White County Rehab and Nursing

Based on observation, interview, and record review, the facility failed to provide privacy during perineal, urinary catheter, and wound care for 1 (R1) of 3 residents reviewed for personal privacy in the sample of 3. Findings include: R1's admission Record documented an admission date of 10/8/24 with diagnoses including enterocolitis due to clostridium difficile, local infection of the skin and subcutaneous tissue, flaccid hemiplegia affecting right dominant side, cerebral infarction. R1's 11/20/24 Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 14, indicating R1 was cognitively intact. R1's care plan documented a 10/9/24 focus area of limited range of motion due to weakness and a 10/9/24 focus area of an alteration with the ability to care for self and need of assistance due to activity intolerance, decreased strength, endurance, and weakness. On 2/21/25 at 10:45 AM, V4 (Certified Nursing Assistant/ CNA) and V5 (CNA) completed hand hygiene and donned gowns and gloves then assisted R1 from his wheelchair to the bed with a mechanical lift. V5…

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 perineal, urinary catheter, and wound care per standards of practice to prevent infections for 1 (R1) of 3 residents reviewed for infection control in a sample of 3. Findings include: R1's admission Record documented an admission date of 10/8/24 with diagnoses including enterocolitis due to clostridium difficile, local infection of the skin and subcutaneous tissue, flaccid hemiplegia affecting right dominant side, cerebral infarction. R1's 11/20/24 Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 14, indicating R1 was cognitively intact. The same MDS documents that R1 is dependent for toileting hygiene, toilet transfers, and chair to bed transfers. R1 has an indwelling catheter, and R1 is always incontinent of bowel. R1's Care Plan documents a focus area of I currently have an infection d/t (due to) C-Difficile (clostridium difficile) with an initiation date of 01/28/2025. Documented interventions for this focus area include: Emphasize good hand washing techniques…

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 ensure residents were free from verbal abuse for 1 of 3 (R2) residents reviewed for abuse in the sample of 6. Findings Include: R2's admission Record documents an initial admission date of 11/21/2022. R2's admission Record documented the following diagnoses of down syndrome, unspecified, type 2 diabetes mellitus without complications. R2's Minimum Data Set (MDS) annual assessment dated [DATE], documented a Brief Interview for Mental Status Score of 15, indicating R2 is cognitively intact. R1's admission Record documents an initial admission date of 5/1/2022. R1's admission Record documented the following diagnoses of major depressive disorders, generalized anxiety disorder and delusional disorders. R1's Minimum Data Set (MDS) quarterly assessment dated [DATE], documented a Brief Interview for Mental Status Score of 15, indicating R1 is cognitively intact. R1's Facility Progress Notes dated 12/20/2024 at 10:11 AM by V9 (Licensed Practical Nurse/LPN),…

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 timely initiate an investigate for an abuse allegation for 1 of 3 resident (R2) reviewed for abuse in a sample of 6. Findings Include: R2's admission Record documents an initial admission date of 11/21/2022. R2's admission Record documented the following diagnoses of down syndrome, unspecified, type 2 diabetes mellitus without complications. R2's Minimum Data Set (MDS) annual assessment dated [DATE], documented a Brief Interview for Mental Status Score of 15, indicating R2 is cognitively intact. R1's admission Record documents an initial admission date of 5/1/2022. R1's admission Record documented the following diagnoses of major depressive disorders, generalized anxiety disorder and delusional disorders. R1's Minimum Data Set (MDS) quarterly assessment dated [DATE], documented a Brief Interview for Mental Status Score of 15, indicating R1 is cognitively intact. R1's Facility Progress Notes dated 12/20/2024 at 4:00 AM by V11 (Registered Nurse/RN),…

