The Hsc Pediatric Skilled Nursing Facility

Based on observations, record review and interview, the facility failed to provide the State Survey Agency with immediate access to medical records. While this was evident for all medical records of the facility, it delayed the State Agencies ability to review medical records for the three of 13 residents selected for sampling during this survey. (Residents #1, #2, and #3) The findings included: According to a Survey and Certification (S&C) memo from the Centers for Medicare and Medicaid Services dated 8/14/09, During the entrance conference, surveyors will verify with the facility the process they will follow in order to have unrestricted access to the medical record. During an entrance conference on 12/11/23 for investigation of a facility reported incident (DC~12475) starting at approximately 9:00 AM, Employee #1 (Administration) was made aware that the State Survey Agency needed access to residents' electronic medical records (EMRs). The Administrator stated that a month ago they started using a new EMR, and she would inform the IT department of the need for access. Also, 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 reviews and interviews, the facility's staff failed to provide continuous pulse-oximeter monitoring, as ordered for one (1) of three (3) sampled residents. The findings included: Resident #1 was admitted to the facility on [DATE] with multiple diagnoses including Lesch Nyhan Syndrome, Nephrocalcinosis, Self-Injurious Behavior, and Developmental Delays. A physician order dated [DATE] instructed, Monitor Pulse Oximetry Continuous per parameters HR (heart rate) 60-120 (beats per minute), POX (pulse-ox) 90-100 (saturation rate). A quarterly MDS dated [DATE] documented, the resident had a Brief Interview for Mental Status summary score of 05 indicating the resident had a severely impaired cognitive status. In addition, the resident was coded for impaired bilateral lower extremities, always incontinent of bladder and bowel, dependent of staff for all Activities of Daily Living, and using a wheelchair. A nurses note dated [DATE] at 11:53 PM documented, Patient Care Overview: Safety check on resident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on a record review and an interview, at the time of survey, the facility failed to have documented evidenced that a thorough investigation had been conducted after the death of a resident for one (1) of three (3) sampled residents. (Resident #1) The findings included: Resident #1 was admitted to the facility on [DATE] with multiple diagnoses including Lesch Nyhan Syndrome, Nephrocalcinosis, Self-Injurious Behavior, and Developmental Delays. A State Survey Agency Facility Reported Incident form # DC~12475 documented, Bedside RN [Employee #4] went in to provide care for [Resident #1] and noticed discoloration in the lips and resident was unresponsive. Rapid Response called and [Resident #1] coded for over an hour but pronounced deceased . SNF Administrator and DON notified, and Medical Examiner called and 911 notified and detectives came out to the facility. Parents notified. A nurses note dated [DATE] at 11:53 PM documented, Patient Care Overview: Safety check on resident done at 1930 (7:30 PM). Resident 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 record reviews and staff interview, the facility's staff failed to develop Baseline Care Plans within 48 hours of admission for two (2) of three (3) sampled residents. (Residents #1 and #2). The findings include: 1.Resident #1 was admitted to the facility on [DATE] with multiple diagnoses including Lesch Nyhan Syndrome, Nephrocalcinosis, Self-Injurious Behavior, and Developmental Delays. A review of the resident's care plan revealed that the care plan was initiatied on 07/20/23. An admission Minimum Data Set, dated [DATE] documents the resident's admission date as 07/06/23. This resident had a Brief Interview for Mental Status summary score of 05, indicating severe cognitive impairment. Also, the resident was coded as dependent on staff for all Activities of Daily Living, always incontinent of bladder and bowel, and wheelchair dependent. 2. Resident #2 was admitted to the facility on [DATE] with multiple diagnoses including Lesch Nyhan Syndrome, Nephrocalcinosis, Self-Injurious Behavior, and Global…

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, the facility failed to develop a care plan for a resident's use of a pulse-ox monitor for three (3) of 3 sampled residents. (Resident #1) The findings included: Resident #1 was admitted to the facility on [DATE] with multiple diagnoses including Lesch Nyhan Syndrome, Nephrocalcinosis, Self-Injurious Behavior, and Developmental Delays. A physician order dated 11/01/23 instructed, Monitor Pulse Oximetry Continuous per parameters HR (heart Rate) 60-120 (beats per minute). POX (pulse-ox) 90-100 (saturation rate). A review of the resident's care plan with a review date of 11/21/23 lacked documented evidence that the facility's staff developed a care plan with goals and interventions for his use of a continuous pulse-oximeter monitoring. During our telephone interview on 12/13/23 at 11:00 AM, Employee #5 (MDS Coordinator) said that the facility was improving their process of developing and reviewing care plans.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, for three (3) of 3 residents, the facility failed to ensure residents care plans were reviewed by the Inter-disciplinary Team; and for one (1) of three (3) sampled residents, the resident's care plan was not reviewed by the Inter-disciplinary Team after each quarterly Minimum Data Set. (Residents #1, #2, and #3). 1. The facility failed to ensure Residents #1, #2, and #3 care plans were reviewed by the Inter-disciplinary Team. 1a. Resident #1 was admitted to the facility on [DATE] with multiple diagnoses including Lesch Nyhan Syndrome, Nephrocalcinosis, Self-Injurious Behavior, and Developmental Delays. A quarterly Minimum Data Set, dated [DATE] documented the resident had a Brief Interview for Mental Status summary score of 05 , indicating severe cognitive impairment. Also, the resident was coded as dependent on staff for all Activities of Daily Living, always incontinent of bladder and bowel, and wheelchair dependent. A review of the resident's care plan revealed that…

