Maple Hills Skilled Nursing & Rehabilitation

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, record review, and facility policy, the facility failed to ensure dialysis communication forms were utilized to ensure communication between the facility and the dialysis center. This affected one resident (#16) of one resident reviewed for dialysis. Facility census was 32. Review of Resident #16's medical record revealed an admission date of 07/23/24. Medical diagnoses included osteomyelitis, diabetes mellitus type 2, severe calorie malnutrition, alcoholic cirrhosis of liver without ascites, end stage renal disease, anxiety, anemia, dependence on dialysis, right below the knee amputation, thrombocytopenia, and atrial fibrillation. Review of Resident #16's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 was cognitively intact, dependent for toilet and tub/shower transfers, and required assistance for mobility and was wheelchair dependent. Review of Resident #16's care plan dated 06/06/25 revealed Resident #16 will experience no complications related to dialysis through…

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, review of an invoice from an outside plumbing company, review of maintenance temperature logs, and staff interview, the facility failed to ensure hot water temperatures were maintained between 105 degrees Fahrenheit (F.) and 120 degrees F. as required and did not pose a potential burn risk for the residents. This had the potential to affect seven residents (#2, #7, #10, #18, #20, #21, and #26), who the facility identified as having the use of the first floor shower room and five residents (#8, #9, #22, #25, and #28), who the facility identified as having the ability to utilize the sinks in their rooms on the second floor, without staff assistance. Findings include: On 04/17/25 at 9:20 A.M., an observation of the facility's boiler room located in the basement revealed there were three hot water tanks for providing hot water throughout the facility. Two of the three hot water tanks were of the same size and were a standard electric water heater. The third hot water tank was larger in size 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, staff interviews, resident interviews, Ombudsman electronic communication, and policy review, the facility failed to provide sufficient staff to meet residents' needs. This affected three residents (#24, #28, and #30) of three residents reviewed for personal care needs and had the potential to affect all 33 of 33 residents in the facility. Findings include: 1. Record review revealed Resident #30 was admitted to the facility on [DATE] with diagnoses including unspecified dementia and hypertension. Review of a nursing note dated 03/13/25 at 4:32 P.M. by Director of Nursing (DON) revealed she was made aware Resident #30 was outside, when she went outside to check, the first floor nurse was with Resident #30. Resident #30 had wandered out the side door with construction workers because she wanted to take a walk. Resident #30 was immediately assessed and had no injuries, she was taken back into the facility, and her wander-guard was checked and working properly. All wander-guards…

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, review of the administrator's job description, observations, review of the facility vendor and supplier bills, and interviews, the facility failed to ensure the facility was administered in a manner that enabled it to use it's resources effectively and efficiently including compliance with all financial obligations for the delivery of care to attain and maintain the highest practicable well being of each resident. This affected 33 of 33 residents residing in the facility. Findings included: 1. Review of information received from an anonymous complainant on 03/18/25 revealed the facility owed over $10,000 for their water bill, but due to it being a nursing facility the water department was either unable to or refused to issue a shut off notice. a .)Review of an invoice dated 04/06/24 from Stockmeister (plumbing, heating, and cooling repair company) revealed the facility owed $110 at the time of receipt for a service call related to the garbage disposal not working. Review of an invoice…