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 ensure staff donned Personal Protective Equipment (PPE) in accordance with current Center for Disease Control (CDC) recommendations for infection control practices to prevent the spread of communicable disease. This has the potential to affect all 54 residents residing in the facility. Findings Include: 1. R1's admission Record documents an admission date of 4/12/2024 and included diagnoses of Metabolic Encephalopathy, Metabolic Acidosis, Chronic Kidney Disease, Congestive Heart Failure, and Epilepsy. R1's Minimum Data Set (MDS) assessment dated [DATE] included a Brief Interview for Mental Status (BIMS) score of 99, indicating severe cognitive impairment. R1's Care Plan documents R1 currently has a communication deficit related to language barrier. The Goal is documented as R1 will be able to make basic needs known by using gestures and communication board on a daily basis through the review date. The Care Plan also documented R1 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 observation, interview, and record review the facility failed to implement procedures for timely acquisition of medications to administer as ordered for 4 (R1, R4, R5, and R7) out of 5 residents reviewed for pharmacy services in a sample of 8. Findings include: 1. On 10/3/24 at 1:11 PM, V9 (Case Coordinator) stated when R1 was admitted to the facility R1 had two seizures in the first week due to the facility not administering R1's seizure medication. R1's admission Record documented an admission date of 9/23/24 with diagnoses including dysphagia following cerebral infarction, extrapyramidal and movement disorder, and epilepsy. R1's 9/25/24 Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 3, indicating R1 was severely cognitively impaired. R1's 9/23/24 After Visit Summary from the hospital documented in part . Start taking these medications . lacosamide 10 mg/ ml solution . Commonly known as: Vimpat . Administer 10 ml through peg tube 2 (two) times a day .…

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 implement current behavior interventions for a resident with inappropriate sexual behaviors and failed to re-assess and implement progressive individualized interventions for increased occurrences of unwanted sexual behaviors for 1 (R1) of 3 residents reviewed for behavioral health in the sample of 5. Findings include: R1's face sheet documented an admission date of 4/12/24 with diagnoses including metabolic encephalopathy, epilepsy, cerebral infarction. R1's 7/14/24 Minimum Data Set, dated [DATE] documented no Brief Interview for Mental Status (BIMS) score due to R1 being rarely/ never understood. A handwritten document was provided by the V1 (Administrator) that documents interviews from R9 and R8 regarding an incident with R1. At the top of the document, it reads Interviews on 5/21/24. R9's interview: He (R1) followed (R8) to our room. (R8) went into the bathroom. He (R1) pulled the curtain and sat down on (R8's) rollator. He (R1) then…

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 ensure residents were free from resident-to-resident abuse for 3 (R1, R2, and R4) of 5 residents reviewed for abuse out of a sample of 13. Findings include: 1. The facility's final Long-Term Care Facility .Serious Injury Incident and Communicable Disease Report dated 8/12/24 documented alleged abuse between R4 and R1 on 8/4/24. Both residents are marked as not interviewable. Under Detailed incident summary . the following is documented: This administrator was educated about an alleged incident between (R4) and (R1) on 8/4/24. Allegedly (R4) and (R1) were kissing and touching each other sexually . Investigation did not confirm incident. (R5) is not a credible witness due to a BIMS (equal to) 5 and often story tells, which is part of his care plan. When (R1) was interviewed by (V6 - Registered Nurse/RN) she indicated that, No, that didn't happen. Staff that were working did not see any interactions between (R4) and (R1). Interview of (R5), conducted by…

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 ensure allegations of resident-to-resident abuse were reported in a timely manner to the administrator of the facility and to other officials including the State Agency for 3 (R1, R2 and R4) of 5 residents reviewed for abuse out of a sample of 13. Findings include: 1. R2's Face Sheet documented an admission date of 4/30/24 with diagnoses including: need for assistance with personal care, dysphagia, muscle wasting, lack of coordination, schizophrenia, cognitive communication deficit. R2's Minimum Data Set (MDS) dated [DATE] documented no Brief Interview for Mental Status (BIMS) score due to R2 being rarely/ never understood. R4's Face Sheet documented an admission date of 4/12/24 with diagnoses including metabolic encephalopathy, epilepsy, cerebral infarction. R4's 7/14/24 MDS documented no BIMS score due to R4 being rarely/ never understood. On 8/8/24 at 1:50 PM, V10 (Certified Nursing Assistant/ CNA) stated that on 8/6/24 V10 was walking through 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 failed to report an allegation of sexual abuse to the State Agency for 1 of 1 resident (R12) in the sample of 13. Findings include: R12's Face sheet documents R12 has an admission date of 03/18/24 with diagnoses including Paranoid Schizophrenia, Adjustment Disorder with Mixed Anxiety and Depression, Cerebral Infarction, Other Paralytic Syndrome following unspecified Cerebrovascular disease, Paralytic gait and Abnormalities of gait and mobility. R12's Minimum Data Sheet (MDS) dated [DATE] documents a Brief Interview of Mental Status (BIMS) score of 15 indicating R12 is cognitively intact. R6's Face sheet documents R6 has an admission date of 01/20/24 with diagnoses including Encephalopathy, Cerebral Infarction, Polyneuropathy, Hemiplegia and Hemiparesis following Cerebral Infarction affecting left non dominant side and Acquired absence of left leg below knee. R6's MDS dated [DATE] documents a BIMS score of 15 indicating resident is cognitively intact. R8's Face…

