Good Samaritan Society - Windom

Based on interview and document review, the facility failed to have an integrated care plan to coordinate and delineate what services hospice was to provide and what services the facility was to provide, to ensure oversight and services would be provided for 1 of 1 sampled resident (R5) reviewed for hospice care.Findings include: R5's 2/6/26, quarterly Minimum Data Set (MDS) identified R5 had severe cognitive impairment and was dependent on staff to assist with his cares. R5 had a condition or chronic disease that may result in life expectancy of less than 6 months and was currently receiving hospice services. R5's hospice care plan identified the hospice NA would perform or assist with duties as directed. The hospice aid would apply lotion, assist with incontinent cares, dressing, and shampoo and haircare. The hospice aid would clean and tidy R5's room and report to the registered nurse with any questions or concerns. The hospice staff would effectively collaborate with facility/agency staff or providers. The collaboration with the facility staff would include discussion of 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 document review, the facility failed to ensure 1 of 1 resident (R1) who had impaired hearing was provided hearing aids daily. Findings include: R1's 10/29/25 comprehensive Minimum Data Set (MDS) assessment identified hearing and cognition are moderately impaired. R1's current, undated care plan identified he has impaired thought process and decision making related to the aging process and he would be able to communicate basic needs on a daily basis. R1 would need assistance with all decision making and staff were to ask him yes or no questions in order to determine his needs. R1 had a communication problem related to his hearing deficit. Staff were to ensure and document hearing aids are both in place during the day and removed at bedtime. R1's care plan did not identify a behavior of refusing hearing aids nor did it identify what staff should do if R1 refused his hearing aids. R1's December 2025 through February 2026, Treatment Administration Record (TAR) identified an order for staff to insert hearing aids at 7:00 a.m., daily and remove them 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 observation, interview, and document review, the facility failed to have signage posted outside the door for 1 of 1 medication room (South) identifying oxygen canisters were stored within. Findings include: Observation on 2/10/26 at 4:32 p.m., of the South medication room with licensed practical nurse (LPN)-A identified a cupboard to the far right of the door, with a pullout drawer containing 3 canisters of oxygen (O2). The canisters were held in place in individual holders inside the cabinet. Upon inspection, the outside of the medication room did not have signage posted notifying staff oxygen was being stored in the medication room. LPN-A normally did not work on that wing and was unaware of the oxygen being stored there. Interview on 2/10/26 at 5:44 p.m., with the director of nursing identified she agreed when O2 was stored in a room, signage should be placed on the outside of the room, identifying O2 was being stored within. Review of the 7/30/25, Oxygen Administration, Safety, Mask Types policy identified its purpose was to store O2 in a safe manner. All appropriate…

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 document review, the facility failed to ensure controlled narcotic medication awaiting destruction were easily reconciled in 1 of 3 med rooms (South) to prevent potential diversion.Findings include: Observation and interview with licensed practical nurse (LPN)-A in the South medication room identified a locked cupboard that contained medication awaiting destruction. Of those medications, the following controlled/narcotic blister-pack medication had been discontinued, but were not noted on any list to verify the medications were tracked and secured from potential diversion:R26 had 4 tablets of tramadol (pain), each 50 milligram (mg) awaiting destruction. R17 had 12 tablets of tramadol, each 50 mg dose awaiting destruction.R24 had 5 tablets of lorazepam (anti-anxiety), each 0.5 mg awaiting destruction.R7 had 1 tablet of preglabin (anti-convulsant) at 150 mg.R17 had 30 tablets of lorazepam, each 0.5 mg awaiting destruction.R2 had 9 tablets of Xanax (anti-anxiety), 0.5 mg each and another blister pack of Xanax 0.5 mg with 10 tablets remaining…

