Trinity Community At Fairborn

Based on record review, staff interview, and review of facility policy, the facility failed to ensure a resident's suprapubic urinary catheter was changed according to physician orders. This affected one Resident (#79) of the three residents review for foley catheters. The facility census was 88. Findings include: Review of medical record for Resident #79 revealed an admission date on 10/30/24. Diagnoses included dementia, hydronephrosis with renal and urethral calculous obstruction, calculus of gall bladder without obstruction, and chronic kidney failure. Review of admission Minimum Data Set (MDS) for Resident #79 dated 11/06/23, revealed he was severely cognitively impaired. Review of Resident #79's care plan dated 10/31/24, revealed Resident #79 had a suprapubic catheter related to obstructive uropathy. Interventions were to monitor for signs and symptoms of infection and change catheter as ordered and as needed. Review of a physician order dated 12/18/24, revealed Resident #79 was ordered to have the suprapubic catheter 14 French with 10 milliliter (mL) balloon changed 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 record reviews, staff interviews, review of facility policy, and review of facility standing orders, the facility failed to ensure residents received medications as ordered. This affected one Resident (#05) of the five residents reviewed for medications. The facility census was 88. Findings include: Review of medical record for Resident #05 revealed an admission date on 05/26/20. Diagnosis included obstructive hypertrophic cardiomyopathy, adult failure to thrive, Alzheimer's disease, chronic kidney disease stage two, orthostatic hypotension, essential hypertension, dementia, history of transient ischemic attack, and nonrheumatic aortic stenosis. The resident was cognitively impaired. Review of a physician order for Resident #05 dated 09/04/24, revealed the resident was ordered Midodrine tablet five milligrams (mg) one tablet in the morning for hypotension (low blood pressure) and to hold for systolic blood pressure (B/P) above 120 millimeters of mercury (mm/Hg). The Midodrine was discontinued on 12/18/24. Review of plan of care dated 01/08/25, revealed that Resident #05 had…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and staff interview, the facility failed to ensure residents' medications were stored properly. This affected one Resident (#26) out of the three residents reviewed. The facility census was 88. Findings include: Review of the medical record for Resident #26 revealed he was admitted to the facility on [DATE]. His diagnoses included, essential primary hypertension, gastro-esophageal reflux disease, diabetes mellitus (DM), obstructive sleep apnea, chronic kidney disease, bradycardia, depression, and obesity. Review of the Minimum Data Set (MDS) assessment for Resident #26, dated 01/31/25, revealed he was cognitively impaired, and the resident was dependent on staff for medication administration. Observation of Resident #26's room on 02/18/25 at 10:51 A.M. with Licensed Practical Nurse (LPN) #680 and Certified Nursing Assistant (CNA) 598, revealed a half full bottle or over the counter (OTC) bottle Pepto Bismol on the resident's table. LPN #680 verified the bottle of Pepto Bismol…

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, record review and review of facility policy, the facility failed to maintain an effective pest control program. This affected Resident (#13) and had the potential to affect all 23 Residents living on the 200 unit. The facility census was 88. Findings include: 1) Review of the medical record for Resident #13 revealed he was admitted to the facility on [DATE]. His diagnoses included anemia, heart failure, hypertension, ortho static hypertension, diabetes mellitus (DM), and aphasia. Resident #13's room was located on the 200-hall. Review of the Minimum Data Set (MDS) assessment for Resident #13 dated 01/28/25, revealed the resident had impaired cognition. Observation of Resident #13's bed on 02/20/25 at 2:50 P.M. with Certified Nursing Assistant (CNA) #511 revealed the resident's bed had active gnats flying around the bed. Resident #13's bed had food crumbs, and the bed was soiled. Interview at the same time with CNA #511 verified the condition of Resident #13's bed. 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, interview ,record review, facilities investigation review, and policy review, revealed the facility failed to implement abuse policies to report allegations of resident abuse. This affected one resident, (Resident #25) of three residents reviewed for reporting abuse . The total facility census was 86. Findings Include: Record review of alleged victim Resident #25 revealed the resident was admitted to the attached skilled living facility on 11/19/20. The resident had a legal guardian and resided on the skilled living unit. Diagnoses for Resident #25 included age related physical debility, diabetes, atrial fibrillation, morbid obesity, dementia, psychosis, communication deficit, depressive disorder, muscle weakness, intellectual disabilities, and cerebrovascular disease. Review of the Minimum Data Set, (MDS) comprehensive assessment dated [DATE] revealed the resident had severely impaired cognition and required maximum assistance of one for transfers and mobility. Review of the State…