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 identify an allegation of sexual abuse and then failed to complete a thorough investigation for an allegation of sexual abuse for 1 (R12) of 1 residents in a sample of 13. Finding include: R12's Face sheet documents R12 has an admission date of 03/18/24 with diagnoses including Paranoid Schizophrenia, Adjustment Disorder with Mixed Anxiety and Depression, Cerebral Infarction, Other Paralytic Syndrome following unspecified Cerebrovascular disease, Paralytic gait and Abnormalities of gait and mobility. R12's Minimum Data Sheet (MDS) dated [DATE] documents a Brief Interview of Mental Status (BIMS) score of 15 indicating R12 is cognitively intact. R6's Face sheet documents R6 has an admission date of 01/20/24 with diagnoses including Encephalopathy, Cerebral Infarction, Polyneuropathy, Hemiplegia and Hemiparesis following Cerebral Infarction affecting left non dominant side and Acquired absence of left leg below knee. R6's MDS dated [DATE] documents a BIMS…

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 accurately assessment a resident for 1 (R8) of 1 resident in a sample of 13. Findings include: R8's Facesheet documents R8 was admitted to the facility on [DATE]. R8's MDS dated [DATE] section C - Cognitive patterns contains only dashes for the complete section. Section D - Mood contains only dashes except for D0700 Social Isolation which designates an answer of 8 - resident unable to respond. and section E - Behavior contains only dashes with the exception of E0100 Potential Indicators of Psychosis which designates none of the above, indicating no hallucinations or delusions. On 06/06/24 at 10:46 AM, V21 (Minimum Data Set Coordinator/MDS) stated she does not do sections C, D, E or Q on the MDS. V21 stated that V3 (Social Services Director) does those sections. On 06/06/24 at 12:45 PM, V3 stated R8's MDS (Minimum Data Set) only has dashes in section C, D, and E because when she was doing the assessment with him she could not get any answers from him.…

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 and record review the facility failed to ensure a resident's personal funds were not charged for service while receiving Medicaid benefits for 1 of 3 residents (R1) reviewed for billing in the sample of 6. Findings include: 1. R1's face sheet documented an admission date of 7/19/21 and a discharge date of 11/7/23 with diagnoses including: rotaviral enteritis, hypotension, syncope, anxiety disorder, and acute kidney failure. On 2/22/24 at 11:54 AM, V3 (R1's Power of Attorney/ POA) said she had been in contact with the facility regarding R1's insurance status. V3 said she had notified the facility she was applying for Medicaid for R1. V3 said the facility failed to submit the required documentation to Illinois Department of Human Services (IDHS) and billed the resident as private pay. V3 said she had contacted IDHS and was told it was the fault of the facility and she could not be billed for service dates after the application was submitted. V3 said she had applied for Medicaid for R1 in July of 2023. On 2/22/24 at 2:23 PM, V2 (IDHS Casework Manager) said 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 observation, interview, and record review the facility failed to provide supervision and assistance during outside medical appointments for a resident with physical limitations for 1 (R2) of 3 residents reviewed for risk of accidents and adequate supervision out of a sample 6. Findings include: 1. R2's face sheet documented an admission date of 1/22/21 with diagnoses including: Huntington's disease, neuromuscular scoliosis, muscle wasting and atrophy, urinary incontinence, anxiety disorder, fusion of spine lumbar region. R2's January 12, 2024, Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 15, indicating R2 was cognitively intact. This same MDS documented R2 required partial/ moderate assistance with toilet hygiene and lower body dressing; and supervision or touching assistance with lying to sitting on side of bed, sit to stand, chair/ bed- to- chair transfer, and toilet transfer. R2's 3/12/21 care plan documented in part . (diagnosis) of Huntington's disease exhibited by jerking, involuntary movements, muscle rigidity, involuntary…

