Sanctuary At Wilmington Place

Based on medical record review, hospital documentation review, staff interview, and review of a facility policy, the facility failed ensure medications were available to administer as ordered. This affected one (#13) of three residents received for medication administration. The census was 54. Findings Included: Review of Resident #13's medical record revealed an admission date of 12/15/24. Diagnoses included chronic obstructive pulmonary disease, asthma, diabetes mellitus type II, atrial fibrillation, and bipolar disorder. Review of a hospital discharge document dated 12/15/24 revealed Resident #13 had a medication order for the decongestant guaifenesin 600 mg one tablet every 12 hours. Review of a physician order dated 12/17/24 revealed Resident #13 was ordered guaifenesin extended release 600 mg one tablet twice daily for cough for seven days. Review of a nursing progress note dated 12/17/24 by Registered Nurse (RN) #219 revealed Resident #13's guaifenesin 600 mg extended release tablet twice a day for seven days for cough was on order. Review of Resident #13's December 2024…

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, hospital documentation review, resident and staff interview, review of a photograph of a medication package, review of a contingent medication inventory list, and review of a facility policy, the facility failed to ensure medications were administered as ordered to prevent significant medication errors. This affected one (#13) of three residents reviewed for medication administration. The facility census was 54. Findings Included: Review of Resident #13's medical record revealed an admission date of 12/15/24. Diagnoses included chronic obstructive pulmonary disease, asthma, diabetes mellitus type II, atrial fibrillation, and bipolar disorder. Review of a hospital discharge document dated 12/15/24 revealed Resident #13 had medication orders for the diuretic furosemide 20 milligrams (mg) by mouth once a day and the steroid Medrol dose package (pack) four (4) mg with instructions to follow the dose pack. Review of physician orders dated 12/16/24 revealed Resident #13 was ordered Medrol 4 mg two (2) tablets in the morning scheduled for 9:00 A.M., 2…

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, staff and resident interview, and policy review, the facility failed to ensure the appropriate size brief was provided to the residents who require and prefer a specific size brief. This affected two (#8 and #16) of two residents reviewed for briefs. The facility census was 60. Findings include: 1. Medical record review for Resident #7 revealed an admission date of 03/20/17. Diagnoses included cerebrovascular attack, coronary artery disease, and morbid obesity. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7 was cognitively intact. Resident #7 was dependent on staff for toileting and was incontinent for bowel and bladder. Interview with Resident #7 on 11/21/24 at 3:21 P.M. revealed the nursing aides do not provide her with a brief that fits. She has asked many times for a three x-large (XML) brief and the facility doesn't have them. Observation of Resident #7 on 11/21/24 at 3:30 P.M. with Certified Nursing Aide (CNA) #169…

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 interview, and policy review the facility failed to ensure a change of condition was reported to the physician. This affected one (#64) of three residents reviewed for change of condition. The facility census was 60. Findings include: Medical record review for Resident #64 revealed an admission date of 08/06/24. Diagnoses included aftercare for a displaced supracondylar fracture with intercondylar extension of lower end of right femur, diabetes mellitus, arthritis, and cerebrovascular accident. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #64 was cognitively intact. Review of the Physical Therapy (PT) notes dated 08/12/24, 08/16/24, 08/20/24, 08/21/24, and 08/22/24 revealed Resident #64 was bleeding from her surgical incision site to her right lower extremity. These notes were absent for notifying the physician of the bleeding. Review of the Occupational Therapy (OT) notes dated 08/12/24, 08/22/24, and 08/30/24 revealed 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 medical record review, observation, staff interview, and policy review, the facility failed to ensure incontinence care was provided appropriately and thoroughly. This affected one (Resident #7) of three residents reviewed for incontinence. The facility census was 60. Findings include: Medical record review for Resident #7 revealed an admission date of 03/20/17. Diagnoses included cerebrovascular attack, coronary artery disease, and morbid obesity. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7 was cognitively intact. Resident #7 was dependent on staff for toileting and was incontinent for bowel and bladder. Interview with Resident #7 on 11/21/24 at 3:21 P.M. revealed the aides do not clean her very good when they provide her with incontinence care. Observation of incontinence care for Resident #7 on 11/24/24 at 6:40 A.M. with Certified Nursing Aide (CAN) #186 and CNA #188 revealed CNA #186 took a end of the bath towel and wet it and placed soap in the cloth…

