Bellbrook Health And Rehab

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview, policy review and record review, the facility failed to notify the provider and resident representative of a resident's change in condition. This affected one (Resident #9) of one resident reviewed for notification of change. The facility census was 34.Findings include:Review of the medical record for Resident #9 revealed an admission date of 10/19/22. Diagnoses included epilepsy. The Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #9 had moderately impaired cognition.The care plan, last revised on 10/17/25, revealed Resident #9 had impaired neurological status related to seizure disorder. Interventions included to monitor and report any seizure activity, monitor environment if involuntary muscle movements place the resident at risk for injury, monitor for need of padding to side rails or wheelchairs, monitor vital signs as needed, and report abnormal to physician.Review of Resident #9's progress notes dated 01/07/25 to 01/14/25 revealed no documentation of 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, resident and staff interviews, and policy review, the facility failed to ensure resident care conferences occurred quarterly with the Interdisciplinary Team and the resident and/or resident representative. This affected three (#8, #9, and #34) of three residents reviewed for care conferences. The facility census was 34. Findings include:1. Review of the medical record for Resident #34 revealed an admission date of 04/01/14. Diagnoses included diffuse traumatic brain injury, disease of digestive system, diabetes mellitus, dysphagia, and major depressive disorder. The Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #34 had severe cognitive impairment. The care plan revealed Resident #24 was a long term resident with no plans to discharge at this time. Interventions included to review with resident at least quarterly for any changes in discharge planning needs. Review of Resident #34's medical record revealed Resident #34 had one care conference held in the year of 2025,…

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, observations, policy review, and staff and resident interviews, the facility failed to ensure a resident who was dependent on staff for personal hygiene and bathing received adequate assistance with nail care. This affected one (#11) of 12 residents reviewed for activities of daily living (ADL). The facility census was 34.Findings include:Review of the medical record for Resident #11 revealed admission date of 08/23/22. The resident was admitted with diagnoses including stroke, dementia without behaviors, type two diabetes mellitus, depression, anxiety and polyneuropathy. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #11 was cognitively impaired. Resident #11 was dependent upon staff for personal hygiene and toileting.Review of the care plan revealed Resident #11 had a physical functioning deficit with interventions which included nail care as needed.Observation and interview on 01/12/26 at 11:01 A.M. revealed Resident #11's fingernails had extended…

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 staff interviews, the facility failed to ensure a resident received adequate care and treatment for intravenous line placements, skin assessments, and a wound vac. This affected one (Resident #46) of five residents reviewed for hospitalization. The facility census was 34.Findings include:Review of Resident #46's medical record revealed an admission date of 08/05/25 with diagnoses including acute respiratory failure with hypoxia, anxiety disorder, tracheostomy status, and depression. The Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #46 had moderately impaired cognition, and dependent on staff with toileting and bathing. Resident #46 discharged from the facility on 08/12/25.Review of Resident #46's assessments from 08/05/25 to 08/12/25 revealed there were no wound or skin assessments completed upon admission or after. Review of Resident #46's physician orders dated 08/05/25 revealed wound vac to abdomen at 100 millimeters of mercury (mmHg) suction to be changed…

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, resident and staff interviews, record review, and policy review, the facility failed to ensure fall interventions were in place for a resident who had a history of falling. This affected one (Resident #9) of two residents reviewed for accidents. The facility census was 34. Findings include:Review of the medical record for Resident #9 revealed an admission date of 10/19/22. Diagnoses included epilepsy, cerebral infarction, and hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side. The Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #9 had moderately impaired cognition and was dependent on staff for toileting, bathing, and personal hygiene.The care plan dated 11/07/23 revealed Resident #9 was at risk for falls related to impaired mobility. Interventions included bilateral fall mats to floor on each side of bed, call light in reach at all times when in bed, educate/remind to use call light prior to transfer, encourage resident to use…

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, staff interviews, and observations, the facility failed to maintain an accurate medical record. This affected one resident (Resident #12) of 13 residents reviewed for accuracy of medical records. The facility census was 34.Findings include:Review of the medical record for Resident #12 revealed an admission date of 05/09/25.Review of a progress note dated 12/08/25 revealed the interdisciplinary team (IDT) met on that date to discuss an incident that occurred involved Resident #12 on 11/10/25. The team determined the resident had poor safety awareness and he was unaware of his transfer limitations. There were no progress notes in the chart on or around 11/10/25 describing the incident. Review of the active physician orders for 01/12/26 revealed a physician order dated 11/12/25 for a fall mat was to be placed to the left side of the Resident #12's bed when he is in bed, and its placement should be verified every day on each shift.Review of the treatment administration record (TAR) for November 2025, December 2025, and January 2026 revealed nursing staff…

