Heritage Hall-Blackstone

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, facility document review and clinical record review, it was determined that the facility staff failed to maintain a comfortable, homelike environment for one of 44 residents in the survey sample, Resident #21. The facility staff failed to maintain Resident #21's wheelchair armrests in good repair. The plastic covering on the armrests was torn and cloth was exposed. The findings include: Resident #21 was admitted to the facility on [DATE]. Resident #21's diagnoses included but were not limited to diabetes, major depressive disorder and convulsions. Resident #21's annual minimum data set with an assessment reference date of 8/23/21, coded the resident's cognition as moderately impaired. On 11/15/21 at 2:01 p.m. and 11/16/21 at 7:59 a.m., observation of Resident #21 was conducted. The resident was sitting in a wheelchair. The plastic covering on both wheelchair armrests was torn with cloth exposed. On 11/16/21 at 2:07 p.m., an interview was conducted with CNA (certified…

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 staff interview, facility document review, and clinical record review, it was determined that the facility staff failed to provide written notification of a transfer to the ombudsman for one of 44 residents in the survey sample, Resident #76. The facility failed to notify the ombudsman of Resident #76's transfer to the hospital on 7/27/21. The findings include: Resident #76 was admitted to the facility on [DATE], and most recently readmitted on [DATE], with diagnoses including a history of a stroke and diabetes. On the most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 10/7/21, Resident #76 was coded as being severely cognitively impaired for making daily decisions, having scored six out of 15 on the BIMS (brief interview for mental status). A review of Resident #76's clinical record revealed the following progress note written on 7/27/21 at 1:20 p.m.: CNA (certified nursing assistant) came to this nurse to report resident coughing up blood. CNA was…

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 staff interview and clinical record review, it was determined that the facility staff failed to follow professional standards of practice for one of 44 residents in the survey sample, Resident # 106. The facility staff failed to ensure timely transcription of a an order for the use of a negative wound vac [vacuum]. The physician ordered the wound Vac on 11/12/21 and the order was not transcribed until 11/15/21. The findings include: Resident # 106's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 10/25/2021, coded Resident # 106 as scoring a 3 [three] on the brief interview for mental status (BIMS) of a score of 0 - 15, 3 [three] - being severely impaired of cognition for making daily decisions. The Wound Evaluation & Management Summary for Resident # 106 dated 11/12/2021 documented in part, Dressing Treatment Plan: Negative pressure wound therapy. The Physician's Telephone Order for Resident # 106 dated 11/15/21 documented, Cleanse wound to R…

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 staff interview and clinical record review, it was determined that the facility staff failed to maintain an accurate clinical record for one of 44 residents in the survey sample, Resident # 106. The facility staff documented on Resident # 106's November 2021 eTAR [electronic treatment administration record] the use of a PICO wound vac [vacuum] [1] that was discontinued on 11/12/2021. The findings include: Resident # 106 was admitted to the facility with diagnoses that included but were not limited to: dementia without complications [2], heart failure, artificial right hip joint. Resident # 106's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 10/25/2021, coded Resident # 106 as scoring a 3 [three] on the brief interview for mental status (BIMS) of a score of 0 - 15, 3 [three] - being severely impaired of cognition for making daily decisions. The Wound Evaluation & Management Summary for Resident # 106 dated, 11/12/2021 documented in part, Dressing Treatment Plan: Negative pressure wound therapy. The Physician's Telephone…

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, staff interview and facility document review, it was determined that the facility staff failed to provide a dignified, homelike dining experience in one of 3 facility dining rooms, the Cottage dining room and failed to promote resident dignity during a meal for one of 51 sampled residents, Resident # 86's. 1. In the Cottage dining room (the memory care unit), the 27 residents present for the lunch meal on 3/5/19, were served their meals cafeteria style, on trays. 2. The facility staff failed to respect Resident # 86's dignity by standing next to her while providing assistance with feeding during the breakfast meal on 3/6/19. The findings include: 1. On 3/05/19 at 1:08 p.m., observation of the Cottage dining room was conducted during the lunch meal. There were 27 residents in the dining room when the tray cart arrived at this time. The dining room staff served all 27 residents their meal on the trays, cafeteria style. No attempt was made to remove the residents' meals from the trays 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 staff interview, clinical record review and facility document review, the facility staff failed to evidence all required documentation was provided to the receiving facility at the time of a facility initiated transfer, for seven of 51 sampled residents; ( Residents #95, #141, #137, #45, #153, #92, and #38). 1. The facility staff failed to evidence that the comprehensive care plan goals for Resident #95 were provided to the receiving facility when the resident was transferred to the hospital on 1/11/19. 2. The facility staff failed to evidence that the comprehensive care plan goals for Resident #141 were provided to the receiving facility when the resident was transferred to the hospital on [DATE], 12/23/18, and 1/23/19. 3. The facility staff failed to evidence that comprehensive care plan goals for Resident # 137 were sent with the resident to the hospital for the transfer on 02/19/19. 4. The facility staff failed to provide the receiving facility with the Resident #45's comprehensive care plan goals…

