The Healthcare Resort Of Olathe

The facility identified a census of 57 residents. The sample included 15 residents, with two residents reviewed for catheters (a flexible tube inserted through a narrow opening into a body cavity, particularly the bladder, for removing fluid). Based on observation, record review, and interviews, the facility failed to ensure the standard of care was provided for Resident (R) 34 who had a history of urinary tract infection (UTI - an infection in any part of the urinary system) when her catheter drainage bag laid directly on the floor. This deficient practice placed R34 at risk of catheter-related complications and further UTIs. Findings included: - R34's Electronic Medical Record (EMR) from the Diagnosis tab documented diagnoses of congestive heart failure (CHF - a condition with low heart output and the body becomes congested with fluid), dementia (a progressive mental disorder characterized by failing memory and confusion), urinary tract infection (UTI - an infection in any part of the urinary system), and need for assistance with personal care. The admission Minimum Data Set (MDS)…

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 57 residents. The sample included 15 residents, with five residents reviewed for unnecessary medications. Based on record review and interviews, the facility failed to ensure dosing instructions for Voltaren (topical pain reliever medication) gel for Resident (R) 28. This deficient practice placed R28 at risk for unnecessary medication use and physical complications for the affected residents. Findings included: - R28's Electronic Medical Record (EMR) from the Diagnosis tab documented diagnoses of edema (swelling resulting from an excessive accumulation of fluid in the body tissues), chronic kidney disease, congestive heart failure, muscle weakness, need for assistance with personal care, and pain. The Annual Minimum Data Set (MDS) dated 06/17/24 documented a Brief Interview of Mental Status (BIMS) score of 15 which indicated intact cognition. The MDS documented R28 required partial to moderate assistance with toileting and mobility. The MDS also documented R28 required substantial to maximum assistance with bathing, lower extremity dressing, 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.

The facility identified a census of 57 residents. The sample included 15 residents, with one resident reviewed for a therapeutic diet. Based on observation, record review, and interviews, the facility failed to implement a therapeutic diet as ordered by the physician order for Resident (R) 28, who had a diagnosis of congestive heart failure (CHF - a condition with low heart output and the body becomes congested with fluid). This deficient practice placed R28 at risk of adverse side effects from unnecessary medication or complications related to CHF. Findings included: - R28's Electronic Medical Record (EMR) from the Diagnosis tab documented diagnoses of edema (swelling resulting from an excessive accumulation of fluid in the body tissues), chronic kidney disease, congestive heart failure, muscle weakness, need for assistance with personal care, and pain. The Annual Minimum Data Set (MDS) dated 06/17/24 documented a Brief Interview of Mental Status (BIMS) score of 15 which indicated intact cognition. The MDS documented R28 required partial to moderate assistance with toileting 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.

The facility identified a census of 62 residents. The sample included three residents. Based on observation, record review, and interview, the facility failed to identify an elopement for Resident (R) 1 as potential neglect and report to the State Agency (SA) as required. This placed R1 at risk for unidentified and ongoing neglect. Findings Included: - R1's Electronic Medical Record (EMR) documented diagnosis of Alzheimer's Disease (progressive mental deterioration characterized by confusion and memory failure), altered mental status, dementia (progressive mental disorder characterized by failing memory, confusion), generalized muscle weakness, repeated falls, cognitive communication deficit (an impairment in organization, sequencing, attention, memory, planning, problem-solving, and safety awareness), and a need for assistance with personal care. The Quarterly Minimum Data Set (MDS) dated 06/13/24 documented a Brief Interview for Mental Status (BIMS) score of five, which indicated severe cognitive impairment. The MDS documented R1 used a wheelchair and was independently mobile. 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 The facility identified a census of 59 residents. The sample included three residents. Based on observation, record review, and interview the facility failed to ensure Resident (R) 1 remained free from verbal abuse when staff made inappropriate statements to R1. On 05/16/24 Certified Nurse Aide (CNA) M became irritated with R1 and made disparaging remarks about the size of R1's genitals. This placed R1 at risk for impaired psychosocial well-being including humiliation and degradation. Findings included: - R1's Electronic Medical Record (EMR) from the Diagnosis tab documented diagnoses of muscle weakness, reduced mobility, need for assistance with personal care, anxiety (mental or emotional reaction characterized by apprehension, uncertainty, and irrational fear), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). The admission Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 15 which indicated intact cognition. R1…

