Madison Health Care

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation, interview and review of the facility policy, the facility failed to ensure Resident #95 was free of significant medication error. This affected one resident (#95) out of four residents observed for medication administration. The facility census was 102. Findings included: Review of the medical record for Resident #95 revealed an admission date of 10/16/24 with diagnoses including chronic obstructive pulmonary disease, dysphagia, hypertension, and acute respiratory failure with hypoxia. Review of the care plan dated 10/22/24 revealed Resident #95 was at risk for alterations in nutrition as he was to have nothing by mouth. He was receiving all his nutrition through a percutaneous endoscopic gastrostomy (PEG) tube (a tube inserted through the abdominal wall into the stomach to provide nutrition, medications, and hydration). Interventions included medications per physician order and provide tube feeding as ordered to meet nutrition and hydration needs. Review of the quarterly…

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 interview, record review, review of statement of expert evaluation and facility policy the facility failed to ensure Resident #103 resided in the least restrictive environment and was free from involuntary seclusion. This affected one resident (Resident #103) out of three residents reviewed for restrictive environment. The facility census was 102. Findings include: Review of Resident #103's closed medical record revealed an admission date of 10/08/22 and diagnoses included generalized idiopathic epilepsy and epileptic syndromes, intractable with status epilepticus, schizoaffective disorder, bipolar type, and unspecified dementia, mild with other behavioral disturbance. Resident #103 was discharged from the facility on 03/14/24. Review of Resident #103's progress notes dated 10/10/22 included Social Worker Assistant (SWA) #323 called Resident #103's daughter who was also her POA (Power of Attorney) to set up an initial care conference. Resident #103's daughter informed SWA #323 that Resident #103 would…

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 and review of the facility policy, the facility failed to implement care planned interventions to ensure Resident #66's open area to the crease of the left buttock and posterior thigh was identified and treated timely. This affected one resident (Resident #66) out of three residents reviewed for wounds. The facility census was 102. Findings include: Review of Resident #66's medical record revealed an admission date of 10/23/23 and diagnoses included type two diabetes mellitus, depression, bipolar disorder, schizoaffective disorder and acquired absence of left upper limb below the elbow. Review of Resident #66's Annual Minimum Data Set assessment dated [DATE] revealed Resident #66 was cognitively intact. Resident #66 was dependent for toileting hygiene, bathing, personal hygiene and lower body dressing. Resident #66 was frequently incontinent of urine and bowel. Review of Resident #66's care plan dated 10/23/23 and revised on 11/13/24 included Resident #66 had 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, interview, record review and review of the facility policy the facility failed to ensure Resident #10 had effective fall interventions in place to prevent frequent falls. This affected one resident (Resident #10) out of three residents reviewed for falls. The facility census was 102. Findings include: Review of Resident #10's medical record revealed an admission date of 05/07/12 and diagnoses included moderate intellectual disabilities, major depressive disorder, generalized idiopathic epilepsy and epileptic syndromes, not intractable without status epilepticus, and unsteadiness on feet. Review of Resident #10's care plan dated 08/20/21 and revised 08/19/24 included Resident #10 had potential risk for falls and injury related to seizures, unsteadiness and use of psychoactive and seizure medications. Resident #10 was provided a helmet but was non compliant with use despite encouragement. Resident #10 continued to attempt self-ambulation and transferring despite constant reminders from the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on interview, record review, local police report review, and policy and procedure review the facility failed to ensure appropriate supervision to prevent a resident from leaving the facility unattended without staff knowledge. This affected one (Resident #82) of three residents reviewed for elopement. The facility census was 95. Findings include: Review of Resident #82's medical records revealed an admission date of 03/08/21. Diagnoses included traumatic brain injury, cognitive communication deficit, impulse disorder and falls. Review of Resident #82's care plan dated 01/01/24 revealed Resident #82 required assistance with activities of daily living (ADL) related to cognitive impairments and traumatic brain injury and fluctuations could occur. Interventions included extensive assistance with some tasks including dressing, toileting and personal hygiene. Review of elopement assessment…

