Maison du Monde Living Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews and interviews, the facility failed to develop and implement a comprehensive person-centered careplan for 2 (#17 and #53) residents in a final sample of 35 residents as evidenced by failing to: 1. notify the physician of Resident #17's abnormal CBG (Capillary Blood Glucose) levels as ordered; and 2. develop a focus area and interventions related to a choking incident for Resident #53. Findings: 1. Review of the facility's policy titled, Obtaining a Fingerstick Glucose Level last reviewed on 10/09/2024, revealed in part, Report abnormal results promptly to the supervisor or Attending Physician. Review of Resident #17's record revealed she was admitted to the facility on [DATE] with diagnoses which included, but were not limited to, end stage heart failure, unspecified dementia, and type 2 diabetes mellitus. A review of Resident #17's Order Summary Report, for the month of 08/2024, revealed an order, dated 08/01/2024, Novolin R Injection Solution (Insulin Regular (Human)) Inject as per…

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 observations, record reviews, and interviews, the facility failed to ensure recipes for pureed diets were followed. This failure had the potential to contribute to an unpleasant dining experience, decreased intake, altered nutritional needs, and weight loss for the 12 residents who received pureed meals. Findings: Review of a facility document titled Puree Recipe Liquid Addition - Quick Guide that read in part Item - vegetables, breads, desserts, pasta, sandwiches, fish, potato dishes, eggs, port, ham, chicken, steak/beef. Liquid - whole milk and margarine/butter for all listed items except steak/beef use gravy. On 12/16/2024 at 10:55 a.m., S4Cook was observed preparing pureed rice with a pan filled with water, pouring a white powdery substance from a white bag that contained instant puree rice into the water, and continuously stirring with a whisk. S4Cook was asked how much water the pan held, and she stated she did not know. S4Cook stated she just poured the pureed rice into the water and stirred until she achieved the smooth blended consistency she wanted. She stated she…

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 and record reviews, the facility failed to provide services that met professional standards for 2(#17 and #21) of 2 (#17 and #21) residents investigated for hospice services, by failing to: 1. Collaborate with the hospice agency to ensure the hospice nurse's visit notes and certification were up-to-date in Resident #21's hospice binder; and 2. Communicate with the hospice agency of Resident #17's high blood sugars. Findings: 1. A review of a document titled Nursing Facility Agreement indicated This Agreement is made and entered into this 23rd day of April 2018 by and between the facility and hospice .4.1 Compilation of Records. Nursing facility and hospice shall each prepare and maintain complete and detailed clinical records concerning each residential hospice patient receiving nursing facility services and hospice services under this agreement in accordance with prudent record keeping procedures and as required by applicable Federal and state law and regulations and applicable Medicare…

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, interviews, and record review, the facility failed to ensure 1 (#49) of 35 sampled residents was safe to perform self-administration of medication. Findings: On 12/18/2024, a review of the facility's policy titled Self- Administration of Medications which was last reviewed on 10/09/2024, read in part, Policy Statement: Residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so; Policy Interpretation and Implementation: 1. As part of their overall evaluation, the staff and/or practitioner will assess each resident's mental and physical, abilities to determine whether self-administering medications is clinically appropriate for the resident. 2. In addition to general evaluation of decision-making capacity, the staff and/or practitioner will perform a more specific skill assessment, 3. If the team determines that a resident cannot safely self-administer, the nursing staff will…