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, and policy review, the facility failed to ensure residents were administered the COVID-19 vaccine when requested. This affected one (#7) of three residents reviewed for vaccines. The facility census was 60. Findings included: Medical record review for Resident #7 revealed an admission date of 03/20/17. Diagnoses included cerebrovascular attack, coronary artery disease, and morbid obesity. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7 was cognitively intact. Review of the vaccine consent form dated 11/05/24 revealed Resident #7 had read the above information concerning risks for vaccines and had an opportunity to ask questions. The form was checked mark the resident requested to have two COVID-19 vaccines administered. Review of the progress notes and the Medication Administration Record (MAR) from 11/05/24 through 11/25/24 revealed no evidence the COVID-19 vaccines were administered to Resident #7.…

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 resident and staff interviews, the facility failed to ensure residents were assisted with arranging transportation to physician appointments. This affected one (#52) of three residents reviewed for appointments. The censes was 57. Findings include: Review of Resident #52's medical record revealed an admission dated of 12/27/23. Diagnoses listed include type two diabetes mellitus, chronic obstructive pulmonary disease, chronic viral hepatitis, hypertension, and osteoarthritis of the hip. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #52 was cognitively intact with a brief interview for mental status (BIMS) score of 14 out of a possible 15. Review of physician orders revealed an order dated 12/28/23 for schedule an appointment with ortho (orthopedic physician). An order dated 01/19/24 was for schedule a follow-up with cardiologist (heart physician). Review of progress notes and transportation information revealed Resident #52 had yet to be…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, review of facility self-reported incidents (SRI's), staff interviews and policy review, the facility failed to timely report an allegation involving misappropriation of resident's medications to the Ohio Department of Health as required. This affected one (#18) out of three residents reviewed for misappropriation. Facility census was 53. Findings include: Review of medical record for Resident #18 revealed admission date of 09/13/23. Diagnoses include wedge compression fracture, hypertension and depression. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #18 had impaired cognition. He required partial assistance for eating and substantial assistance for bed mobility, transfers and toileting. Review of Resident #18's physician orders revealed an order for Oxycodone (narcotic for pain) five milligram (mg) capsule every six hours as needed for pain with a start date of 09/13/23. Further review of the controlled substance record sign out sheet from 09/27/23 through 10/16/23…

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 interviews, the facility failed to ensure residents received timely incontinence care. This affected one (#22) of three residents reviewed for incontinence care. Facility census was 53. Findings include: Review of medical record for Resident #22 revealed admission date of 05/21/23. Diagnoses include prostate cancer, dementia, peripheral vascular disease, depression, anxiety, contact and expected exposure to other hazardous substances (agent orange), non-pressure chronic ulcer of right lower leg and left lower leg. The resident remains in the facility. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #22 had a Brief Interview Mental Status (BIMS) score of 11 out of 15 indicating impaired cognition. He required set up for eating, maximum assistance for toileting, lying to sitting and dependent for transfers. Review of Resident #22's care plan for alteration in elimination was last revised on 07/26/23 with an intervention 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 staffing schedule and staff interview, the facility failed to ensure Registered Nurse (RN) services were used for at least eight consecutive hours a day seven days a week. This had the potential to affect all 58 residents in the facility. The facility census was 58. Findings include: Review of the staffing schedule, dated 12/10/22, revealed no Registered Nurse (RN) was present in the facility on 12/10/22. Interview with Corporate Registered Nurse (CRN) #81 on 12/20/22 at 10:03 A.M. verified the facility did not have an RN present in the facility for eight consecutive hours on 12/10/22. This deficiency represents non-compliance investigated under Complaint Number OH00138026.

Based on review of personnel files and staff interview, the facility failed to complete nurse aide performance reviews at least every 12 months for two State Tested Nurse Aides. This had the potential to affect all 58 residents in the facility. The facility census was 58. Findings include: Review of State Tested Nurse Aide (STNA) #02's personnel file revealed STNA #02 was hired at the facility on 10/01/19. Further review of STNA #02's personnel file revealed STNA #02 did not have any performance reviews completed from 10/01/21 to 12/21/22. Review of STNA #14's personnel file revealed STNA #14 was hired at the facility on 05/24/16. Further review of STNA #14's personnel file revealed STNA #14 did not have any performance reviews completed from 05/24/21 to 12/21/22. Interview on 12/21/22 at 10:50 A.M. with Human Resources (HR) #32 verified STNA #02 and STNA #14 did not have performance reviews completed at least once every 12 months. Review of the facility's undated Evaluation policy revealed the facility will complete formal written work performance evaluations of employees annually.

