Widows Home Of Dayton

Based on medical record review, resident interview, staff interview, and review of the facility policy, the facility failed to ensure care conferences were completed as required. This affected four (Residents #10, #23, #40, and #56) of five residents reviewed for care conferences. The facility failed to ensure care plans were updated following a change in condition. This affected two (Residents #10 and #48) of 19 residents reviewed for care planning. The facility census was 68. Findings include: 1. Review of the medical record of Resident #10 revealed an admission date of 09/04/21 with diagnoses including congestive heart failure (CHF), type two diabetes mellitus, chronic obstructive pulmonary disease (COPD), depression, and schizoaffective disorder. Review of the Minimum Data Set (MDS) assessment for Resident #10 dated 04/07/25 revealed the resident had intact cognition and required staff assistance with activities of daily living. Review of a progress note for Resident #10 dated 10/10/24 revealed the resident and her family were invited to a care conference that was scheduled 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 observation and interview the facility failed to maintain a safe, functional, and sanitary environment in the common areas of the facility. This had the potential to affect all of the residents residing in the facility. The facility census was 68 residents. Findings include: 1.Observation on 05/18/25 at 4:55 P.M. revealed the cove base in the entrance to the rehab hallway was ripped and torn. There were also multiple missing floor tiles. Interivew on 05/18/25 at 4:55 P.M. with Certified Nursing Assistant (CNA) #377 confirmed the cove base to the walls near the entrance to the rehab unit was ripped and torn and there were multiple missing floor tiles. CNA #377 confirmed the floor was in disrepair and presented a trip hazard to residents, staff, and visitors. 2. Observation on 05/21/25 at 3:23 P.M. with Maintenance Supervisor (MS) #307 revealed the ceiling light to the entrance of the rehab unit was not working and the cover to the light fixture was broken. Interview on 05/21/25 at 3:23 P.M. with MS #307 confirmed the ceiling light to the entrance of the rehab unit was in 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, review of resident fund records, staff interview, and review of the facility policy, the facility failed to transfer funds upon death to a resident's estate within thirty days. This affected one (Resident #127) of five residents reviewed for personal funds. The facility census was 68 residents. Findings include: Review of the medical record for Resident #127 revealed an admission date of [DATE] with diagnoses including anemia, atrial fibrillation, hypertension, dementia, and depression. Resident #127 expired in the facility on [DATE]. Review of the resident fund account records revealed the facility sent a dated [DATE] to the estate of Resident #127 with a check containing the balance of $245.51 from the resident's fund account with the facility. Interview on [DATE] at 11:04 A.M. with Business Office Manager (BOM) #310 confirmed Resident # 127 expired on [DATE] in the facility and the facility did not refund balance of $242.51 from the resident's fund account to the resident'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 medical record review, observation, staff interview, and review of the facility policy, the facility failed to properly store medications in a safe and secure manner. This affected one (Resident #62) of 19 residents sampled. The facility census was 68 residents. Findings include: Review of the medical record for Resident #62 revealed an admission date of 04/13/25 with diagnoses including polyneuropathy, congestive heart failure, hypertension, and acute respiratory failure with hypoxia. Review of the Minimum Data Set (MDS) assessment for Resident #62 dated 05/08/25, revealed the resident was cognitively intact and required staff assistance with activities of daily living (ADLs.) Review of the physician's orders for Resident #62 dated May 2025 revealed no orders for cranberry supplement, probiotic tablets, Refresh Tears eye drops, Replenish eye drops, Ketorolac eye drops, multivitamin capsules, and Tums tablets. Review of the Medication Administration Record (MAR) for Resident #62 dated May 2025 revealed there was no documentation of administration of the following…

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 interview, observation, staff interview, and review of the facility policy, the facility failed to ensure resident meal preferences were honored. This affected one (Resident #23) of 19 residents sampled. The facility census was 68 residents. Findings include: Review of the medical record for Resident #23 revealed an admission date of 01/25/25 with diagnoses including fracture of the left humerus, post-traumatic stress disorder, depression, and glaucoma. Review of the Minimum Data Set assessment for Resident #23 dated 05/02/25 revealed the resident was cognitively intact. Review of the lunch order for Resident #23 dated 05/19/25 revealed the resident ordered a hot dog, mashed potatoes and fruit. Interview on 05/18/25 at 10:08 A.M. with Resident #23 confirmed she often did not receive what was written on the menu and would receive a peanut butter and jelly sandwich instead. Observation service on 05/19/25 at 12:59 P.M. of the lunch service revealed Resident #23 received mashed potatoes, fruit, and a peanut butter sandwich. Interview on 05/19/25…

