Pearl Of Crystal Lake, The

Based on observation, interview and record review, the facility failed to puree foods following the recipe to maintain palatability of the food served. This applies to two of two residents (R9, R65) reviewed for puree foods in the sample of 44.The findings include:On 6/2/26 at 10:50 AM, V4 [NAME] was preparing the puree foods for lunch. V4 was pureeing the Asian fried rice and was adding plain hot water to the blender to puree the rice to the correct consistency. V4 and this surveyor tasted the mixture when she was done pureeing the rice and the rice had no flavor. V4 was told by V3 Dietary Manager (DM) to add some salt which she did.On 6/2/26 at 11:19 AM, V4 said the rice was cooked in chicken broth and that is why she used the water to help puree the rice to the correct consistency.On 6/2/26 at 2:00 PM, V3 DM said V4 should have used chicken broth as the liquid to puree the rice. V3 said he had started to boil a pot of water to make some broth, and V4 took the water before he could complete that.On 6/3/26 at 11:44 AM, V5 Dietician said if the recipe calls to add broth to the rice…

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 ensure enhanced barrier precautions were followed for 1 of 7 residents (R21) reviewed for infection control in the sample of 44.The findings include:On 6/2/26 at 10:28 AM R21 had an enhanced barrier precautions (EPB) sign up on doorway to his room. R21 was in bed on his back with the head of his bed elevated. R21 had an air mattress in place on his bed and stated that his bottom hurt because it felt like the bed was inflated enough. R41 stated it felt like his bottom was touching the metal of the bed. V12 Certified Nursing Assistant came into his room, did not have gloves or gown on and removed his blankets, was touching/pressing all over the mattress to check the inflation. V12 moved the linen around on his bed to look at the mattress. At 10:46 AM V13 Restorative Nurse came into the room, put gloves on, did not have a gown on and on and started pushing on the mattress to check the inflation. V13 also put her hands and forearms under the resident to see if the mattress was flat under him. V12 and V13 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 observation, interview and record review the facility failed to ensure the menu was followed to meet the nutritional needs of residents on a pureed diet for 4 of 4 residents (R13, R49, R54 and R65) reviewed for menus and nutritional adequacy in the sample of 18. The findings include: The undated facility provided list of residents on a pureed diet shows that R13, R49, R54 and R65 are all on a pureed diet. The Menu Extension Sheet for 3/10/25 shows that residents on a regular diet were to receive sloppy joe on a bun, cucumber and tomato salad, french fries and mixed fruit for the noon meal. Residents on a pureed diet were to receive pureed #6 (5 1/3 ounces (oz)) scoop of sloppy joe, tomato juice 4 oz, #8 (4 oz) scoop mashed potatoes and pureed #8 scoop of mixed fruit. On 3/10/25 at 10:00 AM, the pureed sloppy joe was made for the residents on a pureed diet. Meat, thickening powder and water were added to the blender and processed. No bread serving was added to the meat. On 3/10/25 at 11:45 AM, R13, R49, R54 and R65's noon meal was plated. A #8 (4 oz) scoop of the pureed…

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 a resident who is morbidly obese received the appropriate wheelchair for 1 of 18 residents (R128) reviewed for accommodation of needs in the sample of 18. The findings include: R128's face sheet printed on 3/12/25 shows R128 was admitted to the facility on [DATE] with a diagnosis that include fracture of left lower leg wearing a cast and morbid (severe), obesity due to excess calorie, and congestive heart failure (CHF) on oxygen. On 3/10/25 at 9:16 AM, V9 and V10 both Certified Nursing Assistants (CNA) were transferring R128 to her wheelchair via a mechanical lift. As R128 was being lowered and placed into the wheelchair, R128 was not positioned well in the wheelchair. V9 and V10 kept on trying to pull R128 back so R128 could fit in the wheelchair, but R128 was not moving an inch, since there was no space on either sides or back of the wheelchair. R128's midsection was wider than the wheelchair. R128 stated this is so tight, It's…