Based on observation, staff interview, and policy review, the facility failed to ensure hair nets were worn appropriately, proper hand hygiene was followed, and food items were maintained in a sanitary manner in the kitchen. This had the potential to affect all 58 residents who received meals from the kitchen. The facility census was 58. Findings include: 1. Observation of the kitchen on 12/18/22 at 8:33 A.M. revealed a gallon zip lock bag of raw chicken which was open to air and dated 12/22/22 sitting on a pan in the walk in refrigerator. The observation further revealed an open undated bag of shredded cheese, an open undated package of American singles, an open undated and unlabeled bag of white substance, and an open undated package of bologna sitting on the shelf in the walk in refrigerator. Further observation of the kitchen revealed an opened undated box of hamburger patties which was open to air and an opened and undated box of tilapia filets in the walk in freezer. Interview with [NAME] #09 on 12/18/22 at 8:33 A.M. verified there was a gallon zip lock bag of raw chicken…

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 personnel files, staff interview, and policy review, the facility failed to ensure the facility was administered in a manner to prevent the falsification of documentation. This had the potential to affect all 58 residents who resided at the facility. The facility census was 58. Findings include: Review of the Administrator's personnel file revealed the Administrator was hired at the facility on 08/22/22. Further review of the Administrator's personnel file revealed the Administrator had a physical date of 08/20/22 that had all original ink except for the signature of Nurse Practitioner #83 which was a copied signature and appeared to be a part of the original form. Review of State Tested Nurse Aide (STNA) #22's personnel file revealed STNA #22 was hired at the facility on 06/01/22. Further review of STNA #22's personnel file revealed STNA #22 had a physical date of 06/02/22 that had all original ink except for the signature of Nurse Practitioner #83 which was a copied signature and appeared to be a part of the original form. Review of STNA #67's personnel file…

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 #15's medical record revealed Resident #15 was admitted to the facility on [DATE] with diagnoses including but not limited to chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, nontraumatic subarachnoid hemorrhage from unspecified intracranial artery, and atherosclerotic heart disease of native coronary artery without angina pectoris. Review of Resident #15's significant change MDS assessment, dated 10/05/22, revealed Resident #15 was cognitively intact. Review of Resident #15's code status care plan, dated 10/31/22, revealed Resident #15 was a Do Not Resuscitate Comfort Care Arrest (DNRCCA). Interventions included code status orders reviewed as needed, offer religious services per advanced care planning preferences, and review advanced care planning wishes upon admission, quarterly and as needed. Review of Resident #15's code status in the paper chart on 12/18/22, revealed Resident #15 was a DNRCC. Further review of the code status form revealed Resident #15'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.

Based on review of menu spreadsheets, observation, staff interview, and policy review, the facility failed to ensure residents received meals according to the menu spreadsheet. This affected all 52 residents residing in the facility who received a regular or mechanical soft diet. The facility identified six residents (#3, #14, #16, #19, #20, and #104) who did not receive a regular or mechanical soft diet. The facility census was 58. Findings include: Review of the undated menu spreadsheet revealed regular diets and mechanical soft diets were to receive four ounces (oz) of ham and cheese strata, a slice of toast, and six oz of cold cereal or oatmeal. Observation of tray line on 12/19/22 at 7:52 A.M. revealed [NAME] #09 was serving regular diets and mechanical soft diets three oz of ham and cheese strata, a slice of toast, and six oz of cold cereal or oatmeal. Interview with Dietary Manager #05 and [NAME] #09 on 12/19/22 at 8:13 A.M. verified the residents on regular diets and mechanical soft diets were served three oz of ham and cheese strata instead of the four oz of ham and cheese…

