Life Care Center Of Hickory Woods

Based on facility policy review, observation, and interview, the facility failed to maintain a clean and sanitary environment when food debris was found on top of and inside the deep fryer, oil was observed dripping from the fryer onto the floor, a black, dried liquid substance was observed on the floor behind and around the stove, oven, deep fryer, ice machine, along the base boards and in the corners of the kitchen and when carbon build up and food debris was observed on the stovetop. The facility's census was 112 and 111 residents received meal trays from the kitchen. The findings include:1. Review of the facility policy titled, Food Safety and Sanitation.Cleaning Schedule, dated 4/30/2025, revealed .shall develop a routine cleaning schedule to ensure.department is maintained in a clean and sanitary manner. 2. Observations in the kitchen on 11/16/2025 at 9:45 AM, 11/17/2025 at 3:50 PM, and 11/18/2025 at 8:15 AM and 2:45 PM, revealed the following: a. The deep fryer had food debris on the top and inside of the deep fryer, oil drippings down the outside of the deep fryer, and oil…

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 the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual, policy review, medical record review, and interview, the facility failed to ensure assessments were signed to reflect timely submission and failed to complete quarterly assessments timely, using the Centers for Medicare & Medicaid Services-specified RAI process within the regulatory time frames for 3 of 23 (Resident #5, #92, and #148) sampled residents reviewed. The findings include: 1. The MDS 3.0 RAI Manual v (version) 1.20.1 October 2025, page 2-35, revealed .The Quarterly assessment is an OBRA (Omnibus Budget Reconciliation Act) non-comprehensive assessment for a resident that must be completed at least every 92 days following the previous OBRA assessment of any type. It is used to track a resident's status between comprehensive assessments to ensure critical indicators of gradual change in a resident's status are monitored.The MDS completion date (Item Z0500B) must be no later than 14 days after the ARD…

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 the Centers for Disease Control and Prevention (CDC) guideline review, policy review, medical record review, observation, and interview, the facility failed to ensure infection control practices to prevent the spread of communicable diseases when 3 of 3 staff (Certified Nursing Assistant (CNA) A, CNA B, and CNA C) failed to don personal protective equipment (PPE) and properly perform urinary catheter care for 2 of 2 (Resident #135 and #158) sampled residents reviewed for enhanced barrier precautions and catheter care. The findings include: 1.Review of the CDC article titled Frequently Asked Questions (FAQs) about Enhanced Barrier Precautions in Nursing Homes, dated June 28, 2024, revealed .Enhanced Barrier Precautions are an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs) in nursing homes. Enhanced Barrier Precautions involve gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO…

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 facility policy review, medical record review, observation, and interview, the facility failed to ensure call lights were within reach for 1 of 118 (Resident #82) sampled residents reviewed for access to call lights. The findings include: Review of the facility's policy titled, Resident Call System, revised on 1/4/2023, revealed, .The nurses' stations in the facility will be equipped to receive resident calls with a communication system through audible or visual signals from resident rooms .The call light should be positioned in reach of the resident .The call system must be accessible to residents while in their bed or other sleeping accommodations within the resident's room . Review of the medical record revealed Resident #82 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included Hemiplegia and Hemiparesis (conditions that cause weakness or paralysis of one side of the body) following cerebral Infarction (condition that occurs when blood flow to the brain is…

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 facility policy review, medical record review, Facility Reported Investigation (FRI) review, and interview, the facility failed to report allegations of abuse within 2 hours for 2 of 3 (Residents #170 and #270) sampled residents reviewed for abuse. The findings include: Review of the facility policy titled, Incident and Reportable Event Management, with revision date of 5/4/2023 revealed, .Reporting of Alleged Violations .Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment .are reported immediately, but not later than 2 hours after the allegation is made . Review of the medical record revealed Resident #170 was admitted to the facility on [DATE] and discharged on 10/3/2023 with diagnoses which included Chronic Obstructive Pulmonary Disease, Altered Mental Status, Cognitive Communication Deficit, Type 2 Diabetes Mellitus with Diabetic Neuropathy, and Atherosclerotic Heart Disease. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #170 had…