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 complete a significant change Minimum Data Set (MDS) assessment after an admission to hospice care for 1 (R18) of 1 resident reviewed for hospice services in a sample of 31. Findings include: R18's Face Sheet with a print date of 1/11/2024 documents diagnoses including: Hemiplegia and Hemiparesis following Cerebral Infarction affecting Right Dominant side, Muscle Wasting and Atrophy, Alzheimer's Disease, Type 2 Diabetes Mellitus, Major Depressive Disorder, and history of Transient Ischemic Attack and Cerebral Infarction without Residual Deficits. R18's Minimum Data Set (MDS) dated [DATE] documents no Brief Interview for Mental Status should be performed due to resident is rarely understood. R18's Physician Order Sheet dated 01/01/24 documents: admit to hospice dated 05/18/23. R18's medical record does not contain a significant change MDS for the admission to hospice care. On 01/11/24 at 10:45 AM, V15 (Minimum Data Set Coordinator/MDS) stated, she must…

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 conduct a Level II PASARR (Pre-admission Screening/Resident Review) screening due to a mental health diagnosis for 1 (R4) of 1 resident reviewed for PASSAR screenings in the sample of 31. Findings include: R4's Face Sheet documents an original admission date of 07/06/09 with admitting diagnoses including: Spastic Hemiplegic Cerebral Palsy, Hyperlipidemia, Heart Failure, Venous Insufficiency, and Spondylosis without Myelopathy or Radiculopathy Cervical Region. R4's Face Sheet documents a diagnosis of Schizophrenia dated 08/24/22. R4's Minimum Data Set (MDS) dated [DATE] documents: a Brief Interview of Mental Status score of 00 indicating R4 has a severe cognitive impairment. R4's medical record contains no documentation of a Level II PASARR screening. R4's Interagency Certification of Screening Results dated 06/24/09 documents: screening indicated nursing facility services are appropriate. On 01/11/24 at 10:45 AM, V8 (Social Services Director/SSD) stated…

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 develop and implement interventions to prevent falls for 2 of 4 (R6, R31) residents reviewed for falls in the sample of 31. Findings included: 1.R6's EHR (Electronic Health Record) under admission, documents R6 was admitted to this facility on 9/5/2023 under hospice care with pertinent diagnoses of COPD (Chronic Obstructive Pulmonary Disease), Hypertensive Chronic Kidney Disease Stage 3B, and Diabetes Mellitus type 2 among others. According to R6's MDS (Minimum Data Set) dated 12/18/2023 R6 is assessed as having impairment to both lower extremities, dependent on staff for transferring and uses a wheelchair for locomotion. This same MDS documents R6 was mentally assessed with a BIMS (Brief Interview for Mental Status) and received a score of 12 out of 15, indicating R6 has moderate cognitive impairment. R6's EHR under Progress Notes document R6 fell on [DATE], 10/28/23, 11/1/23 (2 times), 11/10/23, 11/11/23, 11/14/23 and 11/15/23. R6's care plan, with a…

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 and record review, the facility failed to attempt non-pharmacological interventions prior to administering a PRN (as Needed) anti-psychotic medication, failed to observe 14 day time frames for PRN anti-psychotic medication orders, and failed to ensure when the PRN anti-psychotic medication renewed that the prescribing physician evaluates the resident for continued appropriateness of the medication for 1 of 5 (R6) residents reviewed for unnecessary medications in a sample of 31. Findings included: R6's EHR (Electronic Health Record) under admission, documents R6 was admitted to this facility on 9/5/2023 with pertinent diagnoses of COPD (Chronic Obstructive Pulmonary Disease), Hypertensive Chronic Kidney Disease Stage 3B, and Diabetes Mellitus type 2 among others. According to R6's MDS (Minimum Data Set) dated 12/18/2023 R6 is assessed as having impairment to both lower extremities, dependent on staff for transferring and uses a wheelchair for locomotion. This same MDS documents R6 was mentally assessed with a BIMS (Brief Interview for Mental Status) and received a…