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, interviews, record review, facility investigation report, and policy review, revealed the facility failed to report allegations of abuse. This affected one resident, (Resident #25) of three residents reviewed for reporting abuse. The total facility census was 86. Findings Include: Record review of alleged victim Resident #25 revealed the resident was admitted to the attached skilled living facility on 11/19/20. The resident had a legal guardian and resided on the skilled living unit. Diagnoses for Resident #25 included age related physical debility, diabetes, atrial fibrillation, morbid obesity, dementia, psychosis, communication deficit, depressive disorder, muscle weakness, intellectual disabilities, and cerebrovascular disease. Review of the Minimum Data Set, (MDS) comprehensive assessment dated [DATE] revealed the resident had severely impaired cognition and required maximum assistance of one for transfers and mobility. Review of the State Reportable Incident, (SRI) dated 06/06/24…

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, interview, and policy review, the facility failed to ensure a resident's representative was notified of medication changes. This affected one (Resident #84) of three residents reviewed for notifications. The facility census was 83. Findings include: Review of the medical record for Resident #84 revealed an admission date of 07/22/23 and discharge date of 08/24/23. Diagnoses including but not limited to lobar pneumonia, acute respiratory failure with hypoxia, dementia with behavioral disturbance, depression, and hyperlipidemia. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #84 had severe cognitive impairment. Resident #84 required extensive assistance for activities of daily living, supervision for ambulation, and was independent for eating. Review of physician orders revealed an order for Seroquel 25 milligrams (mg) at bedtime was decreased to seroquel 12.5 mg on 08/18/23 and Zoloft 25 mg was discontinued on 08/18/23. Review of the progress note dated…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview, and policy review, the facility failed to ensure the admission agreement was signed or explained to the resident or resident's representative. This affected one (Resident #84) of three residents reviewed for admission agreements. The facility census was 83. Findings include: Review of the medical record for Resident #84 revealed an admission date of 07/22/23 and discharge date of 08/24/23. Diagnoses including but not limited to lobar pneumonia, acute respiratory failure with hypoxia, dementia with behavioral disturbance, depression, and hyperlipidemia. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #84 had severe cognitive impairment. Resident #84 required extensive assistance for activities of daily living, supervision for ambulation, and was independent for eating. Review of the admission agreement for Resident #84 revealed the agreement was not signed by the resident or resident's representative. Interview on 03/04/24 at 12:41 P.M. with 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, staff and local health department personnel interview, review of the facility policy, and review of guidelines from the Centers for Disease Control and Prevention (CDC), the facility failed to properly isolate residents placed in transmission-based precautions (TBP) per CDC guidelines for Coronavirus Disease 2019 (COVID-19) infections to potentially prevent the spread of COVID-19. This affected four (#74, #68, #25, and #12) of eight residents reviewed for transmission-based precautions and infection control practices. The facility census was 81. Findings include: 1. Medical record review for Resident #62 revealed admission date 11/04/21. Resident #62 was fully vaccinated for COVID-19 and had received a COVID-19 booster vaccine on 11/18/21. Medical diagnosis included chronic diastolic heart failure, hemiplegia and hemiparesis, vascular dementia, chronic obstructive pulmonary disease, and COVID-19. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview and policy review, the facility failed to notify the resident and the Ombudsman of a transfer or discharge from the facility. This affected two (#79 and #330) out of two residents reviewed for discharge notification from the facility. The facility census was 81. Findings Include: Review of medical record for Resident #79 revealed he was admitted to the facility on [DATE] and discharged to the hospital on [DATE]. Diagnosis included metabolic encephalopathy, acute neurologic, rhabdomyolysis, pleural effusion, dementia with behavioral disturbance, essential primary hypertension, diabetes mellitus 2, atrial fibrillation, congestive heart failure and history of malignant neoplasm of prostate. Review of the five day admission Minimum Data Set (MDS) assessment, dated 11/15/21 revealed Resident #79's cognition was not assessed. Further review of the MDS assessment for Resident #79 revealed his assistance from staff was not assessed. Review of the Resident #79's nurse'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 facility policy review, the facility failed to notify residents of the facility bed hold policy prior to discharge from the facility. This affected two (#77, # 330) out of two residents reviewed for the bed hold policy. Facility census was 81. Findings include: 1. Medical record review for Resident #79 revealed he was admitted to the facility on [DATE] and discharged to the hospital on [DATE]. Diagnosis included metabolic encephalopathy, acute neurologic, rhabdomyolysis, pleural effusion, dementia with behavioral disturbance, essential primary hypertension, diabetes mellitus 2, atrial fibrillation, congestive heart failure and history of malignant neoplasm of prostate. Review of the five day admission Minimum Data Set (MDS) assessment, dated 11/15/21 revealed Resident #79's cognition was not assessed. Further review of the MDS assessment for Resident #79 revealed his assistance from staff was not assessed. Review of the Resident #79's nurse's progress notes…

