titled Managing Falls and Falls Risks with a revision date of 08/21/21, documented the following: If falling recurs despite initial interventions, staff will implement additional or different interventions or indicate why the current approach remains relevant. Resident #55 was admitted to the facility on [DATE] with multiple diagnoses that included the following: Difficulty Walking, Unspecified Lack of Coordination, Cognitive Communication Deficit, and Repeated Falls. A review of Resident #55's medical record revealed a progress note dated dated 07/12/24 at 8:24 AM, documenting, During the shift report, staff heared (sp) noise from room [ROOM NUMBER]. Immediately responded to noise and all of us went to room [ROOM NUMBER].…

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 and staff interview, for one (1) out of 19 sampled residents, facility staff failed to implement their antibiotic stewardship system for monitoring antibiotic use and adverse reactions for one (1) resident since 03/14/24, approximately nine (9) months. (Resident #1) The findings included: Review of the facility's Antibiotic Stewardship - Review and Surveillance of Antibiotic Use and Outcomes policy (not dated) documented: - Antibiotic usage and outcome data will be collected and documented using facility-approved antibiotic surveillance tracking form. - The IP (Infection Preventionist) or designee, will review antibiotic utilization as part of the antibiotic stewardship program. - All resident antibiotic regimens will be documented on the facility approved antibiotic surveillance tracking form. Resident #11 was admitted to the facility on [DATE] with multiple diagnoses that included, Chronic Obstructive Pulmonary Disease (COPD), Type 2 Diabetes Mellitus and Hypothyroidism. Review 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 record review and staff interview, for four (4) of 32 sampled residents, facility staff failed to provide written notice of the bed hold policy to include the number of bed hold days to the resident or their responsible party upon transfer to the emergency room. Residents' #197, #253, #27 and #98. The findings included: The facility policy Bed Hold documented, . At the time of transfer or leave of absence, the social worker will notify the resident/responsible party of the transfer and the number of bed-hold days remaining . 1. Resident #197 was admitted to the facility on [DATE] with multiple diagnoses that included: Repeated Falls, Muscle Weakness, Unsteadiness on Feet and Abnormalities of Gait and Mobility. Review of Resident #197's medical record revealed: An admission Minimum Data Set (MDS) dated [DATE] showed facility staff coded: a Brief Interview for Mental Status (BIMS) summary score of 15, indicating intact cognition. A Health Status Note dated 11/03/22 at 8:20 AM documented: On 11/3/22 around…

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 and staff interviews, the facility staff failed to revise and update person-centered care plans for 4 (four) of 32 sampled residents. Residents #12, #41, #17, and #23 The findings included: The facility policy Care Plans, Comprehensive Person-Centered documented, .Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' condition change . The Interdisciplinary Team (IDT) must review and update care plan . when the desired outcome is not met, when the resident has been readmitted to the facility from a hospital stay . 1. Facility staff failed to update Resident #12's care plan to show that the resident had sustained a fall with injuries. Resident #12 was admitted to the facility on [DATE] with the following diagnoses: Unspecified Fall, Multiple Fractures of Pelvis without Disruption of Pelvic Ring, Displaced Intertrochanter Fracture of Right Femur, Osteoporosis, Unsteadiness on Feet, and Generalized Muscle Weakness. Review of…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, the facility staff failed to ensure that three (3 ) of 32 sampled residents had hospice care plans that included: a description of the care, services, and frequency of visits to be provided by the contracted hospice provider. Residents' #252, #4, #23 The findings included: Review of the facility's Hospice contract documented, .Hospice plan of care means a written plan which is established, maintained, reviewed and modified if necessary . which includes . details concerning the scope of frequency of such hospice services . Nursing Home shall develop a nursing home plan of care in coordination with the hospice plan of care . Nursing home will periodically review and modify the nursing home plan of care in coordination with hospice .The Nursing Home shall prepare and maintain complete and detailed clinical records for each residential hospice patient receiving nursing home and hospice services . each medical record shall completely, promptly and accurately documents all…