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, policy review, and interview, the facility failed to ensure the facility provided a safe, sanitary and comfortable environment for residents. This affected 33 of 33 residents residing in the facility. Findings included: Continuous observations on 03/20/25 from 8:39 A.M. to 8:49 A.M. revealed trash throughout the yard, parking lot and woods surrounding the facility. Trash including plastic grocery bags, cigarette butts, and Styrofoam food containers. There was an empty flower pot with three inches of standing water and a Styrofoam container in it with a black mold-like substance. There was a sidewalk next to the building leading to the back where the resident smoking area is. At the back corner of the building, there was a hole which appeared to be created from a water drip. The drop off into the hole was approximately three feet and the hole was starting to go underneath the sidewalk. There was no hand rail for the residents to use. Interview on 03/20/25 at 1:37 P.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 record review and interview, the facility failed to ensure resident medical record documentation was accurate and not falsified. This affected three residents (#24, #26, and #28) of three sampled residents reviewed for accurate medical records. Findings included: Review of medical records for Residents #24, #28, and #26 revealed the director of nursing (DON) entered notes on 02/08/25 which stated Resident assessed noted no signs or symptoms of dizziness, nausea, headache, shortness of breath, confusion, or chest pains. Vital signs obtained and within normal limits. Family and MD (medical director) notified. Interview on 03/20/25 at 10:15 A.M. with the DON revealed she was on the phone with a nurse manager during the time of the gas leak incident (on 02/08/25), but she did not come to the facility. The nurse manager who was at the facility was who completed resident assessments on paper regarding the incident. Interviews on 03/20/25 with Licensed Practical Nurse (LPN) #380 and Registered Nurse (RN) #355 at 1:21 P.M. revealed they did not look into it, but did hear the DON…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, review of the Administrator job description and personnel file and interview, the facility failed to employ a qualified administrator to ensure the facility was effectively and efficiently administered to allow all residents to attain or maintain their highest practicable physical, mental, and psychosocial well-being and to ensure staff were knowledgeable of who the administrator was. This had the potential to affect all 34 residents residing in the facility. Findings Include: On [DATE] between 10:45 A.M. and 12:41 P.M. interviews with Certified Nursing Assistant (CNA) #216, Licensed Practical Nurse (LPN) #223, and Registered Nurse (RN) #220 revealed none of the staff knew who the current facility Administrator was. The staff revealed they were not familiar with Interim Administrator (IA) #260 or Administrator #275. During the interview with the CNA, the CNA revealed she had not met IA #260 or Administrator #275. She stated she was aware there had been a new administrator…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, facility policy review and interview, the facility failed to maintain a safe, functional and comfortable environment for all residents and failed to timely address an alarming carbon monoxide detector to ensure resident safety. This had the potential to affect all 34 residents residing in the facility. The facility census was 34. Findings Include: Review of the Fire Department Run Report dated 02/08/25 revealed the fire department was dispatched to the facility at 9:10 A.M. for a possible gas or carbon monoxide (CO) leak at the facility. There was no gas detected on the first floor of the facility but upon entering the basement, the multi-gas meter started alarming with carbon monoxide level at 87 parts per million (ppm) (normal/average levels 0.5-5.0 ppm). Evacuation and ventilation procedures were started. The gas was shut off at the meter by the fire department. Gas and CO level began falling rapidly once the gas was shut off and normal readings were restored. 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 observation, staff interview, and policy review, the facility failed to ensure food was prepared and served in a sanitary manner. This had the potential to affect all residents that received meals from the facility's kitchen. The facility's census was 30. Findings include: On 11/01/23 at 11:02 A.M., a visit to the facility's kitchen was made to observe the pureed food process, obtain food temperatures prior to tray line and to observe the meal process. During the pureed food process, Dietary [NAME] #177 was observed to pull her N-95 mask down by grasping the outside of her mask with her bare hands. She would then raise her mask after talking to re-cover her mouth and nose. She would then handle food equipment such as pans and food processing equipment with her same bare hands without performing hand hygiene. She was also noted to touch the outside of her N-95 mask when she had gloves while handling trays used to place the residents' food on. She did not remove her gloves or performing hand hygiene before she continued with the serving of the residents' food. Findings were…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure Pre-admission Screening and Resident Reviews (PASARRs) were accurate, updated, and new mental health diagnoses were sent for a Level II review. This affected four residents (#6, #8, #11, and #13) of four residents reviewed for PASARRs. The facility census was 30. Findings included: 1. Record review revealed Resident #8 was admitted to the facility on [DATE] with diagnoses including type II diabetes, hypertension, gastro-esophageal reflux disease, insomnia, and major depressive disorder. On [DATE], Resident #8 received a diagnosis of delusional disorders on [DATE], anxiety on [DATE], and schizoaffective disorder on [DATE]. Review of the medical record revealed Resident #8 had a PASARR completed on [DATE]. An additional PASARR was not completed to include updated mental health diagnoses. Interview on [DATE] at 3:37 P.M. with the Director of Nursing (DON) confirmed a new PASARR had not been completed to include new mental health diagnoses. Review…

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

Based on observation, review of the menu's spreadsheet, staff interview, and policy review, the facility failed to ensure appropriate serving sizes were provided in accordance with the facility's menu's spreadsheet. This affected 19 residents (#1, #3, #4, #5, #6, #8, #9, #11, #13, #14, #15, #17, #18, #21, #26, #29, #31, #32, and #136) who the facility identified as receiving regular/ no added salt/ and carbohydrate controlled diets. Findings include: On 11/01/23 at 12:40 P.M., an observation of the lunch meal process served from the facility's kitchen revealed residents receiving regular diets, no added salt diets, and carbohydrate controlled diets did not receive the appropriate serving size of zucchini and summer squash vegetable blend on their meal tray. Multiple residents' trays (for those residents on those types of diets) were observed to only receive one scoop of the vegetable blend by Dietary [NAME] #177 using a 2 oz spoodle, before being placed in a food cart to be delivered to the units. Prior to the tray line, Dietary [NAME] #177 indicated the serving size of the zucchini…