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 identified a census of 59 residents. The sample included three residents reviewed for abuse. Based on observation, interview, and record review, the facility failed to ensure staff identified an incident as verbal abuse and reported the incident to the Administrator immediately. This deficient practice created the risk of unidentified and ongoing abuse. Findings included: - R1's Electronic Medical Record (EMR) from the Diagnosis tab documented diagnoses of muscle weakness, reduced mobility, need for assistance with personal care, anxiety (mental or emotional reaction characterized by apprehension, uncertainty, and irrational fear), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). The admission Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 15 which indicated intact cognition. R1 had impairment on one side for the upper and lower extremities. R1 required supervision or touching assistance with eating…

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 identified a census of 59 residents. The sample included three residents. Based on observation, record review, and interview the facility failed to ensure Resident (R) 1 received the required assistance with activities of daily living (ADL). This placed R1 at risk for skin breakdown, poor hygiene, and impaired psychosocial well-being. Findings included: - R1's Electronic Medical Record (EMR) from the Diagnosis tab documented diagnoses of muscle weakness, reduced mobility, need for assistance with personal care, anxiety (mental or emotional reaction characterized by apprehension, uncertainty, and irrational fear), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). The admission Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 15 which indicated intact cognition. R1 had impairment on one side for the upper and lower extremities. R1 required supervision or touching assistance with eating and oral hygiene.…

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 63 residents. The sample included three residents reviewed for care medications used. Based on record review, observation, and interview, the facility failed to revise the comprehensive care plan for resident R1's use of an injectable medication for a diagnosed skin condition. This placed R1 at risk for impaired care related to uncommunicated care needs. Findings included: - R1's Electronic Medical Record (EMR) documented R1 had diagnoses of chronic kidney disease, chronic lymphedema (swelling of the leg or arm) diabetes mellitus (DM-a condition characterized by high blood sugar levels and the body's inability to metabolize sugar), and psoriasis (a chronic, sometimes painful skin disease that causes a rash with itchy, scaly patches, on the knees, elbows, trunk, and scalp). The Annual Minimum Data Set (MDS), dated 12/26/23, documented R1 had a Brief Interview for Mental Status score of 15 which indicated R1's cognition was intact. The MDS documented R1 had no mobility problems and used a wheelchair for ambulation. R1 had occasional incontinence 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.

The facility identified a census of 63 residents. The sample included three residents reviewed for medications. Based on record review, observation, and interviews, the facility failed to prevent a significant medication error when Resident (R)1 did not receive a scheduled injectable medication for the treatment of psoriasis (a chronic, sometimes painful skin disease that causes a rash with itchy, scaly patches, on the knees, elbows, trunk, and scalp). On 01/21/24, after an inquiry from R1's representative, it was identified R1's quarterly injection was overdue by 40 days. This placed R1 at risk for decreased therapeutic effect of the medication and complications related to R1's skin disease. Findings included: - R1's Electronic Medical Record (EMR) documented R1 had diagnoses of chronic kidney disease, chronic lymphedema (swelling of the leg or arm) diabetes mellitus (DM-a condition characterized by high blood sugar levels and the body's inability to metabolize sugar), and psoriasis. The Annual Minimum Data Set (MDS), dated 12/26/23, documented R1 had a Brief Interview for Mental…

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 69 residents. One resident was reviewed for abuse. Based on observations, record review, and interviews, the facility failed to ensure Resident (R) 1 received the necessary protective oversight to prevent potential abuse and/or neglect when the facility failed to report a fracture of unknown origin as potential abuse or neglect to the State Agency (SA), within the mandated time frame. This deficient practice placed R1 at risk for unresolved and ongoing abuse, a decrease in psychosocial well-being, and further injuries. Findings included: - The Diagnoses tab of R1's Electronic Medical Record (EMR) documented diagnoses of encephalopathy (damage or disease that affects the brain), need for assistance with personal care, generalized muscle weakness, and dementia (progressive mental disorder characterized by failing memory, confusion) with other behavioral disturbance. The admission Minimum Data Set (MDS) dated 08/25/23, documented R1 had a Brief Interview for Mental Status (BIMS) score of 10 which indicated moderate cognitive impairment. R1 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.