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 interview and document review, the facility failed to ensure pharmacist consultant recommendations were acted upon for 1 of 5 sampled resident (R26).Findings include: R26's accepted 12/27/25, quarterly Minimum Data Set (MDS) assessment identified R26's cognition was intact. She required moderate to total assistance from staff for Activities of Daily Living (ADL'S). R26 took an antipsychotic, antianxiety, and antidepressant medications. R26's current undated, care plan identified she was on medication with warnings of adverse consequences related to major depressive disorder and anxiety. R26 used psychopharmacological medications Seroquel (an anti-psychotic), duloxetine (an anti-depressant), buspirone (an anti-anxiety) related to anxiety and depression. R26's 2/10/26, printed Order Summary Report identified that R26 took quetiapine fumarate (Seroquel) an antipsychotic medication daily. R26's 1/28/26, pharmacist recommendation identified for nursing to complete an abnormal involuntary movement scale (AIMS) assessment. The AIMS assessment was a tool to detect and monitor 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 document review, the facility failed to ensure the overall medication error rate was below 5% for 2 of 25 observations resulting in an 8% medication error rate.Findings include: Observation on 2/10/26 at 11:54 p.m., with licensed practical nurse (LPN)-B identified she went to administer 1 tablet of Baclofen (muscle relaxant) 10 milligrams (mg) and 1 tablet of spironolactone (diuretic) 25 mg, inside of a medication cup to R47 who was reported to be in her room. LPN-B knocked on R47's room door. R47 was not inside her room, so LPN-B left the medication cup containing the medications on R47's dresser drawer just inside her room and shut the door. LPN-B stated R47 was able to self-administer her medications, so she would leave them there for her to take them later. LPN-B then returned to the medication cart and finished the medication pass identifying and marked the medication had been administered in the electronic medical record (PCC). Interview on 2/10/26 at 5:44 p.m. with the director of nursing identified staff were not to leave 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to update the care plan for 1 of 3 residents (R1) reviewed for pressure ulcers. Findings include:R1's face sheet dated 1/20/26, identified R1 admitted with diagnoses of paraplegia (paralysis of legs and lower body), pressure ulcer of right heel (diagnosis added 8/11/25), type 2 diabetes, and obesity. On 1/13/26, diagnoses of pressure ulcer of other site, pressure ulcer of unspecified, pressure ulcer of left buttock were included.R1's admission Minimum Data Set (MDS) dated [DATE], identified R1 had no cognitive impairments, no rejection of care, had an indwelling catheter and ostomy, had impairment on both sides of lower extremities, dependent for lower body care, maximum assistance to roll left and right, and dependent to transfer from surfaces. R1 was at risk of developing pressure ulcers/injuries but did not have any pressure ulcers and no open lesions. Treatments included pressure-reducing devices for chair and bed. R1 was not on a turning 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, interview, and record review the facility failed to provide dignity 2 of 3 residents (R5, R6) who were reviewed for dignity. Findings include:R5's face sheet dated 1/20/26, identified diagnoses of Alzheimer's, and dementia.R5's quarterly MDS dated [DATE], identified R5 had moderate cognitive impairment, no behaviors, used a walker and wheelchair; needed moderate assistance with dressing upper and lower body, independent to roll side to side, touching assistance to transfer locations.R5's care plan dated 10/27/25, identified self-care deficits. Interventions included R5 could not walk, used mechanical lift for transfers, and required 1-2 staff to assist with toileting needs.R5's progress note dated 1/2/26, identified hospice nurse visited and placed a urinary catheter.During an observation and interview on 1/20/26 at 8:23 a.m., R5 was in his recliner chair. R5's urinary catheter collection bag was hanging on a garbage can next to recliner without a dignity cover. Registered nurse (RN)-A 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 interview and record review the facility failed to notify the physician and resident representative regarding changes to skin integrity and treatment orders for 1 of 3 residents (R1) reviewed for change in condition. Findings include:R1's face sheet dated 1/20/26, identified R1 admitted with diagnoses of paraplegia (paralysis of legs and lower body).R1's care plan dated 11/20/25, identified R1 had shearing on his left and right buttock and is at risk for skin breakdown and shearing related to immobilization/chairbound/bedbound and used the total lift sling evidenced by open shearing areas on both left and right buttock. Interventions included to keep skin clean and dry. Use skin barrier cream to buttocks daily and protect these areas with a dressing when open and draining. High risk for skin injury-use caution during transfers when using the sling being cautious to not quickly and forcefully place the sling under R1. Monitor for signs of shearing. Report abnormalities, failure to heal, signs and symptoms of infection, maceration, etc. to health care provider.R1's faxed…

