Good Shepherd Home

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, staff interview, pest control staff interview, and facility policy review, the facility failed to ensure the facility was free from bed bugs and affected areas were properly treated. This affected one (#89) of one residents reviewed for pests. The facility census was 80.Findings include:Record review for Resident #89 revealed the resident was admitted to the facility on [DATE] with diagnoses including pressure ulcer of the sacral region, history of malignant neoplasm of the rectum, vascular dementia, and congestive heart failure.Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had moderately impaired cognition, required supervision with toileting and dressing, and moderate assistance with bathing.Observation on 05/11/26 at 9:45 A.M. revealed Resident #89 was not residing in room [ROOM NUMBER]. A blanket was laid in front of the door with a laundry cart in front of the door.Interview on 05/11/26 at 9:47 A.M. with Licensed Practical…

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 policy review, the facility failed to store foods properly in the refrigerator and failed to discard expired food items. This had the potential to affect all 83 residents who the facility identified received food from the kitchen. The facility census was 83. Findings include: 1. Observation of the main kitchen refrigerator on 10/07/24 at 8:10 A.M. revealed there was a container of thickened pudding dated 09/23/24 and a container of thickened juice dated 09/23/24 which were outdated and failed to be discarded. Observation of the walk in refrigerator on 10/07/24 at 8:23 A.M. revealed a box of sliced mushrooms were on a wire shelf and were open to air. The cardboard lid failed to be secured to the box. Interview with Culinary Director #251 on 10/07/24 at 8:25 A.M. verified the thickened pudding and thickened juice were outdated and not discarded and the mushrooms were not stored properly. 2. Observation of the pureed food preparation on 10/08/24 at 10:45 A.M. revealed Chef #282 was preparing pureed beef stroganoff. After placing the stroganoff…

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, observation, staff interview, and policy review, the facility failed to prepare pureed foods per the recipe and follow the dietician recommendations for serving sizes. This had the potential to affect six residents (#2, #37, #38, #46, #47, and #68) who received pureed meals and had to the potential to affect 77 residents who received regular or mechanical soft meals from the kitchen. The facility census was 83. Findings include: 1. Review of the Dining Manager's recipe for pureed vegetables revealed the recipe called for one quart of vegetables with one-fourth cup of melted margarine. Observation on 10/08/24 at 10:48 A.M. revealed Chef #282 was preparing the vegetable for the pureed diets. The chef placed the vegetables in the food processor then began pouring in a butter tasting substance used for grilling, sauteing, and pan frying. Chef #282 failed to measure the vegetables nor the butter substance. He poured at least one cup of butter substance in the food processor. Interview with Culinary Director #251 on 10/08/24 at 10:44 A.M. verified Chef #282 did not…

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 observations, medical record review, staff interview, facility policy, and review of the Centers of Disease Control and Prevention (CDC) guidance, the facility failed to ensure staff donned appropriate personal protective equipment (PPE) in COVID-19 positive resident's rooms. This had the potential to affect all nine (#48, #49, #65, #67, #73, #76, #82, #88, and #189) residents in the 200 hall who were not COVID-19 positive. In addition, the facility failed to ensure four (#1, #11, #54, and #79) residents with a wound or indwelling medical device had enhanced barrier precautions in place. The facility identified an additional nine (#17, #30, #45, #48, #52, #53, #55, #68, and #189) residents who required enhanced barrier precautions. Additionally, the facility failed to ensure hand hygiene prior to administering medications to Resident #14. The facility census was 83. Findings include: 1. Review of the medical record revealed Resident #188 was admitted on [DATE]. Diagnoses included COVID-19 (10/03/24).…

