Autumn Lake Healthcare At Calvert Manor

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview it was determined the facility failed to ensure resident information was protected from public view. This was evident for one computer screen observed to have resident information exposed during the facility's recertification/complaint survey. The findings include: On 3/26/25 at 1:19PM the surveyor observed a medication cart outside of room [ROOM NUMBER] with an open computer screen present which was observed to be unlocked and unattended and openly displayed the following information: resident names, resident medical record numbers, resident room numbers, and resident photos for the following residents: #17, #76, #21, #5, #381, #59, #23, #63, #379, and #103. The surveyor shared their concern with Unit Manager #16 who observed and acknowledged the surveyor's concern. On 3/26/25 at 1:21PM the surveyor shared their concern with Registered Nurse (RN) #29 who confirmed and acknowledged understanding of the surveyor's concern. At this time RN #29 reported to the surveyor that there…

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 interviews, it was determined that the facility failed to exercise reasonable care for protection of resident's property from loss or theft. This was true for one resident (Resident #24) of 66 residents reviewed during the recertification/complaint survey. Findings Included: On 03/25/25 at 10:43 AM, in a interview with Resident #24, it was revealed that a total of $840 in cash was stored in the resident's wallets and kept at the bedside. The resident stated that the $840 was stolen (date not provided), the resident stated that $135 of the money was later returned in February 2025 but the resident was unsure what happened to the remaining balance. Resident #24 stated that he reported it to the unit manager (unable to provide a name) but no-one came back to say what happened after they completed their investigation. They provided a locked drawer but the resident stated that anyone can open it with a small tool, if they really wanted to. On 03/31/25 at 11:35 AM GNA #53 was asked what do they do if an item for a resident went missing and she stated 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 resident and staff interviews and medical record reviews, it was determined that the facility failed to investigate an alleged abuse of a resident. This was evident for 1 (#64) of 66 residents reviewed during a recertification/complaint survey. The findings include: On 03/24/25 at 10:20 AM, during the survey screening, Resident #64 informed a surveyor that GNA#31 got a hold of my feet and legs and pull me on the side of the bed and since that day my legs have been hurting. The resident also stated that GNA #31 pinched her thighs while assisting with pulling up her pants and when GNA#31 assisted with rolling her over, the Resident hit her thigh on the rail. The Resident stated that GNA #31 seemed irritated. On 04/01/25 at 11:32 AM, on observation, Resident #64 was lying in bed in a hospital gown. This Surveyor conducted a follow up interview. The Resident stated that she informed the Unit Manager #17 that GNA #31 had pinched her thighs and rough handled her legs while assisting her back to bed three weeks ago. An interview was conducted on 04/01/25 11:47 AM with Unit Manager…

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 it was determined the facility failed to ensure the care plan of a resident was comprehensive and person centered. This was evident for one (Resident #26) out of two residents reviewed for limited range of motion during the facility's recertification/complaint survey. The findings include: On 4/1/25 at 8:21AM the surveyor conducted a review of the medical record for Resident #26 which revealed the following medical order dated as beginning on 3/7/25 was in place for care of the resident: SPLINT ORDER: Order for R (right) elbow extension splint on R (right) elbow, wearing schedule: AM to PM shift or as tolerated Hygiene: Wash weekly or as needed; every shift for contracture prevention/management 1) Check splint cleanliness/condition 2) Check skin integrity pre/post application 3) Perform ROM as needed 4) Fasten straps, if applicable 5) Monitor device during use as needed, notify nursing/rehab/MD with any unusual findings. On 4/1/25 at 8:31AM the surveyor reviewed the medical…