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 Pre-admission Screen and Resident Review (PASARR) was in place for Resident #47 and #48. This affected two (#47 and #48) out of two residents reviewed for PASARR status. The facility census was 81. Findings include: 1. Record review revealed Resident #48 was admitted to the facility on [DATE]. Diagnoses included hyperkalemia, heart failure, pressure ulcer of left buttock, essential primary hypertension, hypothyroidism, anxiety disorder, and major depressive disorder. Review of Resident #48 quarterly minimum data sheet (MDS), dated [DATE], revealed resident scored a 13 on her brief interview for mental status (BIMS) indicating she has intact cognition. Further review of the MDS assessment revealed Resident #48 required extensive assistance from facility staff with bed mobility, transfers, dressing, toilet use, and personal hygiene. Resident #48 required supervision from staff with eating. However, Resident #48 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 medical record review, staff interview and policy review, the facility failed to develop a comprehensive care plan to address resident care needs including medical skin condition, a resident's medical diagnosis and a resident's smoking. This affected three (#15, #61 and #47) of twenty-three residents reviewed for care plans. The facility census was 81. Findings include: 1. Record review of the medical record for Resident #15 revealed an admission date of 01/12/21. Admitting diagnosis included atrial fibrillation, acute on chronic congestive heart failure, chronic kidney disease stage four, dementia with behaviors, unspecified psychosis, anxiety, depression and cerebral arthrosclerosis. The quarterly minimum data set (MDS) assessment for Resident #15 dated 10/13/21 revealed a brief interview mental status (BIMS) of three out of 15 indicating severely impaired cognition, no documentation of mental status change, inattention, or altered level of consciousness. There is documentation in section C of the MDS…

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 and staff interview, the facility failed to ensure palm protectors were placed on a resident with limited range of motion per the physician order. This affected one (#21) of two reviewed for range of motion. Facility census was 81. Findings included: Medical record review for Resident #21 revealed an admission date of 03/02/12. Diagnoses included non-traumatic brain dysfunction, Alzheimer's Disease, aphasic, and paraplegic. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #21 was rarely/never understood. Resident #21's functional status was total dependence for bed mobility, transfers, eating and toilet use. Resident #21 had impairment on one side of her upper extremities. Review of Resident #21's physician orders dated 07/14/21 revealed to don palm protectors in the mornings and doff in the evenings. Review of the electronic charting from 09/01/21 through 01/05/22 revealed there was no charting regarding the palm protectors were…