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 and interview, the facility failed to maintain the floors in a safe manner that prevents fall hazards and keeping a homelike environment. This had the potential to affect three residents (#23, #32, and #135). The facility census was 30. Findings included: Observation on 10/31/23 at 9:58 A.M. revealed the floor in Resident #32's room was cracked, uneven, and when stepped on, had two tiles that moved and the linoleum in the bathroom had cracked and risen. Observation on 10/31/23 at 3:13 P.M. revealed the floor in Resident #135's room was bumpy and uneven. Observation on 11/01/23 at 3:23 P.M. revealed the transition strip from Resident #23's room to the hallway was missing. Interview on 11/01/23 at 3:23 P.M. with Licensed Practical Nurse (LPN) #122 confirmed missing transition strip, cracked, bumpy and uneven floors as well as shifting tiles affecting Residents #23, #32, and #135. Review of a policy titled Preventative Maintenance Program revealed the Maintenance Director is responsible for developing and maintaining a schedule of maintenance services to ensure…

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, policy review, and interview, the facility failed to provide written notice of discharge to Resident #34 and the ombudsman. This affected one resident (#34) of two residents reviewed for discharge. The facility census was 30. Findings included: Record review revealed Resident #34 admitted to the facility on [DATE] with diagnoses including chronic osteomyelitis, gastro-esophageal reflux disease, bipolar disorder, anxiety disorder, anemia, hypokalemia, insomnia, major depression, and hyperlipidemia. Further review revealed Resident #34 discharged was discharged on 09/21/23. Review of the record revealed no documented evidence a written notice was given to Resident #34 or sent to the ombudsman. Interview on 11/01/23 at 10:15 A.M. with Director of Nursing verified the facility did not have record of a written discharge notice being given to Resident #34 or the Ombudsman. Review of a policy titled Transfer and Discharge (Including AMA) revealed the facility should provide a transfer/discharge…

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, staff interview, and policy review, the facility failed to ensure a resident who was dependent on staff for personal care received the assistance needed with nail care. This affected one resident (#12) of two residents reviewed for activities of daily living (ADL's). Findings include: A review of Resident #12's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included Parkinson's disease, difficulty walking, muscle wasting and atrophy, and muscle weakness. A review of Resident #12's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues and her cognition was severely impaired. She was not known to have displayed any behaviors or reject care during the seven days of the assessment period. She had a functional limitation in her range of motion of her bilateral lower extremities. A prior quarterly MDS assessment dated [DATE] revealed the resident was totally dependent on two 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, staff interview, and policy review, the facility failed to ensure a resident who was receiving hospice services had relevant hospice related records (Comprehensive Assessments and Plan of Care and visit notes) readily accessible and part of the resident's medical record to ensure continuity of the resident's care. This affected one resident (#20) of one resident reviewed for hospice services. Findings include: A review of Resident #20's medical record revealed he was admitted to the facility on [DATE]. His diagnoses included protein-calorie malnutrition, chronic obstructive pulmonary disease, and muscle wasting and atrophy. A review of Resident #20's physician's orders revealed he was a Do Not Resuscitate Comfort Care Arrest (DNRCC-A). His physician's orders did not include an order for hospice care/ services despite the resident being identified as receiving hospice services on the facility's roster matrix. A review of Resident #20's quarterly Minimum Data Set (MDS) assessment dated…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, facility failed to ensure new fall prevention interventions were established post-fall for two residents. This affected two residents (#24 and #32) of two residents reviewed for falls. The facility census was 30. Findings included: 1. Record review revealed Resident #24 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, hyperlipidemia, muscle weakness, type II diabetes, hypothyroidism, gastro-esophageal reflux disease, heart failure, major depression, hypertension, anemia, and psychotic disorder with delusions. Review of minimum data set (MDS) completed on 08/16/23 revealed Resident #24 had impaired cognition, no behaviors, is occasionally incontinent of bowel, and required total dependence for activities of daily living (ADLs). Review of physician orders revealed Resident #24 used quarter bedrails for a mobility enabler, requires a low bed with floor mat to the open side of the bed, non-skid strips to the floor at bedside, and ted hose…

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, staff interview, and policy review, the facility failed to ensure residents, who were identified as having had significant weight loss, had new nutritional interventions implemented timely to address their known weight loss. This affected two residents (#9 and #24) of two residents reviewed for nutrition. Findings include: 1. A review of Resident #9's medical record revealed the resident was admitted to the facility on [DATE]. Her diagnoses included congestive heart failure, adult onset diabetes mellitus, and major depressive disorder. A review of Resident #9's physician's orders revealed she had an order to receive a frozen nutritional supplement twice a day at lunch and dinner. The nutritional intervention had been in place since 07/25/23. A review of Resident #9's annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues and was cognitively intact. Her height was 60 inches and her weight was 103 pounds. She was…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation and interview, the facility failed to ensure artificial nutrition via gastrostomy tube (g-tube) was completed per professional standards. This affected one resident (#135) of one resident reviewed for tube feeding. The facility census was 30. Findings included: Record review revealed Resident #135 was admitted to the facility on [DATE] with diagnoses including aphasia, down syndrome, autistic disorder, type II diabetes, respiratory disorders, hypertension, gastrostomy status, major depression, anemia, dysphagia, gastro-esophageal reflux disease, and hyperlipidemia. Review of minimum data set assessment from 10/18/23 revealed Resident #135 was dependent on staff for eating and had a feeding tube. Review of orders revealed Resident #135 had an order from 10/11/23 for a nothing by mouth (NPO) diet. On 10/11/23 the resident was ordered enteral feed order every six hours for g-tube, flush peg tube with 200 cubic centimeters (cc's) every six hours, enteral feed order every day 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 observation and staff interview, the facility failed to ensure a clean and sanitary kitchen. This had the potential to affect all residents residing in the facility. Findings include: During the initial tour of the kitchen on 12/13/21 from 8:56 A.M. to 9:31 A.M. with Dietary Manager (DM) #5 revealed the fridge in the kitchen and one fridge at the storage room had debris on the floor of the fridge. Further observation revealed three freezers and one fridge located in the dry storage room had debris on the floor of the freezer and the fridge. Observation on 12/15/21 at 10:30 A.M. with [NAME] #15 while preparing puree for residents, revealed [NAME] #15 had no gloves on, had the knife and measuring spoons sitting on top of the recipe sheet. Observation revealed [NAME] #15 reused spatula that she had used earlier to scrape the food from the food processor and laid it on top of the counter. [NAME] #15 was also observed touching the tip of the measuring spoons with her bare hands before dipping into the seasoning. Further observation revealed water dripping from the base of the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, and medical record review the facility failed to ensure a resident was treated with dignity and respect when the resident's soiled clothing was not changed and the resident was in a public area. This affected one resident (Resident #4) of three sampled residents reviewed for dignity. Findings include: Review of Resident #4's medical record revealed she was admitted on [DATE] with diagnoses that included: Huntington's Disease, essential hypertension, major depressive disorder, anxiety disorder, and pain. Review of Resident #4's quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #4's speech was clear, makes self-understood, understands others, and her cognition was moderately impaired. Resident #4 had no behaviors and did not reject care. Resident #4 required limited assistance of one staff for bed mobility, to transfer, did not walk, required supervision with set up help to eat, and was dependent on one staff to dress. Observation of Resident #4 on 12/13/21 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 and staff interview the facility failed to conduct an admission comprehensive assessments within 14 calendar days as required. This affected two residents (Resident #228 and Resident #229) of 13 sampled residents. Findings include: 1. Review of Resident #228's medical record revealed she was admitted on [DATE] with diagnoses that included: type II diabetes, chronic obstructive pulmonary disease, anxiety disorder, dementia with behavioral disturbance, essential hypertension, and hyper lipodema. Review of Resident #228's admission Minimum Data Set (MDS) 11/09/2021 was in progress and not completed. Interview of Licensed Practical Nurse (LPN) #20 on 12/14/21 1:49 P.M. confirmed Resident #228's admission MDS was not completed within the required 14 calendar days as required. 2. Record review for Resident #229 revealed this resident was admitted to the facility on [DATE] with the following diagnoses: Type 2 diabetes mellitus, gastro esophageal reflux disease, mood disorder, pressure…

