Stanley Post Acute

Based on interview and record review it was determined the facility failed to ensure CNAs received annual performance reviews for 4 of 5 randomly selected CNAs (#s 15, 23, 24, and 25) reviewed for staff performance reviews. This placed residents at risk for lack of care by competent staff. Findings include: On 5/17/24 at 9:58 AM a review of facility personnel records with Staff 31 (Human Resource Director) indicated the following: - Staff 15 (CNA) was hired on 8/17/22; no annual performance review was completed. - Staff 23 (CMA) was hired on 8/31/20; no annual performance reviews were completed. - Staff 24 (CNA) was hired on 6/16/16; no annual performance reviews were completed. - Staff 25 (CNA) was hired on 4/11/16; no annual performance reviews were completed. On 5/17/24 at 4:04 PM Staff 1 (Administrator) stated it was his expectation the annual performance reviews were completed annually. Staff 1 confirmed the annual performance reviews were not completed for Staff 15, Staff 23, Staff 24, or Staff 25.

Based on interview and record review it was determined the facility failed to ensure a resident was treated in a dignified manner for 1 of 4 sampled residents (#114) reviewed for dignity. This placed residents at risk for lessened quality of life. Findings include: Resident 114 was admitted to the facility on 2/2024 with diagnoses including end stage renal disease and depression. A 3/20/24 Mistreatment Investigation revealed the following: * Staff 2 (DNS) was informed on 2/27/24 Resident 114 had a concern regarding her/his care. Staff 2 spoke with Resident 114, who indicated the incident occurred roughly one week prior. During the night shift, a female staff member entered the resident's room because she/he had a bowel movement in bed. The staff person stated, Oh, you shit the bed. Resident 114 did not feel abused, but stated the staff person was rude. Resident 114 stated other staff assisted with cleaning her/him up. *Staff 2 determined Staff 26 (Former RN) worked with Resident 114 on 2/19/24 during the night of the incident. *Staff 26 recalled the incident and stated Resident 114…

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 it was determined the facility failed to assess self-administration of a medication for 2 of 3 sampled residents (#s 8 and 26) reviewed for self-administration of medication. This placed residents at risk for unsafe medication administration. Findings include: The facility's Self-Administration Medication policy last revised on 3/2020, specified the following: -Upon admission the resident's desire to self-administer is ascertained. -During the 14-day admission assessment period the RCM (Resident Care Manager) evaluates the resident's ability to self-administer medications. -If the resident has the cognitive, physical, and emotional ability to self-administer their own medications in a safe and prudent manner a plan for self-administration is established with the resident. -A physician order is obtained indicating the specific medications that the resident is able to self-administer. -The self-administration is on the resident's care plan to include location of drugs, documentation procedure, place of administration and specific…

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 it was determined the facility failed to ensure resident personal property was identified upon admission, and clothing was retained and accessible for 2 of 4 sampled residents (#s 20 and 57) reviewed for personal property. This place residents at risk for loss of personal property. Findings include: The facility's Resident Personal Items Safekeeping policy, last revised 4/2023, specified the following: -All personal items, including but not limited to clothing, dentures, glasses, and hearing aids must be marked with the resident's name upon admission. -The facility designee will assist residents and families with marking the personal belongings. -On admission and thereafter each time a resident's personal possession is brought into the facility, the item will be recorded on the resident's inventory record by designated staff and signed by the resident or responsible party. -If any personal items is lost during a resident's stay, an investigation will be completed…

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 it was determined the facility failed to ensure a written summary of a baseline care plan was reviewed and provided to residents within 48 hours of admission for 2 of 3 sampled residents (#s 4 and 44) reviewed for care planning. This placed residents at risk for being uninformed about their plan of care. Findings include: 1. Resident 4 was admitted to the facility in 2022 with diagnoses including paralysis of left side and osteoporosis. On 5/14/24 Resident 4's clinical record was reviewed. No record was found that Resident 4 had a baseline care plan reviewed or provided to her/him. On 5/16/24 at 12:33 PM Staff 3 (Corporate SSD) confirmed no baseline care plan was discussed or provided to Resident 4. 2. Resident 44 was admitted to the facility in 2/2024 with diagnoses including heart failure and chronic kidney disease. Resident 44's 2/2024 admission MDS indicated she/he was cognitively intact. On 5/14/24 Resident 44's clinical record was reviewed. No record was found that Resident 44 had a baseline care plan reviewed or provided to her/him. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review it was determined the facility failed to follow physician orders and provide bowel medication in a timely manner for 1 of 6 sampled residents (#57) reviewed for medications. This placed residents at risk for medical complications from constipation. Findings include: The facility's Bowel Care Protocol Policy last revised on 2/2019, specified the following: -At beginning of each shift the nurse will pull the bowel care report and identify residents that have not had a BM (Bowel Movement) for 3 days. -Residents who have not had a BM in three days will be given MOM (Milk of Magnesia). -If no BM by the following shift, a Dulcolax suppository is given. -If resident continues without BM by the next shift a Fleets enema will be given. -Residents who are noted as having small bowel movement will be assessed for constipation. -If resident exceeds four days without a BM, the nurse will complete an abdominal assessment and the physician will be notified for further orders. Resident 57…

