Mountainside Skilled Nursing And Rehab

Complaint #NJ181450 Based on interview and record review it was determined that the facility failed to a.) respond to residents' requests for assistance in a timely manner for 5 of 5 residents in attendance at the resident group meeting (Resident #24, 34, 67, 84, and 108) and b.) ensure the call bell (bell used to summon staff for assistance) was placed within a resident's reach for 1 of 30 Residents (Resident # 74). This deficient practice was evidenced by the following: 1. The surveyor conducted the resident group meeting on 2/27/25 at 10:30 AM. All 5 of 5 residents stated that the call bell response was slow on the 11 PM -7 AM shift. One resident stated one time they had waited from 1:00 AM to 3:00 AM. The resident stated they needed drinking water and I have bilateral contractures and can't do it myself. A review of minutes from past resident council meetings included a 12/26/24 comment from a resident stating that staff needs to answer call bells in timely manner. 2. On 2/25/25 at 11:15 AM, during an initial tour of the second-floor unit, the surveyor observed Resident #74 in…

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.

Complaint #: NJ162370; NJ1162293 Based on interview and record review, it was determined that the facility neglected to provide a resident who required extensive assistance of two or more caregivers for personal care the required amount of assistance who complained of rough care while being repositioned by one caregiver. The deficient practice was identified for 1 of 6 residents reviewed for those requiring assistance with activities of daily living (ADL) (Resident #333), and was evidenced by the following: The surveyor reviewed the closed electronic medical record of Resident #333 which revealed the following information: A review of the Minimum Data Set (MDS), an assessment tool dated 2/25/23, indicated the resident had mild cognitive impairment and required extensive assistance of two or more caregivers with bed mobility and incontinence care. A review of the individualized comprehensive care plan (ICCP) included a focus area for ADL self-care deficit as evidenced by the need for assistance related to physical limitations initiated 12/20/21 through 7/21/24. Interventions included…

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 accurately assess a resident's status in the Minimum Data Set (MDS), an assessment tool used to facilitate the management of care. This deficient practice was identified for 3 of 30 residents reviewed (Resident #59, #131, and #132) and was evidenced by the following: 1. The surveyor reviewed Resident # 132's records. The resident was discharged from the facility, and according to the Discharge Return Not Anticipated MDS, dated [DATE], the resident was discharged to the hospital. A review of Resident #132's progress notes dated 12/20/24, revealed the resident was discharged home. On 2/27/25 at 1:06 PM, the surveyor interviewed the Registered Nurse/MDS Coordinator (RN/MDS), who stated that the discharge MDS for Resident #132 should have indicated that the resident was discharged to their home. 2. The surveyor reviewed Resident # 131's records. The resident was discharged from the facility and according 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 observation, interview, and record review, it was determined that the facility failed to accurately develop and implement a person-centered comprehensive care plan for care and service needs. This deficient practice was observed for 1 of 30 residents reviewed, Resident # 236, was evidenced by the following: On 2/25/25 at 1:55 PM, the surveyor observed Resident # 236, in bed in their room and the resident was receiving oxygen therapy via nasal cannula (NC). The surveyor reviewed Resident #236's Electronic Medical Record. Resident #236's face sheet revealed that the resident was admitted to the facility with diagnoses which included but were not limited to; chronic respiratory failure and pulmonary fibrosis. A review of the Physician's Order Sheet dated February 2025, revealed the resident had a physician's order for O2 via NC continuous at 3 LPM. The surveyor reviewed the resident's current care plans. There was no comprehensive care plan developed regarding the resident's order for the oxygen therapy. On 2/27/25 at 10:46 AM, the surveyor interviewed the Licensed Practical…

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 a.) proper administration of Fluticasone nasal spray in accordance with manufacturer's specifications, and b.) administration and availability of prescribed medication(s) in accordance with professional standards of practice. The deficient practice was identified for 1 of 4 nurses who administered medications to 1 of 4 residents (Resident #127) and 1 of 27 Residents reviewed for Medication Record Review. The evidence was as follows: Reference: New Jersey Statutes, Annotated Title 45, Chapter 11. Nursing Board. The nurse practice act for the State of New Jersey states: The practice of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential physical and emotional health problems, through such services as casefinding, health teaching, health counseling, and provision of care supportive to or restorative of life and wellbeing, and executing medical regimens as prescribed by a licensed or otherwise legally authorized…

