Blossom Health Care Center Inc.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations and interviews conducted during the Recertification Survey completed on 12/5/22, it was determined that for three (first, second, and third floors) of three resident use floors, the facility did not provide housekeeping and maintenance services necessary to maintain a safe, clean, comfortable, and homelike environment. Specifically: an exhaust ventilation system was not working, walls were in disrepair or dirty, floors were stained and dirty, resident handwash sinks were stained, privacy curtains were in disrepair or dirty, resident furniture was in disrepair, medical supplies were stored on the floor, a toilet seat was in disrepair, dead insects were present in a light fixture, a resident bed was not functioning properly, and kitchen equipment was not clean. The findings are: On 12/1/22 at 11:46 a.m. the administrator provided the surveyor with the facility policy 'Physical Homelike Environment, effective 1/2022', which included that it is the policy of the facility to have defined…

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, record review, and interview conducted during the Standard Recertification Survey completed on 12/1/22, it was determined that for one (Elevator 1) of two elevators, and two of three laundry dryers the facility did not maintain all mechanical, electrical, and patient care equipment in safe operating condition. Specifically, an elevator serving resident sleeping floors and two resident laundry dryers were out of service, and repairs had not been made. The findings are: 1. On 11/28/22 at 8:30 a.m., it was observed that the right elevator in the lobby was marked with a sign that indicated out of order. During an interview on 11/28/22 at 10:25 a.m. the Director of Maintenance stated that about 2 weeks ago the elevator service company was called in and they took the whole motherboard to try and swap out, but they were waiting on a transistor for the elevator which is on back order. 2. On 11/28/22 at 2:18 p.m. it was observed that there were 3 dryers in the first- floor laundry room. Additionally, the 'Electrolux and 'Wasomat' dryers were observed to be out 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 and interviews conducted during the Standard Recertification Survey completed on 12/1/22 and complaint investigation (#NY00287526), it was determined that for two (second and third floors) of two resident sleeping floors the facility did not properly maintain the resident nurse call system. Specifically, elements of the nurse call system were not functioning. The findings are: 1. Observations and interviews on 11/28/22 from 8:40 a.m. to 2:10 p.m. included the following: a) The nurse call system including wall mounted stations in resident rooms marked as 'Executone' and a corresponding console with lights and room numbers at the nurse stations. b) Two nurse call stations at the bed sides in resident room [ROOM NUMBER] did not illuminate above the door or at the nurse station when pressed. During an interview at this time, resident #25 stated that they were given a tap bell about 5-6 weeks ago and doesn't like it because staff do not come. c) The nurse call station in resident room [ROOM…

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 conducted during the Recertification Survey, completed on 12/5/22, it was determined that for one (Resident #13) of eleven residents reviewed for Activities of Daily Living (ADLs), the facility did not ensure that residents received services with reasonable accommodation of resident's needs. Specifically, the resident was not provided a call bell based on the resident's functional needs and preferences. Additionally, the call bell was observed out of the resident's reach on multiple occasions. This is evidenced by the following: The facility policy Answering the Call Light, dated last reviewed and revised January 2022, documented that when the resident is in bed or is confined to a chair be sure the call light is within easy reach of the resident. The policy included that staff are to ask the resident to return demonstration of use of the call bell, so they will be sure that the resident can operate it. Resident #13 was admitted to the facility on [DATE], 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 record reviews and interviews conducted during the Recertification survey, completed 12/5/22, it was determined that for two of (Resident #5 and #28) of 18 residents reviewed, the facility did not ensure that each resident was screened for a mental illness (MI) or intellectual disability (ID) prior to admission to the facility and that individuals identified with MI or ID were evaluated and received care and services in the most integrated setting to meet their needs. Specifically, for Resident #28, there was no evidence that a Pre-admission Screening and Resident Review (PASARR) was completed and for Resident #5, the PASARR was incomplete. Both resident had been admitted to the facility with a significant MI diagnosis. This is evidenced by the following: 1. Resident #28 was initially admitted to the facility on [DATE], and was readmitted on [DATE], with diagnoses of schizophrenia and anxiety. The Minimum Data Set (MDS) Assessment, dated 10/1/22, documented that Resident #28 rarely or never understood…