The facility identified a census of 69 residents. One resident was reviewed for abuse. Based on observations, record review, and interviews, the facility failed to ensure Resident (R) 1 received the necessary protective oversight to prevent potential abuse and/or neglect when the facility failed to investigate a fracture of unknown origin as potential abuse or neglect and send the completed investigation to the State Agency (SA) within the required timeframe. This deficient practice placed R1 at risk for unresolved and ongoing abuse, a decrease in psychosocial well-being, and further injuries. Findings included: - The Diagnoses tab of R1's Electronic Medical Record (EMR) documented diagnoses of encephalopathy (damage or disease that affects the brain), need for assistance with personal care, generalized muscle weakness, and dementia (progressive mental disorder characterized by failing memory, confusion) with other behavioral disturbance. The admission Minimum Data Set (MDS) dated 08/25/23, documented R1 had a Brief Interview for Mental Status (BIMS) score of 10 which indicated…

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 69 residents. Three residents were reviewed for weight loss. Based on observations, record review, and interviews, the facility failed to follow recommendations from the dietitian and failed to provide consistent weight loss interventions for Resident (R) 1 who had a significant weight loss of 16.3% from 08/14/23 to 10/09/23. This deficient practice placed R1 at risk for further weight loss and physical complications. Findings included: - The Diagnoses tab of R1's Electronic Medical Record (EMR) documented diagnoses of encephalopathy (damage or disease that affects the brain), need for assistance with personal care, generalized muscle weakness, dementia (progressive mental disorder characterized by failing memory, confusion) with other behavioral disturbance, mild protein-calorie malnutrition (condition that results from lack of sufficient nutrients in the body), type 2 diabetes mellitus (DM-when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), and dysphagia (swallowing difficulty). The admission…

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 include 15 residents. Based on observation, record review, and interviews, the facility failed to implement a system to allow residents and/or their representatives to file grievances anonymously. This deficient practice placed the residents at risk for decreased psychosocial wellbeing. Findings Included: - On 08/08/23 at 11:50 AM during Resident Council, Resident (R)22 stated that he was not aware of a way to file a grievance without staff assistance/anonymously. On 08/09/23 at 11:26 AM Activity Z stated residents reported grievances to her, but she was not aware of a way that residents, or families, could file a grievance anonymously. On 08/09/23 at 02:50 PM Licensed Nurse (LN) J stated that grievance forms were in a folder at the desks/nurse's stations on each hall and residents could ask staff for the forms. She stated that she was not aware if there were boxes that residents could put the completed forms in without giving directly to a staff member. The facility's Grievances policy revised on 01/2022, documented 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.

The facility identified a census of 61 residents. The sample included 15 residents. Based on observation, record review, and interviews, the facility failed to provide resident-centered activities for cognitively impaired residents on weekends. This deficient practice placed eight cognitively impaired residents at risk for decreased psychosocial wellbeing. Findings Included: - The facility's Activity Calendar for June, July, and August of 2023 revealed Movie Matinee at 02:00PM on Saturdays and Independent Game Groups on Sundays. The Calendars had no staff led activities noted on the weekends. On 08/08/23 at 01:00PM, the Resident Council reported the facility did not provide staff-led activities on the weekends. The council reported residents could complete independent games and puzzles provided by the facility. The council reported staff would put a movie in the movie player for residents to watch on Saturdays to watch. The council reported the residents just had to push the play button on the player. The council reported that facility had no specific activities set up for residents…

