Forest Creek Village

Based on observation, interview, and record review, the facility failed to ensure a self medication administration assessment was completed for 1 of 1 residents observed with medications at the bedside. (Resident C) Findings include: On 5/20/25 at 8:36 a.m., observed a small pill cup with a round brown tablet sitting on Resident C's bedside table. Resident C was resting in bed. During an interview on 5/20/25 at 8:37 a.m., LPN 2 indicated the brown tablet was senna (medication used to treat constipation) 8.6 milligrams (mg) and should not have been left in Resident C's room. The clinical record for Resident C was reviewed on 5/20/25 at 9:43 a.m. The diagnoses included, but were not limited to, diabetes and metabolic encephalopathy. A quarterly Minimum Data Set (MDS) assessment, dated 3/28/25, indicated Resident C had minimum cognitive impairment. The clinical record lacked a self medication administration assessment. During an interview on 5/21/25 at 12:45 p.m., the Director of Nursing (DON) indicated there was no self medication administration assessment completed for Resident C. On…

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

Based on interview and record review, the facility failed to ensure an accurate Minimum Data Set (MDS) assessment was completed for a resident that was admitted with an indwelling urinary catheter for 1 of 3 residents reviewed for accuracy of the MDS assessment. (Resident F) Findings include: The clinical record was reviewed for Resident F on 5/20/25 at 11:50 a.m. The diagnoses included, but were not limited to, neurogenic bladder, severe morbid obesity, and diabetes. An admission Observation, dated 3/28/25, indicated Resident F was admitted with an indwelling urinary catheter An admission MDS assessment, dated 4/4/25, indicated Resident F did not have an indwelling urinary catheter when he was admitted . A physician's order, initiated on 3/28/25 and discontinued on 4/10/25, indicated Resident F had an indwelling urinary catheter. During an interview on 5/21/25 at 9:25 a.m., RN 1 indicated Resident F's MDS assessment should have indicated he had an indwelling urinary catheter. On 5/21/25 at 12:58 p.m., reviewed the Resident Assessment Instrument (RAI) Manual, dated 10/2023. A review…

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

Based on observation, interview, and record review, the facility failed to ensure oxygen tubing had been changed, a nebulizer machine was cleaned, and the nebulizer tubing was changed for 3 of 3 residents reviewed. (Resident B, Resident D, Resident E) Findings include: 1. On 5/20/25 at 8:43 a.m., Resident B's nebulizer machine (small machine used to administer liquid inhalation medications) was observed to be stained a purplish color and dusty. The nebulizer machine was sitting on the floor next to the heating unit under the window. A clear tube extended from the nebulizer machine up and connected to a clear face mask shaped to fit over the nose and mouth with a small chamber to hold the liquid inhalation solution. The nebulizer face mask was not in a bag but was lying directly on the heating unit. The nebulizer face mask was dated 4/13/25. During an interview on 5/20/25 at 8:51 a.m., LPN 1 indicated a nebulizer machine should not have been placed on the floor and oxygen tubing, the nebulizer tubing, and mask should have been changed weekly. The clinical record for Resident B was…

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

Based on observation, interview, and record review, the facility failed to ensure prescription medications were secured for 2 of 2 random observations. Two prescription medications were sitting on top of an unlocked medication cart in a high traffic resident area unsupervised by staff; and two vials of a prescription aerosol medication were sitting in a resident's room who was not prescribed the aerosol medication. (Resident B) Findings include: 1. During an observation on 5/20/25 at 8:05 a.m., observed the west 200 hall medication cart to be unlocked and sitting against the wall near the nurses station. There was no staff supervising the medication cart. On top of the medication cart, observed a white plastic bottle labeled H-Chlor12 0.125% (prescription wound cleanser used to prevent infection) with approximately two ounces of solution remaining in the bottle and a full plastic bottle labeled lactulose (prescription medication used to treat hepatic encephalopathy and constipation) 10 grams (gm)/15 milliliters (ml) solution. During an interview on 5/20/25 at 8:07 a.m., LPN 1…

