Majestic Care Of Middletown LLC

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interviews and policy review, the facility failed to notify a resident representative of change in health care status. This affected one (#137) of three residents reviewed for change in condition. The facility census was 35. Findings include: Medical record review for Resident #137 revealed an admission on [DATE] and a discharge on [DATE] to hospital. Resident #137 expired on [DATE] under hospice care. Diagnoses including acute diastolic (congestive) heart failure, venous insufficiency (chronic) (peripheral), vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Review of the Minimum Data Set (MDS) assessment dated [DATE] for Resident #137 revealed an impaired cognition. Resident #137 required supervision for eating and total staff dependence for bed mobility, transfers and toileting. Review of the plan of care for Resident #137 revealed the resident exhibits behaviors including refusing care, showers,…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview and policy review, the facility failed to ensure care conferences were completed as required. This affected one (#137) of three residents reviewed for care conferences. The facility census was 135. Findings included Medical record review for Resident #137 revealed an admission on [DATE] and a discharge on [DATE]. Diagnoses including acute diastolic (congestive) heart failure, venous insufficiency (chronic) (peripheral), vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Review of the Minimum Data Set (MDS) assessment dated [DATE] for Resident #137 revealed an impaired cognition. Resident #137 required supervision for eating and total staff dependence for bed mobility, transfers and toileting. Review of the plan of care for Resident #137 revealed the resident exhibits behaviors including refusing care, showers, turning and repositioning, medications and wound care. Interventions include…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview and policy review, the facility failed to follow physicians' orders for medication administration with blood pressure parameters which resulted in significant medication errors. This affected one (#37) of three residents reviewed for medication administration. The facility census was 135. Finding include: Medical record review for Resident #37 revealed an admission on [DATE] with diagnoses including but not limited to chronic respiratory failure, hypotension, hypertension and dependence of respirator with tracheostomy status. Review of the Minimum Data Set (MDS) assessment for Resident #37 revealed an intact cognition. Resident #37 required staff assistance for toileting, bed mobility and eating. Transfers not attempted for safety reasons. Review of the plan of care for Resident #37 revealed resident is at risk for impaired cardiac output related to diagnosis of hypertension and hypotension. Interventions include vital signs as ordered, observe for cardiac…

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 review, the facility failed to implement their infection control policy during medication administration. This affected one (#114) of three residents observed for medication administration. The facility census was 135. Findings include Review of the medical record for Resident #114 revealed an admission on [DATE]. Diagnoses include Coronavirus Disease 2019 (COVID-19), infection following surgical procedure, type two diabetes mellitus, depression and hypertension. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #114 was cognitively intact. Resident #114 required staff assistance for completion of toileting, transfers, and bed mobility tasks. Review of the active physician orders for Resident #114 for the month of December 2024 revealed and order for cholecalciferol tablet 1000 units one tablet one time a day dated 11/13/24, ferrous sulfate tablet 325 milligrams (mg) one tablet daily dated 10/27/24,…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, staff interview, and policy review, the facility failed to perform timely and adequate incontinence care and failed to ensure physician orders were followed for use of incontinence products. This affected four (#14, #43, #108 and #116) out of five residents reviewed for incontinence. The facility census was 142. Findings include: 1. Review of Resident #14's medical record revealed an admission date of 12/28/22 with a diagnosis of hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side. Review of the Minimum Date Set (MDS) assessment dated [DATE] revealed Resident #14 was cognitively intact and required substantial assistance with toileting. Review of the care plan dated 01/02/24 revealed Resident #14 required assistance from staff for incontinence care with an intervention to check routinely for incontinence and provide incontinence care as needed. 2. Review of Resident #43's medical record revealed an admission date of 05/11/23 with…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview, and policy review, the facility failed to notify the physician or nurse practitioner of significant weight changes and wound treatment refusals. This affected one (#26) of three residents reviewed for nutrition and one (#108) of three residents reviewed for wounds. The facility census was 142. Findings include: 1. Review of the medical record for Resident #26 revealed an admission date of 07/14/21 with diagnoses of unspecified dementia with other behavioral disturbance and psychotic disorder with delusions due to known physiological condition. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 had severe cognitive impairment and required supervision assistance with eating. Review of the care plan dated 03/29/24 revealed Resident #26 had a potential for nutritional risk with interventions to obtain weights as ordered/indicated and notify the physician of significant weight changes. Review of Resident #26's weight record revealed the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident and staff interview, medical record review, and policy review, the facility failed to provide residents with a palatable meal with appetizing temperatures. This affected two (#69 and #113) of three residents reviewed for meals. The facility census was 142. Findings include: 1. Review of the medical record for Resident #69 revealed an admission date of 08/02/23 with diagnoses of acquired clubfoot to the right foot, hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting the right dominant side, and mild protein-calorie malnutrition. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #69 was cognitively intact and required supervision assistance with eating. Interview on 05/23/24 at 11:28 A.M. with Resident #69 revealed the food was not favorable and it was usually cold when it should be hot. 2. Review of the medical record for Resident #113 revealed an admission date of 05/01/24 with diagnoses of heart failure, and unspecified…

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 interview, staff interview, the facility failed to ensure the physician was notified when medications were not available due to a national shortage. This affected one (Resident #65) of three residents reviewed. The census was 138. Findings include: Review of Resident #65's medical record revealed an admission date of 12/28/22. Diagnoses included type II diabetes. Review of physician orders revealed an order dated 03/01/24 for Mounjaro subcutaneous pen-injector (diabetic medication) five milligrams (mg) per 0.5 milliliter (ml) inject one time day every Friday for four weeks. Review of medication administration records revealed Mounjaro was not administered due to not being available on 03/15/24, 03/22/24, and 03/29/24. Review of progress revealed no documentation of Resident #65's physician being notified of Mounjaro not being available on 03/15/24, 03/22/24, and 03/29/24. During an interview on 04/17/24 at 3:26 P.M. the Director of Nursing (DON) and Regional Nurse Consultant (RNC) #200 confirmed Resident #65 missed Mounjaro administrations on…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident interview, staff interview, review of facility self-reported incidents (SRI), and review of facility policy, the facility failed to prevent physical abuse. This affected one (Resident #65) of three residents reviewed. The census was 138. Findings include: Review of Resident #65's medical record revealed an admission date of 12/28/22. Diagnoses listed included depressive mood disorder, anxiety disorder, hypertension, dependence of respiratory ventilator, type two diabetes mellitus, morbid obesity, and respiratory failure. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #65 was cognitively intact. Review of a care plan initiated 02/13/23 revealed Resident #65 exhibits behavior symptoms of abusive language and physical aggression directed towards Care Team Members, also makes false accusations of staff, has manipulative behaviors, refuses care, and refuses bed baths and showers. Resident #65 has diagnoses of of mood disorder and anxiety…

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 reviews, staff interview, and policy review, the facility failed to ensure quarterly care conferences were completed. This affected five (#36, #76, #80, #87, and #122) out of five residents reviewed for care conferences. The facility census was 145. Findings included: 1. Review of the medical record for Resident #36 revealed an admission date of 12/07/22 with medical diagnoses of chronic respiratory failure, emphysema, Guillain-Barre syndrome, dementia, and paraplegic. Review of the medical record for Resident #36 revealed a quarterly Minimum Data Set (MDS) assessment, dated 01/03/24, which indicated Resident #36 had moderately impaired cognition and required moderate staff assistance for bed mobility, substantial staff assistance with toilet hygiene and was dependent upon staff for bathing and transfers. Review of the medical record for Resident #36 revealed documentation to support the facility conducted a quarterly care conference on 01/09/23 and 03/12/24. The medical record did not…

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

Based on medical record review, staff interview, and policy review, the facility failed to ensure resident's nutritional needs were met as care planned. This affected five (#9, #43, #87, #201 and #202) of eight residents reviewed for weight changes. The facility census were 145. Findings include: 1. Review of the medical record review for Resident #9 revealed an admission date of 05/11/23 with diagnosis of type 2 diabetes mellitus with ketoacidosis without coma, asthma, chronic obstructive pulmonary disease, unspecified, bipolar disorder, current episode depressed, severe, with psychotic features, difficulty in walking, and major depressive disorder severe with psychotic symptoms. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 02/08/24 revealed Resident #9 was cognitively intact and was dependent with all activities of daily living (ADL's). Review of the Care Plan for Resident #9 revealed resident is at risk for complications related to hypoglycemia or hyperglycemia, hypothyroidism, fluid imbalance. Resident #9 also presents with potential for nutritional risk.…

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 personnel records, review of training documents and staff interviews, the facility failed to ensure that nursing staff had the competencies and skill set to perform their job regarding care for residents with ventilators. This had the potential to affect four (#39, #43, #45 and #48) residents on ventilators. Facility census was 145. Findings include: Review of employee chart for Licensed Practical Nurse (LPN) #77 LPN revealed a hire date of 02/05/24. A pre-employment background check was completed. LPN #77's nursing license was active. Review of training record for LPN #77 revealed a Relias training record showed she completed Infection Control, Respecting Diversity in the Workplace, and Teepa Snow: PAC Skills Make a Difference. No other training documentation available. Review of employee chart for LPN #17 revealed a hire date of 12/20/23. A pre-employment background check was completed. LPN #17's nursing license was active. Review of training record for LPN #17 revealed a Relias training record showed training complete for Communication and Conflict Skills,…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview, and policy review, the facility failed to ensure preadmission screening was completed for a resident prior to admission to the facility. This affected one (#98) out of five residents reviewed for preadmission screening. The facility census was 145. Findings included: Review of the medical record for Resident #98 revealed an admission date of 10/18/23 with medical diagnoses of diabetes mellitus, anxiety, hypertension, and schizophrenia. Review of the medical record for Resident #98 revealed a quarterly Minimum Data Set (MDS) assessment, dated 01/29/24, which indicated Resident #98 was cognitively intact and required supervision with toilet hygiene, bed mobility, and moderate staff assistance with bathing. Review of the medical record for Resident #98 revealed a form titled, Preadmission Screening and Resident Review Results (PASRR) Notice, dated 10/20/23, which indicated Resident #98 had indications of serious mental illness and/or developmental disability 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 medical record review, review of Hospice documentation, interviews with facility staff, Hospice provider and pharmacy representative, and policy review, the facility failed to ensure staff were able to access medications from the facility's electronic medication dispenser (Ebox). This affected one (#203) out of four reviewed for medication administration. Facility census was 145. Findings included: Review of the medical record for Resident #203 revealed an admission date of [DATE] with medical diagnoses of Alzheimer's disease, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and spinal stenosis. Review of the medical record revealed Resident #203 enrolled into Hospice care on [DATE] and expired on [DATE]. Review of the medical record for Resident #203 revealed an annual Minimum Data Set (MDS) assessment, dated [DATE], which indicated Resident #203 had severely impaired cognition and required substantial staff assistance for eating and bathing and was dependent for toileting hygiene, bed…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observations, staff interview and review of a facility policy, the facility failed to ensure staff used the appropriate personal protective equipment (PPE) while in a residents room who was in isolation. This affected one (#43) of three residents reviewed for infection control. The facility census was 145. Findings include: Review of the medical record revealed Resident #43 was admitted to the facility on [DATE] with diagnosis acute and chronic respiratory failure with hypoxia, chronic respiratory failure with hypercapnia, dependence on respirator (ventilator), carrier or suspected carrier of methicillin resistant staphylococcus aureus (MRSA), and anxiety. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 12/19/23, revealed Resident #43 cognition is intact. Review of the quarterly MDS 3.0 assessment, dated 09/27/23, revealed Resident #43 required extensive assistance for bed mobility, dressing, toileting, personal hygiene, and bathing and total dependence for transfers.…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview, and facility policy review, the facility failed to administer influenza vaccine timely. This affected one (#122) out of five residents reviewed for vaccinations. The facility census was 145. Findings included: Review of the medical record for Resident #122 revealed an admission date of 03/31/23 with medical diagnoses of diabetes mellitus, dementia, hypertension, anxiety, and depression. Review of the medical record for Resident #122 revealed a quarterly Minimum Data Set (MDS), dated [DATE], which indicated Resident #122 had moderately impaired cognition and required moderate staff assistance with bathing, supervision with toileting hygiene, and was independent with transfers. Review of the medical record for Resident #122 revealed a consent to administer the influenza vaccine, dated and signed on 09/13/23. Review of the medical record for Resident #122 revealed a nurse's progress note, dated 03/12/24 at 12:08 P.M. stated Resident #122 verbally consented to receive…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff and physician interviews, the facility failed to notify the physician of abnormal laboratory (lab) results in a timely manner which resulted in a delay of treatment. This affected two (#84 and #162) of four residents reviewed for timely care and treatment. The facility census was 147. Findings include: 1. Review of medical record for Resident #84 revealed admission date of [DATE]. The resident was admitted with diagnoses including contracture of right ankle and foot, hemiparesis following stroke, and stroke, depression and anxiety. The resident remains in the facility. The quarterly Minimum Data Set (MDS) dated [DATE] Resident #84 had a Brief Interview Mental Status (BIMS) score of 13 indicating intact cognition. Resident #84 required supervision for eating, maximum assistance for bed mobility bed mobility and toileting transfers were not documented. Record review revealed a positive urinalysis result was collected on [DATE], reported on [DATE] and reviewed by staff on [DATE].…

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, resident and staff interviews the facility failed to ensure residents received timely incontinence care. This affected two (#20 and #154) of three residents reviewed for incontinence care. The facility census was 147. Findings include: 1. Review of medical record for Resident #20 revealed admission date of 01/10/21. Diagnoses include late onset Alzheimer's Disease, diabetes mellitus type two, bipolar disease and Parkinson's disease. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #20 had a Brief Interview Mental Status (BIMS) score of 12 indicating impaired cognition. Resident #20 was dependent for toileting hygiene and transfers. Documentation revealed she was frequently incontinent of bowel and bladder. 2. Review of medical record for Resident #154 revealed admission date of 01/7/23. Diagnoses including chronic obstructive pulmonary disease (COPD), anxiety and congestive heart failure. The annual Minimum Data Set (MDS) dated [DATE] revealed she…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff and physician interviews, the facility failed to timely notify the physician of abnormal laboratory (lab) results which resulted in a delay of treatment for a resident's positive Clostridioides difficile (C-diff) results. This affected one (#162) of four residents reviewed for timely care and treatment. The facility census was 147. Findings include: Review of medical record for Resident #162 revealed admission date of [DATE]. Diagnoses include stroke, hemi paresis affecting right dominant side, and depression. The was sent to the emergency room and expired on [DATE]. The significant change Minimum Data Set (MDS) dated [DATE] revealed Resident #162 had a Brief Interview Mental Status (BIMS) score of 11 indicating impaired cognition. Resident #162 required supervision for eating, maximum assistance for bed mobility, toileting hygiene and no documentation for transfers. Review of Resident #162's provider progress note dated [DATE] revealed the resident had continued loose stools. An…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, the facility failed to notify the physician of abnormal laboratory (lab) results in a timely manner which resulted in a delay of treatment for a resident's urinary tract infection (UTI). This affected one (#84) of four residents reviewed for timely care and treatment. The facility census was 147. Findings include: Review of medical record for Resident #84 revealed admission date of 08/02/23. The resident was admitted with diagnoses including contracture of right ankle and foot, hemiparesis following stroke, and stroke, depression and anxiety. The resident remains in the facility. The quarterly Minimum Data Set (MDS) dated [DATE] Resident #84 had a Brief Interview Mental Status (BIMS) score of 13 indicating intact cognition. Resident #84 required supervision for eating, maximum assistance for bed mobility bed mobility and toileting transfers were not documented. Record review revealed a positive urinalysis result was collected on 01/08/24, reported on 01/11/24 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 record review, review of the State of Ohio Board of Pharmacy Terminal Distributor Licensure of Prescriber Practices, and interviews, the facility failed to ensure medications administered Intravenously (IV) were obtained from a source with a Terminal Distributor of Dangerous Drugs (TDDD) license (which allows a business entity to purchase, possess, and/or distribute dangerous drugs at a specific location) specific to the State of Ohio. This deficiency affected four (Residents #27, #89, #85, and #30) of four reviewed for IV administration. This affected had the potential to 23 (Residents #146, #64, #38, #23, #65, #96, #70, #13, #8, #27, #89, #66, #75, #85, #30, #88, #87, #55, #61, #63, #16, #67, and #145) and 18 discharged Residents (#180, #181, #182, #183, #184, #185, #186, #187, #188, #189, #190, #191, #192, #193, #194, #195, #196, and #197) identified by the facility who received IV fluids from the unlicensed source. The census was 160. Findings include: 1. Review of the medical record for Resident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, review of the State of Ohio Board of Pharmacy Terminal Distributor Licensure of Prescriber Practices, and interview the facility failed to ensure medications were obtained from a source with a Terminal Distributor of Dangerous Drugs (TDDD) license (which allows a business entity to purchase, possess, and/or distribute dangerous drugs at a specific location) specific to the State of Ohio. This deficiency affected four of four Residents (#27, #89, #85, and #30) reviewed for medications administered by a contracted ancillary provider. This affected 23 current Residents (#146, #64, #38, #23, #65, #96, #70, #13, #8, #27, #89, #66, #75, #85, #30, #88, #87, #55, #61, #63, #16, #67, and #145) and 18 discharged Residents (#180, #181, #182, #183, #184, #185, #186, #187, #188, #189, #190, #191, #192, #193, #194, #195, #196, and #197). The census was 160. Findings include: 1. Review of the medical record for Resident #27 revealed an admission date of 04/06/23. Diagnoses included chronic…

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, review of the State of Ohio Board of Pharmacy Terminal Distributor Licensure of Prescriber Practices, review of facility policy, and interview the facility failed to ensure a contracted entity had appropriate State of Ohio required credentials for provision of services for residents. This deficiency affected four of four Residents (#27, #89, #85, and #30) reviewed for medications administered by a contracted ancillary provider. This affected 23 current Residents (#146, #64, #38, #23, #65, #96, #70, #13, #8, #27, #89, #66, #75, #85, #30, #88, #87, #55, #61, #63, #16, #67, and #145) and 18 discharged Residents (#180, #181, #182, #183, #184, #185, #186, #187, #188, #189, #190, #191, #192, #193, #194, #195, #196, and #197). The census was 160. Findings include: 1. Review of the medical record for Resident #27 revealed an admission date of 04/06/23. Diagnoses included chronic respiratory failure with hypercapnia, Chronic Obstructive Pulmonary Disease (COPD), major depressive disorder,…

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, staff interviews, and review of facility policy, the facility failed to ensure medication administration was signed off by appropriate staff. This affected two (Residents #27 and #85) of four reviewed for Intravenous (IV) administration of medications. The census was 160. Findings include: 1. Review of the medical record for Resident #27 revealed an admission date 04/06/23. Diagnoses included chronic respiratory failure with hypercapnia, chronic obstructive pulmonary disease (COPD), major depressive disorder, morbid obesity, malignant neoplasm, Diabetes Mellitus Type 2 (DM2), dependence of respirator, obstructive sleep apnea, and colostomy status. Review of the Medication Administration Record (MAR) for July 2023 revealed facility Licensed Practical Nurse (LPN) #313 signed off an IV medication on 07/06/23. The medication was to have been infused by a contracted Registered Nurse (RN) from the ancillary provider. Interview on 11/15/23 at 4:02 P.M. with the Director of Nursing (DON) verified she spoke with LPN #313 on 11/15/23 at 10:00 A.M. by phone and the LPN…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, medical record review, and staff interview, the facility failed to ensure care planned fall interventions were in place to prevent falls for residents at risk for falls. This affected two (#72 and #81) of three residents reviewed for falls. The census was 177. Findings included: 1. Review of the medical record for Resident #72 revealed an admission date of 01/28/02, with diagnoses including: peripheral vascular disease, diabetes, non-Alzheimer's dementia, depression, and Schizophrenia. Review of care plan dated and revised on 03/05/21 revealed Resident #72 was at risk for injuries/falls related to cataract, glaucoma, legal blindness, diabetes, macular degeneration, dementia, displacement of lumbar disc, peripheral vascular disease, schizophrenia, and medication use. Intervention of the plan revealed on 08/04/23 was to place an elevated perimeter mattress. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #72 was moderately cognitively impaired. His…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, medical record review, staff interview and policy review, the facility failed to ensure a resident was provided incontinence care in a timely manner. This affected one (#72) of three residents reviewed for timeliness incontinence care. The census was 177. Findings included: Review of the medical record for Resident #72 revealed an admission date of 01/28/02, diagnoses including: peripheral vascular disease, diabetes, non-Alzheimer's dementia, depression, and Schizophrenia. Review of care plan dated 03/15/23 for Resident #72 revealed he had episodes of incontinence of bladder and bowels. Interventions were to check routinely for incontinence and provide incontinence care as needed. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed he was moderately cognitively impaired. His functional status was extensive assistance for bed mobility, transfers, and toilet use. He was limited assistance or eating. He was always incontinent for urinary and frequently incontinent…

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

Based on record review, observation and interview, the facility failed to store, serve, and prepare food in a sanitary manner and monitor refrigerator and dishwasher temperatures. This had the potential to affect 167 residents who received food from the kitchen. The facility census was 173. Findings include: Observation on 03/20/23 at 9:18 A.M. revealed following: 1. There was a buildup of food debris on the ovens and stoves and on the floor surrounding the stoves. 2. There were undated and unlabeled foods in the dry storage area including pasta and bread. 3. There were multiple foods in the walk-in refrigerator with undecipherable black markings. A container of rice was unlabeled and dated 03/14/23. 4. The ice machine had the ice scoop laying with the contact surface on top of the ice machine. 5. In the food preparation area, there were two coats stored under the counter of the food preparation table. During interview on 03/20/23 at 9:18 A.M., Account Manager, (AC) #208 stated he needed to purchase food stickers so the markings did not rub off. He stated the food prep area should…

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 maintain a clean and safe homelike environment in the main dining room and in resident rooms. This affected six (Residents # 21, #151, #10, #131 #163 and #145) residents. This had the potential to affect all residents. The facility census was 173. Findings include: 1. During observation on 03/20/23 at 10:56 A.M., Resident #145 was sitting on his bed. The bed footboard was cracked for the length of 18 inches from the right side of the footboard running towards the left side. There was a 4 inch by 2-inch hole along the crack line with jagged edges of foot board material exposed. The edges were rough. There was heavy duty tape residue near the edges of the hole. There was a nightstand with no lower door with hinges exposed. There was a six by one inch hole in the wall near the bathroom. During interview on 03/20/23 at 10:56 A.M., Resident #145's family member revealed the broken and exposed hole in the bed footboard had been present since 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, observation and interview, the facility failed to provide food portions as planned by a Registered Dietitian. This affected four (Residents #115, #6, #7 and #172) who received a puree diet, and one (Resident #177) of 11 residents reviewed for fluid restrictions. 167 residents received food from the kitchen. The census was 173. Findings include: Record review revealed Residents #115, #6, #7 and #172 were on pureed diets. Review of breakfast menu spreadsheet for 03/21/23 revealed the puree diet meal consisted of one #16 (two ounce) portion of pureed eggs and cheese, #16 portion of pureed meat and a #16 scoop of pureed bread. During observation on 03/21/23 at 8:04 A.M. there were no pureed eggs prepared and no resident on a puree diet received the pureed scrambled eggs with cheese. There was no substitution for the pureed scrambled eggs. During interview on 03/21/23 at 8:04 A.M., Account Manager #208 revealed no resident who received a pureed diet received a pureed scrambled egg with cheese because he was told the resident could choke on it. He stated the pureed…

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 and policy review, the facility failed ensure residents had written authorizations for the facility to manage their personal funds. This affected two (Residents #45 and #81) of five residents reviewed for personal funds. 173 residents had personal funds accounts. The facility census was 173. Findings include: 1. Record review revealed Resident #45 was admitted to the facility on [DATE]. Review of Resident #45's written authorization for resident funds revealed the authorization that was signed on 03/21/23. During an interview on 03/21/23, Assistant Business Office Manager (ABOM) #169 verified Resident #45 did not have an authorization for resident funds prior to 03/21/23 and the facility had been managing the resident's personal funds. 2. Record review revealed Resident #81 was admitted to the facility on [DATE]. Review of Resident #81's written authorization for resident funds revealed Resident #81 did not have a signed resident funds authorization. During an interview on…

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 and record review, the facility failed to notify residents that the amount of funds in their accounts was 200 dollars less than the social security income resource limit and that the residents may lose eligibility for Medicaid or social security income. This affected two (Residents #45 and #81) of five residents reviewed for personal funds. The facility census was 173. Findings include: 1. Record review revealed Resident #45 was admitted to the facility on [DATE]. Review of Resident #45's quarterly statement from 07/01/22 to 09/30/22 revealed Resident #45 had an ending balance of $3036.29. Review of Resident #45's quarterly statement from 10/01/22 to 12/30/22 revealed Resident #45 had an ending balance of $1758.37. There was no evidence Resident #45 was given notice their account balance 200 dollars less than the social security income resource limit and Resident #45 may lose eligibility for Medicaid or social security income. 2. Record review revealed Resident #81 was admitted [DATE]. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview and policy review, the facility failed to ensure a potential incident of misappropriation of resident property was reported to the State Agency (SA). This affected one (Resident#145) of two residents reviewed for abuse. The facility census was 173. Findings include: Record review revealed Resident #145 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment, dated 02/14/23, revealed the resident had severely impaired cognition. Review of nursing notes dated 02/15/23 at 1:49 P.M. revealed Licensed Practical Nurse (LPN) #29 documented Resident #145's family member was visiting and noticed the resident's wedding ring was missing. LPN #29 noted the staff would be on the lookout for the ring and LPN Unit Manager #64 was notified of the missing wedding ring. During interview on 03/22/23 at 11:43 A.M., the Administrator revealed no knowledge of Resident #145's missing wedding ring. During interview on 03/20/23 at 2:37 P.M. 10:56 A.M. with Resident #145…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview and policy review, the facility failed to ensure a potential incident of misappropriation of resident property was thoroughly investigated. This affected one (Resident#145) of two residents reviewed for abuse. The facility census was 173. Findings include: Record review revealed Resident #145 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment, dated 02/14/23, revealed the resident had severely impaired cognition. Review of nursing notes dated 02/15/23 at 1:49 P.M. revealed Licensed Practical Nurse (LPN) #29 documented Resident #145's family member was visiting and noticed the resident's wedding ring was missing. LPN #29 noted the staff would be on the lookout for the ring and LPN Unit Manager #64 was notified of the missing wedding ring. During interview on 03/22/23 at 11:43 A.M., the Administrator revealed no knowledge of Resident #145's missing wedding ring. During interview on 03/20/23 at 2:37 P.M. 10:56 A.M. with Resident #145 family…

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 complete a preadmission screening resident review (PASARR) on a newly admitted residents that had an expired hospital exemption and a history of mental illness. This affected one (Resident #136) of five residents reviewed for preadmission screening resident review (PASARR). The facility census was 173. Findings include: 1. Record review revealed Resident #136 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease, hypertension, hyperlipidemia, Parkinson's disease, type two diabetes mellitus with hyperglycemia, bipolar disorder, fusion of spine and gastro esophageal reflux disease without esophagitis. Review of Resident #136's hospital exemption from preadmission screening notification dated [DATE] revealed the nursing facility accepts responsibility for electronically initiating a resident review if required prior to the 30th day following the admission from the hospital. Review of Resident #136's…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure a discharge summary was completed and provided to the resident upon a resident's discharge home. This affected one (Resident #175) of three residents reviewed for discharges. The facility census was 173. Findings include: Record review revealed Resident #175 was admitted to the facility on [DATE] with and discharged from the facility 02/01/23. Review of Resident #175's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident's cognition was not assessed and Resident #175 required extensive assistance with bed mobility, personal hygiene, transfers, dressing, and toileting. Resident #175 required limited assistance with eating. Review of Resident #175's progress notes from 01/09/23 to 02/01/23 revealed no documentation regarding Resident #175's discharge plans or discharge. Resident #175's progress notes did not list a discharge time or location. Review of Resident #175's physician order dated 01/30/23 revealed Resident #175…

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 2. Record review revealed Resident #63 was admitted to the facility on [DATE]. Diagnoses for Resident #63 include Alzheimer's disease, osteoporosis, and cataracts. Review of the MDS comprehensive assessment dated [DATE] revealed the resident had impaired cognition and required extensive assistance of one staff for personal hygiene. During observation on 03/23/23 a 9:05 A.M., Resident #63 had heavy hair growth above her upper lip. During interview at the time of the observation, Resident #63 stated she did not like the hair above her lip had been waiting two days for the hair to be removed. During interview on 03/23/23 at 9:09 A.M., STNA #250 verified Resident #63 had hair growth above her upper lip and the STNA assignment included removal of facial hair. Review of the policy titled Activities of Daily Living, dated October 2022, revealed a resident who could not carry out activities of daily living would receive necessary services to maintain grooming and personal hygiene. Based on record review, obseration 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 and interview, the facility failed to ensure activities were provided to residents consistent with their interests. This affected two (Residents #120 and #13) of four residents reviewed for activities. The census was 180. Findings included: Medical record review for Resident #120 revealed an admission date of 09/12/21. Review of the annual Minimum Data Set (MDS) assessment, dated 09/19/22, revealed it was somewhat important to listen to music, be around animals, to do her favorite activities, and to go outside for fresh air. Review of the care plan dated 09/19/22 revealed the resident preferred to be involved in individual, leisure and one on one based activities. The goal was the resident would participate in one on one activities three times per week. Review of activity log from 02/22/23 to 03/22/23 revealed there was no documentation any one on one activity was provided to Resident #120. During observations on 03/20/23 at 1:40 P.M., 03/21/23 at 3:30 P.M., 03/22/23 at 1:45…

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 podiatry services were provided as ordered. This affected one (Resident #10) of 24 sampled residents. The census was 173. Findings include: Record review revealed Resident #10 was admitted to the facility on [DATE] with diagnoses including diabetes. Record review revealed a physician order dated 02/19/18 for podiatry to be consulted and for podiatry to follow the resident. Record review revealed no documentation of any podiatry follow up. The podiatrist had been to the facility 04/22/22 and 11/22/22, but Resident #10 was not seen. During observation on 03/22/23 at 10:34 AM, Resident #10's left foot was very dry with crusty and flaky skin falling off. Resident #10 had long, black overgrown toenails on both feet. During interview on 03/22/23 at 10:38 AM, Social Services Director (SSD) #110 stated the podiatrist visits the facility quarterly. The next visit is scheduled April 2023. During interview on 03/24/23 at 12:22 P.M., Resident #10 stated 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 record review, interview and policy review, the facility failed to obtain daily and weekly weights upon admission and as ordered. This affected three (Residents #110, #145 and #177) of four residents reviewed for nutrition. The facility census was 173. 1. Review of the medical record for Resident #110 revealed an admission date of 11/21/22. Diagnoses included type 2 diabetes mellitus, cerebral infarction, legal blindness, generalized anxiety disorder, weakness, COVID-19, hyperlipidemia, and depression. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #110, dated 01/23/23, revealed the resident had an impaired cognition. Resident #110 required extensive assistance with hygiene, toileting, dressing, locomotion on/off unit, and walking in room/corridor. The resident required limited assistance from staff for bed mobility, transfers, and eating. No swallowing concerns were noted in the assessment. Resident #110 was on a therapeutic diet according to the assessment. The 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 record review and interview, the facility failed to ensure a dental appointment was scheduled for tooth extractions. This affected one (Resident #13) of two residents reviewed for dental services. Findings include: Record review revealed Resident #13 was admitted on [DATE]. Medical diagnoses included chronic obstructive pulmonary disease. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/31/22, revealed Resident #13 was she was cognitively intact. Review of the dental consultation dated 06/09/22 revealed Resident #13 only wanted to see an oral surgeon for tooth extractions. Review of the dental consultation dated 01/05/23 revealed an oral surgeon referral was recorded on the paperwork from the dentist. Review of progress notes from 01/05/23 to present revealed there were no referrals made to the oral surgeon for tooth extractions. During interview on 03/20/23 at 10:53 A.M., Resident #13 stated she had seen the dentist twice since she was in the facility. She wanted to go to an oral…

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, interview and policy review, the d facility policy the facility failed to accurately document a resident's weight bearing status and accurately assess a resident's need for therapy services. This affected one (Resident #15) of two residents reviewed for therapy services. The facility census was 173. Findings include: Review of the medical record for Resident #15 revealed an admission date of 02/04/23. Diagnoses included fracture of the lower end of the right femur, type 2 diabetes mellitus, bipolar disorder, congestive heart failure, major depressive disorder, anxiety disorder, chronic kidney disease, and hypertension. Review of the admission Minimum Data Set (MDS) assessment, dated 02/11/23, revealed the resident had impaired cognition. The resident required extensive assistance for all activities of daily living except eating, which required limited assistance. Review of the plan of care for Resident #15, dated 02/04/23, revealed the resident received rehabilitation/special services. Interventions included offering pain medications as ordered, physical…

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, observation, staff interview and review of medication storage policy, the facility failed to properly label drugs and biologicals used in the facility. One vial of Tuberculin purified protein derivative (PPD) was opened and undated. This had the potential to affect all residents. There were also four inhalers stored in medication carts that were opened and undated. This directly affected four (#39, #80, #97, and #115) of four residents medications that were observed. Facility census was 171. Findings include: 1. Observation of medication storage refrigerator inside the nursing supervisors office on 07/09/19 at 9:00 A.M. revealed an opened and undated five milliliter (ml) vial of Tuberculin PPD solution. Interview with Registered Nurse (RN) #213 on 07/09/19 at 9:01 A.M. verified the 5 ml vial of PPD used for tuberculin skin tests was opened and undated. RN #213 stated the vial of PPD should have been dated when it was opened. Review of facility policy titled Recommended Medication Storageand dated 01/09/18 revealed the vial of PPD should be dated when…

