Ross Manor

Based on interviews, policy review, and record review, the facility failed to ensure staff reported an allegation of physical abuse immediately for 1 of 1 residents reviewed during a complaint investigation. (Resident #1[R1]) Finding: A review of the facility's policy, Abuse, Neglect, Exploitation or Misappropriation-Reporting and Investigating, revised 02/2023, under the heading, on page 1, Reporting Allegations to the Administrator and Authorities, states, 1. If resident abuse .is suspected, the suspicion must be reported immediately to the administrator .2. The administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies: a. The state licensing/certification agency .3. Immediately is defined as: a. within two hours of an allegation involving abuse . On 11/12/24 at 3:24 p.m., the Division of Licensing and Certification received a reportable incident from the facility, alleging that on 11/11/24 at 9:30 p.m., a Certified Nursing Assistant (CNA #2) witnessed CNA #1 grab R1 by the left thumb and twist R1's arm…

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 and interviews, the facility failed to ensure that a resident requiring feeding assistance was done in a dignified manner for 1 of 2 residents observed requiring feeding assistance (Resident #28 [R28]). Finding: On 5/16/24 between 8:28 a.m. through 8:35 a.m., a surveyor observed Certified Nursing Assistant #2 (CNA2) feeding R28 while standing at the side of the table, facing away from R28, talking to another staff. CNA2 used a spoon to pick up food, looked at R28 briefly to find placement of food in R28's mouth, then looked away and continued conversation with another staff. On 5/16/24 at 8:40 a.m., in an interview with CNA2, a surveyor confirmed the above finding. On 5/16/24 at 8:56 a.m. in an interview with Registered Nurse #2, a surveyor confirmed the above finding that CNA2 was not feeding R28 in a dignified manner.

Based on record review and interviews, the facility failed to review an Advance Beneficiary Notice with a resident's legal guardian for 1 of 4 residents reviewed for beneficiary notices (Resident #147 [R147]). This had the potential to prevent R147's right to appeal discharge. Findings: On 05/15/24, record review indicated R147's admitting diagnosis included bimalleolar fracture of right ankle and intellectual disability. Therapy documentation dated 11/4/23 indicated R147 is intellectually challenged and functions at a 5 year old level. The record identified a legal guardian as the responsible party for medical and financial decisions. However, the record revealed that on 12/16/23 the Advance Beneficiary Notice was signed by R147, not the legal guardian. On 5/15/24 at 11:40 a.m., in an interview with a surveyor, the Licensed Social Worker stated R147 should not have signed, R147 was not able to. On 05/15/24 at 12:16 p.m., in an interview with a surveyor, the Program Director of Therapy stated the notice should have been signed by the legal guardian. At this time a surveyor confirmed…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews and interview, the facility failed to ensure a resident's right to formulate an advanced directive regarding code status (cardiopulmonary resuscitation [CPR]) was accurate in the electronic record for 2 of 6 residents reviewed for advanced directives (Resident #53 [R53] and Resident #68 [R68]). Findings: 1. On [DATE] at 2:05 p.m., review of R53's electronic record revealed a face sheet and provider order indicated under the advanced directive heading, CPR, Full Code. Review of R53's paper chart revealed a form signed by the R53's power of attorney on [DATE] indicating the code status of do not resuscitate (DNR). On [DATE] at 10:34 a.m., in an interview with a surveyor, the Director of Nursing reviewed R53's electronic and paper record and confirmed that R53's clinical record contained two different directions for code status. 2. On [DATE] at 10:16 a.m., review of R68's electronic record revealed a face sheet which indicated under the advanced directive heading, CPR. The provider 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 record review and interview, the facility failed to incorporate recommendations from the Preadmission Screening Resident Review (PASARR) level II determination and the PASARR evaluation report into a resident's assessment, care planning, and transitions of care for 1 of 1 sampled resident (Resident #77 [R77]). Finding: On 05/14/24 at 8:25 a.m., during a record review of R77's record, the PASARR II dated 3/7/24 has the PASRR determination explanation the R77 met the State of Maine's definition for serious mental illness due to a diagnosis of schizoaffective disorder, anxiety disorder and major depressive disorder, these diagnosis has led to intermittent functional limitations in interpersonal functioning, concentration or adaptation to change causing significant distress and impairment in R77's ability to function independently. R77's PASRR recommended: Specialized services for ongoing service or support with ongoing psychiatric services by a psychiatrist to evaluate response and effectiveness of psychotropic medications on target symptoms, modify medication orders, and 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 record review and interviews, the facility failed to provide services to maintain and/or improve residents' highest level of functional mobility. The facility failed to provide Resident Restorative Nursing as outlined in care plan for 1 of 1 sampled resident (Resident #87 [R87]). Finding: Resident #87's care plan for need/preference, approach, goal dated 3/28/24 that directs staff to establish a restorative nursing program for me. R87's Restorative charting has an order for Nursing Rehab/Functional Maintenance Plan: PASSIVE RANGE OF MOTION DATE: 5/2/24 PROBLEM: Decreased range of motion/functional mobility r/t (related to): Disease process, GOAL: Resident will have no further loss of ROM (range of motion)/functional mobility x 3 months INTERVENTIONS: Perform PROM (passive range of motion) to LE (lower extremities) for 15 minutes QD (every day). The facility was not able to provide any documented evidence that R87 received his/her PROM as directed by his/her Restorative plan on 4/1/24, 4/2/24, 4/4/24 through 4/7/24, 4/9/24 through 4/16/24, 4/20/24, 4/21/24, 4/24/24, 4/25/24,…

