Clarksville Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, and record review, the facility failed to ensure that residents were free of significant medication errors for 1 of 1 resident (Resident #15) reviewed for insulin administration. The facility did not ensure LVN K administered Resident #15's Novolog (insulin medication) according to the manufacturer's instructions on 12/08/25. This failure could place residents at risk of medical complications and prevent them from receiving the therapeutic effects of their medications. Findings included: Record review of Resident #15's face sheet, dated 12/10/25, reflected Resident #15 was a [AGE] year-old male, admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included Type 2 diabetes mellitus (lifelong condition where the pancreas makes little or no insulin, which leads to high blood sugar levels), stroke, and high blood pressure Record review of Resident #15's quarterly MDS assessment, dated 11/26/25, indicated Resident #15 made himself understood 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview the facility failed to ensure all drugs were stored in a locked compartment, only accessible by authorized personnel, and labeled and dated correctly for 1 of 25 residents (Resident #11) observed for medication storage. 1. The facility failed to ensure Resident #11 did not have hydrocortisone cream and Neosporin on his bedside table and dresser. These failures could place residents at risk for not receiving drugs and biologicals as needed, or overmedicating, .Findings include: Record review of Resident #11's face sheet dated 12/10/25 indicated he was a [AGE] year-old male who re-admitted to the facility on [DATE] with the diagnoses PTSD (post-traumatic stress disorder), Dementia (cognitive decline that effects daily life caused by brain cell damage), major depressive disorder (persistent sadness, loss of interest, fatigue, and change in sleep/appetite), diabetes mellitus (chronic metabolism condition marked by high blood sugars), and presbyopia (natural age-related loss 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 observations, interviews, and record reviews, the facility failed to provide special eating equipment and utensils for residents who need them and appropriate assistance to ensure that the resident can use the assistive devices when consuming meals for 1 of 5 (Resident #19) residents reviewed for special eating equipment and assistance when consuming meals. The facility failed to ensure Resident #19 had a physician's ordered cup with lid for drinking fluids. This failure could place residents at risk for harm by weight loss, diminished independence, and self-esteem.Findings included:Record review of Resident #19's face sheet, dated 12/10/25, reflected Resident #19 was an [AGE] year-old female, admitted to the facility on [DATE] with a diagnosis which included Alzheimer's (progressive disease that destroys memory and other important mental functions). Record review of Resident #19's order summary report, dated 12/10/25, reflected regular texture, thin consistency, fortified foods, and cup with lid 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 6 residents (Resident #13) room reviewed for infection control practices and enhanced barrier precautions. 1) The facility failed to ensure the Treatment nurse used the proper handwashing technique while providing wound care for Resident #13. 2) The facility failed to ensure the Treatment Nurse disinfected her scissors during wound care when she cut the dirty dressing and then cut the clean dressing with the contaminated scissors. These failures could place residents at increased risk for serious complications from a communicable disease that could diminish the residents' quality of life.Findings included: Record review of Resident #13's face sheet dated 12/10/25 indicated he was an [AGE] year-old male who admitted 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 interview, and record review the facility failed to treat each resident with respect and dignity that promoted maintenance or enhancement of quality of life for 1 of 14 residents reviewed for resident rights. (Resident #12) 1. The facility failed to treat Resident #12 with dignity and respect witnessed by Resident #43 when CNA D told Resident #12 Oh no ma'am, we are not fixing to do this because I am not going to be the one on 03/25/24 with an attitude and rude tone . These failures could place residents at risk for decreased quality of life, decreased self-esteem and increase anxiety. Findings included: 1. Record review of a face sheet dated on 09/17/2024 reflected Resident #12 was an [AGE] year-old female admitted to the facility on [DATE] with the diagnoses of slurred speech (weakness in the muscles used for speech, which often causes slowed or slurred speech), anxiety disorder unspecified (a diagnosis given when someone experiences clinically significant anxiety but doesn't meet the criteria for 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 interview and record review, the facility failed to ensure the Pre-admission Screening and Resident Review (PASRR) Level I assessment accurately reflected the resident's status for 1 of 6 residents (Resident #24) reviewed for PASRR Level I screenings. 1. The facility failed to ensure the accuracy of the PASRR Level 1 screening for Resident #24. The PASRR Level 1 screening did not indicate a diagnosis of mental illness, although the diagnosis (PTSD with an onset date of 04/16/21) was present upon Resident #24's re-admission date on 05/17/2024. 2. The facility failed to ensure the accuracy of the PASRR Level 1 screening for Resident #24. The PASRR Level 1 screening did not indicate a diagnosis of mental illness, after a new diagnosis of major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), with an onset date of 08/28/24. The facility did not complete a 1012 form to update the PASRR Level 1 with the new diagnosis until surveyor intervention 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 observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan to meet each resident's medical, nursing, mental and psychosocial needs for 1 of 6 residents reviewed for care plans. (Resident #28) The facility failed to implement Resident #28's signed physician order dated 03/31/2024 for occupational therapy to evaluate Resident #28 for a coffee lid. This failure could place residents at risk of not having individual needs met, a decreased quality of life, and cause residents not to receive needed services. Findings included: 1. Record review of a face sheet dated on 09/17/2024 indicated Resident #28 was an [AGE] year-old female admitted to the facility on [DATE] with the diagnoses of exudative age-related macular degeneration, left eye, stage, (a severe form of the disease that occurs when abnormal blood vessels grow under the retina and leak fluid and blood), muscle weakness (generalized) (lack of muscle strength), unsteadiness on feet…

