St. Theresa Care Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation, staff interview, review of online resources from the Centers for Disease Control (CDC), and policy review, the facility failed to ensure staff utilized proper handwashing technique while completing wound care. This affected one (#15) of the three Residents (#13, #14, and #15) reviewed for wound care. The facility census was 65. Findings include: Review of the medical record for Resident #15 revealed the resident was admitted on [DATE]. Diagnoses included, but not limited to, Stage IV (full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed) sacral decubitus ulcer, depression, pulmonary embolism, and osteomyelitis. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #15 had mild cognitive deficits and required extensive assistance with activities of daily living (ADLs). Review of the care plan dated 04/23/24, revealed Resident #15 had skin breakdown/open area to bilateral gluteal…

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, interviews with staff and Environmental Specialist, review of the facilities approved water management plan and timeline and policy review, the facility failed to timely implement their approved water management plan to potentially prevent a Legionella outbreak. This affected one (#84) out of three residents reviewed for Legionella and had the potential to affect all 68 residents residing in the facility. The facility census was 68. Findings include: Review of the medical record for Resident #84 revealed the resident was originally admitted to the facility on [DATE] and was readmitted following a hospital stay on 10/24/23. Resident #84 left the faciity on [DATE], against medical advice. Diagnoses included diabetes mellitus, illicit drug use, history of respiratory failure, and pneumonia. Review of Resident #84's quarterly Minimum Data Set (MDS) assessment, dated 10/31/23, revealed the resident had intact cognition. Review of Resident #84's medical record revealed 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 medical record review, resident interview, and staff interview, the facility failed to ensure medical appointments were scheduled timely and transportation was arranged for medical appointments. This affected one (Resident #45) of three residents reviewed for medical appointments. The census was 69. Findings include: Review of Resident #45's medical record revealed Resident #45 was admitted to the facility on [DATE]. Resident #45's diagnoses included but were not limited to type two diabetes, asthma, anxiety disorder, heart failure, tachycardia, acute kidney failure, chest pain, encephalopathy, hypertension, hyperlipidemia, and cognitive communication deficit. Review of Resident #45's Minimum Data Set assessment, dated 01/11/24, revealed Resident #45 was cognitively intact. Review of Resident #45's progress note, dated 09/01/23, revealed social services scheduled a dental/oral surgery appointment for Resident #45 on 01/11/24. The progress note stated she communicated this information, but the note did…

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 staff interview, the facility failed to ensure the dishwasher was properly functioning to ensure the proper sanitation of dishes. This had the potential to affect 65 out of 65 residents who receive their meals from the kitchen, the facility identified one (#62) resident that received no food by mouth/no meals from the kitchen. The facility census was 66. Findings include: Observation of the facility's dishwasher on 01/09/24 at 8:50 A.M. revealed the temperature of the facility's dishwasher was 120 degrees Fahrenheit (F) but the chemicals were zero parts per million (PPM). There was no chemical observed going through the tubing from the chemical tubes to the dishwasher. The dishwasher was not observed to have any leaks. Interview with Maintenance Director #73 on 01/09/24 at 8:50 A.M. verified the temperature of the facility's dishwasher was 120 degrees F and the chemicals were zero parts PPM. Maintenance Director #73 verified the chemical was not entering the dishwasher from the chemical tubs. Interview with the Administrator on 01/09/24 at 11:47 A.M.…

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, staff and resident interviews, and policy review, the facility failed to ensure appropriate personal protective equipment was used in an isolation room. This affected one (#53) out of three residents reviewed for infection control practices. This had the potential to affect 16 (#42, #43, #44, #45, #46, #47, #48, #49, #50, #51, #52, #54, #55, #56, #57, #58) residents residing on the 3rd floor South Unit floor. The facility census was 66. Findings include: Record review revealed Resident #53 was admitted to the facility on [DATE] with diagnosis of Clostridioides difficile (C-diff), anxiety, depression and dementia. Review of Resident #53 physician orders revealed an order dated 01/09/24 for Isolation: C-Diff. Review of lab results for Resident #53 revealed a positive result for Toxigenic C. difficile DNA with a collection date of 01/05/24 and a reported to facility date of 01/08/24. Review of nurse's progress note dated 01/09/24 8:48 A.M. revealed C-diff results positive for…

