Archbold Living Camilla

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, record review, and review of the facility's policy, Facility B failed to ensure residents were informed in advance of their right to attend and participate in their care plan conference for two of four residents reviewed for care planning (Resident (R) 28 and R79) out of 31 sampled residents. This failure placed the residents at risk for their care plans not being person centered. Findings include: Review of the facility's undated policy titled, Care Planning revealed .Our facility's Care planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident .3. The resident, the resident's family and/or the resident's legal representative/guardian or surrogate are encouraged to participate in the development of and revisions to the resident's care plan. 4. Every effort will be made to schedule care plan meetings at the best time of the day for the resident and family . Review of the facility's policy titled, Resident Rights, dated…

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 interview, record review, and facility policy review, Facility A failed to obtain the CMS-10055 (Centers for Medicaid and Medicare Services) Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) and CMS-10123 Notice of Medicare Non-Coverage (NOMNC) for one of five residents (Resident (R) 136) when Part A Medicare services ended. This failure prevented R136 or responsible party from appealing the decision of the facility and/or making an informed decision related to the cost of continued therapy services. Findings include: Review of the facility policy titled Advance Beneficiary Notifications dated 03/2013 revealed, The purpose is to provide instructions for issuing Advance Beneficiary Notice to applicable Medicare patients so that the patient may make an informed decision as to whether they will receive noncovered items or services for which they may have to accept financial responsibility. Review of R136's medical record revealed R136 was admitted to Medicare part A therapy services on (no date listed). R136's last covered day of Part A service was 05/03/25.…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, record reviews, and review of the Centers for Medicare and Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual, Facility A failed to provide a timely quarterly Minimum Data Set (MDS) Assessment data submission for one (Resident (R)78) of one resident reviewed for MDS over 120 days old out of a total sample of 31 residents. Findings include: Review of R78's undated Face Sheet provided by the facility revealed R78 was admitted to the facility on [DATE] with a diagnosis of hemiplegia and hemiparesis following cerebral infarction. Review of R78's quarterly MDS Assessment with an Assessment Reference Date (ARD) of 02/24/25 provided by the facility revealed it was completed on 02/25/25. Review of R78's MDS 3.0 Missing OBRA Assessment Report run date 05/07/25 provided by the facility revealed . Last Record Identifiers: . Target Date 12/03/24. During an interview on 05/15/25 at 9:58 AM, the MDS Coordinator (MDSC) B indicated she completed 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 observation, interview, record review, and review of the facility's policy, Facility B failed to develop care plans related to bed rail use for two of four residents reviewed for care planning (Resident (R) 28 and R75) out of 31 sampled residents. This failure placed the resident at risk for unmet care needs and increased risks of accidents. Findings include: Review of the facility's undated policy titled, Care Planning revealed, Our facility's Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident .2. The care plan is based on the resident's comprehensive assessment . Review of the facility's policy titled, Using Care Plan dated 11/2018 revealed, .The care plan shall be used in developing the resident's daily care routines and will be available to staff personnel who have responsibility for providing care or services to the resident. 1. Review of R28's undated Admitting and Discharge Record provided by the facility revealed…

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 interview, record review, and review of the facility's policy, Facility B failed to review and revise residents' care plans for one of four residents review for care planning (Resident (R) 50). R50's care plan was not revised to reflect his current status. This failure placed the resident at risk for unmet care needs. Findings include: Review of the facility's policy titled, Using Care Plan, dated 11/2018 revealed, The care plan shall be used in developing the resident's daily care routines and will be available to staff personnel who have responsibility for providing care or services to the resident .5. Changes in the resident's condition must be reported to the MDS [Minimum Data Set] Assessment Coordinator so that a review of the resident's care plan can be made . Review of R50's undated Admitting and Discharge Record provided by the facility revealed the resident was readmitted to the facility on [DATE]. Review of R50's Physician Orders provided by the facility revealed on 03/31/25 the resident was…

