Hebrew Home Of Greater Washington

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews, the facility failed to keep the resident free from verbal and mental abuse as evidence by a social worker demonstrating verbal and non-verbal aggressive behavior toward the resident which caused and had the potential to cause the resident to experience humiliation, intimidation, shame, agitation, and/or degradation and did not promote an environment to enhance the resident's dignity. An observation of Resident 17 (R17) on 10/17/25 at 9:40 a.m., revealed a well-groomed person lying in bed who had just finished eating lunch independently. R17 was pleasant and engaging with good recollection of the incident. The room was clean, uncluttered and odor free. An interview with R17 on 10/17/25 at 9:40 a.m., revealed he/she recalled the incident with the Social Worker (SW24) in detail. R17 stated SW24, talked a lot and always had a negative connotation or attitude and that was typical of SW24. R17 stated during the incident, SW24 Jumped up and shouted and screamed,…

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 revies, the facility failed to provide adequate supervision to Resident 20 utilizing an elopement prevention device as evidenced by R20's elopement from the monitored area and the building of residence for approximately 2 hours. An observation of Resident 20 (R20) on 10/14/25 at 1:20 p.m. revealed a well-groomed person sitting on the side of the bed eating lunch. R20 also had water and juice within reach and, he/she did not require assistance with eating. There was no observable WanderGuard in place. The room was clean, cluttered and odor free. An observation of R20's unit 10/14/25 at 1:20 p.m., unit revealed there were cameras pointing toward the exit door and one in the middle, pointing toward the nursing station. The elopement monitoring system testing was observed and appeared to be working properly. An interview with R20 on 10/14/25 at 1:20 p.m. revealed he/she did not have a WanderGuard device in place. When asked about leaving the building, R20 stated, I can't…

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 reported incidents with documentation and interview, it was determined the facility failed to report allegations of abuse, neglect, and injuries of unknown origin within 2 hours of the allegation to the regulatory agency, the Office of Health Care Quality (OHCQ). This was evident for 18 (#631, #647, #646, #627, #641, #637, #621, #5, #620, #250, #94, #229, #157, #96, #278, #264, #77, and #48) residents of 60 facility reported incidents reviewed during an annual and complaint survey. The findings include: 1) On 1/27/25 at 10:12 AM a review of facility reported incident MD00188273 revealed Resident #631 alleged that he/she was raped 5 nights prior by multiple guys. On 1/26/23 at 16:25 (4:25 PM) the daughter informed facility staff. The facility's investigation included an email confirmation as to when the initial report was sent to OHCQ. Review of the email confirmation documented the email was sent to OHCQ on 1/26/23 at 8:55 PM. This was not within 2 hours of the allegation. On 1/28/25 at 2:15 PM the facility reported incident was reviewed with the DON #1.…

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 reported incidents and staff interview, it was determined the facility failed to provide documentation that allegations of abuse were thoroughly investigated. This was evident for 9 (#629, #638, #640, #366, #625, #5, #622, #87, and #619) residents of 60 facility reported incidents reviewed during a recertification/complaint survey. The findings include: The Minimum Dats Set (MDS) is a standardized and comprehensive assessment screening tool used to identify resident's individual needs and areas of concern. BIMS stands for Brief Interview for Mental Status. It is a screening tool used to assist with identifying a resident's current cognition and to help determine if any interventions need to occur. 1) On 1/28/25 at 11:30 AM a review of facility reported incident MD00167904 was conducted and revealed a Clinical Team Manager received an email on 5/31/21 that stated on 5/30/21 around 2pm, Resident #629 complained to a musical therapist that he/she was raped 3 weeks ago. Review of the facility's investigation revealed that 36 staff were interviewed, however…

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 it was determined the facility failed to: 1.) ensure the labeling, dating, and expiration of nourishment items, 2.) ensure a sanitary environment in the nourishment refrigerator and 3.) ensure dishwashing machines met the minimum required manufacturer temperatures recommended for sanitization. This was evident for: 1.) 1 reach-in refrigerator in 1 out of 2 of the facility's kitchens, 2.) 1 nourishment refrigerator in 1 out of 2 of the facility's kitchens, and 3.) 3 out of 4 dishwashing machines, during the facility's recertification/complaint survey. The findings include: 1.) On 1/27/25 at 8:11AM during the surveyor's initial tour of the facility's kitchens, the surveyor observed the reach-in refrigerator located in the main kitchen which contained trays containing the following items which had no labeling or dates present to indicate preparation or expiration dates: plates of orange slices, cold salad sandwiches, approximately 14 individual containers of fruit with cream base, approximately 27 individual containers of cottage…