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 record review and interviews, the facility failed to ensure an alleged injury of unknown source was reported immediately, but not later than two (2) hours after the allegation was made to the State Survey Agency for 2 (#84, #113) out of 3 (#7, #84, #113) sampled residents investigated for falls. The deficient practice had the potential to affect a total census of 112 residents. Findings: On 12/17/2024, a review of the facility's policy titled, Abuse Investigation and Reporting with a last reviewed date of 10/09/2024 revealed the following in part .Reporting 1. All alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of an unknown source and misappropriation of property will be reported by the Facility Administrator, or his/her designee, to the following persons or agencies: a. The State licensing/certification agency responsible for surveying/licensing of facility .2. All alleged violations of abuse, neglect, exploitation or mistreatment (including injuries of…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to notify the State Long Term care Ombudsman of facility-initiated transfer for 2 (#84, #113) out of 2 (#84, #113) residents in a final sample size of 35. The deficient practice has the potential to affect a census of 112. Findings: Review of Resident #84's electronic health record revealed she was admitted to the facility on [DATE] with diagnoses which included, but were not limited to, Alzheimer's disease, major depressive disorder, anxiety disorder, and muscle wasting and atrophy. Review of Resident #84's nurse's notes revealed on 10/15/2024 at 6:00 a.m., the resident was transferred to the hospital. Further review of the nurse's notes revealed that on 10/15/2024 at 10:46 a.m., the resident returned from the hospital back to the facility. Further review of the facility's document titled Census List revealed Resident #84 was transferred to the hospital on [DATE], 11/08/2024 and 11/17/2024. Review of the Emergency Transfer Log for October 2024 revealed…

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 policy review, observations and interviews, the facility failed to ensure that the enteral feeding infused at the ordered rate for one (Resident #63) out of 2 Residents (Resident #63 and Resident #66) investigated for tube feeding. This had the potential to effect 3 residents in the facility who had tube feedings. Findings: Review of the facility's policy titled, Enteral Feedings-Safety Precautions last reviewed on 10/09/2024 revealed in part, the following Preventing errors in administration, 1. Check the enteral nutrition label against the order before administration. Check the following information: g. Rate of administration (ml (milliliters)/hr (hour)). Review of Resident #63's record revealed she was admitted to the facility on [DATE] with diagnoses which included, but were not limited to, Alzheimer's disease, unspecified dementia, dysphagia, chronic systolic (congestive) heart failure, and encounter for attention to gastrostomy. Review of Resident #63's physician orders revealed an order 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 Based on record reviews and interviews, the facility failed to maintain accurate medical records in accordance with accepted professional standards and practices by failing to ensure the comprehensive care plan was accurately documented for 1 (#53) resident. The deficient practice has the potential to affect a census of 112. On 12/19/2024, a review of the facility's policy titled, Charting and Documentation with a last review date of 10/09/2024, read in part, All services provided to the resident, progress toward the care plan goals, or any change in the resident's medical, physical, functional or psychosocial condition, shall be documented in the resident's medical record. The policy also indicated that the following information is to be documented in the resident medical record: Progress toward or changes in the care plan goals and objectives. Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate. Resident #53 Review of Resident #53's record revealed he…

