Lilac Manor Rehabilitation and Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews conducted during the Recertification Survey and Complaint Investigation (NY00326620), the facility did not ensure each resident was free from misappropriation of resident property and exploitation for two (Residents #28, #57) of four residents reviewed for missing property and for three (Residents #59, #99, and #108) residents interviewed during Resident Council. Specifically, the residents reported missing money, clothing, and personal items and the facility was unable to provide documentation that the missing property complaints had been investigated and/or any resolutions offered for the missing property. This is evidenced by the following: The facility policy Personal Property with a revised date of August 2022, documented the facility promptly investigates any complaints of misappropriation or mistreatment of resident property. The facility policy Lost and Found, dated of January 2008, documented the facility shall assist all personnel and residents in safeguarding…

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 review and interviews conducted during the Recertification Survey and Complaint Investigation (NY00327022), for three (Residents #90, #116, #371) of four residents reviewed the facility did not ensure that notification of a discharge/transfer was provided to the resident and/or the resident's representative in writing, and in a language and manner they understood, as soon as possible when an immediate discharge/transfer was required by the resident's urgent medical needs. Additionally, the facility did not ensure a copy of the notice was sent to a representative of the Office of the State Long-Term Care Ombudsman. This is evidenced by the following: Review of the facility policy, Transfer or Discharge Notice, dated March 2021 revealed that residents and/or representatives would be notified in writing, and in a language and format they understood as soon as possible but before the transfer or discharge, when an immediate transfer or discharge was required by the resident's urgent medical needs.…

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 and Complaint Investigations (NY318393, NY00323935, NY00328756, and NY00343607) for three (Residents #52, #76, #87) of nine residents reviewed 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, Resident #52 was not provided with the assistance to obtain a haircut, Resident #76 was observed with uncut nails and unshaven facial hair and Resident #87 had oily and unwashed hair. This is evidenced by the following: The facility policy Supporting Activities of Daily Living dated March 2018, documented that residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out Activities of Daily Living and the date and time of fingernail care, shaving and hair shampooing should be documented in the resident's medical record. 1.…

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 a Recertification Survey the facility did not ensure that proper treatment to maintain hearing abilities was provided for one (Resident #51) of one resident reviewed for hearing. Specifically, Resident #51 did not have their ears flushed per Physician orders. This is evidenced by: The facility policy, Activities of Daily Living, dated May 2018, documented residents will be provided with care, treatment, and services to ensure that their activities of daily living do not diminish unless the circumstances of their clinical conditions demonstrate that diminishing activities of daily living are unavoidable. Resident #51 had diagnoses including chronic obstructive pulmonary disease, diabetes, and hypertension. The Minimum Data Set Resident assessment dated [DATE] documented the resident was cognitively intact and did not require the use of a hearing device and that the resident's hearing was adequate. Review of the Comprehensive Care Plan initiated…

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, the facility did not ensure that residents with limited range of motion received appropriate treatment, equipment, and services to increase range of motion and/or to prevent further decrease in range of motion for two (Resident #37 and #90) of two residents reviewed. Specifically, the residents were observed on multiple occasions not wearing their therapy recommended hand splints. This is evidenced by the following: 1. Resident #37 has diagnoses including dementia, malnutrition, and contractures (permanent tightening of the muscles and tendons causing joint stiffness and pain and loss of function). The Minimum Data Set Resident assessment dated [DATE] documented that the resident was moderately impaired of cognitive function and had no impairment in range of motion to their upper extremities (shoulder, elbow, wrist and hands). Review of Resident #37's current Comprehensive Care Plan and [NAME] (care plan used 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.