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 and staff interview, the facility failed to complete the comprehensive admission Minimum Data Set (MDS) assessment for Resident #12 within 14 days after admission. This affected one (#12) out of five residents reviewed for MDS assessments. The facility census was 66. Findings include: Review of medical record for Resident #12 revealed an admission date of 12/11/23. Diagnoses included sequelae of cerebral infarction, burn of unspecified region and vascular dementia. Review of physician orders dated 01/01/24 revealed resident was to receive Eliquis five mg daily due to cerebral infarction, liquid protein two times daily to promote would healing, Silvadene external cream 1% - apply to right lateral thigh, apply adaptic, abdominal dressing and wrap with kerlix daily. Review of the baseline care plan dated 12/12/23 revealed Resident #12 had tested positive for COVID-19 and was at risk for further complications and potentially infecting others, would be free from complications related to infection through the review date and would be free of infection by the review…

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 and staff interview, the facility failed to develop a comprehensive person-centered care plan for Resident #12. This affected one (#12) out of five residents reviewed for care plans. The facility census was 66. Findings include: Review of medical record for Resident #12 revealed an admission date of 12/11/23. Diagnoses included sequelae of cerebral infarction, burn of unspecified region and vascular dementia. Review of physician orders dated 01/01/24 revealed resident was to receive Eliquis five mg daily due to cerebral infarction, liquid protein two times daily to promote wound healing, Silvadene external cream 1% - apply to right lateral thigh, apply adaptic, abdominal dressing and wrap with kerlix daily. Review of the baseline care plan dated 12/12/23 revealed Resident #12 had tested positive for COVID 19 and was at risk for further complications and potentially infecting others, would be free from complications related to infection through the review date and would be free of infection by the review date. There was no information in the baseline 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 staff interview, review of the facility policy, and record review, the facility failed to notify residents that the amount of funds in their accounts was 200 dollars less than the social security income resource limit and that the residents may lose eligibility for Medicaid or social security income. This affected three (#17, #19, and #31) of five residents reviewed for personal funds. The facility census was 56. Findings include: 1. Review of Resident #17's chart revealed Resident #17 admitted to the facility on [DATE]. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 was cognitively intact. Review of Resident #17's payer source information dated 05/16/23 revealed Resident #17 was on Medicaid from 01/01/20 to 05/03/23 and was changed to Medicare on 05/03/23 when he returned from a hospitalization. Review of Resident #17's account balance dated 05/16/23 revealed Resident #17 had a balance of $2,614.32 in his resident funds account. Review of Resident #17's…

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, review of the facility policy, and staff interview, the facility failed to develop care plans for a resident's cognitive impairment, wandering, and activity needs. This affected two (#43 and #47) residents out of 17 residents reviewed for accuracy of assessments. The facility census was 56. Findings include: 1. Review of Resident #47's medical record revealed Resident #47 admitted to the facility on [DATE]. Diagnoses including dementia with psychotic disturbance. Review of the progress note dated 05/02/23 revealed Resident #47 was not found in his room at 9:30 P.M. and Resident #47 had made several attempts to leave his room and floor prior. Resident #47 stated he was going home. Staff later found Resident #47 on the first floor. Resident #47 was moved to the secured unit for the night. The progress note dated 05/03/23 revealed Resident #47's physician was in to see Resident #47 and a new order was added to place a wanderguard on the left ankle. Review of the physician order dated…