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 assess residents once every three months as required. This affected three sampled residents (Resident #2, Resident #4, and Resident #18) of 13 sampled residents. Findings include: 1. Review of Resident #2's medical record revealed she was admitted on [DATE] with diagnoses that included: type II diabetes, mild cognitive impairment, and bipolar disorder. Review of Resident #2's Minimum Data Sets (MDS) revealed she had an annual MDS dated [DATE]. Review of Resident #2's quarterly MDS revealed it was dated 10/11/21, however this MDS was not completed until 12/07/21. Interview of Licensed Practical Nurse (LPN) #20 on 12/14/21 at 2:22 P.M. confirmed Resident #2's quarterly MDS was not completed timely. 2. Review of Resident #4's medical record revealed she was admitted on [DATE] with diagnoses that included: Huntington's disease, essential hypertension, major depressive disorder, anxiety disorder, and pain. Review of Resident #4's MDS 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 record review, observation, staff interview and policy review, the facility failed to ensure residents' complete comprehensive care plans included care plans for respiratory care and pain. This affected two (Resident #22 and #25) of 15 residents reviewed for care plans. Findings include: 1. A review of Resident #25's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), shortness of breath (SOB) and Covid-19 infection. A review of Resident #25's active physician's orders revealed she had an order to receive oxygen at 2 liters per minute (LPM) per nasal cannula every shift as needed (prn) for SOB or an oxygen saturation level (SPO2) less than 90%. The order for oxygen had been in place since 10/10/21. A review of Resident #25's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues but her cognition was moderately impaired. 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, staff interview, and policy review, the facility failed to ensure residents and/ or their representatives were invited to attend care planning conferences to be a part of the development of their plan of care. This affected two (Resident #18 and #78) of four residents reviewed for care planning. Findings include: 1. A review of Resident #78's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included unspecified toxic encephalopathy, psychoactive substance abuse, stimulant abuse with intoxication, anemia, history of a stroke, and acute kidney failure. Her admission record identified her sister as being her power of attorney for care. A review of Resident #78's electronic health record (EHR) revealed no documented evidence of the resident and/ or her representative being invited to attend an initial care planning conference following her recent admission to the facility. The EHR did not show evidence of any care planning conference being…

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 ensure a resident, who was dependent on staff for assistance with personal care, received the assistance needed to be able to receive showers as she desired. This affected one (Resident #78) of three residents reviewed for activities of daily living (ADL's). Findings include: A review of Resident #78's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included unspecified toxic encephalopathy, psychoactive substance abuse, and stimulant abuse with intoxication. A review of Resident #78's baseline care plans revealed she required the assist of one for bathing activities. The baseline care plan indicated the resident wanted to be showered every other day. A review of Resident #78's shower documentation revealed showers were documented under the task tab in the electronic health record (EHR) when provided. The task tab for bathing documented the resident had only received two bathing activities…

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 ensure residents were properly positioned during meals and a resident was in an appropriate size wheelchair to allow her feet to come into contact with the floor and not dangle while she was sitting in the wheelchair. This affected two (Resident #4 and #23) of three residents reviewed for positioning. Findings include: 1. A review of Resident #23's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included cerebral palsy and lack of coordination. A review of Resident #23's physician's orders revealed she had the use of a mechanical lift for all transfers. She had an order indicating she received occupational therapy (OT) on 10/06/21 for wheelchair management. A review of Resident #23's OT notes for a date of service between 10/06/21 and 11/04/21 revealed the resident's diagnoses included cerebral palsy and abnormal posture. Her plan of treatment included wheelchair management training. 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 record review, observation, resident interview, staff interview, and policy review, the facility failed to ensure fall prevention interventions were implemented as per the plan of care for a resident with a known history of falls. This affected one (Resident #78) of three residents reviewed for falls. Findings include: A review of Resident #78's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included unspecified toxic encephalopathy, psychoactive substance abuse, stimulant abuse with intoxication, convulsions obstructive hydrocephalus and cerebrovascular disease. A review of Resident #78's active physician's orders revealed there were no fall prevention interventions included in the resident's physician's orders. A review of Resident #78's Minimum Data Set (MDS) assessments revealed her admission and Medicare (MCR) 5 day MDS assessments were still in progress. A review of Resident #78's initial care plans revealed, in addition to her baseline care plans, she had a care…