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 it was determined the facility failed to provide appropriate foot care for 3 of 3 sampled residents (#s 26, 41 and 57) reviewed for foot care. This placed residents at risk for lack of nail care and infections. Findings include: 1. Resident 41 was admitted to the facility on 3/2024 with diagnoses including diabetes. A Physician Order dated 3/27/24 directed a licensed nurse to check Resident 41's fingernails and toenails once a week on bath day. The order indicated to trim as needed every day shift on Wednesdays for diabetic nail checks. Staff were directed to document (+) if the nails were trimmed and (-) if nail trimming was not needed. A review of the LN Task from 3/2024 through 5/2024 revealed the following: -3/27/24 nails did not need trimmed. -4/3/24, 4/10/24 and 4/17/24 nails did not need trimmed. 4/24/24 Resident 41 refused nail care. -5/1/24 nails did not need trimmed. 5/8/24 Resident 41 refused nail care. A Progress Note dated 5/9/24 revealed Staff 9…

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 it was determined the facility failed to ensure interventions were in place to prevent smoking related accidents for 1 of 2 sampled residents (#32) reviewed for accidents. This placed residents at risk for smoking-related accidents. Findings include: The facility's 10/2023 Smoking Policy and Procedure indicated the following: -Residents who wish to smoke are evaluated for their ability to smoke safely. A smoking evaluation is completed at admission or at the time they decided to smoke, to evaluate their ability to smoke safely. -Definition of Smoking Materials: Cigarettes, Cigars, Pipes, Novelties - E-Cigarettes, Vapor Devices, Ignition Sources. -Residents who do not adhere to the smoking policies are subject to revocation of their ability to smoke while a resident at the facility. Resident 32 admitted to the facility on [DATE] with diagnoses including right lower extremity cellulitis and diabetes. A 4/28/24 progress note revealed a fire alarm was triggered when…

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 it was determined the facility failed to maintain oxygen equipment and ensure oxygen was administered as ordered for 1 of 2 sampled residents (#46) reviewed for oxygen therapy. This placed residents at risk for increased risk for respiratory failure. Findings include: Resident 46 was admitted to the facility in 2/2024 with diagnoses including acute and chronic respiratory failure with hypoxia (not enough oxygen in the blood) and hypercapnia (buildup of carbon dioxide in the bloodstream). The 2/9/24 admission MDS indicated Resident 46 was cognitively intact. The 5/13/24 physician order for Resident 46 revealed the resident used continuous oxygen with a flow rate of two liters since 4/25/24. On 5/13/24 at 12:04 PM Resident 46 was observed to use an oxygen concentrator with a flow rate of three liters. The external filter on the oxygen concentrator was observed to have a layer of dust when touched with a finger. The resident stated she/he used oxygen most of the time but could not state how many liters were prescribed. On 5/16/24 at…

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 it was determined the facility failed to ensure a resident's ordered pain medication was available and effectively managed the resident's severe pain for 1 of 1 sampled resident (#36) reviewed for pain management. This failure placed residents at risk for unrelieved pain. Findings include: Resident 36 was admitted to the facility in 9/2023 with diagnoses including rheumatoid arthritis, a fractured tibia and polyneuropathy (nerve pain). A Physician Order dated [DATE] directed staff to administer Percocet (pain medication), one tablet 10-325 MG (oxycodone with acetaminophen) by mouth six times a day related to displaced bicondylar fracture of the right tibia. Resident 36's 5/2024 MAR revealed the resident was administered Percocet on [DATE] at 2:00 AM. The resident was not administered Percocet on [DATE] at 6:00 AM, 10:00 AM or 2:00 PM. A Physician Order dated [DATE] directed staff to administer oxycodone 10 MG with 325 MG Tylenol, one tablet by mouth one time only…