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 staff interviews, the facility failed to visibly post signage of the accurate contact information for the State Survey Agency to ensure residents and resident representatives were able to file a complaint. The facility census was 43 on the first day of the survey. The findings included: A Complaint (DC~11004) received by the State Agency on [DATE] at 11:19 AM documented, . She [ resident's daughter] made her [resident 's daughter] complaint to the Ombudsman Office and had been leaving messages for [State Agency Program Manager's name] as posted around the facility. She [residents daughter] learned a few days later that [ contact person name] was deceased , but the signage does not reflect an alternative person to contact. During an observation on [DATE] at 10:30 AM, an 8x10 binder marked Grievance Forms sign posted on the First-Floor unit board at the elevator instructed the resident to After completing a grievance form, please contact the Social Worker . or Charge Nurses to collect 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 record review and staff interviews, for one (1) of 32 sampled residents, the facility staff failed to notify a resident, their representative, or the Ombudsman of the reason for the resident's transfer to the hospital in writing. Resident #253. The findings included: Resident #253 was admitted to the facility on [DATE] with the following diagnoses: Left Hip Arthroplasty, Thrombosis Distal Left Cephalic Vein, Bilateral Leg Swelling, Rheumatoid Arthritis, and Osteoporosis. Resident #253's medical record revealed the following: A Face Sheet that documented that the resident had a representative. A Five (5)-Day Scheduled Minimum Data Set (MDS) assessment dated [DATE] showed that facility staff did not complete Section C (cognitive patterns). A Change in Condition Note dated 11/07/21 at 4:08 PM documented: Situation: Resident reported that her left calf is hurting. Background: Resident .admitted with a diagnosis of left hip replacement . A quick assessment was done; she was noted with a swollen left leg calf…

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 reviews and staff interviews, for three (3) of 32 sampled residents, facility staff failed to accurately code the Minimum Data Set (MDS) for one who had a fall, one resident's Drug Regimen Review, and one resident's hospice services. Residents' #7, #35 and #252. 1. Facility staff failed to accurately code Resident #7's MDS for Drug Regimen Review. Resident #7 was admitted on [DATE] with multiple diagnoses including Alzheimer's Disease, Anxiety Disorder, Dementia and Generalized Muscle Weakness. Pharmacy drug regimen review dated 01/02/23 documented, Recommend a psych consult for continued use of Sertraline, donepezil, and melatonin in context of fall on 01/02/23[doctors name] the psychiatrist. Physician response: Disagree continue for anxiety. The evidence showed the facility staff failed to accurately code the MDS for Resident #7 drug regimen review identify potential clinically significant medication issues that was recommende by the pharmacy on 01/02/23. A review of the follow-up note to 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 record review and staff interview, for two (2) of 32 sampled residents, facility staff failed to develop and implement a comprehensive resident centered care plan to address: Resident #199's right toe wound and Resident #7's use of antianxiety medications. Residents' #199 and #7. The findings included: The facility policy care Plans, Comprehensive Person-Centered documented, .The care plan interventions are derived from thorough analysis of the information gathered as part of the comprehensive assessment .The comprehensive, person-centered care plan will: include measurable objectives .incorporate identified problem areas . identifying problem areas and their causes, and developing interventions that are targeted and meaningful to the resident . 1. Facility staff failed to develop and implement a comprehensive resident centered care plan to address Resident #199's right toe wound. Resident #199 was admitted to the facility on [DATE] with multiple diagnoses that included: Type 2 Diabetes Mellitus, Atrial…

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, record review and staff interviews, for one (1) of 32 sampled residents, facility staff failed to ensure that the resident received proper treatment and assistive devices to maintain hearing abilities. Resident #299. The findings included: Resident #299 was admitted to the facility on [DATE] with multiple diagnoses that included: Hard of Hearing, Blindness and Parkinson's Disease. Review of Resident #299's medical record revealed: A physician's order dated 05/28/20 that directed, Nursing staff to check/ensure resident has both hearing aids. Please document in progress notes every shift. A care plan focus area initiated on 12/03/20 documented, Hearing Aides .Goal: [resident's name] uses hearing aides r/t (related to) hard of hearing .Interventions/Tasks: Change first hearing aid batteries routinely every Friday on 3-11 shift .Change second hearing aid batteries routinely every Friday on 3-11 shift .Check first and second hearing aid for functioning prior to use .Place second hearing aids 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 two (2) observations, record reviews and staff interviews, for one (1) of 32 sampled residents, facility staff failed to ensure that the system to account for the reconciliation, dispensing, and administration of controlled medications was followed. Resident #41. The findings included: The facility policy Controlled Substances documented, The facility shall comply with all laws, regulations and other requirements related to to .documentation of schedule II and other controlled substances .an individual resident controlled substance record must be made for each resident who will be receiving a controlled substance . This record must contain . time of administration . signature of nurse administering medication . 1A. During an observation on 07/30/23 at 6:58 AM of the 2nd floor, medication cart 2's Controlled Drug Shift Count Sheet, it was noted that Employee #5 (Registered Nurse) had signed her name in the area, Nurse off and documented yes in the area drug count correct?. When asked why she had…

