Helia Healthcare Of Energy

Based on observation, interview, and record review the facility failed to discard food items in the refrigerator and dry storage that were past the used by/expiration dates. This has the potential to affect all 73 residents living in the facility Findings include:On 11/25/25 at 12:10 PM, observations of the kitchen began. In the reach in freezer there was an unopened bag of crumbled sausage that had an expiration date of 11/9/25. On the storage rack there was an unopened container of strawberry glaze that had an expiration date of 10/25/25. On the storage rack there was an opened bottle of chocolate fudge that had 5/23 on it as the open date and had an expiration date of 11/13/25 on it. There were 2 unopened bags and 1 open bag of cookie pieces that had an expiration date of 11/23/25. There were 2 unopened boxes of cornstarch on the storage rack that had an expiration date of 8/28/23. There was a bag of opened tortilla chips on the storage rack that had an expiration date of 9/17/25 and no open date. V4 (Dietary Manager) was shown the expired food and stated they were no good…

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, observation, and record review the facility failure to ensure that all licensed staff had a current license while working at the facility. This failure has the potential effect all 73 residents living at the facility.The findings include: On [DATE] at 9:45AM, V20 (Certified Nurse Assistant/CNA) stated that V21 (Licensed Practical Nurse/LPN) is not working at the facility anymore due to the fact that her LPN license was not active. V20 stated she had been working in the facility as and LPN while it was expired. On [DATE] at 10:06AM, V1 (Administrator/ADM) stated the BOM (Business Office Manager) or corporate checks staff nursing licenses. V1 stated V21's license expired at the beginning of the year but he thinks she might have gotten an extension on it but he isn't sure. V1 stated V21 did work as a nurse with an inactive license and passed medications and performed nursing duties during that time. V1 stated V21's LPN license became active again on [DATE]. On [DATE] at 11:30AM, V1 (ADM) said…

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 supply linens (washcloths) and ensure the call lights were within reach for 6 of 6 residents (R1, R3, R4, R7, R22, R35) reviewed for accommodation of needs in a sample of 44. Findings include:1. On 11/26/25 at 2:34 PM, V7 (Certified Nursing Assistant/CNA) stated he ran out of washcloths about 2 weeks ago and had to use a pillowcase as a washcloth. On 11/26/25 at 3:03 PM, V5 (CNA) stated they ran out of washcloths the prior week and she had to cut up a towel to use as a washcloth. On 11/26/25 at 3:24PM observed on C hall cart there was only 1 washcloth noted along with no towels. The cart on long A hall had only 1 washcloth.On 11/26/25 at 3:27PM there were no washcloths noted in the linen cart on the short A hall linen cart.On 11/26/25 at 3:33PM the shower room on A hall did not have any washcloths.On 11/26/25 at 3:41 PM, V9 (CNA) stated he has run out washcloths before and when they don't have washcloths, he will use a towel, or he will…

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 acquire medication from the pharmacy and administer and document medications as ordered for 4 of 13 residents (R2, R3, R17, R19) reviewed for pharmacy services in a sample of 44.Findings include:1. R3's Face Sheet documents an admission date of 8/22/2018 with diagnoses including: Parkinson's disease, type 2 diabetes, long term use of insulin, non-pressure chronic ulcer of skin of other sites limited to breakdown of skin, and diaper dermatitis.R3's Minimum Data Set (MDS) dated [DATE] documents a Brief Interview for Mental Status (BIMS) score of 15, indicating R3's cognition is intact.R3's Care Plan documents a problem category of pressure ulcer/injury. Impaired skin integrity related to wound healing with risk of inadequate fluid and nutritional intake as evidenced by delayed wound healing, poor oral intake, and signs of dehydration with a start date of 2/12/25.R3's Physician Order Report dated 11/2/25-12/2/25 documents an order to place 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 maintain food items served to residents at palatable/hot temperatures for 4 of 4 residents (R1, R2, R3, R14) reviewed for food preferences in the sample of 44. Findings include:On 11/26/25 at 7:00 AM, a digital metal stemmed thermometer used for taking temperatures for this survey was checked for accuracy using the ice-point method and was accurate within +/- 2 degrees Fahrenheit. 1. R1's Face Sheet documents an admission date of 10/16/2023 with diagnoses including in part multiple sclerosis, unspecified protein-calorie malnutrition, non-pressure chronic ulcer of left heel and midfoot with unspecified severity, vitamin B12 deficiency anemia, nutritional anemia, and weakness. R1's Minimum Data Set (MDS) dated [DATE] documents a Brief Interview of Mental Status (BIMS) of 08, indicating moderate cognitive impairment. R1's Care Plan documents a problem category of nutritional status, documenting R1 is at risk for impaired nutrition 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 enhanced barrier precautions while providing wound care for 5 of 5 residents (R15, R3, R17, R19, and R1) observed for wound care in a sample of 44.The findings include:1. R15's Face Sheet documents an admission date of 3/17/25 with diagnoses including in part pain, type 2 diabetes, primary hypertension, and venous insufficiency.R15's Minimum Data Set (MDS) dated [DATE] documents a Brief Interview for Mental Status (BIMS) of 13, indicating R15's cognition is intact.R15's Care Plan documents R15 was admitted with skin ulcer/lesion and is at risk for further skin impairment with a start date of 3/17/25 and R15 requires antibiotic therapy for wound infection with a start date of 3/18/25 with interventions including provide meds as ordered and use good infection control measure with resident.R15's Wound Evaluation and Management Summary Report dated 12/10/25 documents that R15 has the following wounds: diabetic wound of the right…