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 it was determined the facility failed to provide person-centered approaches to behavioral symptoms for 1 of 2 sampled residents (#32) reviewed for psychosocial well-being. This placed residents at risk for unmet psychosocial and mental health needs. Findings include: Resident 32 admitted to the facility on [DATE] with diagnoses including right lower extremity cellulitis and diabetes. The resident did not have a documented diagnosis related to mental health or trauma at the time of admission. A 3/22/24 psychiatric consultation note stated Resident 32 was, labile, cycling through post traumatic memories of fighting in the war with very graphic, disturbing traumatic content, despondent memories and escalating despair. The note recommended Resident 32 continue with psychotherapy treatments. A 4/3/24 physician visit note revealed Resident 32 was distressed from experiences with her/his time in the war. On 5/15/24 at 10:36 AM Staff 28 (CNA) stated Resident 32's…

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 it was determined the facility failed to ensure proper labeling of biologicals for 1 of 2 medication rooms reviewed for medication storage. This placed residents at risk for reduced efficacy of medication. Findings include: According to the Center for Disease Control and Prevention: Multi-Dose Vial Safety Reminders (2023): -When you first put a clean needle in the vial, write the date and time on the label. -The beyond-use-date refers to the date after which an opened multi-dose vial should not be used. The vial should be discarded within 28 days of the opened date. On 5/20/24 at 12:40 PM during a review of station one medication storage room with Staff 2 (DNS), one vial of lidocaine solution was observed to be opened with no open date. The vial indicated it was a multiple dose vial. On 5/20/24 at 12:44 PM Staff 2 acknowledged the vial of lidocaine solution was opened and not labeled with an open date.

Based on observation, interview and record review it was determined the facility failed to protect resident identifiable information and ensure records were accurate for 2 of 4 sampled residents (#s 41 and 42) reviewed for record management and insulin. This placed residents at risk for unauthorized use of their personal information and inaccurate treatment. Findings include: 1. A review of the facility's 12/2023 HIPAA (Health Insurance Portability and Accountability Act) Compliance policy indicated the facility was to safeguard all forms of PHI (Protected Health Information) for each resident. On 5/17/24 at 12:33 PM resident identifiable information including Resident 41's name, medication type, prescription number, and the resident's physician's name was observed inside a clear plastic garbage bag with no lid located on the side of a nurse treatment cart. The treatment cart was in the hallway close to the front entrance of the facility and available for anyone in the facility to see. Other items observed in the garbage bag with the resident identifiable information included used…

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 it was determined the facility failed to have a system in place to ensure residents were provided the opportunity to formulate advance directives for 1 of 1 sampled resident (#33) reviewed for advanced directives. This placed residents at risk for not being informed of choices regarding health care decisions. Findings include: Resident 33 was admitted to the facility in 2020 with diagnoses including stroke. A 1/4/23 Social Service Quarterly Review revealed the resident made her/his own decisions and was able to make her/his needs known using an interpreter. Resident 33's clinical record revealed no documentation to indicate the resident had an advance directive or was provided information concerning the right to formulate an advance directive. On 3/22/23 at 2:41 PM Staff 4 (Social Services Director) stated Resident 33 was her/his own responsible party and she did not provide the resident with an opportunity to formulate an advance directive.

Based on interview and record review it was determined the facility failed to document and conduct a Significant Change MDS assessment for 1 of 6 sampled resident (#38) reviewed for activities of daily living and hospitalizations. This placed residents at risk for unassessed care needs. Findings include: Resident 38 was readmitted to the facility 2/2023 after being hospitalized for longer than 24 hours. The resident's readmission diagnosis was fracture of the left femur. Resident 38's secondary diagnoses included dementia and diabetes. According to the CMS Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual Version 1.15, 10/2017, a Significant Change is a major decline or improvement in a resident's status that will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions; impacts more than one area of the resident's health status; and requires interdisciplinary review and/or revision of the care plan The nursing home may take up to 14 days to determine whether the criteria are met. After 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 interview and record review it was determined the facility failed to ensure a PASRR Level II (Preadmission Screening for individuals with a mental disorder and individuals with intellectual disability) was completed for 1 of 1 sampled resident (#12) reviewed for PASRR. This placed residents at risk for not receiving specialized services. Findings include: Resident 12 was admitted to the facility in 2016 with diagnoses including anxiety, depression and cognitive-communication deficit. A 6/6/2019 PASRR Mental Health Evaluation was completed for Resident 12 which recommended a PASRR Level II be completed for an Intellectual Disability/Developmental Disability as the resident likely had a developmental disability. A review of the resident's medical record revealed a progress note dated 6/2/21 documenting the request for a PASRR Level II for Developmental Disability. No evidence was found in the resident's medical record that a PASRR Level II for Developmental Disability was completed. On 3/22/23/at 2:47 PM Staff 4 (Social Services Director) stated she was not aware Resident 12…