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

Based on interview and record review, the facility failed to ensure documentation was complete and accurate for 2 of 4 residents reviewed for documentation. (Resident B, Resident F) Findings include: 1. On 5/20/25 at 8:43 a.m., observed Resident B's dirty nebulizer machine (small machine used to administer liquid inhalation medications) sitting on the floor next to the heat unit under the window. A clear tube extended from the nebulizer machine up and connected to a clear face mask shaped to fit over the nose and mouth with a small chamber to hold the liquid inhalation solution. The nebulizer face mask was not in a bag but was lying directly on the heat unit. The nebulizer face mask was dated 4/13/25. The clinical record for Resident B was reviewed on 5/20/25 at 10:37 a.m. The diagnoses included, but were not limited to, chronic obstructive pulmonary disorder, dementia, and morbid obesity. The current physician's orders indicated: - Ipratropium-albuterol (prescription medication used to help breathe more easily) 0.5 milligrams (mg)/3 milliliters (ml) inhalation solution administer…

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 implement infection control practices for 3 of 3 residents reviewed for infection control. A nebulizer machine and tubing were not maintained in a sanitary manner, a catheter bag was on the floor, and soiled linens, and a brief were not disposed of in a sanitary manner. (Resident B, Resident E, Resident F) Findings include: 1. On 5/20/25 at 8:43 a.m., observed Resident B's dirty nebulizer machine (small machine used to administer liquid inhalation medications) sitting on the floor next to the heat unit under the window. A clear tube extended from the nebulizer machine up and connected to a clear face mask shaped to fit over the nose and mouth with a small chamber to hold the liquid inhalation solution. The nebulizer face mask was not in a bag but was lying directly on the heat unit. The nebulizer face mask was dated 4/13/25. During an interview on 5/20/25 at 8:51 a.m., LPN 1 indicated Resident B's nebulizer machine should not have been placed on the floor and should have been cleaned. The nebulizer mask…

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

Based on observation, interview, and record review, the facility failed to ensure the facility was free from roaches for 1 of 1 random observations. Finding includes: On 5/20/25 at 9:09 a.m., observed a brown cockroach crawling on the floor outside a resident's room. At that time, Resident H indicated he had seen a roach near his door. On 5/21/25 at 8:15 a.m., the Administrator provided a copy of a facility policy, titled Pest Control, dated 9/2023, and indicated this was the current policy used by the facility. A review of the policy indicated the facility will maintain an effective pest control program so that the facility is free from pests. This citation relates to Complaint IN00458615 3.1-19(f)(4)

Based on observation, interview, and record review, the facility failed to ensure residents were free of a medication error rate greater than 5 percent for 4 of 25 opportunities, resulting in a medication error rate of 16 percent. Resident B , Resident C) Findings include: 1. On 3/14/25 at 7:23 a.m., observed RN 1 administer Wixela 250/50 micrograms (mcg) (prescription metered dose inhaler used to treat asthma and chronic obstructive pulmonary disease) and Incruse Ellipta 62.5 mcg (prescription metered dose inhaler used to treat chronic obstructive pulmonary disease) to Resident B. RN 1 did not ask Resident B to rinse her mouth with water and spit the water out before RN 1 left Resident B's room. At that time, RN 1 indicated he had finished administering Resident B's medications. RN 1 didn't need to have Resident B rinse her mouth and spit after he administered Wixela nor Incruse. The instructions for use for Wixela 250/50 mcg were reviewed on 3/14/25 at 9:00 a.m. A review of the instructions indicated rinse mouth with water after breathing in the medicine. Spit out the water. Do…