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 the facility failed to ensure physicians orders were followed for the use of sliding scale insulin order for 1 of 5 residents reviewed for unnecessary medications. (Resident#19 [R19], Resident #51 [R51]). Findings: 1. R19's clinical record contained a physician order to check blood sugar levels 4 times a day and a physician order to use sliding scale Insulin Aspart for Blood Glucose (BS) readings of 201-250 give 4 units, 251 - 300 give 6 units, 301-350 give 8 units, 351-400 give 10 units, greater than 400 call physician for administration instructions. A review of R19's Task Med Tech Medication Administration Record, (MAR) for May 2024 has the following documented: On 5/3/24 at 11:00 a.m., documentation showed that R19's BS was 254; documentation shows that R19 received 4 units of Aspart Insulin. The sliding scale indicates that for a BS of 254 he/she should have received 6 units of Aspart Insulin for coverage at that time. On 5/4/24 at 8:00 a.m., documentation showed that R19's BS was 90; documentation shows that R19 received 4 units of Aspart…

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, the facility failed to provide supervision for resident safety when they sent a resident out to an appointment in the community independently for 1 of 1 residents reviewed (Resident # 147 [R147]). Findings: On 5/15/24, record review indicated R147's admitting diagnosis included bimalleolar fracture of right ankle and intellectual disability. Therapy documentation dated 11/2/23, indicated R147's baseline needs include assistance from a caregiver 24 hours a day, 7 days a week for cognitive deficits, and safety awareness deficits. The record identified a legal guardian for decision making. A physician order indicated R147 was to be accompanied by a staff member for the scheduled follow up appointment on 12/14/23. On 5/15/24 at 10:40 a.m., in an interview with a surveyor, the Unit Manager stated staff did not accompany R147 to the appointment due to a miscommunication, as the facility thought a member from R147's group home would be there instead. On 5/15/24 at 10:50 a.m., in an interview with a surveyor, the Certified Nursing Assistant (CNA)…

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, the facility failed to ensure the physician reviewed the resident's total program of care, which included signing orders for medications and treatments listed on the Physician Orders (block orders) in a timely manner for 1 of 6 sampled residents (Residents #13 [R13]). Finding: Documentation in Resident #13's clinical record stated the Physician signed Physician Orders (block orders) on 2/16/24. These orders were in effect for 60 days. The next Physician Orders (block orders), including a 10-day grace period, needed review and the Physician's signature by 4/26/24. The medical record lacked evidence that the Physician reviewed and signed orders on or around 4/26/24. On 5/16/24 at 9:00 a.m. in an interview with the Director of Nursing, a surveyor confirmed that the Physician Orders (block orders) were late and they are unable to find another one that was reviewed and signed as of 5/16/24.