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 one (1) observation, record review and staff interview, a multi-dose Humalog (type of Insulin) pen was stored for use that failed to have a resident label or an expiration date. The findings included: The facility policy Administering Medications directed, .the expiration/beyond use date on the mediation label is checked . When opening a multi-dose container, the date opened is recorded on the container . Insulin pens are clearly labeled with the resident's name . During an observation of the 1st floor medication storage room on 07/30/23 at 6:45 AM, it was noted that there was an open and used Humalog pen that failed to have a resident label or an expiration/beyond-use date. During a face-to-face interview conducted at the time of the observation, Employee #4 (Registered Nurse/RN) acknowledged the finding and stated, It's a mistake. Cross Reference 22B DCMR Sec. 3227.19

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, resident and staff interviews, for one (1) of 32 sampled residents, facility staff failed to ensure Resident #41 received the correct food consistency ordered by the physician. The findings included: Resident #41 was admitted to the facility on [DATE] with multiple diagnoses that included: Dysphagia and Protein Calorie Malnutrition. Review of Resident #41's medical record showed the following: An active physician's order dated 07/10/23 that directed, Regular diet, pureed texture, thin consistency An admission Minimum Data Set (MDS) dated [DATE] showed facility staff coded: a Brief Interview for Mental Status (BIMS) summary score of 15, indicating intact cognition and received a mechanically altered diet. A Speech Language Therapy Evaluation and Plan of Treatment Summary dated 07/20/23 recommended, .Solids - mechanical soft textures . An active physician's order dated 07/27/23 directed, Other diet, mechanical soft/chopped meats texture. During a face-to-face interview 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.

Based on observations and interview, facility staff failed to store and distribute food under sanitary condition as evidenced by food items such as brown gravy, baked fish, bread chunks, a squash and zucchini dish, and two (2) liters of a white sauce, stored in various containers in one (1) of one (1) walk-in refrigerator that were not labeled, food items such as five (5) of five (5) containers with chopped and sliced carrots, one (1) of one (1) container of red onions, one (1) of one container of sliced celery, one (1) of one (1) container of chopped cabbage, one (1) of one (1) container of sliced yellow squash, one (1) of one container of sliced zucchini, one (1) of one (1) container of sliced cucumbers, and one (1) of one (1) container of sliced tomatoes, that were labeled with a use-by date of July 29, 2023, one (1) one (1) open pack of cheddar cheese that was labeled with a use-by date of 7/3/23, two (2) of two (2) bottles of eyewash solutions located in the kitchen on Healthcare Center 2 (HCC2) that expired as of 08/2022, and one (1) of one (1) bottle of eyewash solution…

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 record review and staff interview, facility staff failed to ensure resident funds were not commingled with the funds of any other person other than another resident. The facility census was 45. (Identifiers for Non-Residents'- TF1, TF2 and TF3) The findings included: Review of the facility's trial balance report dated 2/18/22 showed a total of 18 resident accounts. When the writer reconciled the trial balance report with the facility census report dated 2/17/22, it was revealed that three (3) of 18 (TF1, TF2, and TF3) accounts listed on the trail balance report did not belong to residents that reside in the skilled nursing facility. Review of the Facility's Assisted Living Census/Resident Roster showed that TF1 and TF2 were listed as residents of the Assistant Living ; and TF3 was a resident of the facility's Memory Care Unit. During a face-to-face interview on 02/22/22 at 2:30 PM, Employee #19, (Chief Financial Officer) reviewed the documents and stated that the names [TF1, TF2, and TF3] and accounts listed on the trial balance report were not residents of the skilled…

