Salemhaven

Based on observation, interview, and policy review, it was determined that the facility failed to store and serve food in accordance with professional standards for food safety to prevent foodborne illness in 1 of 1 kitchen and 3 of 3 kitchenettes observed. Findings include:Review on 4/23/24 of the U.S. Food and Drug Administration Food Code, dated 2017, retrieved from https://www.fda.gov/food/FDA-food-code/food-code-2017 revealed the following: .Annex 3, Public Health Reasons/Administrative Guidelines . Chapter 3 Food .3-305.11 Food Storage .FOOD shall be protected from contamination by storing the FOOD: . On-premises preparation .(D) A date marking system that meets the criteria stated in (A) and (B) of this section may include: (1) Using a method approved by the regulatory authority for refrigerated, ready-to-eat time/temperature control for safety food that is frequently rewrapped, such as lunchmeat or a roast, or for which date marking is impractical, such as soft serve mix or milk in a dispensing machine; (2) Marking the date or day of preparation, with a procedure to discard…

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, it was determined that the facility failed to ensure that physician's orders were followed for 1 of 5 residents reviewed for choices in a final sample of 19 residents. (Resident identifier is #84.)Findings include: Review on 8/13/25 of Resident #84's August 2025's MAR (Medication Administration Record) revealed:Labetalol HCL (Hydrochloric Acid) Oral Tablet (Labetalol HCL) Give 100 mg (milligrams) by mouth every 6 hours for HTN (Hypertension) (Give if SBP (Systolic Blood Pressure) greater than 160, Hold if AP (Apical Pulse) less than 60), Start Date 8/1/25 revealed: 8/3 the medication was administered at 8:00 am with a SBP of 121, at 2:00 p.m. with a SBP of 137, and 8:00 p.m. with a SBP of 134.8/6 the medication was administered at 8:00 p.m. with a SBP of 128.8/7 the medication was administered at 2:00 a.m. with a SBP of 139.8/8 the medication was administered at 2:00 a.m. with a SBP of 141.8/9 the medication was administered at 8:00 a.m. with a SBP of 152, and at 2:00 p.m. with a SBP of 142.8/10 the medication was administered at 2:00 p.m. with…

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, it was determined that the facility failed to ensure that residents received the appropriate care and services for catheter care for 2 of 2 residents reviewed for urinary catheters in a final sample of 19 residents. (Resident identifiers are #1and #5).Findings include:Resident #1 Review on 8/12/25 of Resident #1's physician orders revealed the following: Irrigate Foley/Suprapubic Catheter with normal saline PRN [as needed] per MD [Doctor of Medicine] orders (SPECIFY), dated 7/14/25. Further review revealed that there were no other orders indicating when to irrigate Resident #1's foley catheter and no orders for how much normal saline to use when flushing Resident #1's foley catheter. Review on 8/12/25 of Resident #1's care plan, initiated on 7/15/25 revealed that Resident #1 had an indwelling catheter due to his/her diagnosis of urinary retention. Further review revealed that under interventions included .Report to MD (Doctor of Medicine) no output . Review on 8/12/25 of Resident #1's medical record revealed there was no urine output documented…

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

Based on observation, interview, and record review, it was determined the facility failed to properly label a vial of multidose injectable medication when opened for 2 out of 3 medication refrigerators observed.Findings include:Observation on 8/13/25 at 8:40 a.m. of the third floor medication room refrigerator revealed an open vial of Tuberculin Purified Protein Derivative that was unlabeled with an opened date or an open expiration date. Interview on 8/13/25 at 8:40 a.m. with Staff E (Licensed Practical Nurse) confirmed the above findings. Observation on 8/12/25 at approximately 9:10 a.m. in the Infection Preventionist Office refrigerator revealed one opened undated vial of Tuberculin solution. Interview on 8/12/25 at approximately 9:10 a.m. with Staff D (Infection Preventionist) confirmed the above findings. Review on 8/13/25 of manufacturer's instruction for Tuberculin Purified Protein Derivative revealed: A vial of TUBERSOL which has been entered and in use for 30 days should be discarded. Do not use after expiration date. Review on 8/13/25 of the facility's policy titled…

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, it was determined that the facility failed to conduct an annual review of its infection prevention and control program and implement policies and procedures for Transmission Based Precautions (TBP) to prevent the potential spread of infection for 3 of 4 resident observed for TBP in a final sample of 19 residents. (Resident identifier is #17, #56, and #68.). Findings include:Interview on 8/12/25 at 8:30 a.m. with Staff J (Licensed Practical Nurse) revealed that there was an upper respiratory virus outbreak and the following residents were on contact precautions: Resident #17, Resident #56, and Resident #68. Interview 8/12/2025 at 12:30 p.m. with Staff D (Infection Preventionist) confirmed that rooms Resident #17, Resident #56, and Resident #68 were on droplet precautions recommended by the health department due to a respiratory outbreak at the facility. He/she stated that residents that were symptomatic should remain on droplet precautions until they had completed their antibiotics or symptomatic free for 24 hours. Staff D stated…