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, staff interview, and facility policy review, the facility failed to ensure residents were provided with a proper discharge. This affected one (#100) of the three residents reviewed for discharges. The facility also failed to ensure the discharges were reported to the local ombudsman office. This affected one (#100) of the three residents reviewed. The facility census was 33.Findings include: 1) Review of the medial record or Resident #100 revealed the resident was admitted to the facility on [DATE] and discharged to his home on [DATE]. Diagnoses included orthostatic hypotension, diabetes mellitus (DM), dehydration, dysphagia, and anxiety disorder.Review of the Care Plans dated 04/18/25 for Resident #100, revealed no care plan developed for discharge planning.Review of the April and May 2025 physician orders for Resident #100, revealed no orders for the resident to be discharge from the facility.Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #100 was…

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, record review, facility staff interview, and policy review the facility failed to timely repositioning and turn one resident (#36) of three reviewed for pressure ulcers. The facility census was 42. Findings Included: Review of medical record for Resident #36 revealed a re-admission date of 08/11/24, and an initial admission date of 06/17/24. Diagnoses included anoxic brain damage, stage four pressure ulcer of left elbow and sacrum which were documeted to be present on admission to the facility. Review of plan of care dated 06/18/24 revealed that Resident #36 had actual stage four pressure ulcer to the left elbow. Interventions included turning and repositioning schedule per assessment, turn side to side in bed every one to two hours, and treatments as ordered. Resident #36 also had a stage four pressure ulcer to right sacrum plan of care that included interventions of pillows for positioning, low air loss mattress, turning and repositioning and weekly wound assessment. Resident #36 was at risk for pressure ulcers due to impaired mobility. Interventions included…

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, interview, and facility policy review the facility failed to ensure enhanced barrier precautions were followed for one resident (#36) and failed to ensure soiled gloves were removed prior to touching clean items for one (#36) of three residents reviewed. The facility census was 42. Findings Included: Review of medical record for Resident #36 revealed a re-admission date of 08/11/24, and an initial admission date of 06/17/24. Diagnoses included anoxic brain damage, stage four pressure ulcer of left elbow and sacrum which were documeted to be present on admission to the facility. Observation on 08/14/24 at 11:42 A.M. Registered Nurse (RN) #329 and State Tested Nurse Aide (STNA) #405 enter Resident #36 room to perform incontinence care, repositioning, wound care, and to check urinary catheter for position. The staff were observed to bring the wound treatment cart into Resident #36's room and the staff were observed to put on gloves to provide care to the resident. No other personal protective equipment (PPE) was used by the staff during the observation. STNA #405…

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, resident interview, and staff interview, the facility failed to ensure exterior windows in resident rooms were maintained. This affected seven (Residents #03, #09, #11, #25, #26, #30, and #31) of 37 residents residing at the facility. Findings include: Observation of the facility on 04/26/24 at 11:21 A.M. revealed there was plastic covering Resident #09 and Resident #11's windows and blinds, and the blinds could not be opened without poking a hole in the plastic. Further observation of the facility revealed there were no screens in the exterior windows in Resident #03, #25, #26, #30, and #31's rooms. Interview with Maintenance Director #80 on 04/26/24 at 11:21 A.M. verified there was plastic covering Resident #09 and Resident #11's windows and blinds, and the blinds could not be opened without poking a hole in the plastic. Maintenance Director #80 stated Resident #09 and Resident #11 had plastic over their exterior windows and blinds because the windows were old and allowed cold air in Resident #09 and Resident #11's rooms. Maintenance Director #80 stated 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 record review, interview and policy review, the facility failed to notify a resident's representative of a change in condition and failed to notify the resident's representative and physician of test results timely. This affected one (Resident #45) of three residents reviewed for a change in condition. The facility census was 42. Findings include: Review of the closed medical record for Resident #45 revealed he was admitted to the facility on [DATE], transferred to the hospital on [DATE], and discharged on 11/17/23. Diagnoses included cerebral infarction due to embolism of unspecified cerebral artery, cerebral edema, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, occlusion and stenosis of unspecified carotid artery, acute embolism and thrombosis of left femoral vein, chronic atrial fibrillation, other low back pain, atherosclerosis of coronary artery bypass graft (s) without angina pectoris, congestive heart failure, chronic obstructive pulmonary disease,…

