Carlyle Senior Care of Blackville

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and facility policy review, the facility failed to ensure correct installation, use, and maintenance of bed rails for 3 of 3 residents (Residents (R)4, R56, and R72) reviewed for bed rails out of a total of 20 sampled residents. This failure had the potential for risk of resident entrapment and injury. Findings include:Review of the facility policy titled Proper Use of Bed Rails dated 2022, revealed, It is the policy of this facility to utilize a person-centered approach when determining the use of bed rails . If bed rails are used, the facility ensures correct installation, use, and maintenance of the rails. Under Installation and Maintenance of Bed Rails Item twelve revealed, The facility will assure the correct installation and maintenance of bed rails, prior to use. This includes: a. Checking with the manufacturer(s) to make sure the bed rails, mattress, and bed frame are compatible. Rails should be selected and placed to discourage climbing over rails. B.…

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 5 of 5 Certified Nursing Assistants ((CNA)5, CNA7, CNA8, CNA9, and CNA10), were provided the required 12-hours of annual in-service training. 1.Review of the facility's employment file for CNA 5 revealed a date of hire of 03/17/23. The employment file for CNA5 contained evidence that CNA5 participated in the annual skills fair provided by the facility but lacked evidence of the 12 hours of in-service training annually.2.Review of the facility's employment filed for CNA7 revealed a date of hire of 03/29/23. The employment file for CNA7 contained evidence that CNA7 participated in the annual skills fair provided by the facility but lacked evidence of the 12 hours of required in-service training annually. 3.Review of the facility's employment filed for CNA8 revealed a date of hire of 09/13/10. The employment file for CNA8 contained evidence that CNA8 participated in the annual skills fair provided by the facility but lacked evidence of the 12 hours of required in-service training annually. 4.Review of the facility'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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, record review, document review, and facility policy review, the facility failed to timely report an allegation of sexual abuse to the state survey agency that involved 1 (Resident #5) of 3 sampled residents reviewed for abuse.Findings included:A facility policy titled, Abuse, Neglect and Exploitation, revised 10/24/2022, revealed, VII. Reporting/Response A. The facility will have written procedures that include: 1. Reporting of all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies within specified timeframes: a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury.An admission Record revealed the facility admitted Resident #5 to the facility on [DATE]. According to the admission Record, the resident had a medical history that included diagnoses of chronic obstructive pulmonary disease, muscle weakness, anxiety disorder,…

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, record review, document review, and facility policy review, the facility failed to ensure certified nurse aides (CNAs) notified a nurse of a resident's fall before the staff assisted the resident off the floor. Specifically, on 09/17/2025, CNA #6 and CNA #7 placed Resident #3 back in bed after the resident was found on the floor and did not inform Licensed Practical Nurse (LPN) #8 that the resident had fallen. This failure contributed to a lack of assessment for any injuries the resident might have sustained as the result of the fall. The resident was assessed on 09/18/2025 and had no injuries at the time of the incident on 09/17/2025 or post incident on 09/18/2025. This deficient practice affected 1 (Resident (R)#3) of 3 sampled residents reviewed for accidents.Findings included:A facility policy titled, Fall Prevention Program, revised 09/01/2023, indicated, A fall is an event in which an individual unintentionally comes to rest on the ground, floor, or other level, but was not as a result of an overwhelming external force. The event may be witnessed, reported,…

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 review of facility policy, record review, observation and interviews, the facility failed to provide Residents and/or their Resident Representatives financial quarterly statements for 3 of 4 Residents (R)45, R51, and R52 reviewed for personal funds. Findings include: Review of facility policy titled Resident Personal Funds last revised 07/24 revealed, The resident has the right to manage his or her financial affairs to include the right to know, in advance, what charges a facility may impose against a resident's personal funds. Policy explanation and compliance guidelines: If the resident chooses to deposit personal funds with the facility, upon written authorization of a resident, the facility must act as a fiduciary of the resident's funds and hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility. Accounting and records: the individual financial record must be available to the resident through quarterly statements and upon request. Record 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of facility policy, record review and interviews, the facility failed to notify Residents and Resident Representatives of account balances exceeding the Medicaid eligibility limit, which had the potential to disqualify the residents of Medicaid services for 3 of 4 Residents (R)44, R51, and R52 reviewed for personal funds. Findings include: Review of facility policy titled Resident Personal Funds last revised 07/24 revealed, The residents have a right to manage his or her financial affairs to include the right to know, in advances, what charges a facility may impose against a resident's personal funds. The facility must notify each resident that receives Medicaid benefits when the amount in the resident's account reaches $200 less that the Supplemental Security Income (SSI) resource limit for the one persona and; if the amount in the account, in addition to the value of the resident's other nonexempt resources, reaches the SSI resource limit for one person, the resident may lose eligibility 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 record review and staff interviews, the facility failed to ensure a Registered Nurse (RN) was scheduled for at least eight consecutive hours a day on five days during Quarters 3 and 4 of Fiscal Year (FY) 2022. This had the potential to affect all the residents residing in the facility. Findings include: Review of the facility's policy titled Nursing Services-Registered Nurse (RN) dated 10/24/22 revealed, . It is the intent of the facility to comply with Registered Nurse staffing requirements . The facility will utilize the services of a Registered Nurse for at least 8 consecutive hours per day, 7 days per week . Review of the facility assessment, dated 10/01/22 revealed, . Staffing for the facility is as follows . RN for 8 hours daily . Review of the Payroll Based Journal (PBJ) Staffing Data Report for Quarter 3 (April 1 - June 30) and Quarter 4 (July 1 - September 30) of FY 2022 revealed the facility failed to have a RN on duty for 8 consecutive hours on 04/23/22, 04/24/22, 05/08/22, 05/14/22, 05/15/22, 05/29/22, 06/04, 06/05, 06/12, 06/19/22, 06/25/22, 07/23/22, 08/13/22,…

