Rae Ann Suburban

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident and resident representative interview, staff interviews, and facility policy review, the facility failed to ensure requests for medical records were honored in a timely manner. This affected one (#78) of one residents reviewed for medical record requests. The facility census was 79. Findings include: Review of the medical record for Resident #78 revealed she was admitted to the facility on [DATE] with diagnoses that included encephalopathy, mesothelioma, and type II diabetes. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #78 had a Brief Interview for Mental Status (BIMS) score of six that indicated the resident was cognitively impaired. Review of the MDS assessment revealed Resident #78 required some assistance from staff for activities of daily living (ADLs). Review of the progress note dated 05/28/25 at 12:31 P.M. revealed Registered Nurse (RN) #746 discussed with Resident #78 and Resident #78's sister a request for medical records.…

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

Based on record review and staff interview, the facility failed to ensure Notice of Medicare Non-Coverage (NOMNC) documents contained all required information. This affected three (#12, #75, and #139) of three residents reviewed for beneficiary notices. The facility census was 79. Findings Include: 1. Review of Resident #12's NOMNC form for services ending 02/26/25, and signed 02/21/25, revealed the notice contained no specific information about what services would be discontinued. 2. Review of Resident #75's NOMNC form for services ending 02/17/25, and acknowledge by the resident's family via telephone on 02/13/25, revealed the notice contained no specific information about what services would be discontinued. The area on the form that discussed which services would be discontinued was blank. 3. Review of Resident #139's NOMNC form for services ending 04/08/25, and signed 04/06/25, revealed the notice contained no specific information about what services would be discontinued. The area on the form that discussed which services would be discontinued was blank. Social Service…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident and staff interview, and Ombudsman interview, the facility failed to facilitate an orderly discharge when necessary medical supplies were not provided timely to a resident upon discharge. This affected one (#136) of four residents reviewed for discharges. The facility census was 79. Findings include: Review of the medical record for Resident #136 revealed an admission date of 01/31/25. The resident was discharged home on [DATE]. Diagnoses included acute respiratory failure with hypoxia, pneumonia, morbid obesity, and chronic obstructive pulmonary disease. Review of the Minimum Data Set (MDS) assessment, dated 03/24/25, revealed Resident #136 had intact cognition. Review of the physician order dated 03/17/25 revealed an order for oxygen at one to six liters via nasal cannula for the resident to maintain an oxygen saturation rate greater than or equal to 92 percent (%) every six hours as needed for cough, shortness of breath, wheezing, or resident request. Review of the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, staff interview, and facility policy review, the facility failed to ensure residents were provided with appropriate incontinence and perineal care. This affected one (#4) of two residents reviewed for bowel and bladder. The facility census was 79. Findings included: Review of the medical record for Resident #4 revealed an admission date of 03/19/25. Diagnoses included chronic obstructive pulmonary disease, pain in the right hip, and repeated falls. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #4 had intact cognition. Review of the bladder and bowel section revealed Resident #4 was always incontinent of bladder and bowel. Review of the care plan dated 04/03/25 revealed Resident #4 had self-care performance deficits with an intervention to assistance with toileting. Observation on 06/05/25 at 9:29 A.M. of perineal care for Resident #4 revealed Certified Nurse Aide (CNA) #703 gathered supplies, knocked on the door, provided…

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 facility policy review, the facility failed to ensure the complete physician-ordered treatment was applied to Resident #20's sacral pressure ulcer. This affected one (Resident # 20) of three residents reviewed for wound care. The facility census was 87. Findings include: Review of the medical record for Resident #20 revealed an admission date of 07/19/24 with diagnoses including iron deficiency anemia, obesity, surgical wound, atrial fibrillation, rheumatoid arthritis, pressure ulcer of sacral region, surgical aftercare following surgery on the digestive system. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #20 had intact cognition and had moderate depression. The resident was dependent on staff for activities of daily living. Review of the January 2025 physician's orders revealed Resident #20's had an order dated 12/02/24 for a wound dressing for a sacral pressure ulcer. The order called for the wound 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.

