Maplecrest Rehab & Living Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observations and interviews the facility failed to ensure that two people who are authorized to administer medications signed the Narcotic Bound Book [a logbook used to record medication] Shift Count page indicating that they counted all the controlled substances at the change of shift for multiple shifts on 2 of 3 units observed for medication storage (Embden and [NAME] Control log).1.On 7/7/25 at 8:35 a.m. a review of Embden and [NAME] unit control log with Certified Nursing Assistant/Medication Technician (CNA-M) #3 revealed the following: -control log lacked evidence of oncoming signature during the day shift on 7/4/25 at 06:00, on 6/6/25 at 06:00, on 6/10/25 at 06:00, on 6/27/25 at 06:00, on 6/24/25 at 14:00, and on 6/29/25 at 14:00. -control log lacked outgoing signature on 6/27/25 at 18:00, on 6/29/25 at 22:00, on 6/6/25 at 1:30 p.m., on 6/10/25 at14:00, on 6/11/25 at 11:00, on 6/27/25 at 22:00, on 6/30/25 at 18:00, and on 6/29/25 at 22:00.At this time CNA-M #3 stated 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.

Based on observations, record reviews, and interviews, the facility's quality assurance committee failed to ensure that the Plan of Correction (PoC) for identified deficiencies from the Recertification Survey, dated 7/9/25, were implemented/effective. The facility remains non-compliant with deficiencies F0695 (Respiratory Care), F0755 (Pharmacy Services/Procedures/ Pharmacist/Records), and F0880 (Infection Prevention & Control) which were recited at the re-visit survey on 9/9/25.Findings: 1. On 07/09/25 during the Long-Term Care Survey process (LTCSP), a deficiency was cited at F0695 for the failure to maintain a sanitary environment to help prevent the development and transmission of disease and infection related to respiratory care. The facility's plan of correction for F0695, signed on 8/7/25, indicated that education regarding Cpap, Bipap, oxygen and nebulizer storage will be provided to nursing staff by August 18th, 2025. 2. On 07/09/25 during the Long-Term Care Survey process (LTCSP), a deficiency was cited at F0755 for the failure failed to ensure that two people who are…

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 a resident who had elected to receive a Pneumococcal immunization received the immunization, for 1 of 5 resident records reviewed for immunizations (Resident #25)Review of Resident #25's clinical record revealed a signed Immunization Consent Form, dated 7/24/24, indicating Resident #25's legal representative consented to the Pneumococcal immunization. Further review of the clinical record lacked evidence that Resident #25 received or refused the Pneumococcal immunization.On 7/9/25 at 12:52 p.m., during an interview with two surveyors, the Infection Preventionist stated the Director of Nursing handles immunization tracking. On 7/9/25 at 12:57 p.m., two surveyors reviewed the above findings with the Director of Nursing.

Based on record review and interview, the facility failed to ensure that a resident's choice in the area of bathing was followed for 1 of 3 sampled residents [Resident #1 (R1)]. Finding: On 12/11/24 at 12:30 p.m., during an interview with a surveyor, R1 stated he/she had not been offered a shower since they broke their leg. R1 stated my hair is long overdue for a washing. On 12/11/24, clinical record review indicated R1 fell from a Hoyer lift resulting in a fracture to the left leg on 11/20/24. R1 had a brief interview for mental status (BIMS) score of 15 on 12/2/24, which indicates the resident is cognitively intact. The care plan states, [R1] has a self care deficit related to [Multiple Sclerosis (MS)] as evidenced by residents inability to perform [activities of daily living (ADLs)] without assist. The orthopedic provider signed orders on 12/4/24 stating 1. Continue [left] knee brace, may remove for hygiene and 2. May transfer [from] bed to chair with brace in place as comfort allows. The record lacked evidence that the resident was offered, provided, or refused a shower after…

