Aviston Countryside Manor

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to ensure medications were administered as ordered for 1 (R5) of 3 residents reviewed for medication administration in the sample of 5.Findings Include:R5's face sheet documents that R5 was admitted to the facility on [DATE]. The diagnoses listed on the face sheet include unspecified fracture of left pubis, urinary tract infection, heart failure, unspecified atrial fibrillation, essential hypertension, chronic kidney disease, and hyperkalemia. R5's admission MDS (Minimum Data Set) dated 10/13/2025 documented a BIMS (Brief Interview of Mental Status) of 15, indicating R5 is cognitively intact.R5's progress note dated 11/11/2025, timed 12:25 A.M., authored by V12 (Licensed Practical Nurse) documented R5 received Keppra 750mg and Metoprolol 100 mg in error. The on-call nurse practitioner called and notified him of error. Vital signs at 10:39 P.M. were blood pressure 128/52 and pulse of 74. Per nurse practitioner monitor vital signs during 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 and record review, the facility staff failed to identify a situation of staff to resident verbal abuse and report to the Administrator immediately, for 3 of 5 residents (R2, R4, and R5) reviewed for abuse and neglect in the sample of 10. The findings include: 1.R2's admission Record documents an admission date of 11/23/24 and diagnoses including malignant neoplasm of overlapping [NAME] of left female breast, cerebral infarction, depression, generalized anxiety, unspecified mood disorder, and mild cognitive impairment.R2's Minimum Data Set (MDS) dated [DATE], documents under Section C a Brief Interview for Mental Status (BIMS) score of 5 which indicates severely cognitively impaired. Section B document's ability to hear as adequate.R2's Care Plan documents a focus area of R2 is at risk for abuse/neglect due to residing in a congregate facility with interventions of address all complaints/concerns promptly with grievance policy and procedures and report any suspected abuse/neglect 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint investigation: 25812914/2705654 and 25412177/26911261 Based on interview and record review, the facility failed to provide an environment free of accident hazards for 2 (R1, R3) of 3 residents reviewed for accidents in the sample of 10. The findings include:1.R3's admission Record documented an admission date of 4/3/2025 and diagnoses including unspecified dementia, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, bipolar disorder, current episode manic severe with psychotic features, schizoaffective disorder, bipolar type, other schizophrenia, unspecified asthma, uncomplicated, cerebral infarction, unspecified, other seizures, unspecified. R3's Minimum Data Set (MDS) dated [DATE], documented under section C- (cognitive patterns) C0100, No (resident is rarely/never understood) a BIMS (Brief Interview for Mental Status) not completed, indicating R3 was severely impaired cognition. This same document under section GG- Mobility documented that R3 is partial/moderate…

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 the Facility failed to perform safe turning and repositioning during care for 1 of 3 residents (R1) reviewed for falls in the sample of 3. Findings include:On 9/19/2025 at 10:02 AM, R1 was sitting in his wheelchair watching the television. R1's bed has low air mattress on it.R1's Minimum Data Set (MDS) dated [DATE] document R1 was cognitively intact for decision making of activities of daily living. R1 has impairments of one side on both his upper and lower extremities. R1 uses a wheelchair and needs substantial assistance with most activities of daily living. R1's Care Plan: start date of 11/15/2024 documents, Problem: Resident is at risk for falls and injuries r/t weakness, Parkinson's, left hip dislocation. 8/19/2025 fall from bed.On 9/18/2025 at 9:53 AM, R1 stated he remembered when he fell. He had just had a shower and the staff had put him on the bed but there was only one staff member, it was a male staff, and he rolled him because he was putting some…

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, the facility failed to provide proper supervision to prevent falls for 1 of 7 residents (R45) reviewed for supervision to prevent accidents in the sample of 28. Findings include: 1. R45's Face Sheet documents she was admitted on [DATE] with the diagnosis of Orthostatic Hypotension. On 6/23/24 at 9:30 AM R45 has purple bruises to her face around her left eye and a bruised purple underneath her right eye. R45 has purple linear bruises on her neck. R45 stated I had to pee, I thought I could do it, but I hadn't taken my Midrin and I got dizzy and fell from the commode. R45's Physician Order Sheet dated 1/17/24 documents STAT (immediate) cardio referral. R45's Administrative Note dated 1/17/24 documents Called (local) Cardio referring to STAT Cardio referral. Waiting for a call back to schedule appointment. Administrative Note, dated 1/25/24, documents Got in contact with (A local hospital) Cardiology regarding Cardio referral. Faxing all information over and office…

