Stacyville Community Nursing Home

Based on clinical record review, staff interview and facility policy review the facility staff failed to follow professional standards of practice as they allowed staff to compound (mix together) treatment ointments/creams prior to application for one (1) resident reviewed (Resident #1). The facilities identified a census of 27 residents. Findings include: Resident #1's March 2025 Treatment Administration Record (TAR) form included the following physician orders: a. Ordered 12/31/24: Clotrimazole Betamethasone cream 1 0.05% (for fungal skin infections of the skin) apply to affected areas topically (applied to the skin) every 12 hours as needed (PRN) for a rash until healed. b. Ordered 1/20/25: Nystatin powder (for fungal or yeast infections of the skin) apply topically to bilateral under breasts every 12 hours PRN for wound care. During an interview 3/27/25 at 10:03 AM Staff A, Licensed Practical Nurse (LPN), confirmed she compounded Resident #1's Nystatin and Clotrimazole treatment powder and cream on 2 separate occasions. The amount of each of the medications she compounded/mixed…

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 staff provide photograph, resident, and staff interviews, the facility failed to have a licensed nurse awake and capable of rendering nursing service for 1 day reviewed. On 1/22/24, residents and the facility saw observed Staff C, Licensed Practical Nurse (LPN), sleeping in the front lounge. The facility reported a census of 28 residents. Findings include: 1. Resident #12's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. A photo, (not time stamped) revealed Staff C as she sat reclined in a chair in the front lounge of the facility with her eyes closed. The view out the front picture window revealed it as dark outside. During an interview on 1/23/25 at 12:35 PM Resident #12 indicated she observed Staff C as she slept in the front lounge of the facility while on duty the evening prior. 2. Resident #9's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score 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 clinical record reviews, staff interviews, the Iowa Nursing Board Chapter 6 regarding the Nursing Practice For Registered Nurses (RN)/Licensed Practical Nurses (LPN), the Iowa Department of Inspections, Appeals, and Licensing (DIAL) website page related to the RN/LPN Role & Scope, audio of a submitted video, and employee records, the facility failed to have competent staff to work at the facility. The facility had an LPN perform intravenous (IV) medications via a peripherally-inserted central catheter (a IV that provide medications into a large vein that can stay in for multiple months) for 1 of 1 residents reviewed (Resident #15) without an Iowa approved certification. In addition, the unqualified facility staff diagnosed a resident, they didn't know when to properly intervene when two (2) residents expressed erratic behaviors, and used an unsecure social media platform to communicate with clinic staff about resident's conditions. The facility reported a census of 28 residents. Findings include: 1.…

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 schedule review, time card review, staff interview and facility policy review the facility failed to provide a Registered Nurse (RN) in the facility for eight (8) consecutive hours per day as required by the Federal Regulations. In addition, the facility failed to designate a RN as the Director of Nursing. The facility reported a census of 28 residents. Findings include: 1. Review of staffing calendars provided by the facility from the conclusion of their re certification survey on 9/17/24 that identified staff concerns with inadequate RN staff hours. The facility failed to provide 8 hours of RN coverage on the following dates: 12/4/24, 11/1/24, 11/11/24, 11/18/24, 11/19/24, 11/25/24, 11/26/24, 10/7/24, 10/19/24, 9/1/24, 9/2/24, 9/8/24, 9/16/24, 9/23/24, 9/30/24, 8/10/24, 8/11/24, 8/14/24, 8/18/24, 8/19/24, 8/24/24, 8/31/24, 9/19/24, 9/20/24, 9/27/24 and 9/28/24. An email dated 1/29/25 at 5:08 PM indicated the administrative staff confirmed they failed to staff 8 hours of RN coverage per day. 2. A Quick Confirm License Verification Report form dated 12/13/23 at 5:51 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.

