St Dominic Village Rehabilitation And Nursing Cent

Based on interview and record review, the facility failed to electronically submit to Centers for Medicare and Medicaid Services a complete and accurate direct care staffing information, including information for agency and contract staff, based on 1 of 4 quarters for payroll and other verifiable and auditable data in a uniform format according to specification established by Centers for Medicare and Medicaid Services. The facility failed to submit to Centers for Medicare and Medicaid Services the Payroll Base Journal data for the second quarter of 2026. The failure could put Residents at risk for inadequate staffing and not having their needs meets. Findings include: Record review of Centers for Medicare and Medicaid Services-Payroll Base Journal Staffing Data Report CASPER Report 1705D-Fiscial Year Quarter 2 -2026 (January 1-March 31) reveals the facility failed to submit data for the second quarter of 2026. In an interview on 6/25/2026 at 9:16 a.m. with the Administrator, he stated he has been at the facility since 2018. He stated the Payroll Base Journal for the second quarter…

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 that the medication error rate was not five percent or greater. The facility had a medication error rate of 13% based on 4 errors out of 30 opportunities, which involved 3 of 4 residents (Resident #1, Resident #51, and Resident #75) and 1 of 1 staff (MA A) observed during medication administration reviewed for medication errors. The facility failed to ensure:1. Resident #1's Aspercreme lidocaine patch 4% was applied to the correct area of the body as ordered2. Resident #1 received the enteric coated extended release aspirin instead of chewable aspirin3. Resident #51 did not receive Vitamin D 25 mcg without a physician's order4. Resident #75 received the correct dosage of Cetirizine HCl Theses failures could place residents at risk of not receiving therapeutic dosages and/or effects of medications. Findings included:Resident #1Observation and interview on 6/24/26 at 8:47 a.m. revealed MA A administered chewable aspirin 81 mg tablet to Resident #1 orally and applied lidocaine patch 4% to Resident #1'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 and record review the facility failed to ensure the resident environment remained as free of accident hazards as possible and that each resident received adequate supervision and assistance devices to prevent accidents for 1 of 6 residents (Resident #9) reviewed for adequate supervision.The facility failed to ensure Resident #9 had quarterly fall risk assessments completed. The failure could place residents at risk of possible injury and not having appropriate interventions in place. Findings included:Record review of Resident #9's face sheet dated 6/25/26, revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy (a condition in which the brain's function is impaired due to underlying metabolic or systemic disturbances rather than structural brain damage), muscle wasting and atrophy (decrease in size), other lack of coordination, generalized muscle weakness, weakness, and unspecified abnormalities of gait (a person'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 and record review, the facility failed to ensure resident's medical records included documentation that indicated the resident, or their responsible party, received education of the benefits, and potential side effects, of the influenza or pneumococcal immunization, receipt of the influenza or pneumococcal immunization, or residents did not receive the influenza or pneumococcal immunization due to medical contraindication, or refusal, for 2 of 5 residents reviewed for immunizations. (Resident #3 and Resident #65)The facility failed to document, in Resident #3's and Resident #65's medical records, having had received education, whether by self or with responsible party, of the benefits and potential side effects of the influenza immunization and receipt of the of the pneumococcal immunization or having had not received the pneumococcal immunization due to medical contraindication or refusal.This failure could place residents at risk of contracting a viral illness, influenza and pneumococcal, 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to implement their policy to ensure the residents, or their responsible party, received education of the benefits and risks, or potential side effects of Covid-19 immunizations, receipt of Covid-19 immunizations, or the residents did not receive the Covid-19 immunizations, due to medical contraindication, or refusal, for 2 of 5 residents who were reviewed for immunizations. (Resident #3 and Resident #65) The facility failed to document, in Resident #3's and Resident #65's medical records, having had received education, whether by self or with their responsible party, of the benefits and risk, and potential side effects, of the Covid-19 immunization, receipt of the of the Covid-19 immunization, or having had not received the Covid-19 immunization due to medical contraindication or refusal.This failure could place residents at risk of not being informed of complications and potential adverse health outcomes.Findings included:Resident #3 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 interviews and record reviews, the facility failed to ensure residents were free from misappropriation (Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent.) for 1 of 5 residents (Resident #1) reviewed for misappropriation. The facility failed to protect Resident #1 from being exploited when LVN A deliberately used $800 from the resident's money without the resident's consent. This failure may cause residents to be left without sufficient funds to pay for their own care necessities, psychological distress, paranoia, and feelings of guilt and shame that could prevent them from reporting abuse, neglect, or exploitation. Findings include: Record Review of Resident #1's Face Sheet, dated 04/30/2026 reflected a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE]. Resident #1 had diagnoses which included diabetic retinopathy with macular…

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 for each resident, consistent with the resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 4 out of 5 residents (Resident #2, Resident #3, Resident #4, and Resident #5), reviewed for care plans. - The facility failed to document Resident #2's fall from 8/29/25, and interventions put in place, which included a low bed, and a clutter free area.- The facility failed to document Resident #3's falls from 11/17/25 and 11/27/25, and interventions put in place, which included a low bed.- The facility failed to document Resident #4's falls from 10/22/25, 11/18/25, 11/27/25, and 12/3/25, and interventions put in place which included increased rounding, ordering labs, work up for tachycardia, a low bed, and a clutter free area.- 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 observation, interview and record review the facility failed develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a residents' mental, nursing and mental and psychosocial needs that were identified in the comprehensive assessment for 3 of 7 Residents (Resident #61, Resident #52 and Resident #17) reviewed for care plans. The facility failed to ensure Resident #61's care plan with interventions for the inappropriate sexual interaction on 2/25/2025 was documented in a timely manner. The facility failed to ensure Resident #52's care plan with interventions for the inappropriate sexual interaction on 2/25/2025 was documented in a timely manner. The facility failed to ensure Resident #17's care plan accurately reflected the resident's behaviors which included yelling without stimulus, fighting the air . These deficient practices could place residents at risk of nonconsensual sexual…

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 in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 1 of 1 medication carts (Unit 2-B Nursing Cart) reviewed for medication storage . The facility failed to ensure Unit 2-B Nursing cart revealed was not unlocked and unattended with medication on top of the cart. This failure could place residents at risk of adverse reactions to medications and misappropriation of medications. Findings include: An observation on 04/01/25 at 09:03 AM of the unlocked and unattended Unit 2-B Nursing cart revealed, a vial which contained Resident #16's Timolol eye drops, a medication used to treat glaucoma, on the top of the cart. The cart was in front of a patient room with the drawers easily accessible and facing the hall . In an observation and interview on 04/01/25 at 09:10 AM, inventory of the Unit 2-B Nursing Cart with LVN B revealed all drawers in the cart were…

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 coordinate assessments with the Preadmission Screening and Resident Review (PASARR) program to the maximum extent practicable for 1 of 5 residents (Resident #17) reviewed for PASARR. The facility failed to update the PASARR Level 1 forms for Resident #17 to indicate mental health illness. This failure could place residents requiring PASARR services at risk of not having their special needs assessed and met by the facility. Findings included: Record review of Resident #17's admission Record, dated 12/28/2023, revealed an 84 -year-old male who admitted to the facility on [DATE]. Resident # 17 face sheet dated 02/08/2024 revealed that Resident # 17 had an active diagnosis of (PTSD) Post Traumatic Stress Disorder (a 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.) with an onset documented as of 12/28/2023.…

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 maintained acceptable parameters of nutritional status, such as usual body weight for 1 of 5 residents (Residents #31) reviewed for nutrition. - The facility failed to ensure the implementation of the Registered Dietitian's recommendations that included Fortified meals for Resident #31. This failure could place residents at risk for weight loss and decline in health status. Findings include: Record review of Resident #31's Face Sheet dated 02/06/24 revealed, an [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of: Alzheimer's Disease, and hypertension. Record review of Resident #31's MDS assessment dated [DATE] revealed, severely impaired cognition as indicated by a BIMS score of 01 out of 15, no malnutrition, no specified therapeutic diet, and set-up and clean up assistance for eating. Record review of Resident #31's undated Care Plan revealed, no weight related care areas. 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.

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 for 1 of 4 medication Carts (Station 1 PRN Nursing Cart) reviewed for pharmaceutical services. - The facility failed to ensure the Station 1 PRN nursing cart did not contain an expired bottle of Vitamin C 250 mg. This failure could place residents at risk of not receiving the desired therapeutic effect of their medications and uncontrolled health conditions. Findings Included: In an observation on 02/08/24 at 07:10 AM, inventory of the Station 1 PRN Nursing Cart with LVN A revealed: - An expired, open and in use stock bottle of Vitamin C 250 mg with a manufacturer's expiration date of 01/2024. LVN A said nursing staff are expected to check their medication carts daily for expired medications as they use the medications and then weekly. She said when supplements expire they might be less effective so they should be discarded because use…

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 upon observation, interview and record review the facility failed to ensure drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principles, and under proper temperature controls for 1 out of 8 Residents (Resident #43) and 1 of 4 medication carts ( Station 3 Medication Cart) reviewed for drug labeling and storage. - The facility failed to ensure the Station 3 Medication Cart did not contain an in-use insulin pen for Resident #43 with no open date. This failure could place residents at risk of adverse medication reactions and drug diversions. Findings included: Record review of Resident #43's Face Sheet dated 02/06/24 revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses of anxiety disorder, high cholesterol and type 2 diabetes. Record review of Resident #43's Quarterly MDS assessment dated [DATE] revealed, intact cognition as indicated by a BIMS of 14 out of 15, partial/moderate assistance with most ADLs and always…

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.