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 it was determined the facility failed to ensure a complete medical order for a foley catheter was re-instituted for a resident upon their return from hospitalization, and failed to ensure that complete medical orders were verified and obtained for the foley catheter upon re-insertion of the catheter. This was evident for one (Resident #115) out of two residents reviewed for catheters during the facility's recertification/complaint survey. The findings include: On 3/31/25 at 11:29AM the surveyor reviewed the medical record of Resident #115 which revealed the following medical order was in place dated as beginning on 2/17/25: Foley Cath 22 FR/Balloon size 10ML Dx (diagnosis) Stage 4 Wound Care every shift, and the following order dated as beginning on 12/4/24: Change foley catheter prn (as needed) if dislodged or leaking as needed. On 3/31/25 at 11:29AM the surveyor reviewed the medical record and observed orders in place for care of a foley catheter for Resident #115 which were dated as beginning on 12/4/24. Further review of the medical order…

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 failed to 1) properly date label oxygen tubing when changed, 2) follow physician's orders for the administration of oxygen, and 3) develop and implement a person-centered comprehensive care plan with resident centered goals for respiratory care to include oxygen therapy. This was evident for 1 (Resident #57) of 4 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. On 3/25/2025 at 10:55 AM, surveyor observed Resident #57 sitting in a wheelchair in their room. 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 2LPM (liters per minute). The LPM oxygen flow rate of 2 indicates that 2 liters 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 medical record reviews and interviews, it was determined the facility staff failed to ensure that a resident was given pain medication consistent with professional standards of practice, and failed to ensure pain mangement was effective. This was evident for 3 (#231,#33, #71) of 4 residents reviewed for pain management during a recertification/complaint survey. The findings include: 1) During an initial pool screen of Resident #231 on 3/25/2025 at 8:17 AM, the resident was observed in bed crying and complaining of pain. Resident #231 rated the pain at 8/10 (severe pain) to the right hip and 7/10 right foot. The resident stated s/he had been waiting for pain medication since 3 AM that morning and was just given pain med by the day shift nurse. The resident added that s/he had asked for ice pack to be placed on their right hip but the night nurse told them none was available. Resident #231 further stated that they messed up my meds and s/he waited for over 12 hours when s/he was admitted before they could give him/her pain medication. The resident stated that the nurses were…

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 staff records and interview with facility staff, it was determined that the facility failed to ensure Geriatric Nursing Assistants (GNAs) received a performance review in 2023. This was evident for 1 (Staff #49) out of 3 GNAs randomly selected nursing staff records reviewed for annual training requirements during the recertification/complaint survey. The findings include: The employee files of three GNAs were reviewed on 03/31/25 at 1:30 PM. There was no performance evaluation found for staff # 49 during the review. On 04/01/25 11:21 AM an interview was conducted with the DON regarding performance evaluation. When asked by the surveyor who is responsible for ensuring staff have an annual performance evaluation, the DON stated that it's the responsibility of the DON and unit managers. The DON did not provide any further documentation of the evaluation and stated that the employee worked as needed (PRN) and was overlooked.

Based on record review and interviews, it was determined that the facility failed to ensure medication order parameters were followed and ensure a resident was free from unnecessary medication. This was evident for one (Resident #42) out of one resident reviewed for insulin during the facility's recertification/complaint survey. The findings include: On 3/31/25 at 8:59AM the surveyor conducted a review of the medical record for Resident #42 which revealed the following active medical order for insulin administration dated 8/24/24 was in place which included parameters: Lyumjev KwikPen 100 UNIT/ML Solution pen-injector (Insulin); Inject 15 unit subcutaneously with meals for DM (Diabetes Mellitus) Hold for BS (blood sugar) <150. On 3/31/25 at 9:01AM the surveyor reviewed the medical record which revealed a medication administration record (MAR) for March 2025 in which RN #29 documented administration of insulin to Resident #42 in their right arm on 3/23/25 at 5:20PM with a documented blood sugar of 134 despite the parameter in the medical order for the medication to be held for 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 medical record review and interview it was determined the facility failed to ensure a prn (as needed) antipsychotic medication order was limited to 14 days and failed to ensure a resident was free from uneccessary medication. This was evident for one (Resident #116) out of eight residents reviewed for unnecessary medications during the facility's recertification/complaint survey. The findings include: On 3/26/25 at 11:38AM the surveyor reviewed the medical record of Resident #116 which revealed the following prn (as needed) medication order for the antipsychotic medication, Seroquel which was observed to have a thirty day duration beginning on 3/7/25: Seroquel 50 milligrams, Give 1 tablet by mouth every 8 hours as needed for agitation/anxiety for 30 days which was in addition to a separate order for daily administration of Seroquel. On 3/26/25 at 12:10PM the surveyor conducted an interview regarding prn (as needed) anti-psychotic medication orders with the facility's Assistant Director of Nursing (ADON) who reported that they have had physicians say we are gonna keep this…