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 medical record review, staff interview, and facility policy review, the facility failed to ensure resident centered comprehensive care plans were in place. This affected two residents (#5 and #77) of 21 residents reviewed for resident centered comprehensive care plans. The facility census was 83. Findings include: 1. Review of the medical record for Resident #5 revealed an admission date of 07/25/24. Diagnoses included dementia, anxiety, and lewy body dementia. Review of the admission physician orders dated 07/22/24 for Resident #5 revealed she was admitted with an order for Geodon (antipsychotic) 20 milligrams (mg). Review of the admission Minimum Data Set (MDS) dated [DATE] for Resident #5 revealed she was cognitively impaired and was prescribed routine antipsychotic medications. Review of the current physician orders for 10/2024 for Resident #5 revealed the Geodon was discontinued, and Seroquel (antipsychotic) 25 mg was prescribed. Review of the comprehensive care plan initiated 07/2024 for Resident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, resident and staff interview, and review of the facility policy, the facility failed to provide showers timely to residents who were dependent on staff for showers/bathing. This affected one (Resident #8) of three residents reviewed for activities of daily living (ADL). The facility census was 83. Findings include: Review of Resident #8's medical record revealed an admission date of 03/17/23. Diagnosis included severe sepsis without shock, chronic obstructive pulmonary disease, and congestive heart failure. Review of Resident #8's quarterly Minimum Data Set assessment dated [DATE] revealed the resident had a moderate cognitive impairment. Resident #8 required substantial assistance from staff for showers, baths, and personal hygiene. Review of Resident #8's care plan revealed she had an ADL self-care self-care performance deficit related to activity intolerance, impaired gait and balance, limited mobility, musculoskeletal impairment, and neuropathy, Interventions included the resident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident interview, staff interview, and record review, the facility failed to ensure wound prevention boots were in place as physician ordered and failed to obtain a resident's weekly weight as physician ordered. This affected one (Resident (#11) of one resident reviewed for wounds and 21 residents reviewed for physician orders. The facility census was 83. Findings include: 1. Review of Resident #11's medical record revealed an admission date of 12/01/22. Diagnoses included cerebral vascular accident, diabetes mellitus, pressure induced deep tissue damage of right heel, and non-pressure chronic ulcer of right ankle with fat layer exposed. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #11's cognition was intact. Resident #11 had an open lesion on his foot and required dressings to the feet. Review of the care plan revealed Resident #11 had altered skin integrity related to a right ankle vascular wound, right anterior third toe traumatic wound, and a…

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

Based on observation, staff interview, and review of facility policy, the facility failed to ensure foods were stored properly, staff prepared food in a sanitary manner, and failed to ensure the dishmachine reached appropriate temperatures. This had the potential to affect 88 residents in the facility. The facility identified one resident (#32) did not receive oral nutrition. The facility census was 89. Findings include: 1. Observations on 05/09/22 beginning at 8:33 A.M. revealed an open bag of chicken, an open box of hashbrowns, and individual flatbread lying loose on the shelf in the walk-in freezer, and one large can of mandarin oranges and one large can of raspberry filling dented near the seal stored with the in-use canned food items. Interview on 05/09/22 at 8:46 A.M. with the Culinary Director #507 confirmed the chicken, hashbrowns and flatbread were stored inappropriately, and the dented cans should be removed from use. Observation and interview on 05/09/22 at 8:52 A.M. with the Culinary Director #507 revealed two opened, undated bags of hardboiled eggs with cloudy fluid…

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, resident interviews, and staff interviews, the facility failed to ensure resident rooms and wheelchairs were kept in a clean and sanitary manner. This affected eight residents (#2, #32, #39, #50, #52, #56, #60, and #87) out of eight residents reviewed for environmental concerns. The facility census was 89. Findings include: 1. Observation on 05/10/22 at 8:20 A.M. revealed Resident #39's room smelled of urine. Resident #39 was not in the room at the time. Interview on 05/10/22 at 8:20 A.M. with Medication Aide #513 confirmed Resident #39's room smelled of urine. Observation of Resident #50's room on 05/10/22 from 11:15 A.M. to 11:21 A.M. revealed an unmade bed, dirty linen on the sink and dirty clothing in a pile on the floor in the left hand corner of the room. There was dark, sticky debris on the floor in four of four corners of the room and on the metal threshold between the room and the hallway and the dark, sticky debris rubbed off when scuffed with the Surveyor's shoe. There was also a…

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

Based on observation, staff interview, review of manufacturer's instructions, and review of facility policy, the facility failed to ensure staff properly cleaned and disinfected the blood glucometer per manufacturer's recommendations. This had the potential to affect eight residents (#8, #23, #28, #31, #39, #41, #74 and #75) receiving blood sugar checks in the Meadows Unit. Facility census was 89. Findings include: Observation on 05/10/22 at 7:36 A.M. revealed Licensed Practical Nurse (LPN) #376 administering medications on the Meadows Unit and cleaned the blood glucometer with two alcohol wipes. Interview with LPN #376 at the time of the observation on 05/10/22 at 7:36 A.M. verified blood glucometer's are cleaned with alcohol. Interview with LPN #376 on 05/10/22 at 2:30 P.M. verified LPN #376 used alcohol to clean the blood glucometer before and after the morning blood sugar check for Resident #74, with LPN #376 further stating she should have used a disinfectant wipe. Review of facility policy titled, Glucometer Disinfection, with a review date of 02/21 verified blood glucometer…

