Pine Knoll Path of Journey LLC

Based on observations, staff interviews, and review of the facility policy titled, Food Safety Requirements, the facility failed to ensure the kitchen environment was maintained in a safe, clean, and sanitary manner to prevent foodborne illness. These deficient practices had the potential to affect 96 of 100 residents receiving oral diets from the kitchen.Findings include: Review of the facility's policy titled Food Safety requirements, dated 2/1/2024, documented, It is the policy of this facility to procure food from sources approved or considered satisfactory by federal, state, and local authorities. Food will also be stored, prepared, distributed and served in accordance with professional standards for food service safety. In addition, the Policy Definition of Contamination means, The unintended presence of potentially harmful substances including, but not limited to microorganisms, chemicals, or physical objects. Documented in the Policy Explanation and Compliance Guidelines, number 1 (b) Storage of food in a manner that helps prevent deterioration or contamination of food,…

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 interviews, the facility failed to ensure the outdoor garbage and refuse area was maintained in a sanitary manner. The deficient practice increased the risk of attracting and harboring pests. The facility census was 100. Findings include: Upon entry into the kitchen for initial observation tour on 05/17/2026 at 12:30pm, Food Service Manager (FSM) was on the serving line for the lunch meal, so the Administrator completed the tour on the FSM's behalf and revealed the following observations of the outside refuse and dumpster area:Cardboard boxes were overflowing from a gray colored trash receptacle without a lid. The Administrator confirmed the cardboard boxes were improperly disposed of and uncovered. She stated the boxes were from a Central Supply Department delivery on Friday [05/15/2026], and the Central Supply Manager normally breaks down boxes for disposal. [NAME] sink was lying on the dumpster platform next to the dumpster. The Administrator confirmed the observation and stated the Maintenance Director had removed the sink from the kitchen by 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 observations, staff and resident interviews, record review, and review of the facility's policy titled, Catheter Care, the facility failed to perform catheter care using proper cleaning technique for one of four sampled residents (R) (R48). This deficient practice increased the risk of urinary tract infection (UTI), resistant bacterial strains, and sepsis for R48. Findings include:Review of the electronic medical record (EMR) revealed that R48 was admitted to the facility on [DATE], with pertinent diagnoses including, but not limited to, pressure ulcer of the sacral region, stage 4, and pressure ulcer of the left heel, stage 4.Review of R48's Minimum Data Set (MDS) assessment dated [DATE], revealed a Brief Interview for Mental Status (BIMS) of 15, which indicated little to no cognitive impairment. Section GG, functional status, revealed that the R48 used a wheelchair for mobility and required setup and cleanup for meals and oral hygiene. R48 was dependent on staff for toileting, hygiene, showering, and…

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, staff and resident interviews, record reviews, and review of facility policy titled, Oxygen Concentrator, the facility failed to ensure the respiratory equipment and supplies were maintained, administered, and available according to standards of practice for five of 30 residents (R) (R5, R41, R101, R13, and R23), sampled for respiratory care. Specifically, the facility failed to maintain clean oxygen (O2) concentrator filters, remove surface dirt from the O2 concentrator, ensure the nasal cannula was connected to the O2 humidification bottle, and failed to keep an additional tracheostomy tube at the bedside. These deficient practices had the potential to place residents at risk for respiratory infection, blood O2 desaturation, and delayed intervention for a respiratory emergency. Findings include: 1. Observation conducted on 05/17/2026 at 3:10 PM revealed that R5 was receiving oxygen at 2 liters per minute (LPM) via nasal cannula (NC) from an O2 concentrator (self-contained device used 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 observation, staff interview, and review of the facility policies titled, Dating and Labeling and Food Storage - Refrigerators and Freezers, the facility failed to discard food in the walk-in refrigerator by the use by date, to label opened food items in the walk-in refrigerator and dry storage area, and to follow recipes in the preparation of puree foods. This deficient practice had the potential to affect 102 residents receiving an oral diet. Findings include: Review of the facility policy titled Dating and Labeling dated 4/19/2022 and revised 4/5/2024 stated under Policy Statement: The kitchen will ensure food safety by maintaining proper dates and labels to all goods and ready to eat food products. Under Procedures, item two stated, Label products in storage with date the package was opened. Item four stated Ready to eat foods must be dated with a 72 hour use by date and discarded when expired. Item ten stated Discard all foods that expire immediately. Review of the facility policy for Food Storage - Refrigerators and Freezers dated 4/19/2022 and revised 4/5/2024…