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 #15's medical record revealed Resident #15 was admitted to the facility on [DATE] with diagnoses including but not limited to chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, nontraumatic subarachnoid hemorrhage from unspecified intracranial artery, and atherosclerotic heart disease of native coronary artery without angina pectoris. Review of Resident #15's significant change MDS assessment, dated 10/05/22, revealed Resident #15 was cognitively intact. Review of Resident #15's code status care plan, dated 10/31/22, revealed Resident #15 was a Do Not Resuscitate Comfort Care Arrest (DNRCCA). Interventions included code status orders reviewed as needed, offer religious services per advanced care planning preferences, and review advanced care planning wishes upon admission, quarterly and as needed. Review of Resident #15's code status in the paper chart on 12/18/22, revealed Resident #15 was a DNRCC. Further review of the code status form revealed Resident #15'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, staff interview, and policy review, the facility failed to ensure residents and/or resident representatives were provided Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN) when required. This affected two (#33 and #46) out of three residents reviewed for beneficiary notices. The facility census was 58. Findings include: 1. Review of Resident #33's medical record revealed Resident #33 was admitted to the facility on [DATE] with diagnoses including but not limited to type two diabetes mellitus without complications, unspecified dementia unspecified severity without behavioral disturbance, contracture of muscle of the left lower leg, and contracture of muscle right lower leg. Review of Resident #33's quarterly Minimum Data Set (MDS) assessment, dated 11/09/22, revealed Resident #33 was severely cognitively impaired. Review of Resident #33's payer source documentation revealed Resident #33 was on Medicare Part A with a last covered day of 11/09/22. 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 staff interview, medical record review, and policy review, the facility failed to provide residents and/or resident representatives with bed hold notices upon transfer to the hospital. This affected two (#15 and #43) out of six residents reviewed for hospitalizations. The facility census was 58. Findings include: 1. Review of Resident #15's medical record revealed Resident #15 admitted to the facility on [DATE] with diagnoses including chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, nontraumatic subarachnoid hemorrhage from unspecified intracranial artery, hypertension, displaced fracture of shaft of right clavicle, atherosclerotic heart disease of native coronary artery without angina pectoris. Review of Resident #15's significant change Minimum Data Set (MDS) assessment, dated 10/05/22, revealed Resident #15 was cognitively intact. Review of Resident #15's progress note, dated 09/26/22, revealed Resident #15 was sitting in the front lobby at 10:15 A.M. and was unable…

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 staff interview, the facility failed to ensure medications were administered according to physician order. This affected one (#26) out of five residents reviewed for unnecessary medications. The census was 58. Findings include: Medical record review for Resident #26 revealed an admission date of 09/30/20. Resident #26's medical diagnoses included respiratory failure, heart failure, hypertension, orthostatic hypotension, and peripheral vascular disease. Review of Resident #26's physician orders, dated 11/27/22, revealed an order for Midodrine HCl (medication used to treat orthostatic hypotension) oral tablet, give 10 milligram (mg) by mouth every eight hours related to hypotension. Hold if systolic (the first number in a blood pressure reading) blood pressure was above 110. Review of Resident #26's Medication Administration Record (MAR) from 12/01/22 through 12/21/22 revealed for the 6:00 A.M. dose of Midodrine, Resident #26's blood pressure (BP) on 12/07/22 was 125/75, on 12/08/22 was 119/70, on 12/12/22 was 121/80, on 12/14/22 was 128/45, 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.

Based on medical record review and staff interview, the facility failed to ensure a monthly medication reviews were completed monthly by a licensed pharmacist. This affected two (#26 and #39) of five residents reviewed for unnecessary medications. The census was 58. Findings include: 1. Medical record review for Resident #26 revealed an admission date of 09/30/20. Medical diagnoses included respiratory failure, heart failure, hypertension, orthostatic hypotension, and peripheral vascular disease. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/21/22, revealed Resident #26 was cognitively intact. Resident #26's required extensive assistance for bed mobility, transfers, toilet use, and supervision for eating. Review of the monthly pharmacy reviews since 01/01/22 revealed there was no evidence of a monthly pharmacy review having been completed by a licensed pharmacist since June 2022. Interview with the Minimum Data Set Licensed Practical Nurse (MDSLPN) #82 on 12/21/22 at 1:20 P.M. confirmed Resident #26 did not have a monthly pharmacy review since June 2022. 2.…

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, resident and staff interview, and policy review, the facility failed to ensure a resident with dental issues received routine dental care. This affected one (#43) out of two residents reviewed for dental services. The facility census was 58. Findings include: Review of Resident #43's medical record revealed Resident #43 was admitted to the facility on [DATE] with diagnoses including heart failure, diverticulosis of large intestine without perforation or abscess without bleeding, type two diabetes mellitus with diabetic polyneuropathy, unspecified osteoarthritis, cervicalgia, rectal abscess, other specified abdominal hernia with obstruction, peptic ulcer, major depressive disorder, and hypertension. Review of Resident #43's quarterly Minimum Data Set (MDS) assessment, dated 10/11/22, revealed Resident #43 was cognitively intact. Resident #43 had a broken or loosely fitting full or partial denture that was chipped, cracked, uncleanable, or loose. Review 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.

