Countryside Nursing & Rehab Ctr

Based upon observation, interview, and record review the facility failed to follow policy procedures, failed to ensure that that prescribed medications were administered within regulatory requirements and failed to document medication administration timely for 14 of 68 residents (R3, R5, R7, R14, R23, R46, R51, R66, R76, R109, R114, R127, R140, R150) in the sample. Findings include:The (7/28/25) facility census includes 158 residents.On 7/29/25 at 8:52 am, V11's (LPN/Licensed Practical Nurse) stated that she's a new graduate (1 month ago) and assigned to 44 residents. Surveyor advised that the residents' 9am medication administration would be observed at this time V11 responded I (V11) have 4 residents left and affirmed she (V11) passed 9am medications to 40 of the assigned residents - since 8am (within 52 minutes). V11 dispensed R75's 9am medications and scheduled Amlodipine was not initially found V11 stated It's not on the cart I have to go get it from over there (referring to the facility emergency box) then continued to search the medication cart and located the medication. V11…

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 upon observation, interview, and record review the facility failed to provide supervision, failed to implement fall prevention interventions, and/or failed to address safety hazards for five of 68 residents (R2, R139, R141, R144, R161) in the sample. Findings include: R144 is [AGE] years old and have resided at the facility since 2014, past medical history includes, but not limited to chronic obstructive pulmonary disease, unspecified dementia, type 2 diabetes, Parkinson’s disease, delusional disorder, etc. 07/28/2025 3:32 PM R144 was observed in his room at the end of the hall, awake, alert and oriented with confusion, stated he just came back from the hospital but does not know why. R144 was naked with his dirty diaper on the bed, G-tube plunger noted at the bedside table, resident's bed was unplugged from the wall, another cord not attached to anything was lying close to resident's bed. There was no call light close to resident or any floor mats noted. 07/28/2025 3:36 PM 11 (LPN) said that she is 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 upon observation, interview, and record review the facility failed to ensure that sufficient nursing staff were available to meet the needs for 20 of 68 dependent residents (R2, R3, R5, R7, R8, R14, R23, R36, R46, R51, R66, R76, R109, R114, R127, R139, R140, R141, R150, R161) in the sample and failed to ensure a licensed nurse had the required training/coursework to manage the facility restorative program. These failures have the potential to affect 158 residents. Findings include: Review of facility assignment sheet for 7/20/2025 on third shift documents that V39 (Certified Nursing Assistant) was assigned to A/B unit and V40 (Certified Nursing Assistant) was assigned to the C/D unit. The sheet also documents that V39 and V40 were responsible for the following activities “Answer all call lights, ADLs, POC (point of care)”. On 7/29/2025 at 12:35 AM, V2 (Director of Nursing) affirmed that on 7/20/2025 only 2 certified nursing assistants were assigned to care for the residents in the facility. V2 explained that V2 was not notified of the staffing issues until the morning, when V3…

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 upon observation, interview, and record review the facility failed to maintain an effective pest control program and failed to ensure the facility remained free from flying insects. This affected two residents (R127, R139). These failures have the potential to affect 158 residents.Findings include:The (7/28/25) facility census includes 158 residents.On 7/28/25 at 9:40am, gnats were observed flying in the (Unit B) hallway. On 7/28/25 at 9:44am, gnats were observed flying in R127's room and a can of insect repellent was lying on the bed. Surveyor inquired about facility concerns R127 stated There's gnats all over the place. The bathroom is a st show with gnats in there and affirmed the door is kept shut to prevent gnats from entering the room. Surveyor inspected R127's room however food and/or trash were not present. On 7/28/25 at 9:54am, a total of nine (9) fly traps were observed hanging on the walls in R139's room, multiple flies and/or gnats were noted on each fly trap. On 7/28/25 at 9:56am, surveyor inquired about the gnats observed flying in the (Unit B) hallway V9…

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 a resident's urinary drainage bag was covered in a manner that promotes dignity. This failure affects 1 resident (R150) in a sample of 68.Findings include:R150's Minimum Data Set (7/21/25) documents in part that R150 has a brief interview of mental status summary score of 11, indicating that R150 has cognitive impairment and that R150 utilizes an indwelling catheter. On 7/28/2025 at 9:59 AM, R150 was observed lying in bed with an uncovered urinary drainage bag hanging from the frame of the bed. Approximately 500 mL of straw-colored urine was observed in the bag. R150 stated that the facility staff have not kept the drainage bag in a privacy bag while in bed.On 7/28/2025 at 10:01 AM, V2 (Director of Nursing) observed the uncovered urinary drainage bag and affirmed that the drainage bag was not stored in a manner that promotes resident dignity. V2 stated that the facility standard is that all resident's urinary drainage bags are kept in privacy bag to promote privacy.Facility policy titled, Resident Rights…

