Crest Manor Living and Rehabilitation Center

Based on interviews and record review conducted during a Recertification Survey and complaint investigation (ACTS Reference Number: NY00319641), for one (Resident #51) of three residents reviewed, the facility did not ensure that an incident resulting in a major injury was thoroughly investigated in order to rule out potential abuse, neglect, mistreatment, or care plan violation. Specifically, Resident #51 fell while being assisted in the bathroom by a staff member resulting in a patella fracture (broken kneecap). The facility was unable to provide evidence (including, but not limited to, statements from the resident, involved staff members or potential witnesses) that the incident was thoroughly investigated to rule out potential abuse, neglect, mistreatment, or care plan violation. This is evidenced by the following: The undated facility policy Accident and Incident Reporting documented the facility would provide an accurate record of all incidents occurring on the premises involving any resident, staff, vendors, visitors, volunteers, or clinical students. An incident would be any…

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, and record review conducted during the Recertification Survey from 10/07/2024 to 10/15/2024, for two (Resident #19 and Resident #38) of five residents reviewed, the facility did not implement a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs. Specifically, Resident #19 had a history of falls, was care planned to have a fall mat (a floor mat that helps prevent injuries and is often used for people at risk for falling) in place and was observed with the mat improperly placed near their bed. Resident #38, who had a history of falls, was care planned to have a low bed in place and call bell within reach, and was observed in a bed not in the low position and call bell not within reach. This is evidenced by the following: 1. Resident #38 had diagnoses of dementia, depression, anxiety, and a right above the knee amputation. The Minimum Data Set 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, interviews, and record review conducted during the Recertification Survey and complaint investigations (NY00354611 and NY00349191), for two (Residents #25, and #53) of seven residents reviewed for activities of daily living, the facility did not ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain good grooming and personal hygiene. Specifically, residents' fingernails were observed unclean and uncut over multiple days. Additionally, Resident #53 was observed eating with their hands while their fingernails remained dirty. This is evidenced by the following. The undated facility policy Care of Fingernails/Toenails included that the purpose was to clean the nail bed, to keep nails trimmed, and to prevent infections. The policy included that nail care included daily cleaning and regular trimming and that the treatment should be documented in the resident ' s medical record. Additionally, the policy included that 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, and record review conducted during the Recertification Survey from 10/07/2024 to 10/15/2024, for one (Resident #25) of two residents reviewed, the facility did not ensure the resident received the necessary care, treatment, and services, consistent with professional standards of practice to promote healing, prevent new pressure ulcers from developing, and/or prevent existing pressure ulcers from worsening. Specifically, the facility did not ensure that recommendations from the Wound Care Nurse Practitioner were accurately transcribed and implemented and treatments provided. This is evidenced by the following: The facility policy Pressure Ulcer (Injury) Prevention Program, dated 12/19/2022, included risk factors that impact the development, treatment, and/or healing of a pressure ulcer include residents with end stage renal disease and diabetes. A system will be in place that assures observations are timely and appropriate, interventions are implemented, monitored, and revised as appropriate, and changes in condition are recognized, evaluated,…

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, and interviews conducted during the Recertification Survey from 10/07/2024 to 10/15/2024, for one (Resident #19) of five residents reviewed, the facility did not ensure each resident received adequate supervision and the environment remained as free of accident hazards as possible. Specifically, Resident #19's care planned fall mat was not in place and there was no documented evidence the resident had been assessed by a Registered Nurse following an unwitnessed fall to their fall mat. The facility's undated policy Fall and Fall Risk documented staff with the help of the attending physician, would identify appropriate interventions to reduce the risk of falls. The facility's undated policy Falls Clinical Protocol documented: a. Staff and physician would document in the medical record a history of one or more falls. b. The nurse would assess and document vital signs, recent injuries, range of motion, change in condition, neurological status, pain, and details on how the fall…

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, and record review conducted during the Recertification Survey and complaint investigation (NY00354611), for one (Resident #2) of one resident reviewed, the facility did ensure the resident's pain was managed to the extent possible in accordance with the comprehensive assessment and plan of care, current professional standards of practice, and the residents goals and preferences. Specifically, Resident #2 did not receive their pain medication as ordered by the physician on multiple occasions. In addition, there was no evidence that the medical team was notified. This is evidenced by the following: The facility policy Pain Assessment and Management, dated revised October 2010, included to assess the resident's pain and consequences of pain at least every shift for acute pain or significant changes in levels of chronic pain, and at least weekly in stable chronic pain. Ask the resident if they are experiencing pain and be aware that the resident may avoid the term pain and use other descriptors such as throbbing, aching, hurting, cramping, numbness, or…