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 interviews, the facility's staff failed to provide continuous pulse-oximeter monitoring, as ordered for one (1) of three (3) sampled residents. The findings included: Resident #1 was admitted to the facility on [DATE] with multiple diagnoses including Lesch Nyhan Syndrome, Nephrocalcinosis, Self-Injurious Behavior, and Developmental Delays. A physician order dated [DATE] instructed, Monitor Pulse Oximetry Continuous per parameters HR (heart rate) 60-120 (beats per minute), POX (pulse-ox) 90-100 (saturation rate). A quarterly MDS dated [DATE] documented, the resident had a Brief Interview for Mental Status summary score of 05 indicating the resident had a severely impaired cognitive status. In addition, the resident was coded for impaired bilateral lower extremities, always incontinent of bladder and bowel, dependent of staff for all Activities of Daily Living, and using a wheelchair. A nurses note dated [DATE] at 11:53 PM documented, Patient Care Overview: Safety check on resident…

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

Based on observations and interview, facility staff failed to provide housekeeping services necessary to maintain a safe, clean, comfortable environment as evidenced by privacy curtains that were hanging loose, detached from the curtain tracks in five (5) of eight (8) resident's rooms, and wall clocks in eight (8) of eight (8) resident's rooms that did not display the correct time. The findings included: 1. Privacy curtains in residents' rooms #1077, #1078, #1079, # 1080, and #1082 were hanging loose, detached from curtain hooks and ceiling tracks. 2. Wall clocks in eight (8) of eight (8) resident's rooms did not display actual time. Employee #1 acknowledged the findings during a face-to-face interview on February 8, 2023, at approximately 10:00 AM.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews for three (3) of 13 sampled residents, facility staff failed to implement its written policies and procedures to investigate any potential allegations of neglect as evidenced by the facility's staff failure to investigate two incidents involving residents with a dislodged g (gastrostomy)-tube and one incident involving a resident's decannulation of the tracheostomy tube. (Residents' #1, #8 and #4). The findings included: Review of the facility's policy titled Abuse Investigation and Reporting with a reviewed date of 01/2020, instructs .If an incident or suspected incident of resident abuse, mistreatment, neglect or injury of unknown source is reported, the Administrator will investigate or assign the investigation to an appropriate individual . 1. Facility staff failed to follow its policies to investigate potential neglect by failing to investigate Resident #1's dislodged G-tube. Resident #1 was admitted to the facility on [DATE], with multiple diagnoses that included…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews for three (3) of 13 sampled residents, facility staff failed to conduct thorough investigations as evidenced by there being no evidence that the facility investigated an incident involving one (1) resident's decannulation of the tracheostomy, and for two resident's incidents in which their G (Gastrostomy)-tube dislodged. (Resident's #1, #8, and #4. The findings included: Review of the facility's policy titled Abuse Investigation and Reporting with a reviewed date of 01/2020, instructs .If an incident or suspected incident of resident abuse, mistreatment, neglect or injury of an unknown source is reported, the Administrator will investigate or assign the investigation to an appropriate individual .The individual conducting the investigation will as a minimum .Review the resident's medical record to determine events leading up to the incident; Interview persons reporting the incident . 1. Resident #1 was admitted to the facility on [DATE], with multiple diagnoses that…

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 13 sampled residents, facility staff failed to show documentation that the attending physician reviewed, accepted, acted upon or rejected any identified recommendations made by the pharmacists in the resident's medical record. Residents #9, #7 and #8. The findings included: 1. Resident #9 was admitted to the facility on [DATE] with diagnoses that included: Recurrent Urinary Tract Infection (UTI), Bilateral Hydronephrosis, Seizure, and Chronic Respiratory Failure. Review of Resident #9's monthly Medication Regimen Reviews (MRR) from June 2022 to December 2022 showed the following: Antibiotic usage: yes; Nitrofurantoin PPX (prophylactic) UTI (urinary tract infection) . Nitrofurantoin 50mg (milligrams) [via] GT (gastrostomy tube) [every] p.m. (evening) . Recommendations: Monitor Kidney function. Usage not recommended for Crcl (creatinine clearance/urine test) < (less than) 30ml (milliliters) [per] minute Review of Resident #9's medical record from June…

