Arbors At Pomeroy

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation and interview, facility failed to maintain a homelike environment in resident rooms. This affected two residents (#18 and #55) of four residents reviewed for homelike environment. The census was 65. Findings include: 1. Record review revealed Resident #18 was admitted to the facility on [DATE] with diagnoses including hemiplegia and hemiparesis following cerebral infarction, chronic obstructive pulmonary disease, hypertension, gastro-esophageal reflux disease, dysphagia, schizoaffective disorder, major depression, and acute kidney failure. Observation on 11/29/23 at 10:44 A.M. revealed Resident #18 in his room. The bathroom door in his room had three holes on the bottom, each approximately the size of a golf ball. Interview on 11/29/23 at 10:46 A.M. with Registered Nurse (RN) #145 confirmed the holes in Resident #18's bathroom door. During the course of the annual survey, Resident #18 was not available for interview. 2. Record review revealed Resident #55 was admitted to 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, and staff interview, the facility failed to ensure Minimum Data Set (MDS) assessments were completed accurately in the area of gradual dose reduction attempts being completed when on an antipsychotic medication and the use of personal alarms and wander guards. This affected two residents (#18 and #36) of 23 residents reviewed for assessments. Findings include: 1. A review of Resident #18's medical record revealed he was admitted to the facility on [DATE]. His diagnoses included schizo-affective disorder and major depressive disorder. A review of a pharmacy recommendation for Resident #18 dated 06/27/23 revealed the pharmacist had recommended a gradual dose reduction (GDR) attempt for the use of Seroquel (an antipsychotic medication). The pharmacist indicated the resident had been on 25 milligrams (mg) twice a day since October 2021. The nurse practitioner responding to the recommendation agreed to the recommendation and reduced the dose of the Seroquel from 25 mg twice a day to 12.5 mg…

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 residents had a new resident review completed after a newly diagnosed mental illness was added to their diagnoses. This affected two residents (#12 and #43) of two residents reviewed for Preadmission Screening and Resident Review (PASARR) assessments. Findings include: 1. A review of Resident #43's medical record revealed he was admitted to the facility on [DATE]. His diagnoses included generalized anxiety disorder and depression at the time of his admission. His diagnoses list was updated to reflect an added diagnosis of schizo-affective disorder (type of schizophrenia that also included a mood disorder component) on 12/14/21. A review of Resident #43's PASARR Identification Screen dated 10/26/21 that was completed within 30 days of his admission revealed it was being completed as part of his pre-admission screen (PAS) and was an out of state PAS. Section (E.) Indications of Serious Mental Illness documented any known…

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, policy review, the facility failed to ensure a residents care plan properly reflected a resident's code status. This affected one resident (#67) of the 23 residents reviewed for accurate care planning. The facility census was 65. Findings include: Review of the medical record for Resident #67 revealed an initial admission date of [DATE]. Diagnoses included COVID-19, chronic obstructive pulmonary disease, cerebral infarction and vascular dementia. Review of Resident #67's code status document dated [DATE] revealed a completed and signed document indicating Resident #67 wished to be a Do-Not-Resuscitate (DNR), Comfort Care, Arrest (CCA) DNR-CCA indicating the provider will treat resident as any other without a DNR order until the point of cardiac or respiratory arrest at which point all interventions will cease and the DNR Comfort Care protocol will be implemented. Review of Resident #67's orders for [DATE] revealed a code status order for DNR-CCA with an original…

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 obtain ordered weekly weights for nutritional support monitoring. This affected one resident (#15) of the two residents reviewed for nutrition. The facility census was 65. Findings include: Review of the medical record for Resident #15 revealed an initial admission date of 08/09/11 and a re-entry date of 05/26/23. Diagnoses included dementia, dysphasia, muscle weakness, and impaired renal tubular function. Review of Resident #15's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 01 indicating a severely impaired cognition for daily decision making abilities. Resident #15 was noted to be independent with set up only for eating and was noted to weigh 157 pounds. Review of Resident #15's dietary progress note dated 11/08/23 at 12:27 P.M. created by Dietitian #500 revealed a recommendation for weekly weights due to weight decline. Review of Resident #15's orders 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, observation, staff interview, and policy review, the facility failed to ensure a resident receiving supplemental oxygen had a physician's order to administer oxygen and a physician's order to specify the flow rate in which it was to be received. This affected one resident (#16) of two residents reviewed for respiratory care. Findings include: A review of Resident #16's medical record revealed he was admitted to the facility on [DATE]. His diagnoses included chronic obstructive pulmonary disease (COPD), unspecified asthma, and personal history of Covid-19. A review of Resident #16's active care plans revealed he had impaired pulmonary/ respiratory status related to COPD. The care plan was initiated on 09/26/23. Interventions included administering medications and treatments as ordered. The care plan did not specifically indicate the use of supplemental oxygen as one of the interventions implemented. A review of Resident #16's physician's orders revealed the resident did not have an order…