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 investigations (#NY00291558 and #NY00291712), completed on 12/5/22, it was determined that for two (Resident #8 and Resident #26) of three residents reviewed for pressure ulcers, the facility did not ensure the services provided or arranged by the facility as outlined in the Comprehensive Care Plan (CCP) met professional standards of quality. Specifically, there was incomplete documentation that the residents wound care treatments were administered as ordered by the medical team. This is evidenced by the following: 1. Resident #8 had diagnoses that included paraplegia, osteomyelitis (infection in the bones), and mild protein calorie malnutrition. The Minimum Data Set (MDS) assessment dated [DATE], documented that Resident #8 was cognitively intact, had skin and ulcer/injury treatments, application of nonsurgical dressings, ointments and/or medications, and was at risk for developing pressure ulcers.…

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 (#NY00291558, #NY00297274, #NY00287526), completed on 12/5/22, it was determined that for one (Resident #53) of eleven residents reviewed the facility did not ensure that Activities of Daily Living (ADLs) care was provided for dependent residents. Specifically, the resident was not provided incontinence care in a timely manner. Resident #53 had diagnoses including a stroke, chronic pulmonary obstructive disease (COPD) and anxiety. The Minimum Data Set assessment dated [DATE], documented that the resident was moderately impaired cognitively, was always incontinent of bladder (urine) and bowel (stool) and required extensive assistance with personal hygiene. Review of the current Comprehensive Care Plan (CCP) revealed that Resident #53 required assistance with ADLs. Interventions included encouragement of the resident to use the call bell for assistance, extensive assist of two staff members…

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 12/5/22, it was determined that for one (Resident #28) of one resident reviewed for vision and hearing, the facility did not ensure that the resident received treatment and/or assistive devices to maintain hearing. Specifically, an audiology (ear) evaluation was not obtained for Resident #28, who was identified to be hard of hearing. This is evidenced by the following: Resident #28 was initially admitted to the facility on [DATE] with diagnoses including schizophrenia, chronic obstructive pulmonary disease (COPD), and anxiety. The Minimum Data Set (MDS) assessment dated [DATE], documented that Resident #28 was moderately impaired of cognitive skills for daily decision making, had adequate hearing ability, was able to understand others and did not have hearing aids. Under preferred language the MDS Assessment was blank. When attempting to interview Resident #28 on 11/28/22 at 12:38 p.m., the 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.

Based on record reviews and interviews conducted during a Recertification Survey and complaint investigation (#NY00297130) completed 12/5/22, it was determined that for one of nine residents reviewed for accidents, the facility did not ensure that the resident's environment remained free from accident hazards as possible. Specifically, the facility transportation vehicle did not have a lap belt resulting in Resident #332 sliding out of the wheelchair and onto the floor of the vehicle during transport. This is evidenced by the following: The undated facility policy: 'Transportation Policy and Procedure' included: Daily checks of vehicle safety measures including but not limited to the following: seat belt checks, lift operation checks, headlight check, hazard light check, wiper check. Under the heading 'Protocols for transporting residents', the policy included that if the resident is in a wheelchair, the driver will use the lift to raise the resident onto the bus and securely fasten the resident using the appropriate anchors and then securely fasten the seat belt. Resident #332 had…

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 12/5/22, it was determined that for one of two residents reviewed for feeding tubes, the facility did not provide appropriate treatment and services to prevent complications for a resident with a tube feeding. Specifically, the tube feeding for Resident #34 was not consistently monitored to ensure the accurate amount of daily nutrition via the feeding tube was administered as ordered by the physician. Additionally, the daily amount of free water was not consistently documented to ensure the resident received the adequate amount per physician orders. This is evidenced by: Resident #34 was admitted to the facility on [DATE] with diagnoses including a stroke, adult failure to thrive, dysphagia (difficulty swallowing) and dementia. The Minimum Data Set (MDS) assessment dated [DATE], indicated the resident had severely impaired cognition, received 51% or more of daily calories via a feeding tube, received 501…