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 interview, record review, and review of the facility's policy, Facility B failed to ensure residents who were dependent on staff for activities of daily living (ADLs) received showers for one of two residents (Resident (R) 28) reviewed for ADLs out of 31 sampled residents. This failure placed the resident at risk for an undignified quality of life. Findings include: Review of the facility's policy titled, Bath, Shower/Tub dated 06/07/24 revealed, The purpose of this procedure are [sic] to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. General Guidelines .5. Baths are given per bath schedule .Documentation. 1. The date and time the shower/tub baths was performed per bath schedule .5. If the resident refused the shower/tub bath, the reasons(s) . Review of R28's undated Admitting and Discharge Record, provided by the facility revealed the resident was admitted to the facility on [DATE]. Review of R28's quarterly Minimum Data Set (MDS) with 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 interview, record review, and policy review, Facility A failed to ensure one of four residents (Resident (R) 73) reviewed for pressure ulcers out of a sample of 31 residents did not develop facility acquired pressure ulcers. This failure to not identify a pressure ulcer until it was a Stage II had the potential to escalate to a higher level causing the resident pain and discomfort. Findings include: Review of the facility's policy titled, Pressure Ulcer dated 01/17 revealed, The purpose is to standardize a system-wide protocol that identifies those patients at risk for breakdown and to provide guidelines to prevent pressure ulcer occurrence .Maintain and improve tissue tolerance to pressure in order to prevent injury. All individuals at risk should have skin inspected every shift, paying particular attention to bony prominences and areas under medical devices . Review of R73's undated admission Record located in the electronic medical record (EMR) under the Profile tab revealed R73 was admitted 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 observation, interview, and record review, Facility A failed to monitor a resident's bathroom door protector to ensure it did not injure the resident until the door was replaced for one of seven residents reviewed for accidents out of 31 sampled residents (Resident (R) 64). This failure had the potential to cause injury to the resident. Findings include: Review of R64's undated Face Sheet, provided by the facility, revealed she was admitted to the facility on [DATE] with diagnoses that included Type 2 diabetes mellitus with hyperglycemia, and atherosclerotic heart disease of native coronary artery without angina pectoris. Review of R64's quarterly Minimum Data Set (MDS) Assessment, with an assessment reference date (ARD) of 03/14/25, provided by the facility, revealed she had a Brief Interview for Mental Status (BIMS) score of 15 which indicated she was cognitively intact. Review of the facility's Work Order, dated 04/16/25, provided by the facility, revealed The panel on the outside of the bathroom…

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, interview, record review, and review of the facility's policy, Facility B failed to assess residents for the use of bed rails, review the risks and benefits of bed rail use and obtain informed consent prior to the installation of bed rails for two of seven residents (Resident (R) 28 and R75) reviewed for accidents and hazards out of 31 sampled residents. These failures placed the residents at risk for injury and restraint. Findings include: Review of the facility's policy titled, Bed Safety, dated 08/2019 revealed Our facility shall strive to provide a safe sleeping environment for the resident .1. The resident's sleeping environment shall be assessed by the interdisciplinary team, considering the resident's safety, medical conditions, comfort, and freedom of movement, as well as input from the resident and the family .2. To try to prevent deaths/injuries from the beds and related equipment (including the frame, mattress, side rails .) the facility shall promote the following approaches:…