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 with one kitchen. Based on observation, record review, and interviews, the facility failed to maintain sanitary dietary standards related to storage of food. This deficient practice placed the residents at risk related to food borne illnesses and food safety concerns. Findings included: - On 08/07/23 at 07:30 AM an observation in the kitchen's dry food storage room revealed two opened packages of cream soup base. The packages were undated. On 08/07/23 at 07:32 AM an observation in the kitchen's dry food storage room revealed one opened package of spaghetti noodles. The package was undated. On 08/07/23 at 07:35 AM an observation in the kitchen's walk-in refrigerator revealed one sealable plastic container of mixed fruit. The container was not labeled or dated. On 08/07/23 at 07:37 AM an observation in the kitchen's walk-in refrigerator revealed one opened roll of raw hamburger meat. The meat was in plastic packaging and wrapped in plastic wrap. The packaging/wrapping was undated. On 08/07/23 at 07:38 AM an observation in the kitchen'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 The facility identified a census of 51 residents. The sample included 15 residents. Based on record review, observations, and interviews, the facility failed to maintain sanitary infection control practices related to the storage of oxygen therapy equipment, performing hand hygiene during cares, and sanitization of shared equipment. This deficient practice placed the residents at risk for complications related to infectious diseases. Findings Included: - On 08/07/23 at 09:31AM, Licensed Nurse (LN) J did not sanitize a shared blood pressure cuff before using it on different residents. On 08/07/23 at 10:44AM, R37's continuous positive airway pressure (CPAP- mask used to treat sleep disturbances) mask was on the floor in his room with the face side down touching the floor. R37 reported he was not sure why the mask was on the floor. No storage bag was in the room. On 08/07/23 at 01:26 PM, R28's CPAP mask sat out on his dresser bedside his bed with no storage bag present. On 08/08/23 at 03:33 PM Licensed Nurse (LN) G…

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 with one resident reviewed for dignity. Based on observation, record review, and interviews, the facility failed to ensure Resident (R) 103's window blinds/curtain that open to a street was closed during peri-care and wound treatment to coccyx area. This deficient practice placed R103 at risk for impaired dignity and decreased psychosocial well-being. Findings included: - R103's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of diabetes mellitus (when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), and malnutrition (lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat). The admission Minimum Data Set (MDS) was in progress. R103's Care Area Assessment (CAA) was in progress. R103's Baseline Care Plan dated 08/04/23 documented staff would engage in simple, structured activities that avoid overly demanding tasks. On 08/08/23 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility identified a census of 61 residents and the sample included 15 residents. Based on observation, record review, and interviews, the facility failed to ensure Resident (R)31's call light was within reach. This deficient practice placed R31 at risk for preventable accidents and injuries. Findings Included: - The electronic medical record (EMR) for R31 documented diagnoses of hemiplegia (paralysis of one side of the body) and hemiparesis (muscular weakness of one half of the body) following a 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) affecting right dominant side, speech and language deficits following cerebral infarction, and generalized muscle weakness. R31's Significant Change Minimum Data Set (MDS) dated [DATE] documented a staff interview which indicated the resident had short-term and long-term memory problems. R31 was extensive assistance and required two-person…

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 identified a census of 61 residents. The sample included 15 residents with two residents reviewed for hospitalization. Based on observation, record review, and interviews, the facility failed to provide a written notification of transfers with the required information to Resident (R)18 or to their family/durable power of attorney (DPOA- legal document that named a person to make healthcare decisions when the resident was no longer able to) in a practicable amount of time for a facility-intiated transfer. This deficient practice had the risk of miscommunication between facility and resident/family and possible missed opportunity for healthcare service for R18. Findings included: - The Diagnoses tab of R18's Electronic Medical Record (EMR) documented diagnoses of spondylosis (a condition in which there is abnormal wear on the cartilage and bones of the neck), chronic respiratory failure with hypoxia (a serious condition that makes it difficult to breathe on your own), and congestive heart failure (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 The facility identified a census of 61 residents. The sample included 15 with two reviewed for bed holds. Based on record review, observations, and interviews, the facility failed to provide a bed hold for Resident (R)202 when hospitalized . This deficient practice placed R202 at risk of delayed care or uninformed choices. Findings Included: - The Medical Diagnosis section within R202's Electronic Medical Records (EMR) included chronic kidney disease, type two diabetes mellitus (when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), congestive heart failure (a condition with low heart output and the body becomes congested with fluid), dementia (progressive mental disorder characterized by failing memory, confusion), and dysphagia (swallowing difficulty). A review of R202's EMR revealed she admitted on [DATE]. A review of R202's Discharge Minimum Data Set (MDS) indicated she discharged to an acute care facility on 06/14/22. R202's Care Plan initiated 06/07/23…