Based on observation and staff interview, the facility failed to ensure the kitchen was maintained in a sanitary manner, food was stored off the floor, and food was dated and labeled. This affected 59 of 60 residents who receive food from the kitchen (Residents #11 received nothing by mouth). Findings include: Observations of the kitchen on 11/24/19 from 8:15 A.M. through 8:47 A.M. revealed there was a black, hairy, removable substance on the wall above the sink area. There was also a black, hairy, removable substance inside the ice machine. The refrigerator had a package of uncooked meat that was not dated. Observation of the dry storage area revealed the following items were stored on the floor: one case of peanut butter snack crackers on floor, one case of saltine crackers, one case of dry noodles, one case of individual mustards, one case individual pudding in cups and one case of canned tomato juice. Observation of the facility freezer revealed the following items were stored on the freezer floor: two cases of turkeys, packed four to a case, one case of frozen vegetables, one…

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, resident and staff interview, review of Centers for Disease and Control Prevention (CDC) guidelines and policy review, the facility failed to ensure standard infection control practices were followed for the residents. This affected one (#4) of three residents reviewed for infections. The facility additionally failed to provide monitoring of their water management plan to assist in the prevention of Legionella. This had the potential to affect all 60 residents residing in the facility. Findings Include: 1. Review of Resident #4's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included cellulitis of upper and multiple myeloma. Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/19/19, revealed the resident was cognitively intact and had no delusions, hallucinations or behaviors. Review of the physician orders, dated 11/22/19, revealed the resident had the following orders for caladryl lotion 1-8% apply to rash on the left…

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 store medications, inhalation medications and nutritional supplements according to their expiration dates. This had the potential to affect six residents (#11, #15, #26, #31, #44 and #110) who were identified as having used inhalation medications and seven residents (#20, #27, #33, #38, #43, #45 and #111) as having used nutritional supplements by the facility. The facility census was 60. Findings include: Observation on [DATE] at 11:42 A.M. with Licensed Practical Nurse (LPN) #701 revealed a medication storage room on the 300 and 400 hall. Inside the medication storage room, there were 20 containers of Boost Plus Creamy Strawberry nutritional supplements dated [DATE] and four containers of Med Pass 2.0 Butter Pecan Flavor Nectar Consistency Nutritional Supplement dated [DATE]. Further observation with LPN #701 revealed inside the refrigerator of the 300 and 400 hall medication storage room, there was one box of 10 each 25 milligrams…

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 staff interview, the facility failed to have an accurate advance directive status for one (#40) of 24 residents reviewed in the initial pool during the annual survey. The facility census was 60. Findings include: Medical record review for Resident #40 revealed an admission date of 06/20/19. Diagnoses included peripheral vascular disease, osteomyelitis of vertebra lumbar region, hypertensive heart and chronic kidney disease with heart failure and stage one through four chronic kidney disease, Methicillin resistant staphylococcus aureus infection, acute kidney failure and Charcot's joint. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/28/19, revealed the resident's cognition was slightly impaired. Review of the resident's electronic physician orders, dated 06/20/19, revealed an order for the advanced directive status of full code. Review of the resident's hard chart revealed a signed Do Not Resuscitate Comfort Care Arrest (DNRCCA) form dated 04/18/19. Interview on 11/25/19 at 11:24 A.M. with Licensed Practical Nurse (LPN) # 701…

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 facility staff interview, the facility failed to accurately assess residents on their Minimum Data Set assessments. This affected two (#11 and #48) of 20 resident records reviewed. The total facility census was 60. Findings include: 1. Review of Resident #48's medical record revealed the resident was admitted to the facility on [DATE]. Review of the physician orders, dated 10/17/19, revealed Resident #48 had a new order for Seroquel (antipsychotic) 25 milligrams (mg.) by mouth daily at 2:00 P.M. for dementia with psychosis. Review of the most recent Minimum Data Set (MDS) assessment, dated 11/09/19, revealed the resident was not coded to have the recently new diagnosis of dementia with psychosis. During an interview with Registered Nurse #703 on 11/26/19 at 11:09 A.M., it was verified the resident did not have dementia with psychosis coded on the MDS assessment dated [DATE] when the resident had the diagnosis added as indication for use with the antipsychotic medication Seroquel 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.