Based on observation, staff interview and policy review, the facility failed to ensure its kitchen area was maintained in a clean and sanitary condition. This had the potential to affect all residents. The facility census was 90. Findings include: Observation of the kitchen area on 12/15/24 between 7:30 A.M. and 8:00 A.M. with Dietary Aides (DA) #600 and #601 revealed the following that was verified at the time of discovery; - A large puddle of water was noted in the facility's dishwasher area. DA #600 explained that a drain to the dishwasher had not been working for some time. DA #600 estimated months and thus created a pool of water in the area. - The sanitizer bucket underneath the dishwasher was open and had a swarm of fruit flies around the lid of the bucket. - A package of bacon was observed to be defrosting in the warming area underneath the steam table. The bacon was noted to be lying in a pool of water on the steam table that was yellow in color and had many noticeable food particles floating in the water. - The left side door of the facility's convection oven 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 record review and interview the facility failed to ensure Resident #65's concern was addressed promptly. This affected one resident (#65) of three residents reviewed for grievances. The facility census was 87. Findings Include: Review of the medical record for Resident #65 revealed an admittance date of 06/29/20. Diagnoses included dementia, depressive disorder, bipolar, psychosis, schizoaffective disorder, alcohol abuse. Review of the concern log form dated 03/11/24 through 10/30/24 revealed no identified concerns for Resident #65. Review of the email correspondences dated 10/10/24 at 10:49 A.M. through 10/29/24 at 10:59 A.M. between Resident #65's sister, Resident #65's Power of Attorney (POA), the Director of Nursing (DON), Administrator, and the ombudsmen revealed Resident #65's sister emailed the above recipients regarding concerns that occurred on 10/05/24 when Resident #14 threw a dish towards Resident #65 and on 10/08/24 when Resident #14 pulled Resident #65's private caregiver's hair. The email stated Resident #65's sister and Resident #65's POA would be available…

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 follow physician orders to obtain a urinalysis with culture and sensitivity testing as ordered. This affected one (#2) of three residents reviewed for a change in condition. The census was 87. Findings include: Review of the medical record revealed Resident #2 was admitted to the facility on [DATE]. The resident was discharged from the facility on 06/17/24. Diagnoses included retention of urine, muscle weakness, and lack of coordination. Review of the admission Minimum Data Set assessment dated [DATE] revealed Resident #2 was cognitively intact and had an indwelling catheter. Review of the plan of care dated 06/04/24 revealed Resident #2 had a urinary catheter with an intervention to monitor, record, and report signs and/or symptoms of a urinary tract infection (UTI). Review of the nursing progress notes dated 06/14/24 and timed 4:10 P.M., revealed Resident #2 reported pain when he felt like he needed to urinate. The resident's urinary…

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, self-reported incident (SRI) review and policy review, the facility failed to ensure Resident #28's allegation of misappropriation was reported within 24 hours to the State agency as required. This finding affected one resident (#28) of two residents reviewed for misappropriation. Findings include: Review of a Misappropriation SRI (tracking #245238) dated 03/15/24 indicated Resident #28 went to the activity director and reported Resident #80 had taken pills from his bag a few days ago. The investigation was ongoing. Review of Resident #28's medical record revealed the resident was admitted on [DATE] with diagnoses including unspecified fracture of the left femur, encounter for other orthopedic aftercare, and unspecified cirrhosis of the liver. Review of Resident #28's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition. Review of Resident #80's medical record revealed the resident was admitted on [DATE] with diagnoses including…

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 #73's legionella testing was completed as ordered. This finding affected one resident (#73) of five resident records reviewed for infection control. Findings include: Review of Resident #73's open medical record revealed the resident was admitted on [DATE] with diagnoses including chronic atrial fibrillation, malignant neoplasm of the prostate, and muscle weakness. Review of Resident #73's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment. Review of Resident #73's chest x-ray single view dated 02/22/24 revealed the cardiac silhouette and mediastinal contours were normal. Patchy densities were noted involving the bilateral perihilar regions. Mild prominence of the pulmonary vasculature was identified. No pleural fluid or masses were noted. No pneumothorax was present. Impression was bilateral perihilar atelectasis/infiltrate and a follow up was recommended to document…

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 narcotic medications were removed from circulation when discontinued and accounted appropriately, resulting in one unaccounted oxycodone pill for Resident #94. This affected one resident (#94) of three residents reviewed for controlled medication administration. The facility census was 93. Findings Include: Record review of Resident #94 revealed the resident was admitted on [DATE] and discharged on 02/09/24. Diagnoses included atrial fibrillation, Crohn's disease, and anxiety disorder. The most recent order for oxycodone (a narcotic pain medication) was discontinued on 12/25/23. Review of the medication administration record revealed no evidence the medication was given after this date. Review of the facility investigation documentation revealed a photograph of a medication card including one rectangular pill in the pouch labeled '17'. The pills in all other visible pouches were round. No identifiers were visible in 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, record review, review of facility policy, review of Centers for Disease Control and Prevention guidance, and review of the facility COVID-19 Line List, the facility failed to maintain and implement an effective infection prevention and control program to prevent the development and transmission of COVID-19, including measures to ensure the COVID-19 Line List was completed accurately, proper Personal Protective Equipment (PPE) was worn by staff when entering COVID-19 positive rooms, accurate COVID-19 isolation orders were in place for all COVID-19 positive residents, and responsible parties were notified when their roommates tested positive for COVID-19. This had the potential to affect all 83 residents residing in the facility. The census was 83. Findings include: Review of the facility COVID-19 Line List from 11/16/23 through 11/30/23 revealed 30 residents (Resident's #2, #6, #10, #13, #15, #16, #18, #24, #25, #33, #34, #35, #37, #38, #40, #43, #44, #47, #51, #54, #60, #63, #64,…

