Parkside Health Care Center

Based on medical record review and interview, the facility failed to provide a timely physical therapy (PT) evaluation to assess for a restorative nursing program. This affected one (Resident #28) of three residents reviewed for restorative nursing services. The facility identified 39 residents receiving restorative nursing programs. The facility census was 62. Findings include: Review of Resident #28's open medical record revealed diagnoses including type two diabetes mellitus with diabetic neuropathy, irritable bowel syndrome with diarrhea, anemia, obsessive compulsive disorder, diabetic retinopathy with macular edema in both eyes, somatization disorder, adjustment disorder with mixed anxiety and depressed mood, histrionic personality disorder, and narcissistic personality disorder. A plan of care initiated 05/25/22 and revised on 01/24/24 indicated Resident #28 required an ambulation restorative program due to weakness related to diabetes with neuropathy. A nursing note dated 07/26/23 at 10:03 A.M. indicated Resident #28 requested his restorative program be placed on hold.…

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 interview, the facility failed to ensure bathing was offered in accordance with bathing schedules and resident preferences. This affected one (Resident #28) of three residents reviewed for activities of daily living. The facility census was 62. Findings include: Review of Resident #28's medical record revealed diagnoses included type two diabetes mellitus with diabetic neuropathy, irritable bowel syndrome with diarrhea, obsessive compulsive disorder, and anxiety disorder. A care plan regarding development of person-centered care, initiated 12/27/21, indicated Resident #28 required two or more assists for bathing. A care plan initiated 01/06/22 indicated a self care deficit with interventions to bathe per Resident #28's preference. A care plan initiated 04/07/22 indicated Resident #28 had a conflict with staff related to being accusatory of staff, being demanding, being argumentative, and refusing showers and/or bed baths. Review of a plan of care note dated 02/16/23 at 2:46 P.M. indicated Resident #28 requested he have one bed bath a week. 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 observation, review of physician orders, policy review, and interview, the facility failed to ensure medications were available for administration resulting in the omission of four medications being administered out of 25 opportunities resulting in a 16% medication error rate. This affected one (Resident #56) of two residents observed for medication administration. Findings include: During observation of medication administration on 02/27/24 at 8:53 A.M., Licensed Practical Nurse (LPN) #125 was observed preparing medications for administration to Resident #56. LPN #125 searched for, but was unable to locate, the following ordered medications: chewable aspirin 81 milligram (mg), vitamin D 50 micrograms (mcg), bumex 1 mg (mg), fludrocortisone acetate 0.1 mg, and ferrous gluconate 324 mg. LPN #125 stated Resident #56 only had a 14 day supply of medication delivered at any given time. LPN #125 stated she knew she had re-ordered the medications but they were not in the cart. LPN #125 stated when she finished her medication pass she would look to see if any of the medications…

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, medical record review, policy review, and interview, the facility failed to ensure catheter tubing was placed in a manner that would limit the potential for introduction of pathogens. This affected one (Resident #1) of three residents reviewed for urinary tract infections. The facility census was 62. Findings include: Review of Resident #1's open medical record revealed diagnoses including type two diabetes mellitus, flaccid neuropathic bladder, and neuromuscular dysfunction of the bladder. A plan of care related to use of an indwelling catheter was initiated 08/18/23. Interventions included keeping the foley (catheter) tubing free of kinks and keeping the bag covered and off the surface of the floor. A quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #1 was cognitively intact and had an indwelling urinary catheter. A laboratory report for urine collected on 02/19/24 indicated the identification of mixed flora and indicated further work-up and sensitivity testing…

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 interviews the facility failed to develop a comprehensive behavioral care plan for Resident #53 sexual behaviors. This affected one resident (Resident #53) of three residents reviewed for behavior care plans. Findings include: Review of the medical record for Resident #53 revealed an admission date of 05/12/23. Diagnoses included chronic obstructive pulmonary disease, major depressive disorder and generalized anxiety disorder. Review of the 5-day Minimum Data Set (MDS) assessment revealed Resident #53 required extensive assistance for bed mobility, dressing and personal hygiene. He was totally dependent for transfers and toilet use. He was independent for locomotion and eating. He was cognitively intact and there were no behaviors noted. Review of October 2023's behavior tracking revealed Resident #53's exhibited behavior of making sexually inappropriate remarks. Review of Resident #53's care plan revealed there was no comprehensive care plan in place for any behaviors related to being sexually inappropriate or making inappropriate sexual comments to…