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 maintain medical equipment in good working condition to prevent injuries for 1 of 24 residents reviewed (Resident #108). This deficient practice was evidenced by the following: The surveyor interviewed Resident #108 on 2/25/25 at 1:13 PM. The resident stated several months ago they reported to staff that the raised toilet seat had rusted screws which affixed the seat to the metal frame. The raised toilet seat was replaced with another which had similiar rusted screws and also a crack in the seat. The resident stated they would put a paper towel over the crack and lean to the side in order not to get pinched. At that time, the surveyor observed the raised toilet seat which was in place in the resident's bathroom. The seat had 2 rusted screws and a thin crack running from the center of the seat to the upper edge near the screws. The quarterly 11/21/24 Minimum Data Set (MDS) assessment indicated the resident had no cognitive deficits and required assistance with toilet use. The surveyor…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to a.) administer oxygen therapy according to the physician's order for 2 of 2 residents reviewed for oxygen therapy (Resident #66 and #236) and b.) ensure respiratory nasal cannula (NC) tubing was stored in accordance with infection control measures for 1 of 1 resident (Resident #52). This deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: The practice of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual and potential physical and emotional health problems, through such services as case-finding, health teaching, health counseling, and provision of care supportive to or restorative of life and wellbeing, and executing medical regimens as prescribed by a licensed or otherwise legally…

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.

Refer F658 Based on observation, interview, and record review, it was determined that the facility failed to ensure that the Consultant Pharmacist (CP) identified and reported a medication irregularity, to the attending physician, the facility's medical director, and the director of nursing (DON). This deficient practice was identified for 1 of 5 residents (Resident #13) reviewed for unnecessary medications and was evidenced by the following: On 2/25/25 at 11:31 AM, during the initial tour of the facility the surveyor observed Resident #13 lying in bed. The head of the bed was elevated. The resident stated that the breakfast and care were satisfactory. The surveyor reviewed the medical record of Resident #13. According to the admission Record face sheet, an admission summary, reflected that Resident #13 was admitted to the facility with diagnoses that included, end stage renal disease, dependence on renal dialysis. A review of medication list from the hospital included the following: -Sevelamer carbonate (Renvela; a phosphate binder to control serum phosphorus levels for those 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 provide a nourishing snack at bedtime when the time between dinner and breakfast exceeded 14 hours. The deficient practice was identified for 5 of 5 residents (Resident #34, 84, 67, 108, 24) in attendance at the resident group meeting and was evidenced by the following: The surveyor conducted the resident group meeting on 2/27/25 at 10:30 PM. All 5 of 5 residents stated they were not aware that evening snacks were available for residents. All of the residents resided on the second floor nursing units. All of the residents stated they would like to have an evening snack available to them. Resident #34 stated they eat dinner at 5 pm and eat breakfast at 9 AM. A review of the Meal Truck Delivery Schedule revealed the time between delivery of dinner and the delivery of breakfast ranged from 14.5 hours to 15.5 hours. The 7/2024 facility Frequency of Meals policy indicated a nourishing snack will be offered if the time span between evening meal and the next day's breakfast exceeds 14 hours. NJAC…

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 review of pertinent facility documents, it was determined that the facility failed to follow appropriate infection control practices and perform hand hygiene as indicated during dining observation. This deficient practice was observed in 1 of 2 dining rooms and was evidenced by the following: According to the CDC Hand Hygiene in Healthcare Settings, Hand Hygiene Guidance, last reviewed on January 30, 2020, included that Healthcare personnel should use an alcohol-based hand rub or wash with soap and water for the following clinical indications: Immediately before touching a patient Before performing an aseptic task or handling invasive medical devices Before moving from work on a soiled body site to a clean body site on the same patient After touching a patient or the patient's immediate environment After contact with blood, body fluids, or contaminated surfaces Immediately after glove removal. On 2/25/25 at 12:30 PM, the surveyor observed nine residents seated in the Second-Floor dining room waiting for their lunch meal. On 2/25/25 at 12:35 PM,…

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.