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 interview, the facility failed to ensure medications were administered per physician order resulting in a significant medication error. This affected one (Resident #105) of three residents reviewed for medication administration. The facility census was 103. Findings include: Review of the medical record for Resident #105 revealed an admission date of 02/11/22 with diagnoses including Chronic Obstructive Pulmonary Disease (COPD), hypothyroidism, Vitamin D deficiency, muscle weakness, cirrhosis of liver, type two diabetes without complications, hyperlipidemia, obesity, schizophrenia, tobacco use, difficulty walking, constipation, gastro-esophageal reflux, and schizoaffective disorder bipolar type. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview Mental Status (BIMS) score of 12, indicating cognitive impairment. Resident #105 displayed delusions. Resident #105 did not reject care. Setup or clean up assistance was needed for eating,…

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 review of facility policy the facility failed to ensure food was palatable related to temperature and taste. This had the potential to affect all 103 residents residing in the facility. Findings include: Observation on 10/26/23 at 7:32 A.M. of the tray line for the breakfast meal revealed a sausage patty, homemade french toast, fortified cream of wheat, pureed french toast, pureed sausage, orange juice, other types of juice and milk were on the menu for breakfast. Further observation revealed a tray on a cart next to the tray line area with many bowls of oatmeal with plastic lids on it. [NAME] #402 stated she put the oatmeal in dishes and placed them on the tray before tray line was started. Observation on 10/26/23 at 7:32 A.M. revealed two metal carts without doors or sides next to the tray line area. Further observation revealed three large carts with sides and doors. Dietary Manager (DM) #384 stated the metal carts and large carts with doors were used to transport the meal to the residents on the nursing units. Dietary Manager (DM) #384…

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 and review of the facility policy the facility failed to ensure Resident #86's room was clean and sanitary. This affected one resident (Resident #86) out of three residents reviewed for clean and sanitary rooms. The facility census was 103. Findings include: Review of Resident #86's medical record revealed an admission date of 08/21/23 and diagnoses included delusional disorders, stage three pressure ulcers of right and left heels, and morbid obesity due to excess calories. Review of Resident #86's admission Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #86 was cognitively intact. Resident #86 required extensive assistance of one staff member for bed mobility, limited assistance of one staff member for transfers and toilet use, and was not steady but able to stabilized without staff assistance when moving on and off the toilet. Review of Resident #86's care plan dated 08/23/23 included Resident #86 needed ADL (Activity of Daily Living) assistance…

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 and review of the facility policy the facility failed to ensure Resident #86 was placed on contact precautions for Methicillin Resistant Staphylococcus Aureus (MRSA, spread by contact with infected people or things carrying the bacteria, staph bacteria resistant to common antibiotics) of her bilateral heels. This affected one resident (Resident #86) out of three reviewed for infection control. The facility census was 103. Findings include: Review of Resident #86's medical record revealed an admission date of 08/21/23 and diagnoses included delusional disorders, stage three pressure ulcers of right and left heels, and morbid obesity due to excess calories. Review of Resident #86's admission Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #86 was cognitively intact. Resident #86 required extensive assistance of one staff member for bed mobility, limited assistance of one staff member for transfers and toilet use, and was not steady but able 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.

THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on record review and interview, the facility failed to employ a registered nurse (RN) for at least eight consecutive hours daily who was not acting in the capacity of the Director of Nursing. This had the potential to affect all 102 residents residing in the facility. Findings include: Review of the facility posted staffing information for January 2023 revealed on 01/02/23 there was no RN on duty for at least eight hours who was not acting in the capacity of the Director of Nursing. Review of the facility posted staffing information for August 2023 revealed on 08/11/23 there was no RN on duty for at least eight hours who was not the acting in the capacity of the Director of Nursing, and on 08/19/23 there was no RN on duty in the facility. Interview on 09/27/23 at 2:16 P.M. with Scheduler and State Tested Nursing Assistant (STNA) #422 verified on 01/02/23, 08/11/23, and 08/19/23 there was no RN on duty for at least eight hours who was not acting in 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.

Based on record review and interview, the facility failed to submit payroll-based journal (PBJ) data quarterly as required. This had the potential to affect all 102 residents residing in the facility. Findings include: Review of the PBJ staffing data report dated 09/15/23 revealed the facility failed to submit PBJ data for the second quarter of the federal fiscal year 2023. Review of the facility provided PBJ validation reports for the federal fiscal year 2023 revealed there was no evidence the PBJ data for the second quarter was submitted. Interview on 09/28/23 at 11:34 A.M. with Regional Administrative Director #539 verified there was no PBJ data submitted in the second quarter of the federal fiscal year 2023 as required. This deficiency represents non-compliance investigated under Complaint Number OH00146162.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and facility policy review the facility failed to ensure Resident #94's indwelling urinary catheter (a flexible tube inserted into the bladder to drain urine) drainage bag was covered with a dignity pouch. This affected one resident (#94) out of one resident reviewed for urinary catheter use. This had the potential to affect two residents (#94 and #105) that had urinary catheters at the facility. The facility census was 102. Findings include: Review of the medical record for Resident #94 revealed an admission date of 06/20/23 with diagnoses including benign prostatic hyperplasia (BPH) with lower urinary tract symptoms, and chronic kidney disease. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #94 had impaired cognition. He required limited assistance from one person with bed mobility, transfers, and toileting. He had an indwelling catheter. Review of the care plan dated 07/10/23 revealed Resident #94 had the potential for…

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

Based on record review and interview, the facility failed to obtain witnessed authorizations to manage resident funds. This affected three residents (#48, #67 and #98) of eight records reviewed for personal fund accounts. Findings include: Review of Resident #48's medical record revealed an admission date of 02/22/23. Review of the undated authorization and agreement form to handle resident funds revealed Resident #48's power-of-attorney signed the form and the form did not contain a witness signature as required. Review of Resident #67's medical record revealed an admission date of 06/25/21. Review of the undated authorization and agreement form to handle resident funds revealed Resident #67 signed the form and the form did not contain a witness signature as required. Review of Resident #98's medical record revealed an admission date of 08/17/22. Review of the undated authorization and agreement form to handle resident funds revealed Resident #98's representative payee signed the form and the form did not contain a witness signature as required. Interview on 09/28/23 at 9:24 A.M.…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to ensure Resident #28 wore hand splints as recommended per therapy and/or the physician order. This affected one resident (#28) of one resident reviewed for range of motion (ROM). The facility census was 102. Findings include: Review of the medical record for Resident #28 revealed an admission date of 07/26/19 with diagnoses including sequela of cerebrovascular disease, contracture, and cerebral palsy. The resident was discharged to the hospital on [DATE] and returned to the facility on [DATE]. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE], revealed Resident #28 was moderately cognitively impaired. The assessment indicated the resident required the extensive assistance of two people for bed mobility and dressing. The resident was totally dependent on two people for transfers, toilet use, and personal hygiene and dependent on one person for locomotion. Review of physician orders for Resident #28 for September 2023…

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, and facility policy review the facility failed to ensure infection control standards were followed during dining including a resident feeding another resident utilizing the same utensil that he was using to eat with. This affected two residents (#15 and #57) out of four residents reviewed for nutrition/ hydration and had the potential to affect 35 residents (#1, #2, #3, #4, #5, #9, #12, #14, #16, #18, #19, #20, #24, #25, #29, #31, #34, #35, #40, #44, #50, #52, #57, #59, #60, #68, #75, #77, #80, #90, #91, #92, #95 #97, and #99) residing on the secured units four and five. Findings include: 1. Review of the medical record for Resident #15 revealed an admission date of 01/13/14 with diagnoses including intellectual disability, alcohol-induced persisting dementia, and depression. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #15 had impaired cognition as his Brief Interview for Mental Status (BIMS) score was a four. He…

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 use the services of a registered nurse (RN) for at least eight consecutive hours a day, seven days a week as required. This had the potential to affect all 106 residents residing in the facility. Findings include: Review of the facility posted staffing information for July 2023 revealed there was no RN in the facility on 07/22/23 and 07/23/23. Interview on 08/16/23 at 2:17 P.M. with State Tested Nursing Assistant (STNA) #418 who completed scheduling duties verified the facility did not have a RN in the facility for at least eight consecutive hours on 07/22/23 and 07/23/23 as required. This deficiency represents non-compliance investigated under Complaint Number OH00145230.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, staff interview, review of the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) Memo QSO-20-14-NH (revised 3/10/21), review of the World Health Organization (WHO) hand hygiene brochure, and review of the Centers for Disease Control and Prevention (CDC) guidelines, the facility failed to ensure personal protective equipment (PPE) was donned for Resident #452, who was on quarantine precautions, and hand hygiene was consistently implemented to potentially prevent the spread of infections for Resident #4 while preforming wound care. This had the potential to affect all 106 residents of the facility. The facility had no active COVID-19 cases. Findings include: 1. Record review revealed Resident #452 was admitted to the facility on [DATE] with diagnoses including anxiety disorder, mediastinal large B-cell lymphoma, heart failure, and diabetes mellitus. The admission Minimum Data Set (MDS) 3.0 assessment was currently in progress. Further record review for…

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

5. Review of the medical record for Resident #14 revealed an admission date of 5/22/20 with diagnoses including malignant neoplasm of lower respiratory tract, major depressive disorder, and hypertension. Review of the MDS 3.0 assessment, dated 06/01/21, revealed the resident had intact cognition. The resident was independent for activities of daily living. Resident #14 had an ostomy bag. Observation on 08/30/21 at 11:00 A.M. revealed Resident #14 was sitting in his wheelchair wearing a hospital gown. Further observation revealed many flies on the resident's sheets, and the bed linens were dirty. Interview on 08/30/21 at 11:06 A.M. with Licensed Practical Nurse (LPN) #69 verified that the bed linens were dirty, and there were flies in the room. This deficiency substantiates Master Complaint Number OH00114343. 3. Review of the medical record for Resident #12 revealed an admission date of 09/01/21 with diagnoses including diabetes, polyneuropathy (a malfunction of nerves throughout the body), and abnormal gait. Review of the quarterly MDS 3.0 assessment, dated 08/09/21, 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, staff interview and facility protocol review, the facility failed to ensure handrails were firmly secured to the wall. This affected 28 residents (Resident's #3, #4, #5, #17, #19, #24, #25, #31, #35, #42, #46, #47, #54, #55, #58, #61, #70, #71, #79, #80, #81, #82, #85, #90, #93, #94, #100, #151, #152) located on Unit 4. The facility census was 106. Findings include: Observation on 09/02/21 at 9:07 A.M. of Unit 4, located on the second floor of the facility, revealed a handrail located next to the elevator adjacent to the nursing station and near room [ROOM NUMBER] was loose and not affixed firmly to the wall. Observation on 09/02/21 at 9:08 A.M. of Unit 4, also revealed a handrail between rooms #404 and #405 was not affixed to the wall securely. Interview on 09/02/21 at 10:30 A.M. with Licensed Practical Nurse (LPN) #55 confirmed the handrails were not securely affixed to the wall. LPN #55 revealed she walked and observed both handrails not securely fastened to the wall. LPN #55 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.

Based on review of the surety bond, trial balance funds sheet and staff interview, the facility failed to provide a surety bond large enough to cover the total amount of money in all resident personal funds accounts. This had the potential to affect all 106 residents who currently resided in the facility. Findings include: Review of the facility's surety bond revealed it was in the amount of $32,000.00. Review of the resident trial balance funds documented the total money in the resident funds account totaled $127,362.18. Interview on 09/01/21 at 8:30 A.M. the Administrator verified the amount of monies in the resident funds account exceeded the amount of the surety bond.

Based on record review and interviews, the facility failed to have complete and accurate care plans. This affected two (Resident's #4 and #70) of five residents reviewed for care plans. The facility census was 106. Findings include: 1. Review of the medical record for Resident #4 revealed an admission date of 11/20/19 with diagnoses including morbid (severe) obesity, age-related physical debility, other neuromuscular dysfunction of the bladder, other depressive episodes, type two diabetes mellitus, and chronic obstructive pulmonary disease. Review of the physician's order dated 06/09/21 revealed facility staff and hospice staff were to pad and protect all wounds. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/17/21, revealed the resident had impaired cognition and required extensive assistance for bed mobility and toilet use. Resident #4 had two unstageable (full-thickness skin and tissue loss) pressure ulcers, one unstageable deep tissue injury (persistent non-blanchable deep red, maroon, or purple discoloration of intact or non-intact skin), 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, record review, and guidelines for administering medication, and manufacture instructions the facility failed to administer medication according to professional standards. This affected two residents (Resident #18 and Resident #29) of five residents observed for medication administration. The facility census was 106. Finding include: 1. Review of the medical record for Resident #18 revealed an admission date of 02/25/16 with diagnoses including hypothyroidism (a low level of thyroid hormone), schizophrenia, and depression. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 06/10/21, revealed Resident #18 had impaired cognition. Review of the physician orders for September 2021 revealed and order for Levothyroxine 150 microgram (mcg) for low thyroid level, Buspar 10 milligram (mg) for anxiety and Gabapentin 400 mg to stabilize mood. Observation on 09/01/21 at 7:18 A.M. of Licensed Practical Nurse (LPN) #54 administering medications to Resident #18 revealed she prepared the three medications. LPN #54 walked to the dining room and administered 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, interview and record review, the facility failed to ensure Resident #40's hair was maintained after removal of her dreadlocks. This affected one of three Residents (#4, #40, #42) reviewed for activities of daily living (ADL). The facility census was 106. Findings include: Review of the medical record revealed Resident #40 was admitted to the facility on [DATE] with diagnoses including schizophrenia, psychotic disorder with delusions, muscle weakness, and anxiety. The annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] indicated the resident had moderate cognitive impairment and required supervision with personal hygiene. Observation on 08/31/21 at 10:48 A.M. revealed the resident was seated in the common area with other residents. Resident #40 was noted to be dressed but not groomed. The resident's hair was noted to be matted in the back and sticking straight up on the top. Interview on 08/31/21 at 11:03 A.M. with Registered Nurse (RN) #76 and the resident revealed the resident 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 record review, observations and interviews, the facility failed to complete wound care as ordered by the physician. This affected one (Resident #4) of five residents reviewed for wounds. The facility census was 106. Findings Include: Review of the medical record for Resident #4 revealed an admission date of 11/20/19 with diagnoses including morbid (severe) obesity, age-related physical debility, other neuromuscular dysfunction of the bladder, depressive episodes, type two diabetes mellitus with unspecified complications, and chronic obstructive pulmonary disease. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had impaired cognition. The resident required extensive assistance for bed mobility and toilet use. Resident #4 had two unstageable (full-thickness skin and tissue loss) pressure ulcers, one unstageable deep tissue injury (persistent non-blanchable deep red, maroon, or purple discoloration of intact or non-intact skin), and a suprapubic catheter.…

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 interviews, the facility failed to ensure Resident #3 was provided with eating equipment to maintain independence while eating. This affected one (Resident #3) of 29 residents (Resident's #3, #6, #7, #8, #10, #16, #20, #21, #26, #31, #35, #36, #38, #47, #49, #57, #60, #63, #72, #73, #74, #75, #76, #80, #83, #84, and #86) who required adaptive devices. The facility census was 106. Findings include: Review of the medical record for Resident #3 revealed an admission date of 12/06/20 and readmission date of 02/09/21. Diagnoses included schizophrenia, bipolar, and unspecified lack of coordination. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had severely impaired cognition. The resident required limited assist of one staff for eating. Review of the physician's orders for September 2021 revealed orders for Kennedy cups (a lightweight spill proof drinking cup), individual bowls and a small maroon spoon at all meals…

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.