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

Based on review of Quality Assessment and Assurance (QAA) sign-in sheets, record review, facility policy and procedure review and interview the facility failed to ensure quarterly QAA meetings were conducted and failed to ensure all required members, including the Medical Director (MD) participated/attended the meetings as required. This had the potential to affect all 58 residents residing in the facility. Findings include: Review of an undated facility Quality Assessment Performance Improvement (QAPI) member list revealed the MD was listed as a member of the facility QAPI committee. The QAPI list revealed the following facility staff/positions were part of the QAPI committee: The Administrator, Director of Nursing, Medical Director (MD), Clinical Director, Nurse Aide Supervisor, QA Coordinator, Nutrition Services Director, Restorative Supervisor, Wound Nurse, Social Services, Pharmacy and Laboratory. The Activity Director, Maintenance Director, MDS, Admissions Director, Housekeeping/Laundry Supervisor, and Rehabilitation Director were included on the facility monthly meeting list.…

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 policy and procedure review and interview the facility failed to ensure Resident #3, Resident #5, Resident #9 and Resident #27, who required staff assistance with activities of daily living (ADL) care received timely and adequate nail care to maintain proper hygiene. This affected four residents (#3, #5, #9 and #27) of five residents reviewed for activities of daily living. Findings include: 1. Review of Resident #3's medical record revealed a 02/28/17 admission date with diagnoses including hypokalemia, major depressive disorder, osteoarthritis, hypothyroidism, Alzheimer disease, dementia, chronic kidney disease, need for assist with personal care and anxiety. A plan of care, dated 03/20/19 revealed resident care would be provided according to the plan. An intervention revised 07/13/21 included grooming and hygiene would be provided with assist of one (staff). Review of the 07/02/22 annual Minimum Data Set (MDS) 3.0 assessment revealed the resident was moderately impaired for daily decision making, totally dependent on two staff for bed…

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, manufacturer guidelines review, facility policy and procedure review and interview the facility failed vials of Tuberculin were dated when opened. This affected six residents (#25, #54, #109, #110, #111 and #208) of 58 residents residing in the facility. Findings include: On 09/28/22 at 10:00 A.M. observation of the East medication room refrigerator revealed an opened multi use vial of Tuberculin (purified protein derivative (PPD)) solution, used to detect tuberculosis disease. The bottle did not contain a date when it had been opened. The label indicated the vial was dispensed from the pharmacy on 04/28/22. Directions on the label included discard after 30 days once opened. On 09/28/22 at 10:16 A.M. interview with Licensed Practical Nurse (LPN) #81 confirmed the Tuberculin vial was open and was not dated as to when it had been opened. On 09/28/22 at 10:22 A.M. observation of the North medication room revealed an opened multi use vial of Tuberculin (purified protein derivative (PPD)) solution. The bottle did not contain a date when it had been opened. The label…

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 interview the facility failed to ensure residents who were within $200.00 of the Social Security Income (SSI) resource limit of $2,000.00 were appropriately assisted in spending down the money so the resident did not lose their Medicaid eligibility. This affected one resident (#23) of two residents reviewed for personal fund account spend down. Findings include: Review of Resident #23's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including respiratory diseases, hypertension, depression and dementia. Record review revealed the resident did not have a financial power of attorney or legal guardian. Review of Resident #23's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/14/22 revealed the resident was moderately cognitively impaired. Review of Resident #23's personal funds account revealed on 09/29/22 the resident had a balance of $2,364.38 in her personal funds account. As of 11/03/21 Resident #23's account had exceeded 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 and interview the facility failed to ensure Resident #17 was free from financial exploitation by Former Dietary Aide (DA) #155. This affected one resident (#17) of one resident reviewed for misappropriation/exploitation. Findings include: Review of the medical record for Resident #17 revealed the resident was admitted on [DATE] with diagnoses including encounter for orthopedic aftercare following surgical amputation of left great toe, history of a stroke, type II diabetes and peripheral vascular disease. Review of a facility Self-Reported Incident (SRI), tracking number 218531 initiated 03/02/22 revealed DA #155 asked to borrow $200.00 from Resident #17. The DA reported this to Former Business Office Manager (BOM) #150 on 02/18/22. She was told by the BOM that she should not have done that and needed to give the money back. The DA claimed to have returned the money on 02/19/22 when she placed an envelope with $200.00 in the resident's top drawer. However, no money was found in 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 and interview the facility failed to ensure an allegation of financial exploitation involving Resident #17 by former Dietary Aide (DA) #155 was reported to the Administrator timely and failed to ensure the incident was reported to the State agency timely and as required. This affected one resident (#17) of one resident reviewed for misappropriation/exploitation. Findings include: Review of the medical record for Resident #17 revealed the resident was admitted on [DATE] with diagnoses including encounter for orthopedic aftercare following surgical amputation of left great toe, history of a stroke, type II diabetes and peripheral vascular disease. Review of a facility Self-Reported Incident (SRI), tracking number 218531 initiated 03/02/22 revealed DA #155 asked to borrow $200.00 from Resident #17. The DA reported this to Former Business Office Manager (BOM) #150 on 02/18/22. She was told by the BOM that she should not have done that and needed to give the money back. The DA claimed to have…

