Courtyard Gardens Nursing And Rehab Ctr

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff interviews, it was determined that the facility failed to provide the highest practical well-being by not following physician orders as well as involve the physician in treatment changes for one of two residents reviewed (Resident 2).Findings include:Review of Resident 2's clinical record revealed diagnoses that included respiratory failure (a condition where the lungs cannot get enough oxygen into the blood) and hypertension (high blood pressure).Review of Resident 2's clinical record revealed the Resident was admitted to the facility on [DATE], with an abdominal fistula (an abnormal opening between the intestines or stomach and another organ or the skin, causing leakage of digestive fluids) which is covered with a colostomy bag (a discreet, odor-proof, disposable pouching system that collects waste from the body).Review of Resident 2's current physician orders revealed an active order for abdominal fistula care, cleanse all abdomen area and fistula site, apply the zinc…

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 clinical record review and staff interviews, it was determined that the facility failed to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care for one of one resident reviewed (Resident 2).Findings include:Review of Resident 2's clinical record revealed diagnoses that included respiratory failure (a condition where the lungs cannot get enough oxygen into the blood) and hypertension (high blood pressure).Review of Resident 2's clinical record revealed the Resident was admitted to the facility on [DATE], with an abdominal fistula, which is covered with a colostomy bag.Review of Resident 2's current physician orders revealed an active order for abdominal fistula care, cleanse all abdomen area and fistula site, apply the zinc oxide mixed with A&D ointment (vitamin A & D topical ointment) all over abdomen and around fistula site, then apply pantie liner or…

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 clinical record review and staff interviews, it was determined that the facility failed to ensure the resident assessment accurately reflected the resident status for one of 19 residents reviewed (Resident 36). Findings Include: Review of Resident 36's clinical record revealed diagnoses that included diabetes mellitus (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), psychosis (a mental disorder when a person has trouble telling the difference between what's real and what's not), and muscle weakness. Review of Resident 36's Quarterly MDS (Minimum Data Set - an assessment tool to review all care areas specific to the resident such as a resident's physical, mental, or psychosocial needs) with ARD (assessment reference date- last day of the assessment period) of May 3, 2024, revealed it was coded that the Resident received one insulin injection in the past 7 days and that an insulin order had changed in the past 7 days. Review of Resident 36's Quarterly MDS with ARD of August 2, 2024, revealed it was coded that the Resident 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.

Based on policy review, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure the care plan was reviewed and revised for three of 21 residents reviewed (Residents 18, 69, and 81). Findings include: Review of facility policy, titled Care Plans, last reviewed December 28, 2023, read, in part, This facility will develop and maintain a comprehensive care plan for each resident that includes measurable objectives and timetables to meet the resident's medical, nursing, and mental and psychosocial needs that include but are not limited to those identified in the comprehensive assessment. The plan of care will be reviewed in an ongoing manner and progress or lack thereof toward established goals will be documented within the medical record of the resident. If appropriate, the care plan will be revised as needed. Review of Resident 18's clinical record revealed diagnoses of muscle weakness (a lack of muscle strength) and disorders of phosphorus metabolism (a condition where blood phosphate levels are too low. Symptoms include muscle…

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 policy review, clinical record review, observations, and staff interviews, it was determined that the facility failed to ensure that residents receive necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection for one of four residents reviewed for pressure ulcers (Resident 69). Findings include: Review of the facility policy, titled Skin Integrity Interventions and Protocol for The Middletown Home, last reviewed on December 28, 2023, revealed that interventions for pressure ulcer preventions include: Implement pressure-relieving measures for residents at risk, including: frequent repositioning, use of pressure-reducing mattresses and cushions, proper skin care, including cleansing and moisturizing, adequate nutrition and hydration, and management of incontinence. Review of Resident 69's clinical record revealed diagnoses that included hypertension (high blood pressure) and peripheral vascular disease (a slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel).…

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 document review and staff interviews, it was determined the facility failed to develop a Water Management Program for the prevention, detection, and control of water-borne contaminants, such as Legionella, a bacteria that may cause Legionnaires' Disease (a serious type of pneumonia). Findings include: During an interview with the Nursing Home Administrator (NHA) on November 7, 2023, at 11:00 AM, the NHA was unable to provide a policy that addressed water management or a list of water management team members. During the interview with the NHA on November 7, 2023, data was requested and unable to be provided, that would support implementation of a water management program, such as Legionella risk assessment, a water system flow chart that identifies risk areas such as, testing of shower heads, the ornamental fountain, or the pond that is active during Spring and Summer. The facility was able to provide professional water testing with a most recent date of October 26, 2023, to determine proper functioning of the cooling systems for pH (acidity or basicity), total alkalinity,…