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, interview, record review, review of facility policy, and review of manufacturer's pharmaceutical recommendations, Facility B failed to ensure a medication error rate below five percent. During medication administration for three (Resident (R)10, R51, R108) in the medication administration observation. These failures caused three medication errors out of 25 opportunities for error, or a medication error rate of 12%. These failures had the potential to increase or decrease the effectiveness of these medications. Findings include: Observation during the medication administration observation on 05/15/25 at 11:00AM, Registered Nurse (RN)2 crushed R10's Potassium Chloride Extended Release (ER) 20 milliequivalent (mEq) one tablet, then placed in apple sauce and administered to R10. On 05/15/24 at 11:12AM, crushed R108's ferrous sulfate 300 mg one tablet, then placed in applesauce and administered to R108. On 05/15/25 at 11:31AM, crushed gabapentin, then placed in applesauce and administered 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 record review, interview, and facility policy review, Facility A failed to document a resident's decline, death, and disposition of one of one resident (Resident (R) 141) reviewed for facility death out of a total sample of 31 residents. Findings include: Review of the facility's policy titled Legal Medical Record Policy revised 12/17/20 showed the purpose of the medical record is to provide a record of the patient's health status including observations, measurements, and history/prognosis, and serve as the document describing the healthcare services provided to the patient. Provide a method for clinical communication and care planning among the individual healthcare practitioners serving the patient. Provide supporting documentation for the reimbursement of services provided to the patient. Document and substantiate the patient's clinical care and serve as a key source of data for outcomes research and public health purposes. Serve as a major resource for healthcare practitioner education. Serve to document evidence of quality of care. Serve as the legal business 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and review of the policy titled Sanitation and Infection Prevention/Control, facility A failed to discard expired food in the walk-in refrigerator and walk-in freezer; label and date opened food items in the walk-in refrigerator and dry storage area; store cooking grease in proper container; ensure serving pans and bowls were stacked and stored dry; maintain an updated cleaning log; maintain the cleanliness of the icemaker; ensure the floors and walls in the walk-in refrigerator, dry storage and kitchen area were kept clean; and repair damaged ceiling in the dry storage area. The deficient practices had the potential to adversely affect 41of 44 residents who received oral diets. Findings include: Review of the policy titled Sanitation and Infection Prevention/Control revised January 2020 revealed: Food and Supply Storage - Procedures .products contain an expiration date. The words sell-by, best buy, enjoy by or use-by should not precede the date. The sell by date is the last…

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, interviews, and review of the facility policy titled, Administering Medications, facility A failed to ensure that one of three medication carts (Long Hall medication cart) and the treatment cart was locked and secured when the cart was out of view of the nurse. Specifically, the facility A failed to ensure the treatment cart and the medication cart on the Long Hall medication cart was locked and medications secured when not in use for two of three carts. Findings include: Review of the policy titled Administering Medications with a revised date of 3/2019 revealed the policy statement of: Medications shall be administered in a safe and timely manner, and as prescribed. Policy Interpretation and Implementation: 14. During administration of medications, the mediation cart will be kept closed and locked when out of sight of the medication nurse. Observation on 5/9/23 at 9:52 a.m. of wound care treatment cart containing medications located on the Long Hall located directly in front of room [ROOM…

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, interviews, and review of the policy titled Self Administration of Medication, Facility A failed to ensure one resident (R) (R#110) of 51 sampled residents, was assessed to safely self-administer medications. Findings include: Review of the policy titled Self Administration of Medication revised February 2021, Policy Heading: Residents has the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so. Policy Interpretation and Implementation: 1. As part of the evaluation comprehensive assessment, the interdisciplinary team (IDT) assesses each resident's cognitive and physical abilities to determine whether self-administering medications is Safe and clinically appropriate for the resident. deemed safe and appropriate for a resident to self-administer medications is reassessed periodically based on changes on the resident's medical and/or decision-making status. 8. Self-administered…

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 review, interviews, and review of policy titled Dressing Change Policy, the facility failed to ensure quality of care and services in accordance with professional standards related to not receiving physician orders for treatment/wound care for one of one resident (R#65) with a cancer lesion on her right wrist. The sample size was 51. Findings include: Review of the policy titled Dressing Change Policy revised 3/2020, revealed The purpose of this procedure is to provide guidelines for the care of wounds to promote healing. Preparation: 1. Verify that there is a physician's order for this procedure. Documentation: Complete documentation of the dressing change procedure including photographs if taken and upload into the resident's medical record. Review of the clinical record for R#65 revealed resident was originally admitted to the facility on [DATE] with diagnoses including but not limited to Basal Cell Carcinoma of the Skin. Review of the quarterly Minimum Data Set (MDS) dated…

