Heritage House

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident interview, staff interview, document review and policy review the facility failed to provide food that was appetizing to eat and palatable to 4 of 16 residents reviewed (Resident #3, #5, #10 and #17). The facility reported a census of 55 residents.Findings include: 1. The Minimum Data Set (MDS) dated [DATE] for Resident #3 documented a Brief Interview of Mental Status (BIMS) score of 15 indicating no cognitive impairment.On 9/8/25 at 12:19 PM Resident #3 stated the ham was dry and not enough for a child. Resident #3 stated the ham was cold. Resident #3 stated the ham is so dry he could not even eat it. Resident #3 stated look at this it just fell to little pieces. Observation on 9/8/25 at 12:17 PM revealed Resident #3's lunch meal room tray was brought into his room. Resident #3 picked up the ham and squeezed the ham in his hand. Ham fell to small pieces on Resident #3's plate. Ham appeared dark in color and very dry.2. The MDS dated [DATE] for Resident #5 documented a BIMS score…

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

Based on observations, staff interviews and policy review, the facility failed to ensure open items were dated, covered and labeled. The facility further failed to maintain clean surfaces and flooring in the kitchen and food preparation areas and failed to ensure the thermometer used to test food temperatures was clean and sanitized to prevent cross contamination. The facility reported a census of 55 residents. Findings include:Observation 9/8/25 at 10:10 AM in the main kitchen with the Certified Dietary Manager (CDM) present revealed the following: a. Two open bags of breaded chicken breasts with no date, not sealedb. Two containers of chicken breasts, one without a lid and no date and one with a lid but no date. c. Food debris on the floor by the oven, grill and fryer and in the dry storage pantry. d. Grease build up on the surfaces and sides of the equipment. Observation 9/10/25 at 11:00 AM in the main kitchen with the CDM present revealed the following: a. Grease build up on the sides of the fryer, oven, stove top and grill. This was dried grease and spilled down the sides of…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, clinical record review, resident interview and staff interviews, the facility failed to provide food in a form to meet the resident needs for 1 of 14 residents reviewed (Resident #44). The facility reported a census of 55 residents. Findings Include:The Minimum Data Set (MDS) dated [DATE] documented Resident #44 had a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. The MDS included diagnoses of stroke, anemia, renal insufficiency, malnutrition, unspecified mononeuropathy of left upper limb and hemiplegia affecting left nondominant side. The Care Plan for Resident #44, with a revision date of 4/15/25, included a focus area resident had an Activity of Daily Living (ADL) self-care performance deficit related to CVA (cerebrovascular accident, also known as a stroke) affecting the left side, with a goal of resident will improve current level of function through the review date and the interventions/tasks section indicated the resident was independent 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, Electronic Health Records (EHR) review, policy review and staff interview the facility failed to provide appropriate infection prevention practices when providing care to a resident with a catheter, that was on Enhanced Barrier Precautions (EBP) for 1 of 3 reviewed (Resident #3). The facility reported a census of 55 residents.Findings include: The Minimum Data Set (MDS) dated [DATE] for Resident #3 documented a Brief Interview of Mental Status (BIMS) score of 15 indicating no cognitive impairment. The MDS also documented utilization of an indwelling catheter. Review of Resident #3's EHR titled, Orders documented a physician's order started 8/12/25 to change the indwelling catheter every month and PRN with 18 French with 10mL monthly and as needed. On 9/10/25 at 7:37 AM Staff D, Certified Nurse Assistant (CNA) completed catheter cares with Resident #3. Staff E present in the room during observation of Resident #3's care. Staff D applied a gown, completed hand hygiene, applied gloves, removed…

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 interviews, and facility policy review, the facility failed to maintain a clean environment throughout the length of resident room accessed hallways, when multiple stains were observed on 1 out of 3 that accessed resident rooms. The facility reported a census of 56 residents. Findings include: On 8/7/23 at 11:00 AM observation of the carpeted hallway A used by residents and visitors revealed excessive stains of various sizes and colors. On 8/7/23 at 1:40 PM in an interview with the Executive Director, he reported the Maintenance Department Supervisor was out of the facility. Facility policy for Floor care was requested but not provided for a review. During an interview on 8/8/23 at 9:50 AM Staff A confirmed carpets were stained and such conditions would have to be reported to the Maintenance Department who then would either shampoo the carpets or replace the stained areas with new carpet squares. On 8/10/23 at 9:00 AM in an interview with the Director of Nursing, she acknowledged that carpets were stained. In an interview on 8/10/23 at 10:30 AM, Staff B…

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 document review and a facility policy review, the facility failed to provide a well balanced diet that meets nutritional and special dietary needs by use of incorrect serving size portions for meals for 4 of 56 residents reviewed. The facility reported a census of 56 residents. Findings include: During a continuous observation on 8/9/23 from 11:00 AM through 12:00 PM Staff C, Chef served lunch. Observed mechanical soft diets served to 4 out of 56 residents. While serving mechanical soft meat, portion scoop not utilized. Staff C tilted the meat container towards each plate and used a spoon to push off the meat onto each plate. Observed first 3 plates to have larger meat portions and the 4th plate received a smaller portion. A review of menu document provided by Staff C on 8/9/23 at 1:30 PM, signed by a Registered Dietician (RD), revealed scoop #8, 4-5 oz, was to be used for measuring mechanical soft meat. Staff C acknowledged he didn't follow the appropriate serving size portion for special diets during lunch service. A review 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.

