The Haven Of Farmer City

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility repeatedly failed to maintain Bilevel Positive Airway Pressure (BIPAP) ventilation mask, and tubing, Nebulizer (Neb) medication inhalation mask and tubing, oxygen humidification water bottles, oxygen administration tubing and nasal cannula equipment in a clean sanitary condition and according to the facility policy. These failures affect two of two residents (R1 and R38) reviewed for oxygen therapy on the sample list of 34.Findings include:1.R38's Minimum Data Set (MDS) dated [DATE] documents R38's cognitive status was completed by staff. R38's MDS documents R38 had no cognitive impairment and was independent in daily decision making.R38's Physician Order Sheet (POS) documents the following orders: BIPAP at HS (bedtime), (two liters per minute) 17/7 (inspiration positive pressure/ expiratory positive airway pressure) rate 14 (to deliver a minimum of 14 breathes per minute) with 2L (liters per minute), o2 (oxygen) bled (added supplemental oxygen into…

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 offer and administer an influenza vaccine to ensure a resident was up to date for vaccines for one (R6) of five residents reviewed for immunizations in the sample list of 34.Findings include:R6's Face Sheet dated 3/20/26 documents R6 was admitted to the facility on [DATE], is [AGE] years old and has Chronic Obstructive Pulmonary Disease.R6's Immunization tab documents R6 last received an influenza vaccine on 10/25/24.R6's Influenza Vaccine Consent form dated 8/18/25 documents V20 (R6's Power of Attorney) verbally consented for R6 to receive an annual influenza vaccine.There is no documentation in R6's Medical Record of any attempts to provide R6 with the influenza vaccine.On 3/20/26 at 9:51am, V23 (Regional Nurse Consultant) stated R6 did not receive the influenza vaccine during the facility vaccine clinic. V23 stated unsure why R6 was missed and R6 should have received an influenza vaccine. V23 stated the facility follows current Centers for Disease…

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 offer and administer a COVID-19 vaccine to ensure a resident was up to date for vaccines for one (R6) of five residents reviewed for immunizations in the sample list of 34.Findings include:R6's Face Sheet dated 3/20/26 documents R6 was admitted to the facility on [DATE], is [AGE] years old and has Chronic Obstructive Pulmonary Disease.R6's Immunization tab documents R6 last received a Covid-19 vaccine on 10/25/24.R6's Covid-19 Vaccine Consent form dated 8/18/25 documents V20 (R6's Power of Attorney) verbally consented for R6 to receive a Covid-19 vaccine.There is no documentation in R6's Medical Record of any attempts to provide R6 with the Covid-19 vaccine.On 3/20/26 at 9:51am, V23 (Regional Nurse Consultant) stated R6 did not receive the Covid-19 vaccine during the facility vaccine clinic. V23 stated unsure why R6 was missed during the vaccine clinic and R6 should have received a Covid-19 vaccine. V23 stated the facility follows current Centers 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.

Based on interview and record review the facility failed to allow a resident to refuse a blood glucose check and failed to provide privacy for blood glucose monitoring and insulin administration for one (R1) of three residents reviewed for resident rights on the sample list of five. Findings include:The undated resident rights policy documents on page three (3) the section titled Your rights to dignity and respect: You have a right to make your own choices. The same document states - Your rights to participate in your own care: You have the right to request, refuse, and/or discontinue any treatment.The Medication Administration policy dated 10/25/2014 documents residents may actively refuse medications.R1's Care Plan dated 04/01/2025 documents an admission date of 04/01/2025. The same document lists R1's diagnoses as Cerebral Infarction, Dysphagia Following Cerebral Infarction, Hypertension, Dementia, Without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance, Anxiety, Chronic Kidney Disease, Stage 3, and Type 2 Diabetes Mellitus with Hyperglycemia.The Facility Incident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to develop a discharge plan for administration of diabetic medications and wound care for one of three residents (R2) reviewed for discharge in the sample list of six. Findings include: The facility's undated Transfer and Discharge Policy documents the facility will assure resident transfers and discharges will be conducted in accordance with resident's rights, physician orders, and in such a manner as to maintain continuity of care for the resident. The Medication Administration Record dated 3/12/25 documents orders for R2 to have blood glucose checks before meals and at bedtime, Metformin (antidiabetic)1000 milligrams (mg) in the morning and at bedtime, Trulicity (antidiabetic) 3mg subcutaneously every Thursday, and Lantus insulin 10 units (subcutaneously) every morning. The Treatment Administration Record dated 3/12/25 documents and order for R2 to have a dressing change to R2's right great toe wound daily. The facility's Release of Responsibility 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.

