Apple Ridge Care Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure a resident's vaccination status and/or provide education regarding the pneumonia (a lung infection that causes the air sacs in the lungs to fill with fluid or pus) vaccines upon admission to the facility for five sampled residents (Residents #15, #32, #36, #37, and #342) out of 12 sampled residents. The facility census was 40 residents. Review of the facility's Pneumococcal Vaccine policy dated March 2022 showed: -All residents are offered pneumococcal vaccines to aid in preventing pneumonia/pneumococcal infections. -Prior to or upon admission, residents are assessed for eligibility to receive pneumococcal vaccine series. -Before receiving the vaccine, residents or their representatives are offered education regarding the benefits, risks, and potential side effects of the vaccine. 1. Review of Resident #32's Face Sheet showed he/she was admitted to the facility on [DATE]. Review of the resident's medical records showed: -No documentation 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure provision and documentation of education regarding the benefits, risks and potential side effects associated with the COVID-19 (a new disease caused by a novel (new) coronavirus) vaccine for residents upon admission to the facility for five sampled residents (Residents #15, #32, #36, #37, and #342) out of 12 sampled residents and for five out of five sampled staff (Employees A, B, C, D, and E). The facility census was 40 residents. Review of the Coronavirus Disease (COVID-19) Vaccination of Resident's policy dated May 2023 showed: -Each resident is offered the COVID-19 vaccine unless the vaccine is medically contraindicated or the resident is fully vaccinated. -The resident (or resident's representative) has the opportunity to accept or reject a COVID-19 vaccine. -COVID-19 vaccine education, documentation, and reporting are overseen by the Infection Preventionist. -Before the COVID-19 vaccine is offered, the resident is provided with education…

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 provide written notification of a hospital transfer/discharge for one sampled resident (Resident #23) out of 13 sampled residents, as well as the Ombudsman (a person who advocates for residents of nursing homes) when the resident was transferred to the hospital. The facility census was 40 residents. A policy regarding transfer/discharge was requested from the facility and not provided. 1. Review of Resident #23's nurse progress notes, dated 7/7/24, showed: -The resident was reported to be on the floor. -Resident complained of pain to his/her right hip. -Hospice, Assistant Director of Nursing (ADON), and Administrator were notified. -Facility physician notified and sent orders to send the resident to the emergency room. Review of the resident's quarterly Minimum Data Set (MDS-a federally mandated assessment instrument completed by facility staff for care planning) dated 8/20/24 showed the resident had moderate cognitive impairment. Review of the resident's paper chart and electronic health record showed no notification of a…

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

Based on interview and record review, the facility failed to provide written notification of the facility's Bed Hold policy (a policy that specified how residents can secure their bed in the facility if they have to go to the hospital) for one sampled resident (Resident #23) out of 13 sampled residents when the resident was transferred to the hospital. The facility census was 40 residents. A policy regarding bed hold was requested from the facility and not provided. 1. Review of Resident #23's nurse progress notes, dated 7/7/24, showed: -The resident was reported to be on the floor. -Resident complained of pain to his/her right hip. -Facility physician notified and sent orders to send the resident to the emergency room. Review of the resident's quarterly Minimum Data Set (MDS-a federally mandated assessment instrument completed by facility staff for care planning) dated 8/20/24 showed the resident had moderate cognitive impairment. Review of the resident's paper chart and electronic health record showed no bed hold policy was issued to the resident. During an interview on 9/11/24 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 interview, and record review, the facility failed to complete an annual Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff for care planning) for one sampled resident (Resident #32) out of 13 sampled residents. The facility census was 40 residents. Review of the facility's undated policy titled MDS Completion and Submission Timeframes showed: -The assessment coordinator or designee was responsible for ensuring resident assessments were submitted in accordance with current federal and state guidelines. -The timeframes for completion and submission of assessments were based on the current requirements published in the Resident Assessment Instrument Manual (RAI). Review of the RAI manual, Version 1.18.11, dated October 2023 showed after the admission assessment, the next comprehensive assessment would be scheduled within 366 days. 1. Review of Resident #32's assessments showed the following: -admission MDS was completed on 1/27/23. -No annual MDS was completed (an annual MDS was due 1/28/24). During an interview on 9/11/24 at 9:21 A.M., 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 interview and record review, the facility failed to complete a Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff for care planning) no less frequently than once every three months for one sampled resident (Resident #32) out of 13 sampled residents. The facility census was 40 residents. Review of the facility's undated policy titled MDS Completion and Submission Timeframes showed: -The assessment coordinator or designee was responsible for ensuring resident assessments were submitted in accordance with current federal and state guidelines. -The timeframes for completion and submission of assessments were based on the current requirements published in the Resident Assessment Instrument Manual (RAI). Review of the RAI manual, Version 1.18.11, dated October 2023 showed after the admission assessment, quarterly assessments should be scheduled within 92 days after the previous assessment and the next comprehensive assessment would be scheduled within 366 days after any comprehensive assessment including admission, significant change or annual…