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 of open and closed medical record review, staff interviews, resident representative interview, review of hospital records, review of the death certificate, and review of facility policy, the facility failed to appropriately assess and provide timely intervention for Resident #45 following a change in condition. This resulted in Immediate Jeopardy and placed Resident #45 at risk for serious life-threatening harm, negative health outcomes, and/or death when on [DATE] at approximately 3:06 P.M., Resident #45 complained of lower abdominal pain to Assistant Director of Nursing (ADON) #02 and was unable to tolerate palpation to his abdomen. After Resident #45 complained of abdominal pain, his bowel sounds were not assessed and the physician ordered imaging results, which indicated a possible bowel obstruction, and the results were not relayed to the physician timely. Consequently, Resident #45 was transferred to the hospital on [DATE] at 11:47 A.M. at the request of Resident #45 and his representative and was…

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 staff interview, the facility failed to ensure resident medical records were complete. This affected one (Resident #45) out of three residents reviewed for documentation. The facility census was 42. Findings include: Review of the closed medical record for Resident #45 revealed he was admitted to the facility on [DATE], transferred to the hospital on [DATE], and discharged on 11/17/23. Diagnoses included cerebral infarction due to embolism of unspecified cerebral artery, cerebral edema, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, occlusion and stenosis of unspecified carotid artery, acute embolism and thrombosis of left femoral vein, chronic atrial fibrillation, other low back pain, atherosclerosis of coronary artery bypass graft (s) without angina pectoris, congestive heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, other intervertebral disc degeneration lumbar region, old myocardial infarction, hyperlipidemia,…

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 staff interview , facility personal funds account review, and policy review, the facility failed to close the resident's account after the resident expired. This affected one resident (#137) of three residents who have expired with money in the facility's personal funds account. The facility failed to provide a notice of spend down for a resident whose balance exceeded the maximum asset permitted. This affected one resident (#30) of three resident records reviewed for personal funds accounts. The facility census was 33. Findings include: 1. Review of Resident #137's medical record revealed an admission dated of [DATE]. admission diagnoses included hemiplegia and hemiparesis following cerebral infarction. Review of Resident #137's progress note dated [DATE] revealed the hospital called to inform the facility the resident had passed away. Review of the facility's current personal funds account balances for all residents revealed Resident #137 had a balance of $983.35. Interview on [DATE] at 9:22 A.M. 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.

Based on medical record review and interviews the facility failed to issue a bed hold notification letter to residents who went to the hospital. This affected Resident #13 and #34 who were reviewed for hospitalizations. The facility census was 33. Findings include: 1. Review of medical record for Resident #13 revealed admission date of 10/14/21 with server cognitive deficits. Resident #13 diagnoses included atrial fibrillation , type two diabetic , and encephalopathy. On 06/19/22, he was transferred to the hospital due to problems with his Foley catheter. On 06/24/22, Resident #13 was readmitted to the facility. Review of Resident #13 nurses progress notes from 06/01/22 to 07/01/22 revealed the facility did not send the representative a bed hold notification letter. On 09/20/21 at 5:15 P.M. interview with the Director of Nursing (DON) confirmed a bed hold letter was not issued to Resident #34 or his representative. 2. Review of medical record for Resident #34 revealed admission date of 7/21/22. The resident was admitted with diagnoses chronic respiratory failure with hypoxia,…

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, staff interview and record review, the facility failed to provide services to prevent further decrease in range of motion and mobility. This affected one resident (Resident #33) out of two resident reviewed with splints. The facility census was 33. Findings include: Review of the medical record for Resident #33 revealed an admission date of 08/29/13 with medical diagnoses of unspecified intracranial injury with loss of consciousness, obstructive hydrocephalus, quadriplegia, and immobility syndrome, aphasia, contracture to joints, unspecified, and traumatic brain injury. Review of the medical record revealed the Minimum Data Set (MDS) dated [DATE] which stated Resident #33 was sometime able to understand information and rarely/never able to make self-understood. The MDS revealed Resident #33 had moderate impaired cognition. Further review of MDS revealed resident required extensive staff assistance of two staff members for bed mobility and toileting and was dependent upon staff for transfers…