Based on interviews, employee records reviews, and clinical record reviews, the facility failed to provide an effective leadership to follow the required Federal Regulations and state rules of a long-term care nursing facility. The facility failed to follow the Federal Regulation to have a Registered Nurse (RN) designated as the Director of Nursing (DON). The provisional Administrator designated Staff B, Licensed Practical Nurse (LPN), as the Interim DON knowing she didn't have her RN. In addition, the facility failed to ensure proper chain of command regarding concerns with the DON. The facility reported a census of 28 residents. Findings include: 1. An undated Job Description form for an Administrator identified their supervisor as the Board of Directors. The description indicated the Position Authority and Accountability of the Administrator instructed the Administrator oversees the total operation of the facility. They initiate planning, organization, direction and control over financial and material resources in order to assure residents receive the highest possible quality 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.

Based on facility record review and staff interviews, the facility failed to have an effective quality assurance (QA) program in place to assist in the provision of quality care for residents. See F727 for additional information regarding RN coverage. The facility identified a census of 28 residents. Findings include: The Recertification, Complaint, Incident survey dated 7/17/24 included a deficiency for F727 regarding sufficient nursing staff. The facility's submitted Plan of Correction listed a correction date as 8/16/24. The plan indicated the facility failed to schedule a Registered Nurse for at least 8 consecutive hours a day for 10 days out of 90. The facility reviewed the RN coverage for the rest of the schedule with the Staffing Coordinator for lack of RN coverage. The Administrator created advertisements, with the local newspaper, flyers in local businesses, posted to social media, and raised the starting wage for an RN. The facility requested RN coverage through staffing agency until the RN/ADON could start employment. The monitoring section indicated the Administrator,…

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, resident interview, staff statements and review of Resident Rights, the facility staff failed to treat one (1) resident with dignity and respect while speaking with them (Resident #9). The facility reported a census of 28 residents. Findings include: Resident #9's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. During an interview on 1/23/25 at 12:35 PM Resident #9 indicated the previous evening (1/22/25) she attempted to speak with Staff C, Licensed Practical Nurse (LPN), as she slept in a recliner in the front lounge area of the facility. Resident #9 aroused Staff C and asked her if one (1) of her duties included the management of the dining area at which time the nurse stated, no, I am in charge of meds and that is all. Resident #9 described the staff member's tone of voice as not pleasant and the failure of staff to help all Residents eat in the dining area as no big deal which…

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, staff interview and facility policy review the facility staff failed to follow professional standards of practice for 1 resident reviewed (Resident #1). Staff A, Registered Nurse (RN), drew up liquid morphine, Roxanol (pain medication), without a witness in a 1 milliliter (ml) syringe. Staff B, the Interim Director of Nursing (DON)/Licensed Practical Nurse (LPN), took the syringe from Staff A and administered it to Resident #1. The facility identified a census of 28 residents. Findings include: Resident #1's Minimum Data Set (MDS) assessment dated [DATE] indicated they received an opioid medication during the lookback period. During an interview on 1/21/25 at 2:03 PM Staff A, Registered Nurse (RN), confirmed she drew up a dose of liquid Morphine/Roxanol with no witness present and for Resident #1 (on a date unknown) and took it with her to the Administrator's office. Upon arrival and after a dispute Staff B, Licensed Practical Nurse (LPN) / Interim DON, took the syringe 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.

Based on observation, clinical record review, staff interview and equipment invoices, the facility failed to maintain patient care equipment in safe operating condition. The facility identified a census of 28 residents. Findings include: 1. Resident #2's clinical record reflected he had a code status (what to do in an emergency when resident's heart rate stops) of do not resuscitate (DNR). The Call Summary Report dated 11/14/24 included a call remark at 9:57 AM that indicated Resident #2 choked on peanut butter and the suction didn't work. The Health Status Note dated 11/14/24 at 10:00 AM reflected the writer got a call to go to the living room stat (immediately). When they arrived the found Resident #2 blue and purple with his eyes rolled back into his as he tried to gasp for air. When the Heimlich didn't work, the writer tried to suction his throat, sweeping it clean with their pointer finger. Staff D, assisted after her morning meeting with trying to get the suction machine to work. Then, Staff F, Maintenance, worked on the suction machine to find why it wouldn't work. The Health…