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 and staff interview, the facility failed to serve meals to residents in a dignified manner. This affected two residents (#1 and #21) of four residents reviewed for dining. The facility census was 89. Findings include: 1. Review of the medical record for Resident #1 revealed an admission date of 06/10/20. Diagnoses included type II diabetes mellitus and gout. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 had intact cognition and required limited assistance of one person for eating. Review of an order dated 01/05/22 revealed Resident #1 received a no added salt diet with pureed food and thin liquids. Observation on 05/09/22 at 11:40 A.M. revealed Resident #1 and Resident #89 sitting together at a dining table. Resident #89 was served her meal at that time, Resident #1 was not. Observation on 05/09/22 at 12:25 P.M. revealed Resident #1 received her meal 45 minutes after Resident #89 received her meal. Interview on 05/09/22 at 12:25 P.M. the Culinary…

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 observations and staff interview, the facility failed to provide a comfortable wheelchair for Resident #30. This affected one resident of four reviewed for accommodation of needs. The facility census was 89. Findings include: Review of Resident #30's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including cellulitis (infection of the skin), type two diabetes, gout, lack of coordination, unsteadiness on feet, and dementia with lewy bodies. Assessment completed on 02/20/22 indicated Resident #30 had severe cognitive impairment. The resident's record additionally revealed they were admitted to hospice care on 02/07/22. Observations throughout the afternoon on 05/09/22 found Resident #30 sitting in a geriatric (geri) chair. They were positioned properly but did not appear comfortable as evidenced by his head and shoulders were approximately one foot above the back of the chair. Resident #30 appeared to be sitting stiffly trying to support his head. His face…

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, family interview, and review of facility policy, the facility failed to provide a copy of the baseline care plan to Resident #46 or Resident #46's family. This affected one resident (#46) out of seven residents reviewed for care planning. The facility census was 89. Findings include: Review of the medical record revealed Resident #46 was admitted to the facility on [DATE] with diagnoses including muscle weakness, macular degeneration, dementia, anxiety, heart disease and major depressive disorder. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #46 was severely cognitively impaired. Resident #46 required extensive assistance of two people for bed mobility, toilet use and transfers. Review of the baseline care plan for Resident #46 revealed the baseline care plan was developed on 01/19/22, however was the baseline care plan had not been not signed or dated by Resident #46 or by Resident #46's family. Interview on 05/12/22 at…

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 facility policy, the facility failed to review and revise a resident's care plan. This affected one resident (#30) out of seven residents reviewed for care plannning. The census was 89. Findings include: Review of Resident #30's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including cellulitis (infection of the skin), type two diabetes, gout, lack of coordination, unsteadiness on feet, and dementia with lewy bodies. Assessment completed on 02/20/22 indicated Resident #30 had severe cognitive impairment. The resident's record additionally revealed admission to hospice care on 02/07/22. Further review of the medical record revelaed Resident #30 had falls on 05/01/22 and 05/03/22. Review of progress notes revealed both falls happened when the resident attempted to stand up from a geriatric (geri) chair. No major injuries were noted for either fall. Review of the care plan for Resident #30 revealed an update…

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, resident interview, staff interview, and review of facility policy, the facility failed to ensure dependent residents received assistance with shaving and fingernail care. This affected one resident (#83) of four residents reviewed for activities of daily living. The facility census was 89. Findings Include: Review of Resident #83's medical record revealed an admission date of 01/04/21. Diagnoses included history of COVID-19, dementia, and weakness. Review of Resident #83's Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of nine indicating Resident #83 was moderately cognitively impaired. Resident #83 required extensive assistance with bed mobility, transfers, dressing, toilet use, and personal hygiene. Resident #83 displayed no behaviors during the review period. Review of Resident #83's care plan revised 04/11/22 revealed supports and interventions for risk for having behaviors of rejection of care and getting up unassisted, risk for mood…

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 provide wound treatments as ordered. This affected one resident (#67) out of five residents reviewed for wound care. The facility census was 89. Findings include: Review of the medical record for Resident #67 revealed an admission date of 11/09/09 with medical diagnoses of abnormal posture and anxiety disorder, and non-pressure chronic ulcer of right ankle with unspecified severity. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed Resident #67 had intact cognition and required extensive assistance of two people for bed mobility, dressing, toilet use, personal hygiene, and required total dependence of two people for transfers. Resident #67 used a wheelchair for mobility. Review of Resident #67's orders revealed daily treatment orders for his right outer ankle wound from 12/12/21 through 05/11/22. Review of Resident #67's Treatment Administration Record (TAR) for February 2022 revealed four treatments for his right outer…