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, and record review conducted during the Recertification Survey from 10/07/2024 to 10/15/2024, for one (Resident #18) of five residents reviewed, the facility did not ensure a resident was not given psychotropic (medication used to treat mental processes and behaviors) drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record. Specifically, Resident #18 was prescribed an antipsychotic (medication used to treat symptoms of psychosis such as hallucinations, delusions, and agitation) medication and there was no documentation in the clinical record to show the resident was experiencing behavioral symptoms that presented a danger to the resident or others, symptoms of significant distress, monitoring for the effectiveness of the medication, and/or the resident's response to the treatment. The consultant pharmacist documented recommendations related to the antipsychotic in August 2024 and September 2024, and the facility was unable to provide documented evidence the recommendations were…

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, and record reviews conducted during an Abbreviated Survey (NY00318784), the facility did not ensure a resident who was unable to carry out activities of daily living independently received the necessary services to maintain good grooming and personal hygiene for one (Resident #3) of three residents reviewed. Specifically, Resident #3 had unclean hair and was wearing soiled clothing over the course of two days. There was no documented evidence that the resident had received a shower or bath for several weeks or had been offered and declined a shower or bath. This is evidenced by the following: Resident #3 had diagnoses including kidney disease, heart failure, and an above the knee left leg amputation. The Minimum Data Set Resident Assessment, dated 2/23/24, documented the resident had moderately impaired cognition, required assistance with showering and bathing, and had no rejections of care in that time frame. Review of the Comprehensive Care Plan, dated 6/16/23, revealed that Resident #3 preferred showers. Interventions included for staff to offer…

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, and record review conducted during an Abbreviated Survey (NY00329516, NY00329869, and NY00330543), it was determined that for one (third floor) of three resident use floors the facility did not operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes including notification of termination of a service vital to the health and safety of residents. Specifically, the nurse call system was not functioning properly for an extended period of time and the incident was not reported to the authority having jurisdiction (New York State Department of Health). The findings are: During an interview on 12/22/23 at 8:20 AM the Director of Nursing stated that the nurse call system on the third floor had not been working for at least a month. The Director of Nursing also stated that they had questioned whether the loss of the nurse call system needed to be reported to the Department of Health but it was not their call. During 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 Based on observations, interviews, and record review conducted during an Abbreviated Survey in conjunction with complaint investigations (NY00329516, NY00329869, and NY00330543) it was determined that for one (third floor) of three resident use floors the facility did not properly maintain the resident call system. Specifically, the third-floor nurse call system was not functional and did not allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area from each resident's bedside, toilet, and bathing facilities. The findings are: During an interview on 12/22/23 at 8:20 AM the Director of Nursing stated that the nurse call system on the third floor has not been working for at least a month. The Director of Nursing also stated that they provided tap bells and increased rounding to hourly. During an additional interview at this time, the Director of Maintenance stated that the nurse call system is old, and they have…

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 and record review conducted during an Abbreviated Survey (#NY00329869) completed on 1/16/24, the facility did not ensure that for one (Resident #1) of four residents reviewed for dining, that the resident received a nourishing, well balanced diet that meets the daily nutritional and special dietary needs. Specifically. Resident #1 was not provided a lunch meal three days per week on dialysis days for an extended period of time. This is evidenced by the following: Resident # 1 had diagnoses that include fracture of right hip, malnutrition, and kidney disease requiring hemodialysis (process of filtering the blood when the kidneys are unable to) three days a week. The Minimum Data Set (MDS) Resident assessment dated [DATE], documented the resident was cognitively intact. Review of a Physician progress note regarding nutrition, dated 11/28/23, the physician documented that Resident #1 was as risk for malnutrition due to hemodialysis and multiple wounds. In an observation on 1/5/24…

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, and record review conducted during an Abbreviated Survey (#NY00329869) completed 1/16/24, the facility did not provide food and drink that was palatable, attractive, and at a safe and appetizing temperature for three (Residents #2, #3, and #4) of four residents reviewed. Specifically, cold drinks were served warm and hot food was served lukewarm and not palatable and trays were missing requested resident preferences without explanations. This is evidenced by the following. During an interview on 1/15/24 at 11:11 AM, Family Member #1 stated the food was horrible, the coffee was lukewarm, the main meal cold and there were missing items on every tray. During a second interview on 1/15/24 at 12:39 PM, Family Member #2 stated that the food items were cold and that there were always missing items from the trays at every meal. A test tray was requested on 1/15/24 at 11:30 am which arrived at 12:30 PM and temperatures were taken by the Director of Nursing and the Surveyor. The temperatures of the food on the test tray included the following: chicken…