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 obtain treatment orders for a non-pressure wound and failed to obtain daily weights as ordered for a resident with congestive heart failure. This applies to 2 of 18 residents (R177 and R128) reviewed for quality of care in the sample of 18. The findings include: 1. On 03/10/25 at 10:14 AM, R177 was in bed. R177 had a tan foam dressing to her left forearm. The dressing was not dated. The dressing had shadow drainage that was smaller than a dime. The corners of the dressing were rolled up. On 03/11/25 at 10:18 AM, R177 had a different white dressing to her left forearm. The dressing had shadow drainage that was smaller than a dime. R177's Progress Note dated 03/08/25 showed R177 had a fall and two skin tears to her left forearm were found. One skin tear was 5-6 centimeters (cm), and the other was 3-4 centimeters. The same note showed the skin was cleaned and a dressing was applied. R177's Order Summary Report printed on 3/10/25 did not show…

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 put interventions in place for residents with pressure injuries to 3 of 8 residents (R127, R62, and R44) reviewed for pressure injuries in the sample of 18 The findings include: 1. R127's Physician Order Sheet (POS) printed on 3/10/25 show R127 has an order of LAL (lo air loss mattress) due to R127 being admitted to the facility with a stage 4 sacral area pressure injury with possible infection. The same POS show R127's wound treatment for the Stage 4 sacral wound included cleaning with skin prep peri wound. Apply Therahoney and lightly pack with Alginate tucked to tunnel and depth of wound. Cover with bordered foam. R127's wound assessment dated [DATE] show, pressure injury present on admission Stage 4 measuring 3.20 centimeters (cm) x 3 cm x 1.5 cm with undermining of 12 o'clock to 12 o'clock (2.60 cm) On 03/10/25 at 11:30 AM, R127 was in bed. R127 stated I am soaked and wet, I am lying on these wet sheets and my back is sore, I have been…

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 implement a care plan intervention for a resident at risk for malnutrition for 1 of 3 residents (R73) reviewed for nutrition in the sample of 18. The findings include: R73's face sheet shows she is a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including: pressure ulcer of the sacral region, ascites, generalized edema, chronic kidney disease stage 4, unspecified severe protein-calorie malnutrition and history of gastric bypass surgery. R73's Nutrition Care Plan initiated on 2/12/25 shows she has the potential for nutritional problems and is at risk for malnutrition. Interventions for R73 identified in the Care Plan shows weights should be monitored as ordered. R73's Physician Order Summary shows an order for weight on day one (admission day) and day two then weight weekly for 4 weeks (record in the morning every Tuesday for 4 weeks.) R73's Weight Summary and Medication Administration Record both show R73 was weighed 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 ensure staff wore the required personal protective equipment (PPE) for a resident on enhanced barrier precautions for 1 of 18 residents (R178) reviewed for infection control in the sample of 18. The findings include: R178's Order Summary Report printed on 3/11/25 showed R178 had an order to be on enhanced barrier precautions due to a wound and another order for PPE to be used during high contact resident care activities such as transferring the resident. The orders had a start date of 3/8/25. On 03/10/25 at 10:26 AM, V3 (Infection Control Nurse) put a sign on R178's door indicating R178 was on enhanced barrier precautions. V4 (Occupational Therapist) and V5 (Physical Therapist) were in R178's room assisting R178 to stand, walk across the room, and sit in a chair. V5 supported R178 to transfer by holding onto a gait belt. V4 and V5 had on gloves. V4 and V5 did not have on a gown. On 03/10/25 at 10:48 AM, V3 was asked what triggered her to place an enhanced barrier precaution sign on R179's door. V3 said R178…