Based on observation, interview, and record review, the facility failed to monitor walk-in refrigerator and freezer temperatures and failed to prevent food contamination by storing utensils in bulk food containers. These failures have the potential to affect all 44 residents residing in the facility. Findings Include: The facility's Storage policy dated October 2020 documents Food should be stored at the proper temperature and utensils or tools should not be left in food containers. The facility's Equipment Temperatures policy dated September 2008 documents all refrigerators and freezers shall be monitored regularly to ensure that they are working properly and to correct any mechanical difficulties quickly to prevent food spoilage. The temperatures should be recorded on the corresponding Temperature Charts. On 12/15/24 at 8:30 AM there were scoops and spoons observed in multiple multi-use food containers. A plastic scoop was inside the thickener container with the handle of the scoop in direct contact with the powder. A plastic scoop was inside the oatmeal container with the handle…

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 notify the physician of a new pressure ulcer and nausea/stomach pain for two residents (R5, R247) of two residents reviewed for reporting changes in status in the sample list of 25. Findings include: 1.) R5's Care Plan dated 12/6/24, documents R5 is high risk for Pressure Ulcers due to Osteoarthritis, Weakness, and Incontinence. This same Care Plan documents if open skin is assessed, report to the doctor and responsible party. R5's Nursing Notes by V14 (Registered Nurse) dated 12/8/24 at 4:00 AM, documents open area noted to right coccyx, barrier applied and covered bony prominence with (an absorbent foam dressing). No further documentation is in the nursing notes about the area. On 12/15/24 at 2:29 PM, V3 (Resident Care Coordinator/Licensed Practical Nurse), stated V3 did not know about an open area on R5, and nothing was reported and V3 was not even aware of any orders being documented. V3 stated V14 should have filled out a new skin sheet and notified the doctor and whoever was on call. 2.) R247's undated diagnoses list…

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 to ensure the least restrictive restraint was used for the least amount of time for one resident (R8) of one resident reviewed for restraints in a sample list of 25. Findings Include: The facility's Physical Restraint/Enabler policy revised 7/24/18 states Policy: To allow residents to be free of physical restraints which are not required to treat medical symptoms or as a therapeutic intervention. Physical restraints shall not be used for the purpose of discipline or convenience. It is recognized that there may be emergency situations in which restraints may be required. Under the heading Procedures the policy also states Place physical restraint problem on the resident's Care Plan. The Care Plan must address the duration, type, and circumstances under which the restraint can be used. After initial documentation, all physical restraints require quarterly documentation regarding the type of physical restraint used, resident's response to the physical restraint, and if any reduction plan has been attempted. Initiate…

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 consistently maintain good personal and oral hygiene for one of three residents (R26) reviewed for Activities of Daily Living on the sample list of 25. Findings Include: The facility A.M. Care policy dated 3/20/23 documents A.M. Care will be given to all residents daily. Nursing assistants are responsible for providing daily A.M. care to all residents which includes providing oral hygiene including the brushing of teeth, washing of the face, underarms, and perineal areas, applying deodorant, dressing in clean clothing, and providing nail care. R26's Physician Order Sheet dated December 2024 documents R26 is diagnosed with Epileptic Syndrome with Seizures and Mild Neurocognitive Disorder. R26's Minimum Data Set, dated [DATE] documents R26 is cognitively intact and is totally dependent on staff for oral care, bathing, dressing, and requires maximal assistance with personal hygiene. R26's Care Plan Summary dated 10/25/24 documents R26 has a…

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

Based on observation, interview, and record review, the facility failed to maintain infection control standards for catheter irrigation for one resident (R2) of one resident reviewed for catheter care in the sample list of 25. Findings include: R2's undated diagnoses report documents R2's diagnoses as: Spastic Quadriplegic Cerebral Palsy, other Obstructive and Reflex Uropathy, Atrophy of Kidney (terminal), Benign Prostatic Hyperplasia with Lower Urinary Tract Symptoms, and personal history of Urinary Tract Infections. R2's Medication Administration Record (MAR) dated 12/1/24 through 12/31/24, documents and order to flush (indwelling) catheter twice a day with 10 cubic centimeters (cc) of normal saline. On 12/16/24 at 1:05 PM, V15 (Licensed Practical Nurse) performed irrigation of R2's indwelling catheter. V15 did not wash V15's hands before the procedure. V15 pulled the catheter apart from the drainage tubing to do the irrigation and did not wipe off the catheter before administering the flush or before connecting the catheter back to the drainage tubing. On 12/16/24 at 1:12 PM, V15…