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 accurately assess one sampled resident, (Resident #37), for oral/dental status of broken natural teeth and mouth pain or discomfort, out of 13 sampled residents. The facility census was 40 residents. Review of the undated facility policy Resident Assessments showed: -Comprehensive Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff for care planning) was to include both the completion of the MDS as well as the completion of the Care Area Assessments (CAA, a problem-oriented framework for arranging MDS information and additional clinically relevant information about an individual 's health problems or functional status) process and care planning. -The resident assessment coordinator was responsible for ensuring that the interdisciplinary team conducts timely and appropriate assessments. -Assessments were to be completed by staff members who had the skills and qualifications to assess relevant care…

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 personalize a communication care plan for two sampled residents (Resident #4 and #37) out of 13 sampled residents. The facility census was 40 residents. Review of the undated facility policy Resident Assessments showed: -Information in the Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff for care planning) would consistently reflect information in the progress notes, plans of care, and resident observations and interview. -The results of the assessments would be used to develop, review and revise the resident's comprehensive care plan. Review of the facility's policy titled Care Plans, Comprehensive Person-Centered dated as revised March 2022 showed each resident's comprehensive care plan should be person-centered and describe the services that were to be provided. 1. Review of Resident #4's admission MDS showed the following staff assessment of the resident: -Spanish was the resident's preferred…

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 ensure the activities program was directed by a qualified professional. The facility census was 40 residents. A policy for Activities Director (AD) was requested from the facility and was not provided. 1. Review of facility's undated Activity Director job description education and experience requirements showed: -Must possess, as a minimum, two (2) years of college. -Must be a qualified therapeutic recreation specialist or an activities professional who is licensed by this state and is eligible for certification as a recreation specialist or as an activities professional; or -Must have as a minimum of two (2) years' experience in a social or recreation program within the last five (5) years, and on (1) of which was full time in a patient activities program in a health care setting; or -Must be a qualified occupational therapist or occupational therapy assistant; or -Must have completed a training course approved by this state. Review of the current Activity Director's resume showed: -He/She was a Certified Medication…

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 ensure routine and emergency dental services to meet the needs of residents were offered to one sampled resident, (Resident #37), out of 13 sampled residents. The facility census was 40 residents. Review of the undated facility policy Availability of Services, Dental showed: -Dental services were available to all residents requiring routine and emergency dental care. -Social services was responsible for making necessary dental appointments. 1. Review of Resident #37's undated Face Sheet showed he/she was initially admitted on [DATE] and the most recent admission to the facility on 7/1/24 with a diagnosis of Dysphagia, unspecified, a swallowing disorder that is characterized by difficulty swallowing. Review of the resident's undated Order Summary Report showed an order for a dental consult and treat. Review of the resident's admission Nursing Evaluation dated 6/21/24 and 7/1/24 showed: -Dental: --Resident has his/her own teeth. --Broken…

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 ensure one sampled resident (Resident #1) was free from abuse when on 4/4/24 Resident #2 hit Resident #1 causing a small abrasion (a superficial injury that can occur on the skin and visceral linings of the body, disrupting tissue continuity) to the top of his/her head out of four sampled residents. The facility census was 38 residents. On 4/15/24 the Administrator and Director of Regional Consulting were notified of the past noncompliance that occurred on 4/4/24. The facility administration was made aware of the altercation after staff reported an abrasion to the top of Resident #1's head and an investigation was immediately started. During the investigation all facility staff were educated on abuse and neglect. Resident safety checks were completed from 4/4/24-4/8/24 with no abnormalities. The residents' care plans were updated. The deficiency was corrected on 4/8/24. Review of the facility's undated policy titled Abuse and Neglect…