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 a care plan was updated in order to meet the physical needs of a resident for 1 of 2 residents reviewed during a complaint investigation [Resident #1 (R1)]. Finding: R1 was admitted on [DATE] with a diagnosis of Multiple Sclerosis (MS). On 11/20/24 R1 experienced a fall from a Hoyer lift resulting in a fracture of the left knee. The provider order dated 11/21/24 states wear left knee immobilizer as tolerated. On 12/4/24, the orthopedic physician signed an order stating (1) Continue [left] knee brace, may remove for hygiene. (2) May transfer [from] bed to chair with brace in place as comfort allows. (3) While in chair should have [left] leg supported. (4) Strictly [non weight bearing] on [left] leg. (5) [follow-up] 4 weeks for re-[check] xray. On 12/11/24, review of R1's care plan indicated, [R1] has a self care deficit related to MS as evidenced by residents inability to perform [activities of daily living (ADLs)] without assist. The surveyor…

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, record reviews, and facility policy, the facility failed to ensure care plans were updated/implemented for 2 of 3 residents reviewed during a complaint investigation. Findings: 1. Resident #1 was admitted to the facility on [DATE], with diagnoses including: history of heart attack; cerebral infarction; hemiplegia and hemiparesis; dysphagia; and morbid (severe) obesity. Review of Resident #1's care plan, updated 5/2/24, states, Interventions: Supervision/assistance is required at meal and snack times. Open all items .cut into small pieces . Review of Resident #1's active orders, dated October 2024, revealed diet order dated 6/14/24 for, Consistent carbohydrate, regular texture, continuous. Further review of Resident #1's clinical record lacked evidence of the need to cut food into small pieces. During an interview with 2 surveyors, on 10/28/24 at 10:41 a.m., Director of Nursing (DON) stated it was her expectation that a resident's care plan should reflect their personal goals 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 facility policy, record review, and interviews the facility failed to provide residents/representatives written information concerning the right to accept or refuse medical or surgical treatment and/or formulate an advance directive for 6 of 6 residents reviewed for advanced directives (Resident's #7, #23, #27, #39, #304 and #306). Findings: Review of facility policy Advanced Directive Policy and Procedure dated 10/18 states POLICY .Upon admission, the facility will inform and provide the resident/and/or resident's representative with information about advanced directive. PROCEDURE: Upon admission, identify if the resident has an advance directive and if not, determine if the resident wished to formulate an advance directive . All advance directive document copies will be obtained and located in the resident's medical record . 1. Resident #7 was admitted to facility on 3/5/19 with diagnoses to include multiple sclerosis. Review of annual Minimum Data Set (MDS) dated [DATE] revealed Resident #7 had 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.

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 for the 3 of 4 units (Lakewood, [NAME] Chase [NAME] and [NAME]), a common area and the Laundry room for 1 of 1 facility tours (4/18/24). Findings: On 4/18/24 from 8:40 a.m. to 9:00 a.m., a surveyor, the Administrator, the Maintenance Director and the District Manager for Health Care Services conducted a tour of the facility in which the following findings were observed: Lakewood - Resident room [ROOM NUMBER] (bed 2) - The wallpaper was peeling on the wall underneath the overhead bed light and next to the floor by the head of the bed. [NAME] Chase [NAME] - Resident room [ROOM NUMBER] - The wall, by the bed on the right side of the room, was marred and had chipped/missing paint creating an uncleanable surface. - Resident room [ROOM NUMBER] - The walls by the sink were marred and had chipped/missing paint, the drawers had…

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, interviews, and facility policy the facility failed to update/implement goals and interventions in the areas of enteral feeding (Resident #37), and mobility (Resident #41) for 2 of 14 care plans reviewed. Findings: Review of facility policy Comprehensive Person-Centered Care Planning dated 1/19 states The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with Residents Rights, which includes measurable objectives and timeframes to meet a residents medical nursing, mental, and psychosocial needs . Review of facility policy Vital Signs/Height And Weight Measurements Policy last revised 3/19 states: Procedure: B. Weights will be obtained weekly and documented for the first four weeks after admission (to obtain a baseline) and on a monthly basis unless otherwise ordered by the resident's physician . E. A weight that indicates a variance of +/-3 lbs. from the last obtained weight will necessitate a re-weigh of the resident. a. The original and 2nd weight should be obtained on the same shift and documented.…