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 and resident interviews, and policy review, the facility failed to ensure a medication was available for administration as ordered. This affected one (#51) resident out of the three residents reviewed for medications available from pharmacy for administration. The facility census was 62. Findings include: Review of the medical record for Resident #51 revealed an admission date of 08/14/24 with medical diagnoses of acquired absence of left below knee amputation (BKA), peripheral vascular disease, diabetes mellitus, and hypertension. Review of the medical record for Resident #51 revealed an admission Minimum Data Set (MDS) assessment, dated 08/21/24, which indicated Resident #51 was cognitively intact and required substantial/maximum staff assistance with toilet hygiene and transfers and partial/moderate staff assistance with bathing and bed mobility. Review of the medical record for Resident #51 a physician order dated 09/12/24 for Percocet 5-325 milligram (mg) give one tablet by mouth every four hours for pain. Review of the medical record 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 medical record review, staff interview, and policy review, the facility failed to ensure a resident was free from significant medication error. This affected one (#32) resident out of the three residents reviewed for medication administration. The facility census was 62. Findings include: Review of the medical record for Resident #32 revealed an admission date of 02/24/23 with medical diagnoses of myocardial infarction, cerebral infarctions, diabetes mellitus with neuropathy, spinal stenosis and congestive heart failure. Review of the medical record for Resident #32 revealed a quarterly Minimum Data Set (MDS) assessment, dated 09/24/24, which indicated Resident #32 was cognitively intact and required supervision with toilet hygiene, showers, bed mobility, and transfers. Review of the medical record for Resident #32 revealed a physician order dated 05/12/24 for Insulin Glargine 100 units per milliliter (ml), administer eight units subcutaneous (SQ) daily, an order dated 06/-2/24 for Insulin Lispro 100 units per ml, administer five units SQ before meals daily, and an order…

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 review of the facility policy, the facility failed to ensure nursing staff communicated with resident physicians regarding significant changes in status. This affected one (Resident #14) of three residents reviewed for notification of change. The facility census was 64 residents. Findings include: Review of the medical record for the Resident #14 revealed an admission date of 8/21/24 with diagnoses including periprosthetic fracture around internal prosthetic right hip joint, history of falling, heart failure, chronic obstructive pulmonary disease, and peripheral vascular disease. Resident #14 was discharged to the hospital on [DATE]. Review of the Minimum Data Set (MDS) assessment for Resident #14 dated 08/21/24 revealed the resident was cognitively intact and required extensive assistance of two staff members for bed mobility. Review of the admission assessment for Resident #14 dated 08/21/24 revealed the resident was admitted to the facility following…

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, observations, staff interviews and policy review, the facility failed to ensure a resident's enteral tube feeding orders were implemented as ordered. This affected one (#82) of three residents reviewed for enteral tube feeding. The facility census was 68. Findings include: Review of medical record for Resident #82 revealed admission date of 04/05/24. Diagnoses include chronic obstructive pulmonary disease, lupus, gastrostomy tube, and west nile virus. Resident #82 remains in the facility. Review of the physician orders dated 04/26/24 for Resident #82 revealed an order for Jevity (enteral nutrition) 1.5 calories at 70 milliliters (ml) an hour for 22 hours (12:00 P.M. to 10:00 A.M.). Review of the physician orders dated 04/26/24 for Resident #82 revealed an order for a 50 ml free water flush for 22 hours (12:00 P.M. to 10:00 A.M.). Interview on 05/01/24 at 10:00 A.M. with Licensed Practical Nurse (LPN) #109 stated the enteral nutrition order for Resident #82 was for the tube feeding to run continuously at 70 milliliters (ml) with a 250 milliliter flush every…