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 3. During the tour of Facility B on 7/27/2021 at 12:00 p.m. and 7/28/2021 at 11:30 a.m. the following was observed: In room [ROOM NUMBER] an oxygen tank filter had a large amount of dust build up. The dust buildup was found at the back of oxygen tank and had a brownish gray color. The resident of room [ROOM NUMBER] was currently using the oxygen tank when the dust buildup was observed. In room [ROOM NUMBER] the cream-colored blinds had brown and black spots embedded into them. In room [ROOM NUMBER] the cream-colored blinds had brown and black spots embedded into them. In room [ROOM NUMBER] the cream-colored blinds had brown and black spots embedded into them. In room [ROOM NUMBER] the cream-colored blinds had brown and black spots embedded into them. In room [ROOM NUMBER] there were two ceiling vents with black and brown spots. During the tour on 7/29/2021 at 8:34 a.m. in Facility B the Administrator and Maintenance Director confirmed that the blinds in rooms 204, 206, 208, and 210 had brown and black spots. 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 interview, observations, and review of policy titled Foods Brought by Family/Visitors and Food and Supply Storage, facility A failed to discard expired items, failed to label and date items in the refrigerator and freezer of the resident food pantry, and failed to monitor freezer temperatures for the freezer in the resident food pantry. This deficient practice affected one of one resident food pantry for facility A. Findings included: Review of Facility policy entitled Foods Brought by Family/Visitors revealed the policy statement that food brought to the facility by visitors and family is permitted. Facility staff will strive to balance resident choice and a homelike environment with the nutritional and safety needs of residents. Food brought by family/visitors that is left with the resident to consume later will be labeled and stored in a manner that it is clearly distinguishable from facility prepared food. A. Nonperishable foods will be stored in re-sealable containers with tight fitting lids.…

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 interviews, the facility (Facility A) failed to ensure that privacy curtains provided full visual privacy for a total of 11 of 21 resident shared bedrooms (rooms: 2, 3, 5,8, 9,14, 16, 26, 27, 28, and 29). Findings include: 1. Observation on 7/27/21at 12:28 p.m., 7/28/2021 at 9:15 a.m., 7/29/2021 at 8:49 a.m., and 7/30/2021 at 9:25 a.m. revealed short privacy curtains for room [ROOM NUMBER] bed A. 2.Observation on 7/27/2021 at 8:21 a.m. ,7/28/2021 at 10:00 a.m. 7/29/2021 at 8:47 a.m., and 7/30/2021at 9:29 a.m. revealed short privacy curtains for room [ROOM NUMBER] bed A and bed B. 3. Observations on 7/29/2021 at 11:01 a.m. and 7/30/2021 at 9:31 a.m. revealed short privacy curtains for room [ROOM NUMBER] bed A. The environmental tour began on 7/30/2021 at 9:29 a.m. with the Director of Nursing, Maintenance Director (MS), and the Environmental Service Manger (EVS). The Administrator did not join the tour until the last room was observed on the last hall. During the tour the MS…

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 review, staff interviews, Facility A failed to maintain dignity by ensuring a dignity bag was provided for one of two residents (R) #113) who had an indwelling foley catheter. The facility sample size was 27 Residents. Findings include: Observations on 7/27/2021 at 11:49 a.m., 7/28/2021 at 9:13 a.m., 7/29/2021 at 9:20 a.m., and 7/30/2021 at 2:00 p.m. of R#113 lying in B bed with his catheter bag uncovered and visible from the doorway. Record review of R#113's medical record revealed an admission date of 6/30/2021 and an admitting diagnoses history of urinary tract infection (UTI), urinary retention for which he had an indwelling urinary catheter. Record review of his Significant Change Minimum Data Set (MDS) dated [DATE] included an assessment for an indwelling catheter. Further review documented a Brief Interview for Mental Status (BIMS) score of 8 (a BIMS score of 0 to 10 indicated moderate cognitive impairment). Record review of R#113's care plan dated 4/30/2021 and last updated…

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 interview, the facility policy titled Care Plans-Baseline, facility failed to develop a person-centered baseline care plan which included Transmission Based Precautions (TBP) interventions for one of four newly admitted residents (R) #182) at facility A. Findings include: Record review of facility policy titled Care Plans-Baseline (11/2018) documented A baseline plan of care to meet the resident 's immediate needs shall be developed for each resident within forty -eight (48) hour of admission. 1. To assure that their resident 's immediate care needs are met and maintained, a baseline care plan will be developed within forty-eight (48) hours of the resident admission. The Interdisciplinary Team will review the healthcare practitioner 's orders (dietary needs, medications routine treatment, etc.) and implement a baseline care plan to meet the resident 's immediate care needs including but not limited to. a. Initial goals based on admission orders b. physician…