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 change, date and store oxygen tubing and humidifier bottles in a sanitary manner for two of two residents (R3, R14) reviewed for respiratory care in the sample list of 25. Findings Include: 1. R3's Medical Diagnoses list dated December 2024 documents R3 is diagnosed with Congestive Heart Failure and Atrial Fibrillation. R3's Physician Order Sheet (POS) dated December 2024 documents R3 is prescribed oxygen at two liters per nasal cannula continuously. Nursing is to change oxygen tubing weekly. On 12/15/24 at 10:43 AM R3's oxygen tubing was laying on the ground. The nasal cannula was attached to the concentrator which was running at two liters per minute. The humidifier bottle was empty and both tubing and humidifier bottle were undated. Humidifier bottle was a refillable bottle and appeared to have white dried residue on the bottom of the container. 2. R14's Medical Diagnoses list dated December 2024 documents R14 is diagnosed with Chronic Obstructive Pulmonary Disease. R14's Physician Order Sheet (POS) 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 provide Trauma Informed Care for one resident (R27) of one resident reviewed for Post Traumatic Stress Disorder in a sample of 25. Findings Include: The facility's Trauma Informed Care Policy dated [DATE] states Purpose: To ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for resident's experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident. The third bullet point under Types of trauma survivors is Survivors of abuse. This policy also states If a resident is determined to have suffered a traumatic event, the SSD (Social Service Director) will discuss with the resident or the resident's representative regarding potential triggers that may cause re-traumatization and interventions or preferences that eliminate or decrease triggers that may cause…

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 safe and secure bed rail for one of one resident (R14) reviewed for bed rails on the sample list of 25. Findings Include: R14's Medical Diagnoses list dated December 2024 documents R14 is diagnosed with History of Falling, Mixed Alzheimer's Vascular Dementia with Behavioral Disturbances, Insomnia, Anxiety, Psychotic Disorder, Bipolar Disorder with Psychotic Features, Attention Concentration Deficit, and Chronic Obstructive Pulmonary Disease. R14's Physician Order Sheet (POS) dated December 2024 documents R14 is prescribed the use of a right 1/2 side transfer bar for physical function of bed mobility. On 12/15/24 at 10:30 AM R14's side rail was extremely loose and moved from side to side and front and back leaving a big gap between the bed mattress and side rail. On 12/16/24 at 3:10 PM V16 (Maintenance Director) moved R14's bed rail and stated yes this is very loose and this needs tightened. V16 confirmed R14 has behaviors and can get aggressive and shake the bed rail and is at risk for falls. 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 properly dispose of a medication for one of six residents (R197) reviewed for medication administration in a sample of 25. Findings include: The facility's Drug release/Destruction Policy revised [DATE] states Discontinued medications or medications belonging to discharged residents should be destroyed as soon as practical and within seven days of resident discharge or drug discontinuation. On [DATE] at 11:00AM V2 (Director of Nursing) accompanied surveyor to review the medication room for the facility. During review of the medication refrigerator a zip lock package of Bisacodyl Suppositories were observed in the refrigerator with (R197's) name on the label. V2 stated (R197) expired on [DATE] and those should have been disposed of. On [DATE] at 9:30AM V2 verified it is the facility's policy to destroy or if appropriate return to the resident all medications upon discharge.

Based on observation, interview, and record review the facility failed to administer medications as ordered to keep the medication error rate below five percent (5%). There were three medication errors out of 25 opportunities resulting in a 12% error rate. This failure affected one resident (R19) of six residents reviewed for medications on the sample list of 25. Findings Include: The facility's Medication Administration policy revised 11/18/17 states Medications must be prepared and administered within one hour of the designated time or as ordered. (i.e. Medication time is 9:00AM the medication can be administered as early as 8:00AM or as late as 10:00AM.) Medication is ordered Daily then medication can be given during the day at residents preference. R19's Medication Administration Record for December 2024 lists the following current physician's orders for medications scheduled at 8:00AM. 1. MiraLAX 17 Grams in 8 ounces water Daily 2. Aspirin 325 milligrams (mg) daily 3. Gabapentin 600 mg Three times Daily 4. Multiple vitamin 1 daily 5. Tiotropium Bromide 3% 1 spray in each…