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 ensure the resident's laboratory (lab) work was completed per the physician orders. This affected one (#15) of six residents reviewed for unnecessary medication. The facility census was 81. Findings include: Review of Resident #15's medical record revealed an admission date of 01/12/21 with diagnoses which included dementia, atrial fibrillation, chronic kidney disease, chronic pulmonary edema, chronic respiratory failure, anemia, Barrett's esophagus, hypovolemia and cerebral atherosclerosis. Review of Resident #15's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview Mental Status (BIMS) of three out of 15 which indicated severe cognitive decline. The MDS revealed the resident required total dependence with two assists for transfers, and total dependence with one assist for toileting. The resident required extensive one-person assistance for bed mobility personal hygiene and dressing. The resident 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 medical record review, observation, staff and resident interview and policy review, the facility failed to ensure a residents meal was provided per the residents order and meal ticket. This affected one (#26) of three residents reviewed during the lunch observation. The census was 81. Findings included: Medical record review for Resident #26 revealed an admission date of 07/01/19. Diagnoses included peripheral vascular disease, below the knee amputation, schizophrenia, atrial fibrillation, and diabetes. Review of quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 was cognitively intact. Resident #26 functional status was extensive assistance for bed mobility and toilet use, total dependence for transfers, and supervision for eating. Resident #26 was coded for impairment to one side of upper and lower extremities. Review of physician orders dated 11/02/21 revealed Resident #26's revealed the resident diet was regular diet, mechanical soft, with ground meat textured, regular 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, observation, staff and resident interview, and policy review, the facility failed to ensure an assistive device was provided to a resident during a meal. This affected one (#26) of three resident's reviewed for adaptive equipment during the annual survey. Facility census was 81. Findings included: Medical record review for Resident #26 revealed an admission date of 07/01/19. Diagnoses included peripheral vascular disease, below the knee amputation, schizophrenia, atrial fibrillation, and diabetes. Review of quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 was cognitively intact. Resident #26 functional status was extensive assistance for bed mobility and toilet use, total dependence for transfers, and supervision for eating. Resident #26 was coded for impairment to one side of upper and lower extremities. Review of Resident #26's physician orders from 09/01/21 through 01/10/22 revealed there was no physician order for adaptive equipment. Review of 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, observations, staff interview and facility policy review, the facility failed to provide a clean, comfortable, home-like environment. This affected one (#48) out of three residents reviewed for a clean environment. The facility census was 81. Findings include: Record review revealed Resident #48 was admitted to the facility on [DATE]. Diagnoses included hyperkalemia, heart failure, pressure ulcer of left buttock, essential primary hypertension, hypothyroidism, anxiety disorder, and major depressive disorder. Review of Resident #48 quarterly minimum data sheet (MDS), dated [DATE], revealed the resident scored a 13 out of 15 on her brief interview for mental status (BIMS) indicating she has intact cognition. Further review of the MDS assessment revealed Resident #48 required extensive assistance from facility staff with bed mobility, transfers, dressing, toilet use, and personal hygiene. Resident #48 required supervision from staff with eating. However, Resident #48 was totally…

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, policy review and staff interviews, the facility failed to ensure a physician received and responded to a resident medication not being available for administration. This involved one (#12) of three sampled residents reviewed for physician notice. Facility census was 79. Findings included: Review of Resident #12's medical record revealed and admission date of 02/09/14, with diagnoses included: degenerative joint disease, hypertension, cerebral vascular accident, seizure disorder, dysphasia, chronic obstructive pulmonary disease, depression, paraplegia, anemia, neurogenic bladder, venous thrombosis and embolism. Review of the physician order, dated 04/02/19, revealed Resident #12 was to receive Lyrica 100 milligrams (mg) once a day for seven days. On the second week the Lyrica 100 mg was increased to twice a day, 8:00 A.M. and 4:00 P.M. for seven day. On 04/18/19 the Lyrica was to be increased to 150 mg and given three times a day, 8:00 A.M., 12:00 P.M. and 4:00 P.M., for the next seven days. On 04/26/19, the physician ordered the Lyrica to be increased to 200…

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 staff interview, the facility failed to ensure residents were issued Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) notices upon discharge from Medicare Part A Services with benefit days remaining when they continued to reside in the facility. This affected two (#67 and #68) of three residents reviewed for beneficiary protection notification. The facility census was 79. Findings include: 1. Medical record review revealed Resident #67 was admitted to the facility on [DATE], with a re-entry date of 04/07/19. Diagnoses included encephalopathy, urinary tract infection, pneumonia, congestive heart failure, and cerebral infarction. Review of 30 day Minimum Data Set (MDS) assessment dated [DATE] revealed severely impaired cognitive skills for daily decision making, extensive assistance was required with bed mobility, transfers, eating, toileting, and personal hygiene. Review of Notice of Medicare Non-coverage dated 05/06/19 revealed Medicare Part A Skilled Services would end…

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, review of facility submitted self reported incidents (SRIs), and review of facility policy, resident and staff interview, the facility failed to implement the facility policy on reporting allegations of verbal abuse. This affected three (#16, #21, and #80) of three residents reviewed for abuse. The census was 79. Findings include: 1. Medical record review revealed Resident #16 was admitted to the facility on [DATE], with diagnosis including Alzheimer's disease. Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed severely impaired cognitive skills for daily decision making, supervision was required with bed mobility, transfers, eating, and extensive assistance was required with toileting and personal hygiene. Resident #16 did not require any mobility devices. Review of care plan dated 11/04/15 revealed Resident #16 required a Alzheimer/dementia special care unit related to dementia. On 01/30/17, Resident #16 was moved to a behavior unit due to increased…

