Omni Manor Nursing Home

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on closed medical record review and staff interview the facility failed to ensure wound care was completed as ordered. This affected one resident (Resident #150) of three residents reviewed for wound care. The census was 117. Findings include: Review of Resident #150's closed medical record revealed an admission date of 04/21/23 with the diagnoses of antineutrophilic cytoplasmic antibody vasculitis (a rare autoimmune disorder that causes inflammation of the blood vessels), calculus of the kidney, and an abnormal electrocardiogram (test to detect heart rhythm). Review of Resident #150's care plan dated 05/03/23 revealed interventions to include administration of medications and treatments as ordered. Review of the resident's Quarterly Minimum Data Set (MDS) dated [DATE] revealed intact cognition and the presence of skin tears. Review of the skin assessments revealed the resident had a skin tear to the back of her right hand. Review of the physician orders for Resident #150 revealed an order for wound care…

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 interviews the facility failed to ensure wound care was documented as ordered. This affected two residents (Resident #61 and #101) of three residents reviewed for wound care. The facility census was 117. Findings Include: 1. Medical record review for Resident #61 revealed an admission date of 04/17/23. Resident #61's current diagnoses include congestive heart failure, cerebral infarction (stroke), myocardial infarction (heart attack), neuromuscular dysfunction of the bladder, colostomy, chronic obstructive pulmonary disease, and chronic kidney disease. Review of the 04/02/24 Minimum Data Set (MDS) revealed Resident #61 to be cognitively intact. Review of Resident #61's physician orders revealed an order dated 02/13/24 through 04/23/24 for the sacrum to be cleansed with normal saline, apply drawtec (a dressing that promotes moist wound healing) in a single layer and cover with coversite plus (a waterproof composite dressing that can replace gauze and tape) every shift. A new treatment order was written and completed from 04/24/24 through 04/30/24. Review of…

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

Based on observation, interview, and facility policy review, the facility failed to ensure medication carts and medication storage areas did not contain expired medications and failed to ensure insulin pens were labeled with the date opened. This affected 13 residents (Resident #6, #33, #37, #46, #50, #62, #65, #83, #88, #90, #91, #106, and #113) and had the potential to affect all 109 residents residing in the facility. Findings include: 1. Observation on 04/27/22 at 8:18 A.M. of the medication cart on the South wing revealed the following findings: • Lantus Solostar 100 units per milliliter (u/ml) insulin pen for Resident #91 was not marked with the date opened. • Lispro 100 u/ml insulin pen for Resident #62 was not marked with the date opened. • Lantus 100 u/ml vial for Resident #62 was not marked with the date opened. • Haloperidol oral solution 2 milligrams per milliliter (mg/ml) for Resident #106 was not marked with the date opened. Interview with Registered Nurse (RN) #420 on 04/27/22 at 8:30 A.M. during observation of medication cart for the South wing verified the above…

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 test Resident #9 who was displaying signs and symptoms of COVID-19. This had the potential to affect all 109 residents residing in the facility. Findings include: Review of medical record for Resident #9 revealed an admission date of 02/29/20 with diagnoses including chronic respiratory failure with hypoxia, hypertension, and gastroesophageal reflux disease. Review of quarterly Minimum Data Set assessment dated [DATE] for Resident #9, revealed he had moderate cognitive impairment. Resident #9 required extensive two-person physical assistance for bed mobility, extensive one-person physical assistance for dressing, toileting, and personal hygiene, and supervision set up help only for eating. Resident #9 had an indwelling catheter for urine and was always incontinent of bowel. Review of nursing progress note dated 04/23/22, revealed Resident #9 had an increased temperature of 99 degrees Fahrenheit, his heart rate was increased at 103 beats…