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 respect resident preferences and privacy for 2 of 4 residents (R17, R19) reviewed for resident rights in a sample of 44.Findings include:1. R19's Face Sheet documents an admission date of 9/26/25 with diagnoses including: cellulitis of right lower limb, weakness, depression, and other specified hearing loss bilateral.R19's Minimum Data Set (MDS) dated [DATE] documents a Brief Interview for Mental Status (BIMS) score of 07, indicating R19 has severe cognitive impairment.On 12/8/25 at 11:01 PM, V37 (License Practical Nurse) stated she works 6p-6a. V37 stated she starts doing wound treatments around midnight to 2:30 AM.On 12/08/25 at 11:41 PM, V37 was observed going to do a wound treatment on R19. V37 knocked on R19's door and R19 was asleep in her bed, she woke R19 up and told her she was going to do her treatment.On 12/09/25 at 12:11AM, R19 stated she was tired, and she doesn't like getting her dressing done at night, she would prefer 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 immediately report an allegation of staff to resident abuse to the administrator and failed to identify an incident of possible misappropriation of a resident's property and report the incident to the Illinois Department of Public Health for 2 of 7 residents (R2 and R7) reviewed for abuse and neglect in the sample of 44.Findings include:1. R7's face sheet, dated 12/22/25 documents an admission date of 04/29/2021 with diagnoses in part of unspecified dementia, psychotic disturbance, mood disturbance, anxiety, primary arthritis, spondylosis with myelopathy or radiculopathy, malignant neoplasm of unspecified site of left breast, history of falling, and Vitamin D deficiency.R7's MDS (Minimum Data Set) dated 10/23/2025 documents in Section C a BIMS (Brief Interview for Mental Status) of 8 which indicates moderately impaired cognition. Section GG documents chair/bed to chair transfer as partial/moderate assistance.R7's Care Plan, edited 09/30/25 documents 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 interview and record review the facility failed to thoroughly and immediately investigate allegations of abuse and potential theft, failed to prevent further potential abuse/neglect from occurring while allowing staff to continue to have direct care with residents after allegations were made, and failed to conclude willful intent occurred involving a staff to resident altercation for 2 of 7 (R2 and R7) residents reviewed for abuse in a sample of 44. Findings include:1. R7's face sheet, dated 12/22/25 documents a admission date of 04/29/2021 with diagnoses in part of unspecified dementia, psychotic disturbance, mood disturbance, anxiety, primary arthritis, spondylosis with myelopathy or radiculopathy, malignant neoplasm of unspecified site of left breast, history of falling, and Vitamin D deficiency.R7's MDS (Minimum Data Set) dated 10/23/2025 documents in Section C a BIMS (Brief Interview for Mental Status) of 8 which indicates moderately impaired cognition. Section GG documents chair/bed to chair…

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 a dependent resident timely ADL (Activities of Daily Living) assistance with transfers for 1 of 6 residents (R1) reviewed for ADL assistance in the sample of 44.Findings include:R1's Face Sheet documents an admission date of 10/16/2023 with diagnoses including: multiple sclerosis, anxiety disorder, chronic pain syndrome, abnormal posture, repeated falls, muscle weakness, ataxic gait, and other fatigue.R1's Minimum Data Set (MDS) dated [DATE] documents a Brief Interview for Mental Status (BIMS) score of 08, indicating R1 has moderate cognitive impairment. Section GG of the dame MDS documents R1 is dependent (Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity) for chair/bed to chair transfers.R1's Physician Order Report dated 11/2/25-12/2/25 documents an order for mechanical lift for transfers 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to administrated medications as prescribed by a physician for 2 of 13 (R11, R12) residents reviewed for medication administration in a sample 44. Findings includeOn 12/1/25 at 11:10 AM, the medication administration observation with V15 (Licensed Practical Nurse/LPN) began. V15 opened the top drawer to her medication cart and there were 2 medicine cups of pills with R11 and R12's names on them. This nurse asked V15 what the pills in the cup were and she stated those are R11 and R12's morning pills. V15 stated she tried to give R11 and R12 their pills and they wouldn't wake up, so she just put the pill cup with their pills in it in the drawer and was going to try to administer them later, but stated she forgot. V15 stated she hasn't tried to give the pills a second time yet. At this time, V2 (Director of Nursing/DON) walked by and saw the pills and stated, pills should not be popped unless they are given at that time, and they should not 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 properly dispose of controlled substance medication for 2 (R2 and R3) of 6 residents reviewed for pharmacy services in a sample of 13. The Findings Include:1. R2's Face Sheet dated 07/17/25 documents an admission date of 12/19/24 with diagnoses in part of hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, pain in left knee, malignant neoplasm of oropharynx, squamous cell carcinoma of skin of scalp and neck, malignant neoplasm of esophagus.R2's Minimum Data Set (MDS) dated [DATE] documents in Section C a BIMS (Brief Interview for Mental Status) score of 13, which indicates that R2 is cognitively intact.R2's Physician Order Report dated 06/17/25 to 07/17/25 documents a prescription with a start date of 12/27/24 with an end date of open ended of oxycodone 5mg (Milligrams) 1 tablet every 4 hours for pain. R2's Controlled Substance Report dated 07/01/25 to 07/20/25 for oxycodone every 4 hours PRN (as…