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, observations and staff interview, the facility failed to ensure medications were administered as physician ordered, resulting in three medication errors out of 31 opportunities or a 9.67 percent (%) medication error rate. This affected one (#80) of three residents observed for medication administration pass. The facility census was 68. Findings include: Review of medical record for Resident #80 revealed admission date of 02/27/24. Diagnoses include end stage renal disease, chronic obstructive pulmonary disease and stroke. Resident #80 remains in the facility. Review of Resident #80's physician orders revealed an order for ProRenal + D Oral Tablet (supplement)-give one tablet by mouth one time a day every Monday, Wednesday, and Friday for chronic kidney disease with a start date of 02/28/24; Acidophilus Capsule-give one capsule by mouth in the morning for gut health before breakfast with a start date of 02/28/2024 and Olopatadine Ophthalmic Solution 0.1 % (eye drops)-instill one drop in both eyes two times a day for allergies with a start date 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 review of staffing agency information, review of facility census, staff interview, staffing agency personnel interview, and review of the State of Ohio Nurse Aide Registry, review the Office of Health Assurance and Licensing (OHAL) website, the facility failed to ensure an aide had completed an approved nurse aide training and competency evaluation program (NATCEP) before working the facility. This affected one (Agency Aide #150) of three personnel files reviewed and had the potential to affect all 66 residents residing in the facility. The facility census was 66. Findings Include: Review of staffing information provided by the facility and a staffing agency revealed Agency Aide #150 worked in the facility from 09/13/23 through 12/22/23. Review of the State of Ohio Nurse Aide Registry revealed Agency Aide #150 was not registered as an state tested nursing assistant (STNA). Review of a NATCEP certificate provide by a staffing agency revealed Agency Aide #150 had completed a NATCEP program on 07/31/23. Review the OHAL website revealed the NATCEP program listed on Agency Aide…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of personnel record, staffing schedule information, review of facility census, staff interview, and review of the State of Ohio Nurse Aide Registry, the facility failed to ensure a state tested nursing assistant's (STNA) registration was not expired. This affected one (STNA #130) of three personnel files reviewed and had the potential to affect 17 (#39, #40, #41, #42, #43, #44, #45, #46, #47, #48, #49, #50, #51, #52, #53, #54, and #55) residents that STNA #130 regularly cared for. The facility census was 66. Findings Include: Review of STNA #130's personnel file revealed a hire date of [DATE]. Review of the State of Ohio Nurse Aide Registry revealed STNA #130 was not eligible to work in a long-term care facility due to not having work verification in the past 24 months. STNA #10's nurse aide registration expired on [DATE]. Review of staffing schedule information revealed STNA #130 worked in Rehab Unit on [DATE], [DATE], [DATE], and [DATE] from 7:00 A. M to 7:00 P.M. During an interview on [DATE]…

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 medial record review, staff interview, and review of facility policy, the facility failed to complete pressure ulcer treatments as ordered. This affected three (#1, #4, and #5) of three residents reviewed for pressure ulcer care. The census was 69. Findings include: 1. Review of Resident #1's medical record revealed an admission date of 03/09/22. Diagnoses listed included type two diabetes mellitus, hypertension, congestive heart failure, chronic kidney disease, and stage four pressure ulcer of sacral region. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was severely cognitively impaired and had a stage four pressure ulcer. Review of wound physician documentation dated 10/30/23 and 11/20/23 revealed Resident #1 had a stage four pressure ulcer to the sacrum. Review of physician orders dated 11/21/23 revealed an order dated 11/21/23 for cleanse sacrum with normal saline (NS) or wound cleanser. Pat dry and pack wound lightly with calcium alginate with silver…

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 medial record review and staff interview, the facility failed complete urinary catheter care as ordered. This affected three (#1, #4, and #5) of three residents reviewed for urinary catheters. The census was 69. Findings include: 1. Review of Resident #1's medical record revealed an admission date of 03/09/22. Diagnoses listed included type two diabetes mellitus, hypertension, congestive heart failure, chronic kidney disease, and stage four pressure ulcer of sacral region. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was severely cognitively impaired and had a stage four pressure ulcer. Review of physician orders revealed an order dated 07/19/23 was for Foley (urinary catheter) two times as day and as needed (PRN) for preventative. Review of treatment administration records (TAR's) revealed Foley care was not documented as being completed on two times a day 11/07/23, 11/11/23, 11/15/23, 11/16/23, 11/18/23, and 11/21/23. 2. Review of Resident #4's medical…