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 Resident #2, Resident #32, Resident #37, Resident #39, Resident #65, Resident #68, and Resident #85 bathrooms were in good repair. This affected 7 residents (Resident #2, Resident #32, Resident #37, Resident #39, Resident #65, Resident #68, and Resident #85) of seven residents oberved for environment. Findings include: Observation on 04/26/22 at 8:47 A.M. revealed the bathroom sink faucet was observed to be leaking in the jack and [NAME] bathroom in between Residents #2, #65, and #68. Interview during the observation with Resident #2 confirmed the faucet has been leaking for a long time. Observation on 04/26/22 at 8:48 A.M. revealed the toilet seat in the jack and [NAME] bathroom for Residents #32, #37, #39, and #85 was broken off the toilet. The seat was slid to the right and half covering the opening of the toilet. Interview and observation on 04/28/22 at 8:47 A.M. with Housekeeper #462 confirmed the broken toilet seat 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 observation, interview, record review, and review of the facility policy, the facility failed to ensure Resident #97's oxygen was administered per physician orders by licensed nursing staff. This affected one resident (Resident #97) out of three residents reviewed for respiratory care. Findings include: Review of Resident #97's medical record revealed an admission date of 01/26/22 and diagnoses included Alzheimer's disease, dementia, acute embolism and thrombosis of the left femoral vein. Review of Resident #97's Quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/01/22, revealed Resident #97 had severe cognitive impairment and required the extensive assistance of one person for bed mobility and toilet use, and required total dependence of two staff members for transfers. Review of Resident #97's care plan dated 04/01/22, revealed Resident #97 had altered respiratory status and difficulty breathing related to chronic infiltrates on chest x-ray. Resident #97 would have no complications related to shortness of breath through the review date. 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 observation, interview and policy review, the facility failed to ensure safe storage of resident foods. This had the potential to affect 113 of 115 residents receiving meals/food from the facility (the facility identified two residents, Resident #9 and Resident #48, as not receiving meals/food from the facility). The facility census was 115 residents. Findings include: Observational tour of the resident snack areas with Kitchen Manager (KM) #300 on 04/22/19 starting at 9:38 A.M. revealed the following concerns: the North unit refrigerator had a container of resident food dated 03/24/19; the East unit refrigerator had three unlabeled and undated plates of resident food and the [NAME] unit had a container of some type of dip that was unlabeled and undated. Interview with KM #300 at the time of the above observations revealed dietary staff only monitored the expiration dates of facility-provided nourishments. KM #300 stated foods were to be labeled, dated and discarded within three days if not consumed. Review of a facility policy, Refrigerator and Freezer Outside of Nutrition…

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 accurately represent the acuity needs of the residents, update the assessment when contracted services from staffing agencies were added to the facility and annually educate all staff on abuse training. This had the potential to affect all residents in the facility. The facility census was 115. Findings included: 1. An interview was conducted on 04/25/19 at 9:31 A.M. with the Director of Nursing (DON) who said the facility began utilizing two staffing agencies on 11/26/18 to provide additional State Tested Nursing Assistants and Licensed Nurses to the facility due to staffing challenges. Record review was conducted of the active nurse staffing list provided by the DON revealed approximately 66 agency nursing services staff had been set-up to use the electronic documentation system for the facility. Record review was conducted of the Facility Annual assessment dated [DATE]. The addition of the two contracted staffing agencies was not included on the…

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

Based on record review and interview the facility failed to provide annual abuse prevention training to all staff. This affected four of 11 staff personnel files reviewed and had the potential to affect all residents in the facility. The facility census was 115. Findings included: 1. Review of the personnel file for Licensed Practical Nurse (LPN) #343 no annual abuse training, competency evaluation or dementia with behaviors training. LPN #343 was listed on the active staffing list for the facility. An interview was conducted on 04/26/19 at 10:59 A.M. with Corporate Registered Nurse (CRN) #344 who verified LPN #343 was not included in the annual training and competency evaluation because she only worked per diem (as needed) and had last worked on 09/17/18. CRN #344 verified LPN #343's date of hire was 11/08/16 and she was eligible as an active staff member to work in the facility at any time. 2. The personnel files for State Tested Nursing Assistants (STNAs) #345, #347 and #348 were reviewed. There was no documentation to indicate STNA #345 and STNA #348 had received annual dementia…

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 provide dignity for residents during dining and regarding incontinence status. This affected four (Residents #55, #82, #103, and #110) of all 116 residents observed for dignity. Findings include: 1. On 04/22/19 between 11:51 A.M. and 1:15 P.M., observations were made of dining on the South wing. The first meal cart arrived on the unit at 11:51 A.M. and trays were delivered to residents eating in their rooms. At 12:15 P.M., State Tested Nursing Assistant (STNA) #348 was overheard asking Registered Nurse (RN) #350 to call the dietary department and inform them three trays were needed. RN #350 made the call. Within seconds of the phone call, the second cart arrived. The first meal in the dining was served at 12:19 P.M. Residents #55, #103, and #110 were still sitting at the tables with no meal at 12:53 P.M. while all other residents were eating. Resident #55 stated he sometimes had to wait while other residents ate and it did bother him,…

