Salem Home

Based on observation and interview, the facility failed to store and prepare food in the main kitchen and kitchenette under sanitary conditions to prevent food borne illnesses. Findings included:- The initial tour of South Kitchen on 06/08/2026 at 08:13 AM with Dietary Staff BB identified the following concerns:The reach-in freezer had built-up frost on three shelves.Two deep freezers had food stuck to the top.The table holding coffee pots and a tea machine had dried-on fluids on the white plastic legs and a buildup of dust on the wooden board behind the table.The side by side two-door refrigerator had food on the bottom and front of the bottom door.There was no trash can by the hand-washing sink.Flour and sugar containers had flour and sugar on top of the lid.The kitchen floor drain had a build-up of an unknown substance. Additionally, the tour of the Kitchenette on 06/08/2026 at 10:04 AM with Dietary Staff BB identified the following concerns:The inside of the microwave had dried food throughout.The trash can had dried food and liquids on the top and sides. On 06/10/2026 at 09:13…

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 assess and ensure cognitively impaired Resident (R) 4 ability to safely self-administer medications prior to leaving the medications with the resident to self-administer. Findings included:- R4's Electronic Medical Record (EMR) revealed a diagnosis of dementia (a progressive mental disorder characterized by failing memory and confusion). R4's Significant Change Minimum Data Set (MDS) dated [DATE] documented a Brief Interview of Mental Status (BIMS) score of 10, which indicated moderately impaired cognition. R4's MDS revealed he was administered an antidepressant (a class of medications used to treat mood disorders) and an opioid (a class of controlled drugs used to treat pain). R4's Cognitive Loss/Dementia, dated 05/27/2026, documented R4's cognition during this lookback period; R4 scored a 10 on his BIMs, indicating moderate impairment. R4's Care Plan, dated 06/03/2025, instructed staff to administer medications as ordered.…

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 privacy for Residents (R)3 and R5, while staff performed cares in their rooms. Findings included:1. R3's Electronic Medical Record (EMR) documented a diagnosis of cerebral infarction (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). R3's admission Minimum Data Set (MDS), dated [DATE], documented that R3 had a Brief Interview for Mental Status (BIMS) score of eight, indicating moderately impaired cognition. He was always incontinent of bowel and bladder and dependent on staff for toileting hygiene. R3's Urinary Incontinence and Indwelling Catheter Care Area Assessment (CAA), dated 05/13/2026, documented that R3 required total staff assistance with toileting and transfers. R3's Care Plan instructed staff that he required total assistance with transfers and toileting hygiene. R3's EMR under the Task tab from 05/12/2026 through…

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 appropriate activity of daily living (ADL) assistance to Resident (R)3 when staff did not assist him to change his soiled clothing.- R3's Electronic Medical Record (EMR) documented a diagnosis of cerebral infarction (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). R3's admission Minimum Data Set (MDS), dated [DATE], documented that R3 had a Brief Interview for Mental Status (BIMS) score of eight, indicating moderately impaired cognition. He was dependent on staff for upper-body dressing. R3's Activities of Daily Living (ADL)/Rehabilitation Potential Care Area Assessment (CAA), dated 05/13/2026, documented that R3 had limitations in range of motion (ROM) on his left side and required staff assistance with dressing. R3's Care Plan, dated 05/08/2026, instructed staff that he required total staff assistance for dressing. R3's EMR…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, observation, and record review, the facility failed to provide Resident (R) 17 with a bilevel positive airway pressure (BiPAP- a noninvasive ventilator that helps breathing) as per physician orders. Findings included:- R17's Electronic Medical Record (EMR) revealed diagnoses of sleep apnea (a disorder of sleep characterized by periods without respirations) and Friedreich ataxia (a rare, inherited, progressive neuromuscular disease that damages the nervous system). R17's admission Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) of 14, indicating intact cognition. Total severity score of 0, indicating no depression. No behaviors noted. The resident required total staff dependence with bed mobility. R17's MDS documented that he had a non-invasive mechanical ventilator. R17's Functional Care Area Assessment (CAA), dated 08/19/2025, documented: R17 was admitted following a hospitalization for ankle pain and lack of a caregiver at home. R17 does have a…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to provide sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services necessary to care for residents' needs related to provision of enteral tube feeding and medication administration via percutaneous enteral epigastric tube feeding (PEG tube-external device inserted in the abdomen to deliver nutrition, hydration, and/or medication directly to the stomach). Findings included: - Resident (R) 7's undated physician's order (POS) documented diagnoses which included cerebral vascular accident (CVA-stroke due to interrupted blood flow to the brain), hemiplegia (paralysis of one side of the body), dysphagia (impaired ability to swallow), and dementia (decline in mental abilities severe enough to interfere with daily life). R7's Annual Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) of seven, indicating severe cognitive impairment. The resident was dependent on staff…