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 and record review, the facility failed to ensure resident clothing is returned from the laundry in a timely manner or replaced for 3 of 10 residents (R6, R7, R10) reviewed for laundry in the sample of 10. Findings include: On 12/12/23 at 11:25am, R7 was alert and oriented. R7 stated he has lived at the facility about 4 1/2 years. R7 stated since his admission, the facility has a problem with not returning his laundry, and he has had multiple garments go missing, including the top to a pair of pajamas which was never returned from the laundry within, The past several months. R7 stated he informed staff, who searched for the item. R7 stated the facility did not offer to reimburse him when the garment was not located. On 12/13/23 at 9:35am, V9, Certified Nursing Assistant, stated resident clothing returned from the laundry routinely ends up in the wrong room. On 12/13/23 at 9:50am, V6, Social Services Designee, stated there is an ongoing problem with laundry not being returned to the right residents. On 12/13/23 10:10am, V8, CNA, stated laundry not making it back 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 interview and record review, the facility failed to operationalize its Abuse Policy by immediately initiating investigations into resident reports of staff to resident retaliation and misappropriation of property for 3 of 10 residents (R2 R3 R6) reviewed for abuse in the sample of 10. Findings include: On 12/12/23 at 11:20am, R2 was alert and oriented to person, place, and time. R2 stated within the past 2 weeks he has had a brand new $600 laptop stolen from his room. R2 stated V1, Administrator, is aware of this. R2 stated staff did not try to look for the items and did not call the police, and staff didn't interview him. R2 stated, We residents think (V4, former Certified Nursing Assistant) has been stealing things. On 12/12/23 at 11:25am R7 was alert and oriented to person, place, and time. R7 stated he has not had anything stolen, but he has heard other residents state that V4 has stolen things from them. On 12/12/23 at 11:30am, R3 was alert and oriented to person and place, but not time. R3 stated he does not like it when V4 works because V4, Got mad at me for calling…

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 and record review, the facility failed to report to The State Agency and local law enforcement allegations of staff to resident abuse and misappropriation for 3 of 10 residents (R2 R3 R6) reviewed for abuse in the sample of 10. Findings include: On 12/12/23 at 11:20am, R2 was alert and oriented to person, place, and time. R2 stated within the past 2 weeks he has had a brand new $600 laptop stolen from his room. R2 stated V1, Administrator, is aware of this. R2 stated staff did not try to look for the items and did not call the police, and staff didn't interview him. R2 stated, We residents think (V4, former Certified Nursing Assistant) has been stealing things. On 12/12/23 at 11:25am R7 was alert and oriented to person, place, and time. R7 stated he has not had anything stolen, but he has heard other residents state that V4 has stolen things from them. On 12/12/23 at 11:30am, R3 was alert and oriented to person and place, but not time. R3 stated he does not like it when V4 works because V4, Got mad at me for calling the State Agency and complaining about her, so…

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 and record review, the facility failed to investigate resident reports of staff to resident retaliation and misappropriation of property for 3 of 10 residents (R2 R3 R6) for abuse in the sample of 10. Findings include: On 12/12/23 at 11:20am, R2 was alert and oriented to person, place, and time. R2 stated within the past 2 weeks he has had a brand new $600 laptop stolen from his room. R2 stated V1, Administrator, is aware of this. R2 stated staff did not try to look for the items and did not call the police, and staff didn't interview him. R2 stated, We residents think (V4, former Certified Nursing Assistant) has been stealing things. On 12/12/23 at 11:25am R7 was alert and oriented to person, place, and time. R7 stated he has not had anything stolen, but he has heard other residents state that V4 has stolen things from them. On 12/12/23 at 11:30am, R3 was alert and oriented to person and place, but not time. R3 stated he does not like it when V4 works because V4, Got mad at me for calling The State Agency and complaining about her, so to get me back, she doesn't…