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, staff interview, and policy review, the facility failed to follow infection control procedures when distributing medications and completing wound care. This affected two residents (Resident #10 and Resident #11) out of five residents reviewed. The facility census was 33. Findings include: 1. Review of medical record for Resident #10 revealed an admission date of 02/05/22 with medical diagnoses of acute osteomyelitis, Diabetes Mellitus (DM), chronic kidney disease (CKD) stage 2, neuromuscular dysfunction of bladder, congestive heart failure (CHF), morbid obesity, major Depressive disorder, and status post partial traumatic amputation of right foot. Review of the medical record for Resident #10's revealed a Minimum Data Set (MDS) dated [DATE] which stated the Brief Interview for Mental Status (BIMS) was 15 indicating the resident had no cognitive impairment. Further review of the MDS revealed Resident #10 required extensive staff assistance of two staff members for bed mobility, transfers,…

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 staff interview, resident record review, and policy review, the facility failed to ensure residents were offered their pneumococcal vaccine. This affected two residents (Resident #9 and #21) of five residents reviewed for immunizations. The facility census was 33. Findings include: 1. Review of Resident #9 revealed an admission dated of 07/30/18. admission diagnoses included acute and chronic respiratory failure, anoxic brain damage, chronic obstructive pulmonary disease, congestive heart failure, and dependence on respiratory ventilator. Review of Resident #9's Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview Mental Status (BIMS) unable to be completed. The MDS revealed the resident required total two-person dependence for bed mobility, dressing, toileting and personal hygiene. The MDS revealed transfers and eating had not occurred during the evaluation period. Review of Resident #9's plan of care dated 08/05/22 revealed the resident had an alteration in respiratory status due to chronic…

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 review of the facility time punches and schedules and staff interviews, the facility failed to ensure a Registered Nurse (RN) was working at least eight hours a day. This had the potential to affect 31 of 31 residents at the facility. The facility census was 31. Findings included: Review of the weekend staffing schedules and payroll punches from 10/19/19 through 11/24/19, revealed the facility did not have a RN working for at least eight hours a day on 10/19/19, 10/20/19, 11/02/19, 11/03/19, 11/16/19 and 11/17/19. Interview on 11/26/19 at 2:11 P.M., with Human Resources Director (HR) #101 confirmed there was no RN staffed on 10/19/19, 10/20/19, 11/02/19, 11/03/19, 11/16/19 and 11/17/19. Interview on 11/26/19 at 2:30 P.M., with the Administrator confirmed there was no RN staffed on 10/19/19, 10/20/19, 11/02/19, 11/03/19, 11/16/19 and 11/17/19.

Based on review of personnel files and staff interview, the facility failed to ensure State Tested Nursing Assistants (STNA) received 12 hours of training annually. This affected one (#109) of one STNA reviewed who worked at the facility greater than one year. This had the potential to affect 31 of 31 residents at the facility. The facility census was 31. Findings include: Review of the personnel file for STNA #109 revealed a hire date of 10/15/13. Further review of STNA #109's file revealed no evidence of 12 hours of annual in-services. Interview on 11/26/19 at 11:03 A.M., with Human Resource Director (HR) #101 confirmed the facility was not able to provide a record of on-going training or in-services for STNA #109. HR #101 confirmed there were no other STNAs who had been at the facility greater than one year. Interview on 11/26/19 at 3:54 P.M., with the Director of Nursing (DON) verified the facility had no documentation to support STNA #109 received 12 hours of on-going in-services.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical and personnel record reviews, facility Tuberculosis Risk Assessment review, policy reviews and staff interviews, the facility failed to maintain infection control measures while providing wound care. This affected one (#30) of two residents reviewed for infection control with wounds. The facility identified six residents with pressures wounds at the facility. The facility also failed to provide initial two-step Mantoux testing to three new hired employees. This affected two State Tested Nursing Assistant (STNA) (#115 and #120) and Social Services (SS) #127 of seven personnel files reviewed. This had the potential to affect 31 of 31 residents at the facility. The facility census was 31. Findings include: 1. Review of Resident #30's medical record revealed an admission date of 08/08/19, with diagnoses including a Stage IV pressure ulcer of the sacral region at admission, neuropathic bladder and dependence on respirator (ventilator) status. Review of Resident #30's minimum data set…

