Claymont Health And Rehabilitation

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, interview and facility policy review the facility failed to provide appropriate indwelling urinary catheter care. This deficient practice affected one resident (Resident #14) of two residents reviewed for indwelling urinary catheter. The facility census was 51.Findings Include: Review of Resident #14's medical record revealed an admission date 05/02/25 with diagnoses including but not limited to stoke, epilepsy, neuromuscular dysfunction of the bladder, and major depression.Review of Resident #14's alteration in elimination care plan dated 05/05/25 revealed foley (indwelling urinary) catheter care every shift.Review of Resident #14's physician orders revealed an order dated 05/06/25 for catheter care every shift for maintenance and an order dated 10/01/25 for a 22 French/30 milliliters (ML) Indwelling Catheter to closed drainage system every shift related to neuromuscular dysfunction of bladderReview of Resident #14's quarterly Minimum Data Set (MDS) dated [DATE]…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, interview, and policy review, the facility failed to ensure incontinence barrier cream was applied as ordered. This affected one resident (#17) out of four residents (#3, #10, #17, and #32) reviewed for incontinence care. The facility census was 52. Findings Include: Review of the medical record for Resident #17 revealed an admission date of 01/13/25. Diagnoses included major depression disorder, dementia, chronic obstructive pulmonary disease (COPD), and dysphagia. Review of Resident #17's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was frequently incontinent of bladder and occasionally incontinent of bowel. Review of Resident #17's clinical care assessment dated [DATE] revealed the resident needed partial to moderate assistance with toileting.Review of Resident #17's December 2025 physicians orders revealed an order initiated on 01/13/25 to apply house moisture barrier ointment to perineum area/buttocks/coccyx after (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 observation, medical record review, interview, and policy review, the facility failed to ensure Resident #17 was provided adequate assistance after an incontinent episode, and facility staff maintained proper infection control techniques while providing the care. This affected one resident (#17) out of four residents (#3, #10, #17, and #32) reviewed for incontinence care. The facility census was 52. Findings Include: Review of the medical record for Resident #17 revealed an admission date of 01/13/25. Diagnoses included major depression disorder, dementia, chronic obstructive pulmonary disease (COPD), and dysphagia. Review of Resident #17's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was frequently incontinent of bladder and occasionally incontinent of bowel. Review of Resident #17's clinical care assessment dated [DATE] revealed the resident needed partial to moderate assistance with toileting.Observation on 12/23/25 at 5:24 A.M. revealed Certified Nursing Assistant…

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, facility policy review, and interviews, the facility failed to date and label food items removed from the original packaging in the kitchen freezer, failed to date and remove expired food items from the resident's nourishment room refrigerator, and failed to have clean air returns and heater vents in the ceiling of the kitchen. This deficient practice had the potential to affect all residents residing in the facility and affected one resident (#38) having food items stored in the nourishment room refrigerator. The facility's census was 47. Findings Include: 1. Observation on 12/02/24 from 8:15 A.M. to 8:35 A.M. revealed in the kitchen freezer a small personal pizza in an undated zip lock bag on the top shelf of the freezer. Further observation revealed an undated large zip lock bag which contained ten frozen hot dogs located on the third shelf of the freezer. Interview on 12/02/24 at 8:40 A.M. with Dietary Manager #132 confirmed the undated zip lock bag containing the small personal pizza and the undated zip lock bag containing ten hot dogs.…

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, interview, and policy review, the facility failed to ensure residents with chronic wounds (pressure ulcers) were placed under enhanced barrier precautions (EBP) and failed to ensure personal protective equipment (PPE) was available on the 300 Hall. This affected three residents (#19, #38 and #44) and had the potential to affect an additional 27 residents who resided on the same halls as the affected residents. Findings included: 1. Medical record review revealed Resident #19 was admitted to the facility on [DATE] with diagnoses including fracture of left humerus, severe protein-calorie malnutrition, heart disease, chronic kidney disease, anemia, need for assistance with personal care, cirrhosis, and diabetes. Review of Resident #19's admission skin assessment dated [DATE] revealed the resident had an unstageable pressure ulcer (full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it was obscured by…

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, interview, and policy review the facility failed to identify and timely investigate bruises of unknown origin and failed to ensure communication occurred with hospice services regarding medications not being administered per orders. This affected one (Resident #46) of one residents reviewed for hospice. Findings included: Medial record review revealed Resident #46 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, anxiety disorder, malignant neoplasm of female breast, osteoarthritis, insomnia, and major depressive disorder. Review of Resident #46's current orders dated 12/2024 revealed no evidence of orders for hospice. Review of Resident #46's Minimum Data Set (MDS) dated [DATE] revealed the resident was on hospice services and had severe cognition impairment. The resident was dependent for all activities of daily living (ADL) care and substantial/maximal assistance with rolling left to right (in bed), sit to lying, lying to sitting.…

