Kennebunk Center For Health & Rehabilitation, LLC

Based on record review and interview, the facility failed to issue a written transfer/discharge notice and a bed hold notice to include cost of care and a statement of the resident's appeal rights to the legal representative for 1 of 5 sampled residents reviewed for transfer to an acute care hospital (Resident #77).Finding:1. Documentation in Resident #77's clinical record indicated that he/she was transferred to an acute care hospital on 1/15/26 and on 4/12/26. Further review of Resident #77's clinical record lacked evidence that the facility issued a written transfer and discharge notice and bed hold notice to the resident's representative for the above dates.On 4/15/26 at 2:19 p.m. during an interview in the presence of 4 surveyors, the Business Office Manager confirmed that she does not issue a written transfer/discharge notice and bed hold notice to resident representatives.

Based on observations, record review, and interviews, the facility failed to ensure physician orders were followed for 1 of 1 resident receiving oxygen therapy (Resident #11).Finding:On 4/12/26 at 9:09 a.m. and 11:48 a.m., a surveyor observed Resident #11 asleep in bed, wearing oxygen (O2) via a nasal cannula with the oxygen concentrator flow rate set between 3.5 and 4 liters per minute.A review of Resident #11's clinical record revealed an active physician order for Oxygen at 2 liters per minute continuous via nasal cannula.every shift for shortness of breath.On 4/13/26 at 3:59 p.m., during an interview, Resident #11 stated that staff hand him/her the oxygen tubing and that he/she puts it on and takes it off, but that staff make all adjustments to the oxygen concentrator settings.On 4/14/26 at 8:45 a.m., the surveyor observed Resident #1 asleep in bed wearing oxygen with the oxygen concentrator flow rate set to 2.5 liters per minute.On 4/15/26 at 11:45 a.m., during a repeat observation, Resident #11 was lying in bed and was not wearing oxygen, and his/her oxygen concentrator was…

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, interviews, record review, and facility policy, 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 4 of 5 residents reviewed. (Resident ##2, #3, #4 and #5). Findings: 1. On 2/25/25 from approx. 8:15 through 9:02 a.m., the following was observed: Resident #2 had a medicine cup with an unknown cream on the bedside tray table. Resident #3 had a medicine cup with an unknown cream on the beside dresser. Resident #4 had pump bottle of Bio freeze and a tube of Triad Hydrophilic wound dressing paste on the bedside dresser. Resident #5 had a medicine cup with an unknown opaque color cream with a plastic cup over it on the bedside tray table. 2. Review of Resident #2's medical record lacked evidence of a provider order for any cream treatment other than house stock lotions, an order for self-administration, a self-administration evaluation and a care plan for self-administration. 3. Review of Resident #3's medical record contained a 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews and record reviews, the facility failed to ensure medications including treatments were stored properly on 2 of 4 units observed (Sagamore and [NAME] units). for 1 of 1 day of survey. (2/25/25) Findings: 1. On 2/25/25 at 9:02 a.m., Resident #5 was sitting on the side of the bed with the bedside tray table in front of him/her. On the table was a medicine cup filled with an unknown opaque color cream with a plastic cup over it and 2 medicine cups of applesauce with a spoon. At this time, in a brief interview, Resident #5 stated that the nurse was giving him/her medications, but they were too big to swallow, so she is cutting them in half. The surveyor asked what the unknown cream was for. Resident #5 stated, for arthritis pain. Surveyor asked if the nurse applies the cream, he/she stated, I do. At 9:05 a.m., the nurse entered the room with a cup of pills, upon leaving the room, the arthritis cream was left on the table. 2. On 2/25/25 at 10:05 a.m., the surveyor rounded with the…

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

Based on observation, interview, and a review of Safety Data Sheets (SDS), the facility failed to ensure that the resident's environment was free of accident hazards relating to the storage of a chemical not being properly secured for 1 of 1 days of survey (2/25/25). Findings: The Safety Data Sheet for HDX Disinfectant Spray Linen Scent 19 oz noted the following: Description of first aid measures: Inhalation Remove to fresh air. Eye contact Rinse thoroughly with plenty of water for at least 15 minutes, lifting lower and upper eyelids. Consult a physician. Skin contact Wash skin with soap and water. Ingestion Rinse mouth. On 2/25/25 at 8:31 a.m., the surveyor observed Resident #1 to have a can of Great Value Disinfectant Spray Linen Scent on his/her bedside dresser. In a brief interview, Resident #1 stated he/she uses it for when it smells, and it's his/her personal can. On 2/25/25 at 10:05 a.m., the surveyor and the Director of Nursing (DON) observed Resident #1's can of Great Value Disinfectant Spray Linen Scent on the bedside dresser. At this time, the DON stated she was unaware…