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 observations, record review and interviews, the facility failed to maintain an effective infection control and prevention program by failing to ensure staff used personal protective equipment according to accepted standards of practice during biohazard trash removal. Findings: Review of a facility policy and procedure titled Personal Protective Equipment - Using Gloves, with revised date of 10/09/2024, read in part, .purpose to guide the use of gloves. Objectives - 1. To prevent the spread of infection. 3. To protect hand from potentially infectious material. When to use gloves: 4. When cleaning potentially contaminated items; and 5. Whenever in doubt. On 12/17/2024 at 10:58 a.m., an observation of Hall A revealed a treatment cart positioned against the wall. The treatment cart had a trash can attached with the lid of the trash can opened. A red biohazard trash bag was observed lining the trash can. A partially discarded blue glove was observed hanging half way outside of the red trash bag along with other discarded materials. On 12/17/2024 at 10:59 a.m., an observation 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 Based on record review and interviews, the facility failed to notify the resident's responsible party (RP), the nurse practitioner, and physician of a deteriorating right foot wound for 1 (#2) out of 3 (#1, #2, #3) sampled residents by failing to contact the responsible party (RP), nurse practitioner, and physician in a timely manner. Findings: On 05/07/2024, a review of the facility's policy titled, Wound Prevention with a last revised date of 06/14/2023 revealed in part the following: Policy: The purpose of this policy is to provide information regarding identification of wound/pressure ulcer/injury risk factors and interventions for specific risk factors for prevention of pressure ulcers/wounds. Monitoring: 1. Evaluate, report and document potential changes in the skin including new wounds/pressure ulcers. No mention of which professional discipline could perform the assessments or to who to report changes noted in the policy. Review of Resident #2's medical record revealed he was admitted to the facility on…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and interviews, the facility failed to maintain an effective infection control and prevention program by: 1. Failing to ensure staff sanitized reusable resident care equipment after each resident use. 2. Failing to perform proper hand hygiene after removing gloves This deficient practice had the potential to affect the 108 residents residing in the facility. Findings: Review of a policy titled Cleaning/Disinfection of Resident-Care Items and Equipment read in part Policy Interpretation and Implementation: 3. Reusable resident care equipment will be sterilized between residents according to manufacturer's instructions. Review of a policy titled, Handwashing/Hand Hygiene read in part. Policy Statement. This facility considers hand hygiene the primary means to prevent the spread of infections .6. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap .and water for the following situations .m. after removing gloves. 1.On 11/28/2023 at 8:55 a.m.,…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to provide colostomy care as required by the facility's policy for 1 (Resident #79) of 1 (Resident #79) residnet's reviewed for colostomy care. Findings: Review of facility's policy titled, Colostomy/Ileostomy care read in part . Documentation: the following information should be recorded in the resident's medical record: 1. the date and time the colostomy/ileostomy care was provided. 2. The name and initial of the individual who provided the colostomy/ileostomy care. 3. Any breaks in resident's skin, signs of infection. 4. How the resident tolerated the procedure. 5. If the resident refused the procedure, the reason why and the intervention taken. 6. The signature and title of the person recording the data. Resident #79 was admitted to the facility on [DATE] with diagnoses included Diverticulitis of Large Intestine with perforation and abscess without bleeding, Encounter for attention to Colostomy. A review of Resident #79's physician…

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 record review, observation, and interview, the facility failed to accurately assess and document the location and intensity of pain for 1 (Resident #34) of 1 residents reviewed for pain. Findings: Resident #34 was admitted to the facility on [DATE] with diagnoses that included Polyneuropathy, Type 2 Diabetes Mellitus, Spinal Stenosis, Pain, Neuropathy, Osteoarthritis, Parkinson's Disease with Dyskinesia, and Abnormal Posture. Review of the resident's Minimum Data Sets (MDS) dated [DATE] revealed a BIMS (Brief Interview of Mental Status) score of 10, indicating that the resident is moderately impaired. Review of Resident #34's care plan revealed, in part, alteration in comfort related to pain, neuropathy, OA (Osteoarthritis). Interventions read in part .if pain noted, assess location and intensity of pain. Review of Resident #34's November 2023 Physician orders revealed, in part, Naproxen Tablet (medication used for pain) 500mg (milligrams) give 1 tablet orally every 12 hours as needed for pain. Review…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews and record reviews, the facility failed to ensure the nursing staff demonstrated specific competencies and skill sets necessary to provide care to meet the residents' needs safely to attain or maintain the highest practicable physical well-being for 1 (#34) of 43 sampled residents. This was evidenced by S4LPN (Licensed Practical Nurse) leaving Resident #34's medication at the bedside. Findings: Resident #34 was admitted to the facility on [DATE], with diagnoses that included Polyneuropathy, Type 2 Diabetes Mellitus, Spinal Stenosis, Parkinson's Disease with Dyskinesia, and Abnormal Posture. Review of the resident's Minimum Data Sets (MDS) dated [DATE] revealed a BIMS (Brief Interview of Mental Status) score of 10, indicating that the resident is moderately impaired. Review of the resident's physician's orders dated 11/2023 revealed the following orders: - Sinemet 10-100mg (miligrams) give 1 tablet by mouth three times a day. - Duloxetine 30mg give 1 capsule orally one time a…

