Adept Nursing & Rehab of Blue Hill

Licensure Reference Number 175 NAC 12-007.04(D) Based on observation, record review, and interview the facility failed to ensure that bathroom exhaust vent fans were functioning for 2 of 16 residents observed (Residents 34 and 10). The facility census was 38. Findings are: Record review of the facility's undated admission Agreement Attachment 3 titled Resident Rights revealed that the facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life. The resident has the right to a safe, clean, comfortable, and homelike environment. The facility must provide a safe, clean, comfortable, and homelike environment. The facility must provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. A. Observation on 4/14/25 at 8:00 AM in the bathroom of Resident 10 revealed that the bathroom exhaust vent would not pull up a 1-ply square of toilet paper. Observation on 4/16/25 at 12:48 PM in the room of Resident 10…

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.

Licensure Reference Number 175 NAC 12-006.11E Based on observation, record review, and interview; the facility failed to maintain a sanitary environment for food storage and preparation. This had the potential to affect all residents receiving food from the facility kitchen. The facility stated census was 34. Findings Are: Review of a facility policy titled Kitchen Sanitization dated 10/2008 revealed Kitchen and dining room surfaces not in contact with food shall be cleaned on a regular schedule and frequently enough to prevent accumulation of grime. The food services manager will be responsible for scheduling staff for regular cleaning of kitchen and dining areas. During an observation completed on 05/19/2024 at 8:50 AM the following was observed: -Three cupboards missing doors in the kitchen storage meal prep area of the kitchen exposing dishes stored in these cupboards to be exposed. -Black, brown sticky substance to the handle area of all cupboard doors along the back wall of the main kitchen area. -Cloudy yellow white adhered substance to the stainless steel hood above 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 Licensure Reference Number 175NAC 12-006.09D8b1 Licensure Reference Number 175NAC 12-006.09D8b Based on record review and interviews; the facility failed to evaluate, revise, and implement interventions for weight loss and the nutritional needs for 3 (Resident 1, 4, and 28) of 8 sampled residents. The facility census was 34. Findings are: Review of a facility policy titled Weight Monitoring dated 08/01/2023 revealed based on the resident's comprehensive assessment the facility will ensure that all residents maintain acceptable parameters of nutritional status, such as usual body weight, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise. Weight can be a useful indicator of nutritional status. Significant unintended changes in weight (loss or gain) or insidious weight loss (gradual unintended loss over a period of time) may indicate a nutritional problem. The facility will utilize a systemic approach to optimize a resident's nutritional…

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 Licensure Reference Number 175NAC 12-006.10D Based on observation, record review, and interviews; the facility failed to ensure a medication error rate of less than 5%. Observations of 32 medications administered revealed 4 errors resulting in an observed medication error rate of 12.5%. The errors affected 3 residents (Residents 19, 5, and 16) of 6 residents observed during medication administration. The facility census was 34. Findings are: A. Record review of the facility policy titled Insulin Pen dated 4/24/24 revealed it is the facility policy to use insulin pens in order to improve the accuracy of insulin dosing. Insulin pens will be primed prior to each use to avoid collection of air in the insulin reservoir. The section titled Procedure revealed instructions to attach the pen needle: Remove the pen cap from the insulin pen; wipe the rubber seal with an alcohol pad; screw the pen needle onto the insulin pen; twist open and remove the outer cover from the pen needle. The instructions for priming the insulin…

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 Licensure Reference Number 175NAC 12-006.10D Based on observations, record review, and interviews; the facility failed to ensure that staff followed procedure for blood glucose (blood sugar) monitoring which had the potential for inaccurate blood glucose results, and failed to ensure that staff followed procedure for priming of insulin pens to ensure residents received the physician ordered dose of insulin to prevent significant medication errors. This affected 3 of 3 residents observed (Residents 19, 5, and 16). The facility census was 34. Findings are: A. Record review of the facility policy titled Blood Glucose Monitoring dated 11/28/23 revealed that the nurse will perform the blood glucose test utilizing the facility's glucometer (a medical device used to measure and display the amount of sugar in the blood for residents with diabetes) as per manufacturer's instructions. The section Procedure revealed perform hand hygiene and put on gloves. Select the puncture site. Clean the intended site with an alcohol…

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 interview; the facility staff failed to ensure the resident choice for advance directive (a written statement of a person's wishes regarding medical treatment, made to ensure those wishes are carried out should the person be unable to communicate), and code status (an instruction from you to your medical team about what the medical team should do if you have a cardiac or respiratory arrest) was documented accurately throughout the resident medical record for 2 (Resident 27 and 23) of 16 residents reviewed. The facility staff identified a census of 34. Findings are: The undated facility policy titled, Medical Emergency Response revealed under policy explanation and compliance guidelines: -The employee who first witnesses or is first on the site of a medical emergency, that are trained, will initiate immediate action, including CPR as appropriate, basic first aid and summon for assistance. -CPR will continue unless: a. there is a DNR order in place. b. there are obvious signs of clinical…