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 and interviews conducted during a Recertification Survey conducted from 4/12/23 to 4/18/23 the facility did not provide the residents with a safe, clean, comfortable and homelike environment. Specifically, for two (2nd floor, 3rd floor) of two resident care units reviewed, the facility did not provide clean bed and bath linens resulting in delayed morning care for residents. This is evidenced by: During an observation on 4/12/23 at 9:30 a.m., there was no linen found on the 3rd floor resident unit. Review of the CNA assignment sheet revealed that four resident showers were scheduled for the day shift. During observations on 4/17/23 at 10:45 a.m., the 2nd floor resident unit (resident census of approximately 35) linen cart located in the hallway contained a total of nine washcloths and four gowns. The clean utility room had no bath towels, washcloths, incontinence pads, or gowns. At 10:55 a.m., the 3rd floor resident unit (resident census of approximately 35) linen cart contained three washcloths and two blankets. The clean utility room had no bath towels, wash…

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, and record review conducted during the Standard Recertification Survey and complaint investigation (#NY00308355) completed 4/12/23 to 4/18/23, it was determined that for two (second and third floors) of two resident sleeping floors, the facility did not ensure that the resident environment remained free of accident hazards. Specifically, hot water temperatures exceeding 120 degrees Fahrenheit (°F) were accessible to residents at point of use. The findings are: Observations, interviews, and record review on 4/12/23 from 9:48 a.m. to 2:01 p.m. included: a) Water temperatures at handwash sinks in resident room [ROOM NUMBER] and resident room [ROOM NUMBER] were observed to be 124°F and 122°F, respectively, using a ThermoWorks Thermapen One digital thermometer. Additionally, water temperatures at handwash sinks were observed to be: 127°F in resident room [ROOM NUMBER], 124°F in the third-floor activities room, and 123°F in resident room [ROOM NUMBER]. Each temperature was obtained…

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, and record review conducted during the Standard Recertification Survey completed 4/12/23 to 4/18/23, it was determined that for one of one main kitchen, the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically, 'temperature controlled for safety-TCS' food items were hot held at less than 140 degrees Fahrenheit (°F), condensers and a condensate line had ice buildup, and floor and ceiling tiles were dirty or in disrepair. The findings are: 1. Record review on 4/14/23 at 1:33 p.m. included a facility policy and procedure titled Food Temperatures last revised 5/25/08 that was provided by the Regional Food Service Director (RFSD). The policy included that all hot food items must be cooked to appropriate internal temperatures, held and served at a temperature of at least 140°F. 2. Observations and interviews during the initial tour of the main kitchen on 4/12/23 from 8:25 a.m. to 8:57 a.m. included the following: a) The condenser in the single door cook's cooler had a…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews and record review conducted during the Recertification Survey and complaint investigation (#NY00313247) from 4/12/23 to 4/18/23, it was determined that the facility did not establish and consistently maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infections. Specifically, there was a lack of appropriate hand hygiene and unsanitary storage of medication used during a wound treatment for Resident #9, unsanitary care of a indwelling urine catheter drainage bag for Resident #26, lack of hand hygiene during resident care for Residents #12 and #19 and lack of cleaning/disinfecting resident care equipment after use. This was evidenced by the following. 1. Resident #9 had diagnoses including neuromuscular dysfunction of bladder (difficulty emptying bladder) with a urinary infection, and dementia. The Minimum Data Set (MDS) Assessment,…