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 interviews, the facility failed to ensure as needed antipsychotic medication had an appropriate diagnosis for use and was not administered to residents prior to attempting nonpharmacologic interventions. This affected one resident (#36) of six residents reviewed for unnecessary medications. The facility census was 65. Findings included: Record review revealed Resident #36 was admitted to the facility on [DATE] with diagnoses including stroke, type II diabetes, Crohn's disease, depression, hypertension, dementia, aortic valve stenosis, anxiety disorder, dementia with behaviors, dysphagia, insomnia, atherosclerotic heart disease without angina, fibromyalgia, and gastroesophageal reflux disease. Review of orders revealed Resident #36 had orders in place for a mood stabilizer, depakote 250 milligrams (mg), and an anti-anxiety medication, ativan 0.5 mg. Review of quarterly minimum data set (MDS) from 10/11/23 revealed Resident #36 had impaired cognition and physical behaviors four to six…

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 a resident received an antibiotic for an appropriate diagnosis. This affected one resident (#223) of six residents reviewed for antibiotic stewardship. The facility census was 65. Findings included: Record review revealed Resident #223 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), paraplegia, chronic kidney disease stage 3, type II diabetes, gastro-esophageal reflux disease, hypertension, dysphagia, insomnia, flaccid neuropathic bladder, emphysema, and atrial fibrillation. Review of progress notes revealed Resident #223 was seen by Medical Director (MD) on 06/26/23 for a regulatory visit. MD stated Resident #223 had complaints of being short of breath with movement, is oxygen dependent at baseline, and has a diagnosis of chronic obstructive pulmonary disease. During the visit, Resident #223's vitals were stable, had no congestion, and respiratory system was diminished to bilateral lower…

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 Resident #4, a male resident who displayed inappropriate sexual behaviors prior to admission to the facility was not placed in a room with a bathroom that adjoined to another room where a female resident, Resident #74 resided. This affected two residents (#4 and #74) of the three residents reviewed for appropriate care planning. The facility census was 63. Findings include: Review of the medical record for Resident #4 revealed an initial admission date of 06/22/23 and a re-entry date of 09/29/23. Diagnoses included bipolar disorder current, dementia with behavioral disturbances and cognitive communication deficit. Review of Resident #4's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 10 out of 15 indicating a moderately impaired cognition for daily decision making abilities. Resident #4 was noted to be independent no set up assistance required for for bed mobility, walk in…

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, self-reported incident review, staff interview, and facilities policy review, the facility failed to report an allegation of sexual abuse in a timely manner and to the appropriate State agency. This affected one resident (#74) of three residents reviewed for reporting allegations of abuse. The facility census was 63. Findings include: Review of a facility self-reported incident, tracking number 238948 dated 09/07/23 revealed an allegation of sexual abuse was reported to the State agency. Time and location of occurrence was noted to be 08/24/23 in residents room. Narrative of the incident included, Allegation of sexual abuse. Resident #74 states that male resident, Resident #4 exposed himself and asked her to kiss it or he would break her arm. Staff reported both residents were in females' room, Resident #74's room with the door closed. Both residents were fully clothed during this time. Resident #4 was sitting on the bed and Resident #74 was next to the door in a wheelchair. No report of residents making contact just verbal remarks. Initially 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 and staff interview, this facility failed to develop a comprehensive person centered care plan to reflect behaviors including inappropriate sexual behaviors. This affected one resident (#4) of three residents reviewed for care planning. The facility census was 63. Findings include: Review of the medical record for Resident #4 revealed an initial admission date of 06/22/23 and a re-entry date of 09/29/23. Diagnoses included bipolar disorder current, dementia with behavioral disturbances and cognitive communication deficit. Review of Resident #4's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 10 out of 15 indicating a moderately impaired cognition for daily decision making abilities. Resident #4 was noted to be independent no set up assistance required for for bed mobility, walk in and out of room, locomotion on and off the unit. Resident #4 was noted to be free of any impairment to the bilateral upper or…