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 interview, and staff interview the facility failed to ensure residents received timely care and treatment for vision and audiology. This affected one resident (#83) out of one resident reviewed for ancillary services. The facility census was 89. Findings Include: Review of Resident #83's medical record revealed an admission date of 01/04/21. Diagnoses included personal history of COVID-19, dementia and weakness. Review of Resident #83's Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of nine indicating Resident #83 was moderately cognitively impaired. Resident #83 had adequate vision and hearing at the time of the review. Review of Resident #83's care plan revised 04/11/22 revealed supports and interventions for risk for having behaviors of rejection of care, preferences for personal care, and self-care deficit. Review of Resident #83's ancillary services consent form revealed on 07/08/21 Resident #83's representative…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observations, and staff interview, the facility failed to implement ordered treatments to potentially prevent pressure ulcers. This affected one resident (#30) of four residents reviewed for pressure ulcers. The census was 89. Findings include: Review of Resident #30's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including cellulitis (infection of the skin), type two diabetes, gout, lack of coordination, unsteadiness on feet, and dementia with lewy bodies. Assessment completed on 02/20/22 indicated Resident #30 had severe cognitive impairment. The resident's record additionally revealed Resident #30 admitted to hospice care on 02/07/22. Review of physician orders for Resident #30 revealed an order to, keep elbow protectors in place at all times, dated 01/28/22. It also revealed an order for, bilateral heel lift boots at all times, dated 01/27/22. Observation of Resident #30 throughout the afternoon on 05/09/22 found the resident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident interview, staff interview, and review of facility policy, the facility failed to provide range of motion as ordered. This affected one resident (#7) of four residents reviewed for positioning and range of motion. The facility census was 89. Findings Include: Review of Resident #7's medical record revealed an admission date of 02/03/22. Diagnoses included adjustment disorder, Alzheimer's disease, and wedge compression fracture of first lumbar vertebra (at admission). Review of Resident #7's Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of one indicating Resident #7 was severely cognitively impaired. Resident #7 required extensive assistance with bed mobility, transfers, dressing, toilet use and personal hygiene. Resident #7 was totally dependent on staff for eating. Resident #7 was receiving therapy services at the time of the review. Resident #7 had delusions during the review period and displayed physical and verbal…

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 facility policy, the facility failed to address the nutritional needs of residents with significant weight loss. This affected two residents (#30 and #39) of five residents reviewed for significant weight loss. The census was 89. Findings include: 1. Review of Resident #30's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including cellulitis (infection of the skin), type two diabetes, gout, lack of coordination, unsteadiness on feet, and dementia with lewy bodies. Assessment completed on 02/20/22 indicated Resident #30 had severe cognitive impairment. The resident's record additionally revealed the resident was admitted to hospice care on 02/07/22. Review of Resident #30's weights revealed a weight of 185 pounds on 12/22/21 and 157 pounds on 05/04/22, indicating a significant (15%) weight loss over five months. Resident #30 weighed 173 pounds on 02/09/22 indicating a 12-pound weight loss prior to hospice…

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 pharmacy recommendations were timely addressed by the physician. This affected one resident (#7) of five residents reviewed for unnecessary medications. The facility census was 89. Findings Include: Review of Resident #7's medical record revealed an admission date of 02/03/22. Diagnoses included type II diabetes, adjustment disorder, dementia, major depressive disorder, and Alzheimer's disease. Review of Resident #7's Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of one, indicating Resident #7 was severely cognitively impaired. Resident #7 had delusions during the review period and displayed physical and verbal behavioral symptoms directed toward others one to three days during the review period. Review of Resident #7's care plan revised 04/08/22 revealed supports and interventions for risk for falls, chronic pain, verbal and physical 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 medical record review, resident interview, and staff interview the facility failed to ensure residents received timely dental services. This affected one resident (#83) of one resident reviewed for ancillary services. The facility census was 89. Findings Include: Review of Resident #83's medical record revealed an admission date of 01/04/21. Diagnoses included personal history of COVID-19, dementia and weakness. Review of Resident #83's Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of nine, indicating Resident #83 was moderately cognitively impaired. Resident #83 had no oral concerns at the time of the review. Review of Resident #83's care plan revised 04/11/22 revealed supports and interventions for risk for having behaviors of rejection of care, preferences for personal care, and self-care deficit. Review of Resident #83's ancillary services consent form revealed on 07/08/21 Resident #83's representative consented to vision services, dental services,…

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.