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 time punches, daily staffing sheets, and staff interview the facility failed to ensure there were Registered Nurses (RN) working seven days week for at least eight hours a day. The affected all the residents who resided at the facility. The census was 62. Findings included: Review of the time punches and daily staffing sheets revealed the facility did not have a RN working on 11/04/23 or 11/05/23. During an interview on 11/07/23 at 1:00 P.M., the Administrator confirmed there wasn't a RN working on these dates and he was aware a RN should be working seven days a week at least eight hours. He stated there was a RN scheduled but she didn't show up for work on these days. A policy for staffing was requested but it wasn't received during the survey. This deficiency represents non-compliance investigated under Complaint Number OH00146842.

Based on staff interview, observations, and facility policy review, the facility failed to ensure food and pans were stored in a safe and sanitary manner. This had the potential to affect all but one resident who was identified to not receive food from the kitchen. The facility census was 55. Findings include: Observations on 07/25/22 at 9:26 A.M. during the initial tour of the kitchen with Dietary Manager #758 revealed there were two bags of dry pasta, undated and opened on the shelf in the storage room. There was a bag of moldy hot dog buns on the bread cart. The observations were confirmed immediately with Dietary Manager #758 who revealed dry goods were to be wrapped entirely with plastic wrap, dated, and the bread company delivered and rotated bread twice per week. Observation of the walk-in freezer revealed the food items were undated and/or unsealed: the frozen hot dogs were undated and unsealed, pork breakfast sausage was undated, egg omelets were undated and unsealed, churros were undated, blended pepper strips, were undated and unsealed mixed vegetables were undated, and…

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, observations, and policy review, the facility failed to ensure residents' call lights were within reach. This affected three residents (#17, #35, and #199) of three residents reviewed for call lights. The facility census was 55. Findings include: 1. Review of the medical record for Resident #17 revealed an initial admission date of 01/11/19 and a re-entry date of 03/04/20. Diagnoses included Parkinson's Disease, morbid (severe) obesity, repeated falls, need for assistance with personal care, and muscle weakness. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 had impaired cognition with a Brief Interview of Mental Status (BIMS) score of seven out of 15 (severe cognitive impairment). The resident required extensive assistance of one to two or more staff for bed mobility, dressing, eating, toilet use, and personal hygiene, and was dependent on staff for transfers. Review of the plan of care dated 01/26/20…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview, resident interview, medical record review, review of facility self-reported incidents, and facility policy review, the facility failed to report allegations of abuse to the State Survey Agency. This affected one (Resident #34) out of one resident reviewed for abuse. The facility census was 55. Findings include: Review of the medical record for Resident #34 revealed an initial admission date of 10/21/16 and a re-entry date of 10/29/21. Diagnoses included anxiety disorder, major depressive disorder, and altered mental status. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #34 had moderate cognitive impairment. Her behaviors included hallucinations, verbal behavioral symptoms directed towards others, and rejection of care. She required extensive assistance of one to two or more staff for bed mobility, dressing, and personal hygiene, and required total assistance for toileting. Review of the plan of care, dated 11/14/21 and revised on 02/17/22,…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview, resident interview, medical record review, review of facility self-reported incidents, and facility policy review, the facility failed to investigate allegations of abuse. This affected one (Resident #34) out of one resident reviewed for abuse. The facility census was 55. Findings include: Review of the medical record for Resident #34 revealed an initial admission date of 10/21/16 and a re-entry date of 10/29/21. Diagnoses included anxiety disorder, major depressive disorder, and altered mental status. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #34 had moderate cognitive impairment. Her behaviors included hallucinations, verbal behavioral symptoms directed towards others, and rejection of care. She required extensive assistance of one to two or more staff for bed mobility, dressing, and personal hygiene, and required total assistance for toileting. Review of the plan of care, dated 11/14/21 and revised on 02/17/22, revealed Resident #34 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 staff interviews, observations, medical record review, and review of the facility's policies, the facility failed to complete weekly skin assessment and implement preventative pressure ulcer interventions as physician ordered. This affected one (Resident #42) of four residents reviewed for pressure ulcers. The facility identified three residents with pressure ulcers and 56 residents with preventative skin. The facility census was 55. Findings include: Review of the medical record for Resident #42 revealed an admission date of 06/11/20. Diagnoses included Alzheimer's Disease, cognitive communication deficit, dementia with behavioral disturbances, contracture of the right and left shoulder, left wrist, and right and left hand. Review of the quarterly Minimum Data Set (MDS) assessment, dated 06/05/22, revealed Resident #42 was rarely or never understood. Her short- and long-term memory was not assessed, and her cognitive skills were severely impaired. Resident #42 was dependent on staff for all activities…