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 Licensure Reference Number 175 NAC 12-006.05(1) Based on record review and interviews; the facility failed to provide 2 (Resident 88 and Resident 91) of 3 sampled residents with the cost of continuing to receive skilled Medicare Services, a choice of whether to appeal the facilities Medicare determination to discontinue services, or the reason for the discharge from skilled Medicare services. The facility census was 34. Findings are: A review of the policy Advance Beneficiary Notices dated 08/02/2023 revised on 08/29/2023 state: -It is the policy of this facility to provide timely notices regarding Medicare eligibility and coverage. -The Business Office Manager is the contact person for information regarding Medicare eligibility, coverage, and applying for benefits. -The facility shall inform Medicare beneficiaries of his or her potential liability for payment. -Additional notices shall be issued to Medicare beneficiaries when appropriate. a. If a reduction in care occurs and the beneficiary wants to continue 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.

Licensure Reference Number 175NAC 12-006.05(5)a Based on record review and interviews; the facility failed to notify the resident/resident representative of the facility decision to discharge the resident from the facility for 1 (Resident 89) of 3 sampled residents. This prevented the resident from returning to the facility. The facility census was 34. Findings are: Record review of the facility policy titled Transfer and Discharge (including AMA- against medical advice) dated 8/1/23 revealed it is the policy of the facility to permit each resident to remain in the facility and not initiate transfer or discharge for the resident from the facility except in limited circumstances. The facility will evaluate and determine the level of care needed for the resident prior to admission to ensure the facility's ability to meet the resident's needs. Once admitted , the resident has the right to remain at the facility unless the transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility, or the health of individuals in the facility…

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.

Licensure Reference Number 175NAC 12-006.05(5) Based on record review and interviews; the facility failed to provide the resident/resident representative with written notice of transfer and discharge from the facility. This affected 1 (Resident 89) of 3 sampled residents. The facility census was 34. Findings are: Record review of the facility policy titled Transfer and Discharge (including AMA- against medical advice) dated 8/1/23 revealed it is the policy of the facility to permit each resident to remain in the facility and not initiate transfer or discharge for the resident from the facility except in limited circumstances. The facility's transfer/discharge notice will be provided to the resident and the resident's representative. Generally, the notice must be provided at least 30 days prior to a facility-initiated transfer or discharge of the resident. Exceptions to the 30-day requirement include when an immediate transfer or discharge is required by the resident's urgent medical needs; or the resident has not resided in the facility for 30 days. In these exceptional cases, 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 Licensure Reference Number 175NAC 12-00-09B Based on record review and interviews; the facility failed to accurately complete resident assessments for 2 (Resident 23 and Resident 1) of 4 sampled residents. The facility stated census was 34. Findings are: Review of a facility policy labeled Minimum Data Set (MDS, which is a mandatory comprehensive assessment tool that measures the health status of nursing home residents and is used for care planning) 3.0 Completion dated 08/01/2023 revealed persons completing part of the assessment must attest to the accuracy of the section they completed by signature and indication of the relevant sections. Review of the Resident Assessment Instrument manual dated 10/2023 revealed Parenteral Feeding, (which is an introduction of a nutritive substance into the body by means other than the intestinal tract) and Feeding Tube (which is the presence of any type of tube that can deliver nutritional substances directly into the gastrointestinal system). A. Review of an admission Record…

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 interview; the facility failed to ensure a Preadmission Screening Resident Review (PASARR- federally mandated screening program to ensure Nursing Home residents with mental illness and/or developmental disabilities receive the care and services they need in the most appropriate settings) screen was accurately completed or a new PASSAR initiated to determine if a Level II PASARR review was warranted for 1 (Resident 42) of 2 sampled residents. The facility census was 34. Findings are: Review of Resident 3's admission Minimum Data Set (MDS-a mandatory assessment tool used for care planning) dated 05/03/2024 revealed the resident was admitted [DATE] with the diagnoses of psychotic disorder (a severe mental disorder that causes abnormal thinking and perceptions) and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with one's daily activities). In addition, the assessment indicated the resident received an antipsychotic (a type of…

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.