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 report an allegation of misappropriation for Resident #86. This affected one resident (#86) of three residents reviewed for reporting of abuse or misappropriation. The census was 83. Findings include: Review of the medical record for Resident #83 revealed an admisison date of 06/16/23 and a discharge date of 08/09/23. Diagnoses included automatice dysreflexia, quadriplegia c1-c4 incomplete and neuromuscular dysfunction of bladder. Reivew of medical record revealed no inventory list of personal belongings. Interview on 10/31/23 at 3:32 P.M. with Administrator and Director of Rehab/Administrator in Training (DOR/AIT) #240 revealed they did not report misappropriation when Resident # 86 stated he was missing items after he had been discharged to the the hospital then subsequently another facility. They stated he did not accuse the facility of stealing the items plus he was already discharged therefore they did not believe it was necessary to make 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 observation, record review, and interview, the facility failed to ensure residents received wound care for a vascular sore according to the physician order for wound care. This affected one resident (Resident #43) of three residents reviewed for wound care. The facility census was 83. Findings include: Record review of Resident #43 revealed he was admitted to the facility on [DATE] and had diagnoses including cellulitis, diabetes, morbid obesity, and peripheral vascular disease. He had active orders dated 11/01/23 for dressing changes to both legs to include cleansing with soap and water followed by application of calcium alginate, super absorbent dressing, kerlix, and unna boot (a type of gauze dressing) to be done three times per week. His last wound assessment on 11/01/23 identified him as having a right leg vascular wound measuring 4.0 centimeters (cm) by 2.5 cm, and a left leg vascular wound measuring 11.0 cm by 3.0 cm. The assessment called for both sites to be cleaned with normal saline then…

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 interviews, record reviews and observation the facility failed to ensure Resident #73 wore a smoking apron while smoking. This affected one resident (#73) of three residents reviewed for smoking. The facility census was 83. Findings include: Review of the medical record for Resident #73 revealed an admission date of 09/01/23. Diganoses included Huntington's Disease, dementia and post-traumatic stress syndrome. Review of the Minimum Date Set (MDS) assessment dated [DATE] revealed cognitive status was not assessed at that time. She required extensive assistance for all of her activities of daily living. Review of the smoking assessment dated [DATE] revealed she should have one on one assistance and to wear an apron. Review of the care plan dated 09/05/23 revealed Resident #73 should wear apron while smoking. Observation on 10/31/23 from 1:13 P.M. through 1:29 P.M. revealed Resident #73 was being assisted by another resident with her cigarette. Resident #73 was not wearing an apron while smoking. 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 record review and staff interview, the facility failed to use the services of a registered nurse (RN) for at least eight consecutive hours a day, seven days a week as required. This had the potential to affect all 74 residents residing in the facility. Findings include: Review of the facility staffing schedules and the staff punch details dated from 08/06/23 through 08/12/23, revealed there was no RN coverage for 08/06/23, 08/09/23, 08/10/23, and 08/12/23 except for the Director of Nursing (DON). The census on these dates revealed there was always greater than 60 residents in the building, which excludes the DON from serving as the charge nurse. Interview on 08/22/23 at 11:28 A.M. with Staff Scheduler #179 stated there was always a RN on-call for the facility, however, was not always in the building. She verified there was not a RN on duty, except for the DON, on 08/06/23, 08/09/23, 08/10/23, and 08/12/23. This deficiency represents non-compliance investigated under Complaint Number OH00145402.