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

Based on observations, record reviews and interview, the facility failed to ensure that clinical records were complete and contained accurate information for 1 of 5 residents reviewed for medications (Resident #5). Finding: On 2/25/25 at approx. 9:02 a.m., Resident #5 was sitting on the side of the bed with the bedside tray table in front of him/her. On the table was a medicine cup with an unknown opaque color cream with a plastic cup over it and 2 medicine cups of applesauce with a spoon. At this time, in a brief interview, Resident #5 stated that the nurse was giving him/her medications, but they were too big to swallow, so she is cutting them in half. The surveyor asked what the unknown cream was for. Resident #5 stated, for arthritis pain. Surveyor asked if the nurse applies the cream, he/she stated, I do. At 9:05 a.m., the nurse entered the room with a cup of pills, upon leaving the room, the arthritis cream was left on the table. On 2/25/25 from 10:05 a.m., through 10:17 a.m., during a walk through with the Director of Nursing (DON), both the surveyor and DON observed 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 observations and interviews, the facility failed to adequately provide housekeeping and maintenance services necessary to maintain the building in a sanitary, orderly, and comfortable environment on 4 of 4 units (Windermere, Eagle, Sagamore and Regena, and Laundry Room) for 1 of 4 days of survey. Findings: Sagamore unit: On 1/14/25 at 8:09 a.m., observation of the shared bathroom for room [ROOM NUMBER] and 4 with a black substance around the base of the toilet and the caulking strip peeled up. On 1/13/25 at 11:32 a.m., and on 1/14/25 at 8:11 a.m., observations of the shared bathroom for room [ROOM NUMBER] and 9 with a commode bucket stored on the floor, a large brown circular stain on the floor to the left of the toilet, a brownish tan substance around the base of the toilet and the caulking strip peeled up. On 1/13/25 at 10:29 a.m., observation of the shared bathroom for room [ROOM NUMBER] and 10 with a gray basin stored on floor and leaning against the wall. On 1/16/25 at 3:16 p.m., the above was…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews the facility failed to provide Activities of Daily Living (ADL) care for 6 of 6 resident reviewed for ADL's (Resident #126, #6, #19, #64, #226 and #230). In addition, the facility failed to follow the care plan in the area of oral hygiene for 1 of 1 reviewed. (Resident #6). Findings: The facilities ADL Policy and Procedure issued 6/23 states, Purpose: To provide the level of care required by each individual resident and Procedure: Staff provide assistance to complete ADL activities per their person centered evaluation and care plan. These activities are broken down into eight areas. #1.Bathing/showering . #8 Personal hygiene and grooming. 1. On 4/10/24 the Division of Licensing and Certification received a complaint that Resident #126 did not receive appropriate care with his/her Activities of Daily Living (ADL). He/she was found wearing the hospital [NAME] a day after admission and for the 2 weeks Resident #126 was at the facility, his/her underwear 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 observations and interviews, the facility failed to maintain a sanitary environment to help prevent the development and transmission of disease and infection related to respiratory care for 2 of 3 residents reviewed for respiratory care (Resident # 16 and #20). In addition, the facility failed to follow physician orders for 1 of 3 reviewed for respiratory care (Resident #16). Findings: The facilities Nebulizer Treatments Policy and Procedure revised 2/23, states, post treatment, disconnect the reservoir from the compressor and clean per manufacturer's Instructions, Place reservoir in a plastic bag Manufactures Instruction Manual for Power Neb Ultra Compressor Nebulizer, under section cleaning and maintenance states, clean after every use .disassemble mouthpiece or mask from cap .wash all items, except tubing in a hot water/dishwashing detergent solution. Rince under hot tap water for 30 seconds to remove detergent residue. Allow to air dry. Under section , Filter Change states, Filter should be changed every 6 months or sooner if filter discolors. 1. On 1/13/25 at 11:32…

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 ensure sufficient direct care staff were scheduled and on duty to meet the needs of residents that reside in the facility. This has the potential to affect all residents needing assistance with Activities of Daily Living (ADL's). Findings: Review of Payroll Based Journal staffing report revealed the facility triggered for excessively low weekend staffing during the fourth quarter of 2024 (July 1 - September 30). On 1/15/25 at 3:47 p.m., a surveyor met with the Administrator and reviewed weekend staffing for July 1, 2024, through September 30, 2024, the Administrator confirmed the facility did not have enough staff to meet resident needs on the weekends.