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 interview, and record review the facility failed to assist 1 of 3 residents (R1) who requested to be seen by the dentist. Findings include:R1's face sheet dated 1/20/26, identified diagnoses of paraplegia (paralysis of legs and lower body), type 2 diabetes,R1's admission Minimum Data Set (MDS) dated [DATE], identified R1 had no cognitive impairments, no rejection of care, and no obvious or likely cavities or broken natural teeth.R1's Nursing Admit/Re-admit Data collection dated 8/11/25, identified R1 had no dentures or bridges, no natural teeth or tooth fragments, obvious or likely cavity or broken natural teeth. Additional comments identified R1 would like to pursue some dental care.During an interview on 1/23/26 at 2:41 p.m., R1 stated no one at the facility ever worked with him to make a dental appointment. R1 stated he had told clinical care leader registered nurse (CCLRN)-B at some point.During an interview on 1/20/26 at 11:52 a.m., CCLRN-B stated she had completed R1's Nursing Admit/Re-admit Data.…

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, interview, and record review the facility failed to follow infection control practices for 2 of 3 residents (R1, R5) reviewed for infection control. Findings include:R1's face sheet dated 1/20/26, identified R1 admitted with diagnoses of paraplegia (paralysis of legs and lower body), pressure ulcer of right heel (diagnosis added 8/11/25), type 2 diabetes, and obesity. On 1/13/26, diagnoses of pressure ulcer of other site, pressure ulcer of unspecified, pressure ulcer of left buttock were included.R1's admission Minimum Data Set (MDS) dated [DATE], identified R1 had no cognitive impairments, no rejection of care, had an indwelling catheter and ostomy, had impairment on both sides of lower extremities, dependent for lower body care, maximum assistance to roll left and right, and dependent to transfer from surfaces. R1 was at risk of developing pressure ulcers/injuries but did not have any pressure ulcers and no open lesions. Treatments included pressure-reducing devices for chair and bed. R1…

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 document review the facility failed to maintain a system to analyze monthly surveillance data for trends and patterns to reduce the spread of illness, infections, control transmission of infections and communicable diseases present in the facility. This had the potential to affect all 53 residents who resided in the facility. Findings include: Document titled Monthly Infection Summary August 2024, September 2024, November 2024, indicated resident name, start date, date symptoms resolved, type of infection, status, antimicrobial, infection source and surveillance of criteria met. No mapping or trending of the data was provided. On 12/11/24 at 10:32 a.m., during an interview registered nurse (RN)-B stated she was the infection nurse at the facility. RN-B stated she was responsible for overseeing the facility's infection control program and maintaining the facility's infection control surveillance log. RN-B stated the infections were tracked and documented on the computer tracking form, but no ongoing formal surveillance, monitoring of trends and/or…

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, interview, and document review, the facility failed to ensure residents were provided care in a dignified and respectful manner for 1 of 3 residents (R13) who were observed during care interactions. Findings include: R13's quarterly Minimum Data Set (MDS) assessment dated [DATE], indicated R13 had moderately impaired cognition, had no rejection of care, was frequently incontinent of bladder, always continent of bowel, had a bowel toileting program, and was dependent for toilet transfers and toileting hygiene. R13's care plan dated 11/14/24, indicated a history of bowel incontinence related to loss of sensation, impaired mobility, needing staff assistance with transfers with a goal of 20 or less incontinent episodes of bowel movements through the next review date, constipation related to decreased mobility, frequent bladder incontinence related to stroke side effects with a goal of being continent of bladder during waking hours through the review date. R13's care plan further indicated 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 observation, interview and document review, the facility failed to provide services to restore, maintain and prevent loss of range of motion (ROM) for 1 of 1 resident (R10) reviewed for limited ROM. Findings include: R10's facesheet printed 12/11/24, identified diagnoses of Parkinson's disease (brain disorder that causes unintended or uncontrollable movements), dementia, polyneuropathy (nerves that affects the skin, muscles and organs are damaged and can't sent signals back to the brain) and peripheral vascular disease (veins/arteries in the arms, hands, legs and feet have restricted blood flow). R10's quarterly Minimum Data Set (MDS) assessment dated [DATE], identified R10 had severely impaired cognition, limited range of motion of both upper and lower extremities on both right and left sides, dependent on staff for eating, and all activities of daily living. R10's care plan dated 6/2/24, indicated R10 had a need for a functional maintenance program due to limited mobility in left fingers/palm. Goal…