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, review of facility submitted self reported incidents (SRIs), and review of facility policy, resident and staff interview, the facility failed to report allegations of verbal abuse to the state agency. This affected three (#16, #21, and #80) of three residents reviewed for abuse. The census was 79. Findings include: 1. Medical record review revealed Resident #16 was admitted to the facility on [DATE], with diagnosis including Alzheimer's disease. Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed severely impaired cognitive skills for daily decision making, supervision was required with bed mobility, transfers, eating, and extensive assistance was required with toileting and personal hygiene. Resident #16 did not require any mobility devices. Review of care plan dated 11/04/15 revealed Resident #16 required a Alzheimer/dementia special care unit related to dementia. On 01/30/17, Resident #16 was moved to a behavior unit due to increased behaviors.…

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 staff interview, the facility failed to ensure bed hold notices were provided timely upon hospitalization. This affected two (#21 and #34) of four residents reviewed for hospitalization. The facility census was 79. Findings include: 1. Medical record review revealed Resident #21 was admitted to the facility on [DATE] with a re-entry date of 04/11/19. Diagnoses for Resident #21 included dementia and schizophrenia. Review of quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed intact cognitive skills for daily decision making and supervision was required with all activities of daily living (ADLs) except for limited assistance with personal hygiene. Review of social service progress note dated 03/26/19 at 1:00 P.M., revealed Resident #21 was transported to the hospital for evaluation related to increased violent outbursts. Review of nursing progress note dated 04/11/19 at 7:59 P.M., revealed Resident #21 was readmitted to the facility. Review of notification of available bed…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, resident representative and staff interviews, the facility failed to ensure a resident received needed assistance with activities of daily living (ADLs). This affected one (#34) of four residents reviewed for ADLs. The facility census was 79. Findings include: Medical record review revealed Resident #34 was admitted to the facility on [DATE] with a re-entry date of 10/01/17. Diagnoses for Resident #34 included dementia with behavioral disturbance, cerebral infarction, and contracture left hand. Review of significant change Minimum Data Set (MDS) assessment dated [DATE] revealed moderately impaired cognitive skills for daily decision making, total dependence was required with transfers, toileting, personal hygiene, extensive assistance was required with bed mobility and eating. Review of care plan dated 11/28/16 revealed Resident #34 required extensive assistance with daily care, mobility, and was developing a contracture to the left hand. Review of intervention initiated…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and staff interviews, the facility failed to ensure a resident received care and treatment to non-pressure skin condition. This affected one (#34) of two residents reviewed for non-pressure skin conditions. The facility census was 79. Findings include: Medical record review revealed Resident #34 was admitted to the facility on [DATE] with a re-entry date of 10/01/17. Diagnoses included dementia with behavioral disturbance, cerebral infarction, diabetes, skin cancer, and open scalp wound. Review of significant change Minimum Data Set (MDS) assessment dated [DATE] revealed moderately impaired cognitive skills for daily decision making, total dependence was required with transfers, toileting, personal hygiene, extensive assistance was required with bed mobility and eating. Review of care plan initiated 11/22/16 revealed Resident #34 was admitted with an open wound to the scalp from past surgery and frequently scratches and digs at the open wound and extremities. Interventions…

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

Based on record review and staff interview, the facility failed to ensure medications were administered in accordance to the physician's orders. This involved one (#12) of three sampled residents reviewed for medication availability. Facility census was 79. Findings included: Review of Resident #12's medical record revealed and admission date of 02/09/14, with diagnoses included: degenerative joint disease, hypertension, cerebral vascular accident, seizure disorder, dysphasia, chronic obstructive pulmonary disease, depression, paraplegia, anemia, neurogenic bladder, venous thrombosis and embolism. Review of the physician order, dated 04/02/19, revealed Resident #12 was to receive Lyrica 100 milligrams (mg) once a day for seven days. On the second week the Lyrica 100 mg was increased to twice a day, 8:00 A.M. and 4:00 P.M. for seven day. On 04/18/19 the Lyrica was to be increased to 150 mg and given three times a day, 8:00 A.M., 12:00 P.M. and 4:00 P.M., for the next seven days. On 04/26/19, the physician ordered the Lyrica to be increased to 200 mg three times a day: 8:00 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.