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 the facility failed to ensure a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals, and preferences for 1 of 2 residents (Resident #147) reviewed for respiratory care and services. The facility failed to change the filter on an oxygen concentrator machine that were in use for Resident #147 on 09/16/24. This failure could place residents at risk for developing respiratory complications. Findings included: Record review of Resident #147's face sheet, dated 09/17/24, indicated he was a [AGE] year-old male, admitted to the facility on [DATE]. His diagnoses included heart failure (a chronic condition in which the heart is unable to pump blood effectively), and shortness of breath. Review of Resident #147 MDS reflected they did not have an OBRA MDS assessment completed at the time of this visit. It was not yet due to be completed. During an…

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, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the facility's only kitchen and the facility's only dining room. The facility failed to ensure that a canister of oatmeal was closed properly in an airtight container after opening. The facility failed to ensure that dirty rags were stored in proper containers prior to being taken to the laundry. The facility failed to ensure that the walls and floors inside the kitchen were properly cleaned. The facility failed to ensure the toaster was cleaned after each use per facility protocol. The facility failed to ensure that trash was properly disposed of. The facility failed to ensure that the kitchens fryer was properly cleaned and the oil changed. The facility did not ensure the ice scoop was not left in the ice bucket during the lunch meal service. These failures could place residents at risk of cross-contamination and foodborne illness. Findings included: 1. During an observation on 08/14/2023 starting…

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, the facility failed to provide a safe, clean, and comfortable homelike environment for 2 of 13 resident rooms (room [ROOM NUMBER] and room [ROOM NUMBER]) and 1 of 1 dining room reviewed for physical environment. 1. The facility did not ensure room [ROOM NUMBER] had clean floors and walls. 2. The facility did not ensure the bathroom in room [ROOM NUMBER] had no holes and the sheetrock was in good repair. 3. The facility failed to repair scratches in the paint on the wall behind the head of the bed and on the wall next to the bed in room [ROOM NUMBER]A. 4. The facility failed to ensure the wallpaper in the dining room was in good repair. This failure could place the residents at risk for decreased quality of life and infection due to unsanitary conditions. The findings included: 1. During an observation on 08/14/2023 at 10:24 AM, the dining room had crinkled, floral, boarder wallpaper that had fallen off the wall and was held together by clear tape. During an…

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, interviews, and record review, the facility failed to ensure the meals served to residents met the nutritional needs of residents for 1 of 1 meal (the lunch meal), as evidenced by: The facility failed to ensure [NAME] F followed the menu for the lunch meal on 08/14/23. The facility failed to ensure [NAME] F followed the recipe for pureeing the hamburger beef patty for the lunch meal. These failures could place residents at risk for weight loss, not having their nutritional needs met, and a decreased quality of life. Findings included: During a record review of the facility menu (lunch meal) for Monday 08/14/23 indicated: chicken fajitas, chopped cilantro, Spanish rice, shredded lettuce, diced tomatoes and an oatmeal raisin cookie was served for lunch. (Cycle: Southwest 2 - 1st week dated 07/20/23 - Primary) During an observation on 08/14/23 at 12:40 PM of the lunch, chicken fajitas, Spanish rice, mashed potatoes, green beans, and an oatmeal raisin cookie were served to the residents. During record review of a facility pureed menu (lunch meal) dated 08/14/23…