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, interview and document review, the facility failed to follow standards of care and practice for use of an indwelling catheter for 1 of 1 resident (R15) who used an indwelling catheter. Findings include: R15's facesheet, printed 12/11/24, included diagnoses of ulcerative proctitis (inflammatory bowel disease affecting only the rectum), insomnia, and hypothyroidism. There was no medical diagnosis indicating indication or rationale for Foley catheter. R15's quarterly Minimums Data Set (MDS) assessment dated [DATE], included moderately impaired cognition, requires partial to moderate assistance for toilet transfer, is continent of bowel and has an indwelling catheter. R15 does not have post void (urination) residuals greater than 250 cc. R15's Catheter Data Collection dated 11/15/24, indicated continued use of indwelling catheter. Reason for catheter was overactive bladder. Indications for use of catheter was checked as other with specify other left blank. R15's plan of care dated 8/27/24,…

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 interview and document review, the facility failed to ensure that in the absence of a full-time registered dietician (RD), the supervisor of nutrition and food services (SNFS) was certified to oversee nutrition and food services. This had potential to affect all 56 residents who resided in the facility. Findings include: During an interview on 10/30/23 at 12:58 p.m., SNFS-H stated she had not been certified in any capacity for the role of supervisor of nutrition and food services. SNFS-H had been the supervisor for four and a half years; had started a certified dietary manager (CDM) course through a college in 2020 but had not finished. During a telephone interview on 11/1/23 at 9:06 a.m., registered dietitian (RD)-G stated she had been part-time, and was at the facility once or twice a month. RD-G stated she was aware SNFS-H had not been certified for her role as supervisor of nutrition and food services, and aware she had started the CDM course but had not finished. During an interview on 11/1/23 at 10:50 a.m., the administrator stated she was aware SNFS-H had not been…

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 document review, the facility failed to ensure staff followed appropriate infection control practices while handling cups and silverware during food service. In addition, the facility failed to ensure pans in the kitchen were completely dry before storing to prevent bacterial growth. Further, the facility failed to ensure hairnets were accessible to staff upon entrance to the kitchen. This had potential to affect all 56 residents who resided in the facility. Findings include: During an observation and interview on 10/30/23 at 6:03 p.m., in the North dining room, observed nursing assistant (NA)-J handle two plastic cups and a plastic coffee cup by the rim with bare hands while filling them and setting them on a table. NA-J was informed of observations and admitted she should not have done that as it could spread germs. NA-J stated she had training on proper handling of cups and should have held the cup from the side. During an observation and interview on 10/31/23 at 12:06 p.m., in the Center dining area, observed (NA)-K hold two empty cups by 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 observation, interview and document review, the facility failed to ensure hand hygiene was performed when staff were observed going room to room delivering clean laundry. In addition, the facility failed to monitor risk factor testing associated with the facility water management program to prevent waterborne pathogens including Legionella (bacteria that can cause lung infection). This had potential to affect all 56 residents who resided in the facility. Findings include: WATER MANAGEMENT PROGRAM: Review of the facilities Water Plan dated 4/9/19, did not include a diagram of water input, storage and distribution throughout the facility. The facilities monitoring and verification plan dated 4/9/2019, for minimum requirements for building water systems included 1. Cold water services: To be sampled at the source of nearest outlet. Primary limit was listed as < 77 degrees Fahrenheit (F). Monitoring for cold water systems include water temperature weekly and chlorine residual monthly from nearest outlet, 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review, the facility failed to ensure 1 of 1 resident (R31) who was observed to have medications in her room, had been appropriately assessed and deemed safe to self-administer medications. Findings include: R31's facesheet printed on 11/2/23, included diagnoses of restless legs, osteoarthritis, and gastroesophageal reflux (when stomach acid irritates food pipe lining). R31's admission Minimum Data Set (MDS) assessment dated [DATE], indicated R31 had moderately impaired cognition, had adequate vision and hearing, clear speech, was understood and could understand. R31 could transfer and walk in her room with limited assistance of one staff. R31's physician orders included: ---9/25/23: Tums Tablet Chewable 500 MG (milligram) (Calcium Carbonate Antacid), give one tablet by mouth as needed; may take up to four times a day. ---9/27/23: Trolamine Salicylate External Cream 10 % (Trolamine Salicylate) - also known as Aspercreme. Apply to painful area feet/ legs topically as…