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, resident interview, and staff interview the facility failed to provide an ordered therapeutic diet and failed to maintain a resident's nutritional status. This affected one resident (Resident #18) of one sampled residents reviewed for nutrition. Findings include: Review of Resident #18's medical record revealed she was admitted on [DATE] with diagnoses that included: non infective gastroenteritis and colitis, hypothyroidism, essential hypertension, bone disorder, anxiety, recurrent depressive disorder, recurrent depressive disorders, Parkinson's disease, and over active bladder. Review of Resident #18's annual Minimum Data Set (MDS) dated [DATE] revealed Resident #18's speech was clear, she made herself understood, understands others, and her cognition was intact. Resident #18 had no behaviors and did not reject care. Resident #18 required limited assistance of one staff for bed mobility, to transfer, and was independent with set up help to eat. Resident #18 had no…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and resident and staff interviews, the facility failed to provide respiratory care consistent with professional standards of practice when two residents were receiving oxygen that was outside of the physician ordered parameters. This affected two of four residents (Residents #24 and #26) reviewed for respiratory services. Findings include: 1. A record review for Resident #26 revealed the resident was admitted to the facility on [DATE]. The Resident was re-admitted to the facility from the acute care hospital following a hospitalization in October 2021. The resident had the following diagnoses: obstructive sleep apnea, hypertension, congestive heart failure, and chronic obstructive pulmonary disease. A review of the Minimum Data Set admission Assessment (MDS) dated [DATE], revealed the resident had no cognitive impairment and was receiving oxygen. An observation of the resident, on 12/13/21 at 10:18 AM, revealed the resident was receiving oxygen via nasal cannula at five…

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 medical record review the facility failed to conduct an assessment of a resident's bed rails and did not have evidence of maintaining a resident's side rail. This affected one Resident (Resident #18) of two sampled residents reviewed for accidents. Findings include: Review of Resident #18's medical record revealed she was admitted on [DATE] with diagnoses that included: non infective gastroenteritis and colitis, hypothyroidism, essential hypertension, bone disorder, anxiety, recurrent depressive disorder, recurrent depressive disorders, Parkinson's disease, and over active bladder. Review of Resident #18's quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #18's speech was clear, she made herself understood, understands others, and her cognition was intact. Resident #18 had no behaviors and did not reject care. Resident #18 required extensive assistance of one staff for bed mobility, to transfer, and had no falls. Review of Resident #18's physician orders…

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 provide medically related social services after the death of a resident's child. This affected one resident (Resident #18) of 13 sampled residents. Findings include: Review of Resident #18's medical record revealed she was admitted on [DATE] with diagnoses that included: non infective gastroenteritis and colitis, hypothyroidism, essential hypertension, bone disorder, anxiety, recurrent depressive disorder, recurrent depressive disorders, Parkinson's disease, and over active bladder. Review of Resident #18's annual Minimum Data Set (MDS) dated [DATE] revealed Resident #18's speech was clear, she made herself understood, understands others, and her cognition was intact. Resident #18 had no behaviors and did not reject care. Resident #18 required limited assistance of one staff for bed mobility, and to transfer. Review of Resident #18's progress notes revealed on 08/06/21 Resident # 18 was notified by her sister that Resident #18's son 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 medical record review and staff interview, the facility failed to ensure a resident's indication for use of a pain medication was clear and a resident had adequate monitoring for medications by obtaining laboratory testing as ordered. This affected two residents (Resident #18 and Resident #229) of five sampled residents reviewed for unnecessary medications. Findings include: 1. Review of Resident #18's medical record revealed she was admitted on [DATE] with diagnoses that included: non infective gastroenteritis and colitis, hypothyroidism, essential hypertension, bone disorder, anxiety, recurrent depressive disorder, recurrent depressive disorders, Parkinson's disease, and over active bladder. Review of Resident # 18's annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #18's speech was clear, she made herself understood, understands others, and her cognition was intact. Resident #18 had no behaviors and did not reject care. Review of Resident #18's physician orders revealed thyroid…

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 staff interview and medical record review the facility failed to identify and track a resident's target behaviors when the resident received an antianxiety and antidepressant medication. This affected one sampled resident (Resident #18) of five sampled residents reviewed for unnecessary medications. Findings include: Review of Resident #18's medical record revealed she was admitted on [DATE] with diagnoses that included: non infective gastroenteritis and colitis, hypothyroidism, essential hypertension, bone disorder, anxiety, recurrent depressive disorder, recurrent depressive disorders, Parkinson's disease, and over active bladder. Review of Resident #18's quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #18's speech was clear, she made herself understood, understands others, and her cognition was intact. Resident #18 had no behaviors and did not reject care. Resident #18 required extensive assistance of one staff for bed mobility and to transfer. Resident #18 received an antianxiety 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.