Based on record review and interview, the facility failed to ensure accurate documentation in the medical record for wound care, oxygen and medications. This affected five (Residents #25, #30, #39, #72 and #76) of eight residents reviewed for medication and treatment administrations. The facility census was 74. Findings include: 1. Review of the medical record for Resident #25 revealed an admission date of 07/09/21 with diagnoses including diabetes mellitus, hypertension and peripheral vascular disease. Review of Resident #25's physician's orders for August 2023, revealed she had an order for Lac-Hydrin Lotion 12% (lotion for dry scaly skin), apply to feet and legs sparingly two times a day dated 03/28/23. Review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR) for August 2023, revealed Lac Hydrin was not documented as administered upon rising on 08/01/23, 08/04/23, 08/05/23, 08/06/23, 08/11/23, 08/14/23, 08/16/23, 08/18/23, 08/19/23, 08/20/23, 08/21/23 and at night on 08/19/23. Interview was held on 08/23/23 at 12:10 P.M. with the Director 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 and interview, the facility failed to ensure resident comprehensive assessments were completed timely. This affected two (Residents #15 and #25) of nine residents reviewed for resident assessments. The facility census was 74. Findings include: 1. Review of the medical record for Resident #15 revealed an admission date of 07/27/22 with diagnoses including chronic kidney disease. Review of the annual/comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] was noted to be in progress and had not been completed. The annual assessment was noted to be 8 days overdue. Interview was held on 08/23/23 at 12:10 P.M. with the Administrator where she was informed the MDS had not been completed timely for Resident #15. The Administrator did not disagree. 2. Review of the medical record for Resident #25 revealed an admission date of 07/09/21 with diagnoses including diabetes mellitus, hypertension and peripheral vascular disease. Review of the annual/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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure resident quarterly assessments were completed timely. This affected two (Residents #30 and #72) of nine residents reviewed for resident assessments. The facility census was 74. Findings include: 1. Review of the medical record for Resident #30 revealed an admission date of 05/25/22 with diagnoses including hypertension, chronic obstructive pulmonary disease and multiple sclerosis. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed it was noted to be in progress and had not been completed. The quarterly assessment was noted to be 18 days overdue. Interview was held on 08/23/23 at 12:10 P.M. with the Administrator where she was informed the MDS had not been completed timely for Resident #30. The Administrator did not disagree. 2. Review of the medical record for Resident #72 revealed an admission date of 04/12/23 with diagnoses including diabetes mellitus and peripheral vascular disease. Review of the quarterly…

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 menu spreadsheet review, the facility failed to provide foods at their specified portions. This affected three residents (#8, #50 and #69) of three residents receiving a pureed diet. The facility census was 74 residents. Findings include: Review of a menu spreadsheet for lunch on Monday 08/21/23 revealed residents on a pureed diet were to receive eight ounces of pureed chili mac, four ounces of pureed green beans, a #16-scoop (two ounces) of pureed cornbread and a #16-scoop of pureed cookies. Observation of lunch trayline on 08/21/23 starting at 1:07 P.M. revealed Dietary Manager (DM) #197 was making new purees as the previously prepared purees had water in them from the steamer. No pureed cornbread was present but a #12-scoop of mashed potatoes was provided along with a #12-scoop (2.66 ounces) of pureed green beans and a #8-scoop (four ounces) of pureed chili mac. Resident #50 received two scoops of pureed chili mac as she was to receive double portions. During an interview on 08/21/23 at 1:31 P.M. DM #197 verified the pureed plates did not meet…

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 and interview the facility failed to ensure adequate and timely incontinence care was provided. This affected two residents (#48 and #53) of three observed for incontinence care. The facility identified 29 incontinent residents. The facility census was 73. Findings include: 1. Review of Resident #48's medical records revealed an admission date of 12/30/22. Diagnoses included Alzheimer's, dementia and muscle weakness. Review of Resident #48's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #48 was rarely understood. Resident #48 required extensive assistance with toileting and personal hygiene. Review of Resident #48's care plan dated 06/01/23 revealed Resident #48 was incontinent of bladder. Interventions included to check and change Resident #48 per policy. Observation on 08/01/23 at 8:20 A.M. revealed Resident #48's family was in the hallway yelling at State Tested Nursing Assistant (STNA) #261 about Resident #48's incontinence care. Resident #48's family told STNA #261…

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 ensure enough staff to meet the needs of the residents in an timely manner. This affected three residents who were observed during random observations, Residents #9, #48 and #53. The facility census was 73. Findings include: 1. Interview on 07/31/23 at 9:26 A.M. with State Tested Nurse Aide (STNA) #214 revealed during meal times call light response time took longer due to the passing of meal trays and assisting residents with their meals. Interview on 07/31/23 at 9:36 A.M. with Licensed Practical Nurse (LPN) #207 revealed on occasion, call light response times were delayed and residents had to wait long periods of time. Interview on 07/31/23 at 9:43 A.M. with LPN #292 revealed, at times, call light response time was approximately an hour. Interview on 07/31/23 at 10:33 A.M. with STNA #291 revealed on most days it took long periods of time before call lights were answered. STNA #291 said she had observed residents who had been heavily…

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.