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 interview and document review, the facility failed to ensure the Minimum Data Set (MDS) was accurately coded for antipsychotic medications for 1 of 1 resident (R18) and for fall resulting in major injury for 1 of 1 resident (R2) reviewed for falls. Findings include: R2's significant change MDS assessment dated [DATE], completed by registered nurse (RN)-D, indicated R2 had moderately impaired cognition required two-person physical assist for bed mobility, transfer, toilet use, personal hygiene and dressing. Further, the MDS indicated R2 has had no falls since admission or prior assessment and no fall any time in the last month prior to admission. R2's medical record review included a nursing progress note by RN-F dated 9/8/23 at 8:50 p.m., resident was yelling out and staff found R2 lying on right side in front of dresser by bathroom door in room. Right leg was rotated inward and R2 was sent to the emergency department for evaluation. R2's medical record review included a nursing progress note by RN-E…

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, interview and document review the facility failed to provide timely incontinence care for 1 of 1 resident (R21) who was dependent upon staff for assistance with activities of daily living (ADL). Findings include: R21's quarterly Minimum Data Set (MDS) assessment dated [DATE], indicated R21 had moderately impaired cognition, no rejection of care, required two person physical assist with bed mobility, transfer, dressing, toilet use, and personal hygiene, utilized a wheelchair, always incontinent of bladder, frequently incontinent of bowel, diagnoses included cerebrovascular accident (stroke), and depression. R21's care plan printed 10/31/23, indicated R21 had an ADL self-care performance deficit r/t (related to) lt (left) hemiplegia (paralysis of one side of the body), weakness secondary to CVA E/B (evidenced by) inability to independently dress, groom, toilet, bathe self, unable to transfer independently and interventions included toileting schedule: assist with toileting on bed pan 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review, the facility failed to follow physician orders for compression socks for 1 of 1 resident (R35) reviewed for edema, failed to monitor, treat skin lesions for 2 of 2 residents (R35 and R55) reviewed for non-pressure related skin condition, and failed to monitor the frequency of resident bowel movements and provide intervention for 2 of 2 residents (R36 and R49) reviewed for constipation. Findings include: Skin R55 was admitted to the facility on [DATE], with diagnosis of myocardial infarction (heart muscle damage cause by blocked arteries), peripheral vascular disease (abnormal narrowing of arteries other than those that supply the heart or brain), acute kidney failure, high blood pressure and respiratory failure. R55's 5 day Minimum Data Set (MDS) dated [DATE], indicated R55 had moderate cognitive impairment, uses a walker for mobility and requires partial to moderate assistance with bed mobility, and substantial to maximum assistance with toileting 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, interview and document review the facility failed to ensure range of motion program for upper and lower extremities was implemented for 1 of 2 residents (R47) reviewed who had limited range of motion. Findings include: R47's face sheet printed 11/2/23, identified diagnoses of intracranial injury (head injury causing damage to the brain with long term complications), and autonomic dysreflexia (syndrome with sudden onset of excessively high blood pressure common in people with spinal cord injuries above the thoracic nerves of the spine). R47's quarterly Minimum Data Set (MDS) assessment dated [DATE], identified R47 was unable to speak, had severely impaired cognitive skills for daily decision making and was totally dependent on staff for all activities of daily living (ADL's). Range of motion on upper and lower extremities was not assessed. Diagnosis included traumatic brain dysfunction. R47's care plan, dated 7/5/23, identified a need for functional maintenance intervention related 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 interview and document review, the facility failed to thoroughly explain an arbitration agreement for complete understanding of the agreement upon admission, for 2 of 3 residents (R55 and R111) reviewed for binding arbitration. Finding include: R55 was admitted to the facility on [DATE]. Review of the face sheet (located in the medical record) identified R55 as being his own power of attorney. Review of the admission minimum data set (MDS) assessment dated [DATE], indicated R55 had a brief interview for mental status (BIMS) of 9 meaning moderate impairment of cognition. Review of a admission agreement for R55 Resolution of Legal Disputes/Arbitration Agreement dated 10/3/23, indicated Yes I do wish to arbitrate and I received a copy of this Resolution of Legal Disputes signed by R55. During interview on 11/2/23 at 10:57 a.m., R55 indicated he doesn't remember signing this agreement. Family member (FM)-A was present and indicated she did not understand they were giving up their right to litigation. FM-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.