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, record review the facility failed to ensure prevention of misappropriation of resident property for 3 (R2, R3, and R5) of 6 residents reviewed for abuse in the sample of 13.The Findings Include:1.R2's Face Sheet dated 07/17/25 documents an admission date of 12/19/24 with diagnoses in part of hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, pain in left knee, malignant neoplasm of oropharynx, squamous cell carcinoma of skin of scalp and neck, malignant neoplasm of esophagus.R2's Minimum Data Set (MDS) dated [DATE] documents in Section C a BIMS (Brief Interview for Mental Status) score of 13, which indicates that R2 is cognitively intact.R2's Physician Order Report dated 06/17/25 to 07/17/25 documents a prescription with a start date of 12/27/24 with an end date of open ended of oxycodone 5mg (Milligrams) 1 tablet every 4 hours for pain.R2's Medication Administration History dated 07/01/25 to 07/17/25 documents oxycodone 5mg…

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 report allegations of abuse and misappropriation of property within the required time frames for 3 (R2, R3, and R5) of 6 residents reviewed for abuse in a sample of 13The Findings Include: 1.R2's Face Sheet dated 07/17/25 documents an admission date of 12/19/24 with diagnoses in part of hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, pain in left knee, malignant neoplasm of oropharynx, squamous cell carcinoma of skin of scalp and neck, malignant neoplasm of esophagus.R2's Minimum Data Set (MDS) dated [DATE] documents in Section C a BIMS (Brief Interview for Mental Status) score of 13, which indicates that R2 is cognitively intact.R2's Physician Order Report dated 06/17/25 to 07/17/25 documents a prescription with a start date of 12/27/24 with an end date of open ended of oxycodone 5mg (Milligrams) 1 tablet every 4 hours for pain.R2's Medication Administration History dated 07/01/25…

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 initiate and complete investigations of abuse allegations in accordance with required time frames for 3 (R2, R3, and R5) of 6 residents reviewed for abuse in a sample of 13The Findings Include:1.R2's Face Sheet dated 07/17/25 documents an admission date of 12/19/24 with diagnoses in part of hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, pain in left knee, malignant neoplasm of oropharynx, squamous cell carcinoma of skin of scalp and neck, malignant neoplasm of esophagus.R2's Minimum Data Set (MDS) dated [DATE] documents in Section C a BIMS (Brief Interview for Mental Status) score of 13, which indicates that R2 is cognitively intact.R2's Physician Order Report dated 06/17/25 to 07/17/25 documents a prescription with a start date of 12/27/24 with an end date of open ended of oxycodone 5mg (Milligrams) 1 tablet every 4 hours for pain.R2's Medication Administration History 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to notify the Power of Attorney (POA) of a fall and change in resident's condition for 1 (R1) of 3 residents reviewed for accidents. This past noncompliance occurred between 4/5/25 and 4/5/25. Findings Include: R1's admission Record documents an admission date to the facility of 3/16/25 with diagnoses including displaced intertrochanteric fracture of right femur, altered mental status, unspecified, alzheimer's disease, unspecified and dementia in other diseases classified. This same document under emergency contacts listed V3 (Family) as emergency contact power of attorney for healthcare and primary financial contact. R1's Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) of 3, indicating R1 had severe cognitive impairment. The same MDS section GG documents that R1 has impairment in both sides of upper extremities (shoulder, elbow, wrist, hand) and impairment on one side for lower extremity (hip, knee, ankle foot)…

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 protect a resident from employee to resident verbal abuse for 1 of 10 residents (R3) reviewed for abuse in a sample of 12. The findings include: R3's Face Sheet documents an admission date of 1/4/24 with diagnoses including Muscular Dystrophy, Adjustment Disorder with mixed anxiety and depressed mood, Multiple Sclerosis and Major Depressive Disorder. R3's Minimum Data Set (MDS) dated [DATE] documents that R3 has a Brief Interview for Mental Status (BIMS) score of 15 indicating that R3 is cognitively intact. On 4/16/25 at 10:25 AM, R3 stated the facility started a trial for vitamin IV (intravenous) bags and the first month she agreed to do it but the second month she refused it because she was having diarrhea and wasn't feeling the best. R3 stated when she refused the vitamin bag V2 (Director of Nursing) yelled at her and said she just cost the facility $1,000 dollars. R3 stated she reported it to V1 (Administrator) and he had a meeting to tell everyone…

