Eastgate Manor Nursing And Rehabilitation

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview, the facility failed to ensure an environment that was safe, sanitary, and comfortable for 6 of 18 rooms observed. Walls were damaged, lights were not functional, light pull cords were not functional, and privacy curtains were not clean. (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER]) Findings include: 1. On 4/15/24 at 11:31 a.m., room [ROOM NUMBER] was observed. The bathroom walls were observed to be scratched and gouged. 2. On 4/15/24 at 2:06 p.m., room [ROOM NUMBER] was observed. The light closest to the entry door was observed to not work and the privacy curtain was observed to be stained with a dry brown substance. 3. On 4/15/24 at 2:16 p.m., room [ROOM NUMBER] was observed. The bathroom walls were observed to be scratched and gouged. 4. On 4/15/24 at 2:20 p.m., room [ROOM NUMBER] was observed. Two hooks were observed protruding from the wall above the bed and multiple screws and nails were observed…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure the accuracy of the Minimum Data Set assessment for 2 of 18 residents reviewed. A urinary catheter and discharge was coded inaccurately. (Resident 52, Resident 54) Findings include: 1. Resident 52's clinical record was reviewed on 4/17/24 at 11:55 a.m. The diagnoses included, but were not limited to, obstructive and reflux uropathy, unspecified, and neuromuscular dysfunction of bladder. Physician orders, dated 4/1/24 through 4/19/24, for Resident 52 indicated . cath [catheter] orders: Foley catheter Size: 18 Fr [french] 10 mL [milliliters] bulb . The start date for the Foley catheter was 3/26/24. Resident 52's admission Minimum Data Set (MDS) assessment, dated 3/31/24, indicated the resident did not have a Foley catheter during the 7 day look back period of 3/25/24 through 3/31/24. 2. Resident 54's clinical record was reviewed on 4/17/24 at 11:56 a.m. The diagnosis included, but was not limited to, sepsis. Nursing Progress Notes,…

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

Based on interview and record review, the facility failed to ensure a care plan meeting was held in conjunction with the Quarterly Minimum Data Set (MDS) assessment for 1 of 2 residents reviewed for care planning. (Resident 49) Findings include: During an interview on 4/16/24 at 11:40 a.m., Resident 49 indicated he and his wife had not been invited to a care plan meeting for a long time and he had not been kept informed of what was going on with his plan of care or when he was going to be able to be discharged back home. Resident 49's clinical record was reviewed on 4/17/24 at 11:00 a.m. The diagnoses included, but were not limited to, incomplete lesion at C5 level of cervical spinal cord and quadriplegia. A review on 4/17/24 at 11:15 a.m., of the Care Conference Summary notes indicated Resident 49 and his wife attended a care conference meeting on 1/3/24. A care plan, initiated on 3/22/24, and current through target date 6/22/2024, for Resident 49 indicated, . PROBLEM: Resident's discharge goal is to return to the community. Home with possible home care . GOAL: Resident will be…

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

Based on interview and record review, the facility failed to ensure staff assisted a resident in gaining access to vision services by making appointments for 1 of 1 resident reviewed for ancillary services. (Resident 14) Finding includes: During an interview on 4/15/24 at 2:22 p.m., Resident 14 indicated her eyes were getting worse and she thought she needed new glasses. She indicated she had an eye doctor she was supposed to go see, however, she did not know when her next appointment was scheduled. On 4/16/24 at 11:12 a.m., Resident 14's clinical record was reviewed. The diagnoses included, but were not limited to, diabetes type 2 and hypertension. A 2/7/24 Quarterly Minimum Data Set (MDS) assessment indicated the resident was cognitively intact. A 8/29/23 Optometry Doctor (OD) assessment, indicated the patient was diagnosed with diabetic retinopathy (damage to the blood vessels in the tissue at the back of the eye), macular degeneration (loss in the center of the field of vision), pseudophakia (having an artificial lens implanted after the natural eye lens has been removed), dry…