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

Based on interviews, record review and facility policy, the facility failed to provide residents with a continuous resident centered activities program for 3 of 4 residents reviewed for activity participation. (Resident's #12, #16, and #47). Findings: Review of facility policy Activities undated states .Activities Calendar: This is done monthly and posted in every room and bedside and beside the dining room door. This will include the daily and weekend scheduled activities and the birthdays for that month Review of activity calendars for June 2023 through April 2024 (11 months), lacked evidence that continuous resident centered activities were held on weekends. Review of Resident #12, #16, and #47's Resident Daily Activities Log dated March and April 2024 lacked evidence that activities were offered/refused on the weekend. During an interview on 4/18/24 at 10:24 a.m., Resident #12 indicated they only have activities on weekends if it's a holiday, because the activity director has no help. During an interview on 4/18/24 at 10:27 a.m., Resident #47 indicated [he/she] would like…

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 a review of Safety Data Sheets (SDS), the facility failed to ensure that the resident's environment was free of accident hazards relating to electric wall heating units for 3 of 3 observations and failed to ensure that that a chemical was properly secured for 1 of 4 days of survey. (4/16/24) Findings: 1. On 4/16/24 at 7:00 a.m., a surveyor observed an electric wall heating unit in the hallway across from Administrator office that had the metal front cover hanging half off exposing hot, sharp metal fins. At this time, the Administrator confirmed in an interview that the broken and sharp electric heater was an accident hazard. Additionally, the Administrator confirmed that the facility had vulnerable and independent ambulating residents. 2. On 4/16/24 at 7:50 a.m., a surveyor observed the bathroom electric wall heating unit in Resident room [ROOM NUMBER]/104 to be missing the front cover exposing hot, sharp metal fins. On 4/16/24 at 7:55 a.m., the Administrator confirmed in 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 record reviews and interviews, the facility failed to complete performance reviews at least once every twelve months for 3 of 3 Certified Nursing Assistants selected for review (Certified Nursing Assistant's (CNA) (CNA's #7, #8 and #9). Findings: 1. CNA#7 was hired on 1/7/22. Review of CNA#7's personnel file lacked evidence that a performance evaluation was completed in 2023 and 2024. 2. CNA#8 was hired on 5/5/22. Review of CNA#7's personnel file lacked evidence that a performance evaluation was completed in 2023 and 2024. 3. CNA#9 was hired on 7/15/19. Review of CNA#7's personnel file lacked evidence that a performance evaluation was completed in 2023 and 2024. On 4/18/24 at 9:45 a.m. during an interview, the Director of Nursing confirmed staff have not received their annual reviews.

