Jeanne Jugan Residence

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, for two (2) of 15 sampled residents, facility staff failed to identify and report an alleged incident of resident-to-resident abuse. Residents #15 and #25. The findings included: Review of the facility's Abuse, Neglect, Mistreatment and Misappropriation of Resident Property policy dated January 2025 documented: - Abuse can include verbal, mental, sexual or physical abuse. - The facility will strive to educate staff and other applicable individuals in techniques to protect all parties. - It is the policy of this facility that all staff shall monitor residents and will know how to identify potential signs and symptoms of abuse. Resident #15 was admitted to the facility on [DATE] with multiple diagnoses that included Anxiety Disorder, Dementia and Osteoarthritis. Review of the resident's medical record revealed the following: A Quarterly Minimum Data Set (MDS) assessment dated [DATE] showed that facility staff coded: a Brief Interview for Mental Status (BIMS) summary…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, for one (1) of 15 sampled residents, facility staff failed to ensure that, for six (6) months, Resident #20 received the necessary behavioral health care and services as ordered by the physician. The findings included: Resident #20 was admitted to the facility on [DATE] with multiple diagnoses that included: Major Depressive Disorder, Hemiplegia and Hemiparesis Following Cerebral Infarction, Affecting Left Non-Dominant Side, and Hypothyroidism. Review of the resident's medical record showed the following: A physician's order dated 10/12/23 that directed, Lexapro oral tablet 10 MG (milligrams), give 1 tablet by mouth one time a day for Major Depressive Disorder. A Quarterly Minimum Data Set (MDS) assessment dated [DATE] showed that facility staff coded: a Brief Interview for Mental Status (BIMS) summary score of 15, indicating intact cognitive status; Resident Mood Interview (PHQ-2 to 9 © - Patient Health Questionnaire - mental health screening tool for mood) score 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 interview for two (2) of 15 sampled residents, it was determined that facility staff failed to act upon the Pharmacist's report and recommendation and document in the resident's record any action that had been taken to address the recommendation(s) and failed to ensure one resident's medication order was complete with an indication for use for the twice daily administration of an Opioid medication. Residents #16 and #18. The findings included: Facility's document titled 'Medication Regimen Review' with a reviewed date of 08/2018 documented: It is the policy of this Home that each resident will have a medication regimen review by a licensed pharmacist in accordance to Federal, State and Local regulations as well as current standards of practice. Procedure: 3. Irregularities identified will be documented on a separate, written report and sent to the attending physician, medical director, and director of nursing, listing the resident name, relevant drug and irregularity 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 observations and interview during a tour of the dietary services on May 27, 2025, at approximately 9:20 AM, facility staff failed to store food under sanitary conditions as evidenced by one (1) of one (1) plastic container filled with various types of deli meats, and one (1) of (1) plastic container with shredded lettuce and tomato slices, that were not labeled or dated in the walk-in refrigerator, and dietary staff failing to sanitize one (1) of one (1) digital thermometer before and after each use while checking hot food temperatures in the tray line. The findings include: 1. A container with deli meats in the walk-in refrigerator was not labeled or dated to indicate storage time and use-by date. 2. A container with shredded lettuce and tomato slices in the walk-in refrigerator was not labeled or dated to indicate storage time and use-by date. 3. Dietary staff failed to sanitize one (1) of one (1) food temperature thermometer after each use when testing multiple dishes on the tray line. Employee #5 acknowledged the findings during a face-to-face interview on May 29, 2025,…

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 maintain a safe, and sanitary environment as evidenced by dietary staff failing to sanitize one (1) of one (1) digital thermometer before and after each use, when testing hot food temperatures on the tray line. The findings included: During observations of the tray line on May 27, 2025, at approximately 12:00 PM, a dietary staff member did not clean and sanitize one (1) of one (1) digital metal stem thermometer between uses on the tray line. This deficient practice could potentially cause cross-contamination to occur in food items on the tray line. Employee #5 acknowledged the findings during a face-to-face interview on May 29, 2025, at approximately 9:30 AM.

Based on observations and staff interview, facility staff failed to distribute foods under sanitary condi-tion, as evidenced by dishwashing machine final rinse temperatures that were below 180 degrees Fahrenheit (F), and dietary logs that were not consistently maintained to indicate the concentration of the sanitizing solution from one (1) of one (1) 3-compartment sink. The findings include: 1. Final rinse dishwashing machine temperatures failed to reach 180 degrees Fduring observations on April 4, and April 5, 2024. Facility staff used paper plates for dinner meals on April 4, 2024, and for all meals on April 5, 2024. Final repairs of the dishwashing machine were completed on April 5, 2024, at approximately 3:00 PM, when the final rinse temperature reached 192 degrees F . Observations on April 8, 2024, at 9:35 AM, confirmed that dishwashing machine temperatures were consistent as final rinse temperatures were between 186 degrees F and 192 degrees F, on four (4) consecutive wash cycles. 2. Chemical sanitizer solution logs for one (1) of one (1) 3-compartment sink were incomplete 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.