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, family and resident interview, observations, medical record review, and facility policy review, the facility failed to provide nutritional supplements as physician ordered for a resident receiving dialysis treatment. This affected one (Resident #47) of one resident reviewed for dialysis. The facility identified one resident receiving dialysis services and 20 residents who receive nutritional supplements The facility census was 55. Findings include: Review of the medical record for Resident #47 revealed an admission date of 03/11/21. Diagnoses included hypertensive heart and kidney disease with heart failure and with stage V, chronic kidney disease (CKD), end stage renal disease (ESRD), anemia in CKD, diabetes mellitus (DM), congestive heart failure (CHF), hypertension (HTN), and dependence on renal dialysis. Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/03/22, revealed Resident #47 had moderately impaired cognition with a Brief Interview of Mental Status (BIMS)…

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 staff interview, resident interview, observations, medical record review, and facility policy review, the facility failed to follow a resident's physician orders for oxygen use. This affected one (Resident #47) of one resident reviewed for respiratory services. The facility identified 10 residents receiving respiratory services. The facility census was 55. Findings include: Review of the medical record for Resident #47 revealed an admission date of 03/11/21. Diagnoses included hypertensive heart and kidney disease with heart failure and with stage V, chronic kidney disease (CKD), end stage renal disease (ESRD), and congestive heart failure (CHF). Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/03/22, revealed Resident #47 had moderately impaired cognition with a Brief Interview of Mental Status (BIMS) score of 12 out of 15. Resident #47 required supervision to extensive assistance of one to two staff members for all activities of daily living (ADLs) except eating which he required set up and supervision. Review of the physician's orders dated 08/28/21…

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 and medical record review, the facility failed to notify the resident and or the resident's representative, in writing, of the transfer or discharge and the reason for the move in writing. This affected two (#25 and #62) out of two residents reviewed for transfer and discharge. The facility census was 64. Findings include: 1. Review of the medical record revealed Resident #25 was admitted to the facility on [DATE] with a diagnosis of chronic obstructive pulmonary disease (COPD), bipolar disorder, diabetes type II, depression, hypertension, muscle weakness, and hearing loss. It also revealed Resident #25 was cognitively intact. Review of the progress note dated 02/27/19 revealed Resident #25 continued to have shortness of breath and increased confusion. Chest x-ray revealed sub segmental atelectasis versus mild infiltrate. The physician was notified, and a decision was made to transfer Resident #25 to the hospital for evaluation and treatment. It also revealed the Resident was admitted 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and staff interview the facility failed to send Resident #25 and Resident #62, and or their representative, a bed hold notice explaining the duration of days of the bed hold policy. This affected two (#25 and #62) out of two residents reviewed for transfer and discharge. The facility census was 64. Findings include: 1. Review of the medical record revealed Resident #25 was admitted to the facility on [DATE] with a diagnosis of chronic obstructive pulmonary disease (COPD), bipolar disorder, diabetes type II, depression, hypertension, muscle weakness, and hearing loss. It also revealed Resident #25 was cognitively intact. Review of the progress note dated 02/27/19 revealed Resident #25 continued to have shortness of breath and increased confusion. Chest x-ray revealed sub segmental atelectasis versus mild infiltrate. The physician was notified, and a decision was made to transfer Resident #25 to the hospital for evaluation and treatment. It also revealed the Resident was admitted 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.