Serenity Spring Senior Living At Arlington

Based on observation, staff interview, and policy review, the facility failed to ensure open food products were dated and covered in the kitchen. This had the potential to affect all 33 residents who the facility identified to all receive food from the kitchen. The facility census was 33. Findings include: Observation on 04/15/24 at 8:20 A.M. of the kitchen revealed in the dry storage area, five bags of open pasta were not dated. In the walk-in refrigerator, two trays of mandarin oranges were not covered or dated and two bags of mozzarella cheese open with no date. In the walk-in freezer, one bag of Salisbury steak open with no date. In the reach-in refrigerator, there was one container of ham, one container of strawberries, and one container of dill pickles not dated. Interview on 04/15/24 at 8:30 A.M. with Dietary Manager (DM) #500 verified the five bag of pasta, two trays of mandarin oranges, two bags of mozzarella cheese, one bag of Salisbury steak, one container of each ham, strawberries, and pickles were all not dated. DM #500 verified the mandarin oranges were also not…

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 the facility's water management program information, staff interview, review of the Centers for Disease Control (CDC) guidance, and review of the facility policy, the facility failed to have an appropriate Legionella water management program in place. This had the potential to affect all 33 residents in the facility. Findings include: Review of the most recent Legionella documentation information revealed the facility's Legionella information contained both cold and hot water chlorine testing and eye wash station testing. The cold and hot water chlorine residual testing verified the facility had not conducted a chlorine residual testing since 11/29/23. The 2024 log for the eye wash station revealed the station was inspected (included running water for three minutes) on 02/01/24, 03/11/24, and 04/09/24. Interview on 04/18/24 at 9:00 A.M. and 9:45 A.M. with the Administrator verified the facility has not completed chlorine residual testing since November 2023. There was no evidence of flushing of stagnant water except for monthly inspections of the eyewash stations. 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 review of the medical record, staff interview, and facility policy review, the facility failed to complete for advanced directives for six (#2, #15, #22, #24, #28, and #30) of six residents reviewed for advanced directives and one (#22) resident reviewed hospice. The facility census was 33. Findings include: 1. Review of the medical record for Resident #22 revealed the resident was admitted on [DATE]. Diagnoses included Alzheimer's disease, dementia, cerebral atherosclerosis, occlusion and stenosis of unspecified carotid artery disease, personal history of malignant neoplasm of bladder, benign prostatic hyperplasia (BPH) without lower urinary tract symptoms, and encounter for palliative care. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 was severely cognitively impaired. Review of the facility's provided care plans for Resident #22 revealed the facility failed to develop and implement a comprehensive person-centered care plan for advanced directives and hospice…

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, interview, and policy review, the facility failed to ensure communication was maintained between the facility and dialysis center. This affected one (Resident #2) of one reviewed for dialysis. The facility census was 33. Findings include: Review of the medical record for Resident #2 revealed an admission date of 02/22/24. Diagnoses included end stage renal disease and kidney transplant status. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #2 was cognitively intact. Resident #2 was independent for activities of daily living. Review of the physician orders revealed Resident #2 received dialysis services on Monday, Wednesday, and Friday and check for thrill/bruit to fistula in right upper arm. There was no mention of where dialysis was performed with address and phone number in the physician orders for dialysis. Review of the care plan dated 02/22/24 revealed Resident #2 required hemodialysis related to end stage renal disease. The care plan did not include…

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, staff interviews, and review of the facility policy, the facility failed to ensure proper hand hygiene was used during food preparation and dishwashing. This affected one resident (#11) and had the potential to affect all 36 residents residing in the facility. The facility census was 36. Findings include: 1. Observation of meal service on 07/05/23 beginning at 11:52 A.M. revealed [NAME] #520 wearing plastic gloves and touching serving utensils, drawers, and the lid of the plate-warming machine. [NAME] #520 did not change her gloves and continued to plate Resident #11's meal. [NAME] #520 picked up a knife with her right hand, and held the ham in place with her left gloved hand and cut the ham into bite-sized pieces. [NAME] #520 then placed the plate on the meal cart and the meal cart left the kitchen to be passed out to residents. [NAME] #520 did not change her gloves during the observation. Interview on 07/05/23 at 12:00 P.M. with [NAME] #520 confirmed she touched Resident #11's ham with her left gloved hand which had touched several non-food items in 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 record review, observation, and staff interview, the facility failed to provide adequate portions of protein to residents on texture modified diets. This affected seven residents (#6, #12, #19, #23, #27, #29, and #91) identified by the facility to be on texture modified diets. The facility census was 36. Findings include: Observation during meal service on 07/05/23 beginning at 11:52 A.M. revealed [NAME] #520 served pureed ham using a two-ounce scoop and minced and moist (chopped small) ham using a 1.625 ounce scoop. Interview on 07/05/23 at 12:25 P.M. with [NAME] #520 revealed she did not have a spreadsheet with serving sizes. [NAME] #520 further verified the appropriate serving sizes were listed on each resident's meal tickets. [NAME] #520 confirmed the portion size listed on the meal tickets for pureed ham was five ounces and confirmed she only provided a two ounce portion. [NAME] #520 confirmed the portion listed on the meal ticket for minced and moist ham was four ounces and confirmed she only provided a 1.625 ounce portion. [NAME] #520 confirmed the residents who…