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 reviews, and review of the facility policy titled Care Plans, Comprehensive Person-Centered, Facility A failed to develop a care plan for one resident (R) R#71) related to use of a knee immobilizer and skin assessments and failed to implement a care plan for one resident, R#90, related to a nutritional supplement. The sample size was 27. Findings include: 1. Review of facility policy 'Care Plans, Comprehensive Person Centered' revealed: 13. Assessments of residents are ongoing, and the care plans are revised as information about the residents and the residents' conditions change. 14. The Interdisciplinary Team must review and update the care plan: a. when there has been a significant change in the resident's condition. Resident R#71 was admitted to the facility on [DATE] with diagnoses including but not limited to Alzheimer's disease, chronic hepatitis C, and chronic congestive heart failure. Review of Quarterly Minimum Data Set (MDS) dated [DATE] reveals 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 observation, record review, and staff interview facility A failed to ensure that physician orders were followed related to Magic cup being served at each meal, for one of 10 residents, (R) R#90), with an order for Magic cup. Findings include: Record Review of the clinical record revealed a [AGE] year-old female with a primary diagnosis of Alzheimer's disease, other diagnoses included but not limited to, adult failure to thrive, anorexia, Gastro-esophageal reflux disease, Diverticulosis of intestine, orbital wasting of fat tissue, age-related cognitive decline, chronic pain, weakness, anxiety disorder unspecified, major depressive disorder recurrent moderate, personal history of malignant neoplasm of bladder, personal history of malignant neoplasm of skin, need for assistance, encounter for palliative care, and history of COVID-19. Further record review revealed physicians' orders including but not limited to, pureed consistency diet, nectar thick liquids, meal supplement-Magic Cup with breakfast, lunch,…

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 review, staff interviews, and the facility policy titled Catheter Care, Urinary the facility (Facility A) failed to ensure that the urinary drainage for R#113 was positioned lower than the level of the bladder to prevent unobstructed urine flow and tension for one resident (R#113). The sample size was 27 Residents. Findings include: Record review of facility policy titled, Catheter Care, Urinary (Revised September 2014) stated The purpose of this procedure is to prevent catheter-associated urinary tract infections. Maintaining Unobstructed Flow 1. Check the resident frequently to be sure he or she is not lying on the catheter and to keep the catheter and tubing free of kinks. 3. The urinary drainage bag must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and drainage bag from flowing back into the urinary bladder'. Record review of R#113's medical record revealed an admission date of 6/30/2021 and an admitting diagnoses of malignant…

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, record reviews, staff interview, and the facility policy Storage of Medication, facility A failed to ensure disposal of expired medications and supplies by appropriate expiration dates on one of the two medication carts and one of the one medication storage unit room. The facility census was 137 Residents. Findings include: Review of the facility policy titled 'Storage of Medications (Revised March 2019) revealed 'The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Drug containers that have missing, incomplete, improper, or incorrect labels shall be returned to the pharmacy for proper labeling before storing. The Facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed.' Finding include: Observation on 7/29/2021 at 10:39 a.m. of the facility 'A's medication storage room with Licensed Practical Nurse (LPN) GG revealed the following expired medications and items: 1. Six bottles of Blood Culture Vials two with expiration 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.

Based on observations, record review, and staff interviews, and review of the Department of Public Health Interim Guidance for Long-Term Care (LTC) Facilities Admitting Residents from a Hospital the facility (Facility A) failed to ensure that the door to the room, for one of one unvaccinated resident (R#182) on Transmission Based Precautions for MRSA (Methicillin Resistant Staphylococcus Aureus) and as a newly admitted resident was kept closed at all times. In addition, the facility failed sanitize one of three Hoyer lifts between resident use and failed to use separate gauze or cloths during wound care. Findings include: 1. Record review of document titled, The Department of Public Health Interim Guidance for Long-Term Care (LTC) Facilities Admitting Residents from a Hospital originated December 24, 2020 documented Recommendation for residents admitted to LTC (Long Term Care) facilities, according to COVID-19 status .admitted residents who are neither known to have COVID 19, nor suspected to have it, should be placed on Transmission Based precautions in an observation area or…

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.