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 facility documentation and interview, it was determined the facility failed to have the required members participate on the facility's Quality Assessment and Assurance (QAA) committee meetings. The findings include: On 4/2/2025 at 11:25 AM, the Assistant Director of Nursing (ADON) provided the quality assurance committee meeting attendance sheets from January 2024 through February 2025. Review of the attendance sheets failed to reveal that the following staff routinely attended the quality assurance committee meetings: · The medical director failed to attend the meeting for February 2024 (2/27/2024). · The Nursing Home Administrator (NHA) failed to attend the meetings for April 2024 (4/23/2024), September 2024 (9/24/2024), and October 2024 (10/22/2024). · Both the Director of Nursing (DON) and the ADON failed to attend the meeting for August 2024 (8/27/2024). On 4/2/2025 at 1:31 PM, an interview was conducted with the QAPI (Quality Assurance and Performance Improvement) representative, Staff #14. Staff #14 reviewed the attendance records and sign-in sheets 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of a complaint incident MD00198278, record review and staff interviews, it was determined that the facility failed to provide shower to a resident who was dependent. This was evident for 1 (Resident #140) of 24 complaints reviewed during the recertification/complaint survey. The findings include: On 3/28/25 at 1:48PM review of a complaint incident #MD00198278 had that the facility failed to give Resident #140 a shower for a month after admission to the facility. That resident was dependent on the staff for Activities of Daily Living (ADL). Review of the medical records on 3/28/25 at 1:48PM showed that Resident #140 was admitted on [DATE] to the facility for rehabilitation and review of the care plan with initiation date of 9/7/23 had the resident has an ADL Self Care Performance Deficit r/t Activity Intolerance, Fatigue, Musculoskeletal, Interventions include to assist with personal hygiene such as bathing and grooming. On 3/31/28 at 10:40 AM a review of the resident's shower schedule 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on a complaint #MD00210759, record review and staff interviews, it was determined that the facility failed to accurately interpret a resident's MOLST form, evidenced by the initiation of Cardiopulmonary Resuscitation (CPR) on a resident with a documented Do Not Resuscitate order. This was evident for 1 (Resident #139) of 24 complaints reviewed during the recertification/complaint survey. The findings Include: Cardiopulmonary Resuscitation (CPR) is an emergency procedure that combines chest compressions and rescue breathing to restart a person's breathing or heartbeat when they've stopped. The Maryland Orders for Life Sustaining Treatment (MOLST) is a medical document that communicates a patient 's wishes or preferences regarding resuscitation when the patient has no pulse and/or is not breathing. Do Not Resuscitate (DNR) is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart or breathing stops. Do not intubate (DNI) is a medical…

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 #MD00210759, record review and staff interviews, it was determined that the facility staff lacked proper knowledge required to interpret the MOLST form and on steps to follow in an emergency, as evidenced by performing Cardiopulmonary Resuscitation (CPR) on a resident with a documented Do Not Resuscitate order. This was evident for 1 (Resident #139) of 24 complaints reviewed during the recertification/complaint survey. The findings Include: Cardiopulmonary Resuscitation (CPR) is an emergency procedure that combines chest compressions and rescue breathing to restart a person's breathing or heartbeat when they've stopped. The Maryland Orders for Life Sustaining Treatment (MOLST) is a medical document that communicates a patient 's wishes or preferences regarding resuscitation when the patient has no pulse and/or is not breathing. Do Not Resuscitate (DNR) is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart or breathing…