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 maintain complete and accurate medical records in accordance with accepted professional standards. This was evident for 9 (Resident #366, #63, #367, #615, #626, #628, #644, #649, and #650) resident of 108 residents reviewed during the recertification/complaint survey. The findings include: A medical record is the official documentation of a healthcare organization. As such, it must be maintained in a manner that follows applicable regulations, accreditation standards, professional practice standards, and legal standards. All entries to the record should be legible and accurate. 1) On 1/29/25 at 11:49 AM a review was conducted of Resident #366's medical record. Review of the miscellaneous section of the medical record revealed a Hospital Transfer summary for another resident, Resident #367 dated 5/16/24. There were 2 transfer summary entries. There were 22 pages of medical information on the first transfer summary that…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the facility's pest activity logs and interviews, the facility failed to maintain an effective pest control program. This was evident for 1 of 2 buildings reviewed during the recertification/complaint survey. The findings include: During investigation of multiple complaints including August and October 2024 regarding mice in the facility's [NAME] building from residents' responsible parties the surveyor requested on 2/4/25 the facility's pest control logs from September 2024 through February 4th, 2025. Interview with Staff #23 (Vice President of Building Services) on 2/4/25 at 10:45 AM, Staff #23 states the facility consists of 2 buildings and each building maintains a pest control log at the front desk for the pest control company to address any concerns. Staff #23 stated the pest control company comes to the facility 3 times a week. Review of the Pest Activity Log on 2/4/25 for the [NAME] Building revealed the following entries in patient care areas: 9/2/24 room [ROOM NUMBER] mouse droppings…

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, the facility staff failed to notify a resident's physician and/or responsible party for a change in status in a timely manner (Resident #630, #643). This was evident for 2 of 108 residents reviewed during a recertification/complaint survey. The findings include: 1) The facility staff failed to notify Resident #630's physician and responsible party for changes in the Resident's pressure ulcer. Review of Resident #630's medical record on 1/29/25 revealed on 3/20/23 the Resident was assessed to have a Stage II sacral pressure ulcer. Further review of Resident #630's medical record revealed on 3/30/23 the Resident was assessed by the Wound care doctor to have a Unstageable sacral pressure ulcer. A) Further review of Resident #630's medical record revealed the Wound care doctor saw the Resident weekly except for 4/20/23, 7/3/23, 7/10/23, 7/27/23, 8/3/23 and 8/17/23. On those dates there is no documentation in the medical record the facility staff reviewed the Resident's wound status with Staff #58 (Primary physician) to determine if the wound…

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, medical record review, and interviews with the staff and resident, it was determined that the facility failed to ensure the Comprehensive Minimum Data Set (MDS) assessments accurately reflected the resident's oral/dental status. This was found to be evident in 1 (Resident # 269) of 4 residents reviewed for the MDS assessment during the recertification/complaint survey. The findings include: The 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 must be accurate to ensure each resident receives the appropriate care they need. On 01/31/25 at 10:59 AM, Resident # 269's medical record was reviewed. The resident was initially admitted in February 2024 to the facility after undergoing abdominal surgery. Around mid-April 2024, the resident was hospitalized due to high ostomy output and re-admitted to the facility on [DATE]. On 1/31/2024 at…

