Caroline Nursing And Rehab

Based on complaints, observation, record review, and interview, it was determined the facility staff: 1) failed to revise and update resident care plans to reflect accurate and current interventions, and 2) failed to have timely care plan meetings with a resident and/or resident representative. This was evident for 6 (#38, #68, #63, #19, #37, #241) of 38 residents reviewed during a recertification/complaint survey. The findings include: A care plan is a guide that addresses the unique needs of each resident. It is used to plan, assess, and evaluate the effectiveness of the resident's care. Care conferences are usually held on a regular basis, often quarterly, but can be scheduled more frequently if needed based on the resident's condition. The Minimum Data Set (MDS) is administered to all residents upon admission, quarterly, yearly, and whenever a significant change in an individual's condition occurs. It is a standardized assessment tool to comprehensively evaluate a resident's health status, functional abilities, and needs. It is the foundation for creating a personalized 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.

Based on an interview with a resident, a record review and interview with facility staff, it was determined that the facility failed to ensure comprehensive care plans were developed and implemented. This was evident for 3 residents (Resident #11, Resident # 57 and Resident # 247) out of 38 residents reviewed for developing the comprehensive care plans during the Medicaid/Medicare recertification survey. The findings include: 1)On 11/12/24 at 1:19 PM during the initial screening of the residents, Resident #11 stated that he/she does not participate in any activity within the facility and would like for activity staff to visit him/her in the room so that he/she can know about the kind of activity that he/she could be a part of. On 11/13/24 at 02:57 PM, the surveyor reviewed Resident #11's electronic records for an activity care plan. The care plan did not show any focus, goals or interventions for the resident's activity while in the facility. On 11/13/24 at 03:12 PM, in an interview with the Activities Director (Staff #6), she was asked about how activities were done with 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.

Based on record review and interview with the facility staff and residents, it was determined that the facility staff failed to provide an activities program to meet the needs and preferences of residents. This was evident for 1 (Resident #11) of 6 residents reviewed for activities during the Medicare/Medicaid Recertification survey. The findings include: On 11/12/24 at 1:19 PM, during the initial screening of the residents, Resident #11 stated that he/ she does not participate in any activity within the facility and would like for activity staff to visit him/her in the room so that he/she can know about the kind of activity that he/she could be a part of. On 11/13/24 at 03:12 PM, in an interview with the Activities Director (Staff #6), she was asked about how activities were done with residents who were bed-bound. She stated that she does one-on-one visits. When she was asked about the activities done with Resident #11, she stated that the facility has not yet started an activity with the resident and that she stated that the resident has not been getting activities except 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 Based on the medical record review, resident interview, and staff interview, it was determined that the facility failed to 1) ensure that a resident (Resident #244) received appropriate care regarding dysphagia by failing to supervise and/or assist with feeding, and additionally develop a care plan for dysphagia and 2) ensure adherence to the prescribed frequency and medication administration time (Resident #37, #14). This was evident for 3 (Resident #244, #37, #14) of 38 residents reviewed during the recertification/complaint survey. The findings include: Oropharyngeal dysphagia, also known as transfer dysphagia, is a condition that makes it difficult to move food or liquids from the mouth into the esophagus. 1)On 11/21/24 at 8:50 AM, a review of complaints revealed that Resident #244's family members reported they observed the resident in August 2022 with partially chewed food on his/her lap, stuck to the side of his/her face, and food stuck in the roof of his/her mouth. They also added that they removed…