Based on observation, interview's, and record review, the facility failed to reconcile the narcotic book during shift change on 1 of 3 units (Emden Unit).,failed to monitor and record refrigerator temperatures containing biological's and vaccines in medicaion room (long term care medication room). Findings: 1. On 4/16/24 at 6:20 a.m., During review of long-term care controlled substance log with Certified Nursing Assistant/Medication Technician (CNA-M) #2 a surveyor noted the control substance log index was missing entries for page 49, 55, 59 and 60. At this time CNA-M #2 confirmed the index was missing entries. Review of untitled long term care narcotic log index on 4/17/24 revealed the following: -Index indicated page 48 belonged to Resident #304 for the medication lorazepam. Review of page 48 revealed it belonged to Resident #1 for medication Lyrica with received date 3/28/24. -Index indicated page 49 was missing a name but had quotations and arrows pointing down indicating it also belonged to Resident #304 for the medication lorazepam. Review of page 49 revealed it belonged 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 observations, interviews and the facility's current Cleaning Dishes/Dish Machine policy, Dish Machine Temperature and Sanitizer Log Form policy, Food Storage Procedure, Sink/Bucket Sanitizer logs, Daily High-emp Ware Wash Checklist logs and Freezer and Refrigerator Temperatures Form logs, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner for a ceiling air handling unit, ceiling tiles, ceiling lights, ceiling vents, and wall mounted fans. In addition, the facility failed to ensure products in the reach-in refrigerator and the dry storage room (including a chest freezer) were labeled and/or dated for 1 of 1 kitchen tours. Further, the facility failed to ensure that the dish machine was maintaining proper temperature ranges for proper washing/cleaning and that the refrigerators and freezers were monitored and temperatures documentation consistently. This has the potential to affect all residents. Findings: The facility's Cleaning Dishes/Dish Machine policy noted: All flatware, serving dishes, and cookware will be clean, rinse, 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 Certified Nurse's Aide (CNA) employee education record reviews and interview, the facility failed to monitor and ensure that a CNA attended the required 12 hours of annual in-service education, for 3 of 3 randomly selected CNA's employed greater than 1 year. (#7, #8, and #9). Findings: 1.CNA #7 was hired on 1/7/22. Review of CNA #7's Employee In-service/attendance records revealed CNA #7 has only 3.5 documented in-service hours from 1/7/22 through 14/18/24. 2. CNA #8 was hired on 5/5/22. Review of CNA #8's Employee In-service/attendance records revealed CNA #8 has only 4 documented in-service hours between 5/22/22 through 4/18/24. 3. CNA #9 was hired on 7/15/19. Review of CNA #9's Employee In-service/attendance records revealed CNA #9 has only 3.5 documented in-service hours from 7/15/19 through 4/18/24. During an interview on 4/18/24 at 9:45 a.m., Director of Nursing confirmed the above CNA staff have not completed 12 hours of yearly in-service hours.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, record review, and facility policy, the facility failed to assess a resident for self-administration of medications (Resident #20). Review of facility policy Self-Administration of Medications dated 11/28/16 states .Facility . should assess and determine, . whether Self-Administration of medications is safe and clinically appropriate, based on the resident's functionality and health condition .To ensure safe and appropriate Self-Administration, Facility should educate residents to ensure that a resident is able to; State the name, dose, strength, frequency, and purpose for use of his/her medications; Understand the possible side effects of his/her medications and that he/she should notify Facility staff if he/she experiences any such side effects; correctly administer .his/her medications . Facility should ensure that orders for Self-Administration list the specific medication(s) the resident may Self-Administer Facility should document in the Self-Administration of medications…

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 review, the facility failed to follow a resident's schedule for bathing and to ensure that a resident has a choice about his/her care in the area of bathing for 1 of 1 resident (Resident #11). On 4/17/24 at approximately 10:00 a.m. ,during an interview with a surveyor, Resident #11 voiced his/her frustration that he/she has not been receiving his/her showers on a weekly basis. Further, Resident #11 stated he/she prefers a whirlpool twice a week because it helps make his/her joints feel better and helps with his/her chronic pain. On 4/17/24, a surveyor reviewed the facility's Whirlpool & Shower List which indicates the resident is scheduled to have a shower and/or whirlpool on Wednesday during the day shift. In a review of the resident's electronic bath record from 3/1/24 through 4/17/24 indicates that resident had a shower on 3/27/24 and 4/10/24. The resident did receive a bed bath on the days a shower and/or whirlpool was not provided. On 4/17/24, at approximately 11:30 a.m., during an Interview, the Director of Nurses (DON) confirmed the above…

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 interviews, the facility failed to ensure the resident representative was notified of an injury of unknown origin and failed to follow its own Notification of Changes policy and procedure for 1 of 1 sampled resident reviewed for injury of unknow origin (Resident #9). Findings: The Facilities Notification of Changes policy and procedure, developed September 2018 states, The nurse will immediately notify the resident, residents physician and the residents representatives for the following: An accident involving the resident, which results in injury and has the potential for requiring physician intervention and The nurse will notify the resident, resident physician and the resident representatives for non immediate changes of condition on the shift the changes occurs unless otherwise directed by the physician. On 4/16/24 at 7:15 a.m., observations were made of Resident #9 to have purple bruising around his/her left eye. At this time in an interview, surveyor asked how the bruise was obtained, Resident #9 stated, I don't know, while touching…