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, and record reviews conducted during the Recertification Survey and complaint investigation (#NY00313247) completed 4/12/23 to 4/18/23, it was determined that for two (Resident #26 and Resident #58) of five residents reviewed for activities of daily living (ADLs), the facility did not ensure the residents' rights to make choices about aspects of life that were significant to them. Specifically, the facility could not provide evidence that either resident received showers per their preference or Comprehensive Care Plan (CCP). This is evidenced by the following: Review of the undated facility policy Shower/Tub Bath, revealed that documentation of a shower or tub bath should be recorded on the resident's ADL record and/or in the resident's medical record. The documentation should include the date and time the shower/tub bath was performed, the name and title of the individual(s) who assisted the resident with the shower/tub bath, how the resident tolerated the shower/tub bath, 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review conducted during the Recertification Survey and complaint investigation (#NY00311333 and #NY311604) on 4/12/23 to 4/18/23, it was determined that for one (Resident #420) of seven residents reviewed for activities of daily living (ADLs), the facility did not ensure that ADL care was provided for a dependent resident. Specifically, Resident #420's fingernails were observed to be dirty with jagged edges over several days. This is evidenced by the following: Resident #420 was admitted to the facility on [DATE], with diagnoses of chronic heart failure, poly-osteoarthritis, and muscle weakness. A Brief Interview for Mental Status form dated 3/31/23 documented that Resident #420 was moderately impaired of cognitive function. Review of the Comprehensive Care Plan (CCP) initiated 3/31/23, and the current [NAME] (care plan used by the Certified Nursing Assistant (CNA) for daily care) revealed that Resident #420 required the limited assistance of one staff member 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews conducted during a Recertification Survey completed on 4/12/23- 4/18/23, it was determined that for one (Resident #64) of three residents reviewed for indwelling catheters, the facility did not ensure that the resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan and/or the resident's choice. Specifically, there was no documented evidence that the resident received treatments to their surgical site of a cholecystostomy tube as ordered by the medical team. This is evidenced by the following: Review of the facility policy Wound Care revealed the purpose of the policy was to provide guidelines for the care of wounds to promote healing. The policy included that documentation of the wound care should include, but not limited to, the date and time the care was given, who did the care and if resident refused the care or any problems occurred with the care then the supervisor 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, and record review conducted during a Recertification Survey completed 4/12/23 to 4/18/23, it was determined that for one (Resident #58) of three residents reviewed the facility did not ensure the resident received care, consistent with professional standards of practice, to prevent the development of pressure ulcers, and that the resident received the necessary treatment to promote healing of a pressure ulcer, prevent infection and prevent new ulcers from developing. Specifically, the facility could not provide evidence that the use of an ankle foot orthotic (AFO-a brace to the ankle and foot) was appropriately ordered, care planned and monitored to prevent the development of a pressure injury. In addition, Resident #58 was observed to have the same wound dressing on over three days without being changed per medical orders but was signed off in the medical record as completed. This is evidenced by the following: Review of the undated facility policy Wound Care, revealed 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 observations, interviews, and record reviews conducted during the Recertification Survey, completed on 9/27/21, it was determined that for four (Residents #24, #59, #64, and # 73) of four residents reviewed, the facility did not provide food prepared by methods that conserve nutritive value, flavor, and appearance and provide food and drink that is palatable, attractive, and at a safe and appetizing temperature. Specifically, the facility provided food that was unpalatable, not served at safe temperatures and did not have food substitutions readily offered or available. This is evidenced by, but not limited to, the following: Review of a facility policy, Dining Services Operations: Test Trays, dated February 2015, directs that test trays will be performed eight times per month, using alternating meals, days, and diet plans. Testing includes the following: temperature of foods, portion sizes, visual appearance of food, taste and aroma of the food, missing items or substitutions, therapeutic accuracy,…

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, and record reviews conducted during a Recertification Survey completed on 9/27/21, it was determined that for one of one main kitchen the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically, the floor of the walk-in freezer was dirty, there was a significant build-up of ice on the condenser in the walk-in freezer, an indirect drain for two food prep-sinks was improperly installed, a 'temperature controlled for safety (TCS)' food item was not stored at or below 45 degrees Fahrenheit (°F), a handwash sink was obstructed, and food items were stored directly on the floor. The findings are: 1. Observations during the initial tour of the main kitchen on 9/21/21 from 8:53 a.m. to 9:55 a.m. revealed the following: a) The floor of the walk-in freezer was dirty with food residue and brown debris. b) There were 8 small cups of ice cream and a plastic container of strawberries on the floor of the walk-in freezer under the metal shelves. c) There was a significant buildup 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 Based on observations, interviews and record reviews conducted during the Recertification Survey, completed on 9/27/21, for 1 (Resident # 62) of 25 residents reviewed, the facility did not implement the comprehensive person-centered care plan that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs including resident's goals, desired outcomes, and preferences. Specifically, bilateral Geri Sleeves (protective arm coverings to prevent injury) and bilateral leg Tubigrips (provides support to extremities and helps reduce swelling) were not applied as ordered. This is evidenced by the following: Resident #62 had diagnoses including peripheral vascular disease, edema (excessive fluid in the tissues) and dementia. The Minimum Data Set Assessment, dated 8/23/21, revealed the resident was severely impaired cognitively, had edema in both lower extremities, required extensive assistance of two staff for dressing and did not ambulate. Review of current Physician…

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.