Based on record review, Wound Care Policy and Procedure review, observation and interview, the facility failed to ensure that the infection control practices according to the facility's Wound Policy and Procedure during a pressure ulcer dressing change was followed for 1 of 2 sampled residents with a Stage 3 or higher pressure ulcer (Resident #83 [R83]). Finding: On 5/15/24, a review of R83's clinical record was completed. R83 is diagnosed with insulin dependent diabetes, obesity, status/post acute respiratory failure with hypoxia, kidney failure, hypotension, deep vein thrombosis, and a healing Stage 4 pressure ulcer on the sacrum. In the physician order section, the pressure ulcer treatment is to cleanse with Normal Saline and pat dry. Apply Lotrisone cream (antifungal antibiotic and topical steroid cream) around pressure ulcer wound, pack wound with Aquacel with Silver and cover the wound with Mepilex (absorbent foam dressing). Change daily and as needed. A review of the Wound Care Policy and Procedure indicated under the 'Steps in the Procedure', number 1, Use disposable cloth…

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 the facility failed to respond to residents request for assistance in a manner that maintained or enhanced their dignity by not answering the call bells in a timely manner. In addition, the facility failed to respond to a residents request for assistance in speaking to the Administrator to voice grievance with respect to his/her treatment/care for 2 of 5 residents interviewed. (Resident #3, [R3}, and R2) Findings: 1. On 3/11/24 at 11:25 a.m., during an interview with R3, he/she stated that on Sunday he/she rang their call bell at 7:00 a.m., R3 stated he/she remembers the time because they looked at the clock, and no one came in to assist him/her with pain for 50 minutes. The nurse came into R3's room at 7:50 a.m. to address his/her needs. R3 stated this has happened a few times, the last time being when a family member was visiting and the call bell rang for 35 minutes before the family member had to go find staff to assist . R3 couldn't remember what they needed but he/she stated when they don't answer the call bell it increases their anxiety…

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 the facility failed to ensure that a resident receiving care was free from neglect when the resident was denied a daily shower as ordered by their provider from 2/24/24 to 3/4/24. (Resident #2 [R2]) Finding: On 3/4/24, the department of Health and Human Services received a report of resident neglect. The report alleges that the resident did not receive daily showers as ordered by their provider, and because of the neglect of personal hygiene it was reported that the resident developed a rash in the groin area. During a clinical record review, documentation in R2's clinical records indicated that R2 did have a written order for daily showers with specific instructions to allow staff to complete this task safely. On 2/29/24 a written order is for a shower daily, may get knee wet, put empty saline bottle between elbow and body for support. Left knee daily shower, remove dressing after loose in shower. After showering, flush with saline, apply Medi honey, telfa, ace wrap. Limit knee flexion to 80 degrees max. A review of R2's electronic treatment…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews, and interviews the facility failed to ensure that physician orders were followed for 1 of 5 residents reviewed (Resident #2 [R2] Finding: R2 was admitted on [DATE] from an acute hospital following a short stay for right shoulder rotator cuff tear, severe postoperative pain and impaired mobility due to left quadriceps tendon repair. R2 had greatly impaired mobility and safety related to inability to use right upper extremity and need to use cane due to quadriceps tendon repair. R2 was admitted with discharge orders from the hospital for wound care for dressing changes to right shoulder and left knee. With instructions that if R2 desires to have a shower R2 may have a shower while seated and follow wound care instructions after showering on 2/24/24. On 3/11/24, during a record review for R2 a written order, dated 2/29/24, was written for R2. The order is for a shower daily, may get knee wet, put empty saline bottle between elbow and body for support. Left knee daily shower, remove dressing…

