Merit House LLC

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident interview, medical record review, staff interview and review of facility policy, the facility failed to obtain a physician order for administration of oxygen therapy. This affected one (#30) of three residents reviewed for oxygen therapy. The facility identified 18 residents who received oxygen therapy. The facility census was 81. Findings include: Review of the medical record for Resident #30 revealed an admission date of 12/06/24. Diagnoses included status post cardiac arrest, respiratory arrest, chronic obstructive pulmonary disease (COPD), and congestive heart failure. Review of the admission Minimum Data Set (MDS) assessment, dated 12/12/24, revealed Resident #30 was cognitively intact and received oxygen therapy. Review of the physician orders for December 2024 revealed no order for oxygen therapy. Observation on 12/30/24 at 4:32 P.M. of Resident #30 revealed she was wearing oxygen via nasal cannula, running at two liters per minute (lpm). Concurrent interview with 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.

Based on observation, medical record review, staff interview, review of the emergency medication box (E-box) inventory and review of facility policy, the facility failed to administer medications per physician order. This affected one (#100) of three residents reviewed for medication administration. The facility census was 81. Findings include: Review of the medical record for Resident #100 revealed an admission date of 12/06/24 and a discharge date of 12/18/24. Diagnoses included chronic obstructive pulmonary disease (COPD), emphysema, and anxiety. Review of the admission Minimum Data Set (MDS) assessment, dated 12/13/24, revealed Resident #100 was cognitively intact. Review of the admission orders for Resident #100 revealed he was ordered Zithromax (antibiotic) 250 milligrams (mg) to give two tablets on day one for acute exacerbation of COPD and prednisone (oral steroid used to decrease inflammation) 20 mg to give one and a half tablets (30 mg total) for acute exacerbation of COPD. Review of the Medication Administration Record (MAR) for December 2024 revealed on 12/07/24 a 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 observation, staff interview and review of the facility policy, the facility failed to ensure soiled bedpans were cleaned and disinfected timely. This affected one (#22) of one resident reviewed for bedpan use. The facility identified eight additional residents who utilized bedpans. The facility census was 81. Findings include: Review of the medical record for Resident #22 revealed an admission date of 03/01/24. Diagnoses included spinal stenosis, congestive heart failure (CHF), atrial fibrillation, and hypertension with heart disease. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/07/24, revealed Resident #22 was frequently incontinent and was staff dependent for toileting. Review of the Certified Nursing Assistant (CNA) documentation for the past 30 days revealed Resident #22 was both continent and incontinent. Observation on 12/26/24 at 8:45 A.M. of Resident #22's bathroom revealed a soiled bedpan on the floor of the bathroom. There was a pink substance on the bottom of the bedpan and the bedpan was left, uncovered, in the open. Concurrent interview…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview, and policy review, the facility failed to ensure medications were administered as ordered. This affected one (#93) of three residents reviewed for medications. The facility census was 83. Findings included: Review of Resident #93's medical record revealed an admission ate of 10/02/24. Diagnoses included cellulitis of the left lower extremity, diabetes mellitus, ulcerative colitis, and schizophrenia. The resident was discharged on 10/09/24. Review of Resident #93's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had an intact cognitive function and was independent of most activities of daily living (ADLs). Review of Resident #93's nursing progress note dated 10/02/24 revealed the resident arrived to the facility at 2:00 P.M. from a local hospital. The resident's medications were reviewed and confirmed with the physician. Review of Resident #93's physician orders while in the facility included orders dated 10/02/24 for atorvastatin calcium…

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, review of exterminator documents, and policy review, the facility failed maintain a pest free environment. This affected one (#84) of two residents reviewed for environmental concerns. The facility census was 83. Findings included: Review of Resident #84's medical record revealed an admission date of 01/01/20. Diagnoses included mild intellectual disabilities, congestive heart failure, and diabetes mellitus. Review of Resident #84's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had an intact cognition and was at risk for skin impairment related to weakness. Review of Resident #84's nursing progress note dated 10/08/24 revealed the resident was showered and staff noticed small bug bites all over the resident's legs and arms. The nurse practitioner was notified. Review of Resident #84's nursing progress note dated 10/11/24 revealed the resident was showered with assistance from a nurse aide and bite marks on her bilateral upper and lower extremities…

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, review of facility Self-Reported Incidents (SRIs), review of staff schedules, and review of the facility policy, the facility failed to thoroughly investigate an allegation of verbal abuse and failed to protect residents from potential abuse. This affected three (Resident #9, #42, and #54) of three residents reviewed for abuse. The facility census was 85. Findings include: 1. Review of the medical record revealed Resident #9 was admitted to the facility on [DATE]. Diagnoses included schizophrenia, depression, anxiety, bipolar disorder, and muscle weakness. Review of the quarterly Minimum Data Set assessment dated [DATE] identified the resident as cognitively impaired. The resident required substantial/maximal assistance from staff for a majority of the activities of daily living. Review of the medical record revealed no evidence regarding an allegation of abuse. 2. Review of the medical record revealed Resident #42 was admitted to the facility on [DATE]. Diagnoses…

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

Based on observation, review of a facility investigation, staff interview, and policy review, the facility failed to maintain a safe environment free from an outdoor fire. This had the potential to affect 11 residents (#5, #9, #14, #34, #38, #42, #46, #54, #61, #77, #181) with rooms in proximity to where the fire occurred. The facility census was 85. Findings include Review of an incident summary dated 09/13/24 about 3:50 P.M. by the Administrator revealed a nurse stated there was smoke outside of the 200 Hall lounge exit door on the sidewalk. When the Administrator arrived, there was a small flowerpot under a chair that staff put dirt and water on because it was smoking. There were no residents or staff witnessed sitting in the chair which had a hole. The Administrator reviewed the camera footage but the area was not in view of the camera. Observation on 09/16/24 at 3:15 P.M., with the Director of Maintenance (DM) #416 revealed a red fabric patio chair near the southwest doorway of the interior courtyard with a burn hole in the seat of the chair approximately six inches by four…

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 interview, and staff interview, the facility failed to ensure residents received the necessary services to maintain a dignified appearance. This affected one (Resident #62) of three residents reviewed for dignity. The facility census was 85. Findings include: Review of the medical record revealed Resident #62 was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, chronic kidney disease, heart failure, gout, hypertension, and type II diabetes mellitus. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed Resident #62 had a moderate cognitive impairment. The resident was dependent on staff assistance for dressing and personal hygiene. Review of the physician progress notes dated 01/17/24 and 03/12/24 revealed Resident #62's right breast was surgically absent and an order for a prosthetic bra per patient request. Review of the social service progress notes dated 03/14/24 revealed Resident #62…

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. Review of the medical record revealed Resident #182 was admitted to the facility on [DATE]. Diagnoses included chronic destructive pulmonary disease, asthma, and heart failure. Review of the admission MDS assessment dated [DATE] revealed Resident #182 was cognitively intact. The resident required partial to moderate assistance from staff for bed mobility. Review of the physician orders for September 2024 identified an active order dated 09/05/24 for top bilateral siderails to aide in bed mobility and promote independence. Review of the plan of care dated 09/07/24 identified Resident #182 was at risk for an activities of daily living self-care performance deficit related to limited mobility. Interventions included half rails up as per physician orders for safety during care provision, to assist with bed mobility, and to observe for injury or entrapment related to siderail use. During an interview on 09/18/24, Resident #182's family member reported the resident was admitted to the facility weeks ago and was…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview and facility policy review, the facility failed to notify the physician of resident weight loss. This affected one (Resident #48) of three residents reviewed for nutrition. The facility census was 85. Findings include: Review of the medical record revealed Resident #48 was initially admitted to the facility on [DATE]. Diagnoses included severe protein-calorie malnutrition, nutritional deficiency, heart disease, heart failure, weakness, anxiety, depression, and bipolar disorder. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed Resident #48 was cognitively intact. The resident was noted as having weight gain. Review of the plan of care revised 08/15/24 revealed Resident #48 was at risk for decline in nutrition/hydration status related to diagnoses, weight loss, and inadequate nutrition. The resident had weight gain over the past month, likely related to fluid retention, and also reported increased intakes while at the hospital. Interventions…

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 interview, and staff interview, the facility failed to provide a clean, comfortable, and homelike environment. This affected one (Resident #19) of one resident observed for room cleanliness. The facility census was 85. Findings include: Review of the medical record for Resident #19 revealed an admission date of 04/11/24, with diagnoses that include cerebral infarction, hyperlipidemia, type two diabetes (DM2), bipolar disorder, nutritional deficiency, hypertension (HTN), seborrheic dermatitis, unspecified intellectual disabilities, personal history of COVID-19, tinea unguium. Review of the most recent quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of eight, indicating the resident was moderately cognitively impaired. Observation on 09/16/24 at 3:14 P.M. of the restroom sink in Resident #19's restroom revealed it contained a brown liquid that filled to approximately four inches from the top of the sink, and was 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 medical record review, staff interview, review of facility Self-Reported Incidents (SRIs), and review of the facility policy, the facility failed to report an allegation of verbal abuse to the state agency in a timely manner. This affected three (Resident #9, #42, and #54) of three residents reviewed for abuse. The facility census was 85. Findings include: 1. Review of the medical record revealed Resident #9 was admitted to the facility on [DATE]. Diagnoses included schizophrenia, depression, anxiety, bipolar disorder, and muscle weakness. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed the resident was cognitively impaired. The resident required substantial/maximal assistance from staff for a majority of the activities of daily living. Review of the medical record revealed no evidence regarding an allegation of abuse. 2. Review of the medical record revealed Resident #42 was admitted to the facility on [DATE]. Diagnoses included cardiomyopathy, depression, hypertension, 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, observation, resident interview, and staff interview, the facility failed to ensure admission orders were obtained to provide care and treatment to a resident with a surgical incision. This affected one (#178) of one resident identified with a surgical incision. The facility census was 85. Findings include: Review of the medical record revealed Resident #178 was admitted to the facility on [DATE]. Diagnoses included occlusion and stenosis of left carotid artery, anesthesia of skin, paresthesia of skin, polyneuropathy, hyperlipidemia, and depression. Review of the hospital record dated 09/13/24 revealed Resident #178 was discharged with the recommendation to wash the surgical incision twice daily with soap and water. Review of the admission assessment dated [DATE] revealed Resident #178 was cognitively intact and utilized a walker for ambulation. The resident had a 6.5 centimeter surgical incision on his neck. Observation on 09/16/24 at 10:01 A.M. revealed Resident #178 had several…

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, review of facility policy, staff interview, and resident interview, the facility failed to provide grooming services for a resident. This affected one resident (Resident #20) of three residents observed for ADLs. The facility census was 85. Findings include: Review of the medical record for Resident #20 revealed an admission date of 10/22/24 with diagnoses of polyosteoarthritis, acute respiratory failure, type two diabetes, asthma, pulmonary embolism, metabolic encephalopathy, schizoaffective disorder, stage four chronic kidney disease, major depressive disorder, nutritional deficiency, anxiety, bipolar disorder, hypothyroidism, restless osteoarthritis, and hypertension. Review of the most recent annual Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of seven, indicating Resident #20 was severely cognitively impaired. Review of the MDS revealed that Resident #20 required substantial or maximal assistance 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 assist with vision services in a timely manner. This affected two (#32, #46) of two residents reviewed for vision services. The facility census was 85. Findings include: 1. Review of the medical record for Resident #32 revealed an admission date of 03/18/24. Diagnoses included dementia, epilepsy, anxiety and atrial fibrillation. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had adequate vision with no corrective lenses. Review of the medical record revealed no documentation Resident #32 had seen the provider for vision services. Review of a Request for Service form dated 06/13/24 revealed the resident had requested dental, eye care, and podiatry services. Review of facility documentation revealed the eye physician was last in the facility on 09/16/24. Interview on 09/16/24 at 10:55 A.M., Resident #32 stated since his admission, he had told many staff members he needed to see 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 medical record review, observation, resident interview, and staff interview, the facility failed to ensure dietary supplements were administered per the physician's order. This affected one (#48) of three residents reviewed for nutrition. The facility census was 85. Findings include: Review of the medical record revealed Resident #48 was initially admitted to the facility on [DATE]. Diagnoses included severe protein-calorie malnutrition, nutritional deficiency, heart disease, heart failure, weakness, anxiety, depression, and bipolar disorder. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed Resident #48 was cognitively intact. Review of the plan of care revised 08/15/24 revealed Resident #48 was at risk for decline in nutrition/hydration status related to diagnoses, weight loss, and inadequate nutrition. The resident had weight gain over the past month, was likely related to fluid retention, and also reported increased intakes while at the hospital. Interventions included…

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 medical record, review of physician orders, review of medication administration records, staff interview, and policy review, the facility failed to ensure medications were administered per physician orders. This affected one (#77) of six residents reviewed for medications. The facility census was 85. Findings include Review of the medical record for Resident #77 revealed an admission date of 09/09/24. Diagnoses included fracture of the left femur, type two diabetes mellitus, bipolar disorder, and epilepsy. Review of a physician order dated 09/10/24 revealed the resident was ordered lactulose oral solution 10 grams/15 milliliters (ml), give 45 ml by mouth three times a day for chronic hepatic failure. Review of the Medication Administration Record (MAR) from 09/09/24 through 09/19/24 revealed the resident had not received two doses of the lactulose per physician orders on 09/12/24 and had not received one dose on 09/13/24. Review of the medication orders administration note dated 09/12/24 at 12:30 P.M. revealed the lactulose medication not available 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, medical record review, staff interview, and policy review, the facility failed to ensure medications were administered in accordance with physician orders resulting in a medication error rate of five percent. 37 medications were observed with two medication errors, resulting in a medication error rate of five percent. This affected one (#17) of two residents reviewed for medication administration. The facility census was 85. Findings include Review of the medical record for Resident #17 revealed an admission date of 07/17/24. Diagnoses included malignant neoplasm of breast, type two diabetes mellitus, chronic obstructive pulmonary disease, and chronic kidney disease. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition. Review of the physician order dated 07/18/24 revealed orders for fluticasone propionate suspension 50 micrograms/actuation (mcg/act), one spray in each nostril in the morning for allergic rhinitis. Review of a…

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

Based on observation, facility policy review, and staff interview, the facility failed to utilize proper Personal Protective Equipment (PPE) for a resident positive for COVID-19. This affected one (Resident #4) of one resident observed for COVID-19 precautions. The facility census was 85. Findings include: Review of the medical record for Resident #4 revealed an admission date of 12/26/24 with diagnoses that include Alzheimer's disease, chronic obstructive pulmonary disease (COPD), pseudo-bulbar affect (PBA), type two diabetes (DM2), anxiety disorder, rheumatoid arthritis, osteoarthritis, hypertension, atherosclerotic heart disease, major depressive disorder, and hyperlipidemia. Observation on 09/16/24 at 10:41 A.M. revealed a COVID-19 isolation cart present outside of the room of Resident #4. Resident #4 was positive for COVID-19. The door to Resident #4's room was open. Further observation of State Tested Nursing Assistant (STNA) #503 revealed she doffed her gown and gloves in Resident #4's room exited the room wearing the surgical mask that she wore while in Resident #4's room.…

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 facility electronic medical record, staff interview, and review of facility policy, the facility failed to residents were educated on and received the COVID-19 vaccination. This affected two residents (Resident #332 and Resident #46) of five residents reviewed. The facility census was 85. Findings include: 1. Review of the medical record for Resident #32 revealed an admission date of 03/18/24. Review of the most recent Minimum Data Set (MDS) assessment revealed a Brief Interview for Mental Status (BIMS) score of 13, indicating Resident #32 was cognitively intact. Further review of the medical record revealed no documentation of education of administration or refusal of the COVID-19 vaccination. Interview on 09/19/24 at 3:09 P.M. with Registered Nurse (RN) #484 revealed the facility had no documented of education of administration or refusal of the COVID-19 vaccine for Resident #32. 2. Review of the medical record for Resident #46 revealed an admission date of 03/01/24. Review of the most…

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

Based on observation, staff interview, and review of facility policies, the facility failed to manage soiled and clean linen to potentially prevent cross-contamination. This had the potential to affect 54 of 54 residents who utilized laundry services at the facility. The facility census was 54. Findings included: Observation on 04/27/22 at 7:35 A.M., of the laundry area revealed laundry was located in the basement of the facility. There was one room for folding and hanging clean linen and a separate room where the washers and dryers were located. Interview on 04/27/22 at 7:38 A.M., of Housekeeper (HK) #581 revealed all laundry was transported down the stairway to the laundry rooms. Soiled linens were placed into the washers, dried, and then transported into a separate room to be folded. HK #581 stated since the facility did not have an elevator, staff had to carry armfuls of clean linen up the stairs to place on carts for delivery to resident care areas. Observation on 04/27/22 at 8:36 A.M., of laundry delivery revealed HK #725 pick up a stack of clean towels and hold them against…

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 and resident interviews, and policy review, the facility failed to allow residents to make their own choices related to food options at meals. This affected five (#14, #28, #31, #40 and #45) of five residents interviewed and expressed concerns over the lack of food choices being offered. The census was 54. Findings include: 1. Review of the medical record for Resident #14 revealed an admission date of 06/29/17, with diagnoses including: nutritional deficiency, chronic heart failure, and a history of COVID-19. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 was cognitively intact. Interview on 04/25/22 at 7:33 P.M.,with Resident #14 stated in the past, dietary aides came to the resident's rooms to offer meal options, but they no longer offered those options. Interview on 04/26/22 at 2:33 P.M., with Dietary Manager #747 verified dietary aides used to bring the menu of alternate options around to residents but due to the COVID-19 pandemic…

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 resident trust account balances, review of the surety bond, and staff interview, the facility failed to ensure the surety bond was sufficient to cover the total of resident trust accounts held at the facility. This affected 30 (#1, #3, #4, #6, #7, #8, #10, #13, #14, #16, #17, #18, #20, #21, #22, #23, #25, #28, #29, #30, #31, #35, #38, #40, #43, #44, #45, #48, and #49) of 30 residents identified by the facility as having a resident trust account. The facility census was 54. Findings included: Review of the resident trust account balances, dated 04/25/22, revealed the total of resident trust accounts, including the assisted living facility, totaled $51,050.65. Thirty (#1, #3, #4, #6, #7, #8, #10, #13, #14, #16, #17, #18, #20, #21, #22, #23, #25, #28, #29, #30, #31, #35, #38, #40, #43, #44, #45, #48, and #49) facility residents were listed as having money in the resident trust account. Review of the surety bond, dated 06/16/20, revealed coverage in the amount of $50,000.00. Interview on 04/28/22 at 10:43 A.M., with the Business Office Manager (BOM) #550 verified…

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 review of a wheelchair cleaning schedule, the facility failed to ensure wheelchairs were maintained in a safe and comfortable manner. This affected one (#16) of three reviewed for environmental concerns. The facility identified 36 residents who utilized wheelchairs. The census was 54. Findings include: Review of Resident #16's medical record revealed an admission date of 05/09/19. Diagnoses included chronic obstructive pulmonary disease, acute kidney failure, rhabdomyolysis, congestive heart failure, and altered mental status. Review of the most recently completed Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 was assessed with moderately impaired cognition. Observation on 04/25/22 at 8:37 P.M., revealed Resident #16 was laying awake in bed, with his wheelchair located at the foot of the bed. Further observation of the wheelchair revealed the right arm rest was torn with foam padding exposed and hanging out 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, staff interview, and review of facility policy, the facility failed to complete a significant change in status assessment. This affected one (#29) of 17 residents reviewed for assessments. The facility census was 54. Findings included: Review of the medical record for Resident #29 revealed an admission date of 03/12/18 and a readmission date of 02/11/22. Diagnoses included metabolic encephalopathy, protein calorie malnutrition, acute kidney failure, acute cystitis with hematuria, atrial fibrillation, morbid obesity, personal history of COVID-19, major depressive disorder, brief psychotic disorder, hypertension, [NAME] fever, malignant neoplasm of left breast, and malignant neoplasm of right breast. Review of the Medicare 5-Day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #29 was moderately cognitively impaired and required extensive two person assistance with transfers, dressing, toilet use. Additional review revealed a significant change in condition…

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 review of policy, the facility failed to revise resident's comprehensive care plans to accurately reflect services provided. This affected two (#29 and #26) of 17 residents reviewed for care plans. Findings included: 1. Review of the medical record for Resident #29 revealed an admission date of 03/12/18 and a readmission date of 02/11/22. Diagnoses included metabolic encephalopathy, protein calorie malnutrition, acute kidney failure, acute cystitis with hematuria, atrial fibrillation, morbid obesity, personal history of COVID-19, major depressive disorder, brief psychotic disorder, hypertension, [NAME] fever, malignant neoplasm of left breast, and malignant neoplasm of right breast. Review of the Medicare 5-Day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #29 was moderately cognitively impaired and required extensive two-person assistance with transfers, dressing, toilet use. Additional review revealed a significant change in condition…

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, family and staff interviews, and review of policy, the facility failed to provide nail care to residents dependent for care. This affected one (#35) of 17 residents reviewed for activities of daily living. The facility census was 54. Finidngs include: Review of the medical record for Resident #35 revealed an admission date of 12/17/15. Diagnoses included dementia, heart failure, acute respiratory failure, chronic obstructive pulmonary disease (COPD), kidney disease, schizoaffective disorder, heart disease, anxiety disorder, bipolar disorder, and major depressive disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #35 was moderately cognitively impaired and required extensive assistance with personal hygiene. Review of the plan of care, initiated 12/24/15, revealed Resident #35 required supervision up to extensive assistance, with activities of daily living (ADLs) related to depression, muscle weakness, dementia, 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.