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 facility policy review, observations, product label review, and staff interviews, it was determined that the facility failed to store food and beverages in accordance with professional standards for food service safety in the main kitchen and four of four nourishment areas. Findings include: Review of facility policy, titled Food and Nutrition Services Policies and Procedures: Storage of Goods, revealed, Remove goods from storage for which the expiration date has passed .All foods will be labeled with month/day/year received .Leftovers are to be covered, labeled, and dated with use by date .All foods must be labeled and dated. Review of facility policy, titled Food and Nutrition Services Policies and Procedures: Foods Brought by Family/Visitors, revealed, Perishable foods must be destroyed daily .All food items must be labeled with the resident's name and use by date and the date brought in and/or opened. Observation of the dry storage area on November 5, 2023, at 9:39 AM, revealed: one bag of rice open without a date; one open bag of rotini without an open date; one open…

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 document review and staff interviews, it was determined that the facility failed to ensure each resident is informed of the items and services for which the resident may be charged and the amount of charges for those services at the conclusion of the Medicare A skilled services stay by issuing the Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage form (SNF ABN) for two of three residents reviewed at the conclusion of the Medicare A covered stay (Residents 37 and 64). Findings Include: Review of Resident 37's SNF Beneficiary Protection Notification Review form revealed the Resident's last covered day of Medicare Part A services to be September 22, 2023. Continued review of the form revealed the facility had not issued the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage form [SNF-ABN, CMS-10055] at the conclusion of the Medicare Part A services stay. The SNF-ABN form is the liability form issued by skilled nursing facilities as the liability notice that describes an item or service that is usually paid for by Medicare, but may not be…

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 state regulations, surveyor observation, facility policy review, clinical record review, and staff interview, it was determined that the facility failed to ensure care and services were provided in accordance with professional standards for one of 24 residents reviewed (Resident 27). Findings Include: Review of the Pennsylvania Nursing Practice Act, Chapter 21.145. Functions of the LPN (Licensed Practical Nurse), revealed The LPN administers medication and carries out the therapeutic treatment ordered for the patient in accordance with the following: The LPN may accept a written order for medication and therapeutic treatment from a practitioner authorized by law and by facility to issue orders for medical and therapeutic measures. Review facility policy, titled Medication Administration General Guidelines, dated 2006, revealed in section B. Administration, Step 2. Medications are administered in accordance with written orders of the attending physician. Review of Resident 27's clinical record revealed diagnoses that include low back pain between the lower edge of the ribs…

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 observations, record review, and staff interviews, it was determined that the facility failed to follow physician orders for two of 20 residents reviewed (Residents 38 and 53). Findings Include: Review of Resident 38's clinical record revealed diagnoses that included Parkinson's Disease (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow imprecise movement), dementia (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning), and muscle weakness. Review of Resident 38's physician orders revealed an order for Geri Sleeves BUE (bilateral upper extremities) every shift for skin protection, may remove for care and soilage, with a start date of August 3, 2023. Observation of Resident 38 on November 5, 2023, at 1:28 PM, revealed Resident 38 asleep, sitting in a common area of the hall without Geri sleeves on. Observation of Resident 38 on November 6, 2023, at 10:18 AM, revealed Resident 38 in his room, drinking out of a cup without Geri sleeves on. Observation…

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 clinical record review and staff interview, it was determined that the facility failed to develop and implement a baseline care plan for each resident within 48 hours of the resident's admission for one of 26 residents reviewed (Resident 50). Findings Include: Review of Resident 50's clinical record revealed an admission date of September 19, 2022, and diagnoses that included osteoarthritis (a type of arthritis that occurs when flexible tissue at the ends of bones wears down) and abnormalities of gait (walking) and mobility (the ability to move or be moved freely and easily). Review of Resident 50's admission Fall Risk assessment dated [DATE], revealed that the Resident had experienced three or more falls in the last three months prior to admission, and that their fall risk score was 24. The guidelines on the Fall Risk Assessment indicated that a score of 10 or higher represents a high risk for fall. In the section of the Fall Risk Assessment titled Indicate Care Plan Action Taken, it was marked to…

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

Based on policy reviews, observations, and resident and staff interviews, it was determined that the facility failed to provide respiratory services consistent with professional standards of practice for two of 21 residents reviewed (Resident 32 and 89). Findings include: Review of facility policy titled Nebulizers - Use and Care dated June 2011 revealed After each use, wipe mouth piece with a paper towel, removing all moisture, and store in a plastic bag. Review of facility provided policy titled Oxygen therapy revised June 2019, revealed, Change the cannula, tubing, and humidifier bottle every week or more frequently, if needed. Review of Resident 32's clinical record revealed diagnoses that included chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), dependence on supplemental oxygen, and sleep apnea (a potentially serious sleep disorder in which breathing repeatedly stops and starts). Review of Resident 32's current physician orders revealed the following orders: continuous positive airway pressure (CPAP- a…

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