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 2. Review of Resident #17's medical record revealed Resident #17 was admitted to the facility on [DATE]. Diagnoses included type two diabetes mellitus without complications, major depressive disorder, muscle weakness, and dysphagia. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 was cognitively intact. Resident #17 required supervision from staff with transfers, dressing, eating, toileting, and personal hygiene. Resident #17 was independent with bed mobility. Review of Resident #17's care conferences from 11/15/22 to 05/18/23 revealed Resident #17 had one care conference completed on 01/04/23. Interview with Resident #17 on 05/15/23 at 10:54 A.M. revealed Resident #17 had not been invited to any care conferences and did not have the opportunity to participate in the development of his care plan. Interview with Social Services Director (SSD) #418 on 05/17/23 at 2:27 P.M. verified Resident #17 only had one care conference completed on 01/04/23. SSD #418 stated she 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, observations, staff interviews, and review of tube feed product and preparation guidance, the facility failed to ensure a resident's tube feed formula was properly dated and stored prior to administration. This affected one (#38) of two residents reviewed for tube feeds. The facility census was 56. Findings include: Review of the medical record for Resident #38 revealed an admission date of 03/22/22. Diagnoses included cerebral infarction and aphasia. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #38 was not able to complete a Brief Interview for Mental Status (BIMS) because he was rarely/never understood. Review of the care plan dated 01/20/23 revealed Resident #38 had a nutritional problem related to dysphagia, cognitive communication deficit, aphasia, and unintended weight loss. Interventions included staff to administer water flush through g-tube as ordered. Staff to encourage to allow tube flush. Staff to provide and serve supplement/tube…

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 label open medications properly, and remove expired medications from active medication drawers. This affected three medication storage areas observed during the survey and had the potential to affect one (#15) resident on the [NAME] unit, two (#31 and #170) residents on the [NAME] unit who were identified by the facility as a newly admitted and any other resident who could use a stock supply of expired medications. Facility census was 72. Findings include: 1. Observation on 01/07/12020 at 2:27 P.M. with Licensed Practical Nurse (LPN) #395 revealed one opened Lantus pen (insulin) open with no date when opened or when expires in the North [NAME] medication cart. Interview on 01/07/2020 at 2:33 P.M. with LPN #395 verified that the Lantus pen was not dated and should have an open date or expired date. LPN #395 confirmed the Lantus pen belonged to Resident #15. 2. Observation on 01/07/19 at 2:38 P.M. with LPN #320 revealed a bottle 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.

Based on record review, resident and staff interview, and review of facility policy, the facility failed to ensure a resident was afforded with dignity when staff failed to provide timely toileting assistance during meal time. This affected one (#26) of 18 residents sampled during the survey. The census was 72. Findings include: Review of the medical record for Resident #26 revealed an admitted date of 10/16/19 with diagnoses which included osteomyelitis, diabetes, morbid obesity, and peripheral vascular disease. Review of the Minimum Data Set (MDS) for Resident #26 dated 10/23/19 revealed resident was cognitively intact, required extensive assistance of one staff with toilet use, and was always continent of bowel and bladder. Review of nurse progress note for Resident #26 dated 10/29/19 revealed resident was alert and oriented, able to make needs known and call for assistance when needed, was continent of bowel and bladder and used a bedpan when having a bowel movement. Review of care plan for Resident #26 dated 11/01/19 revealed resident had a self-care performance deficit related…

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, review of personal funds documentation, staff interview, and review of facility policy, the facility failed to obtain written authorization to manage resident personal funds. This affected one (#53) of five residents reviewed for personal funds. The census was 72. Findings include: Review of medical record for Resident #53 revealed an admission date of 07/03/19 with a diagnosis of chronic obstructive pulmonary disease. Review of Minimum Data Set (MDS) for Resident #53 dated 12/25/19 revealed resident was cognitively intact. Review of facility resident trust account quarterly statement for Resident #53 dated 09/30/19 revealed resident had an account with the facility with a balance of approximately $1300. Review of the facility resident trust account records revealed the facility did not have written authorization from Resident #53 to manage her personal funds. Interview on 01/09/29 at 11:20 A.M. with Business Office Manager (BOM) #365 confirmed facility had not obtained authorization in writing to manage Resident #53's funds. Review of facility policy…