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, facility policy, and interviews, the facility failed to ensure that resident's narcotic medication cards were properly accounted for and free from misappropriation for 2 residents (Residents #300 and #301) identified in 1 of 1 facility reported incident/investigation reviewed (9/29/22). Finding: On 9/29/22 at 3:28 p.m., the Department of Licensing & Certification received a facility reported incident (FRI) indicating On 9/28/22 controlled substance medication card was found missing during shift count this morning. Review of facility 5-day follow up dated 10/3/22 states .During the investigation it was identified that 3 other medications were documented in the controlled substance book as destroyed on 9/22/22 with the DNS [Director of Nursing]. The medications were oxycodone 5 milligrams [mg] 111 tabs for resident [Resident #300], Norco 10/325mg 11 tabs for [Resident #301] and Norco 10/325mg 112 tabs for [Resident #301]. Both patients had been discharged before the medications 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews and interviews, the facility failed to develop/implement a care plan with interventions and goals for 1 of 2 sampled residents with a history of post-traumatic stress disorder (PTSD) (Resident #72) and for 1 of 2 sampled residents with contractures (Resident #60). Findings: 1. On 2/14/23, Resident #72's clinical record was reviewed which indicated the resident was admitted to the facility on [DATE]. The clinical record included a late entry note dated 1/30/23, found under the Social Services Assessment/History, for an initial assessment completed on 1/23/23 that indicated Resident #72 had reported that he/she has PTSD but refused to elaborate on the cause, but did answer questions that he/she had upsetting thoughts, dreams, and memories about the event. This note which was written by the Social Services Assistant also indicated that she would report this to the Social Services Director (SSD) and Nurse Manager so the care planning can be initiated. On 2/15/23 at 10:05 a.m., during an…

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, interviews, and record review, the facilities interdisciplinary team failed to determine if it was clinically appropriate for a resident to keep a medication at bedside and self-administer medications for 2 of 4 days a medication was observed unlocked, and available for use in a residents room. (Resident #47) (2/14/23, 2/16/23) Findings: On 2/14/23 at 9:39 a.m., during an interview with Resident #47, a surveyor observed medication, Diclofenac Sodium 1% ointment (a topical pain medication) on the shelving unit beside head of bed. Resident #47 stated he/she does not have pain and disregarded the question about the use of this medication. On 2/16/23 during clinical record review, there was no evidence that the facility interdisciplinary team determined it was clinically appropriate for Resident #47 to keep any medication at bedside and self-administer a medication. On 2/16/23 at 8:13 a.m., during interview and observation with a surveyor, Licensed Practical Nurse (LPN) #1 was shown, and observed that Diclofenac Sodium 1% ointment was in Resident #47's room 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.