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 a complaint, observation, resident and facility staff interviews, and medical record review, the facility failed to prevent new pressure ulcers and document weekly skin and wound assessments for residents with pressure ulcers. This was evident for 1 (Resident # 246) out of 2 residents who were reviewed for pressure ulcer prevention and treatment during the recertification/complaint survey. The findings included: A pressure ulcer, also known as a pressure sore or decubitus ulcer, is any lesion caused by unrelieved pressure that results in damage to the underlying tissue. Pressure ulcers are staged according to their severity from Stage I (area of persistent redness), Stage II (superficial loss of skin such as an abrasion, blister, or shallow crater), Stage III (full-thickness skin loss involving damage to subcutaneous tissue presenting as a deep crater) or Stage IV (full thickness skin loss with extensive damage to muscle, bone or tendon). An unstageable pressure ulcer is a type of bed sore that occurs when full-thickness skin and tissue are lost, but the extent 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 observation, medical record review, and interview, it was determined the facility staff failed to date and label oxygen administration equipment and maintain a nasal cannula in a sanitary manner to prevent potential infection . This was evident for 2 (#39, #74) of 3 residents reviewed for respiratory care during a recertification/complaint survey. The findings include: Oxygen (O2) therapy is a treatment that provides you with extra oxygen to breathe in. It is also called supplemental oxygen. It is only available through a prescription from your health care provider. A care plan is a guide that addresses the unique needs of each resident. It is used to plan, assess, and evaluate the effectiveness of the resident's care. 1) On 11/12/2024 at 10:18 AM, the surveyor observed Resident #39 lying in bed. The resident was wearing a nasal cannula (a device that delivers extra oxygen through a tube and into your nose) that was connected to a humidifier (water) bottle connected to an oxygen concentrator set at 3LPM (liters per minute). The LPM oxygen flow rate of 3 indicates that 3…

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 a review of employee records and interviews, it was determined that the facility staff failed to conduct performance reviews of Geriatric Nursing Assistants (GNAs) and Licensed Practical Nurses (LPN) at least once every 12 months. This was evident for 3 (GNA #42, #43, #44) and 2 Licensed Practical Nurses (#19, #41) of 6 randomly selected nursing staff records reviewed for annual training requirements during the recertification/complaint survey. The findings: On 11/19/20/24 at 9:39 AM, a review of randomly selected GNA's records revealed that GNA #42 was hired on 12/27/2017. Further review of his/her personal file failed to produce a record of his/her annual performance review. GNA #43 was hired in 2013, and GNA #44 was hired on January 2023, and their last documented evaluation was on 1/22. LPN #19 was hired on May 2023, LPN #40 on 10/9/2023, and LPN #41 in August 2022. There were no documented evaluations at the time of this record review. On 11/19/2024 at 3:47 PM, the surveyor requested copies of the annual evaluations for LPN #40, LPN#41, and GNA #44 from the Director 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.

Based on observation and interview it was determined facility staff failed to remove expired medications and patient supplies. This was evident on 2 of 4 nursing units and a central supply room observed during a recertification/complaint survey. The findings include: On 11/19/2024 at 11:35 AM, B/C-Wing med room was reviewed for medication storage and labeling in the presence of B-Wing Unit Manager (UM #19). Surveyor found the following expired supplies in the med room: - Derma Daily Moisturizing lotion with Aloe Vera: lot #20668A, Expiration date 07/24 - Derma Daily Moisturizing lotion with Aloe Vera: lot # 20520A, Expiration date 6/24 UM #19 confirmed the findings and immediately removed the expired supplies from the med room. On 11/19/2024 at 11:50 AM, surveyor reviewed medication storage and labeling for B-Wing OMNICELL room in the presence of UM #19. OMNICELL is a smart medical storage unit equipped with sensors and technology to monitor inventory, track expiration dates, and streamline medication management. The following expired medications were found in the refrigerator in…

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, review of resident medical records, review of facility policy, and interview with facility staff, it was determined that the facility failed to ensure that 1) physician's order for appropriate infection control signage with a COVID-19 positive resident was implemented, 2) follow-up tests were conducted for residents exposed to COVID-19, and 3) failed to ensure that a resident known to be positive for Covid-19 was isolated upon readmission as the resident was readmitted directly into original room with roommate.This was evident for 1 resident(Resident #55) out of 2 residents reviewed for Isolation precautions during the recertification/complaint survey. The findings include: On 11/13/24 at 08:29 AM, during a tour of the facility, the Surveyor observed an Enhanced barrier precaution sign on room D-5 and observed that there were two residents in the same room. On the same day at 08:40 AM, the surveyor asked Licensed Practical Nurse (LPN #14) why the door sign was there. She stated that Resident #55 was on enhanced barrier precaution due to being positive for…