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 resident interview and staff interview, it was determined that the facility staff failed to respect a resident's personal property by not delivering a resident's mail unopened. This was evident for 1 (Resident #66) resident reviewed for personal property during an annual recertification survey. The findings include: In an interview with Resident #66 on 12/12/18 at 1:23 PM, Resident #66 indicated that s/he received a small gift in the mail in December 2017 and that the package had been opened by someone before it had arrived at his/her room. Resident #66 stated that someone removed everything from inside the package and then replaced the items. Resident #66 also stated that the package was clearly addressed to him/her stated nothing was missing. In an interview with the facility director of nursing (DON) and the corporate nurse consultant on 12/13/18 at 2:00 PM, the facility DON stated that s/he was the person who opened Resident #66's mailed gift in December 2017. The facility DON stated that s/he thought the mailed package may have been medical supplies for Resident #66.

Based on staff interview, resident interview and review of documentation, it was determined that the facility failed to ensure an individual financial record was available to a resident through quarterly statements and upon request. This was evident for 1 (#66) of 24 residents identified during sample selection. The findings include: During an interview of Resident #66 on 12/12/2018 at 1:22 PM, surveyors asked about any personal funds managed by the facility. Resident #66 reported that he/she had not received their past few month's statements. The resident stated he/she asked a nurse for their September 2018 statement and had not received it yet. Resident #66 had a Brief Interview for Mental State (BIMS) score of 15 which corresponds with the resident being considered cognitively intact. The BIMS test is a screening tool used to assess cognition On 12/14/2018 at 10:26 AM surveyors met with the Business Office Manager (BOM) and inquired about the facility's process for providing statements. The BOM stated that statements were hand delivered to residents or mailed to resident's Power…

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 staff interview it was determined the facility staff failed to develop a care plan related to the application of a device to treat a resident's edema. This was evident for 1 (Resident #44) of 2 residents reviewed for skin conditions during an annual recertification survey. The findings include: Review of Resident #44's medical record revealed a physician's order, dated 08/08/18, that instructed the nursing staff to apply an ace wrap to Resident #44's right lower leg every morning and remove the ace wrap in the evening for the indication of edema. Further review of Resident #44's medical record revealed a nursing progress note, dated 12/11/18, indicating Resident #44 received a skin tear to the right lower leg during a transfer. During an observation of Resident #44 on 12/12/18 at 10:48 AM, Resident #44 was observed with a dressing to the right lower leg area. In an interview with employee #4 on 12/13/18 at 12:33 PM, employee #4 stated that Resident #44 received a skin tear during a transfer on 12/11/18 at approximately 1 PM. Employee…

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 the facility staff failed to provide interventions for Resident #20 as indicated on the care plan. This was evident for 1 of 1 residents selected for review of nutrition based care plans and 1 of 30 residents selected for review during the annual survey. The findings include: 1A. The facility staff failed to provide Resident #20 with a sippy cup without a lid. Medical record review revealed on 9/13/18, the facility staff initiated a care plan to address nutritional status. The care plan include the following intervention: sippy cup with no lid. The sippy cup is a 2 sided handled cup and has a lid with a spout that allows for slow drinking. Surveyor observation of Resident #20's breakfast on 12/13/18 at 8:45 AM revealed the facility staff failed to provide Resident #20 with a sippy cup. Observation of Resident #20's lunch on 12/13/18 at 12:30 PM revealed Resident #20 had a sippy cup; however,the facility staff placed a lid on the cup. Observation of Resident #20's lunch on 12/14/18 at 12:40 PM 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.