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 a resident received a pneumococcal vaccine for 1 of 5 residents (R52) reviewed for immunizations in the sample of 18. The findings include: R52's Face Sheet shows that she is [AGE] years old and admitted to the facility on [DATE] with diagnoses of: end stage renal disease, dialysis, chronic obstructive pulmonary disease, chronic respiratory failure with hypoxia, congestive heart failure, dependence on supplemental oxygen and obstructive sleep apnea. R52's Pneumococcal Vaccine Consent form dated 10/14/24 shows that she gave consent to receive the pneumococcal vaccine. R52's Immunization Report printed 3/10/25 shows that she received a pneumococcal vaccine (Prevnar 13) on 12/1/2021 and no additional pneumococcal vaccines since then. On 3/11/25 at 1:04 PM, V3 (Infection Preventionist) said that the nurses ask residents upon admission about their immunization history and if they are due for a pneumococcal vaccine, she speaks with them, gets a consent…

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 interviews and record review, the facility failed to prevent the theft of a resident's personal money for one of three residents (R1) reviewed for misappropriation of property. The findings include: The facility's final investigation report with incident date of 10/03/2024 indicated that R1 admitted to the facility on [DATE] with $75 that was documented on her admitting inventory sheet. R1 noticed the money was missing/stolen from her wallet on 09/27/2024. R1 thought her son had picked up the money but he confirmed that he did not take the money. The staff searched through R1's purse and room, as well as the garbage and laundry but were unable to locate the money. After staff, resident, and family interviews were conducted and video surveillance was reviewed, the facility could not ascertain where R1's money went or when it went missing. R1's medical record indicated the resident admitted to the facility on [DATE] with a past medical history not limited to: history of fall, weakness, cervical disk…

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 ensure staff wore the required personal protective equipment (PPE) when entering COVID-19 isolation rooms and for resident rooms that were on isolation for suspected/ruling out COVID-19. The facility also failed to ensure staff disposed of a face shield after use and failed to ensure staff did not wear surgical masks under N95 masks. This applies to 7 of 9 residents (R1, R2, R3, R4, R7, R8, and R9) reviewed for infection control in the sample of 9. The findings include: 1. On 9/18/24 at 8:37 AM, V7 (Certified Nursing Assistant- CNA) entered R3 and R4's room. On the outside of R3 and R4's room were signs indicating R3 and R4 were on droplet and contact isolation. The signs indicated eye protection was required to enter the room. V7 placed on PPE before entering the room; however, V7 did not have on eye protection when entering the room. V7 also had a black surgical mask on under the N-95 mask. A list provided by the facility indicated R3 and R4 were on isolation for COVID-19. 2. On 9/18/24 at 8:45 AM, V8 (CNA)…

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 and record reviews the facility failed to ensure an as needed medication was documented in R1's Medication Administration Record (MAR) for 1 of 10 residents reviewed for pharmacy services in the sample of 10. The findings include: On 07/31/24 at 3:13PM V6 (RN-Registered Nurse) said, I assessed R1 to have pain 6 out of 10. I provided her with the house stock acetaminophen pain medication. I forgot to document the administration. R1 received acetaminophen 650 milligrams by mouth for 6 out of 10 pain. On 08/01/24 at 2:00PM V2 (DON-Director of Nursing) said, the nurse should ensure they document the medication provided to the residents in the residents' MAR. R1's Medication Administration Record dated July 2024 shows, R1 did not receive any as needed acetaminophen while in the facility. The facility's Medication Administration policy dated 03/20/20 shows, Document as each medication is prepared on the MAR.

Based on observation, interview and record review the facility failed to ensure staff safely assisted a resident with repositioning in bed. This applies to 1 of 3 residents (R1) reviewed for safety/supervision in the sample of 3. The findings include: On May 28, 2024, at 9:01 AM, R1 was asleep in bed. R1 had two scabs from lacerations in the shape of a V on his forehead. They measured approximately an inch and a half to 2 inches a piece. He also had a scab from another laceration on the top of his head. There were 7 staples that were visible. The laceration measured approximately 10 inches long. R1 was lying on an air mattress. There were no side rails on the bed or anything for R1 to hold on to when he rolled over. R1 was also a very large man. The bed had an extender on it for length because he appeared to be over 6 feet tall. The left side of the bed had a nightstand, and the right side of the bed had a closet. R1's arms were wrapped with a gauze dressing and very swollen with fluid. R1's electronic medical record shows, he is on hospice and bed bound (he has not been out of bed…