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 the record reviews and interviews, and observations, it was determined that the facility failed to thoroughly investigate an abuse allegation. This is evident for 5 (Resident#232, #235, #63, #32, #7) of 38 residents reviewed during the recertification/complaint survey. The findings include: 1)On 11/13/23 at 3:30 PM, the surveyor reviewed one of the facility's incident reports, MD00198830. The incident report stated that Resident #235 reported to his/her family member that a same-gender staff had sexually assaulted him/her; the reporter described when they did a skin check on 10/20/2023, the incident occurred. The facility's investigation had a written statement from the nurse who conducted a skin assessment upon Resident #235's admission. Also, there were five written statements from staff: three Geriatric Nurse Aides, one other Licensed Practical Nurse, and one statement without the name of the person who wrote it. However, the facility's investigation did not have additional documentation to identify who was involved in this incident. Also, no interviews were documented…

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 a complaint, review of medical records, and staff interview, it was determined facility staff failed to notify a resident's representative when a resident had a medication change. This was evident for 1 (Resident #7) of 15 residents reviewed for complaints during a Recertification/Complaint survey. The findings include: On 11/20/2024 at 8:00 AM, a review of complaint #MD00193361 revealed Resident #7 was started on a new Medication (Mirtazapine, also known as Remeron) but facility staff failed to notify the Resident's Representative (RP). Mirtazapine is a medication used to treat depression and is sometimes used to help with sleep and to increase appetite for people who are not depressed. On 11/20/2024 at 8:24 AM, Review of Resident #7's clinical records revealed the resident was originally admitted to the facility on [DATE] and re-admitted on [DATE] with medical diagnoses that included but not limited to Major Depressive disorder, Alzheimer's disease, Dysphagia following Cerebral Infarction, Feeding…

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 a review of the facility self-report, record reviews, resident interview, and staff interviews, it was determined that the facility failed to ensure residents were free from verbal abuse. This is evident for 1(Resident #63) of 10 residents reviewed for abuse during the recertification/complaint survey. Findings include: On 11/15/2024 at 10:50 AM, a review of a Facility Reported Incident (FRI) submitted to the Office of Health Care Quality (OHCQ) revealed that, on 8/21/24 at 6:30 PM, Resident #63 was verbally abused by a Geriatric Nurse Aide (GNA), and that incident was reported to the facility by another resident's family member. The report revealed that the GNA stated to Resident #63 If you yell at me again, I am going to make you sit in that chair all night. The complainant stated that Resident #63 had been yelling to get into bed. On 11/15/2024 at 10:50 AM, a review of the initial FRI report form revealed that the facility's corrective action was the termination of the alleged perpetrator, Staff #38. A review of the Employee Status Change form confirmed her termination…

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 staff interviews, it was determined that the facility failed to timely report verbal abuse to the State Survey Agency and other agencies as required by law. This is evident for 1 (Resident #63) of 9 residents reviewed for facility reported incidents during the recertification/complaint survey. Findings Include: On 11/15/2024 at 10:50 AM, a review of a Facility Reported Incident submitted to the Office of Health Care Quality (OHCQ) revealed that a self-report for verbal abuse against Resident #63 was submitted to OHCQ on 8/22/2024 at 4:09 PM; however, this alleged incident was witnessed by another resident's family member who notified the supervisor of the incident on 8/21/2024 at 6:35 PM. On 8/21/24, it was alleged that Resident #63 was verbally abused by a Geriatric Nurse Aide (GNA). On 11/15/2024 at 11:50 AM, in a Nursing Home Administrator (NHA) interview, the NHA confirmed verbal abuse and as a result, Staff #38 was terminated on 8/23/2024. The surveyor asked the NHA about the reporting time for abuse to the State Agencies and she stated they notify…