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

Based on observation, interview, and record review, the facility failed to ensure self-administration medication assessments were complete for 1 of 1 residents observed with medications at the bedside. (Resident E). Findings include: On 3/14/25 at 8:09 a.m., observed a small purple pill, a small white pill, and a yellow capsule sitting inside a small plastic medication cup on Resident E's bedside table. There was no staff in Resident E's room. During an interview on 3/14/25 at 8:25 a.m., LPN 1 indicated the three pills that were left in the plastic cup on Resident E's bedside table should not have been left in his room. On 3/14/25 at 9:29 a.m. Resident E's clinical record was reviewed. The diagnoses included, but were not limited to, diabetes and thyroid disorder. The clinical record lacked a self-administration medication assessment. On 3/14/25 at 12:10 p.m., the DON indicated Resident E did not have a self-administration medication assessment and the medications should not have been left at the bedside. On 3/14/25 at 9:15 a.m., the Director of Nursing (DON) provided a copy of 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 ensure medications were dated when opened for 1 of 3 medication carts reviewed for medication storage. (200 Hall Medication Cart) Findings include: On 3/14/25 at 7:23 a.m., observed Wixela 250/50 mcg (micrograms) (prescription inhaler used for chronic obstructive pulmonary disease) sitting inside a clear baggy in the top drawer of the 200 hall medication cart. The label on the Wixela inhaler indicated Resident B, 60 doses were filled, on 1/22/25, and 47 doses remained. There was no opened date written anywhere on the inhaler package nor the inhaler itself. A Lantus Solostar 100 unit/ml (milliliter) insulin pen was observed sitting in the top drawer of the medication cart. The seal was broken on the Lantus Solostar insulin pen. There was no opened date written anywhere on the Lantus Solostar label nor on the insulin pen itself. During an interview on 3/14/25 at 7:47 a.m., RN (Registered Nurse) 1 indicated the Lantus Solostar insulin pen and the Wixela inhaler should have been dated when they were opened. On…

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

Based on observation, interview, and record review, the facility failed to implement infection control practices for 1 of 1 random observations. Staff did not perform hand hygiene prior to putting on and taking off gloves and did not remove gloves prior to exiting the room. (Resident D, LPN 1) Findings include: On 3/14/25 at 7:58 a.m., observed LPN (Licensed Practical Nurse) 1 walk into Resident D's room holding two insulin pens. LPN 1 told Resident D she was going to administer his insulin. LPN 1 put on a pair of clean gloves and administered the insulin to Resident D. No hand hygiene was observed. Then LPN 1 walked out of Resident D's room and removed the dirty gloves. At that time, LPN 1 indicated she should have performed hand hygiene before she put on the gloves and after she removed the gloves. LPN 1 should have removed the gloves before she left Resident D's room. On 3/14/25 at 9:15 a.m., the Director of Nursing (DON) provided a copy of a skills competency, titled Insulin Pen Administration, dated 10/2019, and indicated this was the current skills competency used 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.

Based on observation, interview, and record review, the facility failed to ensure potentially hazardous materials were kept secure behind locked doors to prevent resident's access to the materials for 2 of 2 observations. Finding included: On 1/27/25 at 9:05 a.m., observed the door to the Soiled Utility Room on the west hall across from the laundry room to be unlocked with no staff in the immediate area. In the room, four full sharps containers were observed. One sharps container was not secured and was lying on its side with used needles exposed. During an interview on 1/27/25 at 9:10 a.m., the Maintenance Director indicated that the door to the Soiled Utility Room was supposed to be locked. During an observation on 1/27/25 at 10:00 a.m., the door to Soiled Utility Room was observed to be unlocked with no staff in the area. During an interview on 1/27/25 at 10:11 a.m., Director of Nursing (DON), indicated that the door was supposed to be locked. On 1/27/25 at 10:52 a.m., the DON provided, a copy of American Senior Communities Policy title: Bloodborne Pathogens Exposure Control Plan…