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 The facility identified a census of 61 residents. The sample included 15 residents. Based on observation, record review, and interviews, the facility failed to develop person-centered comprehensive care plan for Resident (R) 104 related to her ability to participate in activities of daily living (ADLs) and storage /use of her nebulizer (an electrically powered machine that turns liquid medication into a mist so that it can be breathed directly into the lungs through a face mask or mouthpiece) mouthpiece. This deficient practice placed R104 at risk of lack of care related to ADL's, possible injuries, skin breakdown, uncommunicated needs, or possible further respiratory infections. Findings included: - R104's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of dementia (progressive mental disorder characterized by failing memory, confusion), Parkinson's disease (slowly progressive neurologic disorder characterized by resting tremor, rolling of the fingers, masklike faces, shuffling gait,…

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 identified a census of 61 residents. The sample included 15 residents with 15 reviewed for care plan revisions. Based on observations, interviews, and record reviews, the facility failed to revise Resident (R)27's care plan to reflect her timed toileting schedule. This deficient practice placed R27 at risk for complications related to uncommunicated care needs. Finding Included: -The Medical Diagnosis section within R27's Electronic Medical Records (EMR) included diagnoses of reduced mobility, need with help for personal cares, anxiety disorder (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear), insomnia (difficulty sleeping), type two diabetes mellitus (when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), chronic kidney disease, osteoarthritis (degenerative changes to one or many joints characterized by swelling and pain), muscle weakness, and dementia (progressive mental disorder characterized by failing…

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 - R104's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of dementia (progressive mental disorder characterized by failing memory, confusion), Parkinson's disease (slowly progressive neurologic disorder characterized by resting tremor, rolling of the fingers, masklike faces, shuffling gait, muscle rigidity and weakness), pneumonia (inflammation of the lungs), muscle weakness, and need for care with personal care. The admission Minimum Data Set (MDS) dated [DATE] documented cognition was not assessed. The MDS documented that R104 was dependent on two staff members assistance for activities of daily living (ADLs). The MDS documented the activity of bathing had occurred during the look back period for R104. R104's Communication Care Area Assessment (CAA) dated 08/02/23 documented the resident was at risk for a problem of potential for miscommunication of safety cues and instructions during therapy sessions, which may impede progress in ADL, related to her communication deficit. R104'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 The facility identified a census of 61 residents. The sample included 15 residents with three residents reviewed for pressure ulcer/injury (localized injury to the skin and/or underlying tissue usually over a bony prominence, because of pressure, or pressure in combination with shear and/or friction). Based on observation, record review, and interviews, the facility failed to ensure pressure reducing measures were placed on Resident (R) 104's bilateral lower extremities to prevent pressure ulcers. The facility also failed to ensure R103's pressure reducing boots on when in bed and to ensure staff implemented appropriate infection control practices during wound care, who was on an antibiotic (medication used to treat bacterial infections). This placed these residents at increased risk for pressure ulcer development and worsening of current wounds. Findings included: - R104's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of dementia (progressive mental disorder characterized by…

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 identified a census of 61 residents. The sample included 15 residents with five reviewed for accidents/falls. Based on observations, interviews, and record reviews, the facility failed to identify causative factors and implement fall interventions related to Resident (R)27's non-injury fall. This deficient practice placed R27 at risk for further falls and injuries. Finding Included: - The Medical Diagnosis section within R27's Electronic Medical Records (EMR) included diagnoses of reduced mobility, need with help for personal cares, anxiety disorder (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear), insomnia (difficulty sleeping), type two diabetes mellitus (when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), chronic kidney disease, osteoarthritis (degenerative changes to one or many joints characterized by swelling and pain), muscle weakness, and dementia (progressive mental disorder characterized by…