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 5. The faciltiy staff failed to provide written notification to the resident and/or responsible party, of a facility initiated transfer for Resident #38 on 11/9/18. Resident #38 was admitted to the facility on [DATE] with a recent readmission on [DATE], with diagnoses that included but were not limited to: urinary tract infection, diabetes, depression, dementia, kidney stones, and sepsis (destruction of tissue by bacterial toxins, contamination, infection) (1). The most recent MDS (minimum data set) assessment, a quarterly assessment with an assessment reference date of 2/27/19, coded the resident as having both short and long term memory difficulties. The nurse's note dated 11/10/18 at 2:02 a.m. documented in part, Late entry for evening shift - Res (resident) rested well in bed, IV (intravenous) of NS (normal saline) infusing in rt (right) forearm .Noted with increased coughing episode at supper, only ate a few bites. RP (responsible party) in to visit. Attendants in to pick up resident for (Name of Hospital)…

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, staff interview, facility document review and clinical record review, it was determined the facility staff failed to develop and/or implement the comprehensive care plan for four of 51 residents in the survey sample, Residents #53, #104, #98 and #138. 1. On 3/5/19, Resident #53 was observed on separate occasions without her physician ordered continuous oxygen in place. The clinical record failed to evidence any documentation regarding staff reapplying the oxygen or the resident being noncompliant with wearing her oxygen and notification to the physician per the comprehensive care plan. 2. The facility staff failed to develop a comprehensive care plan to address Resident #104's diabetes and the care required. 3a. On 3/5/19 during separate observations Resident #98 was observed without prevalon boots in place per the physician orders and comprehensive care plan. 3b. The facility staff failed to develop a comprehensive care to address Resident # 98's sacral wound and the care required. 3c. 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.

Based on observation, staff interview, and facility document review it was determined facility staff failed to store food in a sanitary manner in the facility's kitchen. The facility staff failed to ensure an opened five-pound container of pimento spread available for use had an open date and a use-by-date. The findings include: On 03/04/19 at 6:30 p.m., an observation of the facility's kitchen was conducted with OSM (other staff member) # 1, cook. An observation of the single door reach-in refrigerator revealed a five-pound container of Pimento Spread with approximately two-thirds remaining and available for use. Observation of the Pimento Spread container failed to evidence an open date and a use-by-date. Further observation of the container revealed a black stamped date on the side of the container. Observation of the black stamp revealed it was blurred and unreadable. After looking at the black stamp and examining the container of Pimento Spread OSM # 1 stated, I can't read the use-by-date. When asked if there was, an open date posted on the container, OSM # 1 stated, No. When…

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, staff interview, resident interview and clinical record review, it was determined that the facility staff failed to provide accommodation of resident needs for one of 51 residents in the survey sample, Resident # 89. The facility staff failed to ensure Resident # 89's call bell (a device with a button that can be pushed to alert staff when assistance is needed), was within the resident's reach. The findings include: Resident # 89 was admitted to the facility on [DATE] with a re-admission of 04/14/16 with diagnoses that included but were not limited to intellectual disabilities (1), dementia (2), gastroesophageal reflux disease (3) and Parkinson's disease (4). Resident # 89's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 01/16/19, coded Resident # 89 as scoring an 3 (three) on the brief interview for mental status (BIMS) of a score of 0 - 15, 3 (three) - being severely impaired of cognition for making daily decisions. Resident # 89 was…

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 staff interview, clinical record review, facility document review, and in the course of an investigation of a Facility Reported Incident (FRI), it was determined that the facility staff failed to implement abuse policies and procedures for reporting allegations of potential abuse for two of 51 residents in the survey sample; Resident #29 and Resident #123. The facility staff failed to implement the abuse policy to ensure timely reporting to the State Agency and other officials of a resident to resident altercation and potential abuse between Resident #29 and Resident #123 that occurred on 4/25/19 at approximately 6:30 p.m. The incident was not reported until 4/26/19 at 11:04 a.m., approximately 16 hours after the incident occurred. The findings include: Resident #29 was admitted to the facility on [DATE] with the diagnoses of but not limited to cerebral vascular disease, high blood pressure, diabetes type 2, anxiety, depression, psychosis with hallucinations. Resident #29's Minimum Data Set (MDS) was 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 staff interview, clinical record review, facility document review, and in the course of an investigation of a Facility Reported Incident (FRI), it was determined that the facility staff failed to implement abuse policies and procedures for reporting allegations of potential abuse for two of 51 residents in the survey sample; Resident #29 and Resident #123. The facility staff failed to ensure timely reporting to the State Agency and other officials in accordance with State law through established procedures for a resident to resident altercation and potential abuse between Resident #29 and Resident #123 that occurred on 4/25/19 at approximately 6:30 p.m. The incident was not reported to the State Agency until 4/26/19 at 11:04 a.m., approximately 16 hours after the incident occurred. The findings include: Resident #29 was admitted to the facility on [DATE] with the diagnoses of but not limited to cerebral vascular disease, high blood pressure, diabetes type 2, anxiety, depression, psychosis with…