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 dental services for one of two residents (R26) reviewed for Dental Services on the sample list of 25. Findings Include: R26's Physician Order Sheet (POS) dated December 2024 documents R26 is diagnosed with Epileptic Syndrome with Seizures and Mild Neurocognitive Disorder. The same POS documents an order for dental services to be provided as needed. R26's Care Plan Summary dated 10/25/24 does not address R26's need for dental services and broken teeth. R26's Minimum Data Set (MDS) dated [DATE] documents R26 is cognitively intact. On 12/15/24 at 10:06 AM R26 stated staff never offer to set him up or assist him with brushing his teeth. R26 stated he has had multiple teeth break off and has not seen a dentist since he has been in the facility. R26 stated although he does not have tooth pain currently, the broken teeth do affect how and what he can eat. R26 stated there are things he enjoys that he can't eat anymore due to his broken…

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 and/or assist the resident in arranging dental services for a resident with broken dentures for one resident (R24) of two residents reviewed for dental issues in a sample list of 25. Findings Include: R24's Care Plan dated 4/19/24 Documents R24 requires oral/dental health maintenance related to (R24) is edentulous. Coordinate arrangements for dental care and transportation as needed/as ordered. On 12/15/24 at 10:00AM V20 (R24's family member) stated (R24) hasn't got any dentures. They were broken at the nursing home (R24) was in before (R24) came to (the facility). I have asked for (R24) to be taken to the dentist over and over to get some new teeth. I have even spoken to the administrator, but they just grind (R24's) food. (R24) does not like the ground food. R24's Physician's Order Sheet (POS) for December 1, 2024 through December 31,2024 documents R24 was admitted to the facility on [DATE]. On 12/16/24 at 11:00AM V2 (Director of…

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

Based on interview and record review, the facility failed to have a communication process in place with the Hospice service provider and failed to have an up to date Hospice Plan of Care for one (R36) of one residents reviewed for Hospice Services on the sample list of 25. Findings include: R36's Face Sheet (current) documents the following diagnoses: Generalized Anxiety Disorder, Dementia, and Alzheimer's Disease. R36's Medical Record did not contain a Hospice Plan of Care. The Hospice service provider communication binder does not contain any nursing entries by V18 Hospice Registered Nurse (RN) for R36. On 12/17/24 at 8:35am, V3 Resident Care Coordinator stated V18 Hospice RN would write any new orders/changes directly on the Physician Order Sheet and flag the chart. V3 stated V18's only means of communication to the nursing staff of any resident order changes and/or changes in care was to reposition the page in R36's chart. V3 stated the chart would then be placed back on the shelf or left on the nurses station. V3 stated V18 does not write any communication in the communication…

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 therapy services were provided for two (R1 and R3) of three residents reviewed for therapy services on the sample list of 3. Findings include: On 3/15/24 from 9:00 AM to 2:00 PM there were no therapists working in the facility, and the therapy room was locked. 1. On 3/15/24 at 11:05 AM R1 stated, I was in a hospital in Florida after having a stroke, and V3 (R1's Power of Attorney/POA) wanted me to receive physical therapy closer to V3's house, so that V3 could help out. The facility told me and V3 the facility would be getting a new physical therapy service provider starting on 3/4/24 and that I would be able to start therapy, and so far, they have not come to the facility, and I have not received any physical therapy. I need to get physical therapy so that I can get stronger on my left side and go back home to Florida. R1's Social Service Note dated 2/28/24 documents R1 is a [AGE] year-old white female brought today by medical…

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 employ a clinically qualified Director of Food and Nutrition Services. This failure has the potential to affect all 44 residents in the facility. Findings include: On 12/20/2023 at 10:09AM, V3 (Dietary Manager) was actively supervising dietary operations in the facility kitchen. V3 reported being the full-time manager of the facility food service and reported not being a clinically qualified Certified Dietary Manager or having equivalent training. V3 denied meeting the State of Illinois standards to be a food service manager or dietary manager. V3 reported the facility dietician only works in the facility one day per month. On 12/20/2023 at 10:09AM V3 denied: -being a dietician. -being a certified dietary manager. -having an associate's or higher degree in food service management or in hospitality. -having 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting. -being a graduate of a dietetic and nutrition school or program authorized by 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 have sufficient dietary staff to timely serve meals. This failure has the potential to affect all 44 residents who reside at the facility. Findings Include: On 11/5/23 at 10:31 AM, R24 stated the facility food/meals are always served late. On 11/6/23 at 11:22 AM, V12 (Cook) and V13 (Dietary Aide) were the only two staff working in the kitchen preparing food for lunch. On 11/6/23 at 12:06 PM, V12 served the first meal tray and stated, lunch is supposed to be served at 11:30 am however, it is hard because of only having two people in the kitchen. V12 explained there is always only two staff in the kitchen, a cook, and the aide and that the facility really needs an extra person. V12 also stated that V12 is taking over as Dietary Manager and as soon as V12 can find someone to take V12's spot as the cook. On 11/6/23 at 12:19 PM, V12 had to stop serving lunch trays to make gravy to put onto R23's mashed potatoes stating, I can't serve potatoes…