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, observations and interviews the facility failed to maintain an Infection Control Program designed to help prevent cross contamination and/or development of infection by maintaining a safe and sanitary environment related linen handling, urinary collection devices for 3 of 3 days of survey on 2 of 3 units ([NAME] and Lakewood). Findings: 1. The facility's Linen Handling Policy notes under handling laundry: Soiled linen is considered to be potentially contaminated and standard precautions will be used when being handled. Gloves will be worn when handling soiled linens. Linens will be bagged (a pillowcase may be used) at the point of collection (resident room) and then soared linens are transported to laundry bins. On 4/16/24 at 7:23 a.m., a surveyor observed Certified Nursing Assist (CNA) #4 carrying soiled linen on the [NAME] unit from resident room [ROOM NUMBER] to the soiled utility room. CNA #4 was not wearing gloves and the linen was not bagged as per the facility's Linen Handling…

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 interview, the facility failed to have all residents sharing a table in the dining room eat at the same time. Meals were delivered between 12:24 p.m and 1:11 pm to residents sharing the same table. This has the potential to effect all the residents sitting in the dining room. Findings: On 10/18/22 from 12:24 p.m. to 1:11p.m., a surveyor observed the following during lunch meal pass. In the dining room there were 5 tables, clockwise: Table #1 had 4 residents, table #2 had 3 residents, table #3 had 1 resident (who wandered in and out of the dining room several times looking for his/her meal), table #4 had 4 residents and Table #5 had 2 residents (one of which also wandered in and out of the dining room looking for his/her meal). At 12:24 p.m., while waiting for lunch tray pass, a surveyor overheard one Certified Nursing Aide (CNA) state, it's almost 12:30, I'm about to make lunch myself. Then another CNA stated, where is lunch, this is frustrating. At 12:38 p.m., the first meal cart was delivered to the dining room. 1 CNA was present and began to pass out…

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 good repair and in a sanitary condition on 2 of 4 Units (Lakewood and [NAME]) for 3 of 3 days of survey. Findings: 1. Lakewood Unit: On 10/17/22 at 10:08 a.m., and 10/18/22 at 9:05 a.m., the shared bathrooms for both rooms 101/103 and 105/107 had an unlabeled urinal hanging on the toilet handrails. The shared bathroom for rooms 106/108 had the heating register with the off exposing the heating coils and a unbagged plunger on the floor next to the toilet. 2. [NAME] Unit: On 10/17/22 at 9:57 a.m., 10/18/22 at 10:28 a.m., the end of [NAME] unit had a heater with the cover off exposing the heating coils, the shared bathroom for rooms 423/425 had broken tiles that were dirty around the toilet, room [ROOM NUMBER] comforter had unknown brown/debris stain, room [ROOM NUMBER] closet door (to the right) of the sink was gouged/scuffed, the shared bathroom for rooms…

