Pine Tree Lodge Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to be adequately equipped to allow residents to call for staff through a communication system which relays the call directly to a centralized staff work area for 1 of 18 (Resident #5) residents reviewed for call lights.The facility failed to ensure Resident #5 had a functioning call light.This failure could place residents at risk for a delay in assistance and decreased quality of life, self-worth, and dignity. Findings included: Record review of Resident 5's face sheet dated 03/24/26 indicated the resident was [AGE] years old and originally admitted to the facility on [DATE]. Resident #5 had diagnoses which included diabetes, chronic pulmonary edema (a condition caused by too much fluid in the lungs), and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest).Record review of Resident #5's annual MDS assessment dated [DATE] indicated the resident was understood and understood others.…

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 dialysis services were provided consistently with professional standards of practice for 1 of 1 resident reviewed for dialysis services. (Resident #21) 1. The facility failed to ensure the dialysis communication forms were fully completed to include the post dialysis assessment for Resident #21. 2. The facility failed to ensure the dialysis order was updated when Resident #21's dialysis days changed on [DATE]. This failure could place residents who received dialysis at risk for complications and not receiving proper care and treatment to meet their needs. The findings included: Record review of Resident #21's face sheet, dated [DATE], reflected Resident #21 was a [AGE] year-old female who initially admitted to the facility on [DATE] with a diagnosis of end stage renal disease (occurs when chronic kidney disease - the gradual loss of kidney function - reaches an advanced state). Record review of the significant change 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 establish a system of receipt and disposition of all controlled drugs in sufficient detail to enable accurate reconciliation and determine that drug records are in order and that an account of all controlled drugs was maintained and periodically reconciled for 1 of 1 storage area reviewed for expired and discontinued medications and for the accuracy of administering drugs and biologicals to meet the needs of each resident for 1 of 8 residents (Resident #10) reviewed for insulin administration. 1.The facility failed to keep a record of a receipt of controlled medications awaiting disposition to allow accurate and periodic reconciliation. 2. The facility failed to ensure LVN E primed Resident #10's insulin pen of Fiasp (a rapid-acting insulin) before given. These failures could place residents at risk of not receiving the therapeutic benefit of medications, loss of prescribed medications and drug diversion. Findings included: 1.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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record review, the facility failed to act upon the recommendations of the pharmacist report of irregularities for 3 of 5 residents (Resident's #17, #52, and #56) reviewed for (DRR) Drug Regimen Review. 1. The facility failed to provide documentation of the pharmacy recommendation or rationale for an attempted gradual dose reduction for Resident #17's risperidone (antipsychotic medication), Resident #52's buspirone (antianxiety medication), and Resident #56's paroxetine (antidepressant medication). 2. The facility failed to ensure the Pharmacist Consultant addressed Resident #56's buspirone (antianxiety medication) for a gradual dose reduction. This failure could place residents at risk for receiving unnecessary medications at the most effective dosage. The findings included: 1. Record review of the face sheet, dated 01/15/25, reflected Resident #17 was a [AGE] year-old female who initially admitted to the facility on [DATE] with a diagnosis of bipolar disorder (mental health condition…

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 only accessible by authorized personnel, for 1 of 6 residents (Resident #54), 3 of 6 medication carts (Halls 500, 100, and 200), and 1 of 1 treatment cart reviewed for storage of medications. 1. The facility did not ensure medication was not left unattended on Resident #54's bedside table. 2. The facility failed to ensure LVN E kept the 500-hall medication cart secured and was unable to be accessed by unauthorized personnel. on 01/14/25. 3. The facility failed to ensure LVN A kept the Hall 1 and 2 nurse medication carts locked or within her line of sight when not in use on 01/13/25. 4. The facility failed to ensure the Treatment Nurse locked the treatment cart when she left it unattended in the hallway on 01/15/25. These failures could place residents at risk of not receiving the therapeutic benefit of medications, harm or misuse of medication, drug diversions, and adverse reactions to medications due to improper…