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, the facility failed to provide food that was palatable and served at an appetizing temperature for 3 of 10 residents (Resident's #10, Resident # 21, and Resident # 46) reviewed for palatable food. The facility failed to provide palatable food served at an appetizing temperature or taste to Resident #10, Resident #21, and Resident #46 who complained the food was served cold and did not taste good. This failure could place residents who ate food from the kitchen at risk of weight loss, altered nutritional status, and diminished quality of life. The findings included: During an interview on 08/14/23 at 10:28 AM, Resident #10 stated the food was bland and cold. During an interview on 08/14/23 at 11:01 AM, Resident #21 stated the food was awful: Resident #21 stated the food was overcooked, cold, tasted bad and the meat was crunchy. During an interview on 08/14/23 at 11:17 AM, Resident #46 stated the food tasted bad. Resident #46 stated it just did not taste good and was cold when it gets here. During an observation and interview 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 interview and record review, the facility failed to maintain a quality assessment and assurance committee consisting at a minimum the required committee members for 7 of 8 meetings (January 2023, February 2023, March 2023, April 2023, May 2023, June 2023, July 2023, and August 2023) reviewed for QAPI. The facility did not ensure the DON attended their QAPI meeting in August 2023. The facility did not ensure the Infection Preventionist attended their QAPI meetings in March 2023 and April 2023. The facility did not ensure the Medical Director attended their QAPI meetings in January 2023, February 2023, April 2023, June 2023, and July 2023. This failure could place residents at risk for quality deficiencies being unidentified, no appropriate plans of action developed and implemented, and no appropriate guidance developed. Findings include: 1.Record review of the facility's QAPI Committee sign-in-sheets indicated the following: 2.The DON did not sign in for their meetings in August 2023. 3.The sign-in-sheets did not indicate the Infection Preventionist did not sign in for their…

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, the facility failed to maintain an effective pest control program to keep the facility free from pests in 1 of 1 dining room, 1 of 1 kitchen for pest control. The facility did not maintain an effective pest control program to ensure the facility was free of flies. This failure could place residents at risk for an unsanitary environment and a decreased quality of life. Findings included: During an observation on 08/14/23 starting at 09:35 a.m., multiple flies were observed in the kitchen area. During an observation on 08/14/23 at 11:30 AM, the Dietary Manager was swatting away multiple flies in the kitchen while doing food temperatures. During an observation of the lunch meal on 08/14/23 at 11:50 AM, multiple flies observed in the dining area while the residents were eating their meals. During an observation of the lunch meal on 08/15/23 at 12:15 PM, several residents and staff swatting away multiple flies with their hands in the dining room area. During an interview on 08/16/23 at 11:10 AM, the Maintenance Director said he 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 interview and record review, the facility failed to complete a comprehensive resident-centered assessment of each resident's cognitive, medical, and functional capacity in a timely manner for 1 of 13 residents (Resident #14) reviewed for accuracy of assessments. The facility failed to complete Resident #14's admission MDS assessment within 14 days of admission. This failure could place residents at risk of not having their needs met. Findings included: Record review of a face sheet dated 08/14/2023 indicated Resident #14 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs), Type 2 diabetes mellitus with diabetic neuropathy (chronic condition that affects the way the body processes blood sugar with nerve damage caused by high blood sugars), and bipolar disorder, current episode depressed, severe, without psychotic features (a disorder associated…

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, the facility failed to ensure individuals with mental health disorders were provided an accurate Preadmission Screening and Resident Review (PASRR) Screenings for 1 of 6 residents (Resident #14) reviewed for PASRR. The facility failed to ensure Resident #14's PASRR Level 1 Screening indicated a diagnosis of mental illness. This failure could place residents at risk of not receiving needed assessments (PASRR Evaluation), individualized care, and specialized services to meet their needs. Findings included: Record review of a face sheet dated 08/14/2023 indicated Resident #14 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs), Type 2 diabetes mellitus with diabetic neuropathy (chronic condition that affects the way the body processes blood sugar with nerve damage caused by high blood sugars), and bipolar 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, and record review, the facility failed to develop or implement a comprehensive person-centered care plan to meet resident's medical, nursing, mental and psychosocial needs identified in the comprehensive assessment for 1 of 13 residents reviewed for care plans. (Resident #6) The facility did not develop or implement a comprehensive care plan to address Resident #6's diagnosis of PTSD (mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback, and avoidance of similar situations) and history of trauma. This failure could place residents at risk for inaccurate care plans and decreased quality of care. The findings included: Record review of the face sheet, dated 08/16/23, revealed Resident #6 was a [AGE] year-old male who admitted to the facility initially on 12/24/20 with diagnoses of PTSD (mental health condition that develops following a traumatic event characterized by…