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

Based on staff interview and observation the facility failed to ensure all medications were properly stored and labeled as evidenced by: 1. Failing to ensure Novolog Multidose Insulin Pen was labeled with resident identification; and, 2. Failing to ensure controlled drugs awaiting disposal were stored and separately locked. The deficient practice had the potential to affect a total census was 108. Findings: 1. A review of the facility's policy titled Administering Medications revealed; 17. Insulin pens are clearly labeled with the resident's name or other identifying information. On 11/28/2023 at 10:15 a.m., an observation was made in Med Room A medication refrigerator accompanied by S4LPN. Upon inspection, a Novolog Multidose Insulin Pen was discovered. It was noted with no resident label/information. S4LPN could not confirm to which this medication belonged to and confirmed the medication should have been labeled with resident identification and was not. 2. A review of the facility's policy titled Discarding and Destroying Medications revealed; 1. All unused controlled substances…

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 record review and interview, the facility failed to ensure the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN), form Centers for Medicare and Medicaid Services (CMS)-10055, and Notice of Medicare Non-Coverage form CMS-10123 was completed prior to the discontinuation of Medicare Part A services (short term skilled nursing care and/or rehabilitation) for 1 (Resident #65) of 3 residents reviewed for termination of Medicare Part A services. Findings: Review of the Skilled Nursing Facility Advance Beneficiary Notice, form CMS-10055, completed by the facility revealed, in part, Resident #65's last day of Medicare Part A Services was on 10/04/2023. There was no documented evidence and the facility was unable to present any documented evidence Resident #65 had a signed CMS-10055, and CMS 10123 form prior to Medicare Part A services being terminated by the facility on 10/04/2023. On 11/29/2023 at 11:47 a.m., an interview was conducted with S2MDSA. S2MDSA stated the MDS (Minimum Data Set) coordinators are in charge of the Resident's NOMNC (Notice of Medicare…

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 and interview, the facility failed to provide a clean environment as evidenced by unclean floor and medical equipment at the bedside of 1 (#23) out of a final of 43 final sampled residents. Findings: Resident #23 was admitted to the facility on [DATE] with diagnoses including: Encounter for Attention to Gastrostomy and Dysphagia. The resident had an indwelling feeding tube. On 11/27/2023 at 09:48 a.m., an observation was conducted of Resident #23's room. The resident was lying in her bed with enteral nutrition formula hanging from an IV (intravenous) pole. A wet area was noted underneath the pole. On 11/28/2023 at 09:29 a.m., a second observation was conducted of Resident #23's room. The resident was sleeping in her bed. She was receiving infusions of enteral nutrition formula and water hanging from an IV pole. A closer observation revealed a brown moist buildup of enteral nutrition formula on the bottom of the IV pole, and a moist area with debris underneath the right upper wheel of the…

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

Based on record reviews and interview, the facility failed to ensure resident quarterly Minimum Data Set (MDS) assessments were completed within the required time frame for 2 (Resident #14, Resident #90) out of 43 sampled residents. Findings: A review of Resident #14's EMR (Electronic Medical Record) revealed the residents last quarterly MDS assessment reference date (ARD) was 07/19/2023. Further review of the EMR revealed an assessment was overdue by 27 days. A review of Resident #90's EMR revealed the resident's last quarterly MDS assessment reference date (ARD) was 07/19/2023. Further review of the EMR revealed an assessment was overdue by 27 days. On 11/29/2023 at 11:21 a.m., an interview was conducted with S19MDS. She viewed both resident's EMR and confirmed assessments for both were not completed within the required time frame making them 27 days overdue.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure the assessment accurately reflected the resident's status by failing to accurately code the Minimum Data Set (MDS) for medications for 1 (Resident #8) out of a finalized sample of 43. The deficient practice had the potential to affect a total of 108 residents on the census. Findings: Review of Resident #8's electronic health record revealed she was admitted on [DATE] with diagnoses that included: Fusion of Spine, Neuralgia, Acquired Absence of Left Leg Above Knee, Polyneuropathy. A review of the Quarterly MDS with an Assessment Reference Date (ARD) of 09/29/2023 for Resident #8 revealed, Section N: Medications, was coded 7 (days) for anticoagulant use. A review of the Medication Administration Record (MAR) for September 2023 revealed the residents anticoagulant was stopped on 09/21/2023. On 11/29/2023 at 10:20 a.m., an interview was conducted with S19MDS. She confirmed that the resident was taking an anticoagulant in the month of September 2023…