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 1 resident's (R92) personal and medical information was kept confidential. This failure affects 1 resident (R92) out of a sample of 68 residents reviewed for personal privacy and confidentiality of records.Findings include:On 7/28/25 at 10:11am, during a tour of R92's room, surveyor observed a paper posted directly above R92's bed. The paper documents, in part, (Name of Company that performs PASARRs/ Preadmission Screening and Annual Resident Review); R9's full name; Full name and address of the facility R9 resides at; and stated that R92 is a [NAME] Class Member and R92 requested to not proceed to assessment. R92's room is semi-private, and the information was clearly visible to visitors, staff, and the other resident in the room.On 7/28/25 at 10:11am, R92 said, I (R92) don't know what that paper is. The nurse put it up there.R92's face sheet documents diagnoses that include, but are not limited to major depressive disorder,…

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 upon observation, interview, and record review the facility failed to follow policy procedures and failed to provide a clean, homelike, odor free, and functional environment for three of 68 residents (R127, R129, R140) in the sample and failed to maintain sanitary conditions in the community bathrooms, hallways, and other common areas. Findings include: The (7/28/25) facility census includes 158 residents. On 7/28/25 at 9:44am, surveyor inquired about facility concerns R127 stated The bathroom is a st show with gnats in there and affirmed the community shower is filthy and smells bad. On 7/28/25 at 10:01am, a pullup was observed on R140's bedroom floor and a thick clump of dirt was lying next to it. The pullup appeared to be stepped on (smeared dirt was noted on the outside). Trash was covering R140's dresser and was also noted on the floor. Surveyor inquired what was on R140's floor V10 (CNA/Certified Nursing Assistant) subsequently entered the room and responded, There's a brief right here, and a piece of paper then picked up several items from the floor and stated This…

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 refer 1 resident (R9) with a possible serious mental disorder for Screening and Resident Review to the appropriate state-designated authority for further assessment as required. This failure affects 1 resident (R9) reviewed for pre-admission screening in the sample list of 68 residents.Findings include:R9's face sheet documents, in part, admit date : [DATE] 11:42 AM (latest return) 01/03/2019 03:40 PM (current).R9's face sheet documents diagnoses that include but are not limited to delusional disorders, psychotic disorders, anxiety disorder and major depressive disorder.R9's care plan, last revised date 5/06/25, documents, in part, Problem: Symptoms: (R9) experiences delusions related her following diagnosis: Delusional D/o (disorder), Unspecified Dementia with Behavioral Disturbance, and Other Psychotic D/o not due to substance or psychological condition.On 7/29/25 surveyor unable to locate R9's PASARR (Preadmission Screening and Annual Resident…

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

Based on observation, interview and record review, the facility failed to assess, document, and treat 2 wounds on 1 resident reviewed for skin conditions. These failures have the potential to affect 1 resident (R106) out of a sample of 68 residents.Findings include:On 7/28/25 at 10:00am, R106 was observed in his (R106) room, sitting in the wheelchair. Surveyor observed a quarter sized open area on R106's left shin. R106's right leg was wrapped in a dressing with 2 golf ball sized areas of dried serosanguinous fluid on R106's dressing located on the back (calf) of R106's right leg. On 7/28/25 at 10:00am, R106 said, My legs always be like that. I (R106) sometimes be hitting my legs on the wheelchair.R106's face sheet documents diagnoses that include but are not limited to chronic venous hypertension (idiopathic) with ulcer of left lower extremity, left lower leg venous ulcer, peripheral vascular disease, Cellulitis of right lower limb, and type 2 diabetes mellitus with unspecified complications. R106's BIMS (Brief Interview for Mental Status) Summary Score: 11, dated 6/05/25, suggests…

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 have the low air loss mattress (LAL) at the correct weight settings for one resident (R13) with a chronic wound, who is also at high for developing pressure ulcers. This failure has the potential to affect 1 resident (R13), reviewed for pressure ulcer prevention interventions, in a total sample of 68 residents.Findings include:On 7/28/25 at 9:44am, R13 was observed in her (R13) room, laying on her (R13) back, on a LAL (low air loss mattress) set at 600 to 1000 pounds.R13's most recent, dated 7/07/25 at 9:45am, is documented at 187.8 pounds. R13's LAL mattress is set at minimum 412.2 pounds over the recommended weight.On 7/28/25 at 9:44am, R13 said, No, this mattress is not comfortable. I (R13) feel like I'm (R13) laying on a cement floor.R13's Face Sheet, documents medical diagnoses that include but are not limited multiple sclerosis, gastrostomy status, urinary incontinence, neuromuscular dysfunction of the bladder, and urinary tract infection. R13's BIMS (Brief Interview for Mental Status) Summary Score: 12,…