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, interview, and record review, the facility failed to store food in a manner that prevents foodborne illness. This has the potential to affect all 63 residents living in the Facility. Findings include: On 8/15/23 at 8:07 AM, in the walk-in refrigerator, there was a pitcher containing brown liquid labeled tea and 8/1/23. There was a cart with one tray of individual cups of fruit and three trays with individual cups of dessert. Each tray was covered with another tray, and none were labeled or dated. There was a bag of crumbled sausage that was previously opened and tied up in a knot but was not labeled or dated. There were three bags of shredded cheese that were previously opened and resealed but were not dated. On 8/15/23 at 8:09 AM, in the standing freezer, there was a plastic bag containing yellow, crescent shaped items that was previously opened and resealed, but was not dated or labeled. There was a plastic bag of meat patties with no date or label. V8 (Cook) stated the items in the bags were omelets and hamburgers. On 8/15/23 at 8:11 AM, there were boxes…

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 and record review, the facility failed to answer call lights and address resident's needs in a timely manner for 4 of 4 residents (R9, R29, R30, and R52) reviewed for dignity in the sample of 37. Findings include: On 8/16/23 at 12:38 PM, during the Group Resident Council Meeting, R9, R29, R30, and R52 all stated it often takes more than an hour to get help, especially around bedtime. R9's Minimum Data Set (MDS) dated [DATE] documented R9 was cognitively intact. R29's MDS dated [DATE] documented R29 was moderately cognitively impaired. R30's MDS dated [DATE] documented R30 was cognitively intact. R52's MDS dated [DATE] documented R52 was moderately cognitively impaired. On 8/17/23 at 12:21 PM, V10 (Certified Nurse Aide/CNA), stated sometimes residents have to wait a while for assistance. On 8/17/23 at 12:24 PM, V11 (Licensed Practical Nurse/LPN), stated each hallway could use an extra CNA to help out with call lights. On 8/17/23 at 12:26 PM, V12 (Certified Nurse Aide/CNA) stated, I'm a little…

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 and record review, the facility failed to provide sufficient nursing staff to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of 4 of 4 residents (R9, R29, R30, and R52) reviewed for staffing in the sample of 37. Findings include: On 8/16/23 at 12:38 PM, during the Group Resident Council Meeting, R9, R29, R30, and R52 all stated nurse aid staffing has become a problem. They stated it often takes more than an hour to get help, especially around bedtime. R9's Minimum Data Set (MDS) dated [DATE] documented R9 was cognitively intact. R29's MDS dated [DATE] documented R29 was moderately cognitively impaired. R30's MDS dated [DATE] documented R30 was cognitively intact. R52's MDS dated [DATE] documented R52 was moderately cognitively impaired. On 8/17/23 at 12:21 PM, V10 (Certified Nurse Aide/CNA) stated she was assigned to C Hall but was helping out with a resident on A Hall. She stated sometimes residents have to wait a while 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 interview and record review, the facility failed to establish an infection prevention and control program that reduces the risk of adverse events, including the development of antibiotic-resistant organisms, from unnecessary or inappropriate antibiotic use in 5 of 5 residents (R5, R16, R35, R50, and R217) reviewed for antibiotic stewardship in the sample of 37. Findings include: 1. The Facility's Infection Tracker documents R50's 6/29/23 onset infection type as Prophylaxis. R50's Order History documents order for Trimethoprim tablet; 100 mg (milligrams); Take one tablet by mouth at bedtime for long term abx (antibiotics) for tx (treatment) of frequent UTI (Urinary Tract Infection) with start date of 4/1/22 and end date of 8/15/23. R50's Medication Administrator Record (MAR) for the months of May 2023 through August 2023 document R50 received 106 doses of Trimethoprim. R50's Progress Note dated 7/28/23 at 2:44 PM documents, This nurse informed NP (Nurse Practitioner) of resident long-term use 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 observation, interview, and record review, the facility failed to provide distilled water and cleaning for Continuous Positive Airway Pressure (CPAP) machines for 2 of 2 residents (R2, R25) reviewed for respiratory therapy in the sample of 37. Findings include: R2's Physician Order Sheet (POS) dated 3/8/23 documents CPAP home setting with 2 liters of oxygen bled into CPAP apply at HS (Bedtime) remove upon rising. R2's Care plan dated 6/22/23 and revised on 8/2/23 documents resident (R2) will have an effective respiratory rate and depth and rhythm. R2's Care Plan intervention is assessing signs of ineffective breathing. The CPAP Care Plan does not document the cleaning of the CPAP machine or the changing of the filters. R2's July and August 2023 Medication Administration Record (MAR) documents CPAP at home setting with 2L 02 bled into CPAP twice a day apply at HS and remove upon rising. This MAR did not document cleaning of the CPAP machine. On 8/17/23 at 9:50 AM, V3 (Assistant Director of Nursing/ADON) stated the CPAP was not found on the treatment sheet, but it is found 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.

