Derby Health & Rehabilitation, LLC

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility identified a census of 61 residents. The sample included 15 residents with three residents reviewed for hospitalization. Based on observation, record review, and interviews, the facility failed to provide a written notification of transfer for facility-initiated transfers to Resident (R) 22, R77, and R78 and/or their representative for all applicable transfers/discharges. The facility further failed to notify the State Long Term Care Ombudsman (LTCO) of transfers/discharges for R22, R77, and R78. Findings included:- R22 admitted to the facility on [DATE], the facility transferred him to the hospital on [DATE], and he re-admitted to the facility on [DATE]. R77 admitted to the facility on [DATE], and the facility transferred her to the hospital on [DATE]. R77 did not readmit to the facility. R78 admitted to the facility on [DATE], and the facility transferred her to the hospital on [DATE]. R78 did not readmit to the facility. Upon request, the facility was unable to provide a written notification 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.

The facility reported a census of 61 residents; the sample included five residents reviewed unnecessary medications. Based on observation, interview, and record review revealed the facility failed to obtain physician-ordered orthostatic blood pressures as part of an evaluation following complaints of dizziness and lightheadedness. Findings included:- R45's Electronic Medical Record (EMR) revealed the following diagnoses: anxiety (mental or emotional reaction characterized by apprehension, uncertainty, and irrational fear) and hypotension (low blood pressure). R45's 02/18/26 admission Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) of 14, indicating intact cognition. R45's Care Plan documented that R45 used an antihypotensive medication for hypotension; initiated on 03/08/26. The plan directed staff to monitor and document side effects and the effectiveness of the medication. R45's Care Plan instructed staff to verify blood pressure and pulse prior to giving this medication; initiated on 03/08/26. R45's Progress Note had an Encounter note dated 02/27/26…

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.

The facility reported a census of 69 residents. The sample included seven residents with three residents reviewed for accident hazards. Based on observation, interview and record review, the facility failed to ensure an environment free from accident hazards for two residents, Resident (R)1 and R2 when staff failed to provide adequate hands-on stabilization of the resident from the second staff member during full body mechanical lift transfers. This deficient practice placed R1 and R2 at risk for accidents and injuries related to mechanical lift transfers. Findings included: - During an observation on 04/29/25 at 12:19 PM, Certified Medication Aide (CMA) G and Certified Nurse Aide (CNA) H performed a full body mechanical lift transfer for R1 from her recliner to a wheelchair. CMA G operated the controls of the lift with the legs positioned wide. CMA G raised R1 into the air using the lift. While R1 was in the raised position, CNA H released physical control and stabilization of R1, walked around the lift, R1 and CMA G and stood behind R1's wheelchair. CMA G then pushed the lift with…

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

The facility had a census of 61 residents. The sample included 15 residents. Based on observation, interview, and record review the facility failed to ensure hazardous chemicals were stored safely. This placed the five residents identified by the facility as cognitively impaired and independently mobile at risk for accidents and hazard-related injuries. Findings included: - On 04/24/24 at 08:13 AM, observation in the 300-household revealed an unlocked housekeeping closet with the following hazardous items with Keep out of reach of children instructions stored on a waist-high shelf: One small can of fiberglass resin. One quart bottle of tile sealer. One spray bottle of ant killer. One spray can of ant and roach killer. On 04/24/24 at 08:15 AM, Certified Nurse Aide (CNA) M verified the findings. On 04/24/24 at 09:01 AM, Administrative Nurse D verified staff should ensure housekeeping closets were locked when not under supervision. The facility's Chemical Storage policy, dated 03/12/24, stated all chemicals that are deemed hazardous to residents would be stored in a locked area or used…

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.

The facility had a census of 61 residents. Based on observation, interview, and record review the facility failed to store, prepare, and serve food in a sanitary manner for residents in two of four kitchens and dining rooms. This deficient practice placed residents at risk for food-borne illness. Findings included: - On 04/24/24 at 09:07 AM, observation in the 100-household kitchen freezer revealed a bag of chicken tenders, undated, and a box of hamburger patties opened, and the plastic bag torn leaving the patties open to air. On 04/24/24 at 12:17 PM, observation in the 300-household dining room revealed Certified Nurse Aide (CNA) M served plated food to residents. CNA M touched a resident's shoulders and chair, rubbed his face, and did not wash or sanitize his hands before serving more residents' plates. CNA M wiped his hands on his clothing, scratched his hair rubbed his face numerous times, and continued serving all 12 residents in the dining room without washing or sanitizing his hands. On 04/24/24 at 02:15 PM, observation of the 100 and 300 household kitchens revealed both…

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.

The facility had a census of 61 residents. The sample included 15 residents. Based on record review and interview, the facility failed to provide Resident (R)8, R11, and R160, or their representative, the completed Centers for Medicare and Medicaid (CMS) Skilled Nursing Facility Advanced Beneficiary Notices (ABN) Form 10055. This placed the resident at risk of uninformed decisions about their skilled services. Findings included: - The Medicare ABN form 10055 informed the beneficiary that Medicare may not pay for future skilled therapy services. The form included an option for the beneficiary to receive specific services listed, and bill Medicare for an official decision on payment. The form stated 1) I understand if Medicare does not pay, I will be responsible for payment but can make an appeal to Medicare, (2) receive therapy listed, but do not bill Medicare, I am responsible for payment for services, (3) I do not want the listed services. A review of the ABN provided to R8 revealed the resident received the wrong form. R8 received the CMS-R-131 instead of CMS Form 10055. 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.