Licensure Reference Number 175NAC 12-006.09D2b Based on observation, record review, and interviews; the facility failed to perform wound care consistent with professional standards of practice to promote wound healing for 1 (Resident 1) of 4 sampled residents. The facility stated census was 34. Findings are: Review of a facility policy titled Negative Pressure Wound Therapy dated 08/01/2024 revealed Negative pressure wound therapy will be provided in accordance with physician orders. Clean technique shall be utilized unless otherwise specified by the physician. Use and application of the therapy shall be in accordance with manufacturer's recommendations. Review of 3M Vacuum Assisted Closure (VAC) Therapy Clinical Guidelines dated 2021 revealed under foot wound application technique item #2 to protect intact skin, apply drape or vapor-permeable adhesive film dressing from the wound edge to the anterior aspect of the wound. Item #4 ensure the foam does not come in contact with intact skin. Review of facility policy titled Clean Dressing Change dated 08/01/2024 revealed it is 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 Licensure Reference Number 175NAC 12-006.09 Based on observation, record review, and interviews; the facility failed to assess and manage pain during wound care for 1 (Resident 1) of 4 sampled residents. The facility census was 34. Findings are: A review of a admission Record dated 05/23/2024 indicated Resident 1 admitted to the facility on [DATE] with diagnoses of: osteomyelitis (which is an infection in the bone), of the right ankle and foot, peripheral vascular disease (which is a condition where blood vessels narrow and reduce blood flow to the limbs of the body), and pressure ulcers (which are skin and tissue injury due to pressure over a bony prominence), of the right and left heels. Resident 1's 5 Day Minimum Data Set (MDS, which is a mandatory comprehensive assessment tool that measures the health status of nursing home residents and is used for care planning), dated 04/14/2024 revealed Resident 1 had a Brief Interview for Mental Status (BIMS) score of 8 indicating the resident was moderately cognitively…

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.

Licensure Reference Number 175NAC 12-006.017D Based on observation, record review, and interviewa; the facility failed to adhere to infection control practices to prevent the potential for cross contamination and infection prevention during wound care for 1 (Resident 1) of 4 sampled residents. The facility stated census was 34. Findings are: Record review of a facility policy titled Clean Dressing Change dated 08/01/2023 revealed to loosen the tape and remove existing dressing, remove gloves, wash hands, and put on clean gloves, cleanse the wound as ordered, remove gloves, wash hands, and put on clean gloves, apply and secure new dressing, remove gloves and wash hands. Record review of document labeled CDC Clinical Safety: Hand Hygiene for Healthcare Workers dated 02/27/2024 revealed hands should be sanitized with soap and water or alcohol-based hand sanitizer (ABHS), immediately after glove removal. Gloves should be used when needed for when you anticipate that you will encounter blood or other infections materials, mucous membranes, non-intact skin, potentially contaminated skin,…

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.

Licensure Reference Number 175 NAC 12-006.07c Based on record review and interview, the facility failed to develop and implement a Quality Assurance Process Improvement Plan of action (a systematic data driven approach to improving the quality of care and services provided to residents, to correct a facility identified problem) related to elopements (unsupervised wandering that leads to the resident leaving the facility without notice). This has the potential to affect 4 (Residents 1, 2, 3, and 4) residents within the facility who were identified as elopement risks. The facility census was 33. Findings are: A record review of the facility supplied document labeled Quality Assurance and Performance Improvement (QAPI) Plan dated April 2014 revealed the facility shall develop, implement, and maintain an ongoing, facility wide QAPI Plan designed to monitor and evaluate the quality and safety of resident care, pursue methods to improve care quality, and resolve identified problems. Under objectives of the QAPI Plan are the following: - Provide a means to identify and resolve present 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 record review and interview, the facility failed to ensure that a resident to resident (Residents 2 and 3) sexual abuse investigation report was submitted to the state agency within the required 5 working days. The facility census was 30. Findings are: Record review of the facility policy titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program dated April 2021 revealed that the facility will identify and investigate all possible incidents of abuse. The facility will investigate and report any allegations within timeframes required by federal requirements. Record review of the progress note for Resident 2 dated 12/1/23 at 7:30 PM revealed that Resident 2 was sitting next to Resident 3 in the facility television room. Resident 2 had their hands touching Resident 3 in their private areas underneath Resident 3's clothing. Resident 3 told Resident 2 to stop. Record review of the progress note for Resident 2 dated 12/1/23 at 8:12 PM revealed that the Facility Administrator (FA) reported the incident to Adult Protective Services. Record review of the email…

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.