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 13 sampled residents, facility staff failed to treat Resident #9 with dignity as evidenced by failure to have a privacy bag to cover his indwelling catheter drainage bag. The findings included: Resident #9 was admitted to the facility on [DATE] with diagnoses that included: Bilateral Hydronephrosis and Recurrent Urinary Tract Infection (UTI). Review of Resident #9's medical record revealed a Quarterly Minimum Data Set (MDS) dated [DATE] where facility staff coded: a Brief Interview for Mental Status summary score of 13, indicating intact cognition and that the resident had an indwelling catheter. During a tour of unit 1 North on 02/06/23 at 9:45 AM, Resident #9 was observed lying in bed, his indwelling Foley catheter bag could be seen from the hallway with yellow colored urine. It should be noted that there were multiple building engineers walking around on the unit conducting a test of the unit's electrical system. During a face-to-face…

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 (13) sampled residents, facility staff failed to notify the Ombudsman and the State Agency in writing of the reason for a resident's transfer/discharge to the hospital. Resident #3. The findings included: Resident #3 was admitted to the facility on [DATE] with diagnoses that included Chronic Respiratory Failure, Tracheostomy Present, Spastic Paraplegia, Scoliosis Deformity of the Spine, and Chromosomal Disorder. An Annual Minimum Data Set (MDS) dated [DATE] showed that facility staff documented the Resident had a Brief Interview for Mental Status Score of 15, indicating that the Resident had intact cognition, required suctioning, tracheostomy care, mechanical ventilation, had a gastrostomy tube, had bilateral lower extremity impairment, was at risk for pressure ulcers, and required limited assistance for in most ADLs (activities of daily living) except toileting (required total assistance). A Social Work Progress Note dated 01/20/23 at 2:03 PM…

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 two (2) of 13 sampled residents, facility staff failed to notify residents' representatives of its bed hold policy in writing when residents were discharged from the facility and transferred to a local hospital. Residents' #13 and #3. The findings included: 1. Resident #13 was admitted to the facility on [DATE] with diagnoses that included Chronic Respiratory Failure, Unspecified with Hypoxia, Trach and Vent (tracheostomy and ventilator) Dependent, Congenital Myopathy, and Encounter for Attention to Gastrostomy. Review of Resident #13's medical record revealed a face sheet that showed Resident #13's father listed as the emergency contact and the Resident's mother as the responsible party. A Discharge Minimum Data Set (MDS) dated [DATE] showed that facility staff documented the Resident required oxygen therapy, suctioning, tracheostomy care, and mechanical ventilation and was totally dependent on staff for bed mobility, transfers, dressing, and eating. A Physician's…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, for one (1) of 13 sampled residents, facility staff failed to accurately code Resident #9's Seizure diagnoses and pressure ulcer on his Quarterly Minimum Data Set (MDS). The findings included: Resident #9 was admitted to the facility on [DATE] with diagnoses that included: Seizure, Bilateral Hydronephrosis, Recurrent Urinary Tract Infection (UTI) and Chronic Respiratory Failure. Review of Resident #9's medical record revealed a progress note from the Nurse Practitioner dated 10/03/22 at 4:07 PM documenting, Asked to see [Resident #9] by his nurse due to breakdown to the site of chronic skin breakdown due to persistent rubbing on the left side of his head against a pillow. Superior aspect of the left ear helix and now going into the flat adjacent antihelix is open with yellow mucoid drainage . will begin bacitracin . A physician progress note dated 10/03/22 at 4:08 PM documented, Assessed patient at bedside due to skin breakdown on his L (left) ear. Noted area 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 record reviews and staff interviews for one (1) of 13 sampled residents, facility staff failed to develop a baseline care plan after a resident was readmitted to the facility on [DATE]. Resident #3. The findings included: Resident #3 was admitted to the facility on [DATE] with diagnoses that included Chronic Respiratory Failure, Tracheostomy Present, Spastic Paraplegia, and Scoliosis Deformity of the Spine. Review of Resident #3's medical record revealed: An Annual Minimum Data Set (MDS) dated [DATE] showing that facility staff documented the Resident had a Brief Interview for Mental Status Score of 15, indicating that the Resident had intact cognition, required suctioning, tracheostomy care, mechanical ventilation, had a gastrostomy tube, had bilateral lower extremity impairment, was at risk for pressure ulcers, and required limited assistance for in most ADLs (activities of daily living) except toileting (required total assistance). Review of a Physician's Discharge Summary on 01/27/23 documented:…

