Perry Green Valley Nursing Center, LLC

Based on observation and interview, the facility failed to ensure chemicals were secured for three of five halls observed. The DON identified five halls in which residents resided. Findings: On 11/04/24 at 11:39 a.m., the utility room door on hall eight was observed to be unlocked. A bottle of bleach was observed in the unlocked utility room. LPN #4 stated the door was to be closed and locked due to chemicals. On 11/04/24 at 2:44 p.m., a can of disinfectant spray and a tube of Calmoseptine was observed to be unattended on hall seven by the shower room. The disinfectant spray label documented to store the product in an area inaccessible to small children. The Calmoseptine label was observed to document to keep out of reach of children. The door to the shower room was observed to be open. A four ounce bottle of derma daily moisturizing lotion and a box of 50 germicidal disposable wipes were observed to be unsecured and unattended. The labels on the bottle of lotion and the germicidal wipes documented to keep out of reach of children. On 11/04/24 at 2:51 p.m., LPN #3 stated they were…

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

Based on observation, interview, and record review, the facility failed to ensure residents were assessed for the use of bed rails prior to installation for four (#17, 30, 115, and #55) of four sampled residents who were reviewed for bed rails. The DON identified 24 residents who utilized bed rails. Findings: 1. Resident #17 had diagnoses which included Parkinson's disease. A physician order, dated 11/02/23, documented half side rails bilaterally for bed mobility. The Care Plan, dated 10/03/24, read in part, 1/2 side rails bilat upper bed for self repositioning. On 11/04/24 at 11:35 a.m., Resident #17's bed was observed to contain half side rails bilaterally. Review of the electronic clinical record did not reveal a consent had been completed for the use of bed rails. 2. Resident #30 had diagnoses which included muscle weakness. A physician order, dated 09/18/24, documented the resident may use half bed rails for position/mobility. Review of the care plan did not reveal the use of the bed rails. Review of the clinical record did not reveal a consent had been completed for the use 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, record review, and interview, the facility failed to ensure residents were offered snacks for one (bedtime) of one snack time observed. The DON identified 63 residents who received nourishment from the kitchen. Findings: The undated Resident Meals/Snacks policy, read in part, Staff will pass out optional snacks to residents in-between meals. Residents may also request snacks or simple meals (soups, sandwich, etc.) after dining room hours. On 11/05/24 at 1:37 p.m., seven residents in the resident council meeting stated they were not offered bedtime snacks. On 11/05/24 at 8:04 p.m., the dietary staff were observed in the kitchen. A tour of the facility's nurses stations and resident rooms did not reveal snacks had yet been provided. On 11/05/24 at 8:13 p.m., cook #1 was observed to take a bowl with snacks in it to hall eight. On 11/05/24 at 8:39 p.m., Resident #18 requested a sandwich, chips, and a snack cake from a CNA. Resident #18 stated staff did not offer snacks, but they would ask for them for themselves and their roommate. On 11/05/24 at 8:43 p.m., CMA #1…

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 arbitration agreements documented a location agreed upon by both parties. The administrator identified 63 residents who had signed binding arbitration agreements. Findings: The Mediation and Arbitration Agreement, dated 02/05/1951, read in part, Such mediation will be held in Tulsa or Oklahoma County, Oklahoma in a place agreed to by the parties On 11/06/24 at 3:36 p.m., the administrator stated arbitration would take place in either Tulsa or Oklahoma county. The administrator stated if Tulsa or Oklahoma county was not agreed upon by both parties they thought they could change to another location. The administrator stated they did not know why the arbitration agreement did not indicate arbitration could occur in a location agreeable to both parties.

Based on observation, record review, and interview, the facility failed to: a. ensure control measures and testing protocols were in place for monitoring for the potential presence of water-borne pathogen such as Legionella; and b. follow the enhanced barrier precautions policy for a resident on precautions for one (#6) of 16 sampled residents reviewed for infection control. The administrator identified 63 residents resided in the facility. Findings: An Infection prevention and control program policy, revised July 2024, read in part, Water Management: a. Control measures and testing protocols are in place to address potential hazards associated with the facility's water system. An Enhanced Barrier Precautions policy, revised April 2024, read in part, It is the policy of this facility to implement enhanced barrier precautions for the prevention of transmission of multidrug-resistant organisms. The policy also read, 'Enhanced barrier precautions' (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown…

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 record review, the facility failed to ensure resident beds were maintained and monitored for the use of bed rails for four (#17, 30, 115, and #55) of four sampled residents who were reviewed for bed rails. The DON identified 24 residents who utilized bed rails. Findings: The Bed Safety and Bed Rails policy, dated August 2022, read in part, Maintenance staff routinely inspects all beds and related equipment to identify risks and problems including potential entrapment risks. 1. Resident #17 had diagnoses which included Parkinson's disease. On 11/04/24 at 11:35 a.m., Resident #17's bed was observed to contain half side rails bilaterally. 2. Resident #30 had diagnoses which included muscle weakness. On 11/04/24 at 11:31 a.m., Resident #30 was observed in bed with half side rails in the up position bilaterally. 3. Resident #115 had diagnoses which included atrial fibrillation. On 11/04/24 at 1:12 p.m., Resident #115 was observed in bed with half side rails in the up position bilaterally. 4. Resident #55 had diagnoses which included muscle weakness…

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 not held without a physicians' order for one (#15) and a medication was available to be administered for one (#48) of 15 sampled residents observed during medication pass observation. Findings: A policy and procedure, titled, Administering Medications revised April 2019, read in part, .Medications are administered in a safe and timely manner, and as prescribed .4. Medications are administered in accordance with prescriber orders, including any required time frame . 1. Res #15 had diagnoses which included, unspecified dementia without behavioral disturbances, and hypertension (high blood pressure). Res #15's Physician Order Report', dated 02/14/22 to 03/14/22, documented the resident was to receive metoprolol succinate 25mg extended release, and Losartan 100mg daily at 9:00 a.m. for hypertension. 2. Res #48 had diagnoses which included, recurrent erosion of cornea of the right eye and congestive heart failure. Res #48's Physician Order Report, dated 02/14/02 to 03/14/22, documented,…

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 implement infection prevention/control protocols by ensuring catheter bags were not on the floor, gloves were changed as indicated during provision of incontinent care, and ensure catheter care was provided as an intervention to prevent UTI's for two (#28 and #37) of two sampled residents for catheter care. The DON identified two residents with Foley catheters. Findings: A policy and procedure, titled, Catheter Care, Urinary revised September 2014, read in part .The purpose of this procedure is to prevent catheter-associated urinary tract infections .review the resident's care plan to assess for any special needs of the resident .Infection Control .Be sure the catheter tubing and drainage bag are kept off the floor . 1. Resident #28 had diagnoses which included urinary tract infection, cerebral infarction (stroke) affecting right dominant side, and retention of urine. An admission assessment, dated 01/26/22, documented, resident #28 had moderate cognitive impairment, and required extensive assistance for bed…

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

Based on record review, observation, and interview, the facility failed to ensure resident representatives were notified of skin tears for one (#44) of one sampled resident who was reviewed for notification of change, and failed to consult with the physician before a significant blood pressure medication was held for one (#15) of 15 sampled residents observed during the medication pass. The facility identified five residents who had skin tears. The DON identified 49 residents resided in the facility and received medications. Findings: A policy and procedure, titled, Administering Medications revised April 2019, read in part, .Medications are administered in a safe and timely manner, and as prescribed . Medications are administered in accordance with prescriber orders, including any required time frame . Resident #44 had diagnoses which included falls. An event and progress note, dated 03/06/22, documented the resident had a skin tear to his right second toe and had voiced he had ran over his toe with his wheelchair. The note documented the area was measured and cleaned. On 03/09/22…

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 physician's orders were obtained and completed for a skin tear injury for one (#44) of one sampled resident who was reviewed for a non pressure skin condition. The facility identified five residents who had skin tears. Findings: Resident #44 had diagnoses which included falls. An event and progress note, dated 03/06/22, documented the resident had a skin tear to his right second toe and had voiced he had ran over his toe with his wheelchair. The note documented the area was measured and cleaned. On 03/09/22 at 09:12 a.m., the resident stated he cut his right second toe on the wheelchair. They stated the wheelchair had been repaired by a maintenance employee. The resident pulled his sock off and a adhesive covering was observed on his second toe. Resident #44 was asked how often the staff checked on it and applied bandages. He stated the nurse was supposed to come in and check on it. On 03/10/22 at 2:23 p.m., LPN #3 observed the right foot and removed the bandage on his second toe. Dried blood 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.