Licensure Reference Number 175 NAC 12-006.09D3 Based on observation, record review, and interview, the facility failed to evaluate a residents need for continued laxative use when having diarrhea for 1 resident (Resident #5) of 4 sampled residents. The facility census was 30. Findings are: A review of an admission Record dated 12/28/2023 revealed the facility admitted Resident #5 on 12/11/2023 with a diagnosis of: displaced fracture of left humerus with surgical intervention (left shoulder fracture with surgery to repair). Record review of Resident #5's Minimum Data Set (MDS-a comprehensive assessment used to develop a resident's care plan) dated 12/17/2023 revealed Resident #5 was cognitively intact. The MDS further revealed Resident #5 was dependent on staff assistance with transfers, bed mobility, and toileting hygiene. The MDS revealed Resident #5 was always continent of bowel and occasionally incontinent of urine. Record review of Resident #5 Care Plan dated 12/28/2023 revealed no goals or interventions related to Resident 5's toilet use or bowel and bladder continence.…

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.

Licensure Reference Number 175NAC 12-006.17 Based on record review and interview the facility failed to ensure that Covid-19 testing was completed as required to prevent the potential for Covid-19 infection. This had the potential to affect all facility residents. The facility census was 40. Findings are: Record review of the facility policy titled Coronavirus Disease (Covid-19) Vaccination of Staff dated October 2022 revealed that staff not yet fully vaccinated or that have a pending or granted exemption (a request, or approved request, to not receive the Covid-19 vaccination due to a medical or non-medical circumstance) will adhere to additional precautions intended to mitigate (prevent) the spread of Covid-19. The list is not explicit and does not specify which actions to take. Actions included weekly Covid-19 testing. Staff who refuse to comply may be subject to disciplinary action. Interview on 5/1/23 at 12:50 PM with the Facility Administrator (FA) confirmed that the facility Covid-19 mitigation for unvaccinated staff and staff with exemption from Covid-19 vaccination was that…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure that a required written bed hold notification (written information outlining options for holding or reserving a resident's bed while the resident is absent from the facility for hospitalization) was provided to the resident/resident representative for 2 residents (Residents 27 and 10). This prevented the resident/resident representative from making an informed decision to either request a bed hold (a reservation that allows a resident to return to the facility) or release the resident bed. The facility census was 40. Findings are: A. Record review of the facility policy titled Bed-Holds and Returns dated March 2022 revealed that Residents and/or representatives are informed (in writing) of the facility bed-hold policies. All residents /representatives are provided written information regarding the facility bed-hold policies well in advance of any transfer (in the admission packet), and at the time of transfer (or, if the transfer was 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Licensure Reference Number 175NAC 12-006.09C1a Based on record review and interview, the facility failed to ensure that a review of the baseline care plan (a written plan required to be developed within 48 hours of admission detailing the instructions needed to provide initial effective and person-centered quality care for a resident) was completed with the resident/resident representative and failed to ensure that the resident/resident representative was provided a written summary of the baseline care plan as required for 6 residents (Residents 27, 10, 37, 14, 141, and 142) of 7 residents reviewed. This prevented the resident/resident representative from identifying additional care concerns for inclusion in the care plan. The facility census was 40. Findings are: A. Record review of the facility policy titled Care Plans-Baseline dated December 2016 revealed that a baseline plan of care to meet the resident's immediate needs shall be developed for each resident within twenty-four hours of admission. The facility…

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.

Licensure Reference Number 175NAC 12-006.11E Based on observation, interview, and record review the facility failed to ensure that facility staff did not reuse trays during meal service to prevent the potential for cross-contamination and foodborne illness for 14 residents observed (Residents 7, 10, 20, 141, 143, 29, 5, 3, 33, 9, 32, 12, 6, and 24); and the facility failed to ensure that staff handled foods in a manner to prevent the potential for cross-contamination and foodborne illness. The facility census was 40. Findings are: A. Record review of the Nebraska Food Code, Effective date 7/21/16, 4-602.11 revealed that food contact surfaces and utensils shall be cleaned at any time during the operation when contamination may have occurred. Observation on 4/30/23 at 12:17 PM in the facility dining room revealed Dietary Aide-A (DA-A) carried a tray with meals from the kitchen service window to the table of Residents 5 and 29. DA-A sat the tray on the table between the unmasked residents and delivered the meal plates and bowls to the residents. DA-A picked up the tray and carried it…

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.