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

Based on record review and interviews, it was determined that the facility failed to thoroughly develop and implement a comprehensive person-centered care plan that addresses resident's medical, nursing, and mental and psychosocial needs that was identified in the admission comprehensive assessment. This was evident for 1 (Resident #89) of 4 residents care plans reviewed during the recertification/complaint survey process. The findings include: On 01/28/25 at 09:54 AM, in an interview with the resident's (Resident #89) representative, it was expressed to the surveyor that on 1/27/25 the resident had an episode of incontinence, the resident representative stated that the staff was notified of the resident's incontinence; however, incontinence care was not provided until a couple of hours later. On 01/29/25 at 11:23 AM, a review of the Geriatric Nursing Assistant (GNA) task list for Resident #89 in the month of January 2025 revealed that incontinence care was documented once on 1/27/25 at 1:36 AM. On 01/29/25 at 11:23 AM, review of the medical record revealed that the resident was 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 review of resident medical records and interviews with resident and facility staff, it was determined that the facility failed 1) to involve/invite a resident who had the capacity, to attend his/her own care plan meetings, and 2) to revise the resident's care plan after the resident developed a stage 2 sacral pressure ulcer. This was evident for 2 residents (Resident #96 and #963) out of 4 residents reviewed for care plan during the Medicaid/Medicare recertification/complaint survey. The findings include: 1) On 01/28/25 at 10:47 AM, during the initial screening of Resident #96, when he/she was asked if he/she or someone that he/she had appointed, had been to meetings where his/her own plan of care care was discussed, he/she stated that he/she has never attended one because nobody ever told him/her about any meeting. On 01/29/25 at 09:32 AM, the surveyor reviewed the electronic health records of the resident revealed that Resident #96's Brief Interview for Mental Status (BIMS) score for all quarters in 2024 was 15.0 out 0f 15.0. It also revealed that Resident #96 did not…

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 a complaint, medical record review, and interview, it was determined the facility failed to ensure that a resident who required assistance received showers twice per week. This was evident for 1 (#636) of 30 residents reviewed for complaints during a recertification/complaint survey. The findings include: On 1/30/25 at 9:16 AM a review of complaint MD00195642 revealed an allegation that Resident #636, hardly ever got a bath. Review of Resident #636's medical record revealed the resident was admitted to the facility in December 2022 from an acute care hospital for rehabilitation and strengthening. Review of the 12/24/22 admission MDS documented that the resident required physical help related to bathing. Review of the shower log indicated that the resident was supposed to receive a shower twice per week on Monday and Thursday. Review of the GNA Documentation Report for January 2023 revealed blank spaces for every Monday and Thursday in January, which were 1/2/23, 1/5, 1/9, 1/12, 1/16, 1/19, 1/23, and 1/26/23. On 1/31/25 at 9:00 AM an interview was conducted with…

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 facility reported incident and complaint, medical record review and interview, it was determined the facility failed 1) to provide care to meet the needs of a resident's physical, mental, and psychosocial health, 2) to ensure that residents receive treatment and care to promote the highest practicable wellbeing as evidenced by failures to consistently assess a resident for pain and failures to follow physician orders timely, and 3) to acquire a patient's medication to be administered thereby causing a delay in treatment. This was evident for 3 (Resident #131, #614, and #913) of 108 residents reviewed during a recertification/complaint survey. The findings include: 1) The facility staff failed to properly perform neuro checks after a fall for Resident #614. A neuro check after a fall refers to a neurological assessment performed by a healthcare professional to evaluate potential brain injuries by checking a person's level of consciousness, orientation, pupil response, muscle strength, sensation, and coordination. Review of the facility's 72 hour assessment protocol 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on investigating complaints, medical record review and interview, it was determined that the facility staff failed to provide treatment/services to prevent/heal pressures ulcers (Resident #630 and #660). This is evident for 2 of 4 residents reviewed for pressure ulcers during the recertification/complaint survey. The findings included: A pressure ulcer also known as 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 the 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), Stage IV (full thickness skin loss with extensive damage to muscle, bone or tendon) or Unstageable Pressure Ulcer (full thickness tissue loss in which the base of the ulcer is covered by slough and / or eschar in the wound bed).…

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 resident medical records and interview with facility staff, it was determined that the facility failed to address appropriate care when a resident had weight loss. This was evident for 1 (Resident #660) of 4 residents reviewed for nutrition during this recertificate survey. The findings include: During an investigation of the facility's self-reported incident, MD00208505, on 2/03/25 at 9:27 AM, it was revealed that Resident #660's family members were concerned about the resident's significant weight loss. The surveyor reviewed Resident #660's medical records on 2/03/25 at 9:40 AM; the review revealed that the resident's body weight as below: - initial body weight was 210 lb. (pound) on 5/03/24 via wheelchair, - On 5/14/24: 205.2 lb (4.8 lb , 2% loss from the initial weight) via a mechanical lift, - On 5/22/24: 200.8 lb. (9.2 lb, 4.3 % loss from the initial weight) via a mechanical lift, - On 5/28/24: 192.6 lb. (17.4 lb, 8% loss from initial weight) via a mechanical lift. On 2/03/25 at 10:00…