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 proper food storage, cleanliness of the kitchen and prevent potential food contamination by not ensuring facial hair was covered while preparing and serving food. This failure has the potential to affect all 44 residents who reside at the facility. Findings Include: The facility Kitchen Sanitation Policy dated October 2020 documents the Food Service Manager will monitor sanitation of the Dietary Department on a daily basis. The Dietary Sanitation QA (Quality Assurance) Review shall be used as a tool to monitor compliance with sanitation standards and identify which areas need corrective action. The Food Service Manager will develop a cleaning schedule for the department and ensure that dietary employees complete cleaning tasks as scheduled. The Food Service Manager shall provide cleaning instructions for each area and piece of equipment in the kitchen and specify which chemical and personal protective equipment should be used 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.

Based on interview and record review, the facility failed to give residents and their representatives an option of not signing an arbitration agreement as a condition of admission. This failure has the potential to affect all 44 residents who reside at the facility. Findings include: R28's Agreement to Resolve Disputes by Binding Arbitration dated 9/25/23 was signed by V11 (R28's Spouse) and V4 (Social Service Director/SSD). On 11/6/23 at 10:07 AM, V11 stated upon R28's admission to the facility, V11 does not recall anybody giving V11 the option to not sign the arbitration agreement. V11 explained V11 was just given several papers and was told where V11 needed to sign. On 11/7/23 at 2:33 PM, V4 stated everybody is required to sign it therefore, V4 does not give residents or resident representative's an option. On 11/7/23 at 2:49 PM, V5 (Business Office Manager) checked the computer system for Arbitration Agreements and stated all residents that reside at the facility have a signed Arbitration Agreement. At this time, V1 (Administrator), stated residents and/or 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 interview and record review the facility failed to have timely quarterly Quality Assurance (QA) meetings. This failure has the potential to affect all 44 residents residing in the facility. Findings include: The facility's Quality Assurance meeting sign in sheets for the last year were requested and were provided by V1 (Administrator). The facility had documented meetings on 1/23/23, 6/5/23, 8/15/23, and 10/25/23. The QA Meeting sign in sheet dated 1/23/23 documents the facility reviewed information from the months of October 2022, November 2022, and December 2022. There is no documented QA meeting sign in sheet for April 2023. The QA Meeting sign in sheet dated 6/5/23 documents the facility reviewed information from the months of January, February, and March 2023. The QA Meeting sign in sheet dated 8/15/23 documents the facility reviewed information from the months of April, May, and June 2023. On 11/6/23 at 4:10 PM V1 stated we did not have a meeting in April 2023 and the January-March information was reviewed at the June 2023 meeting. V1 stated as long as we have…

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

Based on interview and record review, the facility failed to implement their Infection Control Surveillance and Monitoring Policy by failing to thoroughly complete infection control logs, analyze the data, identify trends, and implement the appropriate isolation precautions for shingles. This failure has the potential to affect all 44 residents who reside at the facility. Findings Include: The facility Infection Control Surveillance and Monitoring Policy dated 3/10/22 documents the facility will do routine surveillance and monitoring of the facility to determine if compliance with work practices. Monitoring of the day-to-day operation of the Infection Control Program will be conducted by the DON (Director of Nursing). Included in these duties are investigation and implementation of controls to prevent infections in the facility, determine and direct the correct procedures necessary for the prevention of infections (this should be done on an individual basis, applying the concepts of isolation per infection), and follows up on documentation of and reporting of infection to physicians…

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 implement their antibiotic stewardship program. This failure has the potential to affect all 44 residents who reside at the facility. Findings Include: The facility Antibiotic Stewardship Program dated 11/1/17 documents this program is used to improve the use of antibiotics in healthcare to protect residents and reduce the threat of antibiotic resistance through a set of commitments and actions designed to optimize the treatment of infections while reducing adverse events associated with antibiotic use. This will be accomplished utilizing the Core Elements: Leadership Commitment (demonstrates support and commitment for safe and appropriate antibiotic use), Accountability (identify physicians, nursing and pharmacy leads responsible for promoting and overseeing antibiotic stewardship activities), Drug Expertise (establish access to consultant pharmacists or other individuals with experience or training in antibiotic stewardship), Action (implement at least one policy or practice to improve antibiotic use), Tracking (monitor…