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 ensure staff treated one sampled resident (Resident #1) in a respectful manner while assisting the resident up off the floor after a fall for one out of three sampled residents. The facility census was 43 residents. On 10/25/23 the Administrator and acting Director of Nursing (DON) were notified of past non-compliance which occurred on 10/15/23. On 10/15/23 the facility Administrator was notified of the incident and the investigation was started. Nurse Aide (NA) A, Certified Nurse Assistant (CNA) A and Licensed Practical Nurse (LPN) A were suspended on 10/16/23 and NA A and LPN A were later terminated. No employees were allowed to work prior to reeducation completed 10/16/23. The deficiency was corrected on 10/16/23. Record review of the facility's Dignity Policy revised February 2021 showed: -Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. -Residents are treated with dignity and respect 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 interview and record review, the facility failed to ensure three residents (Resident #1, #2 and #3) were free from abuse out of three sampled residents. On 7/23/23, Resident #1 hit Resident #2 with a broom, causing a small cut on the resident's nose. On 7/27/23 and 7/30/23, Resident #1 hit Resident #3 in the head with his/her hand several times. The facility census was 42 residents. Review of the facility's Abuse Prevention Program revised September 2021, showed: -The facility will not tolerate verbal, sexual, physical and mental abuse, corporal punishment, involuntary seclusion, neglect, or misappropriation of resident property, by employee, family members, visitors, or other residents. -Abuse was defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. -Employees will be screened, knowledgeable, and trained in matters of abuse. 1. Review of Resident #1's facility face sheet showed he/she admitted to 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 interview and record review, the facility failed to maintain an escrow (a deed, a bond, money, or a piece of property held in trust by a third party to be turned over to the grantee only upon fulfillment of a condition (the escrow company) guarantees the performance or obligations of a second party (the principal (the nursing home) to a third party (the oblige-- the residents who are a part of the resident trust)) that was one times the average of the monthly balance of the reconciled bank statements for the resident trust. This practice potentially affected 35 residents who allowed the facility to manage their resident funds. The facility census was 44 residents. 1. Record review of the facility maintained Resident Trust Reconciliation for the period 2/2022 through 1/2023, showed an average monthly balance of $55,037.89. Record review of the facility's on file escrow documentation, showed the amount of money in escrow to be $78,000.00. Based on the average balance maintained by the facility the needed an escrow of $82,500.00. During an interview on 3/2/23 at 10:58 A.M.,…

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 ensure the Employee Disqualification List (EDL - a listing of individuals who have been determined to have abused or neglected a resident) ), Criminal Background Checks (CBCs), and/or the Nurse Aide (NA) Registry were completed; to ensure potential employees did not have a Federal Indicator (FI-a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents), failed to complete reference checks prior to hire; and to complete quarterly EDL checks for seven out of nine sampled employees. The facility census was 44 residents. Record review of the facility policy Criminal Background Checks Policy and Procedure revised 2/2022 showed: -After an application was received and it was determined offer of employment would be made, the staff member would request the CBC for the potential employee. -This shall be completed the same day as a decision to hire and prior to allowing the employee to have any contact with the residents. A policy on NA registry and EDL checks 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 interview and record review, the facility failed to ensure all staff were aware of the facility's cardiopulmonary resuscitation (CPR medical intervention used to restore circulation and/or respiratory function that has ceased) policy, maintain CPR certification on file for all staff with current CPR certification, and to ensure staff on all shifts had a method of knowing which staff in the building had current CPR certification. This deficient practice had the potential to affect all residents who had a full code status. The facility census was 44 residents. Record review of the facility's Emergency Procedure - Cardiopulmonary Resuscitation, revised February 2018 showed: -Personnel have completed training on the initiation of CPR, including defibrillation (he use of an electrical current to help your heart return to a normal rhythm), for victims of sudden cardiac arrest. -The facility will: --Maintain American Red Cross or American Heart Association certification in CPR for key clinical staff who will…

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

Based on observation, interview and record review, the facility failed to maintain cleanable surfaces of their storage areas; to have trash cans with self-opening and closing lids near their hand washing sinks; to maintain in cleanable and good repair storage areas and surfaces of their kitchen utensils, cutting boards and skillets; and to prevent grease build-up on their spice containers. These deficient practices of not keeping storage areas and containers clean and not having self-opening and closing lids on trash cans could potentially, promote microorganisms and bacterial growth which could adversely affect the health and well-being of the residents and staff who partook of the meals prepared by the dietary staff. The facility census was 44 residents. 1. Observation on 2/27/23 between 5:45 A.M. and 6:55 A.M. in the kitchen, showed the following: -The spice containers were greasy and gritty to the touch. -The storage areas for the skillets and cutting boards were stored in old, uncleanable, splintering and rotting, wooden cabinets and cupboards. -The storage areas for 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 interview and record review, the facility failed to ensure resident funds were placed in an account separate from the facility operating account. The facility did not provide a resident refund of their personal funds from the operating account in a timely manner for one sampled resident (Resident #100) out of 12 sampled residents. The facility census was 44 residents. 1. Record review of the facility's Interim Aged Analysis Summary dated for the month of February, 2023, showed: -Resident #100 was a private paid resident for his/her room and board. -Resident #100 was discharged on 8/11/22 having a balance in his/her account of $1052.00. -The facility's maintained Interim Aged Analysis Summary for the period 8/1/22 through 2/2023, showed the resident's name with his/her personal funds still held in the facility operating account. During an interview on 3/1/23 at 10:15 A.M., the Business Office Manager said he/she: -Had started in that position at the end of November 2022 and was still adjusting to the corporate procedures. -Would discuss the situation with the Administrator…