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 resident interview, staff interview, facility document review, and clinical record review, it was determined that facility staff failed to provide a bed hold policy to the resident or the resident's representative upon a transfer to the hospital for two of 51 residents in the survey sample, Residents # 45 and # 92. 1. The facility staff failed to provide Resident # 45 or the resident's representative written notification of the bed hold policy when the resident was transferred to the hospital on [DATE]. 2. The facility staff failed to provide Resident #92 or the resident's representative written notification of the bed hold policy when the resident was discharged to the hospital on [DATE]. The findings include: 1. The facility staff failed to provide Resident # 45 or the resident's representative written notification of the bed hold policy when the resident was transferred to the hospital on [DATE]. Resident # 45 was admitted to the facility on [DATE] and a re-admission on [DATE] with diagnoses 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 observation, staff interview, and clinical record review, it was determined that the facility staff failed to review and revise the comprehensive care plan for 1 of 51 residents in the survey sample, Resident 145. The facility staff failed to revise Resident #145's care plan to address and include the 2/11/19 physician ordered nebulizer treatments as needed for shortness of breath. The findings include: Resident #145 was admitted to the facility on [DATE]. Diagnoses for Resident #145 included but were not limited to High Blood Pressure, Depression, and Anxiety Disorder. Resident #145's Annual Minimum Data Set (annual assessment) with an Assessment Reference Date of 02/12/2019 coded Resident #145 with moderate cognitive impairment. In addition, the Minimum Data Set coded Resident #145 as requiring extensive assistance of one staff member with activities of daily living and limited assistance of one staff person for eating. On 03/06/2019, Resident #145's clinical record was reviewed. A physician order…

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 staff interview, facility document review and clinical record review, it was determined the facility staff failed to follow professional standards of practice for two of 51 residents in the survey sample, Residents #145 and #25. 1. The facility staff failed to clarify Resident #145's physician order for oxygen regarding the flow rate parameters for titration of the oxygen. 2. The facility failed to clarify Resident #25's physician order for oxygen regarding the flow rate parameters for titration of the oxygen. The findings include: 1. The facility staff failed to clarify Resident #145's physician order for oxygen regarding the flow rate parameters for titration of the oxygen. Resident #145 was admitted to the facility on [DATE] with diagnoses that included but were not limited to: shortness of breath, diabetes, dementia, and interstitial lung disease [Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. The inflammation and scarring make it hard to get…

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, staff interview, facility document review and clinical record review it was determined the facility staff failed to provide the necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for two of 51 residents in the survey sample, Residents #53 and #98. 1. The facility staff failed to assess, measure, monitor and track Resident #53's sacral pressure sore. 2. The facility staff failed to implement the physician ordered Prevalon boots to off load pressure on Resident #98's feet. On 3/5/19, Resident #98 was observed in bed without the physician ordered Prevalon boots in place. The findings include: 1. The facility staff failed to assess, measure, monitor and track Resident #53's sacral pressure sore. Resident #53 was admitted to the facility on [DATE] with diagnoses that included but were not limited to: hypothyroid disease [decreased activity of the thyroid gland) (1)], rhabdomyolysis [is…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, and clinical record review, it was determined that the facility staff failed to implement interventions to prevent accidents per the physician order for one of 51 residents in the survey sample, Resident #98 The facility staff failed to implement fall mat(s) on each side of Resident #98's bed for fall prevention per the comprehensive care plan and physician order on 03/05/2019. The findings include: Resident #98 was admitted to the facility on [DATE]. Diagnoses for Resident #98 included but were not limited to Heart Failure, High Blood Pressure, and Depression. Resident #98's Minimum Data Set (MDS) with an Assessment Reference Date of 01/18/2019 coded Resident #98 with severe cognitive impairment. In addition, the Minimum Data Set coded Resident #98 as requiring total assistance of one staff member with activities of daily living and total dependence for eating (tube feeding). On 03/05/2019 at approximately at 8:40 a.m., Resident #98 was observed lying in bed, on her right…