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, facility policy and procedure review and interview the facility failed to ensure Resident #29 was provided timely nutritional intervention following a significant weight loss. This affected one resident (#29) of one resident reviewed for weight loss. The facility identified 11 residents with unplanned weight loss or gain. Findings include: Review of Resident #29's medical record revealed a 12/18/03 admission dated with diagnoses including cerebral palsy, Alzheimer's disease, moderate intellectual disabilities, Stage III (full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed) pressure ulcer to right buttock, peripheral vascular disease, anemia, Vitamin D deficiency, gastroesophageal reflux disease and dysphagia. Review of the physician's orders revealed a diet order, dated 03/21/19 for no concentrated sweets diet, pureed texture, regular/thin consistency liquids related to dysphagia oropharyngeal phase. An order, dated 05/13/19 for Arginaid…

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, policy and interview and interview the facility failed to ensure care plans were developed for oxygen use and failed to ensure oxygen tubing was properly dated and/or changed to maintain proper infection control practices. This affected two resident (#3 and #5) of two residents reviewed for respiratory care. The facility identified four residents with respiratory treatments. Findings include: 1. Review of Resident #3's medical record revealed a 02/28/17 admission date with diagnoses including hypokalemia, major depressive disorder, osteoarthritis, hypothyroidism, Alzheimer's disease, dementia, chronic kidney disease and need for assist with personal care and anxiety. Review of the 07/02/22 annual Minimum Data Set (MDS) 3.0 assessment revealed the resident was moderately impaired for daily decision making, totally dependent on two staff for bed mobility and transfers and required extensive assistance from one staff for personal hygiene. The assessment revealed the resident had no behaviors. The resident was on anti-psychotic medication,…

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, and staff interview, the facility failed to properly disinfect the blood sugar testing device, a glucometer. This had the potential to affect eight residents (Resident's #16, #29, #41, #49, #52, #54, #65 and #169) receiving glucometer testing with the glucometer in the medication cart for the East hall and [NAME] short hall. The facility census was 65. Findings include: Observation on 09/10/19 at 3:33 P.M. of glucometer testing, blood sugar testing, was conducted with Licensed Practical Nurse (LPN) #14 on the [NAME] hall. There was one glucometer in the medication cart for use for the residents who received medications from the cart. The cart was used for medications for residents residing on the East and [NAME] halls. LPN #14 indicated the meter had already been cleaned. LPN #14 performed a glucometer test on Resident #29. LPN #14 returned to the medication cart, opened the bottom drawer and pulled out a Clorox bleach wipe manufactured for Clorox Professional Products Company. LPN #14 wiped the surfaces of the outside of the glucometer for less…

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 interview the facility failed to notify the physician when Resident #20 left on a leave of absence (LOA) without her prescribed continuous oxygen. This affected one of three residents reviewed for respiratory care. The facility census was 65. Findings include: Medical record review revealed Resident #20 was admitted on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), bipolar disease, and anxiety. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 07/09/19 revealed a Brief Interview for Mental Status (BIMS) score of 15, indicating she was alert, oriented and had intact cognition. The MDS further revealed she was receiving oxygen therapy and had not exhibited any rejection of care behaviors. Review of a physician order, dated 07/09/19, revealed staff were to administer continuous oxygen at one to four liters per nasal cannula, to maintain her oxygen saturation levels above 90%. Review of a nursing progress note, dated 06/05/19, revealed Licensed…