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 ensure the code status was accurately reflected on the Physician's Orders and the resident's Code Status Care Plan for one sampled resident (Resident #13) out of 12 sampled residents. The facility census was 44 residents. Record review of the facility's Advanced Directives (documents that allow one to communicate their health care preferences when decision-making capacity is lost) policy, revised December, 2016 showed: -Upon admission the resident will be provided written information concerning the right to accept medical or surgical treatment and to formulate an advanced directive if he or she chooses to do so. -Prior to or upon admission the Social Services director or designee will inquire of the resident, his/her family members and/or his/her legal representative about the existence of any written advanced directives. -If the resident is incapacitated and unable to receive information about his/her right to formulate an advanced directive, 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 interview and record review, the facility failed to ensure a resident with new mental disorder diagnoses had a DA-124 Level I screen (used to evaluate for the presence of psychiatric conditions to determine if a preadmission screening/resident review (PASRR) level II screen was required) as required, for one sampled resident (Resident #15) out of 12 sampled residents. The facility census was 44 residents. A policy was requested and not received by the facility. 1. Record review of Resident #15's Face Sheet showed the resident: -Was admitted to the facility on [DATE]. -Had a family member as his/her responsible party. -Had a diagnosis of generalized Anxiety Disorder (a psychiatric disorder causing feelings of persistent anxiety). Record review of the resident's Initial Social Services History dated 2/25/22 showed the resident: -Previously lived in a long-term care facility before moving into this facility. -Was moved to this facility and was placed on a single sex unit due to sexually inappropriate…

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

Based on observation, interview, and record review, the facility failed to ensure nebulizer (a device used to administer medication in the form of a mist inhaled into the lungs) equipment was maintained and stored using infection control practices when not in use for one sampled resident (Resident #38) out of 12 sampled residents. The facility census was 44 residents. Record review of the facility policy titled Administering Medications through a Small Volume Nebulizer revised 10/2010 showed: -Rinse and disinfect the nebulizer equipment according to facility protocol after each use. -Wash pieces with warm soapy water. -Rinse with hot water. -Place all pieces in a bowl and cover with isopropyl (rubbing) alcohol. Soak for five minutes. -Rinse all pieces with sterile water (not tap, bottled, or distilled). -Allow to air dry on a paper towel. -When equipment was completely dry, store in a plastic bag with the resident's name and the date on it. -Change equipment and tubing every seven days, or according to facility protocol. 1. Record review of Resident #38's face sheet showed he/she…

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 maintain an infection control program that provided a safe and sanitary environment for all residents and to help prevent the development and transmission of communicable diseases and infections. The facility staff failed to use proper hand hygiene, failed to change gloves appropriately, failed to ensure perineal care was completed per facility policy for one sampled resident (Resident #10) out of 12 sampled residents. The facility census was 44 residents. 1. Record review of the facility policy titled Perineal Care, revised 2/2018, showed: -Equipment: Wash basin, towels, washcloth, soap and personal protective equipment. -Place equipment on bed side table -Wash and dry hands thoroughly. -Fill basin one-half full of warm water. Place at bedside. -Fold the bed spread toward the foot of the bed. -Fold the sheet down to the lower part of the body. Cover the upper torso with a sheet. -Raise the gown or lower the pajamas. Avoid unnecessary…

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

Based on observation, interview and record review, the facility failed to ensure containers with foods that were not easily identifiable were labeled to identify the foods that were in those containers; failed to maintain the floor under the dishwasher free of grime and debris; failed to maintain the pot holder in a condition without a tear; failed to ensure the table-top can opener blade was cleaned and maintained; failed to maintain the inner part of the ice machine and the door of the ice machine in an easily cleanable condition; failed to to maintain two light fixtures free of a dust buildup; failed to ensure all light fixtures were illuminated; and failed to cover the containers of cereal while light fixtures were being removed. This practice potentially affected all residents. The facility census was 40 residents. 1. Observations during the breakfast meal preparation on 12/1/20 from 6:16 A.M. through 8:11 A.M., showed: -One unlabeled container of a white granulated substance in dry good storage room. -One unlabeled container of a white powdery substance. -The presence of food…

