Presbyterian Village North Special Care Ctr

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure the interdisciplinary team determined self-administration of medication was safe for 1 (Resident # 1) of 8 resident's reviewed for medication self-administration. The facility failed to prevent Resident #1 from possessing and administering an inhaler without an assessment to determine if she could safely self-administer the medication. This failure could place all residents who self-administer medications at risk of not receiving the therapeutic dose of their medication as ordered. Findings included: Record review of Resident # 1's face sheet dated 09/17/25, revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Metabolic Encephalopathy (a condition where the brain's function is impaired due to an imbalance in the body's metabolism), hypertension (high blood pressure), and malignant neoplasm of lower lobe left lung (lung cancer). Record review of Resident #1's admission MDS assessment dated…

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 residents had the right to a safe, clean, comfortable, and homelike environment for 1 of 5 facility shower room and hallway (MU) were reviewed for environment. 1. The facility failed to ensure shower chairs and shower curtains were thoroughly cleaned and stored away from Memory care residents, staff, and visitors. 2. The facility failed to discard used water bottles located on shower chair on the memory unit. These failures could place residents at risk of living in an unclean and unsanitary environment which could lead to a decreased quality of life. An observation on 07/02/2025 at 12:06 PM the facility hydration cart was left open unattended with the ice exposed and the metal scoop. After waiting for approximately 4 minutes, CNA-M was observed coming out of a resident’s room [ROOM NUMBER] minutes later. An observation on 07/02/2025 at 12:39 PM of the memory unit, revealed 3 shower chairs shower chairs, stored in the hallway…

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, including tracheostomy care and tracheal suctioning, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 2 of 5 residents (Residents #21 and #33) reviewed for respiratory care. 1. The facility failed to change and date Residents #21, bag nasal Cannula and CPAP mask when not in use and date and change oxygen and nasal cannula tubing and humidifier bottle every week.2. The facility failed to bag and date Residents #33's bag and date CPAP mask when not in use to prevent infection prevention. These failures could place residents at risk for respiratory infections. Record review of Resident # 21’s face sheet dated 07/02/2025 reflected she was an [AGE] year-old female admitted on [DATE]. Her current DX included: Chronic Systolic Congestive Heart Failure (reduced blood to the hear), Acute…

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 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 1 of 3 residents (Resident #147), reviewed for pharmaceutical services. MA A failed to dispose of Resident #147's used Fentanyl Transdermal Patch, 12 micrograms/hour (applied to the skin to treat moderate to severe chronic pain around the clock. Fentanyl is extremely potent. 2 to 3 milligrams of this drug can lead to death due to decreased breathing which can quickly lead to coma and death.) per facility policy. This failure could place residents at risk for obtaining Fentanyl patches out of the trash and overdosing on them. Findings included: Record review of Resident #147's face sheet, dated 06/20/25, reflected she was a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included colon cancer and a Stage IV…

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 coffee that was palatable to meet the needs of each resident for 2 of 2 residents (Resident #187 and confidential resident), reviewed for Dining services. The facility did not serve beverages that was palatable. Resident #187 and an anonymous resident said the coffee tasted bad. This failure could place residents who drank beverages from the kitchen at risk of a diminished quality of life. Findings included: Observation on 6/18/25, at 1:30pm of a test tray consisted of Salisbury steak and gravy, au gratin potatoes, capri blend vegetables, wheat dinner roll, lemon bar, and a cup of coffee. Surveyor said the coffee did not taste good and tasted bitter. Interview on 6/17/2025 at 11:30am with Resident #187 said the coffee was lousy and too strong. Resident #187 said the coffee does not taste good. Resident revealed for a couple of months the coffee has tasted bad. Interview on 6/17/2025 at 11:45am with anonymous resident stated wanted to remain confidential. Resident stated the coffee was bad and did not…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure that all drugs and biologicals used in the facility are labeled in accordance with professional standards, including expiration dates and with appropriate accessory and cautionary instructions for 2 (Resident #22 and Resident # 323) of 8 residents reviewed for storage of drugs and Biologicals. The facility failed to ensure that MA D secured Resident # 22's medication before walking away from the medication cart. The facility failed to ensure that Resident #323's self-administration medications were secured and not left on the bedside table after administration. These failures could cause accidental ingestion of medication by a resident not prescribed the medication and could cause access, loss, and diversion of medications. Finding included: Resident #22 Review of Resident # 22's face sheet dated 05/14/24 reflected an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included high blood pressure, bone…

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 treat each resident with respect and dignity and care for each resident in a manner that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality for 1 (Residents #30) of 8 residents reviewed for dignity. The facility failed to ensure Residents #30 had the right to a dignified existence when staff stood over the resident while feeding the resident. This failure could affect the residents by placing them at risk for a loss of dignity, decreased self-worth and decreased self-esteem. Finding included: Review of Resident #30's face sheet, dated 05/15/24, revealed a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included dementia a condition of cognitive impairment, severe protein- calorie malnutrition, depression, pain in shoulder, blood clots, age related joint pain, difficulty communicating, and difficulty swallowing. Review of Resident #30's quarterly MDS…

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 store, prepare, distribute, and serve food in accordance with professional standards for food safety for 1 (Resident #5) of 8 residents reviewed for refrigerators in the rooms. The facility failed to monitor Resident #5's refrigerator temperature and to clean out undated foods. These failures could affect residents by placing them at risk for food-borne illness. Finding included: Review of Resident #5's face sheet, dated 05/15/24, reflected an [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included Parkinson's diseases a condition that affects the central nervous system that effects movement and often including tremors, difficulty sleeping, low blood pressure, narcolepsy with cataplexy is a condition of daytime sleepiness with sudden temporary muscle weakness or loss of muscular control, healed fractures, repeated falls, and difficulty communicating. Review of Resident #5's MDS dated [DATE] revealed a BIMS score 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 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 1 of 1 kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure food was properly stored in the facility's dry storage room. 2. The facility failed to ensure expired foods were discarded. These failures could place all residents at risk for food-borne illness. Findings included: Observation of the kitchen's dry storage area on 3/27/23 at 9:35am revealed the following observations: -One box of Peanut butter with label partially peeled off not leaving enough to read the received date. -One box of Swiss Miss no sugar hot chocolate without a received or expiration date -Two boxes of Sweet D' [NAME] individual sugar packets; one box opened without received or expiration dates. -One bundled package of smaller individual packages of croutons wrapped in plastic without a label, without received date and without…

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 maintain an infection control program designed to prevent the development and transmission of infection for one of five residents (Resident #48) observed for infection control. CNA A failed to perform hand hygiene while providing incontinence care to Resident # 48. This failure could place the residents at risk for infection. Findings include: Record review of Resident #48's face sheet dated 03/29/23 reflected he was [AGE] years old male. He was admitted to the facility on [DATE]. He was admitted with dementia, chronic kidney disease, bipolar disease, heart failure, low back pain mad muscle diagnosis. Review of Resident #48 's care plan initiated 03/24/23 reflected Resident #48 had elimination risk as evidence by urinary/bowel incontinence related to mixed incontinence. Further reflected for intervention, to check the resident for incontinence, wash, rinse, and dry perineum (the area between the anus and the scrotum or vulva). 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.