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 it was determined the facility failed to ensure a resident's care plan accurately reflected their needs for 1 of 1 sampled resident (#8) reviewed for anticoagulant medication. Findings include: Resident 8 was admitted to the facility in 2023 with diagnoses including atrial fibrillation (irregular heart rhythm), bruising, anemia, coagulation deficit (lack of blood coagulation) and thrombosis (blood clots in large veins which may block blood flow or get lodged in the lungs). On 3/20/23 at 11:46 AM both of Resident 8's forearms were observed with numerous bruises. Her/his left forearm had a large healing scab. The resident stated she/he bruised from bumping into things and it did not matter how gentle it was. Resident 8's current physician's orders as of 3/2023 included aspirin once daily and Eliquis (anticoagulant) twice daily for atrial fibrillation. Resident 8's plan of care as of 3/2023 did not include monitoring for bruising or bleeding related to anticoagulant use. On 3/24/23 at 9:36 AM Staff 3 (LPN) confirmed Resident 8 received…

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 interview and record review it was determined the facility failed to provide necessary behavioral health care and services for 1 of 1 sampled resident (#12) reviewed for behavioral-emotional needs. This placed residents at risk for unmet behavioral and emotional needs and a decrease in their quality of life. Findings include: Resident 12 was admitted to the facility in 12/2016 with diagnoses including anxiety and depression. A review of Resident 12's Patient Health Questionnaire (PHQ-9, a validated interview that screens for symptoms of depression) scores from 6/2018 to 9/2022 revealed the resident's scores ranged from zero to four, which was indicative of mild depression. Resident 12's [DATE] PHQ-9 score was 10, which indicated moderate depression. Resident 12's [DATE] Social Service Quarterly Review failed to identify the resident's increased PHQ-9 score on [DATE] or provide an assessment of the resident's mood state. Resident 12's [DATE] Care Plan indicated the resident had the potential for mood and…

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 it was determined the facility failed to ensure residents were free from significant medication errors for 1 of 6 sampled residents (#22) reviewed for medications. This placed residents at risk for adverse medication consequences. Findings include: Resident 22 was re-admitted to the facility in 2022 with diagnoses including cancer and was receiving hospice services. Resident 22's 2/2023 MAR revealed the following narcotic medication orders: - Clonazepam (antianxiety) 1 mg, give one tablet every eight hours at 6:00 AM, 2:00 PM and 10:00 PM. The MAR indicated the clonazepam was administered at every ordered administration time from 2/1/23 through 2/26/23. - Lorazepam (antianxiety) 0.5 mg, give 0.5 mg every four hours at 12:00 AM, 4:00 AM, 8:00 AM, 12:00 PM, 4:00 PM and 8:00 PM. The MAR indicated the lorazepam was administered at every ordered administration time from 2/18/23 through 2/26/23. Resident 22's controlled substance log book sheets revealed the following: - Page #27 indicated the clonazepam was administered on 2/20/23 at 12:00 AM and 4:00…

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 it was determined the facility failed to employ a director of food and nutrition services with the required certification for 1 of 1 facility reviewed for qualified dietary staff. This placed residents at risk for unmet dietary needs. Findings include: Observations from 3/20/23 through 3/27/23 from 8:15 AM to 4:30 PM revealed Staff 7 (Food Service Manager) functioned in the capacity of the facility's director of food and nutrition services. On 3/20/23 at 3:42 PM Staff 7 reported he was currently enrolled in a program to become a Certified Food Service Manager and completed the required course. He stated he had not taken the exam yet but planned to in the next couple of weeks. He also stated he attended culinary school but was not sure if that would satisfy the requirements to be a director of food and nutrition services. A review of Staff 7's culinary certification revealed it did not meet the minimum requirements for a director of food and nutrition services. On 3/27/23 at 1:13 PM Staff 1 (Administrator) verified Staff 7 did not…

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 it was determined the facility failed to prepare and store foods in a manner to prevent cross contamination and spoilage for 1 of 1 kitchen reviewed for sanitary practices and 1 of 1 resident (#31) reviewed for food service and storage. This placed residents at risk of foodborne illness. Findings include: 1. On 3/20/23 at 9:10 AM during the initial tour of the facility's kitchen, the main prep island between the stove and dishwashing room was observed to have an open bag of chopped lettuce, an open container of sliced pickles, an open bin of sliced tomatoes and an open bin of sliced onions. Staff 8 (Dietary Aide) was observed scraping food debris from dishes into a garbage container. He reported the cook who was working with these items was on his break. No one else was observed working in the kitchen at that time. On 3/20/23 at 3:38 PM, Staff 7 (Food Service Manager) reported he was aware the cook left the items on the island to go to the bathroom. He reported he expected the items to be covered and stored in the refrigerator when…

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.