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 record review and interview, the facility failed to refer a resident with a newly diagnosed mental disorder to the appropriate state-designated authority for Level II PASARR (Preadmission Screening and Resident Review) evaluation and determination for 1 (Resident #8) resident investigated for PASARR in a final sample of 43 residents. Findings: A review of Resident #8's record revealed an admission date of 03/20/2017. Further review revealed he was diagnosed with Schizoaffective Disorder, Bipolar Type on 12/10/2021. Further review of Resident #8's record revealed a Level 1 PASARR (Preadmission Screening and Resident Review) dated 06/20/2019. There was no evidence that a rescreening had been submitted after the resident received a newly qualifying diagnosis of Schizoaffective Disorder, Bipolar Type on 12/10/2021 and there was no PASARR Level II noted in Resident #8's record. On 11/28/2023 at 2:57 p.m., an interview was conducted with S11SSD. She stated she was not aware that a reevaluation for a Level II PASARR determination should be resubmitted when a resident receives 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 record review and interviews the facility failed to ensure physician orders were implemented as ordered for checking oxygen saturations every shift, monitoring blood pressure before and after dialysis, and monitoring for symptoms before and after dialysis for 1 (#10) of 43 sampled residents. Findings: Review of Resident #10's health record revealed an admission date of 07/14/2021 with diagnoses which included, but were not limited to, End Stage Renal Disease, Shortness of Breath, Systemic Lupus Erythematosus, Edema, and Hypertension. Review of Resident #10's most recent Quarterly Minimum Data Set (MDS) dated [DATE], revealed the resident had a Brief Interview for Mental Status (BIMS) of 15 indicating his cognition was intact. Section O - Special Treatments, Procedures, and Programs checked for dialysis. Review of Resident #10's physician's orders revealed an order dated 09/08/2023 that read, check oxygen saturations every shift, monitor blood pressure pre and post dialysis every shift every Tuesday,…

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, record review and interview, the facility failed to ensure the resident and their representative received assistance in gaining access for hearing services for 1 (#44) out of 2 (#12, #44) residents investigated for hearing impairment out of a total sample of 43 residents. Findings: Resident #44. On 11/27/23 at 10:40 a.m., the resident was observed sitting in her chair in her room. During this observation, the surveyor spoke to the resident and the resident was observed having difficulty understanding. The resident stated that she has trouble with her hearing. Review of the resident's electronic clinical record revealed the resident was admitted to the facility on [DATE]. The resident's diagnoses included Unspecified Dementia without Behavioral Disturbance, and Anxiety. Review of the resident's quarterly MDS (Minimum Data Set Assessment) dated 9/27/2023 revealed the resident was coded having moderate difficulty for hearing. Review of the resident's care plan revealed the resident was care…