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 follow policy and procedure and ensure the tube feeding syringe was changed daily on 1 resident (R13) and failed to label 1 resident's (R13) tube feeding syringe with the resident's name. These failures have the potential to affect 1 resident (R1) reviewed for tube feeding management in the total sample of 68 residents. Findings include:On 7/28/25 at 9:44am, during a tour of R13's room, surveyor observed R13's tube feeding syringe hanging on a pole next to R13's bed. R13's tube feeding syringe was observed in an opened package with the date 7/25 and no without R13's name labeled on it.On 7/28/25 at 9:44am, R13 said, Darling. I'm (R13) not sure how old that (tube feeding syringe) is. If I (R13) need a new one, please toss it and by all means get me a new one.R13's Face Sheet, documents medical diagnoses that include but are not limited multiple sclerosis, gastrostomy status, urinary incontinence, neuromuscular dysfunction of the bladder, and urinary tract infection. R13's BIMS (Brief Interview for Mental…

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 upon observation, interview, and record review the facility failed to ensure that respiratory equipment was labeled with a name/date and failed to contain it in a plastic bag for two of 68 residents (R127, R161) in the sample. Findings include:On 7/28/25 at 9:44am, R127's (unlabeled/undated) CPAP (Continuous Positive Airway Pressure) mask was observed in a dresser drawer and not contained in a bag. Surveyor inquired if staff keep the CPAP mask contained in a bag R127 stated No, why do I have to keep it in a bag?On 7/28/25 at 10:10am, an (unlabeled/undated) CPAP mask was observed lying directly on top of R161's mattress (not a sheet) and it was not contained in a bag. On 7/28/25 at 10:19am, surveyor inquired if R161's CPAP mask was dated and/or contained in a bag V11 (Licensed Practical Nurse) inspected R161's mask and stated, It's not in a bag and there's no date on there. The (revised August 2008) respiratory therapy prevention of infection policy states the purpose of this procedure is to guide prevention of infection associated with respiratory therapy tasks and equipment,…

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 upon interview and record review the facility failed to follow policy procedures, failed to ensure that pharmacist recommendations for medication gradual dose reduction and/or discontinuation were received, and failed to ensure that pharmacy recommendations were implemented for one of five residents (R8) reviewed for unnecessary medications, chemical restraints/psychotropic medications, and medication regimen review.Findings include:R8's (7/14/25) MRR (Medication Regimen Review) states Please take the following action described below however action and/or recommendations were excluded from the document. On 7/30/25 at 2:34pm, surveyor inquired about R8's (7/14/25) pharmacist recommendations which were excluded from the MRR V2 (Director of Nursing) stated He (pharmacist) checked off a recommendation for her (R8) but didn't send us (facility) a recommendation and presented (7/30/25) email (sent to consultant pharmacist) which states for (R8's name) in the chart you (pharmacist) documented a pharmacy recommendation for med (medication) change but there is not recommendation…

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 upon observation, interview, and record review the facility failed to follow policy procedures, failed to follow physician orders, and failed to ensure that 2 of 68 residents (R34, R161) in the sample remained free from significant medication errors.Findings include:R34's (2/16/24) physician orders include Hydralazine (Antihypertensive) 50mg (milligrams) every 8 hours; 6am, 2pm, 10pm, hold if BP (Blood Pressure) is below 100/60.On 7/29/25 at 1:12pm, V26 (Licensed Practical Nurse) obtained R34's blood pressure which was 108/70 prior to medication administration. Surveyor inquired if V26 was prepared to administer R34's (2pm) Hydralazine V26 stated, His (R34) blood pressure was 108/70, so I'm (V26) gonna hold that one and call the doctor. Surveyor responded why are you going to hold the Hydralazine? V26 replied So his (R34) blood pressure doesn't go too low. Surveyor inquired if parameters to hold R34's Hydralazine were included in the orders. V26 (subsequently) reviewed R34's EMAR (Electronic Medication Administration Record) and affirmed the Hydralazine order states, hold if…

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 follow their abuse policy by failing to keep a resident (R2) free from being hit with a tool by another resident, failing to keep a resident (R5) free from being hit in the face, and a resident (R6) from being pushed by another resident, for three residents out of seven reviewed for abuse in a total sample of seven. Findings Include: A. R1 is a [AGE] year-old male admitted on [DATE] with diagnosis not limited to bipolar disorder, hemiplegia affecting the left side, and dementia. R2 is a [AGE] year-old male admitted on [DATE] with diagnosis of but not limited to dementia, heart failure, and Parkinson's disease. On 6/17/25 at 11:49AM, R1 was sitting in a separate dining room from R2 waiting for the lunch meal. When first asked, R1 denied having any physical altercations but then remembered once the surveyor gave R1 more details. R1 was unable to remember when the altercation occurred but reported R1 hit R2 in the arm with a pair of wire pliers in the arm.…