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

Based on observation, interview, and policy review the facility failed to ensure the narcotic contingency box and refrigerated contingency narcotics were reconciled each shift and failed to ensure accurate count of Ativan. This had the potential to affect all 74 residents. Findings include: Observation on 04/05/22 at 10:14 A.M., with Licensed Practical Nurse (LPN) #860 revealed there was plastic narcotic contingency box sitting on the counter that contained 196 controlled narcotics per the control drug disposition and audit record dated 04/01/22. The box was not double locked and was attached to the bottom of on upper cabinet with a small (1/16) wire that could have been easily cut. Further observation of refrigerated contingency narcotic revealed there was six one milliliter (ml) injectable Ativan's in the unlocked plastic box in the unlocked refrigerator. There was no evidence of Ativan Intensol (oral) per the control drug disposition and audit record. Review of the control drug disposition and audit record dated 04/01/22 revealed no evidence of the lock numbers or evidence the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and policy review the facility failed to ensure medications were packaged, labeled, and stored properly. This had the potential to affect all 74 residents. Findings include: 1.Observation on 04/05/22 at 10:14 A.M., with Licensed Practical Nurse (LPN) #860 revealed there was a plastic narcotic contingency box sitting on the counter that contained 196 controlled narcotics per the control drug disposition and audit record dated 04/01/22. The box was not double locked and was attached to the bottom of on upper cabinet with a small (1/16) wire that could have been easily cut. Further observation of refrigerated contingency narcotic revealed there was six one milliliter (ml) injectable Ativan's in the unlocked plastic box in the unlocked refrigerator. Interview on 04/05/22 at 10:25 A.M., with LPN #860 during the observation verified the Ativan was not double locked in the refrigerator, nor was the contingency box double locked in a fixed compartment. Review of the facilities policy…

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 Quality Assessment and Assurance (QAA) sign-in sheets and staff interview the facility failed to hold quarterly meetings with the attendance of the Administrator, the Medical Director, and Director of Nursing (DON). This had the potential to affect all 74 residents living in the facility. Findings include: Review of QAA sign-in sheets from 04/16/2021 to 03/03/2022 revealed the second quarter of 2021 revealed no meeting was held that included all the required members: the 04/16/21 meeting the DON was not in attendance, the May 2021 meeting neither the Administrator or the DON were in attendance, and the June 2021 meeting neither the Administrator nor the Medical Director were in attendance. Review of third quarter of 2021 revealed no meeting was held that included all the required members: the July 2021 meeting neither the Administrator nor Medical Director were in attendance, the August 2021 meeting revealed the DON was not in attendance, and September 2021 the Director of Nursing was not in attendance. There were no sign-in sheets available for review for October…

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 facility policy review the facility failed to ensure resident medical records contained comprehensive and specific documentation pertaining to the circumstances of transfers and failed to ensure required information was provided to the receiving provider for all residents at the time of transfer/hospitalization. This affected four residents (#47, #73, #74 and #57) of five residents reviewed for transfers/hospitalizations. Findings include: 1. Review of the medical record for Resident #73 revealed an initial admission date of 12/30/21 and a readmission date of 03/08/22. Resident #73 had diagnoses including cellulitis of the left lower limb, diastolic heart failure, chronic obstructive pulmonary disease (COPD), Stage III chronic kidney disease (CKD), hypothyroidism, chronic pain syndrome, cervical radiculopathy, cognitive communication deficit, muscle weakness, chronic venous hypertension with ulcer and inflammation of the left lower extremity, pain in the left leg,…

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 facility policy review the facility failed to ensure residents, their responsible parties and/or the Ombudsman were notified of resident transfers/discharges as required. This affected four residents(#64, #47, #74 and #57) of five residents reviewed for transfer/discharge/hospitalizations. Findings include: 1. Review of the medical record for Resident #64 revealed an admission date of 02/06/20 with diagnoses including cerebrovascular disease, type II diabetes mellitus (DM2) with neuropathy, encounter for palliative care, lumbar intervertebral disc degeneration, chronic obstructive pulmonary disease (COPD), mild cognitive impairment, muscle weakness, difficulty walking, unsteadiness on feet, major depressive disorder and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/01/22 revealed the resident had moderately impaired cognition with the a Brief Interview of Mental Status (BIMS) score of 11. Review of a progress note, dated 11/11/2021…