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 record reviews and interviews, it was determined that the facility failed to conduct the annual performance review for the Geriatric Nursing Assistants (GNA). This was identified for 1 of 3 GNA employee record (GNA #71) reviewed during the recertification/complaint survey process. The findings include: On 02/04/25 at 10:00 AM, during the staffing facility task the surveyor reviewed 3 GNAs' employee records. The record review revealed that the facility failed to provide signed documented evidence to support that GNA #71's performance review and in-service education based on the performance review results was completed in the year 2023 and 2024 as required. On 02/06/25 12:53 PM, in a telephone Interview with the Director of Nursing (DON #1), the DON #1 stated that GNA #71's performance review and competency assessment was missed in the year 2023. The 2024 performance review was documented; however, it was not signed because GNA #71 works on a PRN (as needed) schedule. On 02/07/25 at 10:24 AM, in an interview with the DON #1, she was asked if there was a competency assessment…

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 the facility failed to ensure the monitoring for side effects for a psychotropic medication for Resident #25. This was evident for 1 out of 5 residents reviewed for unnecessary medications during the facility's recertification/complaint survey. The findings include: On 1/29/25 at 8:30AM the surveyor conducted a review of the medical record of Resident #25 and observed the following medical order dated as beginning on 1/4/25 for the following medication that they were receiving: Escitalopram Oxalate Oral Tablet 20 MG, Give 1 tablet by mouth one time a day for depression. Further review by the surveyor of the medical record for Resident #25 revealed side effect monitoring had not been instituted for the use of this psychotropic medication. On 1/29/25 at 9:27AM the surveyor conducted an interview with Licensed Practical Nurse #35 who reported to the surveyor that the process the facility uses for monitoring of side effects for residents receiving psychotropic medications is that a separate order is instituted on 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 interviews with staff and the resident, observation, and medical record review, it was determined that the facility failed to provide appropriate dental care. This was evidenced by the resident's dental status not being accurately monitored and failing to have follow-up dental service. This was evident for 1 (Resident # 269) of 1 resident reviewed for dental care during this recertification/complaint survey. The findings include: On 1/31/2025 at 10:59 AM, a medical record review for Resident # 269 was conducted. The review revealed that the resident was admitted to this facility in February 2024 after undergoing abdominal surgery. Around mid-April 2024, the resident was hospitalized due to high ostomy output and re-admitted to the facility on [DATE]. On 1/31/2024 at 11:45 AM, a review of the Nursing admission assessment dated [DATE] revealed that it was documented the presence of own teeth, and the re-admission nursing assessment dated [DATE] documented the presence of partial lower dentures.…

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 surveyor observations and staff interviews, it was determined that the facility staff failed to store food items correctly with use-by dates in the kitchen freezers and refrigerators, and failed to serve food in a sanitary manner to prevent potential contamination. This was evident for 2 of 2 kitchens observed for proper and safe food storage and and in 2 of 11 dining rooms that had steam table service. The findings include: 1. Surveyor observation of the kitchen determined that the facility staff failed to have use-by dates on open packages and containers of food items stored in the freezers and the refrigerators in the facility kitchens. a. On 12-16-18 at 8:38 AM, surveyor observation of the walk-in dairy freezer in the [NAME] building kitchen revealed open packages of cheese manicotti, sliced frozen peaches, and [NAME] pastry sweets were not labeled with use by dates. In the walk-in dairy refrigerator, surveyor found an open flounder fish fillet package, a container of French dressing, and 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 the review of the clinical records, surveyor observations, and interviews with residents and facility staff, it was determined that the facility failed to ensure 1 of 7 residents selected for the Dignity review was treated with respect and dignity by staff (Resident #237). The findings include: On 12-17-19 at 11:00 AM surveyor interview with Resident #237 revealed concerns with attitudes from some of the Geriatric Nursing Assistants (GNAs) at the facility. Further interview revealed the resident stated that the facility needed to provide additional training's to the GNA staff on the caring for and speaking to residents. The resident declined to give specific information of individual GNA staff members. On 12-19-19 at 5:15 PM observation of staff interactions with Resident #237, in the resident's room, revealed GNA (Geriatric Nursing Assistant) #4 entered the resident's room without knocking on the door nor awaiting for a response to enter. Further observation revealed GNA #4 informed the resident that she had come to pick up the resident's dinner selection menu. 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.