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 sufficient staff to provide care in a timely manner for 5 of 12 (R1, R3, R4, R8, and R11) residents reviewed for sufficient staff in the sample of 12. This failure has the potential to affect all 77 residents currently residing at the facility. Findings Include: The facility Midnight Census report dated 2/18/25 documents 77 residents currently reside at the facility. 1. R1's Resident Face Sheet with a print date of 2/18/25 documents R1 was admitted to the facility on [DATE] with diagnoses that include cerebral infarct, heart disease, hypertension, urinary incontinence, and history of falling. R1's MDS (Minimum Data Set) dated 1/8/25 documents a BIMS (Brief Interview for Mental Status) score of 15, indicating R1 is cognitively intact. This same MDS documents R1 requires partial/moderate assist with showers/bathing, dressing, personal hygiene, and transfers. This MDS documents R1 is frequently incontinent of bowel and bladder. R1'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 incontinence care was provided timely and failed to ensure they had enough supplies to provide care for 4 of 5 (R1, R3, R8, R11) residents reviewed for activities of daily living in the sample of 12. Findings Include: 1. R1's Resident Face Sheet with a print date of 2/18/25 documents R1 was admitted to the facility on [DATE] with diagnoses that include cerebral infarct, heart disease, hypertension, urinary incontinence, and history of falling. R1's MDS (Minimum Data Set) dated 1/8/25 documents a BIMS (Brief Interview for Mental Status) score of 15, indicating R1 is cognitively intact. This same MDS documents R1 requires partial/moderate assist with showers/bathing, dressing, personal hygiene, and transfers. This MDS documents R1 is frequently incontinent of bowel and bladder. R1's current Care Plan documents a Problem area with a start date of 11/21/23 of (R1) is frequently incontinent of bowel and bladder. The interventions for…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to ensure residents were able to choose the time they got up for 1 of 4 residents (R4) reviewed for resident rights in the sample of 12. Findings Include: R4's Resident Face Sheet with a print date of 2/19/25 documents R4 was admitted to the facility on [DATE] with diagnoses that include repeated falls, low back pain, arthritis, and pain. R4's MDS (Minimum Data Set) dated 1/7/25 documents a BIMS (Brief Interview for Mental Status) score of 05, which indicates R4 has a severe cognitive deficit. This same MDS documents R4 requires partial/moderate assist of staff for dressing and transfers. R4's current Care Plan documents a Problem area with a start date of 12/27/24 of, resident has had a decline in ADL (Activities of Daily Living) function and requires assistance with transfers and mobility. The interventions documented for the Problem area include, Have consistent approach amongst caregivers . On 2/18/25 at 6:09 AM, R4 stated nobody ever has…

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 identify and treat pressure wounds for 3 (R1, R2, and R3) of 4 residents reviewed for pressure wounds in the sample of 6. Findings include: 1. R1's Resident Face Sheet documented an admission date of 10/12/24 with diagnoses including: extradural and subdural abscess, anorexia, dysphasia, generalized epilepsy, non traumatic intracranial hemorrhage, cerebral infarction, benign neoplasm of the meninges. R1's 12/9/24 Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 5, indicating severe cognitive impairment. R1's 12/9/24 MDS section M documented R1 was at risk to develop pressure ulcers/ injuries and R1 had 1 or more unhealed pressure ulcers/ injuries. R1's 12/6/25 admission Observation documented in part . Alterations in Skin . MASD- Moisture- Associated Skin Damage Describe each skin integrity condition checked in detail . right buttock, redness, and two open areas 1.0 cm long x 0.5 wide . On 1/30/25 at…

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, observations, and record review, the facility failed to notify the physician of a resident's change in condition for 1 of 4 residents (R1) reviewed for physician notification of change in condition in a sample of 7. Findings include: R1's Resident Face Sheet documents an admission date of 11/4/2024 and was discharged to a local hospital on [DATE]. R1's Resident Face Sheet documents diagnoses including: Pressure Ulcer of Sacral Region, Hypertension, Anxiety, Asthma, Dementia, and Urinary Tract Infection. R1's Minimum Data Set (MDS) dated [DATE] includes a Brief Interview for Mental Status (BIMS) of 15, indicating that R1 is cognitively intact. On 1/3/2024 at 1:45PM, V5 (Ombudsman) stated she received a call from V6 (Registered Nurse-RN at Local Hospital Emergency Room) and he reported that R1 was seen in the emergency room on [DATE] in bad condition. On 1/6/2024 at 1:20PM V6 (RN at Local Hospital Emergency Room) stated he was working in the emergency room on [DATE] when R1 arrived by…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record review, the facility failed to implement ordered treatments for wound care for 1 of 5 (R1) residents reviewed for pressure ulcers in a sample of 7. The findings include: R1's Resident Face Sheet documents an admission date of 11/4/2024 and was discharged to a local hospital on [DATE]. R1's Resident Face Sheet documents diagnoses including: Pressure Ulcer of Sacral Region, Hypertension, Anxiety, Asthma, Dementia, and Urinary Tract Infection. R1's Minimum Data Set (MDS) dated [DATE] documents a BIMS of 15, indicating R1 is cognitively intact. Section GG documents R1 requires partial/moderate assistance with oral hygiene, toileting hygiene, and shower/bathing self; is dependent for upper body dressing, lower body dressing, putting on/taking off footwear; and requires substantial /maximal assistance with roll left to right. Section I documents under active diagnoses a pressure ulcer of sacral region stage 2. Section M documents R1 has a pressure ulcer/injury, a scar over bony…