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 review of the fund account authorization agreements and staff interview, the facility failed to provide authorizations with complete information. This affected five (#2, #3, #13, #17 and #24) of five reviewed for resident fund accounts. The facility identified 11 residents with fund accounts. The census was 31. Findings include: Review of the authorization agreements for five Residents (#2, #3, #13, #17 and #24) identified as having fund accounts revealed there was no evidence of the date the fund accounts were authorized. In addition, the authorization for Resident #2 revealed he marked his name with an X and had only one witness signature. The authorization agreement form indicated two witness signatures were required if a resident marked a name with an X. Interview on 11/25/19 at 8:47 A.M. with Business Office Manager (BOM) #100 verified none of the five authorization agreements were dated for Residents #2, #3, #13, #17 and #24. BOM #100 verified Resident #2 signed with an X and there was only one witness signature. The authorization form stated there should be two…

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, resident and staff interviews, the facility failed to consistently provide physician ordered compression leg cuffs. This affected one (#18) of five residents reviewed for unnecessary medications. The census was 31. Finding include: Review of Resident #18's medical record revealed an admission date of 02/20/19, with diagnoses including deep vein thrombosis. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident's cognition was intact. Review of physician's order initiated 03/28/19 revealed to apply compression cuffs bilaterally to the resident's lower extremities 45 minutes twice per day. Review of the recent Treatment Administration Records (TAR) for the resident revealed no evidence the compression cuffs were applied on day shift on 10/01/19, 10/04/19, 10/12/19, 10/20/19, 10/22/19, 10/23/19, 10/24/19, 10/25/19, 10/30/19, 11/04/19, 11/06/19, 11/10/19, 11/19/19 and 11/24/19. There was no information on the TAR that the resident refused the compression…

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, staff and resident interview, the facility failed to ensure catheter care was provided to residents utilizing an urinary catheter. This affected two (#20 and #30) of two residents reviewed for catheter care. The facility identified seven residents with urinary catheters. The facility census was 31. Findings included: 1. Review of Resident #20's medical record revealed an admission date of 07/31/19. Medical diagnosis included neurogenic bladder. Review of admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #20 was cognitively intact. Review of physician orders dated 07/31/19 for Resident #20 revealed to provide catheter care every day and night shift. Review of care plan dated 08/01/19 for Resident #20 revealed she had an alteration in bladder related to urinary catheter for a diagnosis of neuromuscular dysfunction of bladder. Review of the Treatment Administration Record (TAR) from 10/01/19 through 10/31/19 revealed there was no documented evidence 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, observation and staff interview, the facility failed to ensure tube feeding was administered at the correct infusion rate. This affected two (#9, #131) of two residents reviewed for tube feed administration. The facility identified 15 residents who received tube feeding. The census was 31. Findings included: 1. Medical record review for Resident #9 revealed an admission date of 06/15/19. Medical diagnosis included heart failure and diabetes. Review of significant change Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #9 was fed by a feeding tube. Review of the monthly weight records revealed no significant weight loss for the resident. Review of physician order dated 10/15/19 for Resident #9 revealed an Enteral feeding every day and night shift for Glucerna 1.5 at 55 milliliters per hour (ml/hr). Observation of the tube feeding pump on 11/24/19 at 11:52 A.M., for Resident #9 revealed the infusion was at 45 ml/hr. Interview with Licensed Practical Nurse (LPN) #104…

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, review of the menu and recipe, and staff interviews, the facility failed to provide dessert as specified on the approved menu for two (#21 and #5) of five diabetic residents observed with physician's orders for controlled carbohydrate diet. The census was 31. Findings include: 1. Medical record review for Resident #21 revealed she was admitted on [DATE], with diagnosis including insulin dependent diabetes. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition. Review of the Medication Administration Record (MAR) for the past month revealed the resident's accuchecks ranged from 93 to 209 milligrams/deciliter which indicated her blood sugars were elevated at times. The resident's current diet order was for a controlled carbohydrate diet. Observations on 11/24/19 at 12:29 P.M., revealed chocolate cake was served to Resident #21 at lunch topped with chocolate syrup/chocolate chips. 2. Medical record review for Resident #5…

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.