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, staff interview and clinical record review, it was determined that facility staff failed to provide care and services for a suprapubic catheter to prevent urinary tract infections for one of 51 residents in the survey sample, Residents # 45. The facility staff failed to ensure Resident # 45's catheter collection bag and tubing were not resting on the floor. The findings include: Resident # 45 was admitted to the facility on [DATE] and a re-admission on [DATE] with diagnoses that included but were not limited to: retention of urine, urinary tract infection (1), benign prostatic hyperplasia (2), diabetes mellitus (3) and hypertension (4). Resident # 45's most recent MDS (minimum data set), a 30-day assessment with an ARD (assessment reference date) of 12/19/18, coded Resident # 45 as scoring a 9 (nine) on the brief interview for mental status (BIMS) of a score of 0 - 15, 9 (nine) - being moderately impaired of cognition for making daily decisions. Resident # 45 was coded as being totally…

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, staff interview and clinical record review, it was determined the facility staff failed to provide appropriate treatment and services to prevent complications of enteral feeding for one of 51 residents in the survey sample, Residents # 151. The facility staff failed to label Resident # 151's G-tube (1) feeding with Resident # 151's name, rate of feeding, Resident # 151's identification number, and the date and time, the feeding was started. The findings include: The facility staff failed to label Resident # 151's G-tube (1) feeding with the Resident # 151's name, rate of feeding, Resident # 151's identification number, and the date and time, the feeding was started. Resident # 151 was admitted to the facility on [DATE], with a re-admission on [DATE], with diagnoses that included but were not limited to: dysphagia (2), cerebral palsy (3), anemia (4) and gastrostomy (5). Resident # 151's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) 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, resident interview, staff interview, facility document review and clinical record review, it was determined the facility staff failed to respiratory care and services for five of 51 residents in the survey sample, Residents #53, #119, #145, #117, and #90. 1. The facility staff failed to administer oxygen per the physician order for Resident #53. On 3/5/19, Resident #53 was observed on separate occasions without her physician ordered continuous oxygen in place. The clinical record did not document staff reapplied the residents oxygen or any resident noncompliance with wearing the oxygen and notification to the physician 2. The facility staff failed to store a nebulizer mask in a sanitary manner, Resident #119's nebulizer mask was observed sitting on a chair next to the resident's bed on top of a plastic bag uncovered during multiple observations. 3. The facility staff failed to ensure proper storage Resident #145's nebulizer mask after use. On 3/5/19 during separate observations, 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 staff interview, facility document review and clinical record review, it was determined the facility staff failed to ensure pain management consistent with professional standards of practice, for one of 51 residents in the survey sample, Resident #148. The facility staff failed to clarify physician's orders for two as needed pain medications to determine which, as needed pain medication should be administered to Resident #148 based on pain parameters. The findings include: Resident #148 was admitted to the facility on [DATE] with a readmission on [DATE], with diagnoses that included but were not limited to: diabetes, high blood pressure, chronic kidney disease dependent on hemodialysis [a procedure used in toxic conditions and renal [kidney] failure, in which wastes and impurities are removed from the blood by a special machine (1)], COPD [general term for chronic, nonreversible lung disease that is usually a combination of emphysema and chronic bronchitis (2)], and depression. The most recent 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 staff interview, facility document review and clinical record review, it was determined that the facility staff failed to maintain a complete and accurate clinical record for one of 51 residents in the survey sample, Resident #138. The facility staff failed to document non-pharmacological interventions that were provided for Resident #138 in addition to administering as needed Tylenol (1) on multiple dates in February 2019. The findings include: Resident #138 was admitted to the facility on [DATE]. Resident #138's diagnoses included but were not limited to high blood pressure, vitamin B12 deficiency and constipation. Resident #138's most recent MDS (minimum data set), a significant change in status assessment with an ARD (assessment reference date) of 2/15/19, coded the resident's cognition as severely impaired. Section J coded Resident #138 as having received PRN (as needed) pain medication and non-medication intervention during the last five days. Section J further coded Resident #138 reported having…

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, resident interview, staff interview, facility document review and clinical record review, it was determined the facility staff failed to maintain infection control practices for one of 51 residents in the survey sample, Residents #108. The facility staff failed to wash or sanitize their hands after assisting other residents in the Cottage dining room and returning to feed Resident #108. The findings include: Resident #108 was admitted to the facility on [DATE] with the diagnoses of but not limited to Dysphagia, Schizophrenia, Alzheimer's disease, high blood pressure, sleep apnea, osteoporosis, depression with psychotic symptoms, and metabolic encephalopathy. Resident #108's most recent MDS (minimum data set) was a quarterly assessment with an ARD (assessment reference date) of 1/26/19. The resident was coded as requiring total assistance for all areas of activities of daily living. On 3/5/19 at approximately 1:30 p.m. to 1:50 p.m., observations were made in the Cottage dining room for 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.