White House Healthcare And Rehabilitation Center

Based on observation, interview, record review, and policy review, the facility failed to ensure the kitchen was maintained in a sanitary manner, putting 147 residents who received meals from the kitchen (12 residents received nutrition via feeding tubes) out of 159 total residents at potential risk for foodborne illness. Specifically, failures included: improper freezer temperatures, a lack of functioning thermometers in the refrigerators/freezers, improper concentration of sanitizer solutions, uncleanable surfaces due to rust, not labeling foods removed from original packaging with the identification of the contents, unclean microwaves in the pantries, improperly maintained equipment such as refrigerators in the nursing pantries, an ice machine was unclean on the inside box where ice was made and stored, and tray line food holding temperatures were outside of safe temperature ranges.Findings include: Review of the facility's undated Food Receiving and Storage revealed, Foods shall be received and stored in a manner that complies with safe food handling practices . Danger zone…

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 policy review, the facility failed to allow one out of 33 sampled residents (Resident (R)15) to exercise her right to go to the day room to attend activities. R15 was not allowed to co-mingle with other residents in the activity room after she sustained an infection. R15 was currently on enhanced barrier precautions which did not dictate that the resident could not leave her room and attend activities in the day room or socialize there. This created the potential for R15 to experience isolation and the inability to enjoy previous activities in which she had participated.Findings include: Review of the facility's Resident Rights Policy policy, dated 06/2025, revealed, . All residents in this facility have rights guaranteed to them under Federal and State law, and by this facility's personnel . The residents have a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility . To…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the facility failed to ensure one resident and family member out of 32 sampled residents (Resident (R)103) were invited to the quarterly care plan meeting. The facility's practice did not include inviting residents or families to quarterly care plan meetings. This created the potential for residents/families to lack information regarding care and services provided and lack the opportunity to provide input into care provided.Findings include: Review of the facility's Care Planning - Interdisciplinary Team policy, dated 03/2022, revealed, . Comprehensive, person-centered care plans are based on resident assessments and developed by an interdisciplinary team (IDT) . The resident, the resident's family and/or the resident's legal representative/guardian or surrogate are encouraged to participate in the development of and revisions to the resident's care plan . Review of R103's undated admission Record, located in the electronic medical record (EMR)…

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, record review, and policy review, the facility failed to ensure written notice of the facility's bed hold policy and/or transfer notices that contained all necessary information were provided to three of four residents and/or representatives (Resident (R) 1, R22, and R7) reviewed for transfer notices out of a total sample of 32. This failure had the potential for the resident and/or representative not to have knowledge of where and why a resident was transferred, how to appeal the transfer, or to be knowledgeable of the facility's bed hold policy. Findings include: Review of the facility's undated policy titled, Bed-Holds and Returns revealed, . Written information will be given to the residents and the resident representatives that explains in detail:b. The reserve bed payment policy as indicated by the state plan (Medicaid residents),The facility per diem rate required to hold a bed (non-Medicaid residents), or to hold a bed beyond thestate bed-hold period (Medicaid residents); andd. The…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the facility failed to ensure one out of one sample residents reviewed for range of motion (ROM) (Resident (R) 58) out of a total sample of 32 residents, had an elbow splint/hand roll applied in accordance with physician's orders. This created the potential for R 58 to experience a worsening of her contracted left arm/hand.Findings include: Review of the facility's Resident Mobility and Range of Motion (ROM) policy, dated 07/2017, revealed, . Residents with limited range of motion will receive treatment and services to increase and/or prevent a further decrease in ROM . Review of the R58's admission Record, located in the Electronic Medical Record (EMR) under the Profile tab, revealed R58 was admitted to the facility on [DATE]. Diagnoses included hemiplegia (partial or total paralysis on one side of the body) and hemiparesis (weakness on one side of the body) following cerebral infarction (ischemic stroke) affecting left non-dominant side. Review…

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, record review and policy review, the facility failed to ensure laboratory results were followed up on in a timely manner for one of three sampled residents (Resident (R) 58) reviewed for a urinary tract infection (UTI) out of a total sample of 32. R58's Urinalysis and Culture and Sensitivity (C & S) results revealed she may have had a urinary tract infection. There was no documentation of follow up indicating the Physician was notified of the results and no documentation of whether the physician wanted to treat the infection until the surveyor asked about it nine days later. This created the potential for R58 to experience a UTI without treatment. Findings include: Review of the facility's Lab and Diagnostic Test Results - Clinical Protocol, dated 11/2018, revealed, . 1. The physician will identify and order diagnostic and lab testing based on the resident's diagnostic and monitoring needs. 2. The staff will process test requisitions and arrange for tests. 3. The laboratory, diagnostic…