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 for two (2) of (13) sampled residents, facility staff failed to develop and implement comprehensive person-centered care plans to address a resident's infection in the third digit of the left hand and for a resident's use of an indwelling catheter. (Resident #7 and #9) The findings included: 1. Resident #7 was admitted to the facility on [DATE], with multiple diagnoses that included the following: Mild Persistent Asthma, Seizure Disorder, and Global Developmental Delay. A review of Resident #7's medical record revealed the following an admission Minimum Data Set (MDS) dated [DATE], showing that the facility staff coded a brief interview for mental status should not be conducted because the resident is rarely/never understood. Patient care notes documented the following: -12/8/22 at 7:22 AM [Patient Care Note] .Dr .at bedside to assess resident's middle finger on left hand. Mainly involving the last knuckle .Tylenol (analgesic and antipyretic) given this morning with good effect.…

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 (13) sampled residents, facility staff failed to revise and update Resident #8's care plan to reflect the resident's decannulation episode that resulted in oxygen desaturation of 87%. The findings included: Resident #8 was admitted to the facility on [DATE], with multiple diagnoses including the following: Diffuse Traumatic Brain Injury with Loss of Consciousness, Seizure Disorder, Chronic Respiratory Failure, and Dependence on Ventilator. Review of a Facility-Reported Incident (FRI) DC00010811, submitted to the State Agency on 06/15/22, documented .Resident decannulated while CNA(Certified Nurse Aide) (was providing care on 6/13/2022. RN (Registered Nurse) re-inserted trach immediately following decannulation. Resident remained stable. Resident's mother was informed via email. A review of Resident #8's medical record revealed the following: Review of the Quarterly Minimum Data Set (MDS) dated [DATE], showed that the facility staff coded the resident 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 record reviews and staff interviews for one (1) of 13 sampled residents, facility staff failed to document the dislodgement of a resident's tracheostomy completely and accurately in the resident's medical record. Resident #13. The findings included: Resident #13 was admitted to the facility on [DATE] with diagnoses including Chronic Respiratory Failure, Unspecified with Hypoxia, Trach, and Vent (tracheostomy and ventilator) Dependent, Congenital Myopathy, and Encounter for Attention to Gastrostomy. Physician orders dated 06/15/21 at 3:57 PM directed the following: -Trach care BID (twice a day). -Change trach weekly . - .Monitor pulse oximetry per protocol. A Quarterly Minimum Data Set (MDS) dated [DATE] showed that facility staff documented the Resident required oxygen therapy, suctioning, tracheostomy care, and mechanical ventilation and was totally dependent on staff for bed mobility, transfers, dressing, and eating. Nursing Care Flow Sheet dated 07/05/22 at 8:15 AM documented: .Was respiratory…

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, record review, and staff interviews in one (1) of two (2) meal observations facility staff failed to ensure that infection control policies and procedures were implemented as evidenced by staff being observed improperly wearing a face mask below the chin and not performing hand hygiene before reaching in the food cart for a residents tray when delivering meals to the unit, and facility staff failed to provide documented evidence of annually reviewing and updating the facility's infection control policies. The findings included: A review of the policy titled Infection Prevention and Control Program dated 01/01/19, documented the following .[Facility Name] has established an infection prevention and control program which it: .Provides standard and transmission-based precautions to be followed to prevent the spread of infections; .Conducts an annual review of its infection Prevention and Control program and update the program as indicated .Infection Control program components critical to the operations of the healthcare facility may include .Implementing policies…

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 13 sampled residents, facility staff failed to show documented evidence in the resident's medical record of information/education provided regarding the benefits and risks of the influenza vaccine for a resident whose representative declined to give consent for the vaccine. (Resident #7) The findings included: A review of a facility policy titled Influenza Vaccine dated 01/01/2019, documented, .Prior to vaccination the resident and /or residents' representatives will be provided information and education regarding the benefits and potential side effects of the influenza vaccine .Provision of such education shall be documented in the resident's electronic medical records . Resident #7 was admitted to the facility on [DATE], with multiple diagnoses that included the following: Cerebral Palsy, Asthma, and Seizure Disorder. A review of the medical record revealed an admission Minimum Data Set (MDS) dated [DATE] revealing the facility staff coded that 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 two (2) of 13 sampled residents, the facility staff failed to show documented evidence of providing the resident representative with education regarding the benefits and potential risks associated with the COVID-19 vaccine. (Residents #12 and #7). The findings included: 1. Resident #12 was admitted to the facility on [DATE] with multiple diagnoses that included the following: Autistic Disorder, Klinefelter Syndrome, and Severe Malnutrition. A review of the resident's vaccination record in the paper chart revealed that the resident's parent refused consent for the COVID-19 vaccination and the resident was unvaccinated. A review of the medical record lacked documented evidence that education was provided to the resident's representative about the COVID-19 vaccine. 2. Resident #7 was admitted to the facility on [DATE] with multiple diagnoses that included the following: Cerebral Palsy, Asthma, and Seizure Disorder. A review of the resident's vaccination record in 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.