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 observation, the facility failed to have enough staff to provided consistent care to residents. This has the ability to effect all 76 residents living at this facility. Findings include: The Long-Term Care Facility Application for Medicare and Medicaid form CMS-671 dated 11/18/24 documents there are 76 residents living in the facility. 1. R4's face sheet documents R4 was admitted to this facility on 8/22/2023 with diagnoses of chronic ulcer of the left heel, type II diabetes, cerebral infarction and peripheral artery disease among others. R4's MDS (minimum data set) dated 8/22/2024 documented R4 is dependent on staff for showering, dressing and transferring. This same MDS documented R4's BIMS (brief interview for mental status) score of 13 out of 15 indicating R4 is cognitively intact. On 11/19/2024 at 12:00pm, R4 said he has not had a bath or shower in over a month and frequently misses them due to staffing issues. R4 said the facility needs more staff to provide care for the residents.…

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

Based on observation, interview and record review the facility failed to provide a clean and sanitary environment to perform dietary services. This failure has the potential to affect all 76 residents in the facility. Findings include: On 11/18/24 at 9:30 AM the kitchen back wall was missing an area of dry wall where the wall meets the floor approximately 2 feet by approximately 6 to 8 inches depending on the location. This area was an uneven broken area of drywall with an end of cement block in one area of the broken dry wall. On 11/18/24 at 9:30 AM the kitchen wall between the dish machine and the food service area contains an area on the food service side, where the communication wires are extending out of the wall to the floor where the housing is sitting on the floor. The hole in the wall where the wire housing should be located, approximately 18 inches by 4 inches, contains a build up of dirt and mold and the area around the hole on the wall approximately six inches out from the hole contains an accumulation of dirt and mold. The wiring housing sitting on the floor has an…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to provide dignity while assisting dependent residents during mealtimes for 10 of 10 residents (R4, R7, R23, R32, R51, R52, R53, R54, R60, R63) reviewed for dignity in a sample of 39. Findings include: 1. R52's face sheet documents an admission date of 10/18/23 with the following diagnoses in part; Alzheimer's disease and unspecified dementia, severe, with anxiety. R52's Minimum Data Set (MDS) dated [DATE], documents a Brief Interview for Mental Status (BIMS) score of 99, indicating that R52 was severely cognitively impaired. Section GG functional abilities and goals documents that R52 is set up and clean up assistance only for eating. R52's care plan documents that R52 needs set up/supervision to substantial assistance for activities of daily living. R52's Physician's Order Report from 10/21/24-11/21/24 documents a puree diet r/t (related to) chewing and spitting food out. On 11/18/24 at 1:00pm, R52's tray was delivered, she was given…

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, observation and record review the facility failed to provide showers and assistance with meals to 5 of 10 residents (R4, R9, R23, R39, R52) reviewed for activities of daily living in a sample of 39. Findings included: 1. R4's face sheet documents R4 was admitted to this facility on 8/22/2023 with diagnoses of chronic ulcer of the left heel, type II diabetes, cerebral infarction and peripheral artery disease among others. R4's MDS (minimum data set) dated 8/22/2024 documented R4 is dependent on staff for showering, dressing and transferring. This same MDS documented R4's BIMS (brief interview for mental status) score of 13 out of 15 indicating R4 is cognitively intact. On 11/19/2024 at 12:00pm, R4 said he has not had a bath or shower in over a month. R4 said he complains to R2 (Director of Nursing) about it but it doesn't do any good. R4 said the facility needs more staff to provide care for the residents. A facility document titled Shower and Daily Duty List A Wing documents R4 is scheduled…

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, observation, and record review the facility failed to follow dietary order ordered by the physician for 4 (R39, R43, R50 and R53) of 22 residents reviewed for dining in a sample of 39. Findings include: 1. R50's face sheet documents an admission date of 04/29/21 with diagnoses including: dementia, unspecified protein-calorie malnutrition, and history of non-pressure chronic ulcer of buttock with necrosis of muscle. R50's Minimum Data Sheet (MDS) dated [DATE] documents a BIMS (Brief Interview of Mental Status) of 06 indicating R50 is severely cognitively impaired. R50's physician order report documents an order with a start date of 10/17/2024 and an end date listed as open ended of: diet: regular diet with thin liquids, double portion meats, with extra butter/margarine for added calories, whole milk TID (three times a day) with meals and super cereal at breakfast, ice cream at lunch and supper, and health shakes with B/L/D (breakfast/lunch/dinner). On 11/18/24 at 12:45 PM, for the lunch meal…