Based on observations and staff interview, facility staff failed to maintain essential equipment in safe operating condition, as evidenced by final rinse temperatures that were below 180 degrees on April 4, 2024, at 9:15 AM and 10:40 AM. The findings include: During observations in dietary services on April 4, 2024, at 9:15 AM, and 10:40 AM, final rinse temperatures from the dishwashing machine did not reach a minimum of 180 degrees as required. The machine was repaired on April 5, 2024, at approximately 3:00 PM. During a face-to-face interview on April 8, 2024, at approximately 2:00 PM, Employee #5 acknowledged the findings.

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 MDS contained accurate information related to skin integrity for one (1) of 16 sampled resident. (Resident #4) The findings included: Resident #4 was admitted to the facility on [DATE]. The resident had a history of Peripheral Vascular Disease and Cerebral Palsy. A radiology report dated 12/09/23 (Right Duplex Scan - an assessment of how blood flows through arteries and veins), documented the following findings: Rle r/o PVD (Right Lower Extremity rule out Peripheral Vascular Disease), Findings- There is moderate stenosis (narrowing) in the femoral artery. A review of Employee #7's (Wound Care Physician) weekly progress notes dated from 12/13/23 to 02/21/24 documented the following but not limited to: Wound; Location - right heel, Etiology - PVD (Peripheral Vascular Disease). A quarterly Minimum Data Set, dated [DATE] documented the following but not limited to: the resident had a Brief Interview for Mental Status summary 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 record review and staff interview, for one (1) of 16 sampled residents, facility staff failed to accurately code one resident's quarterly Minimum Data Set (MDS) assessment with the accurate number of falls. Resident #24. The findings included: Resident #24 was admitted to the facility on [DATE] with multiple diagnoses that included: Parkinson's Disease, Hypertension and Hypothyroidism. Review of Resident #24's medical record revealed a quarterly MDS dated [DATE] in which facility staff coded: a Brief Interview for Mental Status (BIMS) summary score of 15, indicating intact cognitive response; and in section J (Health Conditions), no of falls since admission/entry or reentry or prior assessment, whichever is more recent. Further review of the medical record revealed the following documentation: 11/15/22 at 2:16 AM [Fall Risk Assessment] .Recent Fall . Score: 12.0; Category: High Risk . Instructions/scoring . 10 or above [equals] High Risk . Notes: Sustained a fall in her room . 11/15/22 at 3:23 AM…

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 16 sampled residents, facility staff failed to develop and implement a comprehensive person-centered care plan with goals and interventions to address one resident's diagnosis of Convulsions and use of anti-seizure medications. Resident #29. The findings included: Resident #29 was admitted to the facility on [DATE] with multiple diagnoses that included: Unspecified Convulsions, Schizoaffective Disorder and Anxiety Disorder. Review of Resident #29's medical record revealed a physician's order dated 09/14/22: Divalproex (anti-seizure medication) Sodium ER (extended release) Tablet . 500 MG (milligrams) Give 2 tablet by mouth two times a day related to Unspecified Convulsions; Seizure precaution every shift related to Unspecified Convulsions; and Primidone (anti-seizure medication) Tablet 50 MG Give 2 tablet by mouth two times a day related to Unspecified Convulsions. Review of Resident #24's comprehensive care plan with a review date of 02/21/23, showed no…

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 16 sampled residents, facility staff failed to revise one resident's medium risk for falls care plan to high risk for falls after sustaining two falls. Resident #24. The findings included: Resident #24 was admitted to the facility on [DATE] with multiple diagnoses that included: Parkinson's Disease, Hypertension and Hypothyroidism. Review of Resident #24's medical record revealed the following documentation: 11/15/22 at 2:16 AM [Fall Risk Assessment], .Recent Fall . Score: 12.0; Category: High Risk . Instructions/scoring . 10 or above [equals] High Risk . Notes: Sustained a fall in her room . 11/15/22 at 3:23 AM [Nursing Progress Note], Resident reports that approximately 1245 a.m., she fell after using the bathroom . 01/04/23 at 1:00 PM [Fall Risk Assessment], .Recent Fall . Score: 16.0; Category: High Risk . 01/04/23 at 2:20 PM [Nursing Progress Note] At about 1:00 pm Writer was called by House keeping to the hallway who observe resident fell on 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.