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 a review of the resident medical records and an interview with facility staff, it was determined that the facility failed to address a significant weight loss for the resident. This was evident for 1 (Resident #238) of 7 residents reviewed for nutrition during this survey. The findings include: During a review of complaints on 11/19/24 at 11:00 AM, it was noted that Resident #238 had significant weight loss from 8/05/22 (258.8 pounds via mechanical lift) to 8/18/22 (194.3 pounds via mechanical lift): 64.5 pounds, 24.9% loss, within 13 days. The following body weight was recorded on 9/02/22 as 198.3 pounds. A review of Resident #238's medical records on 11/19/24 at 11:15 AM revealed that the previous dietitian ( Staff #39) wrote a progress note on 8/29/22 as possible significant weight loss- requested reweigh. Recommendations: continue regular diet with mechanical soft/ honor food preferences as much as able/ encourage intake and assist as needed/ continue liquid protein/ re-evaluate weight when reweight is available. However, there was no additional documentation from 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 observation, record review, and interview, it was determined that the facility staff failed to ensure access to the nurse call bell for residents who were totally dependent on nursing staff due to impaired mobility. This was evident for 4 (#73, #28, #22, #64) of 20 residents reviewed during the initial pool process. The findings include: 1) An observation was made of Resident #73 on 10/8/19 at 2:38 PM, the resident was sitting in a chair at the end of his/her bed, however, the call light was wrapped around the top right bed rail which was out of reach for the resident. Another observation was made of Resident #73 on 10/11/19 at 1:31 PM, the resident was sitting upright in bed and the call light was on the floor. At the time that the observation was made, Geriatric Nursing Assistant (GNA) #7 came in the room to pick up the resident's lunch tray and GNA #8 lowered the head of the bed for resident, however, neither staff person picked up the call light to place it within reach of the resident. During an interview with GNA #8, on 10/11/19 at 1:46 PM, it was revealed that s/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 record review and staff interview, it was determined that the facility failed to develop and implement infection control policies and procedures to prevent resident exposure to tuberculosis and childhood communicable diseases. This was evident for 5 (#13, #14, #15, #16, and #17) of 5 employee files reviewed for immunity of communicable diseases and screening for tuberculosis. The findings include: On 10/11/19 at 11:14 AM, a review of immunization records for Staff #13, #14, #15, #16, and #17 revealed that they did not provide proof of immunity to childhood communicable diseases. Review of tuberculosis screening revealed that Staff #13, #14, and #16 had two tuberculin skin test placed and read, however, there were no times to verify they were read within the 48 - 72 hour time frame as instructed on the manufactures instructions for Sanofi Pasteur Tubersol (https://www.fda.gov/files/vaccines%2C%20blood%20%26%20biologics/published/Tubersol-Package-Insert.pdf). During an interview with Infection Control Preventionist (ICP) #4, on 10/11/19 at 9:46 AM, she confirmed that 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 review, resident interview, and staff interview, it was determined that the facility failed to keep an alleged abuser away from the resident during the investigation. This was evident for 1 (Resident #31) of 3 residents reviewed for abuse. The findings include: Review of the facility reported incident investigation report on 10/9/19 at 2:30 PM, revealed that Resident #31 reported to Licensed Practical Nurse (LPN) #12 on 12/14/18 at 11:25 PM, that Geriatric Nursing Assistant (GNA) #11 had punched him/her in the arm. LPN #12 reported that GNA #11 was removed from resident's care immediately, however, a statement written by GNA #11 on 12/15/18, revealed documentation that she went into Resident #31's room and asked the roommate if he/she witnessed her punch the resident at any time, after she was informed that Resident #31 accused her of punching them. During an interview with Corporate Nurse #6 on 10/10/19 at 8:32 AM, it was revealed that GNA #11 was terminated for other reports of customer services issues. Corporate Nurse #6 was made aware of concerns. 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 medical record review, observation and interview, it was determined that the facility failed to ensure that Minimum Data Set (MDS) assessments accurately reflected the residents status as evidenced by the failure to assess the presence of cracked teeth and failed to assess the use of a wanderguard device. This was found to be evident for one of one resident (Resident #55) reviewed for dental and one of six residents (Resident #4) reviewed for accidents. MDS is a federally-mandated assessment tool used by nursing home staff to gather information on each resident's strengths and needs. Information collected drives resident care planning decisions. MDS assessments need to be accurate to ensure that each resident receives the care they need. The findings include: 1) On 10/9/19 at 8:56 AM, Resident #55 was observed with a broken front tooth. On 10/9/19 at 2:54 PM, review of the medical record revealed an annual MDS assessment with an assessment reference date (ARD) of 6/15/19. Review of this assessment failed to reveal any dental issues being identified in Section L Oral/Dental…