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 the writtten notice of the resident's potential liablity for a non-covered stay (SNFABN) for 2 of 3 residents (R71 and R73) reviewed for Beneficiary Protection Notification in the sample of 39. Findings include: 1. R71's face sheet documents diagnosis including: fracture of left pubis, dementia, and fracture of sacrum. R71's face sheet documents an admission date of 08/05/24. R71's SNF Beneficiary Protection Notification Review form documents a discharge from Medicare Part A services prior to exhaustion of his benefit day allotment. This form documents that a written notice of the resident's potential liability for a non-covered stay (SNFABN - CMS10055) form was not provided to R71 to explain her right to appeal the decision of discharge from Medicare Part A services prior to exhaustion of her benefit days. On 11/25/24 at 4:30 PM, V1 (Administrator) stated they do not have the form (CMS 10055) for R71, he does not know why it was not given. R71's record review does not contain a CMS 10055 document. 2. R73's face…

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

Based on observation, interview and record review the facility failed to provide the diet as ordered for one (R81) of 22 residents reviewed for dining in a sample of 39. Findings include: R81's face sheet documents an admission date of 11/16/24 with diagnoses including: Iron deficiency anemia, malignant neoplasm of liver, hypertension, pulmonary embolism without acute cor pulmonale, gastrointestinal hemorrhage, and type 2 diabetes mellitus. R81's care plan documents a category of disease process with a start date of 11/16/24 documenting: R81 has a diagnosis of cancer of: brain, bone, liver and lymph. (R81) is at risk for excessive weakness, tiredness, weight loss, pain, and depression. R81's care plan documents an approach of encourage good po (per oral) intake with a start date of 11/16/24. R81's care plan documents a problem of psychosocial well-being with a start date of 11/18/24 documenting: R81 is a new admit (admission) and is unaware of surrounding (A/O x1) (alert and oriented times one) at this time. R81's Registered Dietitian note from discharging facility dated 11/14/24…

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.

Based on observation, interview, and record review the facility failed to discard expired medications for 1 of 1 resident (R8) reviewed for expired medications in the sample of 39. Findings include: On 11/20/24 at 11:42 AM the A Hall medication cart had a card of R8's Ultram (Tramadol) 50mg (milligrams) that documented an expiration date of 11/09/24. The Narcotic count sheet documented a dose signed out on 11/19/24 by V25 (Registered Nurse/RN). R8's face sheet documents an admission date of 10/16/23 with the following diagnoses documented in part: hemiplegia, unspecified affecting right dominant side, and idiopathic progressive neuropathy. R8's active orders as of 11/21/24 documents in part; tramadol 50 mg, give 1 tablet by mouth for moderate to severe pain every six hours, PRN (as needed). R8's MAR (Medication Administration Record) documented that a PRN (as needed) dose of Tramadol was administered on 11/19/2024 at 8:08am by V25. On 11/20/24 at 11:26am, V2 (Director of Nursing) stated that she had instructed the staff the day before to look at the medication carts closely and they…

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, observation and record review the facility failed to serve food at a preferred temperature for one (R53) of one resident reviewed for food temperature preferences in a sample of 39. Findings include: R53's face sheet documents an admission date of 05/29/2024 with diagnoses including: type 2 diabetes mellitus, type 2 diabetes mellitus with other skin ulcer, anemia, peripheral vascular disease, and non-pressure chronic ulcer of other part of left lower leg with fat layer exposed. R53's Minimum Data Sheet (MDS) dated [DATE] documents a BIMS (Brief Interview of Mental Status) of 15 indicating R53 is cognitively intact. R53's order sheet documents an order with a start date of 09/26/2024 with an end date listed as open ended of regular consistency with thin liquids, ice cream at lunch, and double protein portion at all meals. On 11/19/24 at 12:43 PM, V21 (Certified Nurse Aide/CNA) picked up R53's plate from the serving counter and placed his container of ice cream on his plate between his…

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 and interview, the facility failed to implement infection prevention strategies while performing wound care for 2 of 3 residents (R1, R66) reviewed for wound care in a sample of 39. Findings included: 1. R1's face sheet documents an admission date of 12/6/2024 with diagnoses of Alzheimer's Disease, schizoaffective disorder, type II diabetes mellitus, cerebral infarction and pressure ulcer of sacral region stage 4. R1's MDS (Minimum Data Set) dated 8/6/2024, documented R1 has a BIMS (Brief Interview for Mental Status) score of 99 which indicated R1 has severe cognitive impairment and could not participate in the testing. This same MDS documents R1 is dependent on staff for care. On 11/19/2024 at 2:30pm, V4 (Licensed Practical Nurse) performed wound care for R1's stage 4 sacral pressure wound. V3 (Wound Care Registered Nurse) was also present and observed V4 perform R1's wound care. V4 began by gathering some of the supplies needed for R1's care and placed them on R1's bed side table without…