Based on observations, interviews, record review and the facility's own Personal Appearance and Dress guidelines and the Personal Hygiene for Food Handlers policy and procedures, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner, failed to serve food in accordance with professional standards for food service safety, failed to monitor food temperatures to prevent food borne illness prior to serving residents for 1 of 2 days of survey (1/13/25), and failed to ensure that plumbing fixtures were properly installed to prevent backflow as required by the Maine State Plumbing Code. This has the potential to affect all residents in the facility. Findings: The facilities Personal Hygiene for Food Handlers, revised on 2/22 states, Hair restraints such as hats, hair coverings or nets, and beard restraints are worn at all times when in the kitchen and Facial hair should be neatly trimmed and covered by mask or beard guard. The 10-114 State of Maine Rules Chapter 226, definition Section A, defines an Air-Gap Separation - A physical separation between 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 and record review, the facility failed to ensure the terms and conditions of a binding arbitration agreement were clearly communicated to the residents or their representatives and not required as a condition of admission due to the agreement being a part of the admission paperwork for 5 of 5 residents reviewed for Arbitration (Resident #126, #230, #23, #64, and #19). Findings: 1. On 1/13/25 at 9:15 a.m., a surveyor conducted an entrance conference with the Administrator and the Director of Nursing and was told, when asked, that no residents in the facility had signed an arbitration agreement. During a record review for Resident #19, a surveyor located a signed Arbitration agreement in Resident #19's Electronic medical Record (EMR). 2. On 1/16/25 at 9:32 a.m., during an interview, the Admissions and Marketing Director stated she is responsible for having the resident/family representative sign the admission packet which also contains the Resident and Facility Arbitration Agreement upon…

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 interviews and record reviews, the facility failed to ensure that a resident's choice in the area of clothing were followed for 1 of 9 sampled residents (Resident #234). Findings: On 4/18/24 the Department of Licensing and Certification (DLC) received a referral from Adult Protective Services (APS) of an incident that occurred on 4/12/24 around 11:00 p.m. where a tooth became cracked during the removal of a sweater. A surveyor reviewed the facility incident report dated and learned that on the night of 4/12/24, two staff members were getting Resident #234 ready for bed and tried to remove his/her sweater. Resident #234 reportedly told the staff she/he did not want to remove the sweater and bit down on the neck of the sweater to prevent removal. The sweater was removed anyway and Resident #234's tooth broke during the removal. On 1/15/25 at 2:10 p.m. a surveyor spoke with the Director of Nursing about the incident and confirmed that the residents' right to keep the sweater on was not respected despite the resident clearly expressing he/she did not want the sweater removed.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy, record review and interviews, the facility failed to adequately evaluate a resident after an unwitnessed fall and complete neurological assessments as per facility policy for 1 of 2 residents reviewed for falls (Resident #125). Findings: The facilities Fall Prevention Program, last revised 3/23 states, If a fall occurs . Monitor resident's status for 72 hours. Some injuries may not be apparent immediately after the fall. The facilities Neurological Evaluation Policy, revised 4/23 states, The licensed nurse performs neurological evaluations whenever there is a possibility of a head injury, change in mentation, or an unwitnessed fall Purpose: Accurate evaluation and monitoring of changes in residence neurological status to allow prompt medical notification treatment Procedure: The neuro care flow sheet includes vital signs temperature, pulse, respirations, and blood pressure and information regarding pupil reaction of both eyes, level of consciousness, motor function, speech, facial…

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, and interviews, the facility failed to maintain adequate pharmaceutical services to ensure that outdated medications, were removed from the medication carts making them no longer available for use in 1 of 3 medication carts. Findings: On [DATE] at 9:06 a.m., a surveyor observed in medication cart on Eagle Wing a medication card for Ondansetron HCL 4 milligrams (mg) for Resident #13 had expired on [DATE]. The surveyor confirmed the finding with the Licensed Practical Nurse (LPN) #1. at 9:12 a.m. On [DATE] at 9:30 a.m., a surveyor discussed the above findings with the Director of Nursing.