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 resident's call lights were answered in a timely manner in order to maintain the resident's quality of life and dignity for 4 of 5 residents (R2, R4, R50 & R40) reviewed for dignity in the sample of 20. The findings include: 1. On 2/21/24 at 9:35 AM, R2 was sitting up in bed with the head of her bed elevated. R2 was wearing a hospital type gown and her hands were deformed. R2 stated, The wait times are horrible. I have to wait 30 minutes to one hour at times for any help. I call because I can't get up and go to the bathroom myself. I end up using my incontinence brief and then need to be changed. I would use the bed pan but I am afraid they will leave me on it for 30 minutes to an hour while I wait for them to answer the light. I shouldn't be on a bedpan longer than 15 minutes because it's not good for my skin. I drink a lot of water. My doctor told me I needed to because of UTI's (urinary tract infection), so that is what I am doing. It makes me…

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 orders for do not resuscitate (DNR) were documented in the physician's orders for 1 of 1 resident (R33) reviewed for advanced directives in the sample of 20. The findings include: On [DATE] at 9:33 AM, R33's electronic medical record was reviewed for advanced directives. R33's POLST (Practitioner Order for Life-Sustaining Treatment) form dated [DATE], located in the miscellaneous section of R33's electronic medical record, showed No CPR (cardio-pulmonary resuscitation). Do not attempt Resuscitation. Selective Treatment: Primary goal is treating medical conditions with limited medical measures. Do Not Intubate or use invasive mechanical ventilation. May use non-invasive forms of positive airway pressure, including CPAP and BIPAP. May use IV fluids, antibiotics, vasopressors, and antiarrhythmics as indicated. Transfer to the hospital if indicated. No information regarding R33's advanced directives for life-sustaining treatment was found in R33's…

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 a resident with poor trunk control was properly positioned; failed to ensure a resident with CHF (Congestive Heart Failure) was weighed daily; and failed to ensure a dressing was in a place to a non-pressure wound for 2 of 7 residents (R23, R282) in the sample of 20. The findings include: 1. On 2/20/24 at 10:22 AM, R23 was sitting in her wheelchair, in the doorway of her room. R23's upper torso was slumped to the right side of her wheelchair. On 2/21/24 at 9:39 AM, R23 was in her room, sleeping in her wheelchair. R23's wheelchair was positioned along the far side of her bed. The wheels were not locked on the wheelchair. R23 was sound asleep with drool noted on her shirt. R23's body was leaning to the left and forward in the wheelchair. R23 did awaken to name but remained in the slouched position. The surveyor asked R23 if she was comfortable and she replied, Not really. The surveyor attempted to ask follow-up questions and R23 fell…

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 restorative program of passive range of motion to upper and lower extremities was being provided daily for 1 of 3 residents (R2) reviewed for restorative services in the sample of 20. The findings include: On 2/21/24 at 09:35 AM, R2 was sitting up in bed with the head of her bed elevated. R2 was wearing a hospital type gown and her hands were deformed. R2 stated, I am also not getting restorative. It is only being done once per week usually, sometimes twice a week. I should be getting it three times per week. I was on therapy and that stopped in December and restorative was supposed to start then. I fractured my left arm in April and can't do range of motion on my own to that arm. I need help with the movement to that arm, so it doesn't get more stiff. There are no set days for the three times per week. It is really supposed to be done 5 days per week. There is supposed to be two girls doing restorative and I have only seen one. I keep getting told that they are going to set up restorative for me, but it…