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 medical record review, observations, resident and staff interview and policy review, the facility failed to ensure the call lights were within reach of residents. This affected one (Resident #12) of five residents reviewed for call lights. The facility census was 36. Findings include: Record review for Resident #12 revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #12 included acute kidney failure, chronic kidney disease, auditory hallucination, depression, and dementia. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had mildly impaired cognition, was incontinent of bowel and bladder, and was a one-person assist with activities of daily living. Review of Resident #12's care plans dated 02/09/20 revealed a focus for risk for falls. Interventions included to educate the resident to ask for assistance. Observation and interview on 07/03/23 at 9:20 A.M. revealed Resident #12 sitting in his wheelchair with his back to his…

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, staff interviews, record review, and review of the facility policy, the facility failed to ensure fall interventions were in place for a resident with a history of falling. This affected one (Resident #17) of four residents reviewed for falls. The facility census was 36. Findings include: Review of the medical record for Resident #17 revealed an admission date of 09/10/21 with diagnoses including chronic pain, insomnia, and a history of falling. Review of a progress note dated 06/02/23 revealed Resident #17 fell at approximately 3:00 A.M. while standing and attempting to remove her nightgown while a state tested nurse aide (STNA) was changing the chair pad. Resident #17 stumbled backwards due to her slip-on slippers. Review of an additional progress note dated 06/02/23 revealed a plan to remove the slip-on slippers and replace them with the new enclosed slippers. Review of the current care plan for Resident #17 revealed she was at risk for falls. Interventions included ensuring 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 record review, observation, staff interview, and review of the facility policy, the facility failed to ensure a resident who was on a fluid restriction had fluid allowances designated to ensure staff knew how much to give the resident at meals, snacks, and medication pass. This affected one (Resident #17) of one resident reviewed on a fluid restriction. The facility census was 36. Findings include: Review of the medical record for Resident #17 revealed an admission date of 09/10/21. Diagnoses included heart failure and chronic kidney disease. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 had intact cognition and was not on a therapeutic diet. Review of a physician order dated 05/16/23 revealed Resident #17 was on a 48-ounce fluid restriction (1,419 millimeters) daily. There was no fluid allocation listed in the physician order on how much fluids Resident #17 can receive at meals, snacks and medication pass for each day. Review of the current care plan…

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, review of facility's infection control logs, and staff interview, the facility failed to ensure residents were receiving the correct antibiotics. This affected one (Resident #17) of five residents reviewed for antibiotic medications. The facility census was 36. Findings include: Record review for Resident #17 revealed the resident was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, chronic kidney disease, and altered mental status. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 had impaired cognition. Review of Resident #17's care plans dated 09/2022 revealed a focus area for increased risk of urinary tract infections (UTI). Interventions included to monitor and report any signs and symptoms of a UTI. Review of Resident #17's laboratory results dated [DATE] revealed the resident's urine culture was positive for E-Coli. On 05/17/23, the resident's culture results revealed the presence 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 medical record review and staff interview; the facility failed to ensure a resident was provided a restorative nursing program as recommended to maintain current level of mobility. This affected one (#4) of one resident reviewed for activities of daily living (ADL). The facility census was 43. Findings include: Review of the medical record for Resident #4 revealed the resident was admitted to the facility on [DATE]. Diagnoses included hypertension, hemiplegia, hypertension, dizziness, hypothyroidism, major depressive disorder, muscle weakness, overactive bladder, and abnormal posture. Review of the plan of care dated 05/22/19 revealed Resident #4 had a need for restorative intervention due to ADL self-care performance deficits/limited and physical mobility related to stroke as evidenced by assistance required from staff to performs her ADL. The goal was the resident will increase level of mobility walking to and from dining room with assistance of one. Interventions include: 1. Active range of motion:…

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.