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 observations, interviews, and record review, the facility failed to provide food that was palatable, attractive, and at a safe and appetizing temperature for 1 of 3 meals reviewed. The dietary staff failed to provide food that was palatable for 1 of 3 meals observed on 1/14/25 (lunch) meal. These failures could place residents at risk of decreased food intake, hunger, and unwanted weight loss. The findings included: Record review of the menu indicated the lunch meal items on 1/14/25 included beef steak, mash potatoes, spinach, dinner roll, and cheesecake. Record review of the Dietary staff in-services indicated Recipe in-service was last completed on July 2, 2024. During an interview on 01/13/2025 beginning at 10:09 AM, Resident #43 stated the food was too salty. During an interview on 1/13/25 at 11:18a.m., Resident # 38 stated the food was not good. During an interview on 1/13/25 at 11:23 a.m., Resident # 50 stated the food was cold. During an interview on 1/14/25 at 08:56 a.m., Resident #268 stated the food was not warm when he got it. During an interview on 1/14/25 at…

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 store, prepare, distribute, and serve food in accordance with professional standards for food service safety in (1 of 1) kitchen reviewed for dietary services. 1) The facility failed to dispose of expired food items. 2) The facility failed to clean the bread [NAME] storage container, microwave, can opener, and utensil drawer. These failures could place residents at risk for food contamination and foodborne illness. The findings included: During an observation in the kitchen of Refrigerator 1 of 2 on 1/13/25 at 9:56 a.m., the following were observed: -(1) container of carrots had a prep date of 12/8/24 and use by date of 12/15/24. (expired) During observation in the kitchen dry storage area on 1/13/25 at 10:15 a.m., the following were observed: -(1) container of bread crumps was empty; container had not been cleaned. During an observation in the kitchen on 1/13/25 at 10:20 a.m., the following were observed: - Dirty can opener with food…

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 coordinate assessments with pre-admission screening and resident review (PASRR) program under Medicaid to the maximum extent practicable to avoid duplicative testing and effort which included referring all level II residents and all residents with newly evident or possible serious mental disorder, intellectual disability, or a related condition for level II resident review upon a significant change in status assessment for 1 of 5 residents (Resident #61) reviewed for PASRR Level I screenings. The facility failed to ensure the correct PASRR (a preliminary assessment completed for all individuals before admission to a Medicaid-certified nursing facility to determine whether they might have a mental illness or intellectual disability) Level 1 Screening was submitted to the local authority for Resident #61 who had a diagnosis of mental illness upon admission. This failure could place residents at risk for a diminished quality of life and not receiving…

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 develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs, for 1 of 6 (Resident #9) residents reviewed for the care plans. The facility failed to ensure a fall mat was beside Resident #9's bed as stated in her care plan. This failure could affect residents by placing them at risk of not receiving appropriate interventions to meet their current needs. Findings included: Record review of Resident #9's face sheet, dated 01/15/25, indicated an [AGE] year-old female who was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included Dementia (loss of memory, language, problem-solving and other thinking abilities that were severe enough to interfere with daily life), Bipolar disorder (a chronic mental health condition characterized by extreme mood swings between…

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 the residents environment remained free of accident hazards by not adequately monitoring the proper storage of oxygen cylinders for 1 of 2 residents (Resident #62). The facility failed to ensure the oxygen cylinder in Resident #62's room was properly secured. This failure could place the resident at risk for injury. Findings included: Record review of Resident #62's face sheet dated 01/15/25, indicated a [AGE] year-old female who initially admitted to the facility on [DATE]. Resident #62 had diagnoses which included dementia (memory loss), chronic obstructive pulmonary disease (group of lung diseases that block airflow and make it difficult to breathe), osteoporosis (condition when bones become weak and brittle), and hallucinations (a perception of having, seen, heard, touched, tasted, or smelled something that was not actually there). Record review of Resident #62's quarterly MDS assessment dated [DATE], indicated Resident was able…