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, it was determined that the facility failed to implement policies and procedures on COVID-19 immunization for 1 of 1 staff reviewed for COVID-19 immunizations. (Staff identifier is Staff M).Findings include: Review on 8/14/25 of the facility's policy titled COVID-19 Vaccination implemented on 8/12/25 revealed, . It is the policy of this facility to minimize the risk of acquiring, transmitting or experiencing complications from COVID-19 . by education and offering our residents and staff the COVID-19 vaccine . Up-to-date is defined as receiving a 2024-2025 updated COVID-19 vaccine . 14. The facility will educate and offer the COVID-19 vaccine to residents, resident represents and staff and maintain documentation of such. 15. The facility will maintain documentation related to staff COVID-19 vaccination and include at a minimum: a. Education to the staff regarding the risks, benefits, and potential side effects of the COVID-19 vaccine; b. The offering of the COVID-19 vaccine or information on obtaining the COVID-19 vaccine; c. The COVID-19 vaccine…

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, it was determined that the facility failed to follow accepted guidelines to prevent the spread of infections for 5 of 10 residents reviewed for infection control (Resident identifier #15, #22, #69, #84, and #343) and for 1 out of 4 residents observed for medication administration (Resident identifier is #14). Findings include: Resident #14 Observation on 8/7/24 at approximately 7:24 a.m. with Staff O (Licensed Practical Nurse (LPN)) during medication administration observation revealed that Staff O donned gloves and administered Resident #14's Insulin Glargine 20 units subcutaneously at the left upper quadrant of the abdomen. Staff O did not doff used gloves and did not perform hand hygiene before administering brinzolamide-brimonidine 1-0.2% (percent) eye drops to Resident #14. Staff O then touched Resident #14's bilateral lower eyelids and on the top of his/her head, while wearing the gloves, during administration of the eye drops. Further observation…

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, it was determined that the facility failed to ensure that alleged violations of neglect were reported immediately or no later than 2 hours after the allegation was made to the State Survey Agency (SSA) for 2 of 3 residents reviewed for neglect (Resident Identifiers are #20 and #79). Findings include: Resident #79 Review on 8/6/24 of the facility grievance log revealed the following allegations of neglect: An allegation of neglect dated 7/24/24 reported by Resident #79 stating that he/she rang the call bell Tuesday at 3:30 a.m. and the call bell was not answered until 4:15 a.m When staff entered the room the call light was shut off and Resident #79 was told We don't have time right now, you need to wait your turn. Resident #79 further reported that prior to breakfast that same morning, an Licensed Nursing Assistant (LNA) entered her room and stated get up while pulling the blankets off her. Resident #20 Allegation of neglect 7/22/24 for a complaint of Staff R (LNA) refusing to answer Resident #20's call bell, causing incontinence, then when 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, record review, and policy review, it was determined that the facility failed to ensure that expired medications were removed from use for 2 of 2 medication rooms observed and 2 of 3 medication carts observed. (Resident identifiers are #62 and #63.) Findings include: Observation on 7/31/23 at approximately 8:00 a.m. of the 2 East Medication Cart with Staff D (Licensed Practical Nurse) revealed: 1 Bottle of Vitamin C 500 milligrams (mg) with an expiration date of 2/23; 1 Bottle of Vitamin B12 100 micrograms (mcg) with an expiration date of 6/23. Interview on 7/31/23 at approximately 8:00 a.m. with Staff D confirmed the above findings. Observation on 8/1/23 at approximately 8:30 a.m. of the 2 [NAME] Medication Cart with Staff A (Unit Manager) revealed: 1 Bottle of Delsym Cough Syrup with an expiration date of 07/23; 1 opened Lispro Insulin 100 units per milliliter (U/mL) pen for Resident #62 with no open date, no open expiration date, and a dispense date of 6/28/23 with a pharmacy label indicating to discard 28 days after opening; 1 medication card 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.

Based on observation, interview, and record review, it was determined that the facility failed to ensure that food was prepared in accordance with professional standards for food service safety for 1 of 1 main kitchen observed and the facility failed to store food in accordance with professional standards for food safety to prevent foodborne illness for 3 of 3 kitchenettes observed. Findings include: Observation on 7/31/23 at 8:40 a.m. in the main kitchen with Staff E (Food Service Director) revealed that the range hood over the stove had accumulated gray dust and grease debris on the grates located on the inside of the hood. Interview on 7/31/23 at 8:40 a.m. with Staff E confirmed the above finding. Observation on 7/31/23 at approximately 8:40 a.m. revealed two fans in the dishwashing area with gray dust and grease debris on the front and back of the fans blowing onto air-dried clean dishes. Interview on 7/31/23 at approximately 8:40 a.m. with Staff E confirmed above finding. Review on 8/3/23 of the FDA [Food and Drug Administration] Food Code, dated 2022, retrieved from:…

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.