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 medical record review and interview, it was determined that the facility failed to ensure the baseline care plan included instructions needed to provide effective and person-centered care of the resident that meets professional standards as evidenced by failure to include interventions for actual skin breakdown in the baseline care plan. This was found to be evident for one of three residents (Resident #135) reviewed for possible pressure ulcers. The findings include: On 10/10/19 review of Resident #135's medical record revealed the resident was admitted to the facility on [DATE]. Review of the primary care physician note, dated 10/4/19, revealed the following: .Pt [patient] has been bed bound for awhile and is unable to move self about. Pt has had a sore on [his/her] bottom for at least the last 2-3 yrs that comes and goes but never completely resolved . Review of a Weekly Skin Checks assessment, dated and signed by nurse (RN #19) on 10/4/19, revealed the following documentation: 1.8 x 2.0 x u…

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 medical record review and staff interview, it was determined the facility 1) failed to follow a resident's care plan related to activities of daily living (ADL), 2a) failed to follow a resident care plan related to monitoring for psychotropic drug side effects, 2b) failed to develop and implement comprehensive, person-centered care plans with non-pharmacological approaches to care for a resident receiving psychotropic medication, and 3) failed to implement the use of fall mats as indicated in the resident's fall care plan. This was evident for one (Resident #132) of two residents reviewed for discharge; one (Resident #17) of five resident's reviewed for unnecessary medications; and one of six residents (Resident #64) reviewed for accidents. The findings include: A care plan is a guide that addresses the unique needs of each resident. It is used to plan, assess and evaluate the effectiveness of the resident's care. 1) Resident #132's closed medical record was reviewed on 10/10/19 at 5:04 PM. Review of Resident #132's annual assessment with an assessment reference date 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.

Based on observation, record review and staff interview, it was determined that the facility failed to provide Activities of Daily Living (ADL) for a resident who required assistance from staff for bathing. This was evident for 1 (Resident #132) of 2 residents reviewed for discharge. The findings include: ADLs are activities that people perform every day such as, getting dressed, taking showers or baths, cooking, and eating. On 10/10/19 at 5:04 PM, Resident #132's closed medical record was reviewed and revealed that the physician documented in a discharge summary that the resident had initially been admitted to the facility for rehab after a fall with fracture and eventually had an amputation after multiple infections. Resident #132's annual assessment, with an assessment reference date of 1/11/19, was reviewed and revealed documentation that Resident #132 had diagnoses that included: absence of the right leg, below the knee, repeated falls, difficulty in walking and muscle weakness and documented that Resident #132 required assistance for bathing. Review of Resident #132's 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.

Based on observation, family interview, record review, and staff interview, it was determined that the facility staff failed to provide activities for a resident who required individual activities in their room. This was evident for 1 (Resident #22) of 2 residents reviewed for activities. The findings include: During multiple observations of Resident #22 on 10/8/19, 10/9/19, and 10/10/19, at varying times, the resident was lying in bed on his/her back with no television or radio on. An interview with a family member on 10/9/19 at 11:01 AM, revealed that resident was in bed for most of the time, other than to go to physical therapy. The family member reported that resident would enjoy music groups. Medical record review on 10/11/19 at 9:00 AM, revealed an Activities care plan initiated on 5/8/19, with the interventions that staff would provide 1:1 visits of interest and listed music, social, and reading 6 times a month. Another intervention documented was that staff would provide a place to visit with family and friends as desired. The Activity Director (AD) Staff #10 was interviewed…

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.

2) On 10/09/19 at 10:14 AM, Resident #4 was observed to be wearing a wanderguard. Review of the resident's medical record revealed diagnosis of dementia and delusions. A wanderguard is a device, that the resident wears like a braclet on either the writst or ankle, that alarms when the resident is within a certain distance from an exit. On 10/11/19 at 9:20 AM, review of the resident's medical record revealed orders to check the Wanderguard function every morning and to check the placement every shift. Both of these orders were in effect since June 2018. Review of the treatment administration record (TAR) revealed the order to Check Wanderguard function in the morning was scheduled for 6:00 AM indicating this check should be completed by the night shift nurse. Review of the October 2019 TAR failed to reveal documentation that the wanderguard function check had been assessed on October 6, 7 or 11, 2019. Review of the September TAR failed to reveal documentation that the wanderguard function check had occurred on September 7, 8, 22, or 23, 2019. On 10/11/19 at 10:09 AM, the nurse (LPN…