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 clinical record review, staff interview, and facility policy review the facility failed to report missing narcotics from the facility's emergency narcotic box within the required 24 hours. The facility identified a census of 28 residents. Findings include: Review of a facility self-reported incident #126148 I revealed on 1/15/25 the facility identified a discrepancy with the emergency narcotic lock box. The facility failed to report the missing narcotics to the Department of Inspections, Appeals and Licensing until 1/23/25 at 11:51 AM. During an interview on 1/23/25 at approximately 5:10 PM the current Interim Administrator and current Administrator indicated they failed to report the missing narcotics to the Department in a timely manner because of their investigation being progressive.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, clinical record review, staff interview, and facility policy review, the facility failed to provide adequate assessments and interventions in a timely manner for 1 of 3 residents reviewed (Resident #3) following a change of condition. The facility identified a census of 28 residents. Findings include: Resident #3's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 9, indicating moderately impaired cognition. The MDS listed Resident #3 as always continent of bowel and bladder. The Health Status Note dated 11/4/24 at 8:00 AM indicated as Resident #3 sat at the breakfast table he started to rub his abdomen, then his entire demeanor changed. He started grimacing and when asked if he had pain he replied yes. The writer observed him for about ten minutes, he took 2 bites of his food then stopped eating. He then just sat there in pain so the writer went to him and asked him where he had pain. He rubbed his lower right side of his abdomen…

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, staff interviews, and policy review, the facility failed to maintain a safe environment for one (1) resident residents reviewed (Resident #15). While assisting Resident #15, the nurse found a marijuana pipe and a medication bottle labeled Lasix (diuretic) with contents unknown in his drawer. Instead of removing the items, the nurse allowed Resident #15 to keep the items in his room with direction for his family to pick up. The facility reported a census of 28. Findings include: Resident #15's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. Resident #15 reported an occasional pain rating of 5, indicating moderate pain (based on 0 = no pain and 10 = very severe horrible). The Health Status Note dated 4/14/24 at 9:49 AM reflected as the nurse put Resident #15's wallet in his top drawer of the end table, they found a box, a pot (marijuana) pipe, a lighter, and a medication bottle labeled…

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 time card review, schedule review, and staff interviews, the facility failed to provide a Registered Nurse (RN) in the facility for eight (8) consecutive hours per day as required by the Federal Regulations. The facility reported a census of 31 residents. Finding include: Review of all RN Timesheets from 1/1/24 thru 3/31/24 and schedules from 6/14/24 thru 7/14/24 revealed the facility failed to staff an RN on the following dates: 2/10/24, 3/9/24, 3/23/24, 3/24/24, 3/31/24, 6/16/24, 6/22/24, 6/30/24, 7/8/24, and 7/10/24. During an interview on 7/16/24 at 1:30 PM, the Administrator reported the facility thought they had a waiver for RN coverage. The Administrator learned they didn't, so the facility had times without an RN covering for 8 hours in a day.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, staff interviews, and policy review the facility failed to submit a new Pre admission Screening and Resident Review (PASRR) for 1 of 1 resident (Resident #11) for review when he received new diagnoses documented in his medical record. The facility reported a census of 31 residents. Findings include: Resident #11's Minimum Data Set (MDS) assessment dated [DATE] included diagnoses of depression and psychotic disorder. Resident #11's Medical Diagnoses reviewed on 7/16/24 listed the following diagnoses: a. 7/28/21 - Major depression disorder b. 2/22/22 - Unspecified psychosis not due to a substance or known physiological condition Resident #11's current PASRR dated 3/17/20 lacked major depression disorder and unspecified psychosis not due to a substance or known physiological condition. During an interview on 7/17/24 at 11:39 AM the Administrator reported she submitted Resident #11's PASRR for review that day. The PASRR triggered the need for a Level II review. The facility provided 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 clinical record review, and staff interview and policy review, the facility failed to accurately complete a comprehensive Care Plan 3 of 14 residents reviewed (Resident #9, #25 and #28). The facility reported a census of 31 residents. Finding include: 1. Resident #9's Minimum Data Set (MDS) assessment dated [DATE] identified a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. The MDS included diagnoses of arthritis, stage 3 pressure ulcer to left and right hip, hypertension (high blood pressure), and heart failure. The MDS reflected Resident #9 used bed rails as a physical restraint (physical restraints are any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body). On 7/14/24 at 2:31 PM Resident #9 reported he is able to get in and out of bed independently with the bed rails on. During an interview 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 review and staff interview the facility failed to revise 1 of 1 Residents (Resident #11) Care Plan when Diagnoses of Psychosis and depression were documented in his medical record to ensure proper interventions were in place. The facility reported a census of 31 residents. Findings include: Resident #11's Minimum Data Set (MDS) assessment dated [DATE] included diagnoses of depression and psychotic disorder. Resident #11's Medical Diagnoses reviewed on 7/16/24 listed the following diagnoses: a. 7/28/21 - Major depression disorder b. 2/22/22 - Unspecified psychosis not due to a substance or known physiological condition Resident #11's Current Care Plan reviewed on 7/15/24 lacked instruction and interventions related to his major depression disorder and psychosis. During an interview on 7/17/24 at 11:39 AM the Administrator reported they reviewed Resident #11's Care Plan on 7/18/24 with a consulting agency. She added she expected a resident's Care Plan to include interventions and directions for…