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 and staff interview, facility staff failed to prepare and serve foods under sanitary conditions as evidenced by four (4) of four (4) damaged cutting boards, one (1) of one (1) soiled salamander grill, one (1) of one (1) fire extinguisher that was past due its yearly inspection date, four (4) of eight (8) soiled fire suppression nozzles, one (1) of three (3) dishwashing machines that leaked from the bottom when used, and one (1) of three (3) dishwashing machine that did not consistently reach a minimum final rinse temperature of 180 degrees Fahrenheit. The findings included: During a walkthrough of dietary services on February 17, 2022, at approximately 10:30 AM and on February 24, 2022, at approximately 9:45 AM, the following were observed: 1. Two (2) of two (2) red cutting boards and one (1) of one (1) white cutting board that were stored for use, and one (1) of one (1) green cutting board that was being used to slice carrots were damaged with deep grooves that could possibly inhibit bacteria and odor. 2. One (1) of One (1) salamander grill was soiled with…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and staff interviews, for five (5) of 32 sampled residents, the facility's staff failed to maintain Infection Control Practices to minimize or prevent the potential spread of infection as evidenced by: (1) staff not performing hand hygiene before serving a lunch tray for one (1) resident; (2) staff not performing hand hygiene between care (hygiene) for two (2) residents; (3) staff not providing a barrier during wound care for 1 resident; and (4) not wearing clean gloves when changing bed linen for one (1) resident. (Residents' #1, #2, #9, #17, and #239). The findings included: 1. The facility's staff failed to perform hand hygiene before serving Resident #9 her lunch tray. Review of a policy titled, Assisting the Impaired Resident with In Room Meals, instructed staff to, wash their hands before serving food to residents . Resident #9 was admitted to the facility on [DATE] with multiple diagnoses including Dementia without Behavioral Disturbances and Dysphagia. During an…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations and staff interview, facility staff failed to maintain essential equipment in safe condition as evidenced by one (1) of one (1) high temperature dishwashing machine in the main kitchen that did not reach a minimum final rinse temperature of 180 degrees Fahrenheit on two (2) of three (3) observations, and one (1) of one (1) dishwashing machine in second floor kitchen that consistently leaked from the bottom when in use. The findings included: 1. One (1) of one (1) dishwashing machine in the main kitchen failed to reach a minimum of 180 degrees Fahrenheit on two (2) of three (3) observations on February 24, 2022, at approximately 9:45 AM. The contracting repair company ([NAME]) came in and determined that one (1) of three (3) heater elements inside the machine was inoperative, but the machine was still able to reach a minimum final rinse temperature of 180 degrees Fahrenheit on most occasions. A replacement part was ordered, and the machine was used to clean and disinfect dishes along with 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 record review and staff interview, facility staff failed to ensure that one (1) resident's funds were conveyed within 30 days of their death. The facility census was 45. (Resident #289) The findings included: Review of the facility's trial balance dated [DATE] showed a total of 18 resident accounts. Review of the trial balance report showed that Resident #289 had a resident funds account with a balance of $1659.69. The status of the account was recorded as frozen as of [DATE]. According to the Death in Facility Tracking Record, Minimum Data Set, dated [DATE] showed that Resident #289 was coded as follows: Section A2000 (discharge date ) was recorded as [DATE]; and Under Section A2100 Discharge Status the resident was coded as deceased . During a face-to-face interview on [DATE] at approximately 4:30 PM, Employee #19, (Chief Financial Officer) stated, The accountant (facility staff) believed Social Security would take back the January [2022] Social Security Administration payment due to death so she is…

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 reviews and staff interviews for three (3) of 32 sampled residents, facility staff failed to offer residents or their representatives an opportunity to formulate an Advance Directive. (Residents' #20, #37 and #38). The findings included: 1.Resident #20 was admitted to the facility on [DATE] with multiple diagnoses including Parkinson's Disease, Alzheimer's Disease, and Non-Alzheimer's Dementia. Review of the Quarterly Minimum Data Set, dated [DATE] showed in Section C (Cognitive Patterns) Resident #20 had a Brief Interview for Mental Status (BIMS ) summary score of 06, indicating severely impaired cognition. Review of Resident #20 's medical record revealed: [DATE] [physician's order] instructed, CPR (Cardiopulmonary Resuscitation). [DATE] [care plan] showed the following: - Focus Area: Code status showed, Full Code. - Goal: All staff will remain aware of [resident's name] wishes regarding code status and will ensure proper documentation. - Interventions included: Clarify [resident's name] code…

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, staff and family interview, the facility's staff failed to inform a resident's family member about the resident's change in status (bruise to right brow) for one (1) of 32 sampled residents. (Resident #19) The findings included: Review of a policy titled, Accident /Incident instructed staff to, report the accident/incident to his/her immediate supervisor as soon as practicable . During a face-to-face interview on 02/17/22 at approximately 11:30 AM, Resident #19's daughter (responsible party) stated that when she visited her mother in January (2022), she observed her mother with a left black eye and swollen area on her forehead on the same side. However, no one from the facility made her aware. When she asked staff about her mother's injuries, they informed her that her mother hit her face on the side rail during the night. Resident #19 was admitted to the facility on [DATE]. The resident had multiple diagnoses including Muscle Weakness, Repeat Falls, and Insomnia. Review of an incident…