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 observations, interviews, and record review the facility failed to ensure necessary services to maintain personal hygiene were provided for 1 of 47 residents reviewed for ADLs. (Resident #11). The facility did not ensure Resident #11 received fingernail care. These failures could place residents at risk of not receiving services or care, decreased quality of life, and decreased self-esteem. The findings included: Record review of the face sheet, dated on 8/16/23, indicated that Resident #11 was a [AGE] year-old female who admitted to the facility on initial admission dated 1/18/23, with a diagnosis of Parkinson's Disease (brain disorder that causes unintended or uncontrollable movements), Type 2 Diabetes mellitus (chronic condition that affects the way the body processes blood sugar), Lack of coordination (disorder that affects body movements),and Polyarthritis (disorder that causes pain, stiffness or swelling in the joints). Record Review of Resident #11 MDS assessment, dated 6/20/23 indicated that…

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 observations, interviews, and record review, the facility failed to ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents' experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident for 1 of 2 residents' (Resident #6) reviewed for trauma-informed care. The facility did not ensure Resident #6 had an accurate trauma screen that identified possible triggers when Resident #6 had a diagnosis of PTSD (mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback, and avoidance of similar situations). This failure could put residents at an increased risk for psychological distress due to re-traumatization. The findings included: Record review of the face sheet, dated 08/16/23, revealed Resident #6 was a [AGE] year-old male who…

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, interviews, and record review, the facility failed provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident, for 2 of 6 residents (Resident #43, #45) reviewed for medication administration. 1. The facility did not ensure Resident #43 rinsed and spit after administration of an inhalation medication (Breo Elipta) for a diagnosis of COPD. 2. Resident #43 was not given a multivitamin tablet as prescribed by the physician. 3. Resident #45 was not given senna 8.6mg (laxative) as prescribed by the physician. This failure could place residents at an increased risk for inaccurate drug administration and not receiving the care and services to meet their individual needs. The findings included: 1. Record review of the face sheet, dated 08/16/23, revealed Resident #43 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnosis COPD - chronic…

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, the facility failed to ensure a medication error rate of less than 5 percent. There were 3 errors out of 25 opportunities, resulting in a 12 percent medication error rate for 2 of 6 residents reviewed for medication error. (Resident #43, Resident #45) The facility failed to ensure the following: 1. Resident #43 rinsed and spit after administration of an inhalation medication (Breo Elipta). 2. Resident #43 was given a multivitamin tablet as prescribed by the physician. 3. Resident #45 was given senna 8.6mg (laxative) as prescribed by the physician. These failures could place residents at risk for inaccurate drug administration. The findings included: 1. During an observation on 8/15/23 at 8:45 AM, LVN E was preparing Resident #43's medication for administration. LVN E obtained a bottle of multivitamin with minerals and placed one, round, pale pink tablet in the cup. LVN E finished preparing the remainder of Resident #43's morning medication, which included the Breo Ellipta aerosol inhaler. LVN E obtained a plastic glass of water 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to implement written policies that prohibit and prevent abuse, neglect, and exploitation for 2 of 4 (Resident #1 and Resident #2) residents reviewed for abuse and neglect. The facility failed to implement the abuse and neglect policy and procedure regarding reporting resident-to-resident altercation. This failure could place the residents at increased risk for abuse and neglect. The findings included: Record Review of the Policy and Procedures for Abuse, Neglect and Exploitation dated 2/01/2021 indicated that (A) Each covered individual shall report to the State Agency and one or more law enforcement entities for the political subdivision in which the facility is located any responsible suspicion of a crime against an individual who is a resident of or is receiving care from the facility (B) Each covered, individual shall report immediately, but not later than 2 hours after forming the suspicion, if the events that cause the suspicion result in serious…

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 the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported 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, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for 2 of 4 (Resident #1 and Resident #2) residents reviewed for abuse and neglect. The facility failed to report to the state agency within 24 hours of being notified of resident to resident altercation for Resident #1 and 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 observations, interviews, and record review, the facility failed to ensure all drugs were stored in a locked compartment and only accessible by authorized personnel for 1 of 1 (Resident #3) residents reviewed for medication storage. 1. The facility failed to keep medication being administered under the direct observation of the person administering medications. Resident #3 had a medication cup with 4 tablets and 1 capsule sitting on top of her dresser. This failure could place residents at risk for health complications and not receiving the intended therapeutic benefit of their medication. Findings included: During an observation on 8/8/2023 at 10:20 AM revealed Resident #3 had a clear plastic medication cup with 4 tablets and 1 capsule sitting by a clear plastic cup of water on top of her dresser. Resident #3 stated the medication belonged to her roommate however, records indicated resident # 3 didn't have a roommate. Record review of face sheet, dated 10/12/2022, revealed Resident #3 was an [AGE]…

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.