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 facility policy review, Resident Assessment Instrument (RAI) Version 3.0 Manual review, medical record review, and interview, the facility failed to complete a Significant Change Minimum Data Set (MDS) assessment for 1 of 4 residents (Resident #273) reviewed. The findings include: Review of the facility's policy titled, Resident Assessment Instrument & Care Plan Development, revised [DATE], revealed, .The facility will follow the procedures set forth in the Resident Assessment Instrument (RAI) User's Manual 3.0 when completing the MDS, Care Area Assessment, and Comprehensive Care Plan .MDS assessments are completed at a minimum upon admission, quarterly, and with a significant change in patient status . Review of the RAI Version 3.0 Manual revealed, .When a SNF [Skilled Nursing Facility] or NF [Nursing Facility] is the hospice resident's residence for purposes of the hospice benefit .the resident must be assessed using the RAI .Comprehensive assessments are completed upon admission, annually, and when 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, medical record review, document review, and interview the facility failed to revise care plans for 2 of 5 (Residents #170 and #270) sampled residents reviewed for resident-to-resident physical altercations, 1 of 6 (Resident #175) sampled residents reviewed for fall interventions, 1 of 3 (Resident #111) sampled residents with urinary catheters, 1 of 5 (Resident #18) sampled residents reviewed for changes to antipsychotic medication, and 1 of 4 (Resident #273) sampled residents reviewed for hospice services. The findings include: Review of the facility's policy titled, Comprehensive Care Plan and Revision dated [DATE], revealed, .The facility will ensure .that the comprehensive care plan is reviewed and revised by an interdisciplinary team .The facility should monitor the resident over time to help identify changes in the resident condition that may warrant an update to the person-centered plan of care .When changes occur, the facility should review and update the plan of care 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, facility documentation, and interview, the facility failed to provide incontinence care for 6 of 31 (Residents #6, #40, #55, #99, #103, and #108) sampled residents reviewed for incontinence care. The findings include: Review of the facility policy titled, Activities of Daily Living (ADLs), with a revision date 2/12/2024 revealed, .The resident will receive assistance as needed to complete activities of daily living .Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice .and the residents ' choices .The facility must provide care and services in accordance with paragraph (a) for the following activities of daily living .Hygiene-bathing, dressing, grooming .A resident who is unable to carry out activities of daily living receives the necessary services to maintain good .grooming, and personal .hygiene .Assist resident with bed/wheelchair repositioning as necessary…

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 facility policy review, medical record review, and interview, the facility failed to follow Medical Doctor's (MD) orders for 1 of 9 (Resident #275) sampled residents reviewed. The findings include: Review of the facility policy titled, Administration of Medications, revised 2/13/2023, revealed, .The facility will ensure medications are administered safely and appropriately per physician order to address residents' diagnoses and signs and symptoms .Staff who are responsible for medication administration will adhere to the 10 Rights of Medication Administration .Right Documentation .Medication administrations should be documented timely following the administration to the resident. Review of the facility policy titled, Nursing Documentation, issued 8/20/2019, revealed, .The medical record must reflect .the care and services provided across all disciplines . Review of the medical record revealed Resident #275 was admitted to the facility on [DATE] with diagnoses which included Acute Respiratory Failure,…

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 facility policy review, medical record review, facility documentation, and interview, the facility failed to implement an effective pain management regimen for 1 of 6 (Resident #111) sampled residents reviewed for pain management. The findings include: Review of the facility policy titled, Pain Assessment and Management, with revision date 9/12/2023 revealed, .All residents will be assessed for pain indicators upon admission/readmission, quarterly and with any change in condition .The facility must ensure that pain management is provided to residents who require such services; consistent with professional standards of practice .and the residents ' goals and preferences .Identifying and using specific strategies for preventing or minimizing different levels or sources of pain or pain-related symptoms based on the resident-specific assessment, preferences and choices, a pertinent clinical rationale, and the resident's goals . Review of the medical record revealed Resident #111 was admitted to 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, medical record review, facility document review, and interview the facility failed to provide pharmaceutical services policies and procedures that ensured the dispensing and disposition (possession or control of medication) of physician ordered medications to meet the needs of each resident in 1 of 1 (Resident #275) sampled resident reviewed for taking medications brought in from home by a family member. The findings include: Review of the facility policy titled, MEDICATIONS BROUGHT TO NURSING CARE CENTER BY RESIDENT OR RESPONSIBLE PARTY, dated 1/2023, revealed, .Medications brought into the nursing care center by a resident or responsible party are accepted only with a current order by the resident's prescriber, after the contents are verified by the nurse, and if packaging meets the state, federal and pharmacy's guidelines .Use of the medications brought to the nursing care center by a resident or responsible party is allowed only when the following conditions are met and is…

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, observation, and interview the facility failed to maintain a resident call system to allow a resident or resident representative to call for staff assistance through a communication system which relays the call directly to a centralized staff work area for 1 of 31 (Resident #105) sampled residents reviewed. The findings include: Review of the facility's policy titled, Resident Call System, revised on 1/4/2023, revealed, .The nurses' stations in the facility will be equipped to receive resident calls with a communication system through audible or visual signals from resident rooms .The call light should be positioned in reach of the resident .The call system must be accessible to residents while in their bed or other sleeping accommodations within the resident's room .In the event that the nurse call system becomes inoperable .Director of Maintenance .should be called immediately if there is a malfunction of any portion of the system . Observation in Resident #105's room on 8/20/2024 at 10:15 AM, the call light was without a cord for the resident or resident…

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 facility policy review, medical record review and interview, the facility failed to provide a duration for the use of a PRN (as needed) psychotropic (chemical substance that alters perception, mood, consciousness, cognition or behavior) medication for 1 (#14) of 16 residents reviewed for unnecessary medications. The findings include: Review of facility policy, Psychotropic Medication Use, revised 11/28/16 revealed .A psychotropic drug is any medication that affects brain activities associated with mental processes and behavior .PRN [as needed] orders for psychotropic drugs should be limited to 14 days .if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order .PRN orders for anti-psychotic drugs should be limited to 14 days and should not be renewed unless the attending physician or prescribing practitioner…

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.