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 (NY00315983, NY00318393), for one (Resident #42) of two residents reviewed for respiratory care, the facility did not ensure residents who needed respiratory care were provided such care consistent with professional standards of practice. Specifically, Resident #42 did not have a physician order in place for oxygen use, did not have a person-centered comprehensive care plan for oxygen, and was not provided a clean well-functioning oxygen concentrator. This is evidenced by the following: The facility policy, Oxygen Administration, dated October 2010 included to verify there was a physician's order, review the residen's care plan to assess for any special needs, check equipment to be sure it was in good working order, and document in the resident's medical record how the resident tolerated the oxygen. Resident #42 had diagnoses that included respiratory failure, congestive heart failure,…

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 (NY00318393) it was determined that for one (Resident #52) 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 resident's goals and preferences. Specifically, Resident #52's pain medication was not administered as ordered on multiple occasions without Physician notification and the resident did not have a comprehensive care plan for chronic pain that included measurable goals and person centered interventions. This is evidenced by the following: The facility policy Pain - Clinical Protocol dated March 2018, included that with input from the resident to the extent possible, the physician and staff will establish goals of pain treatment. The physician will order appropriate non-pharmacological and medication interventions 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 reviews conducted during the Recertification Survey the facility did not ensure the resident received the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care for one (Resident #52) of one resident reviewed. Specifically, Resident #52 did not receive medication changes as recommended, did not have a comprehensive care plan that included an individualized person-centered approach to address their behavioral health needs, and did not receive consistent psychiatric services. This is evidenced by the following: The facility policy Behavioral Health Services, dated March 2019, included the facility will provide and the residents will receive behavioral health services as needed to attain or maintain the highest practicable physical, mental, and psychosocial well-being in accordance with the comprehensive assessment and plan of care. The interdisciplinary team will evaluate behavioral symptoms 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.

Based on observations, record review, and interview conducted during the Recertification Survey, it was determined that the facility did not ensure compliance with all applicable State codes. Specifically, the facility was not in compliance with section 915 of the 2015 edition of the International Fire Code as adopted by New York State, which requires the use of carbon monoxide detection in a building that has fuel-burning appliances. The findings are: On 5/30/24 at 10:00AM, records for inspection and testing of facility carbon monoxide detectors were provided to the surveyor for review. The logs included a monthly signoff and listing of the locations of carbon monoxide detectors in the following areas: boiler room, kitchen, generator, and laundry. Observations on 5/31/24 from 11:10 AM to 11:24 AM included carbon monoxide detectors were not present in the first-floor laundry room and kitchen. Further observations at this time included three natural gas-powered dryers were in the laundry room and a natural gas range was present in the kitchen. During an interview at this time, 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 observations, interviews, and record review during the Recertification Survey completed on 2/8/23, it was determined that for one (Resident #109) of one resident reviewed for notification of changes, the facility did not notify the resident's medical team of a change in the resident's physical, mental or psychosocial status. Specifically, Resident #109 was noted to have a skin condition which was not reported to the medical team in a timely manner. This is evidenced by the following. Resident #109 had diagnoses that included Non-Hodgkin's Lymphoma ( a type of blood cancer), anxiety disorder and depression. The Minimum Data Set assessment dated [DATE], documented that Resident #109 was severely impaired cognitively and required extensive assist and total dependance on staff for personal hygiene and bathing respecfully. Review of current physician orders included to check Resident #109's skin for any changes during their shower/bath and to report any changes to the supervisor. During an observation on…

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 on 2/8/23, it was determined that for one (Resident #377) of two residents reviewed for pressure ulcers, the facility did not revise the resident's care plan to reflect the resident's current needs. Specifically, Resident #377's Comprehensive Care Plan (CCP) was not revised to include the presence of multiple wounds, goals and related interventions. This is evidenced by the following: Resident #377 was admitted to the facility on [DATE] with diagnoses of end-stage renal disease (dependent on hemodialysis), diabetes, and heart failure. The Minimum Data Set assessment dated [DATE], documented that Resident #377 was cognitively intact, and did not have any pressure ulcers. Review of the current CCP revealed that Resident #377 had the potential for skin impairment due to decreased mobility and moisture, with related interventions. The CCP did not include that the resident had any current wounds or 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.