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 closed medical record review, and staff interview, the facility failed to provide the required Notice of Medicare Non-Coverage (NOMNC) when Medicare Part A residents were discharged from the facility to home with skilled days remaining. This affected two (#327 and #328) of four residents reviewed for beneficiary protection notification. The facility census was 171. Findings include: 1. Review of the closed medical record for Resident #327 revealed a progress note dated 02/21/19 noting the Interdisciplinary Team (IDT) met and felt that Resident #327 was able to return home. Review of the facility completed Beneficiary Notice form revealed Resident #327 received Medicare Part A services and was discharged home on [DATE] with skilled days remaining. Further review of the information was silent of verification that the resident was provided the required NOMNC forms prior to discharge 2. Review of the close medical record for Resident #328 revealed a progress note dated 04/25/19 from Social Services noting…

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 review of facility policy, the facility failed to implement their abuse policy in regards to an allegation of sexual abuse. This affected two (#16 and #35) of 34 resident's records reviewed during the initial pool stage. Facility census was 171. Findings include: 1. Review of the medical record for Resident #16 revealed an admission date of 12/25/18. Diagnoses included altered mental status, cerebral infarction, major depressive disorder, Parkinson's disease and dementia without behavioral disturbances. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had impaired cognition. Resident #16 had no behaviors, did not reject care, did not wander and required extensive assistance with activities of daily living (ADLs). 2. Review of the medical record for Resident #35 revealed an admission date of 06/26/16. Diagnoses included dementia without behavioral disturbances, muscle weakness, major depressive disorder, schizophrenia 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 record review, staff interview and review of facility policy, the facility failed to report an allegation of sexual abuse to the Ohio Department of Health. This affected two (#16 and #35) of 34 resident's records reviewed during the initial pool stage. Facility census was 171. Findings include: 1. Review of the medical record for Resident #16 revealed an admission date of 12/25/18. Diagnoses included altered mental status, cerebral infarction, major depressive disorder, Parkinson's disease and dementia without behavioral disturbances. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had impaired cognition. Resident #16 had no behaviors, did not reject care, did not wander and required extensive assistance with activities of daily living (ADLs). 2. Review of the medical record for Resident #35 revealed an admission date of 06/26/16. Diagnoses included dementia without behavioral disturbances, muscle weakness, major depressive disorder, schizophrenia 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 record review, staff interview and review of facility policy, the facility failed to thoroughly investigate an allegation of sexual abuse. This affected two (#16 and #35) of 34 resident's records reviewed during the initial pool stage. Facility census was 171. Findings include: 1. Review of the medical record for Resident #16 revealed an admission date of 12/25/18. Diagnoses included altered mental status, cerebral infarction, major depressive disorder, Parkinson's disease and dementia without behavioral disturbances. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had impaired cognition. Resident #16 had no behaviors, did not reject care, did not wander and required extensive assistance with activities of daily living (ADLs). 2. Review of the medical record for Resident #35 revealed an admission date of 06/26/16. Diagnoses included dementia without behavioral disturbances, muscle weakness, major depressive disorder, schizophrenia and anxiety. Review of the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, resident and staff interviews, and review of the facility policy, the facility failed to provide residents assistance with Activities of Daily Living (ADLs) this affected two Residents (#75 and #173) of four reviewed for dignity and/or ADLs. The facility census was 171. Findings include: 1. Review of the medical record revealed Resident #173 was admitted to the facility on [DATE] with diagnoses including congestive heart failure, major depressive disorder, type two diabetes, cellulitis, shortness of breath, anxiety disorder, polyosteoarthritis, obesity, chronic pain, and nontoxic goiter. Review of the admission Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively intact with no noted behaviors. Review of Section G- functional status revealed the resident required extensive two-person assistance with bed mobility, toileting, transfer, extensive one-person assistance with locomotion, dressing, personal hygiene, and supervision with eating. Resident…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident and staff interview, the facility failed to timely obtain hearing services for residents. This affected one (#80) of one resident reviewed for hearing services. The census was 171. Finding include: Review of Resident #80's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses of cerebral infarction, dementia, psychosis, ataxia, chronic obstructive pulmonary disease, hemiplegia, anxiety, and hypertension. Review of the quarterly Minimum Data Set (MDS) dated on 05/05/19 revealed the resident had moderately impaired cognition, no hallucinations but there were verbal behaviors expressed. The resident was extensive assistance with activities of daily living and incontinent of bowels and bladder. Review of the plan of care dated 07/12/15, revealed Resident #80 was hard of hearing. An intervention included to arrange consult with audiologist as desired by family/resident and assist with care and insertion of head phones as needed, check…

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.