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

Based on observation, interview, and record review, the facility failed to ensure a urinary drainage bag and tubing attached to a urinary catheter was positioned off the floor for 1 of 1 resident reviewed for urinary catheters. (Resident 52) Finding includes: On 4/15/24 at 10:54 a.m., Resident 52 was observed to be sitting in her wheelchair in her room. The urinary drainage bag was observed to be touching the floor. On 4/15/24 at 3:08 p.m., Resident 52 was observed to be rolling around the hallway in her wheelchair. The urinary drainage bag was observed to be dragging the floor. On 4/17/24 at 11:10 a.m., Resident 52 was observed to be sitting in her wheelchair in her room. The urinary drainage tubing was observed to be been touching the floor. Resident 52's clinical record was reviewed on 4/17/24 at 11:55 a.m. The diagnoses included, but were not limited to, obstructive and reflux uropathy, unspecified, and neuromuscular dysfunction of bladder. Physician orders, dated 4/1/24 through 4/19/24, for Resident 52 indicated . cath [catheter] orders: Foley catheter Size: 18 Fr [french] 10…

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 food was stored and distributed in accordance with professional standards for food service safety during 2 of 2 kitchen observations. Food packages were stored on the floor of the walk-in refrigerator and walk-in freezer, and food was open to air in the walk-in freezer. Finding includes: During an observation on 2/28/24 at 10:35 A.M. a walk-in freezer contained a bag of peas that were open to air. A walk-in refrigerator contained a box of chopped celery and a box of whole tomatoes resting directly on the floor. During an observation on 2/29/24 at 9:55 A.M., a walk-in freezer contained a bag of peas that were open to air and a box of meat patties resting directly on the floor. A walk-in refrigerator contained a box of chopped celery and a box of whole tomatoes resting directly on the floor. During an interview on 2/29/24 at 10:00 A.M., [NAME] 2 indicated that stored food containers should be wrapped up or closed tightly to ensure the food is not open to air and that food containers should be stored up…

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 food items were properly labeled and not expired. There was food in the freezer open to air. The wall by the oven hood was peeled off, parts of the wall were hanging, brick was exposed, and debris was on the floor under the oven which included parts of the wall during 4 of 4 kitchen observations. Findings include: During the initial tour of the kitchen on 7/11/22 at 10:03 A.M., the following was observed: Dry storage: An open bag of devils food cake mix wrapped in plastic wrap dated 4/17/22 and 4/22/22. An open bag of cheese sauce wrapped in plastic wrap dated 5/21/22, 6/28/22, 7/4/22. A large container with oats dated 6/5/22 and 7/5/22. An open vanilla instant pudding wrapped in plastic wrap dated 11/12/21. An open chocolate pudding dated 12/3/21 and 3/28/22. Plastic wrapped around aluminum foil with white crumbs dispersed throughout dated 10/17/22, 10/25/21, and two other unreadable dates. Refrigerator: A quart of half and half milk with the cap dated 7/2/22 and 7/8/22. Freezer: A clear bag 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to maintain a safe, sanitary, and a homelike environment in resident spaces in 1 of 4 halls observed. (South hall) Findings include: 1. On 07/12/22 at 10:20 A.M., 2 (two) rolls of toilet paper were uncovered and sitting on top of the toilet tank in the bathroom of room [ROOM NUMBER]. On 07/13/22 at 11:38 A.M., the same was observed. 2. On 7/11/22 at 11:10 A.M., the call light in the bathroom of room [ROOM NUMBER] was detached from the wall and hanging with wires out and the call light was not working. The sink was slow to drain. On 07/13/22 02:49 P.M., the same was observed. 3. On 07/11/22 at 10:51 A.M., there was a used washrag laying on an uncovered dishpan on the floor of the bathroom in the room of 136 observed. 1 (one) roll of toilet paper was uncovered and sitting on top of the toilet tank. A set of uncovered tongs was laying on the floor by the toilet and the sink was slow to drain. On 07/13/22 at 02:18 P.M., 2 (two) rolls of toilet…

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 a comprehensive person-centered care plan for each resident in order to meet medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. Staff did not implement care plan interventions for 1 of 1 residents reviewed for hydration, and 2 of 2 residents reviewed for activities of daily living. (Resident 17, Resident 23, Resident 1) Findings include: 1. On 7/11/22 at 10:50 A.M., Resident 17 was observed lying in bed. A grab bar on the left side of the bed was observed attached and in an upright position. No grab bar was observed on the right side of the bed. A call light was observed lying at the head of the bed above Resident 17's head. Resident 17 was unable to reach the call light when asked to. On 7/12/22 at 1:44 P.M., Resident 17's clinical record was reviewed. Diagnoses included, but were not limited to, depression and Parkinson's disease. The most recent significant change MDS (minimum data set) Assessment, dated 5/10/22 indicated Resident 17 required…

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