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 reviews the facility failed to follow their behavior management policy and procedures for ensuring a resident's safety by attempting to physically restrain an alert and oriented resident who refused to return to the facility after eloping. This failure applies to one of one resident (R1) reviewed for resident rights. Findings include: R1 is a [AGE] year-old male with a diagnosis history of Severe Bipolar Disorder with Psychotic Features, Generalized Anxiety Disorder, Hypertensive Heart Disease (04/11/2025) Without Heart Failure, Cannabis Use, and Nicotine Dependence who was admitted to the facility 04/11/2025. R1's Current Care Plan initiated 04/24/2025 documents he was at low risk for elopement, he will remain on supervised access to the community. R1's admission progress note dated 04/22/2025 documents he was admitted on [DATE] alert and oriented to person, place, and time and currently does not exhibit elopement risk. R1's progress note dated 05/05/2025 at 06:22 PM documents he…

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 reviews the facility failed to follow their policy and procedures for behavior and substance use management by not ensuring residents with a significant history of self-harm, suicidal behavior, and substance use received therapeutic mental health or substance abuse counseling or services; not establishing personalized care planned interventions for these behaviors based on identified causes of behaviors, preferences and individual interests; and not performing timely assessment of substance abuse history to apply knowledge and understanding of past and development of person-centered treatment interventions. This failure applies to two of two residents (R1 and R4) reviewed for behavioral health services. Findings include: 1. R1 is a [AGE] year-old male with a diagnosis history of Severe Bipolar Disorder with Psychotic Features, Generalized Anxiety Disorder, Hypertensive Heart Disease (04/11/2025) Without Heart Failure, Cannabis Use, and Nicotine Dependence who was admitted to 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 interview and record review, the facility failed to follow the facility policy on conducting background and fingerprint checks for four employees (V11, V12, V13, V14) at time of hire. This failure has the potential to affect 144 residents currently residing in the facility. Findings include: Per census report there are 144 residents currently residing in the facility. On 2/10/2025, at 2:10 PM, V3 (Human Resource) brought requested files to surveyor for review. V3 stated, what is in the file is what I have. I do not have the background checks for V11 (Maintenance) or the Illinois Sex Offender check for V13 (Certified Nursing Assistant). V14 (Maintenance) does not work here he is on the termination list with a termination of employment date of 4/18/2023. Regarding V12 (Activity Aide), I just checked the IDPH website, and his application shows not yet determined. Fingerprints for V12 were done 8/13/2024 and his hire date was 5/16/2024. On 2/11/2025, at 9:25 AM, V3 Human Resource stated regarding V14 we looked in the old records and could not find any of the background checks…

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 follow its staffing policy by not having four nurses working on the overnight shift on 12/31/24. There was no nurse present in this facility from 2:00AM until 6:04AM on 1/1/25. This failure resulted in 4 residents (R8, R9, R10, and R16) not receiving 6:00AM scheduled medications until more than one hour later or not at all; 5 diabetic residents (R7, R11, R13, R14, and R15) not having 6:00AM blood sugar level checked, and insulin administered; none of the residents received scheduled assessments and/or vital sign monitoring on the night shift. This failure has the potential to affect all 155 residents residing in this facility. Findings include: On 01.15.2025 the facaility roster indicated there were 155 residents residing in the facility. On 1/15/25 at 1:30PM, V4 LPN (licensed practical nurse) stated that she worked day shift on 1/1/25 on C wing. V4 stated that when V4 was doing med pass on 1/1/25, there were overdue documentations in all her assigned residents' MARs from night shift. V4 stated that she needed 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 interviews and record reviews, the facility failed to follow its medication administration policy and consistently monitor the effectiveness of pain medication and accurately document the administration of controlled substances for four of residents (R3, R17, R18, and R19) out of four reviewed for receiving high alert medications in a sample of 19. Findings include: On 1/16/25 at 11:45AM, V7 (nurse) stated that the nurse is expected to sign out in the resident's MAR (medication administration record) and controlled substance sheet when a high alert medication is administered. V7 stated that if a pain medication is administered, the nurse is expected to follow-up with resident regarding the medication's effectiveness. On 1/17/25 at 11:00AM, V2 DON (director of nursing) stated that the nurse is expected to make sure all high alert medications are signed out on resident's controlled substance sheet and MAR. V2 stated that the nurse is expected to follow up with the resident every time an as needed medication is administered to monitor the medication's effectiveness. V2 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 notify resident's representative of a change in condition. This failure applied to one (R1) of five residents reviewed for change in condition. Findings include: R1 is a [AGE] year-old male admitted to the facility on [DATE] with past medical history of Rheumatoid arthritis, Hypertensive heart disease, dysphasia oral phase, coagulation defect, epistaxis, gastro -esophageal reflux disease with esophagitis without bleeding, dependent on supplemental oxygen, dyspnea, difficulty walking, etc. Progress note written by V13 (Licensed Practical Nurse / LPN) dated 08/10/2024 03:02 PM, reads: code blue was called on resident for being unresponsive, staff started chest compressions and continued until emergency services arrived. Resident was transported to a local hospital around 9:35AM, MD and nursing administration notified, unable to reach family. Surveyor review of medical records did not include any documentation of any endorsement to the next shift 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 Based on interview and record review, the facility failed to ensure that a follow-up appointment was scheduled with specialists physician for a resident as ordered; they failed to administer prescribed medications and monitor and document resident's respiratory and oxygen status per physician orders and plan of care; and failed to ensure that staff accurately assess and document emergency response for a resident. This failure applied to one (R1) of one resident reviewed for nursing care. Findings include: R1 is a [AGE] year-old make admitted to the facility on [DATE] with past medical history of Rheumatoid arthritis, Hypertensive heart disease, dysphasia oral phase, coagulation defect, epistaxis, gastro -esophageal reflux disease with esophagitis without bleeding, dependent on supplemental oxygen, dyspnea, difficulty walking, etc. R1 had a cardiac arrest at the facility on [DATE], facility called a code blue, resident was later transferred to a local hospital where he died two days later. Primary cause of death…