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 sufficient staff were available to provide restorative nursing services. This affected one resident (Resident #22) of three residents reviewed for accidents and had the potential to affect all 36 other residents identified by the facility who were currently on restorative nursing programs (Residents #1, #4, #5, #6, #10, #17, #19, #20, #21, #23, #25, #26, #28, #29, #32, #35, #38, #40, #47, #53, #57, #58, #61, #69, #71, #76, #77, #78, #85, #86, #101, #102, #105, #107, #109, and #113). Findings include: Review of Resident #22's medical record revealed diagnoses including emphysema, polyarthritis, chronic pain and chronic obstructive pulmonary disease. A restorative plan of care revealed Resident #22 was scheduled to receive a restorative ambulation program six to seven days a week for 15 minute sessions because she was at risk for decline with ambulation due to weakness and decreased mobility related to emphysema and decreased endurance. Review of restorative delivery records for February 2019 and March 2019 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to ensure appropriate infection control practices were maintained for Resident #216, who was on contact isolation. This had the potential to affect the other residents on the South wing, one of four resident units. The facility identified 34 residents (Residents #4, #5, #8, #21, #22, #23, #26, #27, #32, #38, #39, #46, #53, #54, #55, #59, #62, #64, #71, #75, #76, #77, #79, #85, #92, #95, #102, #103, #104, #107, #109, #110, #215, #216) who resided on South wing. Findings include: Resident #216 was admitted to the facility on [DATE] and diagnoses included cellulitis. Review of Resident #216's medical record revealed a physician order dated 04/19/19 for contact isolation to be in place due to pseudomonas, an infection, in his leg wounds. On 04/24/19 at 9:50 A.M., State Tested Nursing Assistant (STNA) #352 was observed pushing an over bed table with a water mug out of Resident #216's room and leaving the table sitting in the hall outside the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview the facility did not ensure a witness signature was obtained on an authorization to manage personal funds in the facility for Resident #6. This affected one of five residents reviewed for personal funds. The facility census was 115. Findings include: Record review was conducted for Resident #6 who was admitted to the facility on [DATE] with diagnoses that included cerebral palsy and unspecified intellectual disabilities. The Minimum Data Set (MDS) assessment dated [DATE] revealed he was severely impaired for cognitive skills for decision making, was unable to complete the resident interview for cognition and was totally dependent on staff for transfers, eating, toileting and hygiene. Resident #6's brother was listed as his Power of Attorney (POA) over his financial and clinical care. Review of the facility document titled, Trust Transaction History, dated 01/03/19 to 03/31/19 revealed Resident #6's financial liability was being paid to the facility from the income source…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, review of a facility self-reported incident (SRI) and associated investigation, and interviews, the facility failed to ensure adequate supervision to protect Resident #27 from sexual abuse, failed to implement their action plan to protect residents from sexual abuse, and failed to ensure staff were knowledgeable regarding interventions implemented to prevent future abuse. This affected two (Residents #79 and #27) of four residents reviewed for abuse. Findings include: Review of Resident #79's medical record revealed he was admitted to the facility 10/24/17 and diagnoses included depression. A plan of care card dated 07/13/18, and updated 10/31/18, indicated Resident #79 used a power wheelchair independently. A quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #79 was able to make himself understood and he understood others. Resident #79 was assessed as cognitively intact with no behavioral symptoms. Resident #79 required limited assistance with locomotion on the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, review of a facility self-reported incident (SRI) and associated investigation, and interviews, the facility failed to conduct a thorough investigation into an allegation of sexual abuse, failed to implement their action plan to protect residents from sexual abuse, and failed to ensure staff were knowledgeable regarding interventions implemented to prevent future abuse. This affected two (Residents #79 and #27) of four residents reviewed for abuse. Findings include: Review of Resident #79's medical record revealed he was a male resident admitted to the facility 10/24/17. Resident #79 had a diagnosis of depression. A plan of care card dated 07/13/18, and updated 10/31/18, indicated Resident #79 used a power wheelchair independently. A quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #79 was able to make himself understood and he understood others. Resident #79 was assessed as cognitively intact with no behavioral symptoms. Resident #79 required limited assistance…

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 minimum data set (MDS) assessments were correctly coded to accurately reflect resident condition. This affected three residents (Resident #22, Resident #54 and Resident #109) of 28 residents reviewed for accurate assessments. Findings include: 1. Record review revealed Resident #54 was admitted on [DATE] with diagnoses including dementia with behavioral disturbances, Alzheimer's disease, blindness in left eye, and hypertension (high blood pressure). The medical record revealed a hospice contract was signed 05/23/18 and a physician's order dated 05/22/18 to start hospice care. A plan of care dated 05/23/18 was in place for Resident #54's hospice services, with a goal of the resident being supported to promote dignity and comfort throughout the dying process daily though 06/30/19. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the Resident #54 was cognitively impaired but was not coded as receiving hospice services…