Based on observations, staff interviews, and document review, the facility failed to store and prepare food in accordance with professional standards for 56 of 56 residents. Resident food had not been prepared under sanitary conditions and with clean sanitary equipment. The facility reported a census of 56 residents. Findings include: On 8/7/23 from 10:00 AM-11:00 AM continuous observation during the initial primary kitchen tour revealed the following: 1. The upright stainless steel refrigerator/freezer unit located near cooking equipment revealed the refrigerator unit had a soaked hand towel inside on the bottom portion to absorb excess water leaking on the left side of the unit. Debris noted on the bottom of the fridge. Container #1 with a gravy-like substance, labeled but the label was unreadable. In the freezer unit, Containers #2, #3, #4, #5 not labeled, overfilled with frozen food items, lids not sealed tight. Container #6, #7 not labeled, missing lids, food exposed to air. A buildup of debris noted on the bottom of the freezer. The 2-compartment industrial oil deep fryer…

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 clinical record review and staff interview, the facility failed to notify a resident of charges for services provided for 1 of 3 residents reviewed (Resident #49). The facility reported a census of 56 residents. Findings include: The admission Minimum Data Set (MDS) dated [DATE] documented an admission date of 3/27/23 for Resident #49. The MDS further documented a Brief Interview for Mental Status (BIMS) score of 14 out of 15 indicating intact cognition for decision making. Review of Resident #49's clinical record revealed the facility did not provide a documented advance notice for Medicare coverage end of stay. During an interview on 8/09/23 at 1:20pm, the Social Services Director acknowledged documentation regarding the cost of stay at the facility had not been completed on Resident 49's paperwork as expected.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, resident interview and staff interviews the facility failed to represent an accurate assessment of the resident's status during the observation period of the Minimum Data Set (MDS) by not accurately recording diagnosis to 1 of 8 residents reviewed (Resident #26). The facility reported a census of 56 residents. Finding include: The MDS dated [DATE] documented Resident #26 had a Brief Interview of Mental Status (BIMS) of 15 out of 15 indicating no cognitive impairment. The MDS revealed documentation that dialysis was performed while a resident of the facility in the last 14 days. On 8/8/23 at 10:16 AM Resident #26 stated that he is not and never has been on dialysis. Record review of the Care Plan's dated 5/12/23 and 6/27/23 revealed no Care Plan for dialysis. Review of the Progress Notes for the months of May and June 2023 revealed no documentation of dialysis treatment. Review of electronic records titled Assessments for the months of May and June 2023 revealed no documentation…

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, clinical record review and staff interviews the facility failed to implement the care plan for transfers for 1 of 8 residents reviewed (Resident #20). The facility reported a census of 56 residents. Finding include: The Minimum Data Set (MDS) dated [DATE] for Resident #20 documented the resident as severely impaired for cognitive skills. The MDS documented the resident required extensive assist of one person for bed mobility, transfers, dressing, and toileting. The Care Plan dated 6/8/23 for Resident #20 documented the resident as assist of one for pivot transfers to/from wheelchair. On 8/9/23 at 9:10 AM observed Staff E Certified Nursing Assistant (CNA) transfer Resident #20 without a gait belt. Staff E completed the transfer to the recliner while Resident #20's bedroom door was open. Staff F entered Resident #20 room and told Staff E of gait belt expectations with transfers. On 8/9/23 at 9:15 AM Staff F RN, stated the Staff E is a CNA with hospice. Staff F stated it was her expectation…

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 document review and staff interview the facility failed to employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service by not having a certified dietary manager for 56 of 56 residents. The facility reported a census of 56 residents. Findings include: On 8/7/23 at 1:30 PM, a request for documentation from the Executive Director of qualifications for dietary manager revealed no certification or documentation. On 8/9/23 at 4:00 PM the Executive Director stated they are actively recruiting a candidate for the Certified Dietary Manager. She stated the current Dietary Supervisor has been in the management role for one year but is not a certified food service manager, does not have a national certification for food service management and safety from a national certifying body, does not have an associate's or higher degree in food service management or in hospitality, and does not have 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting.