Edgewood Manor Of Greenfield

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident and staff interview, and medical record review, the facility failed to develop care plans to address resident needs and interventions. This affected four (#12, #24, #39, and #42) of 24 residents reviewed for care planning. The facility census was 50. Findings include: 1. Review of Resident #12's medical record revealed the resident admitted to the facility on [DATE] with diagnoses including schizoaffective disorder, type two diabetes mellitus with other specified complications, congestive heart failure, polyneuropathy, personal history of transient ischemic attack and cerebral infarction without residual deficits, congestive obstructive pulmonary disease, constipation, and centrilobular emphysema. Review of Resident #12's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and was assessed to receive an anticoagulant medication. Review of Resident #12's physician order dated 06/06/24 revealed the resident received the anticoagulant…

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 a resident list, and review of a food recipe, revealed the facility failed to prepare food in a palatable and attractive manner. This affected four (#1, #3, #6, and #42) of four residents who received mashed potatoes during meal observations. The facility census was 50. Findings include: Observation of meal service on 01/22/25 at 4:45 P.M. revealed [NAME] #406 served mashed potatoes as an alternate using a four ounce scoop. Further observation revealed [NAME] #406 went to scoop out a portion of mashed potatoes and part of the scoop was the dry potato mix. Interview with [NAME] #406 on 01/22/25 at 4:45 P.M. verified the mashed potatoes were not thoroughly mixed and residents were served dry mashed potato mix in their mashed potatoes. Review of the facility's undated mashed potato recipe revealed to mix the dry potato mix and water together, add margarine, and mix thoroughly. Review of the facility's undated list of residents that received mashed potatoes on 01/22/25 revealed four (#1, #3, #6 and #42) residents received the alternate…

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 a resident diet list, the facility failed to ensure mechanically altered meat was prepared in a form to meet resident needs. This affected 11 (#1, #4, #3, #6, #20, #23, #36, #42, #46, #47, and #202) of 11 residents that received mechanically altered diets. The facility census was 50. Findings include: Observation of meal service on 01/22/25 at 4:45 P.M. revealed a pan of mechanically altered country fried steak on the tray line. There were large chucks of the country fried steak in the pan that were larger than the size of a quarter. [NAME] #406 was observed to use a three ounce scoop to serve the mechanically altered country fried steak with chunks in it to residents that received mechanical diets. Interview with [NAME] #406 on 01/22/25 at 4:45 P.M. verified there were large chucks of mechanically altered pieces of country fried steak that were larger than the size of a quarter in the pan on the tray line. [NAME] #406 also verified she served residents that received mechanical soft diets the mechanically altered country fried steak…

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 notify the state mental health authority with a significant change Preadmission Screening and Resident Review (PASARR) for a resident with a change in their mental health condition. This affected two (#2 and #33) of three residents reviewed for PASARR. The facility census was 50. Findings include: 1. Review of Resident #33's medical record revealed the resident admitted to the facility on [DATE] with diagnoses including major depressive disorder, hypothyroidism, personal history of traumatic brain injury, hypokalemia, other developmental disorders of speech and language, muscle weakness, and xerosis cutis. Review of Resident #33's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was assessed as severely cognitively impaired. Review of Resident #33's PASARR document dated 11/05/21 revealed Resident #33 had no diagnoses of mental disorders. Resident #33 did not have indications of serious mental illness. 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, staff interview, hospital documentation review, and review of a facility policy, the facility failed to ensure non-pressure wounds were properly assessed and treated in a timely manner. This affected one (#37) of one residents reviewed for wounds. The facility census was 50. Findings Include: Record review for Resident #37 revealed she was admitted to the facility on [DATE]. Diagnoses included, rheumatoid arthritis, essential primary hypertension, gastro-esophageal reflux disease (GERD), chronic pain syndrome, anxiety disorder, and major depressive disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #37 was cognitively intact. Resident #37 was dependent on staff for bathing, toilet use, dressing, and personal hygiene, and required maximum assistance from staff with eating, and oral hygiene. Review of the hospital discharge report titled, admission Continuity of Care, included in Resident #37's admission paperwork dated 11/30/24 revealed…

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, and staff interview, the facility failed to ensure a resident was served food on a divided plate per the physician order. This affected one (#37) of one residents reviewed for assistive eating equipment and utensils. The facility census was 50. Findings include: Review of Resident #37's medical record revealed the resident was admitted to the facility on [DATE]. Her diagnoses included rheumatoid arthritis, essential primary hypertension, gastro-esophageal, chronic pain syndrome, anxiety disorder, and major depressive disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #37 was cognitively intact. Resident #37 was dependent on staff for medication administration, bathing, toilet use, dressing, and personal hygiene, and required maximum assistance from staff with eating and oral hygiene. Review of Resident #37's diet order dated 12/12/24 revealed the resident was ordered a regular diet with regular texture and regular consistency.…

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, medical record review, staff interview, policy review, the facility failed to maintain proper signage and personal protective equipment for a resident with an indwelling medical device placed on enhanced barrier precautions. This affected one (#9) of five residents reviewed for infection control. The facility census was 50. Findings include: Review of Resident #9's medical record revealed an admission date of 01/18/22. Diagnoses included chronic obstructive pulmonary disease, mixed hyperlipidemia, tracheostomy status, cognitive communication deficit, disease of the pancreas, acquired absence of the larynx, dysphagia pharyngeal phase, obesity due to excess calories, epilepsy, chronic kidney disease, major depressive disorder, and type two diabetes mellitus with hypoglycemia. Review of the 12/23/24 quarterly Minimum Data Set (MDS) assessment revealed Resident #9 was cognitively intact and require tracheostomy care while a resident. Review of Resident #9's physician orders revealed an order dated 10/03/24 for enhanced barrier precautions related to a tracheostomy.…

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

Based on medical record review, staff interview, and policy review, the facility failed to timely administer pneumococcal vaccines. This affected two (#11 and #29) of five residents reviewed for vaccinations. The facility census was 50. Findings include: 1. Review of Resident #11's medical record revealed an admission date of 08/16/19. Diagnoses included chronic obstructive pulmonary disease, insomnia, hyperlipidemia, diabetes mellitus with diabetic neuropathy, peripheral vascular disease, mild cognitive impairment, vascular dementia, and hypothyroidism. Review of Resident #11's medical record on 01/23/25 revealed no documented evidence of the resident receiving a pneumococcal vaccine. 2. Review of Resident #29's medical record revealed an admission date of 02/01/23. Diagnoses included encounter for orthopedic aftercare, anxiety disorder, nausea, anemia, psychoactive substance abuse, tobacco use, spinal stenosis, chronic obstructive pulmonary disease, hemiplegia and hemiparesis following cerebral infarction, cord compression, solitary pulmonary nodule, and chronic pain syndrome.…

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 safe and functional environment for the residents. This had the potential to affect all 46 residents residing in the facility. Findings include: Observations of the facility on 05/01/24 at 9:45 A.M. revealed multiple rain gutters that were hanging unattached to the fascia board on the left side front of the building near resident room [ROOM NUMBER]. Gutter mounting nails had broken loose from the building due to extended weather conditions causing the wood to rot and an unstable attachment. A second area was located outside the main entrance above the business office. The gutter system had also become unattached to the fascia board causing the wood to rot. A third area was located at the back of the building near a resident courtyard, with the gutters hanging below the attachment points. Observation of room [ROOM NUMBER] on 05/01/24 at 10:30 A.M. revealed a large brown stain on the ceiling above the room window. Interview 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 observation, staff interviews, record reviews, and review of online Centers for Disease and Control (CDC) guidance, the facility failed to ensure the use of appropriate Personal Protective Equipment (PPE) and hand hygiene when providing care to residents in isolation precautions for active infection with Clostridium Difficile (C-Diff). This had the potential to affect all residents residing in the facility except two residents (#13 and #399) who had an active infection with C-Diff. The facility census was 48. Findings include: Review for Resident #13's medical record revealed an admission date of 05/19/22 and had diagnosis including enterocolitis due to C-Diff infection. Review of the physicians order for Resident #13, dated 05/21/22, revealed an order for Vancomycin 125 milligram (mg) capsule, administer one capsule four times a day for 10 days for enterocolitis due to C-Diff. Record review for Resident #399 revealed this resident was admitted to the facility on [DATE] and had diagnoses including…

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 patient trust account review, surety bond review, policy review, and staff interviews, the facility failed to ensure the surety bond covered the total balance of resident funds. This had the potential to affect 23 of 23 residents who had their funds handled by the facility. The facility census was 48. Findings include: Interview with the Director of Nursing for entrance conference on 05/31/22 at 9:35 A.M., revealed the surveyors need a copy of the surety bond and all resident funds with their total balances. Review of the funds balance dated 05/27/22 on 06/02/22 revealed the balance of the residents facility accounts was $37,042.43. There was 23 resident accounts listed. Review of the facility surety bond on 06/02/22 revealed the bond was increased from $35,000 to $50,000 on 06/01/22. Interview with the Administrator on 06/02/22 at 11:53 A.M., verified the funds have been over the amount of the $35,000 surety bond amount and she noticed it on 06/01/22 and got the surety bond increased to $50,000. Review of the monthly funds balance report from 01/31/22 to present revealed…

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, Beneficiary Notice- Residents discharged list review, and staff interview, the facility failed to inform the resident or his or her legal representative in writing that Medicare will not pay for covered skilled services, and why these specific services may not be covered and the potential liability for payment for the non-covered services. This affected three (#30, #97, and #98) of three residents reviewed for beneficiary notices. The facility census was 48. Findings include: 1. Review of Resident #30's medical record revealed an admission date of 03/17/21. Diagnoses included chronic peripheral venous insufficiency, gastro-esophageal reflux, personal history venous thrombosis and embolism, osteoarthritis, lack of physical excercise, and weakness. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed the resident had impaired cognition. The resident was dependent on two staff for bed mobility and transfers, dependent on one person for toileting, and…

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

Based on medical record review, resident personal funds list review, policy review, and staff interview, the facility failed to notify a resident who receives medicaid benefits when their personal funds account reaches less than $200 of the Supplemental Security Income (SSI) resource limit of $2000. This affected two (#20 and #44) of five reviewed for personal funds. The facility currently identified eight (#2, #5, #6, #7, #20, #22, #28, and #44) residents with over $2000 in their accounts. The facility census was 48. Findings include: 1 Review of Resident #20's medical record revealed an admission date of 04/20/16, with diagnoses including: hemiplegia, history of COVID-19, hypertension, mild cognitive impairment, and dementia. Resident #20's pay source was Medicaid Review of the Resident personal funds account list dated 05/27/22 revealed Resident #20 current balance was $5461.72 and has been over $5000 since 01/31/22. Interview with the Administrator on 06/02/22 at 11:15 A.M., revealed the policy is to notify the Resident when their account reaches $200 less than the Supplemental…

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 notify the ombudsmen of a resident's discharge from the facility. This affected one (#28) of two residents reviewed for hospitalization. The facility census was 48. Findings include: Review of the medical record for Resident #28 revealed an admission of 04/11/11, with diagnoses including transient ischemic attack, bipolar disorder, schizoaffective disorder, major depressive disorder, and chronic obstructive pulmonary disease. Review of the Medicare Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #28 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require one-person extensive assistance with transfers, dressing, toileting, and bathing, and supervision in eating. Review of the progress note dated 03/24/22 at 3:45 P.M., revealed Resident #28 had edema and redness to left lower extremity and redness and warmth to right lower extremity as well as pain.…

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 policy review, the facility failed to provide bed hold notices to residents/resident representatives within 24-hours of transferring to the hospital. This affected two (#10 and #28) of two residents reviewed for hospitalization. The facility census was 48. Findings include: 1. Review of the medical record of Resident #10 revealed an admission date of 06/08/20. The resident transferred to the hospital on [DATE] and returned to the facility on [DATE]. The resident transferred to the hospital again on 05/07/22 and returned to the facility on [DATE]. Diagnoses included dementia without behavioral disturbance, repeated falls, lack of coordination, osteoarthritis, abnormal posture, attention and concentration deficit, conversion disorder with seizures or convulsions, gastro-esophageal reflux disease, and major depressive disorder. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed the resident had impaired cognition. The resident exhibited…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, staff interview, and policy reviews, the facility failed to ensure a resident was lifted in a safe manner in order to prevent potential injury. The facility also failed to ensure fall interventions were implemented. This affected one (#10) of two reviewed for accidents. The facility census was 48. Findings include: Review of the medical record of Resident #10 revealed an admission date of 06/08/20. Diagnoses included dementia without behavioral disturbance, repeated falls, lack of coordination, osteoarthritis, abnormal posture, attention and concentration deficit, conversion disorder with seizures or convulsions, gastro-esophageal reflux disease, and major depressive disorder. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed the resident had impaired cognition. The resident exhibited fluctuating inattention and altered level of consciousness during the assessment period. The resident required extensive assistance of one staff for 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.

Based on review of the facility's vaccination matrix, review of staff vaccination records, staff interview, review of Centers for Medicare & Medicaid Services (CMS) memorandum, and review of the facility's policy, the facility failed to ensure 100 percent of their staff were fully vaccinated against COVID-19 or had been granted a medical or religious exemption. The vaccination rate for the facility was calculated at 94.2%. The facility census was 48. Findings include: Review of the undated facility staff COVID-19 vaccination matrix revealed the facility had a total of 70 employees. There were 66 employees fully vaccinated for COVID-19 or were granted a medical or religious exemption and four employees partially vaccinated for COVID-19, indicating a staff vaccination rate of 94.2%. Review of the COVID-19 vaccination record for Activities Aide #2 revealed the employee had received the first dose of the Pfizer COVID-19 vaccine on 11/24/21. There was no documentation of the second dose of the vaccine being administered. Review of the COVID-19 vaccination record for Certified Nurse Aide…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observations, staff interviews, and review of the facility's policy, the facility failed to ensure a resident's call light was properly functioning. This affected one (Resident #19) of 16 residents reviewed in the initial pool sample. The facility census was 48. Findings include: Review of the medical record for Resident #19 revealed Resident #19 was admitted to the facility on [DATE]. Diagnoses included cerebral infarction, anxiety disorder, parapleural psychosis, and dementia without behavioral disturbance. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #19 had severe cognitive impairment. Resident #19 was assessed to required one-person extensive assistance with toileting and bathing. Observation on 05/31/22 at 11:12 A.M. revealed Resident #19's call light was lying on the floor underneath the bed. Resident #19's call light was not properly functioning. Interview on 05/31/22 at 11:15 A.M. with Occupational Therapist Assistant #64…

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 have a policy or procedure for time frames in the medication regimen review and steps when an irregularity required immediate action and failed to ensure a residents pharmacy recommendations were not addressed for over a month. This affected one Resident (#32) of five Residents reviewed for medications and had the potential to affect all residents who had monthly pharmacy medication reviews. The facility census was 59. Findings include: 1. Interview with the Director of Nursing (DON) on 08/01/19 at 10:18 A.M. revealed she would get the facility policy on time frames in the medication regimen review and steps when an irregularity requires immediate action. Review of a facility policy titled Medication Utilization and Prescribing dated 09/01/12 revealed no information concerning time frames in the medication regimen review and steps when an irregularity required immediate action. Interview with the Administrator on 08/01/19 at 12:53 P.M., verified the policy did not address the time frames in the medication regimen…

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, interview, and facilities policy review, the facility failed to provide a clean and well maintained resident smoking area that was free from used smoking materials and failed to keep ash trays emptied and in good condition. This had the potential to affect 20 residents ( Resident #16, #28, #256, #40, #44, #43, #39, #5, #307, #257, #13, #258, #29, #22, #306, #305, #255, #41, #34, and #37) in the facility who are smokers. The facility census was 59. Findings include : Observation was conducted on 07/29/19 at 11:22 A.M., of the resident smoking area and noted one smoking receptacle with no lid that contained multiple cigarette butts, ashes, a plastic bag, a pop can, and empty packs of cigarettes. Another smoking receptacle with half of a lid and contained cigarette butts, ashes, a paper coffee cup, and packs of empty cigarettes. There was one trash can that contained a lid and noted cigarette butts and ashes and numerous trash. There was one ash tray that sat on table that was noted to be in poor repair with the sides rusted open exposing ashes and cigarettes.…

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 accurately assess antidepressant use on a resident's comprehensive admission Minimum Data Set (MDS) assessment. This affected one resident (Resident #25) of five residents reviewed for unnecessary medications. The facility census was 59. Findings include: Review of the medical record for Resident #25 revealed an admission date of 05/21/19 with diagnoses including but not limited to end stage renal disease, hypertension, anxiety, and depression. Review of physician orders dated July 2019 revealed Resident #25 had an order dated 05/21/19 for an antidepressant medication Prozac daily for depression. Review of medication administration record dated May 2019 revealed Resident #25 received an antidepressant medication everyday from 05/23/19 through 05/27/19 and from 05/29/19 through 05/31/19. Review of admission minimum data set (MDS) dated [DATE] revealed Resident #25 was cognitively intact and received no antidepressant medication. Interview…