Based on record reviews and interview, the facility failed to review and revise the care plan by an interdisciplinary team (IDT) after each assessment and/or included the participation of the resident and resident's representative, for 1 of 2 newly admitted residents who were reviewed for care planning (Resident #80). Finding: During a review of Resident #80's clinical record, the surveyor noted a Minimum Data Set (MDS) 3.0 admission assessment, dated 11/18/22. The clinical record lacked evidence that the resident and resident representative were included in the care plan meeting. On 2/14/23 at 11:04 a.m. during an interview with Resident #80, he/she stated they could not remember being invited to participate in the care plan meeting. On 2/15/23 at approximately 2:00 p.m. during an interview with the Licensed Social Worder, the surveyor confirmed that they do not have any documentation that the resident had a care plan meeting or was involved to create his/her care plan.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews, the facility failed to provide Restorative services as outlined in the resident's restorative therapy program to maintain and/or improve a residents highest level of Active Range of Motion (AROM and Passive Range of Motion (PROM), for 1 of 2 sampled residents (Resident #58). Finding: On 2/13/23, Resident #58's clinical record was reviewed. Resident #58's restorative therapy program (Nursing Rehab/Functional Maintenance Plan) directed staff to perform AROM to all extremities for 15 minutes every day (QD) and to perform PROM to lower extremities for 15 minutes QD. Staff are to document the minutes for each. On 2/16/23 at 11:00 a.m., the Unit Manager (UM) #2 and a surveyor reviewed February's documentation for AROM and PROM for Resident #58 and it was noticed that there were 11 out of 15 days that the range of motions (ROM) were not completed 15 minutes daily. On 2/16/23 at 11:10 a.m., during an interview with a surveyor, Certified Nursing Assistant (CNA) #3 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 record review and interview, the facility failed to follow a physician ordered treatment to complete daily wound documentation and failed to ensure that weekly pressure ulcer assessment documentation, used to monitor the healing progress of the wounds, included stage, length, width, and depth for 1 of 2 residents reviewed with a pressure ulcer (Resident #49). Findings: On 2/13/23, Resident #49's clinical record was reviewed which indicated that pressure injuries were found on 1/16/23 to both of Resident #49's heels. The Resident Matrix was received on 2/13/23 and was returned to the Director of Nursing for further clarification of Resident #49's pressure injuries to the heels. The Resident Matrix was updated on 2/14/23, to indicate that Resident #49 had an unstageable pressure injury that had worsened. 1. Resident #49's most recent physician orders included the following: on 2/3/23, a treatment was entered in the physician orders to complete daily wound documentation (for a pressure wound) 6 times a week for the left heel and on 2/6/23, a treatment was entered in 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 record review and interviews, the facility failed to ensure the physician wrote a rationale for the continued use of an as needed (PRN) psychotropic medication beyond the 14-day limit for 1 of 5 sampled residents reviewed for unnecessary medications (Resident #72). Finding: Resident #72 was admitted to the facility on [DATE] with an order for Alprazolam (Xanax), a psychotropic medication, 1 milligrams (mg) by mouth every 4 hours as needed with a 14 day stop date of 2/2/23, for anxiety. On 1/31/23, documentation in the clinical record completed by a Medical Provider (MP) #1 indicated that short term Xanax allow to fall of the Medication Administration Record (MAR). On 2/6/23, a telephone order was received from MP #2, an on-call provider, to renew Alprazolam 1 mg every 4 hours as needed for anxiety x 14 days. On 2/8/23, a progress note completed by MP #3 did not even acknowledge that Resident #72 was using the Xanax or that the resident had increased anxiety. On 2/16/23 at 8:14 a.m., during an interview…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, and facility policy, the facility failed to ensure expired medications were removed from the supply available for use and failed to ensure medications were appropriately administered to resident(s) after being removed from Pixus medication cabinet for 1 of 4 medication carts reviewed ([NAME] Unit). Findings: During a medication pass observation on the [NAME] Unit on 2/13/23 at 2:15 p.m., two unlabeled plastic zip lock bags were noted in the top left draw of the Medication Technician cart. One bag contained one foil sealed tablet labeled as hydroxyzine HCL [antihistamine]25 mg tablet. Second bag contained 6 foil sealed and loose tablets of lisinopril [cardiac medication]25 mg, 1 foil sealed tablet of vancomycin [antibiotic] 125 mg. 2 sealed tablets of carbidopa/levodopa [for treatment of Parkinson's disease] 25mg/100mg tablets and 2 tablets of sevelamer [medication for kidney disease] 800 mg with expiration date of 1/8/23. All the available medications were in the medication cart…

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

Based on record review and interview, the facility failed to ensure that the resident representative was provided the opportunity to accept or refuse a Pneumococcal vaccine and ensure that the resident's clinical record included documentation of the status of Pneumococcal Vaccine for 1 of 5 residents reviewed for immunizations (Resident #32). Finding: On 2/16/23, during a clinical record review for vaccination status for Resident #32 (who was admitted in 2019), the surveyor was unable to verify in the electronic record that the resident had received or refused his/her Pneumococcal Vaccine. On 2/16/23 at 3:30 p.m., during an interview with a surveyor, the Infection Preventionist/Director of Skilled Nursing Services stated she has found the consent form in Resident #32's paper chart that is still awaiting family consent and that the form has been sitting in the chart for a while and had not been addressed.