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 document the drug dispositions for 2 of 3 residents reviewed for drug disposition. (Resident 295, Resident 91) Findings included: 1. On 1/29/25 at 10:35 a.m., the clinical record of Resident 295 was reviewed. The diagnoses included, but were not limited to, Alzheimer's disease and transient cerebral ischemic attack. A physician's order summary report of medications, dated for active orders as of 6/16/24, included, but were not limited to: - Eliquis 6 mg (milligrams) for transient cerebral ischemic attack - Norvasc 10 mg for hypertension - Vitamin D3 for vitamin D deficiency A progress note, dated 12/27/24 at 3:04 p.m., indicated Resident 295 was transferred to another facility along with her medications. Resident 295's clinical record lacked documentation listing any name, type, or amount of medications that were sent home with the resident or resident's representative. During an interview on 1/29/25 at 10:50 a.m., the Regional Director of Nursing indicated that the facility lacked documentation for drug dispositions 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 ensure that a staff member (QMA 2) followed pain medication administration protocols by administering a controlled substance on the wrong day at the wrong time for 1 of 3 residents reviewed for pain medications. (Resident B) Finding includes: On 10/24/24 at 9:00 a.m., Resident B's clinical record was reviewed. The diagnoses included, but were not limited to, respiratory failure, COPD (a lung disease that makes it difficult to breathe), opioid dependence, and hepatitis C (a viral infection that affects the liver). A physician's order report, dated 9/1/24 to 10/24/24 indicated: Fentanyl (a potent synthetic schedule II controlled opioid drug given for pain relief) was prescribed on 9/26/24 with a stop date of 9/29/24. Staff were to apply the 12 mcg (micrograms) Fentanyl transdermal patch once every three days and to rotate the site of application. A new physician order, dated 9/29/24 with no end date, indicated apply Fentanyl 12 mcg transdermal patch every three days and rotate the site. The old patch was to be removed 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.

Based on observation, interview, and record review, the facility failed to ensure foods were served in a sanitary and safe manner for 3 of 4 kitchen observations. Staff hair was not covered while in the kitchen food preparation area. (Cook 5, Dietary Staff 6) Findings include: 1. During the initial kitchen observation on 2/11/24 from 9:35 a.m. to 9:45 a.m., observed [NAME] 5 walking throughout the kitchen area. [NAME] 5 had hair pulled from the front to the back of the head and hair in front of and behind the ears. The hair was observed to not be covered. 2. During a follow up kitchen observation on 2/11/24 from 12:20 p.m. to 12:30 p.m., the following was observed: - [NAME] 5 was working at the steam table where the noon meal was being held. [NAME] 5 was observed obtaining the noon meal starting temperatures. [NAME] 5's hair was pulled from the front to the back of the head and hair in front of and behind the ears. The hair was not observed to be covered. - Dietary Aide 6 was observed walking throughout the kitchen area and at the steam table where the noon meal was being held.…

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

Based on interview and record review, the facility failed to ensure an Advanced Directive (code status) preference was documented accurately in the clinical record for 1 of 24 residents reviewed for Advanced Directives. (Resident 196) Finding includes: On 2/12/24 at 8:50 a.m., Resident 196's clinical record was reviewed. The admission MDS (Minimum Data Set) assessment, dated 1/28/24, indicated Resident 196 was moderately cognitive impaired. The main screen tab portion of the electronic clinical record included an overview of Resident 196's vital information. A review of the tab indicated Resident 196's Advanced Directive (code status - decision regarding health care intervention) as DNR (Do Not Attempt Resuscitation - meaning no desire for life sustaining measures to be implemented). The Physician Orders, dated 1/24/24 and with no end date noted, indicated Resident 196 was a full code (desire for all life sustaining measures to be implemented). Resident 196's care plan, start date: 2/5/24 and valid through 6/27/24, indicated .problem: Resident/legal representative has formulated 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.