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 follow a professional standard during G-Tube medication administration for one (R27) of one resident observed for G-Tube medication administration in a sample of 29 residents. Findings Include: On 9/11/2024 at 01:15 PM - Observed V16 (LPN) administer medication to R27 via G-Tube. V27 did not check the G-Tube placement before administering the medication. On 9/11/2024 at 1:21 PM, V16 said that she checks the placement by observing and palpating G-Tube placement site. On 9/11/2024 01:38 PM, V2 (Director of Nursing/DON) said that she expects the staff to check G-Tube placement either by auscultation or residual before administering medication. R27 is a [AGE] year-old female admitted on [DATE] with a diagnosis not limited to multiple sclerosis-end stage, anxiety disorder, essential (primary) hypertension, and hyperlipidemia. Policy: Enteral Tube Medication Objective: 1. To safely and accurately administer oral medications through an enteral…

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 feeding assistance, nail care and foot care for resident who need assistance with Activity of Daily Living (ADL). This deficiency affects one (R91) of three residents in the sample of 29 reviewed for ADL care. Findings include: On 9/10/24 at 12:17PM, Observed R91 in bed on left side lying position facing the door. V7 Social Worker (SW) said that she is on hospice care. Lunch tray untouched was left on bedside tray table on the right side of the bed towards the window. R91 said that she needs help in eating. V7 SW said that R91 eats by herself, and she does not need assistance from the staff. R91 said she is in pain and showed her swollen right arm. Noted dressing on right upper arm and right chest. Noted right fingernails long, thick, discolored and curved inward pressing the skin. On 9/10/24 at 1:00PM, V9 LPN (Licensed Practical Nurse) said that R91 does not need assistance in eating she eats by herself. V9 added that R91 is on…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to implement fall preventive measures to resident who is at high risk for falls. This deficiency affects two (R91 and R141) of three residents in the sample of 29 reviewed for Fall Prevention Program. Findings include: On 9/10/24 at 12:17PM, Observed R91 in bed on left side lying position facing the door. The bed is in high position. On 9/11/24 at 10:21AM, Observed R91 in bed on left side lying facing the door. Her bed is in high position. Showed observation to V2 DON (Director of Nursing), V2 said that the bed should be in the lowest position when resident in bed for safety. The bed control is hanging underneath the bed frame, unable for the resident to reach. V2 took the bed control and placed the bed in the lowest position. On 9/11/24 at 10:25AM, V14 CNA (Certified Nurse Assistant) said that she is the regular assigned CNA for R91. V14 said that R91 is not high risk for falls, her bed should not be in the lowest position. V2 DON informed…

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 follow physician order in administration of enteral feeding. This deficiency affects one (R108) of three residents in the sample of 29 reviewed for Enteral feeding management. Finding include: On 9/10/24 at 12:16PM, Observed R108 up in high back wheelchair by the hallway in front of nursing station. No enteral feeding was attached. On 9/12/24 at 10:37AM, Observed R108 in the Restorative gym for his restorative exercise treatment. No enteral feeding tube attached. On 9/12/24 at 10:40AM, Informed V2 DON that R108 was observed intermittently not receiving continuous enteral tube feeding. Reviewed R108's medical records with V2 DON and V9 LPN. V2 said that they should be following physician order for R108's enteral feeding instruction. R108 has ordered of continuous G-tube feeding Osmolite 1.2 at 70ml/hour x 24 hours with FWF (Free water flushes) 200ml every shift (TID /3x/day). V19 RD (Registered Dietitian) ordered it on 8/15/24 due to recent…