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 interviews, observation and record review, the facility failed to implement adequate infection control practices related to respiratory equipment for Resident (R) 17 and hand hygiene during incontinence care for R7. Findings included:1. On 06/08/2026 at 09:49 AM, R17 was in his room in bed. His bilevel positive airway pressure (BiPAP- a noninvasive ventilator that helps breathing) mask lay directly on the floor on the left side of his bed. R17 reported that he has no place to put the BiPAP mask when he takes it off. On 06/09/2026 at 08:20 AM, R17's BIPAP mask was noted on the floor next to his bed. On 06/10/2026 at 07:55 AM, Certified Nurse Aide (CNA) L reported that she does not do anything with the BiPAP machines; the Certified Medication Aides and Licensed Nurses (LN) take care of them. CNA L reported the mask should not be on the floor, though. On 06/10/2026 at 07:59 AM, LN G reported that R17's BiPAP machine had been broken for about a month now. LN G reported that the mask should not be on the floor, that is should be placed in a bag, and reported that since he has…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility reported a census of 44 residents. Based on observation, interview, and record review, the facility failed to ensure foods were stored, prepared, and distributed in a manner to prevent foodborne illness to the residents. Findings included: - Observation on 08/06/24 at 10:45 AM, revealed room trays for residents set with beverages. Two trays contained a glass of milk, and one contained a liquid nutritional supplement in a glass. Observation, on 08/06/24 at 11:15 AM, revealed Dietary Staff DD, obtained the temperature a glass of milk on the tray and revealed a temperature of 60 degrees Fahrenheit (F). Dietary Staff DD stated the milk should be served at 41 degrees F, and the supplier delivered the milk earlier and may not have cooled down to 41 degrees F. Dietary Staff DD obtained two new glasses of milk from newly delivered milk from the refrigerator and revealed a temperature of 48 degrees F. Dietary Staff DD obtained the temperature of the nutritional supplement and revealed a temperature of 57…

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 44 residents. Based on interview and record review, the facility failed to electronically submit complete and accurate staffing information to the Federal regulatory agency through Payroll-Based Journaling (PBJ) when the facility failed to accurately submit hourly staffing data for all nursing personnel. Findings included: - Review of the PBJ Staffing Data Report for Fiscal Year (FY) for Quarter 3 - 2023 (April 1 - June 30), the data indicated the facility failed to have Licensed Nursing Coverage 24 hours/Day on the following dates: 04/01/23 Saturday (SA), 04/09/23 Sunday (SU), 04/16/23 (SU), 04/29/23 (SA) and 05/13/23 (SA). Review of the nursing schedule and payroll data sheets for the above dates revealed adequate hours to account for 24-hour nursing coverage. On 08/07/24 at 08:24 AM, Administrative Nurse D reported that payroll data and scheduling data reflected that 24- hour nursing coverage and that nursing staff were scheduled for either eight-hour or 12-hour shifts where no lunch was taken but the PBJ submission deducted a 30-minute period…

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 census totaled 44 residents on two halls with a commons area where residents gathered for meals and activities. The facility had two medication carts and a nurse treatment cart. Based on observation, interview, and record review, the facility failed to provide a safe environment for nine residents by the failure to ensure a nurse treatment cart that contained insulin (a medication used to treat diabetes [a disease when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin]) remained locked when not in direct line of vision of the nurse. Findings included: - On 08/06/24 at 11:19 AM, a treatment cart on the 200 hall observed unlocked and unattended. On 08/06/24 at 11:20 AM, Licensed Nurse (LN) G confirmed the medication cart was left unattended and unlocked. LN G further confirmed that the cart serviced nine residents and contained insulin and general wound care supplies. LN G revealed that the medication cart should be always locked when unattended and stated that she failed to lock the medication cart before going the nurses'…

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 44 residents. The facility identified two residents required pureed diets. Based on observation, interview, and record review, the facility failed to ensure pureed foods were prepared to ensure nutritional and flavor compatibility with the menu to enhance the dining experience for these two residents. Findings included: - Observation, on 08/06/24 at 10:45 AM revealed Dietary Staff CC prepared pureed diet for two residents. The menu for the noon meal included beef soft taco with lettuce, cheese, tomato, sour cream, spanish rice, and fiesta corn. Dietary staff CC stated the facility form Mechanically Soft Level Two Diet indicated that staff should avoid corn or regular rice, so she substituted mashed beans (pork and beans) for the corn and mashed potatoes and gravy for the fiesta rice. Dietary staff CC stated she did not have a nutritionally equivalent substitute guide for the spanish rice or fiesta corn for pureed diets. Interview, on 08/07/24 at 09:00 AM, with Dietary Staff BB confirmed that the facility had a computerized program for dietary…

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 42 residents. The sample included 13 residents of which one reviewed for dignity. Based on observation, record review and interviews, the facility failed to ensure Resident (R)21 was treated with respect and dignity and cared for in a manner that promotes quality of life. This placed R21 at risk for impaired psychosocial well-being. Findings included: - R21's Annual Minimum Data Set (MDS), dated [DATE], recorded the resident had intact cognition and received daily insulin (a medication used for high blood sugar given by an injection). On 12/08/22 at 11:25AM, observation revealed R21 sat in his wheelchair at the dining table. Further observation revealed 23 other facility residents also sat in the dining room. R21 lifted up his shirt and exposed his abdomen and his right side and Licensed Nurse (LN) G administered a Novolog (insulin medication) injection at the table. On 12/08/22 at 11:35AM, LN G stated she always gave R21 his insulin in the dining room at the table. LN G then stated…

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.