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 administer medication in accordance with professional standards for 2 (R1 and R3) of 3 residents reviewed for medication administration in a sample of 4. Findings include: 1. R3's face sheet documented an admission date of 4/10/24 with diagnoses including: anxiety disorder, disorder of thyroid, pain, hypertension, nausea, depression, opioid dependence, and hyperlipidemia. R3's Physician Order Report dated 3/15/24 - 4/12/24 documented the following orders: 4/10/24 methimazole 5 mg (milligram) tablet once a morning, 4/10/24 pantoprazole 40 mg tablet once a morning, 4/10/24 roflumilast 500 mcg (microgram) tablet once a morning, 4/10/24 sulfamethoxazole- trimethoprim 800 - 160 mg twice a day. R3's 4/1/24 - 4/12/24 Medication Administration Record (MAR) documented the following: 4/11/24 7:00 AM - 10:00 AM V3 (RN) administered methimazole 5 mg 1 tablet, pantoprazole 40 mg 1 tab, roflumilast 500 mcg 1 tablet, sertraline 50 mg 1 tablet, sulfamethoxazole - trimethoprim 800 - 160 mg 1 tablet. 4/12/24 7:00 AM - 10:00 AM…

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 sufficient staff were available to provide needed care in a timely manner. This failure affected (R31, R34 and R64) and has the potential to affect all 74 residents residing in the facility. Findings Include: 1. R34's undated Resident Face Sheet documents R34 was admitted to the facility on [DATE] with diagnoses that include spinal stenosis, diabetes, acute kidney failure, urinary tract infection, muscle wasting, atrophy, dependence on supplemental oxygen, and hypertension. R34's MDS (Minimum Data Set) dated 9/14/23 documents R34 has a BIMS (Brief Interview for Mental Status) score of 15, which indicates R34 is cognitively intact. This same MDS documents under Section G that R34 is totally dependent on staff for bathing and requires physical assist of two staff for toileting. R34's Care Plan dated 12/15/23 documents a Problem area with a start date of 05/12/22 of R34 needs extensive assist x (times) 2 (assist) for activities of daily living r/t…

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

Based on observation, interview, and record review, the facility failed to prepare meals as indicated per the facility menu. This failure has the potential to affect all 74 residents residing in the facility. Findings Include: 1. On 12/20/23 at 01:40 PM, R131 who was alert to person, place and time; and stated portion sizes of food are inconsistent at times. R131 stated she has spoke with V2 (Dietary Manger) regarding her concerns and feels she is making a good faith effort to get them resolved. Review of the lunch menu for 12/20/23 read as follows: Meatloaf, Mashed Potatoes, [NAME] Beans, Wheat Bread, Cherry Chocolate Bar, Margarine, Coffee/Tea. On 12/20/23 at 12:38 PM, V6 (Cook) was observed slicing multiple sizes of meatloaf slices in the baking pan. V6 stated 4 oz (ounces) is the meatloaf portion served. V6 was asked to confirm the 4 oz amount, when she looked at the recipe and stated she meant 3oz. V6 was asked to weigh a piece of the meatloaf, which measured 5.2 oz. V6 was observed then adjusting the portion size to smaller, more symmetrical pieces. Tray line was observed in…

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

Based on observation, interview, and record review, the facility failed to maintain equipment in clean and sanitary condition, and effectively sanitize equipment and work surfaces. This failure has the potential to affect all 74 residents residing in the facility. Findings Include: On 12/19/23 at 09:45 AM, V6 (Cook) was asked to check the sanitizer concentration level of the dishwasher. V6 was observed dipping a chlorine sanitizer test strip into the dishwasher water at multiple times of the wash cycle, never registering sanitizer. V6 was then observed holding the strip in the dishwater water throughout the entire dishwasher cycle, demonstrating varying colors present on the strip throughout the cycle beneath the water. V6 stated she will have maintenance check the dishwasher to see why she's having trouble getting the test strips to register. A basin of foggy water with soap bubbles and rags present in the water was then observed sitting in the 3rd compartment of the 3-compartment sink. V6 stated this water is used to wipe down surfaces in the kitchen, such as counter tops, 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 maintain a safe, comfortable, and homelike environment for 4 of 4 residents (R26, R30, R36, and R64) reviewed for environment is a sample of 45. Findings Include: On 12/21/23 at 2:27 PM, a tour was conducted with V5 (Maintenance) noting the following findings in which V5 provided the size dimensions given: -The room occupied by R26 has an approximate 2 inch wide circular hole in the closet door. -The room occupied by R30 and R64 has multiple paint chipped and peeling areas approximately 4 foot x 4 foot on the walls. -The room occupied by R36 has non-functioning blinds, which are observed as being diagonally raised across the window and the door handle sticks, requiring twisting force to open. V5 stated with the exceptions of room [ROOM NUMBER] needing painting completed, he was not aware of any of the repairs needing made. V5 stated normally, staff verbally communicate to him any maintenance concerns they may have or leave him a note 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 answer call lights for residents needing assistance in a timely manner to promote dignity and respect for 3 of 3 residents (R31, R34, and R64) reviewed for call lights in the sample of 45. Findings Include: 1. R34's undated Resident Face Sheet documents R34 was admitted to the facility on [DATE] with diagnoses that include spinal stenosis, diabetes, acute kidney failure, urinary tract infection, muscle wasting, atrophy, dependence on supplemental oxygen, and hypertension. R34's MDS (Minimum Data Set) dated 9/14/23 documents R34 has a BIMS (Brief Interview for Mental Status) score of 15, which indicates R34 is cognitively intact. This same MDS documents under Section G that R34 requires two person physical assist for toileting. On 12/21/23 at 1:28 PM, R34 stated they have enough staff, most of the time. R34 stated he uses a bed pan when he needs to have a bowel movement. R34 stated the facility staff answer call lights pretty quickly or as quickly as…