Based on record review, observation, resident interview, staff interview, and review of job description, the facility failed to ensure clothing other than hospital gowns were obtained for daily wear for one (#140) out of one resident reviewed for choices. The facility census was 49. Findings include: Review of the medical record of Resident #140 revealed an admission date of 05/09/19. Diagnoses included systolic and diastolic heart failure, altered mental status, hypertension, and benign lipomatous neoplasm of skin and subcutaneous tissue of unspecified limb. Review of the admission Minimum Data Set assessment, dated 05/16/19, revealed Resident #140 had severe cognition impairment and it was very important to the resident to choose what clothes to wear. Random observations on 05/28/19, 05/29/19, and 05/30/19 revealed Resident #140 to be dressed in a hospital type gown and seated in a wheelchair or in his bed. Interview on 05/30/19 at 9:26 A.M., Resident #140 revealed he would like to have clothes to wear but has none. He denies anyone talking with him regarding clothes. He admits he…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, resident interview, staff interview, and facility policy review, the facility failed to ensure the call light was within reach for two (#34 and #4) of 42 residents identified by the facility to utilize call lights. The facility census was 49. Findings include: 1. Resident #34 was admitted to the facility on [DATE] with diagnoses including congestive heart failure, psychosis, anxiety disorder, hypertension, and morbid obesity. Review of the significant change in status Minimum Data Set (MDS) assessment, dated 05/06/19, revealed the resident had no cognitive deficits and was dependent on one staff member for bed mobility, transfers, and toileting. Review of the plan of care dated 05/01/19 noted the resident was incontinent of bowel and bladder. The interventions included to ask and encourage the resident to utilize the call light system to report the need to use the bathroom. Observation and interview on 05/28/19 at 11:01 A.M., Resident #34 asked the surveyor to get…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and staff interview, the facility failed to provide residents and their representative(s) with written notice of the reason for the discharge to three (#37, #39 and #28) of three residents reviewed for hospitalization. The facility census was 49. Finding include: 1. Review of the medical record revealed Resident #37 was admitted to the facility on [DATE]. Diagnoses included multiple sclerosis, peripheral vascular disease, neurogenic bladder, flexion contracture of left lower leg, and amputation right lower leg. Review of the medical record revealed the resident was admitted to the hospital on [DATE] for an infection. She returned to the facility on [DATE]. There was no evidence in the resident's medical record indicating the resident and her representative were provided a written reason for the transfer to the hospital. Interview with Social Service Director (SSD) #220 on 05/28/19 at 2:00 P.M. she verified she did not give Resident #37 or her representative a written statement for…

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

Based on record review, resident interview, staff interview and review of the care conference documentation, the facility failed to hold care conferences with resident input for one (#2) out of three residents reviewed for care plan participation. The facility census was 49. Findings include: Review of the medical record of Resident #2 revealed an admission date of 08/13/18. Diagnoses included chronic obstructive pulmonary disease, iron deficiency anemia, diabetes mellitus, major depression and chronic pulmonary edema. Review of the quarterly Minimum Data Set assessment, dated 02/20/19, revealed Resident #2 to have no cognitive deficit. Interview on 05/28/19 at 11:10 A.M., Resident #2 revealed she has not been invited nor has she attended a care plan conference since admission here. Review of the Care Plan Conference form for Resident #2, dated 03/28/19, revealed it to be blank except for the signatures on the last page. This was verified by the Director of Nursing at the time of review on 05/29/17 at 12:18 P.M. Interview on 05/29/19 at 2:35 P.M., Social Service Director (SSD) #220…

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 interview, staff interview, and facility policy review, the facility failed to address the use of signage to inform the public of a communicable disease requiring isolation and failed to provide signage for isolation for one resident (#19) of one resident reviewed for isolation. The facility identified one resident in the facility in isolation. The facility census was 49. Findings include: Review of the medical record revealed Resident #19 was admitted to the facility on [DATE]. Diagnoses included intellectual disabilities, depression, schizoaffective disorder, neuromuscular dysfunction of the bladder, a history of Methicillin Resistant Staphylococcus Aureus (MRSA) infection, hypertension and anxiety. Review of the physician order dated 05/16/19 revealed an order for a urinalysis with a culture and sensitivity (UA C&S) due to blood tinged sediment noted in his urine. On 05/16/19 the antibiotic Macrobid 100 milligrams (mg) twice daily for ten days was ordered…

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.