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 provide indwelling urinary catheter care for 1 of 3 residents (R40) reviewed for catheters in the sample of 20. The findings include: On 2/20/24 at 10:03 AM, R40 was sitting in bed with the head of his bed raised. R40 had an indwelling urinary catheter with the drainage bag attached to the lower part of the bed. R40 had chunks of white sediment in his catheter tubing and drainage bag. R40 stated staff do not provide catheter care such as cleaning his penis and catheter tubing. Catheter care for a male resident was discussed with R40 and he stated, They don't do any of that. On 2/21/24 at 2:10 PM, V3 ADON (Assistant Director of Nursing) stated catheter care is provided with any incontinence episode of stool and every shift for sure. V3 stated staff should clean the urethral meatus so a resident doesn't develop an infection and empty the drainage bag so there is no backflow of urine, and this should be done every shift. V3 stated there should be CNA task documentation and perineal care/catheter care should be part of the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to implement contact precautions to alert staff and visitors of a resident with an active infection, failed to ensure catheter care was provided in a manner to prevent cross-contamination for a resident with an active infection, and failed to ensure supplies used for personal cares were not contaminated. The facility also failed to ensure staff wore PPE (personal protection equipment) when performing wound care for a resident on enhanced barrier precautions. This applies to 2 of 8 residents (R67, R44) reviewed for infection control in the sample of 20. The findings include: 1. R67's admission Record, provided by the facility on 2/22/24, showed he was admitted with diagnoses including hemiplegia (paralysis affecting one side of the body), malignant neoplasm of bronchus or lung, secondary malignant neoplasm of brain, chronic kidney disease stage 4 (severe), an extracorporeal (wide-bore central venous line) dialysis catheter, urinary tract…

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 ongoing monitoring of a resident for 1 of 3 residents (R1) reviewed for quality of care in the sample of 5. The findings include: R1's face sheet showed she was admitted to the facility on [DATE] with diagnoses to include acute on chronic systolic and diastolic heart failure, cardiomegaly, chronic obstructive pulmonary disease, dependence on supplemental oxygen, hypertensive heart and chronic kidney disease with heart failure and with Stage 5 Chronic Kidney Disease, paroxysmal atrial fibrillation, pressure ulcer of sacral region, pulmonary hypertension, atherosclerosis of coronary artery bypass grafts, chronic respiratory failure with hypoxia, dependence on renal dialysis, dysphagia, occlusion and stenosis of carotid artery, pericardial effusion, peripheral vascular disease, and pressure induced deep tissue damage of left heel. R1's facility assessment dated [DATE] showed she had moderate cognitive impairment and required…

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 assistance to a resident that needed extensive assist with activities of daily living (ADL's) for 1 of 4 residents (R2) reviewed for ADLs in the sample of 4. The findings include: On 10/5/23 at 9:20 AM, R2's call light was on. At 9:30 AM, V4 (Certified Nursing Assistant-CNA) entered the room and served R2's breakfast then turn R2's call light off saying I will need help to do that. This surveyor asked R2 how she was doing. A strong smell of urine was noted coming from R2. R2 said her call light was on since this morning wanting to be changed. R2 said she told the CNA (V4), but the CNA said she would have to go get help, so she went ahead and ate her breakfast. R2 said the last time she was changed was last night when she went to bed. At 9:50 AM, V5 and V6 (both CNA's) entered the room and provided incontinence care to R2. R2's incontinent pad was totally soaked with urine. V5 said she was R2's CNA. V5 said she was called in to come…

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 thaw foods in a manner that prevents cross-contamination and food borne illness. This has the potential to affect all residents in the facility. The findings include: The completed Facility Data Sheet dated 8/31/23, shows a census of 63 residents. 1. On 8/31/23 at 8:48 AM, black portion cups filled with mandarin oranges were in the refrigerator by the ice machine without a date and label. On 8/31/23 at 8:50 AM, two bowls of an unknown soup were in the refrigerator by the ovens without a date and label. On 8/31/23 at 8:56 AM, one can of mushroom stems and pieces, two cans of vegetarian beans, two cans of Manwich, one can of diced potatoes, and three cans of cut sweet potatoes were stored without a received by date. On 8/31/23 at 8:59 AM, an opened log of hard salami was wrapped in plastic without a date and label on the top rack in the basement refrigerator. Also on the top rack was a used bag of diced ham, sealed, and in a hotel pan without a date or label. On 8/31/23 at 9:02 AM, two opened bags 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.