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 submit a Third Party Liability (TPL) form (a form which is sent to Missouri (MO) Health Net, which gives an accounting of the remaining balance of that resident's funds in the resident trust account), which is required to be sent within 30 days after death, to MO Health Net after the death of one sampled resident (Resident #145). The facility census was 40 residents. 1. Record review of the facility's Admit/Discharge report dated [DATE], showed Resident #145 died on [DATE]. Record review of the resident's Resident Trust Fund statement showed the resident had a balance of $2,348.73 in his/her account at the time of his/her death. Record review of the TPL form showed the TPL form was sent in to MO Health Net on [DATE], 113 days after the resident's death. During an interview on [DATE] at 11:01 A.M., the Business Office Manager (BOM) who was a new hire on [DATE], said she was not aware of the TPL forms that need to be sent in within 30 days of death for 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 interview and record review, the facility failed to fully investigate an alleged incident of non-consensual sexual touching for one sampled resident (Resident #33) out of 12 sampled residents. The facility census was 40 residents. Record review of facility Abuse Prevention Program policy, last revised April, 2019, showed: -Witnessed events, which include, but were not limited to, slapping, hitting, pinching, yelling at, cursing, threatening, harassing, etc., should be reported. -Unwitnessed events, which include, but were not limited to, reports of abuse made by a resident, resident representative, visitor or employee should be reported. -Indicators of potential abuse as in finding unwitnessed injuries such as skin tears, bruising, swelling, should be reported. -The charge nurse would complete a Resident Abuse/Neglect Report. -The charge nurse would forward the Resident Abuse/Neglect Report to the Director of Nursing Services (DON), or designee, who will report to the Administrator. -Reports were to be…

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 check the Certified Nursing Assistant (CNA) Registry to ensure individuals did not have a Federal Indicator (a marker given by the federal government to individuals who have committed abuse/neglect) for two sampled employees (Employees D and E), out of five sampled employees hired since the last annual survey. The facility census was 40 residents. Record review of the facility's Abuse Prevention Program policy dated April 2019 showed the following related to pre-employment screening: -Background checks will be done at the time of hire in accordance with the facility background check policy. Staff will not be hired who have been found guilty, or plead nolo contendere (no contest), of abuse, neglect, mistreatment of residents, or misappropriation of resident property by a court of law. Such a determination will not be limited to residents but shall include any known abusive acts against others. -The nurse aide registry will be checked prior to employment for each state where a nurse aide has shown to have worked, or have 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 interview and record review, the facility failed to report to the State Agency (SA) an alleged incident of non-consensual sexual touching, and to report the results of the investigation within five working days of the incident, for one sampled resident (Resident #33) out of 12 sampled residents. The facility census was 40 residents. Record review of the facility's Abuse Prevention Program policy, last revised April 2019, showed: -Witnessed events, which include, but were not limited to, slapping, hitting, pinching, yelling at, cursing, threatening, harassing, etc., should be reported. -Unwitnessed events, which include, but were not limited to, reports of abuse made by a resident, resident representative, visitor or employee should be reported. -A resident or resident representative may make a report of abuse. -The charge nurse would complete a Resident Abuse/Neglect Report. -The charge nurse would forward the Resident Abuse/Neglect Report to the Director of Nursing Services (DON), or designee, who…

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 ensure one sampled resident (Resident #10) with a mental disorder had an updated DA-124 level I screen (used to evaluate for the presence of psychiatric conditions to determine if a preadmission screening/resident review (PASARR) level II screen is required) as required out of 12 sampled residents. The facility census was 40 residents. Record review of the Missouri Department of Health and Senior Services (DHSS) guide titled, PASARR Desk Reference, dated 3/3/08, showed: -The PASARR is a federally mandated screening process for any person for whom placement in a Medicaid Title (XIX) certified bed is being sought. This is a Level I screening (completion of the DA124C form). (In this facility, all beds are Medicaid certified). -A Level II assessment is completed on those persons identified at Level I who are known or suspected to have a serious mental illness (such as schizophrenia, dementia, major depression, etc., MR or related MR condition to determine…

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.