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 provide notification of transfer to the Ombudsman. This affected one (#57) of one reviewed for hospitalizations. The facility census was 72. Findings include: Review of Resident #57 medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses include hyperlipidemia, encephalopathy, symbolic dysfunctions, mixed receptive expressive language disorder, dementia in other diseases classified, psychosis not due to substance or known, supraventricular tachycardia, Alzheimer's disease, hypercholesterolemia, insomnia, anxiety, epilepsy and major depressive disorder. Review Minimum Data Set (MDS) assessment for admission dated 12/06/19 documented the resident had a Brief Interview for Mental Status (BIMS) score of 99 indicating severe impaired cognition and extensive assistance required for activities of daily living (ADLs). Further review of the medical record revealed Resident #57 was transferred to the hospital 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 record review, staff interview, and review of the Resident Assessment Instrument (RAI) Manual, the facility failed to ensure accuracy of resident assessments regarding discharge status. This affected one (#72) of two closed records reviewed. The census was 72. Findings include: Review of the closed medical record for Resident #72 revealed resident was admitted on [DATE] with a diagnosis of peritoneal abscess and was discharged on 11/28/19. Review of Minimum Data Set (MDS) for Resident #72 revealed resident was discharged with a return not anticipated to an acute care hospital. Review of nurse progress note and discharge summary for Resident #72 dated 11/28/19 revealed the resident was discharged to home in the community. Review of nurse progress notes for Resident #72 dated 06/24/19 through 11/28/19 revealed resident had no hospital transfers during his stay at the facility. Interview on 01/09/20 at 2:20 P.M. with Registered Nurse (RN) #15 confirmed the MDS dated [DATE] for Resident #72 had been…

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, record review, and interview the facility failed to complete comprehensive care plans. This affected two (#65, & #120) out of 18 residents reviewed for care plans. Facility census was 72. Findings include: 1. Review of Resident #65's medical record revealed the resident was admitted to the facility on [DATE] with a re-entry on 07/01/19. Diagnoses including congenital malformations of the brain, epilepsy, hypomagnesemia, post traumatic seizures, anxiety, diabetes, hypertension, idiopathic gout, malignant neoplasm of the brain, and bladder cancer. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #65 has no cognitive deficits, requires only supervision with all activities of daily living, and is always continent of bowel and bladder. Review of care plans revealed there were no care plan present for Resident #65 regarding his discharge status or discharge plans. Interview on 01/09/2020 at approximately 12:30 P.M. with Social Service Designee #425 verified there 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 medical record review, observation, resident and staff interview, and review of facility policy, the facility failed to provide activities of daily living (ADL) assistance to dependent residents. This affected one (#69) of three residents reviewed for ADLs. The census was 72. Findings include: Review of record for Resident #69 revealed an admission date of 07/31/19 with diagnoses which included diabetes, right below the knee amputation, and schizophrenia. Review of Minimum Data Set (MDS) for Resident #69 dated 12/27/19 revealed resident was cognitively intact, was coded as negative for rejection of care, and required extensive assistance of one staff with bathing and personal hygiene. Review of care plan for Resident #69 dated 03/13/19 revealed resident had a self-care performance deficit related to amputation of lower leg. Interventions included to assist with bathing as needed. Review of nurse progress notes for Resident #69 dated 12/01/19 through 01/06/20 revealed there was no documentation regarding refusal of shower and/or refusal of resident to have her hair washed.…

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, observation, resident and staff interview, and review of facility policy, the facility failed to change a resident's intravenous (IV) dressing as ordered by the attending physician. This affected one (#69) of 18 residents sampled during the survey. The census was 72. Findings include: Review of record for Resident #69 revealed an admission date of 07/31/19 with diagnoses which included diabetes, right below the knee amputation, and schizophrenia. Review of Minimum Data Set (MDS) for Resident #69 dated 12/27/19 revealed resident was cognitively intact, was coded as negative for rejection of care, and required extensive assistance of one staff with activities of daily living. Review of physician orders for Resident #69 dated 12/05/19 revealed an order to change IV dressing to right upper chest weekly every Friday and as needed. Review of nurse progress note for Resident #69 dated 01/02/20 revealed IV dressing to resident's right upper chest was intact and due to be changed on 01/03/20. Review of nurse progress note for Resident #69 dated 01/03/20…