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 follow its pain management policy and reassess for pain for 1 of 3 resident's (R141) reviewed for pain management in a sample of 29. Findings Include: On 9/11/2024 at 1:30pm R141 said that his left knee is very painful from a fall in the hallway and the nurses will only give him acetaminophen. On 9/11/2024 at 1:40pm V6 (Licensed Practical Nurse-LPN) said that R141 does not ask for pain medication and the only thing he has ordered is acetaminophen, I'll call the physician for a stronger pain medication. On 9/11/2024 at 2:10pm V2 (Director of Nursing-DON) said I expect the nurses to assess for pain every shift and as needed, and if a resident complains of pain, I expect for the nurses to follow up with the physician. An event report dated 9/4/2024 at 8:25pm indicated that R141 had a witnessed fall in water on the floor due to improper footwear. A local hospital after visit summary dated 9/4/2024 indicted that R141 sustained a sprain of the left knee, unspecified ligament. A medication list dated 9/5/2024…

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 collaborate coordinated care by failure to ensure that resident's updated hospice medical records are available and accessible to all interdisciplinary team (IDT) in the facility. This deficiency affects one (R91) of three residents in the sample of 29 reviewed for Hospice care services. Findings include: On 9/10/24 at 12:17PM, Observed R91 in bed on left side lying position facing the door. The bed is in high position. V7 Social Service (SW) said that she is on hospice care. R91 as swollen right arm. Noted right fingernails long, thick, discolored and curved inward pressing the skin. On 9/10/24 at 1:10PM, Reviewed R91's hospice record binder with V2 DON (Director of Nursing). Noted plan of care (POC) dated 9/28/22. No updated POC in chart. Interdisciplinary progress notes documented in white bond paper without properly identification of IDT documenting. The dates notes for last 2 pages indicated 1/20/24, 2/1/24, 2/3/24, 8/5/24 and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to implement infection control policy for resident who is on Enhanced Barrier Precaution (EBP). This deficiency affects one (R108) of three residents in the sample of 29 reviewed for infection control. Findings include: On 9/10/24 at 12:16PM, Observed R108's room without signage posted of Enhanced Barrier Precaution at the door. V7 Social Worker said that R108 is not on isolation. There is no sign at the door. R108 is re-admitted on [DATE] with diagnosis listed in part but not limited to Cerebral infarction, Dysphagia, Gastrotomy. Physician order sheet indicates continuous feed Gastrotomy tube feeding Osmolyte 1.2 at 70ml/hour x 24 hour with FWF (Free water flushes) 200ml every shift (TID/three times a day). No order for Enhanced Barrier Precaution in active physician order sheet. On 9/10/24 at 12:25PM, Rounds made with V4 Infection Coordinator to R108's room. V4 said that R108 is on EBP because of enteral feeding/GT feeding. There should be…

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 follow their policy and ensure that medical records were released in a timely manner when requested by legal representative for one (R4) resident. This failure affected one resident (R4) in a sample of 5 residents reviewed for policy and procedures. Findings include: R4 is an [AGE] year-old resident initially admitted to the facility on [DATE] with diagnoses including but not limited to: Dementia, Alzheimer's disease, and bipolar disorder. Brief Interview for Mental Status (BIMS) dated 08/15/2024 documents score of 6 which suggests severe cognitive impairment. Complaint dated 08/15/2024 provides document signed by legal guardian of R4 on 04/30/2024 which gives authorization to a law office to request medical records on his behalf for R4. Complaint dated 08/15/2024 also provides fax transmission result showing success on 04/30/2024 for fax requesting medical records for R4. On 08/19/2024 V4 (Quality Assurance/Medical Records) assistant produced…