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 identified a census of 61 residents. The sample included 15 residents with five residents reviewed for respiratory care. Based on observation, record review, and interviews, the facility failed to store Resident (R) 104's nebulizer (an electrically powered machine that turns liquid medication into a mist so that it can be breathed directly into the lungs through a face mask or mouthpiece) mouthpiece in a sanitary manner. This deficient practice placed R104, who was being treated for pneumonia (inflammation of the lungs), at increased risk to develop other respiratory infections or delay of recovery. Findings included: - R104's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of dementia (progressive mental disorder characterized by failing memory, confusion), Parkinson's disease (slowly progressive neurologic disorder characterized by resting tremor, rolling of the fingers, masklike faces, shuffling gait, muscle rigidity and weakness), pneumonia, muscle weakness, and need…

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 with five sampled for unnecessary medications. Based on observation, record review and interview, the facility failed to ensure the Consultant Pharmacist (CP) identified and reported Resident (R)16's Zyprexa (anti-psychotic -class of medications used to treat psychosis and other mental emotional conditions) medication had an appropriate indication for use, or the required physician documentation. This deficient practice placed R16 at risk of unnecessary psychotropic (alters mood or thought) medication administration and possible adverse side effects. Findings included: - The Diagnoses tab of R16's Electronic Medical Record (EMR) documented diagnoses of Alzheimer's disease (progressive mental deterioration characterized by confusion and memory failure), anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), and major depressive disorder (abnormal emotional state characterized by exaggerated feelings…

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 with five reviewed for unnecessary medications. Based on observations, record review, and interviews, the facility failed to ensure ordered parameters were followed for Resident (R) 11's antihypertensive medications (medications used to treat high blood pressure). This deficient practice had the risk for physical complications and unnecessary medication usage. Findings included: - The Diagnoses tab of R38's Electronic Medical Record (EMR) documented diagnoses of hypertension (high blood pressure), heart failure, atrial fibrillation (rapid, irregular heartbeat) and a cardiac pacemaker (implanted device to regulate the beating of the heart). The Quarterly Review Minimum Data Set (MDS) dated 06/02/2023, documented R11 had a Brief Interview for Mental Status (BIMS) score of 15 which indicated intact cognition. R11 required supervision of one staff member for locomotion, dressing, eating and personal hygiene. R11 required limited assistance of one staff member for toileting, bed mobility and transfers. 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 with five sampled for unnecessary medications. Based on observation, record review and interview, the facility failed to ensure Resident (R)16's Zyprexa (antipsychotic -a class of medications used to treat psychosis and other mental emotional conditions) medication had an appropriate indication for use, or the required physician documentation. This deficient practice placed R16 at risk of unnecessary psychotropic (alters mood or thought) medication administration and possible adverse side effects. Findings included: - The Diagnoses tab of R16's Electronic Medical Record (EMR) documented diagnoses of Alzheimer's disease (progressive mental deterioration characterized by confusion and memory failure), anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), and major depressive disorder (abnormal emotional state characterized by exaggerated feelings of sadness, worthlessness, emptiness 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 identified a census of 61 residents. The sample included 15 residents. Based on observation, record review, and interviews, the facility failed to ensure Resident (R) 104 was free from medication errors when twelve medications were crushed and mixed together then administered via percutaneous endoscope gastrostomy (PEG-a tube inserted through the wall of the abdomen directly into the stomach) without a physician order. This deficient practice placed R104 at risk for increased complications and adverse side effects related medication interaction. Findings included: - R104's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of dementia (progressive mental disorder characterized by failing memory, confusion), Parkinson's disease (slowly progressive neurologic disorder characterized by resting tremor, rolling of the fingers, masklike faces, shuffling gait, muscle rigidity and weakness), pneumonia (inflammation of the lungs), muscle weakness, and need for care with personal…