The facility identified a census of 61 residents. The sample included 15 residents. Based on observation, record review, and interview, the facility failed to ensure residents remained free from abuse when multiple residents' medications were misappropriated. This deficient practice placed all residents who had controlled medications stored in the facility at risk for further misappropriation and impaired care related to missing or stolen medications. Findings included: - The facility's investigation report 6803 dated 04/03/24 documented on 03/25/24, Administrative Nurse E noted Resident (R)162's entire card of oxycodone (schedule II opioid pain medication with high use for misuse or addiction) five milligrams (mg) tablets were missing. The pharmacy delivered the card on 03/22/24 and it was received by Licensed Nurse (LN) H. Per the log, the card had 12 pills. The pharmacy was contacted and confirmed that on 03/22/23 at 07:00 PM, LN H received and signed for three narcotic cards including oxycodone 5 mg (12 pills), oxycodone-acetaminophen 5/325 mg (20 pills), and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility had a census of 61 residents. The sample included 15 residents of which two were reviewed for the gastrostomy tube (G-tube: surgical creation of an artificial opening into the stomach through the abdominal wall) feeding management. Based on observation, record review, and interview, the facility failed to provide G-tube care per the physician's orders for Resident (R)41 when staff failed to administer the required amount of water prior to the nutritional feeding through the G-tube. This placed the resident at risk for G-tube related complications. Finding included: - R41's Electronic Health Record (EHR) revealed diagnosis of dysphasia (swallowing difficulty), cerebrovascular accident (CVA-stroke- sudden death of brain cells due to lack of oxygen caused by impaired blood flow to the brain by blockage or rupture of an artery to the brain), hemiplegia (paralysis of one side of the body), and diabetes mellitus (DM-when the body cannot use glucose, not enough insulin made or the body cannot respond to…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility had a census of 61 residents. The sample included 15 residents with five reviewed for unnecessary drugs. Based on observation, interview, and record review the facility failed to ensure the Consultant Pharmacist identified and reported Resident (R) 47's blood pressure medication administered outside the physician-ordered blood pressure parameters. This deficient practice placed R47 at risk for unnecessary medications and related complications. Findings included: - R47's Electronic Medical Record (EMR) documented diagnoses including end-stage renal disease (ESRD-a terminal disease of the kidneys), atrial fibrillation (rapid, irregular heartbeat), and hypocalcemia (abnormally low level of calcium in the blood). The admission Minimum Data Set (MDS), dated [DATE], documented a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. The MDS documented R47 required supervision for eating and was dependent on staff assistance for toileting, bathing, and dressing. R47 received…

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 The facility had a census of 61 residents. The sample included 15 residents with five reviewed for unnecessary drugs. Based on observation, interview, and record review the facility failed to hold Resident (R) 47's blood pressure medication per the physician-ordered blood pressure parameters. This deficient practice placed R47 at risk for unnecessary medications and related complications. Findings included: - R47's Electronic Medical Record (EMR) documented diagnoses including end-stage renal disease (ESRD-a terminal disease of the kidneys), atrial fibrillation (rapid, irregular heartbeat), and hypocalcemia (abnormally low level of calcium in the blood). The admission Minimum Data Set (MDS), dated [DATE], documented a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. The MDS documented R47 required supervision for eating and was dependent on staff assistance for toileting, bathing, and dressing. R47 received antianxiety (a class of medications that calm and relax people) and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 69 residents with 20 residents sampled, including four residents reviewed for accidents. Based on interview, record review and observation, the facility failed to initiate the planned intervention for one of the four sampled, Resident (R)2, with the use of a motion alarm placed under the resident in bed/chair/wheelchair, to prevent further falls. Findings included: - Review of Resident (R)2's electronic medical record (EMR), included a diagnosis of dementia (progressive mental disorder characterized by failing memory, confusion). The admission Minimum Data Set (MDS), dated [DATE], documented the resident had a Brief Interview for Mental Status (BIMS) score of 5, indicating severe cognitive impairment. She required extensive assistance of one staff for transfers and walking and had impairment on her bilateral upper extremities. She used a walker or a wheelchair for locomotion. She had one non-injury fall since admission. The Falls Care Area Assessment (CAA), dated 10/16/22,…

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 The facility reported a census of 69 resident with 20 selected for review which included three residents reviewed for urinary catheter/urinary tract infections. Based on observation, interview and record review, the facility failed to ensure sanitary catheter care for two of the three sampled resident's (R)30 and R55, to prevent urinary tract infections. Findings included: - Review of Resident (R)30's Physician Order Sheet, dated 10/16/22, revealed diagnoses included heart failure, cerebral vascular disorder (stroke) aphasia (condition with disordered or absent language function) and neuromuscular dysfunction of the bladder (dysfunction of the urinary bladder caused by a lesion of the nervous system). The admission Minimum Data Set (MDS), dated [DATE], assessed the resident with normal cognitive function, required extensive assistance of one staff for dressing, toilet use and personal hygiene. The resident had an indwelling urinary catheter. The Dehydration/Fluid Maintenance Care Area Assessment (CAA), 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 The facility reported a census of 69 residents with two residents reviewed for labeling of insulin pens. Based on observation, interview and record review, the facility failed to ensure correct expiration dating/labeling of insulin (a medication used to lower blood sugar levels) for sampled residents (R) 29 and R17. Findings included: - Observation, on [DATE] at 09:02 AM, revealed resident (R)17's Novolog flex pen, (a device containing insulin for the administration of insulin), contained a label in which staff documented the open date of [DATE] and the expiration date written as [DATE]. The resident's Lantus Solostar insulin pen lacked a label from the pharmacy as required and staff wrote the dates on them. Observation, on [DATE] at 09:15 AM, revealed staff documented the open date of [DATE] on R29's Lantus Solostar insulin pen and documented the expiration date of [DATE]. The resident's Humalog insulin pen contained and open date of [DATE], with the expiration date written as [DATE]. Interview, on [DATE] at…

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