COMPLAINT: # NJ00179522 Based on interviews, record review, and review of pertinent facility documents on 11/14/2024, it was determined that the facility failed to ensure that residents were free of significant medication errors for 2 of 5 residents (Resident #1 and Resident #2) reviewed for medication administration, follow the facility's Licensed Practical Nurse (LPN) job description, and follow the facility policy titled Administering Medications. This deficient practice is evidenced by the following: 1. According to the admission Record (AR) Resident #1 was admitted to the facility with diagnoses that included but were not limited to encephalopathy, unspecified (a syndrome of overall brain dysfunction); hepatitis A without hepatic coma (an infectious disease of the liver); type 2 diabetes mellitus with hyperglycemia; legal blindness; and chronic pain syndrome. The most recent Minimum Data Set (MDS), an assessment tool, revealed that Resident #1's Brief Interview for Mental Status (BIMS) was 9 out of 15 indicating that Resident #1's cognition was moderately impaired. Review 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint #: NJ172131, NJ175519 Based on observation, interview, review of the medical record, and review of other facility documentation, it was determined that the facility failed to obtain a physician's order for the care of an indwelling Foley catheter (a catheter that is inserted through the urethra to allow for bladder drainage), for Resident #2. This deficient practice was identified for 1 of 4 residents (Resident #2) reviewed for the use of an indwelling Foley catheters and was evidenced by the following: According to the admission Record, Resident #2 had diagnoses that included, but were not limited to, Chronic Kidney Disease (CKD) (A condition characterized by a gradual loss of kidney function), Obstructive and Reflux Uropathy (flow of urine is blocked, causing urine to back up and injure one or both kidneys), and Acute Kidney Failure (kidneys suddenly can't filter waste products from the blood). Review of Resident #2's Quarterly Minimum Data Set (MDS), dated [DATE], included the resident had a Brief…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record reviews, document review, and facility policy review, it was determined that the facility failed to follow the planned, written menu and ensure residents were notified in advance of menu changes for 1 of 1 meal observed. The facility identified 86 residents who received meals from the kitchen (total census 118). Review of a facility policy titled, Menu Overview and Changes, dated 11/2020, revealed the suggested steps to follow when changing the menu included, 4. The registered/licensed dietician approves the changes and signs the diet spreadsheet where changes were made. The food service director makes the approved changes on the following menu components: week at a glance, diet spreadsheet, posting menus, and selective menus. Review of a facility policy titled, Portion Control Equipment, dated 11/2020, revealed, Portioning is used with standardized recipes to meet menu requirements. 1. Identify portion control equipment needed by checking recipes and the diet…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record review, and facility policy review, the facility failed to cover a urinary drainage bag to provide privacy and dignity for 1 (Resident #108) of 1 resident who had an indwelling urinary catheter. Findings included: A review of the facility's policy, Catheter Care: Indwelling Catheter-Resident Services, with a copyright of 2023, indicated the catheter should be in catheter bag holder if appropriate. A review of the admission Record Report indicated the facility admitted Resident 108 with diagnoses that included quadriplegia, anemia, urinary tract infection, and acute cystitis. The quarterly Minimum Data Set (MDS), dated [DATE], revealed Resident #108 had a Brief Interview for Metal Status (BIMS) score of 15, which indicated the resident was cognitively intact. The MDS indicated Resident #108 required total assistance for all activities of daily living and identified Resident #108 used an indwelling urinary catheter. Review of Resident #108's care plan with a revision date…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record review, and facility policy review, the facility failed to obtain an order and assess a resident's ability to self-administer medications for 1 (Resident #13) of 1 sampled resident observed with prescription medications at the bedside. Findings included: A review of a facility policy titled, Medication self-administration, long-term care, dated as revised 05/20/2022, indicated, The interpretive guidelines in the SOM [State Operations Manual] state that if a resident requests to self-administer drugs, then the interdisciplinary team is responsible for determining whether it's safe for the resident to do so before the resident may exercise that right. The interdisciplinary team also must determine who will be responsible (the resident or the nursing staff) for storing and documenting administration of drugs as well as the site of drug administration (for example, in the resident's room, at the nurses' station, or in the activities room). This information should 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record review, document review, and facility policy review, it was determined that the facility failed to ensure reasonable accommodations were provided to meet resident needs and functional ability for 2 (Resident #36 and Resident #108) of 2 residents reviewed for accommodations of needs. Specifically, the facility failed to: 1. Ensure Resident #108 was provided with a modified call light that the resident was able to use. 2. Ensure Resident #36's call light was placed within the resident's reach. Findings included: 1. A review of an undated facility policy titled, F Tag 558-Reasonable Accommodations of Needs/Preferences indicated residents had, The right to reside and receive services in the facility with reasonable accommodations of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents. A review of an admission Record Report revealed the facility admitted Resident #108 with diagnoses that included…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, record review, document review, and facility policy review, it was determined the facility failed to ensure Minimum Data Set (MDS) assessments accurately reflected residents' status to facilitate appropriate care planning for 2 (Resident #71 and Resident #85) of 24 sampled residents reviewed for MDS accuracy. Findings included: Review of the Long-Term Care Resident Assessment Instrument (RAI) 3.0 User's Manual, dated 10/2019, specified, 1.3 Completion of the RAI. The RAI process has multiple regulatory requirements. Federal regulation at 42 Code of Federal Regulation (CFR) 483/20 (b) (1) (xviii), (g), and (h) require that (1) the assessment accurately reflects the resident's status. A review of an admission Record Report revealed the facility admitted Resident #85 with diagnoses that included tracheostomy status, anoxic brain damage, and gastrostomy status. Review of a Care Plan, dated as initiated 09/12/2021, revealed Resident #85 was at risk for respiratory impairment related to hypoxemia…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, record reviews, and facility policy review, it was determined the facility failed to ensure residents with a new mental illness diagnosis were referred to the state-designated authority for a level two pre-admission screening and resident review (PASRR) for 2 (Resident #74 and Resident #71) of 3 sampled residents reviewed for PASRR. Findings included: A review of the facility policy titled, Preadmission Screening and Resident Review (PASARR), copyright 2023, revealed, 4. Social services staff are required to coordinate the PASARR assessments and recommendations including: Referring Level II patients and patients with newly evident or possible serious mental disorder, intellectual, or a related condition for Level II review upon a significant change in status assessment. 1. A review of an admission Record Report revealed the facility admitted Resident #74 on 08/22/2022 with diagnoses including type 2 diabetes mellitus and unspecified dementia. A review of a Preadmission Screening and Resident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, interviews, and facility policy review, the facility failed to provide treatment and services to prevent potential complications related to the use of an indwelling urinary catheter for 1 (Resident #108) of 1 sampled resident reviewed for urinary catheter care. Specifically, the facility failed to secure Resident #108's catheter to prevent excessive tension on the catheter which could cause dislodgement of the catheter or injury to the bladder/urethra; failed to ensure the catheter's drainage bag was maintained below the level of the bladder to facilitate bladder emptying; and failed to avoid application of creams/ointments to the catheter tubing to prevent potential urinary tract infection. Findings included: A review of a facility policy titled, Catheter Care: Indwelling Catheter-Resident Services, copywrite 2023, indicated, Secure catheter tubing to resident's leg using a securement device or Velcro leg strap as ordered and clinically indicated - prevents traction on 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 observations, interviews, record review, and facility policy review, the facility failed to: 1. Ensure staff donned proper personal protective equipment (PPE) when entering a room where a resident was on contact isolation for 1 (Resident #12) of 2 residents observed on isolation precautions. 2. Ensure staff properly cleaned a glucometer following manufacturer's instructions during 1 of 1 fingerstick blood sugar observation. Findings included: 1. A review of the facility's Practice Guidelines, dated 07/2021, revealed Contact transmission is the most important and frequent mode of transmission of healthcare associated infections. It is divided into two (2) subgroups: direct and indirect contact transmission. The guidelines added that in addition to standard precautions, other measures were necessary for contact precautions including gloves, gown, disposable patient care equipment, and to limit transport and movement of residents outside the room and provide a private room when possible. An observation was made on 01/24/2023 at 9:05 AM of Registered Nurse (RN) #8 entering the…