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 provide restorative nursing services according to the care plan for Resident #22. This affected one of three residents reviewed for accidents. Findings include: Review of Resident #22's medical record revealed diagnoses including emphysema, polyarthritis, chronic pain and chronic obstructive pulmonary disease. A restorative plan of care revealed Resident #22 was scheduled to receive a restorative ambulation program six to seven days a week for 15 minute sessions because she was at risk for decline with ambulation due to weakness and decreased mobility related to emphysema and decreased endurance. Review of restorative delivery records for February 2019 revealed the services were not documented as provided in accordance with the plan of care. For the week of 02/03/19 through 02/09/19 Resident #22 received five days of restorative ambulation. For the week of 02/10/19 through 02/06/19 she only received three days of restorative ambulation. For the week of 02/17/19 through 02/23/19 she only received five days 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, observation and interview the facility failed to ensure Resident #44 and Resident #97 were provided activities of interest to meet their individualized needs. This affected two of two residents reviewed for activities. The facility census was 115. Findings included: 1. Record review revealed Resident #44 was admitted to the facility on [DATE] with diagnoses including stroke, legal blindness, traumatic brain injury, major depression and dementia. The Minimum Data Set (MDS) assessment dated [DATE] indicated he had severe cognitive impairment, needed extensive assistance of one to two staff for all activities of daily living. The plan of care, initiated on 11/13/17, indicated he needed assistance with all activities of daily living. An observation was conducted of Resident #44 on 04/23/19 from 11:52 A.M. to 12:33 P.M. He was initially found sitting in his wheelchair in a hallway near a common area where other residents were sitting in a group. He was approximately ten feet away from the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation and interviews the facility failed to provide a nutritional supplement according to physician orders for Resident #44. This affected one of six residents reviewed for nutrition. Findings included: Record review for Resident #44 revealed he was admitted to the facility on [DATE] with diagnoses including stroke, legal blindness, traumatic brain injury, major depression and dementia. The Minimum Data Set (MDS) assessment dated [DATE] indicated he had severe cognitive impairment, needed extensive assistance of one to two staff for bed mobility, transfers, toileting, eating, dressing and hygiene. The plan of care with an initial date of 11/02/17 indicated he had the potential for skin, nutrition and hydration problems related to his cognitive impairment, was at risk for weight loss and should be provided nutritional supplements as ordered. Review of the Medical Nutrition Therapy Evaluation dated 04/09/19, authored by Registered Dietitian (RD) #301, on indicated that Resident #44…

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 and interview, the facility failed to ensure medications were administered in accordance with physician orders resulting in three medication errors out of 25 opportunities with a medication error rate of 12%. This affected three (Residents #17, #48, and #72) of eight residents observed for medication administration. Findings include: 1. On 04/24/19 at 8:07 A.M., Licensed Practical Nurse (LPN) #306 was observed administering medication to Resident #48. As LPN #306 prepared to apply a Lidocaine 5% patch (applied topically to the skin for pain) to Resident #48's arm she discovered there was already a patch on the right arm. LPN #306 removed the Lidocaine patch from the right arm and applied the new patch to the left arm. Immediately following the application of the patch, LPN #306 verified the order for the Lidocaine patch indicated it was to be applied for 12 hours then removed for 12 hours. LPN #306 verified the Medication Administration Record (MAR) revealed the lidocaine patch had been applied on the right arm the morning of 04/23/19. Although,…

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 interview and record review the facility failed to ensure meal and supplement intake records were consistently recorded. This affected two residents (Resident #42 and Resident #49) of six residents reviewed for nutrition. The facility census was 115 residents. Findings include: 1. Review of Resident #42's medical record revealed an admission date of 02/04/19 with diagnoses including repeated falls, hypertension (high blood pressure), depression and hypothyroidism. Review of physician orders for April 2019 revealed an order dated 02/27/19 for a no added salt diet with vanilla ice cream at dinner. Review of the April 2019 treatment administration record (TAR) revealed oral intakes at meals were not recorded for dinner on 04/02/19; all three meals on 04/03/19; breakfast and lunch on 04/04/19, 04/05/19 and 04/06/19; dinner on 04/07/19; all three meals on 04/08/19, 04/09/19 and 04/10/19; breakfast and lunch on 04/11/19, 04/12/19 and 04/13/19; all three meals on 04/14/19; dinner on 04/15/19; all three meals on 04/16/19 and 04/17/19; dinner on 04/18/19; breakfast and lunch on…

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