Based on record review, interviews, and facility policy, the facility failed to ensure that two people, who are authorized to administer medications, signed the Narcotic Bound Book Shift Count page indicating that they counted all the controlled substances at the change of shift for multiple shifts between 8/14/24 and 9/3/24 (total of 56 shifts) for 1 of 4 units reviewed for drug diversion (Sagamore). Findings: Review of the facility policy Controlled Substances dated 10/07 states: At each shift change, a physical inventory of controlled medications, as defined by state regulation, is conducted by two licensed clinicians and is documented on an audit record. On 8/16/24, the Department of Licensing and Certification received a facility reported incident indicating during shift change on 8/16/24 at 16:00, a 30ml bottle of Ativan could not be located. Review of provided Sagamore Unit shift count log lacked documented evidence that a shift change count was conducted by two qualified staff on the following days 8/14/24 at 15:00 during oncoming shift. 8/15/25 at 23:00 during outgoing…

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 facility failed to provide a separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse for 1 of 1 observation. Findings: On 8/16/24, the Department of Licensing and Certification received a facility reported incident indicating during shift change on 8/16/24 at 16:00, a 30ml bottle of Ativan could not be located. On 9/3/24 at 9:15 a.m. an observation of the locked refrigerator in the locked Medication Room, a surveyor observed that there was no separate, locked box that is attached to the refrigerator for storage of Controlled Substances. On 9/3/24 at 11:00a.m. in an interview with the Director of Nursing, she stated that there had never been a seperate locked box in that refrigerator. On 9/3/24 at 11:05a.m. the above were confirmed with the Director of Nursing.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations and interviews, the facility failed to adequately provide housekeeping and maintenance services necessary to maintain the building in good repair and in a sanitary condition, on 2 of 4 units (Sagamore and [NAME]) for 1 of 1 environmental tour. Findings: 1. [NAME] wing - room [ROOM NUMBER] - resident by the door, arm of wheel chair is cracked with open areas creating an uncleanable surface. 2. Sagamore wing - room [ROOM NUMBER], the wall to the left of the door upon entry has deep gouges in wall door frame. 3. Sagamore wing - room [ROOM NUMBER] - wall between dresser and bathroom has gouges in the lower portion of the wall. 4. Sagamore wing - room [ROOM NUMBER]'s bathroom - Ceiling vent full of dust and cobwebs. On 10/19/23, at 2:20 p.m the above finding was confirmed with the Administrator.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to revise a care plan to reflect the current needs for 3 of 27 residents reviewed in the areas of transmission-based precautions and respiratory care (#51, #173, #176); and failed to revise the care plan after each assessment for 1 out of 3 sampled residents (#39) receiving in-house therapy services. Findings: 1. On 10/16/23 at 11:16 a.m., a surveyor observed a personal protective equipment (PPE) station with signage advising of the need for transmission-based precautions (TBP) outside of Resident #51's room. A review of Resident #51's clinical record revealed a history and physical, dated 6/25/23, which noted the diagnosis of Vancomycin Resistant Enterococcus (VRE) in the resident's urine. A review of Resident #51's care plan noted the last revision was completed on 9/2/23 and did not include the need to use TBP when providing care for the resident. On 10/18/23 at 12:15 p.m., in an interview with a surveyor, the Director of Nursing confirmed 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 record reviews, observations and interviews, the facility failed to develop and implement a safe discharge plan that focused on a resident's discharge goals, preparation, and effective transition of care for 5 out of 6 sampled residents discharged from the facility. (#25, #168, #268, #269 and #271) Findings: 1. On 10/16/23 at 9:30 a.m. a surveyor reviewed closed records for Resident #171 in response to a complaint received at the Department of Licensing and Certification on 8/3/22. Review found Resident #271 was admitted on [DATE] and discharged to home on 7/30/22. Discharge orders included orders for home health services. The medical record lacked evidence that home health services was located. Resident #271 was readmitted to acute care on 8/1/22 with sepsis. 2. On 10/16/23 at 9:50 a.m., a surveyor reviewed closed records for Resident #269 in response to a complaint received at the Department of Licensing Certification on 10/18/22. Review found Resident #269 was admitted on [DATE] and discharged 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews and interviews, the facility failed to follow doctor's orders and their own Weight Policy & Procedure to document weights for 4 out of 4 residents (#6, #13, #26 and #53) with daily or weekly weight orders. Findings: 1. On 10/19/23 at 11:00 a.m a surveyor reviewed Resident #6 physician orders located in the Electronic Medical Record (EMR) and found an order dated 4/15/23 to obtain Daily Weights for a diagnosis of Congestive Heart Failure (CHF). Daily weights were not recorded for sampled months of 9/23 and 10/23. No documentation found with an explanation for the missing weights. 2. On 10/19/23 at 11:30 am a surveyor reviewed Resident #13 physician orders located in the EMR and found an order dated 4/19/23 one-time weekly weight, do every Monday for CHF. Weights were not recorded weekly for the months of 5/23, 6/23, 7/23 and 8/23. No documentation found with an explanation for the missing weights. 3. On 10/19/23 at 11:40 a.m., a surveyor reviewed Resident #53 orders located in the EMR and…