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 and staff interview, for three (3) of 32 sampled residents, facility staff failed to implement its written policy and procedure to investigate injuries of unknown source. (Residents' #4, #11 and #189) The findings included: Review of the facility's document provided to the surveyor on 02/23/22 entitled, Reporting Incident Process revealed: . Reportable incidents/accidents include, but not limited to . injuries of unknown origin . pressure injuries, skin tears .Investigation: Interview all staff working at the time, or if necessary, staff working previous shifts, of incident and collect written witness statements from all staff . 1. Resident #4 was admitted to the facility on [DATE] with multiple diagnoses that included: Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-Dominant Side, Peripheral Vascular Disease and Muscle Weakness. Review of the medical record revealed the following: Quarterly Minimum Data Set (MDS) dated [DATE], facility staff coded a Brief…

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, record reviews, and staff interviews, for three (3) of 32 sampled residents facility staff failed to report to the State Agency: (1) a facility-reported-incident (FRI) involving a medication error for one (1) resident;(2) a FRI involving an injury of unknown origin for one resident; and (3) a FRI involving an accident(fall) within the required time frame of 24 hours for one (1) resident. (Residents' #3, #20 and #239). The findings included: 1. The facility's staff failed to report a FRI involving a medication error to the State Agency for Resident #3. Resident #3 was admitted to the facility on [DATE] with multiple diagnoses including Major Depressive Disorder, Anxiety, Post-Traumatic Stress Disorder, and Psychosis. During multiple observations from 02/17/22 to 02/25/22 starting at approximately 11:00 AM to approximately 5:00 PM, Resident #3 was noted in his room, well groomed, calm and cooperative with staff. Review of the medical record showed the following: 11/06/20 [physician order]…

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 and staff interview, for one (1) of 32 sampled residents, facility staff failed to convey a resident's comprehensive care plan goals to the receiving provider during three (3) hospital transfers. (Resident #20) The findings included: Resident #20 was admitted to the facility on [DATE] with multiple diagnoses including Parkinson's Disease, Osteoporosis, Osteoarthritis. History of hip fracture, Alzheimer's Disease, Non-Alzheimer's Dementia, History of Falls with Multiple Injuries, and Dislocation of Internal Right Hip Prosthesis. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] showed the following: In Section C (Cognitive Patterns) - the resident had a Brief Interview for Mental Status (BIMS) summary score of 12, indicating mildly impaired cognition. In Section G (Functional Status)- Resident #20 was coded as being totally dependent and required the physical assistance of one-person for bed mobility and dressing. The resident was also coded a s totally dependent and requiring 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 record review and staff interview, facility staff failed to ensure Minimum Data Set (MDS) was accurately coded for a resident's discharge status for one (1) of 32 sampled residents. (Resident #141) The findings included: Review of the Physician's orders showed the following: 11/23/21 at 3:00 PM - T.O. (Telephone order) . Resident may be discharge (sp) home when ready; 11/24/21- Discharge home. The Physician's Discharge Summary signed and dated by the physician on 11/24/21 for Resident #141 showed: admission date -11/19/21 discharge date - 11/24/21. Final Diagnosis- Cerebrovascular Accident, Other Significant Diagnosis: Dementia, Hypertension, Glaucoma and Hyperlipidemia. Disposition- Discharge with approval; Destination - Home. According to the Discharge Reporting Minimum Data Set, dated [DATE] the resident was coded as being discharged assessment -return not anticipated from the facility under Section F (Entry/Discharge Reporting); Under Section A2100 Discharge Status the Resident was coded as being…

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, record review and staff interview for one (1) of 32 sampled residents, facility staff failed to develop a baseline care plan to include Residents low vision resulting from an active diagnosis of Macular degeneration within 48 hours of admission to the facility. (Resident #139) The findings included: Resident #139 was re-admitted to the facility on [DATE] with multiple diagnoses including Nonexudative Age Related Macular Degeneration Right Eye Stage Unspecified. During a face-to-face interview on 02/23/22 at 11:22 AM, Resident #139 stated I have Macular Degeneration. I can't hardly see. I'm afraid I'm going to knock my glass of water over. Review of the Electronic Health Record (EHR) for Resident #139, who was re-admitted to the facility on [DATE] showed the resident had a diagnosis of Nonexudative Age-Related Macular Degeneration Right Eye Stage Unspecified listed on her face sheet, Medication Administrative Record, Treatment Administration Record and Comprehensive-Care Plans from previous…