D. Observation of Resident 14 on 5/02/23 at 11:22 AM revealed Resident 14 was sitting in their recliner in their room talking on the phone. Resident 14 had an indwelling urinary catheter (a tube inserted into and left in the bladder to drain urine) and the catheter urine collection bag was not in a cover and was hanging on the trash can that had visible garbage in it. E. Observation of Resident 18 on 5/1/23 at 10:11 AM revealed Resident 18 was sitting in their wheelchair in the hall. Resident 18 had an indwelling urinary catheter and the tubing connecting the catheter bag to the catheter was dragging on the floor. F. Observation of Resident 141 on 4/30/23 at 2:25 PM revealed Resident 141was sitting in the recliner in the living room. Resident 141 had an indwelling urinary catheter and the catheter urine collection bag was uncovered and laying on the floor. Interview with the VPCS (Vice President of Clinical Services) on 5/02/23 at 4:45 PM revealed the facility did not have a policy for the storage of catheter tubing and catheter bags. Interview with the DON (Director of Nursing) on…

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.

LICENSURE REFERENCE NUMBER 175 NAC 12-006.05 (21) Based on observation and interview, the facility failed to ensure resident dignity was maintained for Resident 14 by failing to place a visual barrier between the bathroom and the room door which placed Resident 14 at risk for exposure if a staff person or another resident opened the door while Resident 14 was using the bathroom. This affected 1 of 3 sampled residents. The facility identified a census of 40 at the time of survey. Findings are: Observation of Resident 14's room on 4/30/2023 at 5:40 PM and 5/1/23 at 10:16 AM revealed the room did not have a bathroom door or a curtain and the bathroom, including the toilet, was visible from the hall/open door placing Resident 14 at risk for exposure if a staff person or another resident inadvertently opened the room door. Interview with the DON (Director of Nursing) on 5/02/23 at 4:20 PM revealed the bathroom door had been removed because Resident 14's arms were getting bumped on the door as Resident 14 had to be transferred onto the toilet with a mechanical sit-to-stand lift. The DON…

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.

LICENSURE REFERENCE NUMBER 175 NAC 12-006.05 (4) Based on interview and record review; the facility failed to honor bathing preference for 1 of 1 sampled residents, Resident 19. The facility identified a census of 40 at the time of survey. Findings are: Review of Resident 19's quarterly MDS (Minimum Data Set-a comprehensive assessment used to develop a resident's care plan) dated 4/4/23 revealed an admission date of 12/24/2019. Resident 19 was dependent upon facility staff for bathing. Interview with Resident 19's family member on 4/30/23 at 3:31 PM revealed they had requested Resident 19 receive 2 baths a week but maybe only gets one or the bath gets skipped. Resident 19's family member revealed that sometimes it looked like Resident 19 had gone a while without a bath due to Resident 19's unclean appearance. Observation of Resident 19 on 5/01/23 at 10:18 AM revealed Resident 19 was sitting in a wheeled recliner in the living room. The skin on Resident 19's face was flaking and their hair was greasy. Review of Resident 19's Care Plan dated 12/5/2020 revealed Resident 19 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.

LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D1c Based on observation, interview, and record review; the facility failed to assist residents with activities of daily living (ADLs) for 2 residents (Residents 19 and 25). This affected 2 of 3 sampled residents. The facility identified a census of 40 at the time of survey. Findings are: A. Review of Resident 19's quarterly MDS (Minimum Data Set-a comprehensive assessment used to develop a resident's care plan) dated 4/4/23 revealed an admission date of 12/24/2019. Resident 19 was dependent upon facility staff for bathing. Interview with Resident 19's family member on 4/30/23 at 3:31 PM revealed they had requested Resident 19 receive 2 baths a week but maybe only gets one or the bath got skipped. Resident 19's family member revealed that sometimes it looked like Resident 19 had gone a while without a bath due to Resident 19's unclean appearance. Observation of Resident 19 on 5/01/23 at 10:18 AM revealed Resident 19 was sitting in a wheeled recliner in the living room. The skin on Resident 19's face was flaking and their hair was greasy.…

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.

LICENSURE REFERENCE NUMBER 175 NAC 12-006.18B Based on observation and interview, the facility failed to maintain toilet risers to prevent a potential accident hazard for Resident 141. This affected 1 of 3 sampled residents. The facility identified a census of 40 at the time of survey. Findings are: Review of Resident 141's admission MDS (Minimum Data Set-a comprehensive assessment used to develop a resident's care plan) dated 4/23/2023 revealed Resident 141 required limited assistance of one staff person for toilet use. Observation of Resident 141's bathroom on 4/30/23 at 3:43 PM revealed the toilet riser was not secured to the toilet. The toilet riser style had handles on the side with the screw type lock on the front. Observation of the toilet riser in Resident 141's bathroom with the DON (Director of Nursing) on 5/01/23 at 2:00 PM revealed it was not secured to the toilet. Interview with the DON at that time revealed the toilet riser should have been secured to the toilet and that staff should have been monitoring the toilet risers. Interview with the FA (Facility 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.