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, interview, record review, and facility policy review, the facility failed to ensure one (Resident (R)224) of twenty sampled residents was clinically appropriate to self-administer medication and did not self-administer his inhalant (nebulizer) medication. The facility's deficient practice increased R224's risk of adverse medication consequences. Findings include: Review of the facility's policy titled Resident Self-Administration of Medication, dated 10/22/22, revealed, . It is the policy of this facility to support each resident's right to self-administer medication. A resident may only self-administer medication after the facility's interdisciplinary team has determined which medications may be self-administered safely . The results of the interdisciplinary team assessment are recorded on the Medication Self-Administration Assessment Form, which is placed in the resident's medical record . Review of the facility's policy titled Medication Administration, dated 04/15/19, revealed, . Medications are administered by licensed nurse . Review of the facility'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, interview, record review, and facility policy review, the facility failed to ensure one (Resident (R)24) of three sampled residents reviewed for activities of daily living (ADLs) received assistance with nail care and oral care. The facility's deficient practice increased R24's risk of poor personal hygiene and plaque associated oral diseases. Findings include: Review of the facility's policy titled Providing Nail Care, dated 05/12/21 revealed, . The purpose of this procedure is to provide guidance for the provision of care to a resident's nails for good grooming and health . Routine cleaning and inspection of nails will be provided during ADL care on an ongoing basis . Routine nail care, to include trimming and filing, will be provided on a regular schedule as indicated. Nail care will be provided between scheduled occasions as the need arises . Nail should be kept smooth to avoid skin injury . Only licensed nurses shall trim or file fingernails of a resident with diabetes . Review of the facility's policy titled Oral Care, dated 11/20/18 revealed, . It is 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, interview, and policy review, the facility failed to ensure the attending physician provided a clinical rationale for declining the pharmacist recommendation for one (Resident (R)48) of five sampled residents reviewed for unnecessary medications. This failure increased the risk that residents would continue to receive unnecessary medications that potentially could cause serious adverse effects. Findings include: Review of the facility's policy titled Gradual Dose Reduction of Psychotropic Drugs, dated 10/24/22 revealed, . Residents who use psychotropic drugs receive gradual dose reductions and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs . Reducing the need for and maximizing the effectiveness of medications shall be considered for all residents who use psychotropic drugs. Therefore, dose reductions and behavioral interventions are part of medication management . For any individual who is receiving a psychotropic medication to treat a disorder other than expressions or indications of distress related 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 record review and interview, the facility failed to ensure that binding arbitration agreements contained explicit language informing residents that signing the binding arbitration was not a condition of admission to the facility and failed to ensure residents indicated by signature that they understood the binding arbitration agreement for 2 (Resident (R) 29 and R58) of 3 sampled residents reviewed for binding arbitration agreements. Findings include: 1. Review of R29's admission Minimum Data Set (MDS), located in the electronic medical record (EMR) under the MDS tab and with an Assessment Reference Date (ARD) of 01/31/23, revealed R29 was admitted to the facility with diagnoses that included nontraumatic intracranial hemorrhage, altered mental status, and generalized muscle weakness. The MDS indicated R29 had a Brief Interview for Mental Status (BIMS) score of 11 out of 15, indicating moderate cognitive impairment. Review of the facility's Binding Arbitration Agreement, provided by the facility, revealed, . Warranty of Capacity and Comprehension. Resident and, if present,…

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, record review, facility policy review, and Centers for Disease Control and Prevention (CDC) guidelines, the facility failed to ensure the pneumococcal vaccination was offered to four (Resident (R) 38, 50, 51, and 52) of five sampled residents reviewed for influenza/pneumococcal vaccinations. Findings include: Review of the facility's policy titled Pneumococcal Vaccine (Series), dated 10/24/22 and provided by the facility revealed, . Each resident will be offered a pneumococcal immunization unless it is medically contraindicated, or the resident has already been immunized. Following assessment for any medical contraindications, the immunization may be administered in accordance with physician-approved 'standing orders' . The type of pneumococcal vaccine (PCV13, PPSV23/PPSV) offered will depend upon the recipient's age and susceptibility to pneumonia, in accordance with current CDC guidelines and recommendations . A series of vaccinations will be offered to immunocompetent* [sic] adults [equal…

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.