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, record review, and staff interviews for two (2) of 32 sampled residents, the facility's staff failed to: (1) assess one (1) resident for edema to her left arm; and (2) follow physician's order to spoon feed one (1) resident at all meals. (Residents' #39 and #139) The findings included: 1.The facility's staff failed to assess for edema that was present in Resident #139's left arm. Resident #139 was re-admitted to the facility on [DATE], with multiple diagnoses including Acute Kidney Failure, Muscle Weakness, and Chronic Obstructive Pulmonary Disease. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed the following: In section C (Cognitive Patterns) the resident had a Brief Interview for Mental Status (BIMS) summary score of 15 indicating intact cognition. In section G (Functional Status) G0110 Activities of Daily Living (ADL) Assistance, Bed Mobility facility staff coded extensive assistance and resident requires one-person physical assist Transfer, facility staff coded…

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, record review, and responsible party and staff interview, the facility's staff failed to ensure durable medical equipment (sling of a sit-to-stand mechanical lift) was in good working condition before transferring (to the commode) Resident #19, who subsequently had an assisted fall without injuries. The findings included: Resident #19 was admitted to the facility on [DATE]. The resident had an history of multiple diagnoses including Muscle Weakness, Repeated Falls, Obesity, and Transient Ischemic Attack. The Department of Health (DOH) received the following updated incident report on 11/29/21: During transfer to bathroom with 2 CNAs (certified nurse aide) with sit to stand lift during pm care, the sling hooked to the machine broke thereby causing resident to be lowered to the floor in a sitting position [on 11/26/21 at 9:30 PM]. The 2 CNAs called Charge Nurse and 2 other persons to assist resident off the floor after the head-to-toe assessment was conducted on the resident. Range of motion…

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 and resident and staff interview, the physician failed to review the resident's complete health record to include residents' diagnosis of Macular Degeneration for one (1) of 32 sampled residents. (Resident #139) The findings included: Resident #139 was re-admitted to the facility on [DATE], with multiple diagnoses including Nonexudative Age Related Macular Degeneration Right Eye Stage Unspecified. During a face-to-face interview conducted on 02/23/22 at 11:22 AM, Resident #139 stated I have Macular Degeneration I can't hardly see. I'm afraid I'm going to knock my glass of water over. Review of the Electronic Health Record (EHR) for Resident #139, who was re-admitted to the facility on [DATE] showed the resident had a diagnosis of Nonexudative Age-Related Macular Degeneration Right Eye Stage Unspecified listed on her face sheet, Medication Administrative Record, Treatment Administration Record and Comprehensive-Care Plans from previous stay at the facility (admitted on [DATE] and discharged…

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

Based on observation and staff interview during a tour of one (1) of two (2) medication storage rooms, facility staff failed to ensure that three (3) of three (3) insulin vials were dated when first opened. The findings included . According to the manufacture's storage instructions, The Lantus vials you are using should be thrown away after 28 days, even if it still has insulin left in it. https://www.lantus.com/how-to-use/how-to-inject According to the manufacture's storage instructions, Recommended storage conditions for NovoLog Insulin is 28 days after first use. https://www.novonordiskmedical.com/our-products/storage-and-stability.html On 02/17/22 at approximately 2:40 PM in the presence of Employee # 16 (Nurse Supervisor) an observation of the first floor medication refrigerator was conducted and the following was noted: Two (2) of 2 vials of Lantus Insulin 100 units were observed open with no date recorded (written) on the vial or the holding/outer container to indicate the first date it was open for use. One (1) of 1 vial of Novolog Insulin was observed opened with no 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 record reviews and staff interview, the facility staff failed to accurately document a resident's Advance Directive directions (wish) to be a Do Not Resuscitate (DNR) in the medical record one (1) of 32 sampled residents. (Resident #36) The findings include: Resident #36 was admitted to the facility on [DATE] with multiple diagnoses that included, Dysphagia, Oropharyngeal Phase, Unspecified Protein-Calorie Malnutrition, Abnormal Weight Loss, Unspecified Glaucoma and Unspecified Dementia Without Behavioral Disturbance. Review of the Quarterly Minimum Data Set (MDS) dated on [DATE], the resident had a Brief Interview for Mental Status (BIMS) summary score of 03 indicating severe cognitive impairment. Review of the medical record revealed a document titled, Advance Directives signed and dated by Resident #36 and his Power-of-Attorney on [DATE]. The Advance Directive form documented that the resident's code status as No Code/Do Not Resuscitate. However, review of an active physician's order 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.