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 the Recertification Survey, it was determined that the facility did not establish and maintain an Infection Prevention and Control Program (IPCP) designed to provide a safe, sanitary, comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility was unable to provide evidence of an IPCP that consistently identified, tracked, investigated, monitored and analyzed surveillance data to prevent infections in the facility. This is evidenced by the following: Review of the facility policy, Infection Control Program, dated 1/29/20, revealed that the facility will establish and maintain an IPCP to help prevent the development and transmission of disease to the extent possible. The Infection Preventionist will establish an Infection Control Committee and create the IPCP, which will be reviewed annually, and include surveillance, data collection and an individual infection profile monthly that is reportable to the Administration and 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 observations, interviews and record review during the Recertification Survey, it was determined the facility did not ensure the Infection Prevention and Control Program included antibiotic use protocols and a system to monitor antibiotic use. Specifically, the facility did not implement an Antibiotic Stewardship Program. This is evidenced by the following: The facility policy, Infection Control Program, dated 1/29/20, included a general approach to prevention and control of infections including a system for antibiotic review and control to include data reports from the Consultant Pharmacist. Review of the facility policy, Antibiotic Therapy, dated 1/4/19, revealed antibiotic therapy will be prescribed by the medical team as needed and will include fluid monitoring, cultures, indications for use, and pharmacy review. The binder labeled, Antibiotic Stewardship Program provided by the facility, included an index which documented policy and procedures, staff education materials, treatment guidelines, and antibiotic use reports. The binder included a template for an Antibiotic…

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 interviews and record reviews during the Recertification Survey, it was determined for two (Residents #14 and #17) of two residents reviewed, the facility did not ensure that each resident was given the right, along with their representative, to participate in the care planning process with their interdisciplinary team members. Specifically, there was no evidence that the residents or their representatives were notified of and provided an opportunity to participate in interdisciplinary care plan meetings. This is evidenced by the following: 1. Resident #14 has diagnoses including diabetes, chronic pain syndrome and neurogenic bowel with colostomy. The Minimum Data Set (MDS) Assessment, dated 10/16/20, revealed the resident was cognitively intact. The 6/12/20 Social Services progress note documented that on 6/10/20, the interdisciplinary care team met that day to review the resident's comprehensive care plan. The care plan problems, strength and weaknesses, goals and interventions were reviewed. The resident/family/friend/ responsible party did not attend the meeting due 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.

Based on observations, interviews and record review during the Recertification Survey and Complaint Investigation (#NY00260114), the facility did not ensure that all alleged violations of abuse are thoroughly investigated for two (Residents #6 and #187) of three residents reviewed. Specifically, the facility did not initiate or complete a thorough investigation for allegations of abuse. This evidenced by the following: The facility policy, Abuse, Neglect and Misappropriation, dated as revised 2/8/12, included the facility requires reporting of any potential or actual violations to administration, who will take immediate action to address the incident, and ensure documentation to support the conclusion staff comes to when investigating the incident. 1. Resident #6 had diagnoses including end stage renal disease, diabetes and anxiety. The Minimum Data Set (MDS) Assessment, dated 7/29/20, revealed the resident was cognitively intact and had no difficulties with hearing. When interviewed on 11/3/20 at 8:36 a.m. the resident stated a staff person called them a heifer and identified 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 reviews conducted during the Recertification Survey for 3 of 23 residents reviewed, the facility did not develop and implement a person-centered Comprehensive Care Plan to meet the resident's medical, nursing, mental, and psychosocial needs and included goals, desired outcomes and preferences. Specifically, Resident #14 did not have compression stockings in place, Resident #18 was not wearing a palm protector on their left hand, and Resident #31 did not have a care plan developed to include interventions related to accident hazards. This is evidenced by the following: 1. Resident #14 had diagnoses including chronic pain syndrome, congestive heart failure and edema. The Minimum Data Set (MDS) Assessment, dated 10/16/20, revealed the resident was cognitively intact and required assistance with dressing. Review of the physician orders, from 8/1/20 through 11/4/20, included orders for Certified Nursing Assistants (CNA) to apply TEDS (compression stockings) in the morning and remove in the evening. The current Comprehensive Care Plan (CCP) and…