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 and staff interview, the facility failed to ensure restorative nursing services were provided as indicated. This affected one (Resident #5) of one residents reviewed for restorative nursing services. The facility census was 47. Findings include: Review of Resident #5's medical record revealed an admission date of 01/08/21 with diagnoses that included cerebrovascular accident, chronic obstructive pulmonary disease and diabetes mellitus. Further review of the medical record revealed physician's orders from 02/27/24 to 10/31/24 which indicated the resident is recommended to wear a left hand splint as tolerated to decrease risk of worsening contracture, requires assistance to don (apply), monitor for skin irritation and encourage Passive Range of Motion (PROM) to left upper extremity (LUE) prior to donning and post doffing (removing) due to limited Range of Motion (ROM) and tone. An additional physician's orders from 12/14/23 to 01/15/24 also indicated the use of a soft rolled hand splint with digit separators to the left hand/forearm for up…

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, policy review and interview, the facility failed to ensure nebulizer masks and tubing were disposed during weekly oxygen and breathing treatment supply change. The deficient practice affected two residents (#35 and #26) of three residents reviewed for respiratory care. The facility census was 47. Findings include: 1. Review of medical record for Resident #35 reveals an admission date of 06/14/23. Diagnoses include Type two diabetes mellitus, intellectual disabilities, chronic obstructive pulmonary disease (COPD), atrial fibrillation, essential hypertension, anxiety disorder, major depressive disorder and seizures. Review of the most recent Minimum Data Set (MDS) 3.0 reveals a Brief Interview for Mental Status (BIMS) of 9 out of 15 indicating cognitive impairment. The resident was assessed to require assistance and is dependent for all Activities of Daily Living (ADL's). Review of the plan of care dated 11/26/24 reveals the interventions: respiratory assessments, nebulizer treatments, Medications as ordered, monitor for s/s of distress & report 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 record review and interviews, the facility failed to ensure resident assessments were accurately completed. This affected two (Residents #6 and #48) of four residents reviewed for Minimum Data Set (MDS) 3.0 assessments recorded for pain. Findings include: 1. Review of the medical record for Resident #6 revealed an admission date of 09/06/22 with diagnoses including diabetes mellitus and pain in the right shoulder. Review of the pain assessment dated [DATE] revealed Resident #6 had pain in the previous five days to her lower extremities rating it as a six on a scale of zero to ten. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #6 had intact cognition. Review of section J revealed the question, should staff attempt to conduct an interview with the resident, was marked yes. However, the pain assessment interview was answered not assessed. The assessment was signed by Licensed Practical Nurse (LPN) #821, dated 12/10/22. Interview on 02/07/23 at 10:40 A.M. with LPN #821 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.

Based on observations, interviews, and record review, the facility failed to obtain a physician order for oxygen administrations and to document weekly oxygen tubing changes for Resident #24. This affected one resident (Resident #24) of two residents reviewed for oxygen administration. The facility census was 48. Findings include: Review of medical records for Resident #24 revealed an admission date of 08/21/20 and diagnosis of malignant neoplasm (cancer) of the bronchus or lung, chronic obstructive pulmonary disease (COPD), and acute bronchitis. Review of the physician's orders for February 2023 revealed Resident #24 did not have an order for oxygen administration or for nursing staff to change her nasal cannula and oxygen tubing once a week. Nursing progress dated 02/01/23 at 09:14 P.M. written by Registered Nurse (RN) #845 revealed resident's respirations were easy and non-labored on oxygen at two liters via nasal cannula. Observation and interview on 02/06/23 at 11:33 A.M. with Resident #24 revealed she was on oxygen via nasal cannula all the time except when going out to smoke.…

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 food was properly covered and dated, and failed to ensure staff delivered residents' trays in a sanitary manner. This had the potential to affect 42 of 42 residents on a regular diet, and four (Residents #1, #6, #10 and #34) of 20 residents residing on the 300 hall that were observed during the lunch meal service. Findings include: 1. Observation of the kitchen on 02/06/23 at 8:15 A.M. with the Dietary Manager (DM) revealed, in the refrigerator, 19 cups of fruit cocktail and 19 cups of gelatin with fruit, all uncovered, undated, and open to air. Interview on 02/06/23 at 8:20 A.M., the DM confirmed the food was not properly covered and dated. Review of the facility policy, Food Storage-Labeling and Dating, dated July 2018, revealed all foods should be securely closed to avoid being exposed to the air. 2. During observation of the lunch tray delivery on 02/06/23 at 12:43 P.M., Registered Nurse (RN) #32 did not perform hand hygiene before or after providing tray delivery and set-up assistance to two…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews and record review, the facility failed to implement proper infection control policies and procedures to ensure staff followed contact isolation precautions (wearing gown and gloves) and having trash and linen barrels available for Resident #19. This affected one (Resident #19) of two resident reviewed for contact isolation. The facility census was 48. Findings include: Review of the medical record for Resident #19 revealed he was admitted on [DATE] with diagnoses including hypertension and dementia. He was diagnosed on [DATE] with Clostridium Difficile (a contagious bacteria that causes diarrhea and inflammation of the colon). Review of the physician's orders dated 02/01/23 revealed Resident #19 was on contact precautions for Clostridium Difficile until 02/15/23. Observation on 02/06/23 at 11:25 A.M. of Resident #19 with State Tested Nurse Aide (STNA) #835 revealed he was on contact precautions. The sign stated everyone must clean their hands before entering and leaving 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.