Based on observation, medical record review and staff interview it was determined the facility staff failed to follow a physician's order to treat a resident's edema. This was evident for 1 (Resident #44) of 2 residents reviewed for skin conditions during an annual recertification survey. The findings include: Review of Resident #44's medical record revealed a physician's order, dated 08/08/18, that instructed the nursing staff to apply an ace wrap to Resident #44's right lower leg every morning and remove the ace wrap in the evening for the indication of edema. Further review of Resident #44's medical record revealed a nursing progress note, dated 12/11/18, indicating Resident #44 received a skin tear to the right lower leg during a transfer. A further review of Resident #44's medical record revealed nursing documentation that indicated Resident #44's 12/11/18 day shift nurse had signed off that Resident #44's ace wrap had been applied at 10:25 AM on the morning of 12/11/18. During an observation of Resident #44 on 12/12/18 at 10:48 AM, Resident #44 was observed with a dressing 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.

Based on reviews of a medical record, administrative records, and staff interview, it was determined the facility staff failed to provide a resident with a safe environment, during a shower, to prevent the resident from sliding out of a shower chair onto the floor. This was evident for 1 (Resident #22) of 5 residents reviewed for accidents during an annual recertification survey. The findings include: Review of Resident #22 medical record on 12/12/18 revealed a nursing note indicating Resident #22 had slid out of a shower chair onto the floor while receiving a shower on 10/31/17. Review of Resident #22's fall prevention care plan on 12/14/18 revealed Resident #22 was at risk for falls due to cognitive loss, gait and transfer dysfunction, and vision impairment. Reviews of nursing interventions to prevent Resident #22 from falling included: to ensure proper use of devices as ordered and specified on the ADL care plan, to evaluate medications which may increase risk for falls, and ensure resident has proper shoes on. Further review of Resident #22's care plans failed to reveal any…

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 determine the facility staff provided Resident #20 with straws, even though there was a physician's order for no straws. This was evident of 1 of 2 residents selected for review of nutrition during the survey process and 1 of 30 residents selected for review during the annual survey process. The findings include: Medical record review for Resident #20 revealed on 9/19/18 the physician ordered: no straws. Surveyor observation of Resident #20's breakfast on 12/13/18 at 8:45 AM revealed Resident #20 was served a carton of low fat milk and a carton on apple juice; however, the facility staff placed a straw into each of those liquids. On subsequent observations of Resident #20's meals throughout the survey process, no further notation of straws were noted. Interview with the corporate nurse on 12/14/18 at 2:00 PM revealed the facility staff provided Resident #20 with milk and apple juice with straws. Interview with the Director of Nursing and corporate nurse on 12/17/18 at 1:00 PM confirmed the facility staff provided…

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 obtain laboratory blood specimen as ordered by the physician for Resident #75. This was evident for 1 of 1 resident selected for review of laboratory services and 1 out of 30 residents selected for review during the annual survey process. The findings include: Medical record review for Resident #75 revealed on 9/6/18 the physician ordered BMP in 1 week. Basic Metabolic Panel (BMP). The Basic Metabolic Panel (BMP) can be used to evaluate kidney function, blood acid/base balance, and levels of blood sugar, and electrolytes. Components of the BMP are four electrolytes: sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine and glucose. Further record review revealed the facility staff failed to obtain the laboratory blood test as ordered by the physician. Interview with the south side unit manager on 12/13/18 at 10:00 AM revealed the facility staff failed to obtain laboratory blood test as ordered. Interview with the Director of Nursing and Corporate nurse on 12/17/18 at 1:00…

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 of facility staff, it was determined that food service employees failed to ensure safe food handling practices were followed to reduce the risk of food-borne illness. The findings include: During a tour of the kitchen on 12/14/2018 at 10:00 AM surveyors observed an upright mixer placed directly adjacent to a hand-washing sink that did not have splash guards. The mixer had an open top and was being used to mix chocolate mousse at the time of observation. The close proximity to the hand sink and lack of splash guards put the mixer at high risk of contamination from splashes when the hand sink was in use. Surveyors interviewed the Director of Food and Nutrition who stated that the mixer could be moved and splashguards put in place. The DOFN was made aware of these findings on 12/14/2018 at 10:10 AM.