Based on interviews and record reviews conducted during the Recertification Survey completed on 2/8/23, it was determined that for three (Resident #29, #71, and #80) of five residents reviewed for unnecessary medications, the facility did not ensure that the Drug Regimen Review (DRR) that was completed by the pharmacist was reviewed by the physician for irregularities/recommendations and action taken if any and/or a rationale if no action taken. Specifically, the pharmacist made recommendations for each of the identified residents during the period of August 2022 through December 2022 and the facility was unable to provide evidence that the recommendations had been addressed by the physician in a timely manner. This is evidenced by the following: The facility policy, Drug Regimen Review (DRR) Monthly Report updated December 2022, revealed that facility supports pharmacy services that includes drug regimen review, defined as the systematic evaluation of drug therapy when a consultant pharmacist reviews the medication regimen of each resident at least monthly. Resident specific drug…

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, completed on 4/23/21, the facility failed to maintained an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of COVID-19 for 1 (5th floor resident care unit) of 4 units reviewed. Specifically, staff were not wearing required Personal Protective Equipment (PPE) while providing care to residents on transmission-based precautions (TBP). This is evidenced by but not limited to the following: The NYSDOH Health Advisory titled COVID-19 Cases in Nursing Homes (NH) and Adult Care Facilities dated 3/13/20 with a revised date of 7/10/20, included that if there are confirmed cases of COVID-19 in a NH, all residents on affected units should be placed on TBP or Droplet (respiratory protection with masks and face shields) and Contact Precautions (gown and gloves for hands on care), regardless of presence of symptoms and regardless of COVID-19 status. The Centers for Disease Control 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 interview and record review conducted during the Recertification Survey and complaint investigation (# NY00272244) it was determined for 1 (# 302) of 2 residents reviewed for hospitalization, the facility did not notify the legal representative of a change in condition or transfer to the hospital. This is evidenced by the following: The facility policy Transfer and Discharge from the Facility, dated June 2019 included the resident and representative will receive timely notification of any discharge from the facility and in an emergency as soon as practicable. Resident #302 was admitted [DATE] with diagnoses of bacteremia (infection of the bloodstream), methicillin resistant staphylococcus aureus infection, and alcoholic cirrhosis of the liver. The resident was discharged to the hospital on 2/26/21. Review of the interdisciplinary progress notes dated 2/26/21 are as follows: a. At 3:00 a.m. Resident #302 had a large amount of epistaxis (nosebleed) and the supervisor was made aware. b. At 11:07 a.m. 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 observations, interviews and record review conducted during a Recertification Survey it was determined that for one (Resident #37) of two residents reviewed the facility did not investigate injuries of unknown origin in order to rule out abuse, mistreatment, or neglect. The issue involved the lack of an investigation for multiple bruises. This was evidenced by the following: Review of the facility policy titled Abuse (alleged) Reporting, dated 6/27/04, included an injury is classified as unknown when the source of the injury was not observed by any person or the source of the injury cannot be explained and the injury is suspicious because of the extent of the injury. Resident # 37 was admitted to the facility on [DATE] with diagnoses that included bipolar disease, intellectual disability, and drug induced dyskinesia (involuntary erratic movements). The Minimum Data Set Assessment, dated 1/24/21, revealed the resident was sometimes understood by others and had severely impaired cognition. Current…

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, it was determined that for 2 (Residents # 41 and #74) of 25 residents reviewed , the facility did not develop and implement a Comprehensive Care Plan (CCP) that included measurable objectives to meet the resident's medical, nursing and psychosocial needs that include the resident's goals, desired outcomes and preferences to attain or maintain the resident's highest practicable well-being. Specifically, there was a lack of care planning to address the use of an anti-depressive medication and an anti-coagulant medication for Resident #41 and lack of care planning to address the use of an anti-psychotic medication for Resident #74. This is evidenced by the following: 1.Resident #41 had diagnoses that included atrial fibrillation (irregular heart rate), anxiety, and repeated falls. The Minimum Data Set (MDS) Assessment, dated 2/18/21, revealed the resident had moderately impaired cognition and received antidepressants…