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 with two residents reviewed for hospice and end of life care. Based on observation, record review, and interviews, the facility failed to collaborate with hospice to determine and direct the services, medication, and equipment provided to Resident (R)34 by hospice services. This deficient practice created a risk for missed opportunities for services and delayed treatment. Findings included: - The Diagnoses tab of R34's Electronic Medical Record (EMR) documented diagnoses of dementia (progressive mental disorder characterized by failing memory, confusion), anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily), depression (abnormal emotional state characterized by exaggerated feelings of sadness, worthlessness and emptiness), and Parkinson's disease (a chronic and progressive movement disorder that initially causes tremor in one hand, stiffness or slowing of movement). The Significant Change Minimum Data Set…

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 identified a census of 66 residents. The sample included 18 residents with 10 residents reviewed for activities of daily living (ADLs). Based on observations, record reviews, and interviews, the facility failed to provide consistent bathing per the residents ' preferences and bathing schedules for Residents (R) 28, R32, R9, R16, R55, R18, R20, R31, R37, and R48. This placed the residents at risk for poor hygiene and decreased self-esteem. Findings include- - The electronic medical record (EMR) documented the following diagnosis for R28: bipolar disorder (major mental illness that caused people to have episodes of severe high and low moods), chronic kidney disease, osteoarthritis (degenerative changes to one or many joints characterized by swelling and pain), hypothyroidism( condition characterized by decreased activity of the thyroid gland), hyperlipidemia(abnormally high level of protein in the blood), major depressive disorder(major mood disorder), acute kidney failure (disease characterized by 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.

The facility identified a census of 66 residents with 18 residents sampled. Based on observations, record reviews, and interviews, the facility failed to ensure appropriate hand hygiene during meal pass and failed to ensure sanitary laundry handling. This deficient practice increased the risk of the spread of illness and infection to the residents. Findings Include: - On 12/27/21 at 09:35 AM an unidentified nursing staff carried a resident's blanket to the resident's room and allowed the blanket to drag on the floor past the nurse's station. Observation on 12/28/21 at 10:00 AM revealed the laundry cart containing clean linen sat in the west hallway, uncovered and unattended. On 12/28/21 at 12:30 PM kitchen staff served plates to several residents in the west dining room. Staff performed hand hygiene prior to lunch service and then assisted several residents with no hand hygiene performed between individual residents. Kitchen staff washed hands and donned gloves to serve resident meals. The kitchen staff did not change their gloves after serving resident's plates and then returned 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 identified a census of 66 residents. The sample included 18 residents. Based on observation, record review, and interviews, the facility failed to ensure R31 choice was honored for his preferred bathing schedule and choice of bathing, which placed the resident at risk for negative psychosocial impact and increased feelings of shame and worthlessness. Findings included: - R31's electronic medical record (EMR) from the Diagnoses tab documented diagnoses of depression (abnormal emotional state characterized by exaggerated feelings of sadness, worthlessness and emptiness), pressure ulcer (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction), and need for assistance with personal care. The admission Minimum Data Set (MDS) dated [DATE] documented a Brief Interview of Mental Status (BIMS) score of 13 which indicated intact cognition. The MDS documented that R31 required extensive assistance 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 The facility identified a census of 66 residents. The sample included 18 residents. Based on observation, record review, and interviews, the facility failed to provide a sanitary and comfortable, homelike environment for Resident (R)45. This placed R45 at risk for impaired psychosocial wellbeing. Findings Include: - The electronic medical record (EMR) documented the following diagnoses for R45: lymphedema (swelling caused by accumulation of lymph), hypertension(high blood pressure), hypothyroidism (condition characterized by decreased activity of the thyroid gland), localized edema (swelling resulting from an excessive accumulation of fluid in the body tissues), type two diabetes (when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), anxiety disorder (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear), major depressive disorder (major mood disorder), insomnia (inability to sleep), gastro-esophageal reflux disease (backflow…

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 identified a census of 66 residents. The sample included 18 residents. Based on observation, record review, and interviews, the facility failed to obtain weekly weights for Resident (R) 3 who had an unintended weight loss, which had the potential for physical complications related to nutritional deficits. Findings included: - R3's electronic medical record (EMR) from the Diagnoses tab documented diagnoses of depression (abnormal emotional state characterized by exaggerated feelings of sadness, worthlessness and emptiness), pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction), and rheumatoid arthritis (chronic inflammatory disease that affected joints and other organ systems). The Significant Change Minimum Data Set (MDS) dated [DATE] documented a Brief Interview of Mental Status (BIMS) score of 14 which indicated intact cognition. The MDS documented R3 was independent…