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 investigate an allegation of abuse. This failure affects one (R28) of five residents reviewed for abuse in the sample list of 33. Findings include: The facility's Abuse Prevention policy revised 11/28/16 documents abuse allegation investigative procedures include interviewing staff, residents, visitors/family members who were in the vicinity of the incident, and interviewing staff to determine if they have ever witnessed other incidents of mistreatment. The Facility Reported Incidents report form (initial notification to state survey agency) dated 10/27/23 at 5:27 PM documents on 10/26/23 V9 (Visitor) reported that V11 (R28's Spouse) was feeding R28, R28 refused and pushed V11's hand away, and V11 hit R28 in the mouth. The facility's Notification Form dated 11/1/23 documents the incident between V11 and R28 occurred on 10/26/23 at 6:50 PM, the investigation was completed, and the facility did not substantiate abuse. The facility'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 interview and record review the facility failed to ensure a Level II PASARR (Preadmission Screening and Resident Review) was completed for one of one resident (R35) reviewed for PASARR in the sample list of 33. Findings include: R35's November 2023 Physician's Order Summary documents R35 admitted to the facility on [DATE], has a diagnosis of Bipolar and includes orders for Divalproex 250 milligrams (mg) three times daily for Bipolar and Mirtazapine 7.5 mg daily for Bipolar. R35's October and November 2023 Behavior Tracking Records document R35 has manic aggressive outbursts of yelling at staff. R35's undated Problem Detail documents R35 has an active diagnosis of Bipolar since 5/29/20. R35's Notice of PASARR Level 1 Screen Outcome dated 5/13/22 documents a Level II screen was not required due to no diagnoses of Serious Mental Illness, Intellectual Disability, or Related Condition. On 11/05/23 at 1:37 PM V4 (Social Services Director) stated V5 (Business Office Manager) sets up the OBRA (Omnibus Budget…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to develop a baseline care plan to include fall risk and interventions for one (R28) of 13 residents reviewed for care plans in the sample list of 33. Findings include: On 11/05/23 at 10:54 AM V11 (R28's Spouse) stated R28 admitted to the facility after a fall at home with a hip fracture that required surgical repair. V11 stated R28 fell at the facility a few days after admission. R28's admission Minimum Data Set, dated [DATE] documents R28 has severe cognitive impairment and requires extensive assistance of one staff person for bed mobility, transfers, dressing, toileting, personal hygiene, and bathing. R28's Fall Investigations dated 9/28/23 at 7:20 PM, 10/7/23 at 6:25 AM, 10/17/23 at 7:45 PM, and 10/20/23 at 11:15 AM document R28's falls. These investigations document R28's fall interventions include hospital evaluation for stent placement, low bed, fall mat, bedroom furniture rearranged, and a pressure alarm. R28's Baseline Care Plan dated 9/25/23…

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 the facility failed to initiate care plans to include resident centered problems, goals, and interventions for four residents (R11, R15, R28) of 12 residents reviewed for care plans in a sample list of 33. Findings include: 1. R11's Physician's Order Sheet (POS) for November 2023 includes the following diagnoses: Parkinson's Disease, Depression, Anxiety and Chronic Fatigue Syndrome. R11's Minimum Data Set (MDS) dated [DATE] documents R11 is cognitively intact and requires staff assistance or is dependent on staff for Activities of Daily Living (ADLS). On 11/05/23 at 11:55 AM R11 was observed lying in her bed. There was a Stop sign on R11's door. R11 spoke in a very faint voice. R11 stated I can't move very much, and I can't talk very loud because I have Parkinson's Disease. I'm pretty weak. That woman (R15) comes in my room, and she has threatened me. That is why they have the stop sign that is on the door. She just takes it off and comes in anyway. She threatens to hit…