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 resident and staff interviews, record review, and review of the facility policy titled, Administering Medications, the facility failed to ensure that Physician Orders for medication were followed for one of 25 residents (R) (R11) reviewed for professional standards. Specifically, R11 did not receive inhaler medication on 5/12/2023 or 5/13/2023. The findings include: Review of the facility policy titled, Administering Medications revealed .3. Medications must be administered in accordance with the orders, including any required time frame. Record review noted R11 was admitted with diagnoses including chronic obstructive pulmonary disease (COPD). Review of the medication administration record (MAR) for R11 identified that R11 was prescribed an inhalant, Breztri Aerosphere 160-9-4.8mcg [micrograms]. According to the Physician's Order, R #11 was to take two (2) puff inhalations orally two (2) times a day for the diagnosis of COPD. Further review of the MAR revealed the nursing staff did not administer the Breztri Aerosphere per Physician's Order on 5/12/2023 and 5/13/2023.…

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 review of the facility policy titled Quality of Life - Dignity, the facility failed promote, maintain, and protect a resident's dignity for two of seven residents (R) (R#36 and R#95) with a urinary catheter. Findings included: Review of the policy titled Quality of Life - Dignity dated 2001 and revised 8/2009 revealed the policy statement of: Each resident shall be cared for in a manner that promotes and enhances quality of life, respect, and individuality. Policy and implementation item numbered 11: Demeaning practices and standards of care that compromise dignity are prohibited. Staff shall promote dignity and assist residents as needed by: a. Helping the resident keep urinary catheter bags covered. 1. On 1/31/23 at 10:20 a.m. an observation and interview with R#36 revealed was in bed in her room. A urinary catheter drainage bag containing yellow urine was observed secured to the bed frame and not in a privacy bag. The bag was visible in the room and from…

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, staff interviews, and review of facility document titled, Housekeeping In-Service Training, Bathroom Cleaning with a revised date of March 2020, the facility failed to maintain a safe, clean, sanitary environment related to a build-up of whit fuzzy material on vent covers in six of six adjoining bathrooms 211/212, 216/217, 218/219, 220/221, 222/223, 224/225, and bathroom [ROOM NUMBER] on the [NAME] Wing. The deficient practice had the potential to affect 39 residents residing in 13 rooms on the [NAME] Wing. The sample size was 22. Findings included: Review of facility document titled, Housekeeping In-Service Training, Bathroom Cleaning, revealed the purpose of: To provide all housekeeping employees with a complete outline of the equipment and supplies necessary to perform the daily routine of a bathroom cleaning. Daily cleaning will ensure optimum levels of cleanliness and sanitation, prohibit the spread of infection and bacteria, and maintain the outward appearance of the facility. 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 observations, interviews, review of the policies titled Storage of Medications, Administering Medications and Controlled Substances, and review of the document titled Omnicare Medication Storage Guidelines, the facility failed to ensure treatment dressings were stored properly, failed to ensure that one oral inhaled medication was labeled with an open date, two ophthalmic solutions were labeled with an open date, three ophthalmic solutions were discarded after use by date on one of five medication carts (Unit 1 - Cart 1), failed to ensure that four ophthalmic solutions were labeled with an open date, six ophthalmic solutions were discarded after use by date, and five Insulin pen injectables were labeled with an open date on one of five medication carts (Unit 2- Cart3), failed to ensure medications and injection supplies were stored securely and that resident identifying information was secure and not accessible on one of five medication carts when unattended (Unit 2 - Cart 3), failed to ensure that one…

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, record review, and policy review, the facility failed to ensure storage of nebulizer mask in a manner to prevent cross contamination for one of 14 residents (R) (R#93) receiving nebulizer administration. Findings included: 1. Review of the policy titled Administering Medications Through a Small Volume (Handheld) Nebulizer dated 2001 and revised October 2010 revealed a purpose of to safely and aseptically administer aerosolized particles of medication into the resident's airway. The section titled Steps in the Procedure line number 29 stated: When equipment is completely dry, store in a plastic bag with the resident's name and the date on it. On 1/31/23 at 10:30 a.m. and 2/1/23 at 8:45 a.m. observations of R#93's room revealed a nebulizer machine on the bedside table with a nebulizer mask lying on top of the table, not in a protective bag and exposed to the environment. On 1/31/23 at 10:30 a.m. and 2/1/23 at 8:45 a.m. interviews with R#93 revealed she had not used the nebulizer…

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.