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 the physician of resident weight loss for 3 of 6 residents (R25, R42, R70) reviewed for weight loss in the sample of 45. Findings include: 1. R25's Face Sheet documented an admission Date of 07/24/23 and listed diagnoses including Type 2 Diabetes and Chronic Kidney Disease (CKD). R25's Care Plan dated 11/29/23 documented a problem area, (R25) Requires a mechanically altered diet with a diagnosis of Dysphagia. (R25) is at risk for potential weight loss due to Anorexia, with a corresponding intervention, Monitor/record weight. Notify MD (Medical Doctor) and family of significant weight change. R25's Minimum Data Set, dated [DATE] documented that R25 eats independently and requires a mechanically altered diet. R25's Weight Record documented a 12/5/23 weight of 149.5 lb. (pounds) and a 12/13/23 weight of 131.5 lb. There was no documentation in the medical record that R25's Physician had been notified of the weight loss. On 12/21/23 at 12:28pm, V4,…

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, observation and record review the facility failed to provide feeding assistance and failed to ensure showers were provided as scheduled for 3 of 4 (R8, R34, and R132) residents reviewed for Activities of Daily Living in the sample of 45. Findings Include: 1. R132's Care Plan dated 10/27/23 documented a problem area, admitted to (the facility) for long term care. I require a Baseline Care Plan identifying care needs, risks, strengths and goals within the first 48 hours, with a corresponding approach, Nutrition: I will eat regular meals. I will eat in the dining room. My fluids are regular. I need limited assist with eating. My weight is at risk for weight loss. R132's Medical Record contained no documentation of Physicians diet orders, weight orders, nor any Dietary department documentation. R132's Weight Record documented the following: 10/31/2023 175.4 lbs. (pounds), 11/03/2023 174 lbs. 11/07/2023 173.9 lbs. 12/05/2023: 171.0 lbs. On 12/19/23 from 12:22pm through 12/19/23 at 1:08pm,…

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 immunizations were administered per current standards of practice for 1 of 5 (R45) residents reviewed for immunizations in the sample of 45. Findings Include: R45's undated Resident Face Sheet documents R45 was admitted to the facility on [DATE] with diagnoses that include muscle wasting and atrophy, hypertension, diabetes, and morbid obesity. R45's MDS (Minimum Data Set) dated 11/15/23 documents R45 has a BIMS (Brief Interview for Mental Status) score of 15, which indicates R15 is cognitively intact. R45's Preventative Health Care Report dated 10/1/22 to 12/21/23 documents under pneumococcal vaccine dated 10/10/23, Not recommended at this time. On 12/22/23 at 9:00 AM, R45 stated he would like to receive the Prevnar immunization, should he be eligible. On 12/21/23 at 12:20 PM, V11 (RN Case Manager) stated R45 has not had the Prevnar 20 vaccine. V11 stated he believed R45 should have had it and it was just missed. V11 stated he was in the process…

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 and interview the facility failed to ensure a functioning call system for 1 (R11) of 24 residents reviewed for call systems in the sample of 45. Findings Include: On 12/19/23 at 10:21 AM, R11 was observed sitting on the side of her bed, yelling for help, as she had visibly been incontinent of bowel. R11's call light was observed as being activated, but not illuminating on the light above the outside of R11's door. On 12/19/23 at 10:23 AM, V20 (CNA) responded to R11's yelling. R11 told V20 she was dirty. V20 was notified of the potentially malfunctioning call light, in which she wiggled the call light cord at the wall plug in, in which the light then flickered on and off with cord movement. V20 stated it might be when the recliner is pushed up against it, it caused it not to work. On 12/19/23 at 10:55 AM, V5 (Maintenance) was observed walking through the hallway, looking at call light bulbs above resident doors, stating he was doing his weekly bulb check. V5 stated he is unaware of any call light concerns. V5 was notified of the observed call light concerns with…

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 fall care plan was initiated and interventions were implemented for 2 of 3 (R1 and R2) residents reviewed for falls in the sample of 7. Findings Include: 1. R1's Resident Face Sheet with a print date of 11/29/23 documents R1 was admitted to the facility on [DATE] with diagnoses that include Parkinson's disease, abnormalities of gait and mobility, anemia, history of falling, psychotic disorder with hallucinations, and insomnia. R1's MDS (Minimum Data Set) dated 10/21/23 documents a BIMS (Brief Interview for Mental Status) score of 14, which indicates R1 is cognitively intact. This same MDS documents R1 requires partial/moderate assistance with transfers and that R1 has had falls with a major injury since admission to the facility. R1's Fall Risk assessment dated [DATE] documents a score of 11.0, which indicates R1 has a moderate fall risk. R1's undated Baseline Care plan does not document a fall risk problem area and/or fall…

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.