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 interview, and record review the facility failed to implement interventions to appropriately supervise a resident with a history of elopement for 1 (R1) of 3 residents reviewed for supervision in the sample of 4. Findings include: 1. R1's face sheet documented an admission date of 3/1/23 indicates diagnoses including: cerebral infarction, unsteadiness on feet, dementia, unspecified psychosis not due to a substance or known physiological condition, major depressive disorder, presence of cardiac pacemaker. R1's Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 15, indicating R1 is cognitively intact. This same MDS documented R1 was independent with moving from a seated position to standing and walking. R1's care plan initiated 6/23/23 documented Focus: My current risk to Wandering/ Elopement is (High Risk 7 or higher) and my safety will be monitored every shift by all staff . Goal: 7/21/23 I will comply with wearing a wander guard as needed . Interventions:…

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 allow residents the right to smoke for 7 of 7 residents (R1, R2, R5, R6, R7, R8, R9) reviewed for smoking in a sample of 13. Findings Include: R1's face sheet documents an admission date of 08/02/23 and a diagnosis of tobacco use. R1's Minimum Data Sheet (MDS) dated [DATE] documents a Brief Interview of Mental Status (BIMS) is documented at 15 indicating cognitively intact. R1's Care plan dated 08/02/23 documents: R1 is currently a nicotine user and uses cigarettes with interventions documented including I (R1) will be supervised every 2 hours during smoking times, R1's smoking materials will be kept by the nursing staff and given to R1 every 2 hours for smoke time with a date of 08/02/23. R2's Face sheet documents an admission date of 06/20/2019 with diagnosis including Nicotine dependence, bipolar disorder, anxiety disorder, and schizophrenia. R2's Minimum Data Sheet (MDS) dated [DATE] documents a Brief Interview of Mental Status (BIMS)…

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 the correct portion size as documented on the approved menu for 6 of 6 residents (R1, R2, R5, R6, R7 and R8) reviewed for portion size in a sample of 13. Findings include: The Diet Spreadsheet dated Day 17: Tuesday documents: regular diet: #6 scoop (5.3 ounces) of pork, #8 scoop (4 oz) scoop of rice, 4 oz of green beans and onions, 4 oz of pears, and bread with margarine. On 08/22/23 at 12:15PM V13 (Dietary) was weighing the pieces of pork for the regular diet on a food scale. V13 did not zero the scale out after small pieces of meat were left on the scale. V13 was observed weighing pork and placing each portion on the plate of the trays containing R1, R2, R5, R6, R7, and R8's diet card. The weight of the pork servings were observed as follows: R1- 2.5 ounces, R2- 3 ounces, R5-3 ounces, R6- 3 ounces, R7- 2.5 ounces, and R8- 3 ounces. On 8/22/23 at 12:30 PM, R1, R2, R5, R6, R7, and R8's meal trays containing the pork servings were…

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 and interview the facility failed to ensure quarterly assessments were completed in a timely manner for 8 of 8 residents (R3, R8, R12, R18, R23, R29, R31 and R36) reviewed for timely quarterly assessments in a sample of 30 . The Findings Include: 1. R3's admission record documents an admission date of 3/18/21. On 12/1/22 at 10:30 AM, V4 (Minimum Data Set Coordinator) confirmed that the most recent completed minimum data set (MDS) completed on 7/22/22 . V4 stated that a quarterly MDS was due on 10/20/22 and is not completed. 2. R8's admission record documents an admission date of 9/13/17. On 12/1/22 at 10:30 AM, V4 confirmed that the most recent MDS completed was on 7/22/22 with one in progress but not yet completed due on 10/21/22. 3. R12's admission record documents an admission date of 12/10/21. On 12/1/22 at 10:30 AM, V4 confirmed that the most recent completed MDS was completed on 7/21/22 with one in progress but not yet completed due on 10/20/22. 4. R18's admission record documents an admission date of 2/12/16. On 12/1/22 at 10:30 AM, V4 confirmed that…

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.