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 medical record review and staff interviews, it was determined that the facility staff failed to ensure that a resident's medication regimen was free from unnecessary medication by failing to ensure that 1) psychotropic medication prescribed as needed included the frequency the medication could be administered and 2) that the psychotropic order was limited to 14 days or had a specific duration, with rationale for an extended time period documented in the medical record, and 3) failed to monitor a resident for side effects related to the use of antidepressant medications. This was evident for 1 (Resident #17) of 5 residents reviewed for unnecessary medications. The findings include: On 10/11/19 at 12:32 PM, Resident #17's medical record was reviewed. Review of Resident #17's October 2019 MAR (medication administration record) revealed an order, Xanax (Alprazolam) tablet 0.5 MG (milligrams) by mouth as needed for anxiety, agitation, related to delusional disorders, generalized anxiety disorder, medication is not to have a stop date, do not put a stop date onto this order 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and staff interview, it was determined that the facility failed to keep complete and accurate medical records as evidenced by having two conflicting Maryland Medical Order for Life Sustaining Treatment (MOLST) forms in the electronic health record. This was evident for 1 (Resident #83) of 3 closed records reviewed. The MOLST documents a person's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatments. The findings include: On [DATE] at 1:44 PM, review of Resident #83's closed electronic medical record revealed that Resident #83 had 2 physician signed MOLST forms. One MOLST was signed and dated [DATE] and documented Resident #83 elected Attempt CPR, indicating that, if cardiac and/or pulmonary arrest occurs, attempt CPR. The second MOLST was signed and dated [DATE] and documented that Resident #83 elected No CPR, Option B, Palliative and Supportive Care. Page 2 of the MOLST documented Resident #83's preferences that applied to other situations other…

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 review of employee files and interview with staff it was determined that the facility failed to have a system in place to ensure that all geriatric nursing assistants (GNA) and certified medicine aides (CMA) were able to demonstrate competency in skills and techniques necessary to care for residents This was evident for 7 of 15 GNA and CMA's records (#5, #6, #9, #10, #11, #12 and #13) selected for review. The findings include: A review of 13 GNA and 2 CMA employment files was completed. During the review it was noted that there was no skills competency checklists to be found in the records for staff #5, #6, #9, #10, #11, #12 and #13. The GNA's skills competency checklists are to be completed during orientation to demonstrate mastery of skills such as resident bathing, feeding, and transferring. The CMA's the list includes items such as administering eye drops or ear drops properly and knowing what medications can be crushed. Once each skill is demonstrated then the CMA/GNA's preceptor signs the checklist as completed and the new employee is available to work without 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 medical record review and staff interview, it was determined that facility staff failed to initiate a Care Plan for a bowel regimen. This was true for 1 of 1 residents (#47) reviewed for bowel regimen. The findings include: A Care Plan is a guide that addresses the unique needs of each resident. It is used to plan, assess, and evaluate the effectiveness of the resident's care. On 5/16/18 a review of Resident #47's medical record was initiated. A review of the record indicated the Resident had not had a bowel movement on 5/12/18 or 5/13/18. On 5/14/18 there was a notation indicating that the resident's stool was small. A review of the care plans did not reveal a care plan for bowel regimen (constipation). Observation of the resident on 5/14/18 at 12:33 PM revealed he/she was in bed because he/she had been given laxatives and was told not to get out of bed. The Resident had a physician's order for a Bowel Regimen- 1. MOM Suspension, 400mgm/30ml by mouth as needed, if no bowel movement for 48 hours. 2. Bisacodyl Suppository 10mgm after MOM. 3. Fleets enema 7-19 GM/118ml if no…

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, medical record review and interview with facility staff, it was determined the facility failed to 1. apply Geri sleeves to the Bilateral Lower Extremities as ordered by the physician (#131) and 2. document a change in condition assessment (#81). This was evident for 2 of 37 residents reviewed. The findings include: Geri Sleeves- Breathable cotton blend Lycra that protects against skin tears. Review of Resident (#131's) medical record on 5/16/18 at 11 AM revealed a physician order dated 3/5/18 to apply Geri Sleeves to the BLU (Bilateral Upper Extremities) and BLE (bilateral Lower Extremities) at all times every shift except during care. During observations on 5/14/18 at 11am, 5/15/18 at 1pm, 5/16/18 at 9am and 5/17/18 at 3pm, the resident did not have the Geri sleeves on his/her lower extremities; however, the Treatment Administration Record was signed off that the Geri sleeves were applied. During interview with the Charge Nurse of D wing and the [NAME] President of Operations the finding was verified. 2) The facility failed to ensure that a nurse who assessed…

