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NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview, record review, review of the facility's Self-Reported Incidents (SRI), and policy review the facility failed to report an allegation of abuse to the state agency. This affected one (#53) of the three residents reviewed. The facility census was 51. Findings include: Review of the closed medical record of Resident #53 revealed an admission date of [DATE] and expired in the facility on [DATE]. Diagnoses included rhabdomyolysis, chronic kidney disease, traumatic ischemia of muscle and hard of hearing. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #53 was cognitively impaired and dependent on staff for Activities of Daily Living (ADL). Review of the facility's Self-Reported Incidents (SRI) in the Certification and Licensure System (CALS), revealed no SRI being created on or around [DATE] related to allegations of abuse by staff members towards Resident #53. During an interview on [DATE] at 10:35 A.M., the Administrator stated she received a video from 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, staff interview, and review of the facility policy, the facility failed to ensure care plans were accurate and current. This affected two residents, (#10 and #20) out of five residents reviewed for care plans. The current census was 53. Findings include: 1. Review of the medical record for Resident #10 revealed the resident was admitted to the facility on [DATE]. Diagnoses included fracture of right humerus, unspecified intellectual disabilities, depression, anxiety, insomnia, and pain. Review of Resident #10's Minimum Data Set (MDS) admission assessment dated [DATE] revealed the resident had impaired cognition. Review of the psychiatric diagnostic evaluation dated 02/17/23 revealed the Psychiatric Licensed Social Worker (PLSW) documented Resident #10 had a history of past trauma involving the murder of her brother, abuse by her parent, and abuse by her partner. Per the evaluation ongoing counseling and evaluation from a psychiatrist for medication management was recommended. Review 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 observation, staff interviews and review of facility policy, the facility failed to ensure proper infection control measures wre followed for nephrostomy collection bag. This affected one Resident #144 of two reviewed for urinary catheter care. The facility census was 53. Findings included: Review of medical record for Resident #144 revealed an admission date of 01/10/25. Diagnoses included hydronephrosis with renal and ureteral calculous obstruction with a nephrostomy. Observation on 01/16/25 at 6:57 A.M revealed the resident was lying on his left side with the nephrostomy drainage bags hanging off the left side of the bed touching the ground. Interview with Certified Registered Care Associate (CRCA) # 329 on 01/16/25 at 7:15 A.M. verified the drainage bags were over the left side of the bed and touching the floor. Review of the policy titled Urinary Catheter Care, dated 12/16/24, revealed the urinary drainage bag should be held or positioned lower than the bladder to prevent the urine in the tubing and drainage bag from flowing back into the urinary bladder. Be sure the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, resident and staff interview, and review of facility policy, the facility failed to ensure resident smoking supplies were stored in a locked area. This affected one (Resident #7) out of one resident reviewed for smoking and had the potential to affect three additional residents (#4, #9, and #28) who were identified by the facility as being cognitively impaired and independently mobile. The facility census was 47. Findings include: Review of the medical record revealed Resident #29 was admitted on [DATE]. Diagnoses included but were not limited to hypertensive heart disease with heart failure, acute respiratory failure with hypoxia, and type two diabetes mellitus without complications. Review of Resident #29's Minimum Data Set assessment, dated 07/01/22, revealed Resident #29 was cognitively intact. Interview on 08/22/22 at 2:07 P.M. with Resident #29 revealed Resident #29 stored cigarettes and a lighter in his dresser drawer. Observation on 08/24/22 at 8:35 A.M.…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, staff interview, and review of facility policy, the facility failed to ensure medications were not left unattended at bedside. This affected one (Resident #34) out of one resident reviewed for self-administration of medication and had the potential to affect three additional residents (#4, #9, and #28) who were identified by the facility as being cognitively impaired and independently mobile. The facility census was 47. Findings include: Review of the medical record revealed Resident #34 was admitted on [DATE]. Diagnoses included polyneuropathy, unspecified protein-calorie malnutrition, hypocalcemia, hypertensive heart disease with heart failure, acute on chronic systolic (congestive) heart failure, hypothyroidism, hyperlipidemia, and major depressive disorder. Review of the admission Minimum Data Set (MDS) assessment, dated 07/06/22, revealed Resident #34 was cognitively intact. Review of Resident #34's physician order, dated 07/28/22, revealed an order 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 and staff interview, the facility failed to ensure a care plan was developed to address resident medical diagnoses. This affected three (Resident #18, #23, and #103) out of 11 residents reviewed for care plans. The facility census was 47. Findings include: 1. Review of the medical record for Resident #18 revealed an admission date of 05/20/22. Diagnoses included congestive heart failure (CHF), atherosclerotic heart disease (ASHD), hypertension, and headache syndrome. Review of Resident #18's admission Minimum Data Set (MDS) assessment, dated 08/17/22, revealed diagnoses of CHF, ASHD, hypertension, and headache syndrome. Review of Resident #18's most recent care plan, last updated 08/22/22, revealed there were no interventions for CHF, ASHD, hypertension, or headache syndrome in the care plan. Interview on 08/24/22 at 1:18 P.M. with Registered Nurse (RN) #139 and RN MDS Support #185 verified Resident #18's diagnoses of CHF, ASHD, hypertension, and headache syndrome were not addressed in the care plan. 2. Review of the medical record for Resident #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.