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, policy review, resident, and staff interview the facility failed to implement discharge planning upon admission for 1 of 1 resident reviewed (Resident #28). Resident #28 voiced she would like to discharge upon admission to a different facility. The facility reported a census of 31 residents. Findings include: Resident #28's MDS assessment dated [DATE] listed an admission date of 6/12/24. The MDS identified a Brief Interview of Mental Status (BIMS) of 13, indicating intact cognition. On 7/14/24 at 3:45 PM Resident #28 reported she wanted to go to a different nursing home in Minnesota. She felt like a prisoner at the facility. The Progress Note dated 6/14/24 at 9:25 PM reflected Resident #28 became upset and said she would like to leave the facility. The Care Plan reviewed on 7/16/24 lacked a comprehensive review and interventions for her to discharge to another facility. During an interview on 7/16/24 at 4:14 PM with the Director of Nursing (DON) reported Resident #28 needed 24-hour care…

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 1 of 1 resident (Resident #28) received an anti psychotic medication (Olanzapine) for only the diagnoses related to psychiatric/mood disorders upon admission. The facility reported a census of 31 residents. Findings include: Resident #28's MDS assessment dated [DATE] listed an admission date of 6/12/24. The MDS identified a Brief Interview of Mental Status (BIMS) of 13, indicating intact cognition. The MDS lacked documentation of psychiatric or mood disorders. The Order Note dated 6/23/24 at 7:36 PM reflected an order for olanzapine in the evening related to dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. The History and Physical (H&P) dated 6/12/24 lacked documentation that Resident #28 received an antipsychotic medication at home prior to her hospitalization on 5/25/24. Resident #28's Clinic Nursing Home Note, dated 6/13/24,…

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, the Centers for Medicare and Medicaid Services (CMS), and the Assure Prism Manual, the facility failed to adequately sanitize the blood sugar meter and use barrier when doing blood sugar checks and insulin for 3 of 3 residents reviewed (Resident #25, #10,and #26). The facility reported a census of 31. Findings include: 1. Resident #25's MDS assessment dated [DATE] identified a BIMS score of 15, indicating intact cognition. The MDS included a diagnosis of diabetes. The MDS listed Resident #25 received insulin injections. During an observation on 7/16/24 at 8:05 AM, Staff B, Certified Medication Aide reported she planned to check Resident #25's blood sugar. Staff B performed hand hygiene, gathered the Assure Prism blood sugar meter (a device used to measure the concentration of glucose in the blood, typically using a small drop of blood placed on a disposable test strip) supplies, and went to the dining table. Staff B set the supplies down on the table, cleansed 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 staff interviews, the facility failed to provide a qualified Infection Preventionist to monitor and provide oversight to the facility infection prevention program. The facility reported a census of 31 residents. Findings include: During an interview on 7/15/24 at 12:20 PM, the Administrator reported Staff A, Registered Nurse (RN), didn't have her certification but took the class and finished it but needed to take the test. During an interview on 7/16/24 at 11:34 AM Staff A reported she took the class but didn't complete the test.