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

Based on observations, interviews, and record reviews, the facility failed to prevent an incident of resident to resident abuse. This affected two of three residents (R1, R2) reviewed for abuse. This failure resulted in R1, with a history of aggressive behavior, exhibiting verbal aggression towards R2 which escalated to physical aggression with R1 swinging his arms at R2 and pushing R2 onto the floor. Findings include: On 8/14/24 at 10:00 AM, this surveyor observed the men's shower room located 8 feet from the nurses' station. The shower stalls are located immediately to the left of the door. On 8/14/24 at 1:30 PM, V4 LPN (licensed practical nurse) stated that V4 was at the nurses' station at time of incident on 6/20/24. V4 stated that R2 kept opening shower room door while R1 was taking a shower. V4 stated that R1 asked R2 to shut the door. V4 stated that attempts to re-direct R2 were unsuccessful. V4 stated that R2 then held the shower room door open. V4 stated that R1 asked R2 again to shut door, then R1 came out of shower and tackled R2, both residents fell to floor. On 8/14/24…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to keep a resident (R3) free from abuse by another resident (R5) and failed to keep a resident (R5) free from verbal abuse by staff. These failures applied to two (R3, R5) of five residents reviewed for abuse. Findings include: 1. R3 is a [AGE] year-old male with a diagnoses history of Vision Loss in Right Eye, History of Falling, Abnormal Posture, Unsteadiness on Feet, Prostate Cancer, Hypertensive Heart Disease, and Type 2 Diabetes Mellitus who was admitted to the facility 05/20/2024. R5 is a [AGE] year-old male with a diagnoses history of Multiple Fractures, Unspecified Psychosis, Psychoactive Substance Use, and Cerebral Infarction who was admitted to the facility 06/26/2023. On 08/05/2024 from 11:55 AM - 12:03 PM Observed R3 sitting in the nursing office with a large bump on the top of his head. Observed V4 (Assistant Director of Nursing) placing ice on top of R3's bump. V4 stated R3's bump resulted from the physical altercation he 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 interview and record review, the facility failed to follow their policy and procedures for identifying and reporting an injury of unknown origin to the State agency. This failure applied to one (R3) of five residents reviewed for resident injuries. Findings include: R3 is a [AGE] year-old male with a diagnoses history of Vision Loss in Right Eye, History of Falling, Abnormal Posture, Unsteadiness on Feet, Prostate Cancer, Hypertensive Heart Disease, and Type 2 Diabetes Mellitus who was admitted to the facility 05/20/2024. Grievance form dated 05/22/2024 documents V12 (Family Member) reported another family member observed R3 earlier that day with a swollen left eye when visiting, and asked if he had a fall or was hit by someone, Investigation revealed he had a swollen left eye, he was unsure of what happened and his roommate reported he had a fall, R3 was assessed by nursing and was sent to the emergency room for an evaluation and returned. The grievance form did include any record that R3's roommate…

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 was not physically abused by another resident for 1 of 5 residents (R10) reviewed for abuse in the sample of 11. The findings include: R10's Face Sheet, printed 3/17/24, shows diagnoses to include: Type 2 diabetes mellitus, Schizophrenia, Major depressive disorder, Anxiety disorder, and Psychotic disorder with delusions due to known physiological condition. R10's facility assessment, dated 1/11/24, shows R10 has no cognitive impairment and has no behaviors. R10's Progress Note, dated 2/28/24 at 4:11PM, shows, Resident was standing at the nurses station when another resident pushed resident causing resident to fall to the ground hitting her left shoulder and left knee. Resident has complaint of pain scheduled pain medication administered. MD (Medical Doctor) called gave order to send resident to hospital for acute evaluation .Resident is own POA (Power of Attorney). R10's Behavioral Incident of Resident to Resident, dated…

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 an allegation of staff to resident physical abuse was reported immediately to the Administrator for 1 of 5 residents (R1) reviewed for abuse in the sample of 11. The findings include: R1's resident face sheet shows diagnosis to include: Major depressive disorder, Generalized anxiety disorder, Impulse disorder, and Anxiety disorder due to physiological condition. R1's Facility Assessment, dated 12/13/23, shows R1 has moderate cognitive impairment and disorganized thinking. This assessment showed R1 required supervision with ambulating and transfers. On 3/19/24 at 9:20AM, R1 said she was in the hall waiting for a snack and had her toes on the strip in the room on the floor. A male CNA took her arm and twisted it, hurting her arm. R1 said that was when I first got here. R1 said the CNA said she couldn't leave her room and he is no longer here (at the facility). R1 said, I can leave my room, this is my home. He pulled me and twisted it (R1 moved her arm where it was bent at the elbow and demonstrated 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure the safety of a resident by transferring him with a mechanical lift for 1 of 5 residents (R2) reviewed for injuries of unknown origin the sample of 11. The findings include: R2's facility assessment of [DATE] shows R2 has had no behaviors, and has impairment of both upper and lower extremities, both sides. This assessment shows R2 requires substantial/maximal assistance with shower/bathing, and personal hygiene. This assessment shows R2 is dependent on staff (helper does all the work) for chair to bed transfers. R2's facility electronic record shows R2 has diagnoses to include: hemiplegia, Major Depressive Disorder, Aphasia, Left leg amputation, Right below the knee amputation, and Femur fracture. R2's ADL Skills Analysis for Restorative Program shows the ability to come to a standing position from sitting in a chair, wheelchair, or side of the bed - not applicable-not attempted and the resident did not perform this activity prior…