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

Based on observations, record reviews, and interviews, the facility failed to provide respiratory services as directed by physician orders related to oxygen use and monitoring for 2 of 2 residents reviewed for oxygen therapy (#51, #173). Findings: 1. On 10/16/23 at 11:16 a.m., a surveyor observed an oxygen concentrator set at 3 liters/minute in use next to Resident #51's bed. A review of the clinical record revealed a physician's order, dated 9/22/23, which stated Oxygen 2-5 liters per minute via nasal cannula as needed for shortness of breath. Indicate O2 (oxygen) saturation. A review of Resident #51's medication and treatment administration records found no documentation of when oxygen was in use or what the saturation levels were. 2. On 10/16/23 at 3:04 p.m., a surveyor observed an oxygen concentrator set at 1 liter/minute and in use next to Resident #173's bed. A review of the clinical record revealed a physician's order, dated 10/4/23, which stated Oxygen via nasal cannula, titrate to keep O2 saturation greater than 90% every shift. A review of Resident #173's medication and…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews and interviews, the facility failed to provide food that accommodated resident preferences for 2 out of 3 residents (#3 and #13) sampled about the food choices available. Findings: On 10/17/23 at 11:30 a.m., in an interview with Resident #13, stated he/she has repeatedly asked for ice cream as a snack and hamburgers as a meal alternative and has not received them. Resident #13 stated their goal is to gain weight because they have lost a lot of weight and that is why they are at the facility. Resident #13 would like more sugar snacks like ice cream and cookies, but they never get them. Dessert is frequently fruit cocktail. On 10/17/23 at 12:00 p.m., a surveyor observed Resident #13 ask the [NAME] Unit Helper for some ice cream. This surveyor walked with the [NAME] Unit Helper to get some ice cream and met the Head Chef in the hallway. The [NAME] Unit Helper asked for ice cream for Resident #13 and was told ice cream is no longer stocked and they would have to go buy some 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 closed record review and interview, the facility failed to ensure the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (Form CMS -10055) (SNFABN) were provided to 1 out of 2 residents reviewed whose Medicare Part A services were discontinued. (Resident #267) Finding: On 10/19/23 at 10:45 a.m. a surveyor reviewed Resident #267's medical record. Resident #267 received Medicare Part A services that ended on 6/16/23. The Medical record lacked evidence that the required Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN) was provided to the resident so that he/she could make an informed decision to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. On 10/19/23 at 11:15 a.m. a surveyor met with the Business Office Manager and confirmed this notice was not issued prior to the end of Medicare Part A services.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on closed record reviews and interviews, the facility failed to permit a resident's return to facility for 1 out of 1 resident reviewed for facility-initiated discharge to the hospital (Resident #270). Findings: On 5/16/23 at 9:16 a.m., Division of Licensing and Certification received a complaint indicating on 5/15/23 the facility transferred a resident to the hospital and failed to accept return of the resident. On 10/17/23 at 9:30 a.m., a closed record review of Resident #270's showed Resident #270 was admitted to the facility on [DATE] with a complicated medical history. The hospital discharge summary included follow up appointments scheduled for 5/2/23 and 5/3/23 involving out of state providers. Resident #270 was transferred on 4/15/23 to the facility by ambulance due to their inability to tolerate sitting upright for the duration of the ride. On 10/17/23 at 11:00 a.m., in an interview with the admission Coordinator, stated that transportation was a known problem prior to admitting Resident #270. 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.