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, resident and staff interview, and review of facility policy, the facility failed to adequately treat and manage resident pain. This affected one (#26) of four residents reviewed for pain management. The census was 72. Findings include: Review of the medical record for Resident #26 revealed an admitted date of 10/16/19 with diagnoses which included osteomyelitis, diabetes, morbid obesity, and peripheral vascular disease. Review of the Minimum Data Set (MDS) for Resident #26 dated 10/23/19 revealed resident was cognitively intact and required extensive assistance of one staff with activities of daily living. Further review of the MDS revealed resident reported almost constant pain which made it difficult to sleep at night, and pain level over the last five days had been a level six on a scale from one to 10 with 10 being the worst pain. Review of care plan for Resident #26 dated 11/02/19 revealed resident had acute and chronic pain. Interventions included administer pain medication as ordered, anticipate the resident's need for pain relief and respond…

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, resident interview, and staff interview, the facility failed to ensure resident medication was available for administration. This affected one (#69) of five residents reviewed for medications. The census was 72. Findings include: Review of record for Resident #69 revealed an admission date of 07/31/19 with diagnoses which included diabetes, right below the knee amputation, and schizophrenia. Review of Minimum Data Set (MDS) for Resident #69 dated 12/27/19 revealed resident was cognitively intact and required extensive assistance of one staff with activities of daily living (ADLs). Review of physician order dated 08/04/19 for Resident #69 revealed an order for Trulicity an injectable medication for diabetes to be administered once weekly. Review of Medication Administration Record (MAR) for Resident #69 revealed resident did not receive two of her weekly doses of Trulicity on 10/06/19 and 10/13/19. Review of nurse progress note for Resident #69 dated 10/06/19 revealed resident's Trulicity was not available for administration. Further review of note revealed…

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, staff interview, and review of facility policy the facility failed to ensure resident's were free from unnecessary medications when staff failed to monitor pain level for residents receiving opioid pain medications. This affected two (#44 and #26) of six residents reviewed for medications. The census was 72. Findings include: 1. Review of record for Resident #44 revealed an admission date of 04/04/19 with a diagnosis of osteoporosis. Review of Minimum Data Set (MDS) for Resident #44 dated 11/21/19 revealed resident was cognitively intact and required supervision with activities of daily living (ADLs). Further review of MDS revealed resident reported pain almost constantly with no effect on functioning, and pain was a level three on a scale of one to 10 at its worst. Review of care plan for Resident #44 dated 11/26/18 revealed resident was at risk for pain due to history of pain. Interventions included the following: administer pain medication as ordered, observe for pain/discomfort and perform pain assessment as needed, observe for worsening 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.

Based on medical record review and resident and staff interview, the facility failed to arrange for routine dental services for residents. This affected one (#69) of 18 residents sampled during the survey. The census was 72. Findings include: Review of the medical record for Resident #69 revealed an admission date of 01/16/19 with a diagnoses which included diabetes, right below the knee amputation, and schizophrenia. Review of the Minimum Data Set (MDS) for Resident #69 dated 12/27/19 revealed resident was cognitively intact and required extensive assistance with activities of daily living. Review of the medical record for Resident #69 revealed a consent form to receive dental services from the facility in-house dentist was signed by the resident. Review of the medical record for Resident #69 revealed it did not include any dental progress notes for resident. Interview on 01/06/20 at 1:27 P.M. with Resident #69 confirmed she had requested to see the facility dentist on multiple occasions, but she had not seen a dentist during her staff at the facility. Interview on 01/08/20 at 1:00…

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, and resident and staff interview, the facility failed to have all call lights functioning properly. This affected one (#32) out of 18 residents reviewed and observed for the initial pool for functioning of the call light system. Facility census was 72. Findings include: Review of Resident #32's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses include dementia, obesity, pressure ulcer right heel, hypotension, fall history, peripheral vascular disease, mood disorder, traumatic brain injury, abnormal gait, anxiety, benign prostatic hyperplasia, dysphagia, depression, chronic obstructive pulmonary disease, muscle weakness, gastro-esophageal reflux disease, schizophrenia, and cognitive communication deficit. Review of the Annual Minimum Data Set, dated [DATE] revealed Resident #32 has severe cognitive deficits, requires total dependence with toileting, extensive assistance with personal hygiene, dressing, bed mobility, limited…

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.