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 record review, and staff interview, the facility failed to ensure a complete Long Term Care Minimum Data Set (MDS) 3.0 (a health status screening and assessment tool used for all residents of long term care nursing facilities) assessment was completed. This affected one resident (Resident #4) of 15 resident records reviewed. Findings Include: Review of Resident #4's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including dementia, Alzheimer's disease, bipolar disorder, depression and schizophrenia. The physician's orders included Prolixin 2.5 milligrams (mg) daily for schizophrenia. Review of the annual MDS 3.0 assessment completed on 04/28/19 revealed Section C (cognitive assessment), Section D (mood assessment), and Section F (personal preferences) was not completed for Resident #4. A psychoactive medical evaluation completed on 05/02/19 identified Prolixin was used for the diagnoses of schizophrenia. Behaviors identified on 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, resident interview, and staff interview, the facility failed to follow up on the assistive hearing device needs for one (Resident #17) of one resident reviewed for hearing services. The facility census was 59. Findings include: Review of Resident #17's medical record revealed an admission date of 01/04/08 with diagnoses including intellectual disabilities (unspecified), anxiety disorder, dysphagia, and schizophrenia. Review of the Certificate of Medical Necessity dated 12/07/18 revealed Resident #17 had a hearing test on 09/13/18 with a moderately severe hearing loss noted to the right and left ears and digital hearing aids prescribed to provide optimal sound quality to be programmed to specifically meet the need of a hearing loss configuration. Review of Resident #17's care plan dated 01/13/19 revealed a category of Cognition/Neurology and resident had a hearing loss and hearing aids with an intervention of resident chose when to wear them and have been lost or misplaced multiple times.…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview and document review, the facility failed to ensure a resident with oxygen had the nasal cannula changed and dated weekly. This affected one (Resident #16) of two Residents reviewed for oxygen care. This had the potential to affect 15 (Resident #2, #12, #15, #16, #17, #21, #25, #28, #34, #37, #44, #48, #52, #256, and #308,) facility identified residents on oxygen. The facility census was 59. Findings include: Record review of Resident #16 revealed an admission date of 5/10/19 with pertinent diagnosis of: acute and chronic respiratory failure, chronic obstructive pulmonary disease, diabetes mellitus, and dementia. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was severely cognitively impaired and used oxygen while in the facility. Observation on 07/31/19 at 8:25 A.M., revealed an undated oxygen nasal cannula tubing was noted in Resident #16's room. The resident stated she did not know when it was last changed. Interview 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 record review, observation and staff interview, the facility failed to monitor behaviors for one resident (Resident #4) who was receiving antipsychotic medications of six residents were reviewed for unnecessary medications. The facility census was 59. Findings Include: Resident #4 was admitted to the facility on [DATE] with diagnoses including dementia, Alzheimer's disease, bipolar disorder, depression and schizophrenia. The physician's orders included Prolixin 2.5 milligrams (mg) daily for schizophrenia. The plan of care dated 10/12/17 indicated Resident #4 received an antipsychotic medication and to monitor behavior symptoms with the goal the resident would not resist care. A Psychoactive medical evaluation completed on 05/02/19 identified Prolixin was used for the diagnosis of schizophrenia. Behaviors identified on the evaluation included aggression, inappropriate responses, unwarranted suspiciousness, delusions and paranoia. A physician progress note dated 06/2019 indicated Resident #4 continued to…

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

Based on observation, medical record review, staff interview, and facilities policy review, the facility failed to follow infection control practices with a resident on contact precautions. This affected one (Resident #13) of two residents reviewed on precautions. The facility census was 59. Findings include: Review of the medical record for Resident #13 revealed an admission date of 01/16/19 with diagnoses including but not limited to traumatic brain injury, seizures, and clostridium difficile (c-diff). Review of physician orders dated 06/28/19 revealed an antibiotic order and to place Resident #13 under contact precautions. Review of physician progress note dated 07/17/19 revealed Resident #13 was being treated for c-diff colitis. Observation conducted on 07/29/19 at 11:47 A.M., revealed State Tested Nursing Assistant (STNA) #56 went into Resident #13's room with clean bed linens in hand and made his bed. STNA #56 did not wash hands upon entering and exiting room and did not have on any personal protective equipment when making Resident #13's bed. STNA #56 then took in 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.