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 identified a census of 66 residents. The sample included 18 residents. Based on observation, record review, and interviews, the facility failed to provide respiratory services per the standards of practice when staff failed to store oxygen (O2) tubing (device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help) and store/clean the equipment for bilevel positive airway pressure (BiPAP/BPAP -a ventilation device used to treat sleep apnea [disorder of sleep characterized by periods without respirations], that uses mild air pressure to keep airways open during sleep) for R20. This deficient practice placed R20 at increased risk for development of respiratory complications. Findings included: - R20's electronic medical record (EMR) from the Diagnoses tab documented diagnoses of atrial fibrillation (rapid, irregular heart beat), congestive heart failure (CHF-a condition with low heart output and the body becomes congested with fluid), chronic…

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 identified a census of 66 residents. The sample included 18 residents. Five residents were reviewed for unnecessary medications. Based on observation, record review, and interviews, the facility failed to ensure the Consultant Pharmacist (CP) identified and reported irregularities for R37's hypertensive medication (class of medication used to treat hypertension (high blood pressure) given outside the physician ordered parameters, which had the potential of unnecessary medication administration thus leading to possible harmful side effects. Findings included: - R37 's electronic medical record (EMR) from the Diagnoses tab documented diagnoses of depression (abnormal emotional state characterized by exaggerated feelings of sadness, worthlessness and emptiness), dementia (progressive mental disorder characterized by failing memory, confusion), hypertension (elevated blood pressure), and need for assistance with personal care. The admission Minimum Data Set (MDS) dated [DATE] documented that R37 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility identified a census of 66 residents. The sample included 18 residents, with five residents reviewed for unnecessary medications. Based on observation, record review, and interviews, the facility failed to follow a physician order for Resident (R) 20 and failed to hold antihypertensive (class of medication used to treat high blood pressure ) medication when indicated by the parameters set by the physician for R37. This deficient practice had the potential for unnecessary medication use and possible unwarranted side effects. Findings included: - R20's electronic medical record (EMR) from the Diagnoses tab documented diagnoses of atrial fibrillation (rapid, irregular heart beat), congestive heart failure (CHF- a condition with low heart output and the body becomes congested with fluid), chronic obstructive pulmonary disease (COPD- progressive and irreversible condition characterized by diminished lung capacity and difficulty or discomfort in breathing) and need for assistance with personal care. 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 The facility identified a census of 66 residents. The sample included 18 residents with one resident reviewed for food concerns. Based on observations, record reviews, and interviews, the facility failed to review Resident (R) 45's indicated allergies and offer nutritional substitutes to meet R45's dietary needs. This placed the resident at risk for malnutrition, complications from allergic reactions, and further dietary concerns. Findings Include: -The electronic medical record (EMR) documented the following diagnosis for R45: lymphedema (swelling caused by accumulation of lymph), hypertension(high blood pressure), hypothyroidism (condition characterized by decreased activity of the thyroid gland), localized edema(swelling resulting from an excessive accumulation of fluid in the body tissues), type two diabetes(when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), anxiety disorder (mental or emotional reaction characterized by apprehension, uncertainty 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 identified at census of 66 resident. The sample included 18 residents. Based on observation, interview, and record review, the facility failed to ensure that a communication process was implemented, which included how the communication was documented, between the facility and the hospice (type of health care that focuses on a terminally ill patient's pain and symptoms and attends to their emotional and spiritual needs at the end of life) provider, and a failed to provide a description of the services, medication, and equipment provided by hospice to Resident (R)16 and R48. This deficient practice created a risk for missed opportunities for hospice services, miscommunication between hospice and facility, and delayed treatment. Findings included: - The electronic medical record (EMR) for R16 documented diagnoses of malignant neoplasm of the breast and bone (a cancer/disease in which abnormal cells divide uncontrollably and destroy body tissue, cirrhosis of the liver (a chronic degenerative disease 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.