Saint Simeons Episcopal Home

Based on record review and interview, the facility failed to ensure residents were treated with dignity and respect for 1 (#4) of 4 residents who were reviewed for dignity. The administrator identified 78 residents who resided at the facility. Findings: Resident #4 had diagnoses which included mood disorder, PTSD, and anxiety. The five day assessment, dated 01/20/25, showed Resident #4 had a BIMS score of 13 and was cognitively intact for decision making. Review of the care plan, dated 01/31/25, for Resident #4, showed a focus of being dependent on staff for ADLs in toileting hygiene and transfers. Review of the ODH Form 283, dated 02/26/25, showed Resident #4 had alleged allegations of abuse/mistreatment by CNA #1. The form showed on 02/26/25 CNA #2 had reported Resident #4 told them they feared CNA #1 and did not want them to return to their room at night. The form documented Resident #4 stated CNA #1 came to their room to change their wet brief, removed their brief and left them naked to soil the bed and never returned. The form showed CNA#1 had been suspended pending 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 ensure residents were free from neglect for 1 (#4) of 4 residents who were sampled and reviewed for neglect. The administrator identified 78 residents who resided at the facility. Findings: Resident #4 had diagnoses which included mood disorder, PTSD, and anxiety. The five day assessment, dated 01/20/25, showed Resident #4 had a BIMS score of 13 and was cognitively intact for decision making The Abuse, Neglect, Exploitation and Misappropriation Prevention Program policy, revised April 2021, read in part, Develop and implement policies and protocols to prevent and identify: a. abuse or mistreatment of residents; b. neglect of residents. An Identifying Neglect policy, revised September 2022, read in part, Preventing resident neglect is a priority throughout all levels of this organization.Neglect is defined as the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical pain, mental anguish, or emotional distress.Neglect occurs when 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 ensure assistance with activities of daily living was provided for 1 (#4) of 4 residents who were reviewed for ADL assistance. The administrator identified 78 residents who resided in the facility. Findings: Resident #4 had diagnoses which included fracture of neck of left femur, fracture of left pubis and glaucoma. The five day assessment, dated 01/20/25, showed Resident #4 had a BIMS score of 13 and was cognitively intact for decision making. A care plan, revised 01/29/25, showed Resident #4 was dependent for toileting hygiene. On 02/27/25 at 2:34 p.m., Resident #4 stated an incident occurred when a CNA #1 had left them naked in bed. They stated they were pleased CNA #1 had been suspended and that it was unlikely CNA #1 would return. Resident #4 stated CNA #1 was not mean or hurt them, they felt CNA #1 did not like their job. They stated no other CNA had left them like that, just CNA #1. On 03/03/25 at 6:14 p.m., CNA #4 stated they had found Resident #4 at the start of their day shift on 02/26/25, sitting on the side 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 record review and interview, the facility failed to ensure discharge assessments were submitted to CMS within seven days of completion of the assessment for two (#64 and #66) of 18 sampled residents whose assessments were reviewed. The administrator reported 75 residents resided in the facility. Findings: Res #64 admitted to the facility with diagnoses which included hypertension, hyponatremia, and malnutrition. A discharge assessment, dated 08/29/24, was completed but not submitted to CMS. Res #66 admitted to the facility with diagnoses of chronic obstructive pulmonary disease, cerebrovascular accident, and hypertension. A discharge assessment, dated 08/31/24, was completed but not submitted to CMS. On 01/24/25 at 11:03 a.m., the MDS coordinator reported the assessments should have been submitted

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure assessments were coded accurately for one (#75) of 18 sampled residents whose assessments were reviewed. The administrator reported 75 residents resided in the facility. Findings: Res #75 admitted to the facility with diagnoses which included heart failure, hypertension, and diabetes. A Discharge summary, dated [DATE], documented the resident went home. A discharge assessment, dated 10/28/24, documented the resident was discharged to the hospital. On 01/23/25 at 1:44 p.m., the MDS coordinator reported the assessment was not accurate.

Based on record review and interview, the facility failed to obtain an order for suprapubic catheter care for one (#46) of one resident reviewed for catheter care. The administrator identified 75 residents resided in the facility. Findings: Resident #46 had diagnoses which included benign prostatic hyperplasia with lower urinary tract symptoms. On 1/24/25 at 10:57 a.m., LPN #1 was preparing to perform suprapubic catheter care. When reviewing the resident's orders they noted there was not an order for catheter care. LPN #1 stated there should be an order for catheter care. On 1/24/25 at 11:29 a.m., the DON stated the resident went to the hospital and when they returned the order for catheter care was not put into the resident's orders.

Based on record review, and interview, the facility failed to ensure residents were free from abuse for two (#3 and #4) of three residents sampled for abuse. On 10/05/24 Res #3 was left soiled in bed and stuck between the bed and the wall. On 10/14/24 LPN #4 did not provide hydration, medication, or dressing changes for Res #4. The facility was in past noncompliance after having put the final measures in place to correct the deficiency on 12/13/24. The administrator identified 75 residents who resided in the facility. Findings: 1. Res #3 had diagnoses which included Parkinson's and immobility. A state reportable incident form, dated 10/05/24, documented on 10/05/24 CNA #4 left Resident #3 soiled and wedged in the bed while covering for another aide who was on break. The form documented CNA #4 was removed from patient care immediately and suspended. The form documented the administrator contacted the family, resident's legal representative, Adult Protective Services, and the appropriate licensing board. The form documented all residents residing in the facility were questioned 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.

Based on record review and interview, the facility failed to prevent abuse for one (#2) of three sampled residents who were sampled for abuse. Administrator #1 identified 71 residents resided in the facility. Findings: Resident #2 had diagnoses which included dementia and anxiety. An Incident Report Form, dated 10/12/23, documented the ADON overheard Resident #2 ask CNA #1 if the police were there yet because they were still scared. It was documented the ADON interviewed the resident and they stated they did not want to go back to their room because they were afraid of being hit again. It was documented Resident #2 stated CNA #2 took the buzzer so they could not call for help, turned of the lights and the TV, and would not help them all night. It was documented the resident stated they began to scream for the nurse when CNA #2 came back into the room and hit them. The facility's in-services records documented they had in-services with all staff on abuse dated 06/17/24. A review of the quality assurance records indicated abuse was being monitored with each quality assurance meeting…

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 a resident was not involuntarily discharged for one (#1) of three sampled residents reviewed for involuntary discharge. The Administrator identified 77 residents resided in the facility. Findings: A Transfer or Discharge, Facility-Initiated policy, revised 10/23, read in part, Once admitted to the facility, residents have the right to remain in the facility. Facility-initiated transfers and discharges, when necessary, must meet specific criteria and require residents/representative notification and orientation, and documentation as specified in this policy. 1. Each resident will be permitted to remain in the facility, and not be transferred or discharged unless: a .necessary for the resident's welfare . b . the resident no longer needs the services provided by this facility . c. the safety of individuals in the facility is endangered . d. the health of individuals in the facility would otherwise be endangered; e.nonpayment . f. the facility…

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 track infection and analyze the data for trends in infection for three, (June, July, and August of 2022), of three months of tracking and trending data. The administrator identified 83 residents resided in the facility. Findings: On 08/17/22, the infection control tracking and trending reports were requested from the Infection Control Preventionist (ICP). The ICP was unable to provide these reports. On 08/18/22 the reports were again requested. The ICP stated she was working on them. On 08/18/22 at 1:05 p.m., the ICP stated, I was doing the tracking and trending, but then we got a lot of Covid19 and the tracking and trending just kind of fell off. Since mid June there has not been tracking and trending on the form. I was keeping up with the tracking and trending on a daily basis by looking at the individual lab sheets. We had not formally compiled the information. When asked if this was the proper way to do tracking and trending the ICP stated no. On 08/ 18/22 at 1:36 p.m. the administrator stated she was unaware 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 ensure services related to dialysis were coordinated for one (#75) of one residents who were reviewed for dialysis services. The Resident Census and Conditions of Residents form documented one resident received dialysis. Findings: Resident #75 had diagnoses which included end stage renal disease. A physician order, dated 02/18/22, documented the resident was to be referred to dialysis for treatment. A quarterly assessment, dated 07/06/22, documented the resident received dialysis. A nurse's note, dated 07/27/22, documented the resident had returned from dialysis and had been seen by the nephrologist. The note documented the resident returned with a physician progress note to plan for surgery to place an upper fistula or graft. A physician progress note, dated 07/27/22, documented the resident had a failed left forearm fistula and to plan for surgery for an upper arm fistula or graft. The progress note was noted by LPN #1. Review of the clinical record did not reveal documentation a follow up had occurred for 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, observation, and interview, the facility failed to ensure residents were free of significant medication errors for one (#69) of five residents whose medications were reviewed during an observation of the medication pass. The administrator identified 83 residents who received medications. Findings: The monthly physician's orders, dated August 2022, documented the resident was to receive one phenytoin sodium extended release 100mg three times daily for a diagnosis of epilepsy. On 08/18/22 at 9:10 a.m., CMA #1 was observed to administer two phenytoin sodium extended release 100mg capsules to resident #69 during the morning medication pass. The CMA placed two capsules in the souffle cup and handed the medication card to the surveyor. The medication card documented to give the resident two phenytoin sodium extended release 100mg capsules in the morning, one in the afternoon, and one in the evening. On 08/18/22 at 3:05 p.m., the CMA was asked how many phenytoin sodium extended release capsules they administered to resident #69. The CMA stated the medication card…

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 correctly label stored medications for one (#69) of five residents whose medications were reviewed during an observation of the medication pass. This resulted in a significant medication error for resident #69. The administrator identified 83 residents who received medications. Findings: The monthly physician's orders, dated August 2022, documented resident #69 was to receive phenytoin sodium extended release 100mg three times daily for a diagnosis of epilepsy. On 08/18/22 at 9:10 a.m., CMA #1 was observed to administer two phenytoin sodium extended release 100mg capsules to resident #69 during the morning medication pass. The CMA placed two capsules in the souffle cup and handed the medication card to the surveyor. The medication card documented to give the resident two phenytoin sodium extended release 100mg capsules in the morning, one in the afternoon, and one in the evening. There was no indicator to identify the medication dosage had been changed. On 08/18/22 at 3:05 p.m., the CMA was asked how many…

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.