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 and record review, the facility failed to ensure that a resident who had a urinary catheter received services to prevent urinary tract infection for 1 (#65) of 43 sampled residents. Findings: Resident #65 was admitted to the facility on [DATE] with diagnoses including Urinary Retention. The resident had an indwelling catheter. Review of Resident # 65's plan of care revealed she had a history of Urinary Tract Infections, with the last one on 10/09/2023 and a goal to have no urinary Tract Infections this quarter. The resident was also care planned for having a Foley Catheter (indwelling urine drainage tube) and at risk for infections. Goal was for the catheter to remain patent, and interventions include ensuring tube is patent and free from twists and kinks. Review of Physician's Orders revealed an order written on 08/15/2023 to change indwelling catheter leg strap weekly and PRN (as needed). On 11/28/2023 at 09:05 a.m., an observation was conducted of S14CNA (Certified Nursing Assistant) 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 Based on observation, interview, and record review, the facility failed to ensure a resident's continuous positive airway pressure (CPAP) mask stored properly for 1 (Resident #63) of 4 sampled residents reviewed for respiratory care. Findings: Review of facility's policy, titled, Respiratory Therapy, read in part . Infection Control Considerations Related to Oxygen Administration . 5. Keep the oxygen cannula and tubing used PRN (as needed) in a plastic bag when not in use. Review of Resident #63's record revealed the resident was admitted to the facility on [DATE] with diagnoses of Parkinson's Disease and Obstructive Sleep Apnea (OSA). Review of Resident #63's care plan read in part . Diagnosis- sleep apnea: at risk for altered sleep pattern, interventions: change tubing/mask as ordered. Review of Resident #63's Physician Orders for November 2023 revealed, in part, Resident #63's Auto-PAP 9-15 (CPAP) worn for every sleep. On 11/27/2023 at 09:23 a.m., an observation was made of Resident #63's room. The resident…

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 record reviews and interviews, the facility failed to ensure ongoing communication and collaboration with the dialysis facility through dialysis communication forms for 1 (#10) out of 1 (#10) residents sampled for dialysis services. Findings: Review of the facility's policy, End-Stage Renal Disease, Care of a Resident with revealed, in part, the following: Policy Statement: Residents with end-stage renal disease (ESRD) will be cared for according to currently recognized standards of care. Policy Interpretation and Implementation . 3. Agreements between the facility and the contracted ESRD facility include all aspects of how the resident's care will be manages, including: a. How information will be exchanged between facilities. Review of Resident #10's health record revealed an admission date of 07/14/2021 with diagnoses which included, but were not limited to, End Stage Renal Disease, Systemic Lupus Erythematosus, Edema, and Hypertension. Review of Resident #10's most recent Quarterly 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.

Based on observation, interview and record review, the facility failed to honor and accommodate food preferences for 1(#7) out of 2 (#7, #55) residents reviewed for food. This deficient practice had the potential to affect 107 residents who consumed meals from the kitchen. Findings: Review of Resident #7's record revealed an admission date of 08/24/2023 with diagnoses that included Gastro-Esophageal Reflux Disease, Diarrhea, Nausea, Constipation, Abnormality of Albumin, Dysphagia, Hyperlipidemia, Vitamin B Deficiency. Review of Resident #7's care plan revealed a focus area for food preferences that stated no peanuts. Review of admission progress note dated 08/24/2023 revealed no peanuts. On 11/27/2023 at 10:35 a.m., an interview was conducted with Resident #7. She stated she was allergic to peanuts and still received it on her food tray. On 11/27/2023 at 11:15 a.m., an observation was made of Resident #7's lunch time meal tray. She was served peanut butter frosting on her dessert. The meal ticket indicated no peanuts. On 11/27/2023 at 11:17 a.m., an interview was conducted with S2DM…

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

Based on observation, interview, and record review, the facility failed to store food in accordance with professional standards in the kitchen by failing to ensure compromised cans in the dry storage room were disposed and not readily available for use. Findings: On 11/27/2023 at 8:40 a.m., an observation of the dry storage room with S2DM (Dietary Manager) revealed 4 cans of vegetable soup, 1 can of condensed cream of mushroom soup, and 3 cans of mandarin oranges that were dented near the lip of the cans. An interview with S2DM confirmed the cans on the shelf were compromised, available for use, and should have been discarded.