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 review and revise the care plan by an interdisciplinary team (IDT), that included, to the extent possible, participation of the resident and/or his/her representative to review and revise the care plan after each assessment for 5 of 13 sampled residents (#2, #3, #4, #28, #30). Findings: 1. On 10/19/22 at 11:47 a.m., during an interview with Resident #2's representative, when asked if he/she is invited and/or participates in his/her plan of care the representative stated, once [Resident #2] switched over to hospice, I didn't know if they were doing them anymore because I haven't been asked to come back. Review of Resident #2's medical record, the surveyor noted a Minimum Data Sets (MDS) Quarterly assessment dated [DATE], the clinical record lacked evidence of an IDT which included the resident, and resident's representative after the 7/19/22 assessment. 2. Review of Resident #3's medical record, the surveyor noted MDS Annual assessment dated [DATE] 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 observation and interviews, the facility failed to ensure expired medications were removed from the supply available for use in 1 of 1 medication rooms and 2 out of 3 medication carts observed. Findings: On 10/17/22 at 11:12 a.m., during observation of the facilities medication room and the Long Term Care and Skilled care medication carts with the Medication Technician (CNA-M) the following was observed: 1. Medication room contained an unopened bottle of Calcium 600 +D with best by date of 6/22. 2. In the [NAME] and Embden medication cart: a bingo card of 30 tabs of Fludrocortisone 0.1milligram (mg) tabs with expiration date of 8/31/22, 2 bingo cards with 30 tabs each of Glipizide 10mg with expiration date of 9/30/22, 2 bingo cards of Gabapentin 100mg (one with 30 tabs, another with 1 tab) with expiration date of 9/30/22 and a bingo card with 24 tabs of Quetiapine 200mg with expiration date of 6/30/22. 3. In the Lakewood and [NAME] Chase medication cart: 2 bingo cards of Baclofen 5mg (one with 30 tabs,…

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, Resident Council Meeting Minutes, observations and lunch meal test tray, the facility failed to serve hot foods hot for 1 of 1 lunch meals tested for appetizing temperatures. (Residents #38, #9, #30) Findings: 1. On 10/17/22 at 9:43 a.m., during an interview with Resident #38, he/she stated, the food is always cold, almost every morning. I think I'm one of the few that ask to have it warmed up. 2. On 10/17/22 at 10:58 a.m., during an interview with Resident #9, he/she stated, the food is not hot and there is no steam table in dining room, not since COVID. It used to be good when the steam table was available. Food is not hot now. 3. On 10/18/22 at 1:34 p.m., during an interview with Resident #30. Surveyor asked about timeliness of meal trays. Resident stated Trays are late every day. I don't even bother to ask them to warm it up. That'll take an hour. 4. On 10/18/22 1:18 p.m. a lunch test tray was tested by two surveyors. The tray was tested after the last tray was served to a resident 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 and interviews, the facility failed to assure the kitchen was maintained in a clean and sanity manner for an ice machine, ceiling tiles, and a fan, 1 of 1 kitchen tours. Findings: On 10/19/22 from approximately 10:55 a.m. to 11:10 a.m., a surveyor conducted a kitchen tour with the Food Service Director in which the following findings were observed: The ice machine had rust on the right hinge of the door (that opens upwards). The ceiling tile above/near the vector light had visible debris. The fan on the wall in the dish room (facing the dishwasher) had dust/debris on it. The dish room had 4 ceiling tiles with dirt/debris (near the ceiling fan/exhaust, near the exit). The dish room exhaust fan (on the ceiling) had dust/debris. On 10/19/22 at 11:10 a.m., the above findings were confirmed with the Food Service Director. In addition, on 10/19/22 at 12:27 p.m. the above findings were discussed with the Administrator.

Based on interview and record review, the facility failed to implement and maintain an effective training program which includes, at a minimum, training on abuse, neglect, exploitation and misappropriation of resident property and dementia management by failing to ensure that 4 of 5 Certified Nursing Assistants (CNAs) reviewed for in-service training completed the required training (#1, #2, #3 and #5). Findings: On 10/18/22 during a review of facility staff education records the following were noted: CNA #1 was hired on 5/21/22. The last dementia training received by CNA #1 was completed on 10/29/20. The record lacks evidence of mandatory Dementia related training in 2021. CNA #2 was hired on 8/27/01. The last abuse and dementia training received by CNA #2 was completed on 10/29/20. The record lacks evidence of mandatory Abuse and Dementia related training in 2021. CNA #3 was hired on 5/21/22. The last dementia training received by CNA #3 was completed on 10/29/20. The record lacks evidence of mandatory Abuse and Dementia related training in 2021. CNA #5 was hired on 10/30/96. 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.