Based on interview and record review, the facility failed to ensure the Minimum Data Set (MDS) assessment was accurate for 1 of 2 residents reviewed for hospice. (Resident 32) Finding includes: On 2/12/24 at 1:46 p.m., the clinical record of Resident 32 was reviewed. The diagnosis included, but was not limited to, dementia. The Physician's Orders included, but were not limited, admit to hospice services due to dementia, initiated 3/27/23, with no end date was noted. Resident 32's care plan included, but was not limited to, .start date 3/1/23 problem: Resident requires hospice R/T [related to] progressing dementia .target date 2/27/24 goal: advanced directive wishes will be honored .approach: resident requires hospice R/T progressing dementia . The Annual Minimum Data Set (MDS) assessment, dated 2/6/24, indicated Resident 32 was severely cognitive impaired and was not receiving hospice services. The Quarterly MDS assessment, dated 11/14/23, indicated Resident 32 was severely cognitive impaired and was not receiving hospice services. During an interview on 2/13/24 at 9:30 a.m.,…

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 services to ensure a gastrostomy site dressing was changed for a resident with a g-tube used for enteral feedings for 1 of 3 residents reviewed for gastrostomy services. (Resident B) Findings included: During an interview on 2/12/24 at 10:48 a.m., Resident B indicated the facility had not changed his gastrostomy tube (g-tube) dressing recently. Resident B indicated the facility had not changed the dressing daily like they are supposed to. During an observation on 2/11/24 at 1:00 p.m., observed Resident B's g-tube dressing to be undated. During an observation on 2/12/24 at 10:30 a.m., observed Resident B's g-tube dressing to be undated. During an observation on 2/13/24 at 11:00 a.m., observed Resident B's g-tube dressing to be undated. During an interview on 2/13/24 at 11:15 a.m., LPN 3 indicated Resident B's g-tube dressing should have been dated after each dressing change. On 2/11/24 at 11:00 a.m., the clinical record of Resident B was reviewed. The diagnosis included, but was not limited to,…

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

Based on observation, interview, and record review, the facility failed to ensure medications were labeled with an open date for 1 of 3 medication carts observed. (Moving Forward/Split Cart) Finding includes: On 2/13/24 at 8:50 a.m., the Moving Forward/Split Cart was observed. In the cart, three opened vials of Insulin Lispro (a short acting medication to treat Diabetes Mellitus) 100 units/ml (milliliter) and one opened Insulin Glargine (a long acting medication to treat Diabetes Mellitus) Flex Pen 100 units/ml were observed. The vials and Flex Pen were not labeled to indicate the date the medication was opened. During an interview at that time, LPN 8 indicated the vials should have been dated at the time they were opened. On 2/13/24 at 10:24 a.m., the Director of Nursing provided a policy titled, Storage and Expiration Dating of Medications, Biologicals, dated January 2002, and indicated it was the current policy being used by the facility. A review of the policy indicated 5. Once any medication or biological package is opened; Facility should follow manufacturer or supplier…

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 accurately and completely document services provided for 1 of 2 residents reviewed for catheter care. (Resident 88) Findings include: On 2/11/24 at 1:20 p.m., Resident 88 was observed resting in bed. An indwelling urinary catheter (a medical device that helps drain urine from the bladder) was connected to the catheter tubing which was connected to the catheter drainage bag (a medical bag that held urine) was observed. On 2/14/24 at 9:22 a.m. Resident 88's clinical record was reviewed. The diagnoses included, but were not limited to, malignant neoplasm of prostate (prostate cancer); neuromuscular dysfunction of bladder (urinary condition where people lack bladder control); and urine retention (difficulty urinating and completely emptying the bladder). The admission Minimum Data Set (MDS) assessment, dated 1/25/24, indicated Resident 88 was moderately cognitively intact and had an indwelling urinary catheter. Resident 88's care plan indicated .Problem start date: 11/20/23 .Resident requires an indwelling…

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.