Based on record review, staff interviews, and policy review the facility failed to have a system in place for residents to decline vaccinations if desired for 3 of 4 residents (Resident #16, #5, and #20). The facility reported a census of 31 residents. Findings include: Resident #16's Immunization History reflected he received his last Influenza vaccine on 10/22/21. Resident #5's Immunization History identified he never received an influenza vaccine. Resident #20's Immunization History indicated they received their last Influenza vaccine on 11/26/12. During an email correspondence on 7/17/24 at 11:14 AM the Administrator reported the Infection Preventionist (IP) didn't get written documentation showing she educated Residents #16, #5, and #20 about the risks and benefits of the Influenza vaccine. In addition, the IP didn't document their choice to receive or decline the Influenza vaccine. The Influenza Vaccine Program directed the documentation in the resident's medical record will include: a. The resident or the resident's representative received education regarding the benefits 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 resident and staff interviews, and policy review the facility failed to ensure 1 of 3 residents reviewed (Resident #4) was spoken to respectfully and in a dignified manner by facility staff. The facility reported a census of 22 residents. Findings include: The Minimum Data Set (MDS) dated [DATE] for Resident #4 documented a Brief Interview for Mental Status (BIMS) score of 15 indicating he was cognitively intact. During an interview on 2/7/24 at 2:04 PM Staff A, facilities prior Administrator's Assistant at the facility informed she witnessed an encounter with Staff D and Resident #4 in July of 2023. She revealed Staff D walked down to Resident #4's room to ask questions regarding the status of his Medicaid application since things were not going as planned. Staff D knocked on the door, and instantly started shouting asking questions regarding where Resident #4's information was for the Medicaid application. Resident #4 felt attacked and shouted back at Staff D and said, I do not appreciate you coming…

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, staff interview, and policy review, the facility failed to submit a Level 2 Preadmission Screening and Resident Review (PASRR) evaluation for 1 of 1 residents reviewed with a new mental health diagnosis (Resident #4). The facility reported a census of 17 residents. Findings include: The Minimum Data Set (MDS) dated [DATE] documented Resident #4 had a Brief Interview for Mental Status (BIMS) of 13 indicating intact cognition. The MDS further documented the resident had diagnoses including psychotic disorder, depression, and Parkinson's disease. The Care Plan for Resident #4 revised 4/14/20 with a focus area psycho-social well-being/mood state directed staff to observe for signs and symptoms of decrease in mood/behavior and to allow the resident to express his feelings and offer him reassurance about things that happened in the past. Clinical record review revealed Resident #4 had a diagnosis effective 2/2/22 of unspecified psychosis. Clinical record review further revealed 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, record review, and staff interview the facility failed to routinely assess a resident with a pressure ulcer and report changes to the provider for any necessary treatment and services to promote healing and prevent infection for 1 of 3 residents reviewed (Resident #3). The facility reported a census of 17 residents. Findings include: According to the Minimum Data Set (MDS) assessment dated [DATE] Resident #3 scored 15 on the Brief Interview for Mental Status (BIMS) indicating no cognitive impairment. The resident required extensive assistance with transfer, dressing, eating, and personal hygiene. The resident's diagnoses included cerebrovascular disease, renal failure, diabetes, and chronic lung disease. The resident had 2 unstageable pressure ulcers and 2 arterial/venous ulcers. The MDS Describes the stages of pressure ulcers: Stage 1 An observable, pressure related alteration of intact skin whose indicators, as compared to an adjacent or opposite area on the body, may include changes 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 clinical record review, policy review, and staff interview, the facility failed to limit as needed (PRN) antipsychotic medication to 14 days without a new order and without evaluating the resident for 1 of 5 residents reviewed for unnecessary medications (Resident #9). The facility reported a census of 17 residents. Findings include: The Minimum Data Set (MDS) dated [DATE] documented Resident #9 had a Brief Interview for Mental Status (BIMS) of 11 indicating moderately impaired cognition. The MDS further revealed she had diagnoses including anxiety, depression, and non-Alzheimer's dementia. The Care Plan revised 5/1/23 documented Resident #9 had a behavior problem related to significant anxiety and dementia. The Care Plan and directed staff to intervene as necessary to protect the rights and safety of others. Review of the Medication Administration Record dated May 2023 for Resident #9 revealed she had an order for Seroquel (antipsychotic) 25 milligrams (MG) every 4 hours as needed for anxiety 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.