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 medical record review and interview, it was determined the facility staff failed to complete an annual nutritional assessment following a significant weight loss. This was evident for 1 of 5 residents (#12) reviewed for nutrition during this annual survey. The findings include: Record review revealed Resident #12 weighed 130 lbs. on 8/9/17, 119 lbs. on 11/8/17, 116 lbs. on 2/7/18, and 114 lbs. on 5/9/18. This represents a 12.31% weight loss. On 3/2/18 the facility dietitian completed part of Resident #12's annual Minimum Data Set (MDS) assessment and answered question K0300 - Loss of 5% or more in the last month or loss of 10% or more weight in the last 6 months? -- answered Yes and not on prescribed weight-loss regimen. The annual 3/2/18 MDS assessment revealed the continued weight loss. The facility policy requires quarterly nutrition assessments to reassess resident's nutritional needs. The MDS is a federally-mandated assessment tool that helps nursing home staff gather information on each resident's strengths and needs. Information collected drives resident 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 medical record review and interview, the physician's nurse practitioner failed to 1. document current medications accurately (Resident #1 and #55) and 2. have psychiatry visit notes available in a timely manner. This was evident for 3 of 37 residents reviewed in the final sample. The findings include: The psychiatric nurse practitioner visited Resident #55 on 5-15-18. The visit note listed Resident #55 on Zyprexa for delusions, Trazodone for insomnia and Remeron for depression. The Trazodone had been discontinued by the primary physician on 4-18-18 because it was causing urinary retention. Interview with the nurse practitioner on 5-18-18 at 9:23 AM confirmed the inaccurate medications on the visit note. This finding of incorrect medications listed was also was confirmed by Staff #1 on 5-16-18 at 9:00 AM. 2. Review of Resident #1's medical record on 5/18/18 at 11:52 AM revealed the resident's included Depakote Sprinkles DR 125mg 4 capsules 2x a day for mood stabilization ordered 5/8/18, a reduction from…

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 medical record review and staff interviews, it was determined that the facility staff failed to indicate a rationale for the continued use of a cognitive-enhancing medication for Resident #65. This was evident for 1 of 37 residents reviewed. The findings include: Review of Resident #5's medical record on 5/17/18 at 12pm, revealed a pharmacy consultation which documented the following: Note to attending physician/prescriber-resident is currently receiving therapy with Aricept. Most recent BIMS assessment shows a score of 3. Is therapy with Aricept still indicated? Aricept is a medication used to treat mild to moderate dementia caused by Alzheimer's disease. BIMS- is a (Brief Interview for Mental Status). 13-15 points: (the person is intact cognitively). 8-12 points: (the person is moderately impaired) 0-7 points: (the person is severely impaired). Continued review of the medical record revealed that the resident primary physician checked disagree- continue with RX (prescription) on 1/26/18; however, failed to document the rationale for the continuation of the medication.…

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 medical record review of facility documentation and interview with facility staff, it was determined that the facility failed to ensure and/or maintain accurate medical records for residents (#31 and #65). This was evident for 2 of 37 residents reviewed in the final sample. The findings include: The facility failed to clarify the diagnosis for a resident (#31) receiving Remeron. 1. Review of Resident #31's medical record on 5/17/18 at 2:30 PM revealed a Medication Management assessment dated [DATE] and 5/15/18 by the Nurse Practitioner documenting the resident was receiving Remeron 15mg at bedtime for depression/appetite. Continued review of the medical record revealed a physician order dated 4/17/18 to administer Remeron 15mg at bedtime for insomnia. Remeron is an antidepressant medication used to treat depression. During interview with the Charge Nurse on 5/17/18 at 3pm s/he verified the findings. 2. During medication observation on 05/16/18 at 9am, CMA #1 (Certified Medication Aide) administered…

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.