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 appropriate interventions were implemented for a resident experiencing a behavior, and failed to identify a trigger for a resident's behaivor for 1 resident (R1) reviewed for behaviors in the sample of 11. The findings include: R1's resident face sheet shows diagnosis to include: Major depressive disorder, Generalized anxiety disorder, Impulse disorder, and Anxiety disorder due to physiological condition. R1's Facility Assessment, dated 12/13/23, shows R1 has moderate cognitive impairment and disorganized thinking. This assessment showed R1 required supervision with ambulating and transfers. R1 was observed walking in her room, and throughout the facility. R1 was pleasant and well groomed, her hair was combed and she was smiling. R1 said she was in the hall waiting for a snack and had her toes on the strip in the room on the floor. A male CNA (Certified Nursing Assistant) took her arm and twisted it, hurting her arm. R1 said that was when I first got here. R1 said the CNA said she couldn't leave her…

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 prevent physical resident to resident abuse for 2 of 3 residents (R1 and R11) reviewed for abuse in the sample of 13. The findings include: A Behavioral Incident Notation, dated 11/9/23 at 8:54 PM, was documented in R11's chart. The documentation shows R11 was involved in a verbal exchange that escalated into a physical altercation, when a peer entered his room and refused to leave when asked. A Psychosocial Wellbeing admission note documented in R11's chart on 11/18/23 at 9:14 AM, shows the writer met with R11 regarding his involvement in a physical altercation with his peer. A Behavioral Incident Notation, dated 11/9/23 at 8:45 PM, was documented in R1's chart. The documentation shows R1 was involved in an altercation with a peer whose room he entered a verbal altercation escalated into a physical exchange. The facility's Facility Reported Incidents documentation (undated) show on 11/9/23, R1 pushed R11 and R11 reacted by striking R1. On 1/5/24 at 11:33 AM, R11 said R1 was constantly coming into his room and smoking. R11…

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 initiate a new Level I screen for a resident who stayed longer than the approved stay, for one of two residents (R133) reviewed for Pre-admission Screening and Record Review (PASARR) in a sample of 29. Findings include: On 10/04/2023 at 2:30PM during record review, R133 was noted to have a PASARR level II, dated 09/07/2022, indicating short term approval without specialized services and short term approval, end date of 12/07/2022. It also indicated if R133 needs to stay after that date, a nursing facility staff member must submit a new Level I screen to Maximus, and should be submitted no later than 10 days before the Date Short Term Approval Ends. On 10/05/2023 at 11:44AM, V7 (Clinical Service Director) stated if the PASARR level II for R133 was for short term approval and indicated an end date, a new PASARR level I should have been submitted before it ended on 12/07/2022. V7 also said there was no PASARR level I initiated for R133 when it ended on 12/07/2022. R133's Physician Order Report, dated 09/06/2023 to 10/06/2023,…

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 sanitize equipment before obtaining blood pressure for two residents (R79 and R119), and failed to perform hand hygiene before obtaining a blood glucose measurement for one resident (R98), of eight residents reviewed for infection control in the sample of 29. Findings include: 1. On 10/4/23 at 8:29 AM, V5 (Licensed Practical Nurse/Restorative Nurse) measured the blood pressure of R79. V5 did not sanitize the cuff of the blood pressure machine before or after measuring R79's blood pressure. At 8:50 AM, V5 measured R119's blood pressure. V5 did not sanitize the cuff of the blood pressure machine before or after measuring R119's blood pressure. On 10/4/23 at 9:45 AM, V5 said, I probably should have cleaned the blood pressure cuff. 2. On 10/4/23 at 9:22 AM V6 (Licensed Practical Nurse/Quality Assurance Nurse) donned gloves, prepared and administered Lispro Insulin 1 unit to R98. V6 did not perform hand hygiene before donning gloves, preparing, or administering Insulin. On 10/4/23 at 9:23 AM, V6 said, Yes, I…

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 that the temperature in resident's rooms and common areas were maintained at adequate levels; failed to have a procedure in place to monitor the temperature inside the facility; and failed to restrict access to outside and the patio when outside temperature is in the 90s as indicated in their hot weather policy. These failures applied to 76 residents currently residing on the C and D units of the facility. Findings include: 8/24/2023 at 12:18PM while conducting observation in the units, noted the hallways in the C and D wing to be very hot and humid, no ceiling fans were noted in the area, the only visible ceiling fan observed was located above the C/D wing nursing station. Some staff were observed passing water to residents in the A/B wing, but no such observation in the C/D wing; residents were noted going out and coming in, some were dressed in sweatshirt and hoodies; no staff was observed offering or applying sunscreen 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.