3. Review of Resident #25's medical record revealed an admission date of 04/06/19 and a readmission date of 04/18/2020. Diagnoses included dysphagia (difficulty swallowing), pulmonary embolism, cardiac arrest, COPD, and COVID-19. Review of Resident #25's physician orders revealed an order dated 07/04/22 for Ipratropium-Albuterol nebulization solution 0.5-2.5 (3) mg/three ml inhale three ml orally every six hours as needed for shortness of breath (SOB). Observation on 08/02/22 at 11:12 A.M. with the DON and CAN #304 verified Resident #25's nebulizer was open to air sitting on his bedside table and it was not dated. Interview with the DON during the observation revealed nebulizers were to be covered and dated. 4. Review of Resident #50's medical record revealed an admission date of 09/30/21 and diagnoses including COPD, stroke, peripheral vascular disease, and hypertension. Review of Resident #50's physician orders revealed an order dated 02/23/22 for Albuterol Sulfate 0.083% nebulization solution 2.5 mg/three ml inhale one vial orally via nebulizer one time a day for COPD and SOB.…

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

Based on record review, staff interviews, and facility policy review the facility failed to ensure a baseline care plan was completed for newly admitted residents. This affected three (Resident's #231, #233, and #234) of three residents reviewed for baseline care plans. The facility census was 69. Findings include: 1. Review of the medical record for Resident #231 revealed an admission date of 07/27/22 with diagnoses including COVID-19, acute kidney failure, schizoaffective disorder, bipolar disorder, and other speech disturbances. Further review of the medical chart revealed the admission comprehensive Minimum Data Set (MDS) 3.0 assessment was still in progress. Review of Resident #231's electronic medical record and hard medical chart revealed there was no baseline care plan initiated. Interview on 08/01/22 at 4:00 P.M. the Director of Nursing (DON) verified no baseline care plan was completed for Resident #231. She stated she had a checklist that she used for new admissions. 2. Review of the medical record for Resident #233 revealed an admission date of 07/21/22 with 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 staff interview, review of personnel files and the abuse policy and procedure, the facility failed to screen all employees against the State of Ohio Nurse Aide Registry to identify if an employee had a finding concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property. This affected all 80 residents in the facility. Findings include: Review of personnel files revealed Housekeeper #20, Receptionist #22 and Licensed Social Worker #24 were not screened using the State of Ohio Nurse Aide Registry to identify any negative findings. The identification of findings in the Nurse Aide Registry would be necessary to determine if any employee had actions identified that would validate allegations of abuse, neglect, exploitation, mistreatment of residents, or misappropriation of their property. Interview with Administrative assistant #25 on 08/08/19 at 10:30 A.M. verified the facility did not check all employees against the State of Ohio Nurse Aide Registry. He reported the facility checked the Office of Inspector General, United States…

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

Based on observation and interview the facility failed to prepare the dessert to the proper consistency for the residents receiving a pureed diet. This affected seven (Resident #48, Resident #173, Resident #7, Resident #13, Resident #29, Resident #60, Resident #16) of seven residents served a pureed diet. The facility census was 80. Findings include: An observation on 08/07/19 at 12:40 P.M. revealed 11 bowls of pureed chocolate cake were prepared to serve residents for the lunch meal. Observation of the pureed chocolate cake revealed the consistency was very thin to a consistency of nectar liquid. [NAME] #1 and Kitchen Manager agreed the pureed chocolate cake was too thin and the 11 servings were placed back in the food processor. [NAME] #1 prepared the pureed chocolate cake a second time and the consistency was again too thin. [NAME] #1 added additional pieces of cake to the mixture. [NAME] #1 filled the pureed chocolate cake in to the bowls and the mixture was the consistency of honey. A taste test indicated the chocolate cake was the consistency of honey. [NAME] #1 asked 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 respiratory care in accordance with the physician's order and consistent with the resident plan of care. This affected one resident (#5) of two residents reviewed for respiratory care. The facility identified 12 residents requiring respiratory care in the facility. Findings include: Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with diagnoses that included dysphagia (difficulty swallowing), presence of a gastrostomy tube (feeding tube into the stomach), and chronic obstructive pulmonary disease (COPD). Review of Resident #5's comprehensive assessment dated [DATE], revealed Resident #5 received oxygen therapy and had shortness of breath with exertion, while lying and sitting. Review of a physician order dated 06/17/19 for Resident #5 revealed oxygen at two liters per minute to keep pulse oximetery (measurement of oxygen in the blood) above 92%. Further review of the medical record revealed…

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