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 residents requiring respiratory care were provided such care, consistent with professional standards of practices for 1 of 65 residents (Resident #35) reviewed for respiratory care. The Facility failed to ensure Resident #35 nebulizer mask was bagged when not in use. This failure could place residents who receive respiratory care at risk for developing respiratory complications. The findings included: Record review of the profile sheet, dated 1/15/25, revealed Resident #35 was an [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses of chronic obstructive pulmonary disease with acute lower respiratory infection(COPD) (an inflammatory lung disease that causes obstructed airflow from the lungs), unspecified dementia (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life) and hypertension (high blood pressure). Record review of the…

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

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 2 of 5 residents (Resident #s 12 and 46) reviewed for infection control. 1. The facility failed to ensure CNA C changed her gloves when she provided incontinent care to Resident #12 on 01/13/25. 2. The facility failed to ensure CNA C did not apply the dirty linen that had fallen to the floor on 01/13/25 to Resident #12. 3. The facility failed to ensure LVN E wore a gown when she gave Resident #46 his medication through his gastrostomy (also known as a G-tube, is a thin, flexible tube inserted through the abdominal wall directly into the stomach used to provide nutrition and medications directly to the stomach when a person is unable to eat or drink adequately by mouth). These failures could place residents and staff at risk…

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 review, the facility failed to ensure that each resident was offered a pneumococcal immunization, unless the immunization was medically contraindicated, or the resident had already been immunized for 1 of 5 resident's (Resident #16) reviewed for pneumococcal vaccinations. The facility failed to ensure Resident #16 was offered the pneumococcal vaccination in accordance with the CDC schedule and timing for the pneumococcal vaccine. This failure could place residents at risk for contracting a viral disease that could spread through the facility and cause respiratory complications, and potential adverse health outcomes. The findings included: Record review of the face sheet, dated 01/15/25, reflected Resident #16 was an [AGE] year-old female who initially admitted to the facility on [DATE] with a diagnosis of asthma (condition in which your airways narrow and swell and may produce extra mucus). Record review of the significant change MDS assessment, dated 01/05/25, reflected 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 observation, interview, and record review, the facility failed to ensure residents received appropriate treatment and services to prevent further decrease of ROM for 2 of 4 residents reviewed for range of motion. (Resident #1 and Resident #2) 1. The facility failed to ensure Resident #1 had a contracture prevention device in place for the treatment of his right-hand contracture. 2. The facility failed to ensure Resident #2 had a contracture prevention device in place for the treatment of her right-hand contracture. These failures could place residents at risk for decrease in mobility and range of motion and contribute to worsening of contractures. Findings included: 1. Record review of Resident #1's face sheet, dated 10/31/24, indicated he was a [AGE] year-old male, admitted to the facility on [DATE], with a most recent readmission of 10/08/24. His diagnoses included quadriplegia (paralysis that affects all a person's limbs), and contracture of the right hand (A permanent tightening of the muscles,…

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 store, prepare, distribute, and serve food in accordance with professional standards for food service safety in (1 of 1) kitchen reviewed for dietary services. 1) The facility failed to label and date all food items. 2) Dietary staff failed to dispose of expired foods items. 3) Dietary Staff failed to effectively reseal, label, and date frozen food items. These failures could place residents at risk for food contamination and foodborne illness. The findings included: During observation in the kitchen refrigerator on 10/3/24 at 10:49 a.m., the following were observed: -(3) ready-made sandwiches not labeled or dated. -(10) cups of tea and punch juice not labeled or dated. -(1) bag of turkey lunch meat opened on 9/18/24 had no expiration date. -(1) large container of Pineapple Tidbits prepared on 9/17/24 was expired. -(3) blocks of sliced cheese had no open date, no expiration, and was not labeled -(1) large container of prepared chili 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 treat each resident with respect and dignity and provide care in a manner that promoted maintenance or enhancement of his or her quality of life for 1 of 5 residents reviewed for resident rights. (Resident #1) The facility failed to ensure staff assisted Resident #1 when answering his call light by turning his call light off and not returning to provide assistance. This failure could place residents at risk for decreased quality of life, decreased self-esteem and increase anxiety. Findings included: Record review of an undated face sheet indicated Resident #1 was a [AGE] year-old male admitted to the facility on [DATE] with the diagnoses of quadriplegia (the paralysis of both arms and legs due to various conditions, such as spinal cord injury, stroke, or cerebral palsy), anxiety, and seizures (uncontrolled electrical disturbance in the brain which can cause changes in behavior, movements, feelings, and consciousness). Record review of the significant…