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 policy review, the facility failed to ensure one of one sampled resident (Resident (R)103) reviewed for dental services out of a total sample of 32 was scheduled for dental services within three days and in accordance with facility policy after her dentures were lost on 05/25/25.Findings include: Review of the facility's undated Dental Services policy revealed, . Routine and 24-hour emergency dental services are available to meet the resident's oral health service in accordance with the resident's assessment and plan of care . Dentures will be protected from loss or damage, to the extent practicable, while being stored . If dentures are damaged or lost, residents will be referred for dental services within 3 days . Review of R103's undated admission Record, located in the electronic medical record (EMR) under the Profile tab, revealed R103 was admitted to the facility on [DATE] with diagnoses including cerebral infarction (ischemic stroke) and vascular…

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 a.) ensure the physician signed and dated monthly medication orders and b.) ensure the physician or the non-physician practitioner (NPP) performed face-to-face monthly visits. The deficient practice was identified for 19 of 32 residents reviewed (#29, 129, 22, 51, 65, 121, 97, 116, 53, 10, 101, 11, 2, 69, 33, 80, 138, 75, 118) and occurred over a 6 month period. The deficient practice was evidenced by the following. 1. A review of the hybrid medical record for Resident #29 revealed the resident's physician had not hand signed or electronically signed the monthly physician's orders for January, February, March, April, or May 2024. 2. A review of the hybrid medical record for Resident #129 revealed the resident's physician had not hand signed or electronically signed the monthly physician's orders for January, February, March, April, or May 2024. One physician progress note (5/4/24) was electronically entered into 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, it was determined that the Consultant Pharmacist (CP) failed to report irregularities found in the medical records to the facility. This deficient practice was observed for the following resident. On 6/4/24 at 12:21 PM, the surveyor reviewed the hybrid medical record (paper and electronic) for Resident #83. The resident's admission Record (AR) reflected that the resident was admitted with diagnoses including but not limited to Hypertension (elevated blood pressure) and Gastrostomy (G-tube) (an opening into the stomach from the abdomen, for the introduction of food or medications). A review of the resident's Medicare 5 Day Minimum Data Set (MDS) (a standardized assessment tool that measures health status in nursing home residents) dated 4/8/24, which reflected that the resident had a Brief Interview for Mental Status (BIMS) (a tool used to screen and identify the cognitive condition) Score of three (3) which reflects severe cognitive impairment. The surveyor reviewed the May and June 2024 electronic medication administration record (eMAR) and the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and facility policy review, the facility failed to maintain the cleanliness of the oxygen concentrator filter, change nasal cannula tubing, and transfer orders from the hospital to the residents Electronic Medical Record (EMR), for one of two residents (Resident (R) 120), sampled for respiratory care. This deficient practice increased the risk for infection in a resident that had respiratory distress. Findings include: 1. Review of R120's Profile located in the EMR revealed that R120 was initially admitted to the facility on [DATE] and readmitted on [DATE], from a hospital admission. Diagnoses included; adult failure to thrive and respiratory distress. Observation on 08/08/22 at 1:37 PM and 08/09/22 at 9:14 AM, revealed that R120's oxygen tubing was dated 07/27/22. The oxygen concentrator that was black in color, was completely covered in a thick white dust. Observation on 08/10/22 at 8:51 AM, revealed that R120's oxygen tubing had been changed and was dated…

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, record review, review of the Centers for Disease and Prevention (CDC) guidelines, and facility policy review, the facility failed to ensure that one Resident(R)111, of five residents sampled for immunization reviews, were offered and given the option to receive or decline an additional pneumonia vaccine. Findings include: Review of the CDC guidelines located at: https://cdc.gov/vaccines/vpd/pneumo/hcp/recommendations, revealed adults with a previous Pneumococcal Vaccine Polyvalent (PPSV23) only, the CDC recommends for those over [AGE] years of age a Pneumococcal valent Conjugate Vaccine (PCV), either PCV20 or PCV15 should be given greater than one year after their last PPSV23 dose. 1. Review of R111's undated Face Sheet located in R111's electronic medical record (EMR) located under the Profile tab, indicated R111 was initially admitted to the facility on [DATE] with a readmission on [DATE], with diagnoses including; metabolic encephalopathy, streptococcal sepsis, and type 2 diabetes…

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.