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 investigations (#NY00272865, #NY00260255, #NY00260976, #NY00264416, #NY00271424, #NY00268463, #NY00268822, #NY00272312) it was determined that for two of nine residents reviewed the facility did not provide the residents who were unable to carry out activities of daily living (ADLs) the necessary services to maintain grooming, personal care and oral hygiene. Specifically, Resident #26 lacked shaving and mouth and nail care and Resident #58 lacked hair care. This is evidenced by the following: The facility policy ADL Care Guidelines, dated March 2020, included that caregivers will review resident nursing care instructions at the beginning of each shift to assure that care is given according to the individual's plan of care. The resident will be encouraged to make choices during their care. Resident refusals will be followed-up with a second attempt or offer to provide services and continued refusals will…

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 a Recertification Survey it was determined that for three (Residents #32, #37 and #41) of four residents reviewed, the facility did not provide an ongoing activity program based on the comprehensive assessment and resident care plans to meet the interest of and support the physical, mental and psychosocial well-being of each resident. Specifically, residents were not consistently provided with activities of their choice. This is evidenced by the following: The facility policy titled Responsibilities of Recreation Staff, dated December 2016, included the recreation staff will provide a variety of programs based on the resident's functioning levels that will meet their individual needs and will participate with the interdisciplinary team to establish goals and approaches for group activities or individual activities suited to the resident's functioning level. The facility policy titled Activity Calendar included calendars should be completed 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review conducted during the Recertification Survey, it was determined for 2 of 2 residents reviewed, the facility did not ensure that residents who need respiratory care are provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences. Specifically, Resident #10 was not receiving oxygen according to the physician order and the oxygen tubing was dirty and unlabeled. Resident #43 was not receiving oxygen according to the physician order, there was missing documentation for oxygen administration, and oxygen tubing had not been changed. This is evidenced by the following: The facility policy, Oxygen Concentrators, dated March 2020, included that upon determination that a resident requires oxygen therapy, the medical provider will enter an order for the administration of oxygen in the resident's medical record. Nursing is to enter an order in the resident electronic Treatment…

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 review conducted during the Recertification Survey, it was determined that for one (Resident # 10) of five residents reviewed, the facility did not ensure that pharmacy recommendations were addressed or acted upon in a timely manner. Specifically, Resident #10 pharmacy recommendations related to a gradual dose reduction (GDR) of a psychotropic medication and irregularities noted by the pharmacist were not addressed. This is evidenced by the following: The facility policy, Psychotropic Medication Monitoring, dated March 2020, revealed that the Medication Regimen Review (MRR) findings will reflect information to assist the medical provider in ordering the most effective medication regimen for the resident. The Nurse Manager or designee will complete the review in the resident's electronic medical record. Upon completion of the evaluation, the nurse manager or designee will forward any findings indicating that a dose reduction is in order to the resident's medical provider. A gradual dose reduction of the reviewed medication will be attempted at regular…

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 and interview conducted during the Recertification Survey, it was determined that for one of one main lobby, the facility did not provide a safe environment for residents, staff, and the public. Specifically, a heating surface exceeded 125 degrees (°) Fahrenheit (F) and was not protected from accidental contact. The findings are: The 2010 edition of the Facility Guidelines Institute (Guidelines for Design and Construction of Healthcare Facilities) requires heating units to have a maximum surface temperature of 125° F or (52°Celsius) or shall be protected from occupant contact. Observations and interview on 4/20/2021 at 12:55 p.m. revealed an electric decorative fireplace located in the main lobby. Further observations revealed the fireplace was equipped with two recessed functional buttons labeled heater and flame, and both were on. When the surface of the upper metal edge was measured using a digital thermometer, the surface temperature was 160° F. There was no barrier in place to prevent accidental contact of the hot surface. When interviewed at this time, 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.