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 update a care plan to include a significant weight loss for two residents (R26, R45) of 12 residents reviewed for care plans in a sample list of 30. Findings Include: 1. R45's Physician's Order Sheet (POS) for November 2023 includes the following diagnoses: Dementia with Behavioral Disturbance, Depression, Anxiety, Insomnia, and History of Fall with Hip Fracture. The facility's Weight flow sheet for the preceding 12 months documents on 08/01/2023, R45 weighed 127 pounds (lbs.) and on 10/01/2023 R45 weighed 112 lbs. which is an 11.81 % Loss. On 11/6/23 from 11:30AM to 12:15PM R45 was observed sitting in the dining room and attempting to leave the table. When table mates were served before R45, R45 attempted to take food and drink off another resident's tray. R45's Care Plan does not address significant weight loss or interventions to address R45's inattention at meals. On 11/9/23 at 2:24PM V2 (Director of Nursing/DON) confirmed R45's Care…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to provide Restorative Nursing Programs for one resident (R24) of one resident reviewed for positioning and mobility in a sample list of 33 residents. Findings Include: R24's Physician's Order Sheet (POS) for November includes the following diagnoses: Cerebral Infarct, Emphysema, Chronic Kidney Disease Stage III, Malignant Neoplasm of the Spinal Cord, Type II Diabetes, and Depression. On 11/6/23 at 11:00AM R24 stated After I finished therapy, they were supposed to start Restorative programs, but I don't get them. R24's Minimum Data Set (MDS) dated [DATE] documents R24 is to receive Passive Range of Motion, Active Assisted Range of Motion, Bed Mobility, Transfer, dressing, and grooming restorative programs. On 11/08/23 at 9:09 AM V2 (Director of Nursing/DON) stated the CNAs (Certified Nursing Assistants) are supposed to do restorative programs. We did have a Restorative Aide, but she quit a little while ago. They should be documented in the CNA book. R24'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 interview and record review the facility failed to complete a fall risk assessment and thoroughly investigate falls for one (R28) of four residents reviewed for accidents in a sample list of 33 residents. Findings include: On 11/05/23 at 10:54 AM V11 (R28's Spouse) stated R28 admitted to the facility after a fall at home with a hip fracture that required surgical repair. V11 stated R28 fell at the facility a few days after admission. R28's Minimum Data Set (MDS) dated [DATE] documents R28 has severe cognitive impairment, requires extensive assistance of one staff person for transfers, bed mobility, dressing and toileting, and requires staff assistance to stabilize balance during transitions and walking. R28's November 2023 Physician Order Summary documents R28 has diagnoses of Dementia and Closed Fracture of Neck of Left Femur. R28's medical record does not contain a completed Fall Risk Assessment or a comprehensive care plan to address fall risk, history of falls, or interventions to prevent falls.…

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 correctly perform incontinence care for one (R6) of four residents reviewed for Urinary Tract Infections in the sample list of 33. Findings include: The facility's Perineal Cleansing policy dates as revised 9/21/10 documents for female perineal cleansing use long strokes from the most anterior down to the base of the labia (front to back motion), turn resident onto side and wash peri-anal area from the base of the labia up over the buttocks (front to back motion). On 11/05/23 at 11:30 AM R6 stated R6 has been in the hospital three to four times within the last year, including a few times for Urinary Tract Infections (UTIs). R6 stated R6 is incontinent, and staff provide R6's incontinence cares. R6's Minimum Data Set, dated [DATE] documents R6 has a Brief Interview for Mental Status score of 12 (the higher end of moderate cognitive impairment), R6 requires extensive assistance of one staff person for toileting, and R6 is frequently…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to report significant weight loss to the resident representative and physician, timely implement nutritional recommendations, and record amount of intake for nutritional supplements for one (R26) of two residents reviewed for nutrition in the sample list of 33. Findings include: The facility's Resident Weight Monitoring policy revised March 2019 documents significant weight changes of 5% or more in one month, 7.5% or more in 3 months, and 10% or more in six months will be reported to the resident, resident representative, and physician. This policy documents the dietitian will make recommendations for nutritional interventions and nursing will convey the recommendations to the physician to obtain orders. The facility's Monthly Weight Grid dated November 2022-October 2023 documents R26 weighed 134 pounds (lbs.) in February and March, 129 lbs. in May, 122 lbs. in June (8.96% since March and 5.43% loss in 1 month), 120 lbs. in August, and 118 lbs. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to identify the risk for entrapment for one (R11) of one resident reviewed for bed rails in a sample list of 33 residents. Findings Include: R11's Physician's Order Sheet (POS) for November 2023 includes the following diagnoses: Parkinson's Disease, Depression, Anxiety and Chronic Fatigue Syndrome. R11's Minimum Data Set, dated [DATE] documents R11 is cognitively intact and requires staff assistance or is dependent on staff for Activities of Daily Living (ADL's). On 11/05/23 at 11:55 AM R11 was lying in her bed. There is a 1/2 length side rail in place to both sides of R11's bed. On the end of the rail toward R11's legs there is a gap in the rail approximately 5 by 10. R11 is very thin, and her left foot is against the rail. When comparing R11's foot with the rail it could easily fit into the gap. On 11/06/23 at 2:32 PM V21 (Maintenance Director) stated that is a 10 gap and I see that (R11) could get an arm or leg caught in that. I 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.

