Bridgeview Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record review, and facility policy review, the facility failed to ensure that the residents environment remained as free of accident hazards as is possible by failing to 1) assess Resident #7 for smoking safety and 2) failing to supervise Resident #8 during smoking, from a sample of three residents reviewed for smoking, from a total sample of 7 residents who smoked.The findings include:1. On 8/4/25 at 3:45 pm, Resident #7 was observed smoking in the lobby. He was on oxygen via nasal canula, and his portable oxygen tank was at the back of his wheelchair. The receptionist was observed turning off the oxygen tank and removing the canula from the resident's nose. She then wheeled the resident to the designated smoking area near the lobby but left the oxygen tank at the back of his wheelchair.A clinical record review for Resident #7 indicated he was admitted to the facility on [DATE]. His diagnoses included Chronic Obstructive Pulmonary Disease (COPD), dementia, unspecified…

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 failed to ensure the completion of a Preadmission Screening and Resident Review (PASRR) for one (Resident #9) of two residents selected for PASRR review, from a total survey sample of 23 residents. The findings include: A review of Resident #9's medical record revealed that he was admitted to the facility on [DATE]. No PASRR was found for the resident's 1/17/2023 admission. Further review of the resident's record revealed that he was admitted with diagnoses including, but not limited to, dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance; major depressive disorder; schizoaffective disorder, bipolar type; brief psychotic disorder, and other specified persistent mood disorders. On 12/04/24 at 1:30 PM, the Director of Nursing (DON) was asked to provide Resident #9's admission PASRR. She provided a PASRR dated 2016. On 12/05/24 at 9:00 AM, the DON was asked if a more recent PASRR had been completed. She…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record review, and facility policy and procedure review, the facility's failed to maintain an infection prevention and control program to help prevent the development and transmission of communicable diseases and infections. The facility failed to follow isolation guidelines for COVID 19 for five (Residents #1, #2, #3, #4, and #5) of seven residents who were positive for COVID 19, from a total sample of 9 residents. Failure to follow proper infection control standards increases the risk of adverse health outcomes for facility residents, staff, and other facility occupants. The findings include: On 7/29/24 at 10:00 am, Licensed Practical Nurse (LPN) A was observed passing medication to Resident #1. A sign on the door noted Resident #1 was on droplet precaution. LPN A was observed wearing a surgical mask below her chin and had no gown or gloves. She was standing at the door interacting with Resident #1 who was sitting in his chair near the door less than one foot from LPN A. When…

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 medical record review, interview, and facility policy review, the facility failed to ensure the resident care plan for one (Resident #1) of three residents reviewed for falls, was revised to reflect new interventions for risk of injury due to recent falls. Failing to revise care plans places the residents at risk of not receiving appropriate care. The findings include: A review of Resident #1's medical record revealed she was admitted to the facility on [DATE] with a re-entry on 12/5/23 with diagnoses of muscle wasting, unsteadiness on feet, unspecified dementia, and Parkinson's disease. Further review of Resident #1's medical record revealed she had falls in the facility on 11/8/23, 11/19/23, 12/4/23, and 1/9/24. A review of Resident #1's care plan initiated on 8/30/22 revealed she was at risk for falls with a goal to minimize risk for injury related to falls with interventions in place. However, interventions were noted to remain the same, and no documentation was found to support the facility 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and facility policy review, the facility failed to ensure eight (132, 126, 124, 125, 216, 212, 214, and 115) of thirteen resident bedroom privacy curtains observed were maintained to ensure a safe, functional, sanitary, and comfortable environment for residents. The findings include: 1. A visit to room [ROOM NUMBER] on 08/08/2023 at 10:28 AM, found the privacy curtain in the bedroom area to have multiple reddish-brown splatters on it. (Photographic evidence obtained) 2. A visit to room [ROOM NUMBER] on 08/08/2023 at 10:39 AM, found the privacy curtain in the bedroom area to have multiple reddish-brown splatters on it. (Photographic evidence obtained) 3. A visit to room [ROOM NUMBER] on 08/08/2023 at 10:44 AM, found the privacy curtain in the bedroom area to have multiple reddish-brown splatters on it. (Photographic evidence obtained) 4. A visit to room [ROOM NUMBER] on 08/08/2023 at 10:48 AM, found the privacy curtain in the bedroom area to have multiple reddish-brown splatters…

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 an interview with the Social Worker, the facility failed to keep complete records of Notice of Medicare Non-coverage (NOMNC) and Advance Beneficiary Notice of Non-coverage (ABN) for two (Residents #30 and #40) of six sampled residents, discharged within the last six months, from a Medicare A-covered stay with benefit days remaining. The findings include: A review of six residents' records with remaining Medicare Part A days, revealed that two residents (#30 and #40) had missing signatures on both the NOMNC and ABN forms. (Copies obtained) The signature areas had no information or date on either form. The two residents' ABN forms did not have an Options box selected, a signature, or a date of contact on them. On the NOMNC forms for the two residents, the signature area and date areas were blank. This form had an additional information (optional) area filled out, but did not indicate whether the residents had declined, planned to appeal, or were not available to sign the forms. A receipt for certified mail was given, but there was no verification 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.

Based on observations, interviews, and record review, the facility failed to ensure one (Resident #231) of 39 sampled residents had access to the call light while in bed. The findings include: An observation was made of Resident #231 on 1/9/23 at 1:05 PM. She was in a double room in the bed nearest to the window and she had no roommate. No call light was seen near or next to the resident. She was asked where her call light was, but she was not able to locate it. During this time the call light was observed pinned to her privacy curtain. (Photographic evidence obtained) A second observation of resident #231's room on 1/9/23 at 2:20 PM. The call light was still hanging from the privacy curtain near the wall and out of the resident's reach. At this time Certified Nursing Assistant N was interviewed and reported that she had clipped the call light on the curtain 5 to 10 minutes ago. When asked where the call light should be in relation to resident, she stated, within reach of resident. On 1/11/23 at 12:25 PM, Resident #231's call light was observed on the floor out of reach 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, observation, and interview, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices related to skin care for one of 43 residents. (Resident #28) The findings include: Record review for Resident #28 revealed he was admitted to the facility on [DATE] with his most recent readmission on [DATE]. A review of the care plan, revised on 5/20/2021, revealed the following: Focus: Resident is at risk for alteration in skin integrity related to hygiene issues, incontinence, dementia, diabetes, dandruff on scalp, boil on abdomen. Goal: Will receive appropriate services and treatments to minimize potential skin breakdown, and will implement interventions to minimize the risk of skin impairment through next review, and facial rash will continue to improve within two weeks. Interventions: apply moisture, observe skin with ADLs (activities of daily living) and report…

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, observations and staff interviews, the facility failed to follow physician orders for the administration of intravenous therapy (IV) for 1 of 1 residents sampled for IV administration from a total sample of 43. (Resident #2) The findings include: A record review for Resident #2 revealed a [AGE] year-old female admitted on [DATE] with diagnoses including a fractured right femur and a urinary tract infection (UTI). The admission nursing note revealed she had a peripherally inserted central catheter (PICC line) to the mid-right arm for administration of intravenous (IV) antibiotics. A review of a 5/10/2021 physician's order revealed: Ceftriaxone (antibiotic) 2 grams IV every 24 hours via the PICC line, infuse over 30 minutes; Vancomycin (antibiotic) 1 gram every 12 hours IV, infuse over 60 minutes; flush PICC line with normal saline 0.9% solution 10 ml (milliliters) IV every shift. Also change the PICC line dressing every 5-7 days. A review of the May 2021 Medication Administration Record…

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.