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, interviews, and policy reviews the facility failed to ensure Preadmission Screening and Resident Review (PASARR) were accurate and/or resubmitted after change of diagnoses that required Level II review. This affected four (Resident #43, #46, #49, and #71) of five reviewed for PASARR. Findings included: 1. Record review revealed Resident #43 was admitted to the facility on [DATE]. On 02/03/20 psychosis was added to the diagnoses list, 06/16/20 schizoaffective disorder was added to the diagnoses list, and on 12/13/20 major depression was added to the diagnoses list. Review of Resident #43 last PASARR dated 12/14/15 revealed no evidence the resident had any mental illness and did not qualify for level two services. Review of Resident #43's annual Minimum Data Set (MDS) dated [DATE] revealed the resident was not currently considered by the state Level II PASARR process to have serious mental illness and or/or intellectual disability or related condition. Review of Resident #43's orders 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 staff interview, resident interview, observations, medical record review, and facility policy review, the facility failed to care plan Oxygen therapy and restorative therapy. This affected three (#71, #41, and #59) of three residents reviewed for care plans. The facility census was 74. Findings include: 1. Review of the medical record for the Resident #71 revealed an admission date of 03/04/22. Diagnoses included Chronic Obstructive Pulmonary Disease (COPD), emphysema, schizoaffective disorder-bipolar type, mood disorder due to known physiological conditions with mixed features, bipolar disorder, and schizophrenia. Review of the comprehensive Minimum Data Set (MDS) assessment, dated 03/04/22, revealed the resident had intact cognition with a Brief Interview of Mental Status (BIMS) score of 14 out of 15 (no impairment) and no behaviors. The resident was independent or required supervision for all Activities of daily Living (ADL's). Further Review of the MDS assessment revealed the resident did not…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review the facility failed to ensure interventions were timely implemented to prevent significant weight loss and residents were provided with accurate nutritional assessments and care plans. This affected three residents (#1, #7, and #57) of three residents reviewed for nutrition. The facility census was 74. Findings included: 1. Record review revealed Resident #7 was admitted to the facility on [DATE] with diagnoses including hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage (stroke) affecting left non-dominant side, diabetes mellitus, need for assistance with personal care, and generalized muscle weakness. Review of Resident #7's weights revealed on 01/05/2022, the resident weighed 223.0 pounds (lbs.) and on 01/19/2022, the resident weighed 207.8 pounds. This was a 6.82% weight loss in two weeks. Resident #7 lost over 5% of her weight in a two-week period. She then continued to lose weight as noted with a weight of 203.4 lbs.…

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 staff interview, resident interview, observations, medical record review, facility policy review, the facility failed to store and change respiratory tubing per facility policy. This affected four (#47, #71, #325, and #73) of four residents reviewed for respiratory care. The facility census was 74. Findings include: 1. Review of the medical record for the Resident #71 revealed an admission date of 03/04/22. Diagnoses included Chronic Obstructive Pulmonary Disease (COPD), emphysema, schizoaffective disorder-bipolar type, mood disorder due to known physiological conditions with mixed features, bipolar disorder, and schizophrenia. Review of the comprehensive Minimum Data Set (MDS) assessment, dated 03/04/22, revealed the resident had intact cognition with a Brief Interview of Mental Status (BIMS) score of 14 out of 15 (no impairment) and no behaviors. The resident was independent or required supervision for all Activities of daily Living (ADL's). Further review of the MDS assessment revealed the resident did not receive Oxygen services but did have a COPD diagnosis. Review of…

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, observation, review of glucometer disinfecting guidelines, review of Sani-Cloth (germicidal disposable wipe) instructions, and policy review the facility failed to ensure indwelling urinary catheter tubing was maintained to prevent contamination and failed to ensure multiple use glucometers were disinfected properly to prevent the spread of communicable diseases. This affected one (Resident #36) of one reviewed for urinary catheter and had the potential to affect all 19 residents (Resident's #63, #60, #35, #62, #5, #33, #12, #43, #20, #46, #16, #7, #73, #57, #21, #324, #47, #40, and #22) that the facility had identified as receiving blood glucose monitoring with the facilities glucometers. Findings include: 1. Observation on 04/05/22 at 5:13 P.M., with Licensed Practical Nurse (LPN) #860 revealed the LPN had two glucometers lying on the top of the medication cart. One glucometer was wrapped in a Sani-Cloth bleach wipe and the other one was uncovered. LPN #860 performed a…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, review of the facility's code status book, staff interview and policy review the facility failed to ensure Resident #62's code status was consistent between what was identified in the medical record and what the advanced directives indicated the code status to be in the facility's code status book maintained on the unit. This affected one resident (#62) of three residents reviewed for advanced directives. Findings include: A review of Resident #62's medical record revealed the resident was admitted to the facility on [DATE]. Resident #62 had diagnoses including a history of a stroke with hemiplegia (paralysis) and hemiparesis (weakness) affecting the right dominant side, adult onset diabetes mellitus, hypertension and history of a myocardial infarction (heart attack). A review of Resident #62's physician's orders revealed his advance directives/code status was a Do Not Resuscitate Comfort Care Arrest (DNRCC-A). The order had been in place since 02/18/22. A review of the facility's code…

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

Based on review of the advance beneficiary notices, staff interview and policy review the facility failed to ensure residents and/or their responsible parties received the appropriate advance beneficiary notices when cut from Medicare (MCR) Part A services. This affected two resident (#225 and #226) of three residents reviewed for beneficiary protection notification. Findings include: 1. A review of the facility's list of residents who received a liability notice in the past six months revealed Resident #225 was cut from MCR Part A services on 01/20/22. The resident was identified as having remained in the facility after her skilled service had ended. The facility was not able to provide documented evidence of Resident #225 and/or the resident's representative receiving the required notice of the resident's skilled service ending. The facility could not find the CMS Form 10123 (Notice of MCR Non-Coverage) or CMS Form 10055 (Skilled Nursing Facility Advance Beneficiary Notice) that should have been provided to the resident and/or the resident's representative when the resident 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.

Based on observation, record review, interview and policy review the facility failed to ensure Resident #73 and Resident #22 were provided privacy in their shared room. Observations on 04/04/22 and 04/05/22 revealed no privacy curtain or privacy devices were in the resident's room to ensure the visual privacy of both residents. This affected two residents (#73 and #22) of two residents observed for privacy curtains. Findings include: 1. Review of the medical record for Resident #22 revealed an admission date of 11/20/20 with diagnoses including cerebral infarction due to unspecified occlusion or stenosis or the right middle cerebral artery, chronic atrial fibrillation, type II diabetes mellitus (DM2), hypertension (HTN), hypomagnesemia, major depressive disorder, dysphagia, anemia, restless leg syndrome, gastroesophageal reflux disease without esophagitis (GERD) and hyperlipidemia. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 01/19/22 revealed Resident #22 had moderately impaired cognition with a Brief Interview of Mental Status (BIMS) score of 12 of 15 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, interview and policy review the facility failed to ensure Resident #59 was free from an incident of verbal abuse. This affected one resident (#59) of two residents reviewed for resident to resident altercations. Findings include: Review of Resident #59's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including quadriplegia C5-C7, convulsions, neurogenic, bowel, mood disorder, major depressive disorder, morbid obesity, post-traumatic stress disorder, with mixed anxiety and depressed mood, hearing loss, impacted teeth and hypokalemia. Review of Resident #59's admission Minimum Data Set (MDS) 3.0 assessment, dated 12/30/2021 revealed the resident had clear speech, understands others, made self-understood and her cognition was intact. Resident #59 had minimum depression, no indicators of psychosis, no behaviors and did not reject care. Resident #59 required extensive assistance of two staff for bed mobility, was dependent on two staff to transfer,…

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 personal funds statements, interview and policy review the facility failed to prevent an incident of misappropriation of personal funds for Resident #43. This affected one resident (#43) of one reviewed for misappropriation. Findings include: Record review revealed Resident #43 was admitted to the facility on [DATE] with diagnoses including heart disease, diabetes, amputation of left leg below knee and amputation of right leg above knee. Review of Resident #43's quarterly Minimums Data Set (MDS) 3.0 assessment, dated 02/14/22 revealed the resident was moderately cognitively impaired with a Brief Interview for Mental Status (BIMS) score of 12. Review of Resident #43's personal funds statements dated 01/2022 to 04/05/22 revealed the resident withdrew $50.00 cash on 01/06/22 and 02/17/22, $25.00 on 03/15/22, $45.00 on 03/21/22, and $30.00 on 04/05/22. On 04/05/22 at 8:47 A.M. interview with Resident #43 revealed he was missing $58.00, which he kept in a small plastic box. 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, interview and policy review the facility failed to ensure all alleged incidents of abuse and/or misappropriation were immediately reported to the Administrator and/or to the State agency as required. This affected two residents (#43 and #59) of two residents reviewed for abuse. Findings include: 1. Record review revealed Resident #43 was admitted to the facility on [DATE] with diagnoses including heart disease, diabetes, amputation of left leg below knee and amputation of right leg above knee. Review of Resident #43's quarterly Minimums Data Set (MDS) 3.0 assessment, dated 02/14/22 revealed the resident was moderately cognitively impaired with a Brief Interview for Mental Status (BIMS) score of 12. Review of Resident #43's personal funds statements dated 01/2022 to 04/05/22 revealed the resident withdrew $50.00 cash on 01/06/22 and 02/17/22, $25.00 on 03/15/22, $45.00 on 03/21/22, and $30.00 on 04/05/22. On 04/05/22 at 8:47 A.M. interview with Resident #43 revealed he was missing $58.00,…

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 facility policy review the facility failed to ensure all allegations of abuse and misappropriation were thoroughly and timely investigated. This affected three residents (#12, #43 and #59) of three residents reviewed for abuse. Findings include: 1. Record review revealed Resident #43 was admitted to the facility on [DATE] with diagnoses including heart disease, diabetes, amputation of left leg below knee and amputation of right leg above knee. Review of Resident #43's quarterly Minimums Data Set (MDS) 3.0 assessment, dated 02/14/22 revealed the resident was moderately cognitively impaired with a Brief Interview for Mental Status (BIMS) score of 12. Review of Resident #43's personal funds statements dated 01/2022 to 04/05/22 revealed the resident withdrew $50.00 cash on 01/06/22 and 02/17/22, $25.00 on 03/15/22, $45.00 on 03/21/22, and $30.00 on 04/05/22. On 04/05/22 at 8:47 A.M. interview with Resident #43 revealed he was missing $58.00, which he kept in a small plastic box.…

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 residents assessments were accurate with regard to pressure injuries, life expectancy, and functional range of motion. This affected two of 23 sampled residents (Resident #1 and Resident #43) whose assessments were reviewed. Findings include: 1. Review of Resident #1's medical record revealed he was admitted on [DATE] with diagnoses that included: acute and chronic respiratory failure, nontraumatic subarachnoid hemorrhage, tracheostomy, gastrostomy, moderate protein calorie malnutrition, morbid obesity, conversion disorder with seizures or convulsions, peripheral vascular disease, gastroesophageal reflux disease, and anemia. Review of Resident #1's significant change Minimum Data Set (MDS) dated [DATE] revealed the following. Resident #1 had no speech, rarely/never was understood, rarely/never understands, and he had no recall. Resident #1's life expectancy was not six months or less and was on hospice. Resident #1 was at risk 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, family interview, staff interview, and policy review, the facility failed to ensure residents and/ or their resident representative were invited to attend quarterly care planning conferences to be a part of the resident's care planning process. This affected one (Resident #5) of one residents reviewed for care planning conferences. Findings include: A review of Resident #5's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included dementia with behavioral disturbances, personality disorder, schizo-affective disorder, major depressive disorder, difficulty walking and need for assistance with personal care. A review of Resident #5's profile in the electronic health record (EHR) revealed the resident was identified as her own responsible party for financial and clinical. No other people were identified as her emergency contact. A review of Resident #5's annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review the facility failed to ensure interventions were implemented per therapy recommendation and failed to assess and implement new intervention to maintain resident's ability to eat without physical assistance. This affected one Resident (#7) of 11 residents reviewed for decline in activity of daily living. The facility census was 74. Findings included: Record review revealed Resident #7 was admitted to the facility on [DATE] with diagnoses including hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage (stroke) affecting left non-dominant side, diabetes mellitus, need for assistance with personal care, and generalized muscle weakness. There was no documented evidence of left hand/wrist contractures. Review of Resident #7's admission Minimum Data Set (MDS) dated [DATE] revealed she was moderately cognitively impaired and was eating with supervision with one person physically assisting. The quarterly 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, interview, observation, and policy review the facility failed to ensure dependent residents were provided showers per their preference. This affected nine Residents (#5, #31, #36, #41, #62, #64, #66, #73, and #424) of 11 residents reviewed for activities of daily living. The facility census was 74. Findings included: 1. Record review revealed Resident #31 was admitted to the facility on [DATE] with the diagnoses including Chronic Obstructive Pulmonary Disease (COPD), cervical disc disorder, seizures, and syncope and collapse. Review of Resident #31's admission Minimum Data Set (MDS), dated [DATE], revealed the resident was cognitively intact. She required one person to physically assist with bathing activity and that the ability to choose between a tub bath, shower, bed bath or sponge bath was somewhat important to her. Review of the facility's shower schedule, undated, revealed Resident #31 was to have two showers a week. Review of Resident #31's shower documentation, dated 02/2022 to…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the medical record, facility policy review, and staff interview the facility failed to ensure communication between the facility and the hospice provider in order to provide continuity of care for the resident. This affected one of two residents reviewed who received hospice services (Resident #1). The facility census was 74. Findings include: Review of Resident #1's medical record revealed he was admitted on [DATE] with diagnoses that included: acute and chronic respiratory failure, nontraumatic subarachnoid hemorrhage, tracheostomy, gastrostomy, moderate protein calorie malnutrition, morbid obesity, conversion disorder with seizures or convulsions, peripheral vascular disease, gastroesophageal reflux disease, and anemia. Review of Resident #1's significant change Minimum Data Set (MDS) dated [DATE] revealed the following. Resident #1 had no speech, rarely/never was understood, rarely/never understands, and he had no recall. Resident #1 had no indicators of psychosis, and no behaviors 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 observation, record review, facility policy and procedure review, and interview the facility failed to ensure necessary treatment and services for the care of pressure ulcers. This affected two residents (#1 and #73) of four residents reviewed for pressure ulcer care. Findings include: 1. Review of the medical record for Resident #73 revealed an initial admission date of 12/30/21 and a readmission date of 03/08/22. Resident #73 had diagnoses including cellulitis of the left lower limb, diastolic heart failure, chronic obstructive pulmonary disease (COPD), Stage III chronic kidney disease (CKD), hypothyroidism, chronic pain syndrome, cervical radiculopathy, cognitive communication deficit, muscle weakness, chronic venous hypertension with ulcer and inflammation of the left lower extremity, pain in the left leg, hypertension, type II diabetes mellitus (DM2), major depressive disorder, gastroesophageal reflux disease (GERD) and anxiety disorder. Review of the comprehensive Minimum Data Set (MDS) 3.0…

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 staff interview, resident interview, observations, medical record review, facility policy review, the facility failed to implement ordered fall interventions. This affected one (#22) of four residents reviewed for accidents. The facility census was 74. Findings include: Review of the medical record for Resident #22 revealed an admission date of 11/20/20. Diagnoses included cerebral infarction due to unspecified occlusion or stenosis or the right middle cerebral artery, chronic atrial fibrillation, type II diabetes mellitus (DM2), hypertension (HTN), hypomagnesemia, major depressive disorder, dysphagia, anemia, restless leg syndrome, gastro-esophageal reflux disease without esophagitis (GERD), and hyperlipidemia. Review of the physician order dated 08/11/21, revealed the resident was to have mats next to her bed due to recent falls. Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/19/22, revealed the resident had impaired cognition with a Brief Interview of Mental Status (BIMS) score of 12 out of 15 (moderate impairment) and no documented behaviors. 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 staff interview, resident interview, observations, medical record review, facility policy review, the facility failed to label/date an intermittently ran tube feeding bottle. This affected one (#51) of three residents who received enteral feedings. The facility census was 74. Findings include: 1. Review of the medical record for Resident #51 revealed an admission date of 02/28/11. Diagnoses included chronic obstructive pulmonary disease (COPD), gastrostomy, and alcohol dependence with alcohol-induced persisting dementia. Review of the quarterly Minimum Data Set (MDS) assessment, dated 02/23/22, revealed the resident had impaired cognition with a Brief Interview of Mental Status (BIMS) score of three out of 15 (severe impairment) and no noted behaviors. The resident required total assistance of one staff member for eating. He required extensive to total assistance of one to two or more staff members for all Activities of daily Living (ADL's). Review of the plan of care dated 01/11/22 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, interview, and record review the facility failed to provide the necessary mental health treatment to maintain the resident's highest mental health status. This affected one resident (Resident #25) of two residents reviewed for behavioral health needs. The facility census was 74. Findings include: Review of the medical record revealed Resident #25 was admitted to the facility on [DATE] with diagnoses of major depressive disorder, single episode, and mental disorder. Review of Resident #25's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident was mildly cognitively impaired with a mood interview score of 05 (mild depression). The resident's quarterly MDS, dated [DATE], revealed he was cognitively intact with a mood interview score of 00 (no depression). Review of Resident #25's orders, dated 10/01/22, revealed mental health medication orders for Venlafaxine HCL Extended Release 150 milligram (mg) capsule one time a day for depression, Bupropion HCL Extended…

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 staff interview, resident interview, observations, medical record review, facility policy review, the facility failed to monitor and treat psychotropic medication side effect/adverse reactions. This affected one (Resident #73) of six residents reviewed for unnecessary medications. The facility census was 74. Findings include: Review of the medical record for Resident #73 revealed an initial admission date of 12/30/21 and a readmission date of 03/08/22. Diagnoses included cellulitis of the left lower limb, diastolic heart failure, chronic obstructive pulmonary disease (COPD), Stage III chronic kidney disease (CKD), hypothyroidism, chronic pain syndrome, cervical radiculopathy, cognitive communication deficit, muscle weakness, chronic venous hypertension with ulcer and inflammation of the left lower extremity, pain in the left leg, hypertension, type II diabetes mellitus (DM2), major depressive disorder, gastro-esophageal reflux disease (GERD), and anxiety disorder. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 03/14/22, revealed Resident #73 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 review of the infection and antibiotic stewardship program, interview, and policy review the facility failed to ensure residents met criteria of antibiotic treatment. This affected one (Resident #47) of five residents reviewed for hospitalization. Findings include: Record review revealed Resident #47 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), atrial fibrillation, paraplegia, diabetes, emphysema, and history of COVID-19 on 02/09/22. Review of Resident #47's hospital records dated 12/18/21 revealed the resident's principal diagnoses was hypoxia and secondary was acute exacerbation of COPD. Resident #47 was provided instructions on atrial fibrillation, pneumonia, and booster injection for COVID-19. Review of Resident #47 nursing progress note dated 12/14/21 revealed the hospital reported the resident was admitted to intensive care and was on antibiotics for a urinary tract infection (UTI). Further of Resident #47 discharge prescriptions 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, Centers for Disease Control and Prevention (CDC) Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes, staff interview, and medical record review the facility failed to ensure a resident who was not up to date on COVID-19 vaccination was tested between the fifth or seventh day after admission. This affected one (Resident #124) of one resident reviewed for transmission-based precautions. The facility census was 74. Findings include: Review of Resident #124's medical record revealed an admission date of 03/25/22 with diagnoses including polyneuropathy, chronic kidney, obstructive reflux, anemia, chronic congestive heart failure, major depressive disorder, and urinary retention. Resident #124 was placed on quarantine upon admission as he was not up to date with COVID-19 vaccinations. Interview of the Director of Nursing (DON) on 04/04/22 at 7:10 A.M. revealed Resident #124 was on transmission-based precautions because he was a newly admitted and was not up to date with COVID-19 vaccinations. Observation of 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, interview, and policy review the facility failed to ensure a resident's call light was functional. This affected one (Resident #31) of one resident reviewed for call light function. The facility census was 74. Findings include: Record review revealed Resident #31 was admitted to the facility on [DATE] with the diagnoses including chronic obstructive pulmonary disease (COPD), cervical disc disorder, seizures, and syncope and collapse. Review of Resident #31's care plan dated 01/19/22 revealed she should have the call light within reach and encourage her to use it for assistance as needed. Review of Resident #31's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed she was cognitively intact and could walk in her room or in the corridor independently without physical assistance from staff. Interview on 04/04/22 at 8:20 P.M. with Resident #31 revealed her call light was not working. Resident #31 reported the call light had not been working for a while since 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.