Based on interview and record review the facility failed to provide physician visits at least every 60 days alternating with an advanced practice nurse for three of four residents (R11, R15,R45) reviewed for physician's visits in the sample list of 33. Findings Include: The facility's Policy Physician's Services (not dated) documents After the first 90 days a resident must be seen by a physician at least every 60 days. The physician may schedule alternate visits by a Physician's Assistant or a Nurse Practitioner. 1. R11's Nurse Practitioner Progress note dated 8/31/23 documents R11 has been a resident since 2015. V24 (Nurse Practitioner) documented assessments for R11 on 8/31/23. There is no documentation to indicate a physician has evaluated R11 in July, August, September, or October 2023. There is no documentation to indicate R11 has been assessed by a physician so far in November 2023. 2. R15's Face Sheet documents R15 has been a resident since 5/24/23. V24 (Nurse Practitioner) documented assessments for R15 on 9/18/23, and 10/5/23. There is no documentation to indicate a…

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

Based on observation, interview, and record review the facility failed to track targeted behaviors for one (R15) of five residents reviewed for psychotropic medications in a sample list of 33 residents. Findings Include: R15's Physician's Order Sheet (POS) for November 2023 includes the following diagnoses: Mixed Alzheimer's Disease, Vascular Dementia with behavioral disturbances, Anxiety, and Major Depression. This POS also documents current physician's orders for the following psychotropic medications: 1. Alprazolam (antianxiety) 0.25 milligrams (MG) in the AM and 0.5 mg at Bedtime. 2. Quetiapine (antipsychotic) 12.5 mg every morning. 3. Buspar (Antianxiety) 15 mg twice daily. 3. Remeron (antidepressant) 7.5 mg at bedtime. 4. Melatonin (sleep aide) 10 mg at bedtime. The only behavior tracking sheet documented for R15 is for November 2023 and the sheet is blank. On 11/8/23 V1 (Administrator) stated We are aware our psychotropic medication documentation and care plans are not complete. We lost the Care Plan Coordinator recently and we found that the documentation was not what it…

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

Based on interview and record review the facility failed to administer insulin per orders, have parameters for notifying the physician of blood glucose results, and coordinate times for glucose monitoring and insulin administration. These failures resulted in significant medication errors for one (R28) of five residents reviewed for medications in the sample list of 33. Findings include: R28's October 2023 Physician Order Summary (POS) documents R28 has Type 1 Diabetes Mellitus. This POS documents an order dated 10/23/23 for Novolog (insulin) 5 units subcutaneous with meals (8:00 AM, 12:00 PM, and 4:00 PM). R28's November 2023 POS includes the following orders: Novolog give three times daily (8:00 AM, 11:00 AM, and 4:00 PM) per sliding scale, for blood glucose 161-220 give 1 unit, 221-280 give 2 units, 281-340 give 3 units, 341-400 give 4 units, and greater than 400 give 5 units. Notify the physician for blood glucose levels greater than 400, implemented on 11/6/23. R28's blood glucose checks are ordered at 6:00 AM, 11:00 AM, 4:00 PM, and 8:00 PM. There is no documentation that…

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

Based on interview and record review, the facility failed to provide pneumococcal vaccinations per resident/resident representative request for two of five residents (R27, R31) reviewed for vaccinations on the sample list of 33. Findings Include: 1.) R27's Consent for vaccinations dated 12/28/22 documents R27 wishes to have the PPSV23 (Pneumococcal Polysaccharide Vaccination) and/or PCV13 (Pneumococcal Conjugate Vaccination), whichever vaccination R27 is able to receive. R27's medical record does not document that R27 has historically received a Pneumococcal vaccination or that the facility administered the PPSV23 or PCV13 vaccination as requested. 2.) R31's Consent for vaccinations dated 8/12/22 documents R31 wishes to have the PPSV23 and/or PCV13, whichever vaccination R31 is able to receive. R31's medical record does not document that R31 has historically received a Pneumococcal vaccination or that the facility administered the PPSV23 or PCV13 vaccination as requested. On 11/8/23 at 9:31 AM, V2 (Director of Nursing) stated Pneumonia Vaccination requests are only obtained upon…

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.