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 accurately stage Resident #45's pressure ulcer. This affected one of three residents reviewed for pressure ulcers. The facility census was 65. Findings include: Medical record review revealed Resident #45 was admitted on [DATE] with diagnoses including hemiplegia (weakness affecting one side of the body), dementia, and diabetes mellitus. Review of Resident #45's skin/wound assessment note, dated 08/14/19, revealed a pressure ulcer located on the right buttock. It was listed as a Stage 1, an area of intact skin with a localized area of non-blanchable erythema (redness) which in darker skin tones, may appear with persistent red, blue, or purple hues. Measurements were documented as 0.7 centimeters (cm) long by 0.8 cm wide and 0.2 cm deep. The wound was described as being beefy red with granulation tissue noted. The skin/wound assessment incorrectly identified this pressure ulcer as a Stage 1, which would have intact skin. This assessment…

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 and interview, the facility failed to ensure fall safety measures were in place and the plan of care updated for a resident with a history of falls. This affected one (Resident #59) of one resident reviewed for accidents. Findings include: Review of Resident #59 revealed an admission date of 02/12/19. Current diagnoses included dislocation of internal right hip prosthesis, high blood pressure, depression, legally blind, abnormal posture, muscle weakness, lack of coordination, displaced fracture of base of neck of right femur, osteoarthritis, senile degeneration of brain, wedge compression fracture of lumbar vertebra, osteoporosis, chronic kidney disease and repeated falls. The admission Morse Fall Risk assessment indicated the resident was a high fall risk due to previous falls, diagnoses, use of wheelchair and weakness while walking. Review of the 08/09/19 quarterly Minimum Data Set (MDS) assessment revealed Resident #59 was severely cognitively impaired for daily decision making, required extensive assistance of two staff for bed mobility,…

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 interview, the facility failed to provide medically-related social services to obtain necessary medical equipment for Resident #20 to use for during a personal leave of absence (LOA) from the facility. This affected one of three residents reviewed for respiratory care. The facility census was 65. Findings include: Medical record review revealed Resident #20 was admitted on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), bipolar disease, and anxiety. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 07/09/19 revealed a Brief Interview for Mental Status (BIMS) score of 15, indicating Resident #20 was alert, oriented and had intact cognition. The MDS further revealed she was receiving oxygen therapy and had not exhibited any rejection of care. Review of a physician order, dated 07/09/19, revealed an order for continuous oxygen at one to four liters per nasal cannula, to maintain oxygen saturation levels above 90%. Review of a nursing progress note,…

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 interview, the facility failed to ensure the attending physician documented rationale in the resident's medical record when declining recommendations by the pharmacist. This affected one (Resident #22) of five residents reviewed for unnecessary medications. Findings include: Review of Resident #22 revealed an admission date of 04/26/17 with diagnoses including vascular dementia with behavioral disturbance, depression, insomnia, dementia with psychosis, and vascular dementia with delusions and delusional disorder. Review of the 07/10/19 quarterly minimum data set assessment revealed the resident was moderately cognitively impaired for daily decision making and displayed no behaviors. This assessment indicated Resident #22 had moods including having little interest or pleasure in doing things, feeling down, and feeling tired or having little energy. There was no evidence of hallucinations, delusions or behaviors. Resident #22 was coded as receiving antipsychotic, antidepressant medications in the seven day look back period. Physician orders included a…

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

Based on record review and interview, the facility failed to ensure gradual dose reductions were attempted for antipsychotic medications and failed to monitor behaviors for Resident #22. This affected one of five residents reviewed for unnecessary medications. Findings include: Review of Resident #22 revealed an admission date of 04/26/17 with diagnoses including vascular dementia with behavioral disturbance, depression, insomnia, dementia with psychosis, and vascular dementia with delusional and delusional disorder. A diagnosis of dementia with psychosis was added 05/09/17. Physician orders included an order on 11/11/17 for Remeron, an antidepressant, 45 milligrams (mg) for depression and an order on 11/13/17 for Seroquel, an antipsychotic, 25 mg three times a day for vascular dementia with behavioral disturbance. On 11/27/17 a physician progress note indicated Resident #22 had vascular dementia with delusions and delusional disorder. Pharmacy recommendations on 10/09/18 and 04/11/19 recommended the physician attempt a dose reduction for the antipsychotic, Seroquel 25 mg. These…

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.