Based on observation, interview, and record review the facility failed to store and label food in a manner that keeps it free from contaminants. This has the potential to affect all 57 residents living in the facility. Findings include: On 07/12/22 at 8:08 AM on the initial tour and follow-up tour on 07/13/22 at 7:45 AM of kitchen, the following dry foods were found opened, not dated and no expiration date: - 50-pound bag of rolled oats was opened and left open with no date of opening. - 60-ounce bag of croutons open, with no date of opening. Bag was closed with a rubber band - 60-ounce bag of baking coconut, open, with no date of opening and taped closed. - 100-ounce bag of spaghetti, open, with no date of opening and closed with a rubber band. - 160-ounce bag of macaroni, open with no opening date and closed with a rubber band. On 07/13/22 at 7:45 AM, the following refrigerated items were found to be unlabeled and undated: Two 1- gallon pitchers with liquid (1 red and 1 brown) were not labeled and without a date. On 7/13/22 at 7:45 AM, V18 (Dietary Manager) states This must have…

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, interview and record review, the facility failed to identify and assess pressure ulcers for one of five residents (R44) reviewed for pressure ulcers in the sample of 33. Findings Include: R44's Skin Integrity Care Plan date initiated is 12/25/20 documents I will have no skin issues/break down through next review period. The Care Plan also documents Do a weekly skin check and notify my family and Physician of any new areas. Peri care after each incontinence episode. R44's Physician Order Sheets (POS) dated 6/26/22 with an open-ended date, documents cleanse right buttocks with normal saline and apply Santyl and Calcium Alginate. Cover it with a dry dressing. R44's June POS dated 6/29/22 to 7/7/22 documents cleanse scrotal area with normal saline and apply collagen powder, cover with dry dressing daily until healed. R44's Local Wound consultant Form dated 7/6/22 also documents R44's Non pressure ulcer to scrotum with fat layer exposed is resolved. R44's Local Wound consultant Form documents R44's right buttock pressure ulcer is resolved and discontinue treatment.…

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, the facility failed to provide supervision and implement effective interventions to prevent accidents/falls for 2 of 2 residents (R21, R257) reviewed for supervision to prevent accidents/falls in the sample of 33. Findings include: 1. R21's Care Plan dated 4/27/2022 (initiated 8/21/2021) documents At risk for skin breakdown. I have thin skin and am prone to skin tears. I wear derma-sleeves to my bilateral lower extremities R/T (related to) frequent reoccurrence of skin tears to my lower legs. Goal: My skin tear will be closed without infection by next review. Interventions/tasks: Administer treatment as ordered. See current physician order sheet or treatment book. Apply derma-sleeves to my lower extremities prior to getting out of bed and remove at bedtime. Encourage me to be out of bed as tolerated. Keep skin tear site clean and dry. Monitor dressing(s) if applicable and let the nurse know if it is saturated or falling off. Monitor fingernails weekly for length…

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 observation the facility failed to provide catheter care without breaches in infection control, and or reassess catheter after self-removal for two of three residents (R44, R30) reviewed for catheter care in the sample of 33. Findings Include: 1. R44's Minimum Data Set (MDS) dated [DATE] documents R44 has a catheter and is always incontinent of bowel. R44's Catheter Care Plan initiated on 9/24/2020 documents R44 has a suprapubic catheter and will show no signs and symptoms of a urinary tract infection. The Catheter Care Plan also documents cleanse the suprapubic catheter every day, and apply triad paste. Cover the catheter with a dry dressing. On 7/14/22 at 11:00 AM, V7 (Certified Nursing Assistant/CNA) removed the old dressing off of R44's left buttock, because he was incontinent of bowel. but she did not wash her hands or change her gloves. She wiped feces off of the resident with a washcloth that she wet in a basin of water and no rinse peri wash. V7 then went into 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.