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 the necessary services to maintain personal hygiene for 3 of 8 resident reviewed for ADLs. (Resident #1, Resident #2, Resident #3) The facility failed to provide Resident #1, Resident #2, and Resident #3 their scheduled bath/showers. This failure could place residents who required assistance from staff for ADLs at risk of not receiving care and services to meet their needs which could result in poor care, risk for skin breakdown, feelings of poor self-esteem, lack of dignity and health. Findings included: Record review of Resident #1's face sheet dated 06/05/24 indicated Resident #1 was a [AGE] year-old, male and admitted on [DATE] and 04/12/24 with diagnoses including quadriplegia (is a symptom of paralysis that affects all a person's limbs and body from the neck down), contracture (a permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff), cerebral…

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 had a right to reasonable accommodation of resident needs for 1 of 4 residents reviewed for acumination of needs ( Resident #2) Resident #2 pulled his call button to receive assistance with turning and repositioning, getting water to drink and colostomy care. The resident did not receive care for almost 3 hours. This negative practice could endanger the resident's health and safety. Findings included: Record review of Resident #2's face sheet dated 1/17/24 indicated he was a [AGE] year-old male admitted to the facility on [DATE]. Some of his diagnoses were anxiety disorder, colostomy status, quadriplegia (paralysis of all four limbs) contracture of the right hand, seizures, stroke, stage 4 pressure ulcer of the left hip, and need for assistance with personal care. Record review of Resident #2's quarterly MDS dated [DATE] indicated he had no cognitive impairment. His upper and lower extremities were impaired on both sides. Record…

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 had the right to privacy for 1 of 3 residents reviewed for privacy. (Resident #1) Resident #1 was not fully dressed when the Maintenance Director entered her room without knocking. This noncompliance was identified as PNC. The noncompliance began on 1/15/24 and ended on 1/15/24. The facility corrected the noncompliance before the survey began. This negative finding could cause the resident embarrassment and discomfort. Findings included: Record review of Resident #1's face sheet dated 1/22/24 indicated she was a [AGE] year-old female admitted to the facility on [DATE]. Some of her diagnoses were dementia, depression, difficulty walking, lack of coordination, reduced mobility, and need for personal care assistance. Record review of Resident #1's quarterly MDS dated [DATE] indicated she had severely impaired cognitive impairment. She required extensive assist of two people with bed mobility, and transfers. 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 observation, interview, and record review the facility failed to ensure each resident received the necessary care and services to maintain the highest practicable wellbeing consistent with the resident comprehensive assessment and care plan for 2 of 3 residents reviewed for quality of life in that: (Resident #1 and Resident #2.) Resident #1 did not receive showers as scheduled and she was not transferred according to her care plan. Resident #2 did not receive care and services as requested when the aide turned off his call light and did not return for 3 hours. His care plan indicated he was to be turned and repositioned every two hours and receive colostomy care as needed. This negative finding could cause resident to have a decline in their physical, and psychosocial wellbeing. Findings included: Resident #1 Record review of Resident #1's face sheet dated 1/22/24 indicated she was a [AGE] year-old female admitted to the facility on [DATE]. Some of her diagnoses were dementia, depression, difficulty…