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

Based on observations, interviews, and record reviews during the Recertification Survey, it was determined that for one (Resident #137) of two residents reviewed, the facility did not provide appropriate treatment and services to prevent potential complications for a resident with a tube feeding (tube inserted directly into the stomach to administer fluid nutrition). Specifically, physician orders were not clarified to ensure accuracy, daily tube feeding amounts were not observed being administered as ordered, and the amount of tube feeding and water flushes were not consistently documented or monitored. This is evidenced by the following: Resident #137 has diagnoses including chronic obstructive pulmonary disease, chronic respiratory failure and shortness of breath. The Minimum Data Set Assessment, dated 10/10/20, revealed that the resident was cognitively intact and received 51 percent or more of total calories and 501 cubic centimeters (cc) or more of fluids per day via a feeding tube. Physician orders, dated as renewed 10/12/20, included that the resident received nothing by…

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 during the Recertification Survey, it was determined that for one (Resident #6) of one resident reviewed, the facility did not ensure that residents who require dialysis received services consistent with professional standards of practice. Specifically, there was no evidence that the facility consistently monitored the resident's fluid intake per physician orders. This is evidenced by the following: Resident #6 had diagnoses that included end stage renal disease with hemodialysis, diabetes and anxiety. The Minimum Data Set Assessment, dated 7/28/20, revealed the resident was cognitively intact and received dialysis. The undated facility policy, Intake and Output Monitoring and the policy, Fluid Intake Monitoring, dated 3/1/12, instructed that staff record the total number of cubic centimeters (cc) of fluid in the first half of the meal box. The total intake is completed by the night nurse at the end of each day. Each resident has a fluid goal established and if the goal is not met, the night nurse will notify the Nurse Manager.…

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 during the Recertification Survey, it was determined that for one of five residents reviewed, the facility did not ensure that each resident's medication regimen was free from unnecessary medications. Specifically, Resident #9 did not receive any attempts of a gradual dose reduction of an anti-depressant medication within the first year following admission to the facility. This is evidenced by the following: Resident #9 was admitted to the facility on [DATE] with diagnoses including major depressive disorder, single episode, diabetes and congestive heart failure. The Minimum Data Set Assessment, dated 7/24/20, revealed that the resident had moderately impaired cognition, and scored a 5 of 27 on the PHQ-9 test (test used to determine depression) for feeling depressed and having little interest in doing things at that time, and used an antidepressant daily. Physician orders, dated 10/12/20, included Sertraline (antidepressant) 75 milligrams (mgs) once a day. 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, it was determined that the facility did not ensure that a qualified dietician carried out the functions of the food and nutrition services. Specifically, the consultant Registered Dietician has not been in the facility since March 2020. Physical nutritional assessments were not completed, and the non-clinical Dietetic Food Supervisor was not provided frequently scheduled consultations. This is evidenced by the following: During interviews on 11/2/20 at 11:27 a.m., 11/4/20 at 2:18 p.m., and 11/5/20 at 11:21 a.m., the Dietetic Service Supervisor said the Registered Dietician works remotely offsite and has not been in the building since the pandemic started in March 2020. She said there has not been any direction or involvement from the Registered Dietician. When interviewed on 11/5/20 at 11:45 a.m., the Diet Technician said the Registered Dietician has not provided on-site visits since March 2020. In an interview by telephone on 11/6/20 at 9:35 a.m., the Registered Dietician said 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 reviews conducted during the Recertification Survey, it was determined that for 8 of 42 residents, the facility did not correctly follow a recipe to prepare modified consistency diets (ground and pureed). Specifically, facility staff did not weigh cooked chicken, prior to grinding or pureeing, to ensure accuracy of portion size and did not follow a recipe for preparation of pureed meat. This is evidenced by the following: The facility policy, Blending of Pureed Food, dated 2020, directs to cook meat according to menu cycle, see daily production sheet for the number of portions needed and weigh the meat. During an observation and interview on 11/4/20 at 10:50 a.m. and 10:57 a.m., the Chef said there were a total of eight servings needed for the modified consistency diets (five grounds and three pureed) for the lunch meal of fried chicken that day. He said the individual protein requirement was 3 ounces and he would be using cooked chopped chicken. The Chef said he uses a 3-ounce scoop to measure the meat and does not use a scale. The Chef…

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.