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

Based on observation, interview, and review of other facility documentation, it was determined that the facility failed to handle potentially hazardous foods and maintain sanitation in a safe consistent manner to prevent food borne illness. This deficient practice was evidenced by the following: On 12/6/20 at 9:19 AM, the surveyor, accompanied by the Food Service Director (FSD), observed the following in the kitchen: 1. The surveyor observed a four-pound jar of grape jelly opened and more than half empty stored on a shelf next to a tub of peanut butter in the sandwich prep area. The jelly had an expiration date of 3/11/22 and an open date of 11/30/20. When interviewed at the time, the FSD said jelly should be stored in the refrigerator when not in use, however, a Food Service Worker (FSW) was, Just using it. The surveyor felt the jar which felt room temperature. The surveyor requested the FSD take temperature of the jelly using a calibrated thermometer. The temperature on the jelly was 73 Fahrenheit. The FSD read the label which indicated the product should be refrigerated after…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, it was determined that the facility failed to consistently maintain communication with the dialysis center and coordinate medication administration according to the dialysis schedule. This deficient practice was observed for 1 of 3 residents (Resident #84) reviewed for dialysis services. The deficient practice was evidenced by the following: On 12/17/20 at 12:47 PM, the surveyor observed the resident in bed awake with oxygen in place. The resident informed the surveyor that they go to dialysis Tuesday, Thursday and Saturday. The resident gets picked up approximately 2:30 PM and returns at approximately 7 PM. The surveyor reviewed Resident #84's medical records which revealed the following: According to the admission record, Resident #84 was admitted [DATE] with diagnoses that included End Stage Renal Disease. The November 2020 and December 2020 Physician's Orders (PO) and Medication Administration Records (MAR) revealed the following medications were ordered 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.