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 therapeutic diet as ordered by the physician for 1 of 3 residents reviewed for diets (Resident #1), in that: Resident #1 had a physician order for magic cups three times a day that were not provided for two meals. This negative finding could contribute to Resident weight loss. Findings included: Record review of Resident #1's face sheet dated 1/22/24 indicated she was a [AGE] year-old female admitted to the facility on [DATE]. Some of her diagnoses were unspecified protein calorie malnutrition, dementia, anxiety, and difficulty swallowing. Record review of Resident #1's quarterly MDS dated [DATE] indicated she had severely impaired cognitive impairment. She required extensive assist of two people with bed mobility, and transfers. She required one-person physical assist with eating. Record review of Resident #1's Care Plan dated 9/19/23 indicated a Focused area of at risk for malnutrition. The goal was for her to maintain a stable…

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 an accurate MDS was completed for 5 of 19 residents reviewed for MDS assessment accuracy. (Resident #49, #39, #43, #45, and #18). 1. The facility failed to accurately reflect Resident #49's weight loss on the MDS assessment. 2. The facility inaccurately coded Residents #39, #43, #45, and #18 as having received an anticoagulant medication. These failures could place residents at risk for not receiving care and services to meet their needs. Findings included: 1. Record review of Resident #49 face sheet, dated 12/20/23, indicated Resident #49 was an [AGE] year-old female, readmitted to the facility on [DATE] with diagnoses which included unspecified protein-calorie malnutrition, iron deficiency anemia unspecified, muscle weakness, Hypothyroidism (thyroid gland does not produce enough thyroid hormone, unspecified lack of coordination, unspecified dementia, unspecified severity without behavioral disturbances, psychotic disturbance, mood disturbance…

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 (1 of 1) kitchen reviewed for dietary services. 1) The Dietary staff failed to date all food items. 2) Dietary staff failed to dispose of expired foods items located in the dry storage area. 3) Dietary staff failed to store (2) dented can in a separate area. 4) Dietary staff failed to effectively reseal, label and date frozen food items. 5) The Dietary staff failed test strip on sterilization sink in the three compartment sink 6) The Dietary staff failed to clean the ice machine These failures could place residents at risk for food contamination and foodborne illness. The findings include: During observations on 12/18/23 at 9:58 am, the following observations were made in the kitchen walk in freezer (1 of 4) (1) box of 4 oz Sherbet cups receive date 12/5/23, no open date, no expiration date (1) bag of 6 frozen tortilla not sealed (1) bag of 24 frozen tortilla not sealed. During observations 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 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 2 of 5 halls (Hall 4 and Hall 5) and 4 of 13 staff (CNA L, Floor Tech M, CNA C, LVN F) for infection control practices and transmission-based precautions. 1. The facility failed to follow their policy for testing residents following a COVID-19 outbreak in the facility after Resident #500 residing on Hall 5 tested positive for COVID-19 on 12/14/2023. 2. The facility failed to ensure COVID-19 was not spread to residents on Hall 4. 3. The facility failed to ensure that CNA L and Floor Tech M were tested prior to working their shifts following a COVID-19 outbreak in the facility. 4. The facility did not ensure CNA L performed hand hygiene in between meal trays, during the lunch meal. 5. CNA C failed to perform hand hygiene 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.

Based on interview and record review, the facility failed to develop, implement, and maintain annually an effective training program for existing staff, consistent with their expected roles for 3 of 21 employees (Dietician, ST, and OT) reviewed for required annual trainings. The facility failed to ensure the Dietician received annual HIV training. The facility failed to ensure the Dietician, ST, and OT received annual Restraint training. These failures could place residents at risk for the inappropriate use of restraints and exposure to HIV. Findings included: Record review of the employee files revealed there was no annual HIV training completed for the following staff: *Dietician (hire date 9/20/19) Record review of the employee files revealed there was no annual restraint training completed for the following staff: *Dietician (hire date 09/20/19), *ST (hire date 02/02/18), *OT (hire date 08/10/22), During an interview on 12/20/23 at 3:03 PM, the HR coordinator stated she was responsible for making sure the annual trainings were completed. The HR coordinator stated 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 observations, 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, mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 19 residents (Resident #1) reviewed for comprehensive person-centered care plans. The facility failed to ensure Resident #1's comprehensive care plan addressed that she received oxygen. This failure could place residents at risk of not receiving necessary medications and services. Findings included: Record review of Resident #1's face sheet dated 12/20/23, indicated an [AGE] year-old female who initially admitted to the facility on [DATE] with diagnoses which included dementia (memory loss), protein-calorie malnutrition (inadequate protein intake), and essential hypertension (high blood pressure). Record review of Resident #1 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 observations, interviews and record reviews, the facility failed to review and revise the comprehensive person-centered care plan for 1 of 67 residents (Resident #49) reviewed for comprehensive care plans. The facility failed to ensure Resident #49's care plan was updated to indicate weight loss. These failures could place residents at increased risk of not having their individual needs met and a decreased quality of life. The findings included: Record review of Resident #49 face sheet, dated 12/20/23, indicated Resident #49 was an [AGE] year-old female, readmitted to the facility on [DATE] with diagnoses which included unspecified protein-calorie malnutrition, iron deficiency anemia unspecified, muscle weakness, Hypothyroidism (thyroid gland does not produce enough thyroid hormone, unspecified lack of coordination, unspecified dementia, unspecified severity without behavioral disturbances, psychotic disturbance, mood disturbance and anxiety (loss of memory, language, problem solving and other thinking…

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 fed by enteral means received the appropriate treatment and services to prevent complications for 1 of 1 resident reviewed for enteral nutrition (Resident #48). The facility failed to ensure LVN F rinsed Resident #48's gastrostomy tube (feeding tube inserted in stomach used for feeding and medication administration) syringe after she administered a medication. This failure could affect residents receiving enteral nutrition and hydration by placing them at risk for gastric infections. Findings included: Record review of Resident #48's face sheet dated 12/20/23, indicated a [AGE] year-old male who initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #48's diagnoses included Parkinson's disease (a disorder oof the central nervous system that affects movement, often including tremors), Meniere's disease (inner ear disorder that causes episodes of dizziness), gastrostomy, and dysphagia (difficulty…

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 respiratory care was provided with professional standards of practice for 1 of 4 resident reviewed for quality of care. (Resident #1) The facility failed to obtain the amount of oxygen to be administered to Resident #1. This failure could place residents who receive respiratory care at risk for developing respiratory complications. Findings included: Record review of Resident #1's face sheet dated 12/20/23, indicated an [AGE] year-old female who initially admitted to the facility on [DATE] with diagnoses which included dementia (memory loss), protein-calorie malnutrition (inadequate protein intake), and essential hypertension (high blood pressure). Record review of Resident #1 quarterly MDS assessment dated [DATE], indicated Resident #1 was rarely/never understood and rarely/never understood others. The MDS assessment indicated Resident #1 cognition was severely impaired. Resident #1 was totally dependent on staff with all ADLs.…

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 residents were free of significant medication errors for 1 of 6 residents reviewed for pharmacy services. (Resident #54) The facility failed to ensure MA G administered Resident #54's nifedipine (blood pressure medication) extended release correctly. This failure could place the resident at risk of medical complications and not receiving the therapeutic effects of their medications. Findings included: Record review of Resident #54's face sheet dated 05/26/22, indicated she was admitted to the facility on [DATE] with diagnoses included cerebral infarction (stroke), depression, essential hypertension (high blood pressure), and dysphagia (difficulty swallowing). Record review of Resident #54's quarterly MDS assessment dated [DATE], indicated she was rarely/never understood and sometimes understood others. The MDS assessment indicated Resident #54's cognition was moderately impaired. Record review of Resident #54's comprehensive…

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.