Based on observation, resident interview, and staff interview, the facility failed to ensure staff trimmed the fingernails of residents who were unable to carry out activities of daily living. This affected one (Resident #22) out of 47 residents reviewed for personal hygiene. The facility census was 47. Findings include: Review of the medical record for Resident #22 revealed an admission date of 06/08/22. Diagnoses included left femur fracture, paranoid schizophrenia, unspecified psychosis, and anxiety. Review of the admission Minimum Data Set assessment, dated 06/13/22, revealed Resident #22 was cognitively intact and required extensive assistance of two staff for personal hygiene. Observations on 08/22/22, 08/23/22, and 08/24/22 revealed Resident #22's fingernails were past the fingertips. Resident #22's nails were clean. Interview on 08/23/22 at 11:00 A.M. with Resident #22 revealed he preferred his nails to be shorter and no one had trimmed them for quite a while. Interview on 08/24/22 at 11:00 A.M. with Director of Health Services and Registered Nurse Clinical Campus Support…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident and staff interview, and facility policy review, the facility failed to ensure residents blood sugar levels were checked as ordered. This affected two (Resident #7 and #29) out of five residents reviewed for unnecessary medications. The facility census was 47. Findings include: 1. Review of Resident #29's medical record revealed Resident #29 was admitted on [DATE]. Diagnoses included but were not limited to type two diabetes mellitus without complications, acute respiratory failure with hypoxia, and chronic combined systemic and diastolic heart failure. Review of Resident #29's Minimum Data Set (MDS) assessment, dated 07/01/22, revealed the resident was cognitively intact and received insulin. Review of Resident #29's physician order, dated 08/10/22, revealed an order for Novolog (insulin) three milliliter (ML) 100 units/ML per sliding scale based on blood sugar results four times a day. Review of Resident #29's Medication Administration Record (MAR), dated August 2022,…

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, and staff interview, the facility failed to maintain and store a rigid suction catheter in clean and sanitary manner. This affected one (Resident #20) out of one resident reviewed for respiratory suctioning. The facility census was 47. Findings include: Review of the medical record for Resident #20 revealed an admission date of 03/29/22. Diagnoses included sepsis due to methicillin resistant staphylococcus aureus and pseudomonas, acute respiratory failure, and acquired absence of larynx. Review of the admission Minimum Data Set assessment, dated 06/10/22, revealed Resident #20 was cognitively intact and required extensive assistance of one staff for personal hygiene. The assessment further indicated respiratory suctioning was performed. Observation on 08/22/22 at 10:30 A.M. revealed a rigid suction catheter, attached to a suction hose, was draped over the suction machine in Resident #20's room. The tip of the catheter was exposed to the air and was noted to be crusted with a dark brown substance. Interview with Resident #20 at the time of…

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

Based on medical record review, observation, and staff interview, the facility failed to ensure wound measurements were accurately documented on a wound assessment. This affected one (Resident #22) out of two residents reviewed for pressure ulcers. The facility census was 47. Findings include: Review of the medical record for Resident #22 revealed an admission date of 06/08/22. Diagnoses included left femur fracture, unspecified psychosis, paranoid schizophrenia, and anxiety. Review of the Wound Management Detail Report, dated 08/24/22, by Director of Health Services (DHS), revealed Resident #22's wound measured five cm in length, 3.2 cm in width, and 0.2 cm in depth. The wound was documented as unstageable with slough and/or eschar. The tissue type was slough with 25% of wound covered with granulation tissue and 75% of the wound covered with slough tissue. Observation on 08/24/22 at 2:00 P.M. of Resident #22's wound dressing change, performed by DHS, revealed the wound had 75% slough in the wound bed. DHS measured the wound and stated it was five cm in length and 3.2 cm in width.…

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, staff interview and facility policy review the facility failed to maintain the kitchen in a clean manner, failed to store foods as per guidelines and failed to ensure proper sanitation of utensils, pots and pans while using the sink. This had the potential to effect all 44 residents residing in the facility. Findings include: Observation on 08/26/19 at 8:30 A.M., during the tour of the kitchen, revealed two dust pans heavily coated with old food and paper products. The outer surfaces of the lids of the dried food storage bins were soiled with dust and loose food. The surface of the shelf, used to store spices, had a thick coat of grease and dust. The floors, in areas under tables and counters, were soiled with a dried brown substance. Loose plastic items were under the refrigerator. The convection oven was heavily splattered on the inside of the door and the oven floor. The walk-in freezer contained a three tier rolling cart that held nine small dishes of ice cream, uncovered and undated. The sanitizer sink had already been used by the kitchen staff, earlier in…

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 manufacturer guidelines, the facility failed to ensure a resident's insulin was administered according to manufacturer guidelines, resulting in a significant medication error. This affected one Resident (#5) of two residents observed for insulin administration. The facility identified three residents receiving insulin. The facility census was 44. Findings include: Review of Resident #5's medical record revealed an admission date of 07/26/18. Medical diagnoses included chronic kidney disease, diabetes mellitus, major depressive disorder, hypertension, malignant neoplasm of colon, and anxiety disorder. Review of the resident's physician's orders revealed an order dated 08/23/19 for Lantus insulin (long acting insulin) pen 33 units subcutaneous once daily. Observation of medication administration on 08/28/19 at 8:06 A.M. with Registered Nurse (RN) #200 revealed she prepared Resident #5's Lantus pen by turning the dial to 33 units. She then administered Lantus 33 units subcutaneous without priming the Lantus…

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 facility policy review the facility failed to implement appropriate hand hygiene during a dressing change. This effected one Resident (#5) of two observed for dressing changes. The facility census was 44. Findings include: Review of the medical record of Resident #15 revealed an admission date of 07/27/12. Diagnoses included cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery, chronic kidney disease, major depressive disorder, generalized anxiety disorder, hypertension, anemia, deficiency of other specified B group vitamins, unspecified mononeuropathy of left lower limb, and hyperlipidemia. Review of the annual Minimum Data Set, dated [DATE] revealed Resident #15 had severe cognitive deficit and did not have a pressure ulcer at the time of the assessment. Review of the care plan last revised 08/06/19 revealed Resident #15 has a pressure ulcer and treatment was to be administered as per physician order. Review…

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