Autumn Care Of Madison

Based on staff interview, facility document review and clinical record review, it was determined the facility staff failed follow the physician's order for obtaining daily weights for one of 28 residents in the survey sample, Resident #33. The findings include: For Resident #33 (R33), the facility staff failed to obtain daily weights twice in December 2022 and three times in January 2023. On the most recent MDS (minimum data set) assessment, a quarterly/Medicare five day assessment, with an assessment reference date of 1/2/2023, the resident scored an eight out of 15 on the BIMS (brief interview for mental status) score, indicating the resident was moderately cognitively impaired for making daily decisions. R33 has a diagnosis of congestive heart failure (CHF). The physician order dated, 11/17/2022, documented, Daily Weight. The December 2022 and January 2023, MAR (medication administration record) documented the above order for daily weights. The following dates were blank: 12/29/2022, 12/20/2022, 1/3/2023, 1/4/2023, 1/29/2023. Review of the Weights tab in the electronic medical…

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, facility document review, and clinical record review, it was determined the facility staff failed to ensure a new heel wound was assessed accurately, and a treatment was obtained and implemented timely, for one of 28 residents in the survey sample, Resident #33 (R33). The findings include: For R33, the facility staff failed to obtain a physician's order for a treatment to an opened heel blister, and, the heel blister was not assessed and staged as a pressure injury per the National Pressure Injury Advisory Panel (NPIAP) guidelines. On the most recent MDS (minimum data set) assessment, a quarterly/Medicare five-day assessment, with an assessment reference date of 1/2/2023, the resident scored an eight out of 15 on the BIMS (brief interview for mental status) score, indicating the resident was moderately cognitively impaired for making daily decisions. In Section M - Skin Conditions, R33 was not coded as having any pressure ulcers. The Weekly Wound Assessment dated 2/10/2023, documented in part, Wound type: other. Other wound type: open blister. Stage: N/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 observation, resident interview, clinical record review, staff interview and facility document review it was determined that the facility staff failed to provide foot care for two of 28 residents, Resident #43 and Resident #7. The findings include: 1. For Resident #43 (R43), the facility staff failed to provide foot care services. On the most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 1/19/2023, the resident scored 11 out of 15 on the BIMS (brief interview for mental status) assessment, indicating the resident was moderately impaired for making daily decisions. Section G documented R43 requiring extensive assistance of one staff member for personal hygiene. Section I documented R43 having diagnoses including but not limited to Diabetes Mellitus (1). On 2/21/2023 at 12:29 p.m., R43 was observed lying in bed asleep. R43's right foot was observed outside of the blanket uncovered. The toenail on the great toe was observed to be uneven with thick jagged…

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, resident interview, clinical record review, staff interview and facility document review it was determined that the facility staff failed to provide respiratory care and services consistent with professional standards of practice for two of 28 residents, Resident #43 and Resident #45. The findings include: 1. For Resident #43 (R43), the facility staff failed to properly store a BiPAP (1) mask in a sanitary manner when not in use. On the most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 1/19/2023, the resident scored 11 out of 15 on the BIMS (brief interview for mental status) assessment, indicating the resident was moderately impaired for making daily decisions. Section I documented R43 having diagnoses including but not limited to Obstructive Sleep Apnea. On 2/21/2023 at 12:29 p.m., an observation was made of R43 in their room. A BiPAP machine was observed on the nightstand to the right side of R43's bed. A mask with tubing was attached to the machine. The mask was observed to be uncovered and laying on 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 resident interview, clinical record review, staff interview and facility document review, it was determined the facility staff failed to evidence consistent communication to the hemodialysis (1) center for one of 28 residents in the survey sample, Resident #35. The findings include: For Resident #35 (R35), the facility staff failed to evidence communication to the dialysis facility for nine of 32 dialysis appointments between 12/10/2022-2/23/2023. There was no evidence of dialysis communication from the facility to the dialysis center on 12/27/2022, 1/5/2023, 1/10/2023, 1/14/2023, 1/17/2023, 1/19/2023, 2/7/2023, 2/11/2023 and 2/16/2023. On the most recent MDS (minimum data set) assessment, an admission assessment with an ARD (assessment reference date) of 12/17/2022 the resident scored 12 out of 15 on the BIMS (brief interview for mental status) assessment, indicating the resident was moderately impaired for making daily decisions. Section O documented R35 receiving dialysis services while a resident at the facility. On 2/22/2023 at 9:22 a.m., an interview was conducted…

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 clinical record review, it was determined the facility staff failed to maintain effective infection control for one of 28 residents in the survey sample, Resident #33. The findings include: For Resident #33 (R33), the facility staff failed to provide a treatment to a pressure ulcer in a manner to prevent infection. The physician order dated, 2/21/2023, documented, Cleanse right heel with wound cleanser and apply xeroform and dressing daily to open blister. On 2/23/2023 at 9:15 a.m., LPN (licensed practical nurse) #4 was observed providing a treatment to R33's right heel. LPN #4 was at the treatment cart where she got a 4x4 gauze packet, opened the packet by tearing it across one corner, used her hands to pull the gauze out of the packet and placed in on the outside of the packet. She proceeded to spray the gauze pad with wound cleanser. LPN #4 gathered the rest of her supplies; a xeroform dressing, a bordered gauze dressing, a 4x4 gauze pad, a red plastic bag, and a sterile field packet. LPN #4 entered the room. She placed the supplies on…

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

Based on observation, staff interview, and facility document review it was determined facility staff failed to store food in the kitchen in accordance with professional standards for food service safety. The facility failed to properly dispose of dry goods that were past their expiration date, dispose of milk past it expiration date and date/label refrigerated juice not stored in it's original container. The findings include: On 9/14/2021 at approximately 11:00 a.m., an observation of the facility's kitchen was conducted. Observation of the kitchen's dry storage area revealed an opened 24 ounce bag of french fried onions approximately three-quarters full with no open date on the package and a manufacturer's date on the package documenting Best used by 19:35 Jun (June) 24 2021. A second 24 ounce bag of french fried onions was observed on the shelf unopened with a manufacturer's date on the package documenting Best used by 19:33 Jun 24 2021. Observations of the kitchen's walk in refrigerator revealed an approximately two quart sized clear plastic pitcher filled with a red liquid…

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, clinical record review, staff interviews and facility document review it was determined that the facility staff failed to ensure an injury of unknown origin was immediately reported to the administrator, State Agency and other officials for one of 34 residents in the survey sample, Resident #609. The facility staff failed to immediately report an injury of unknown origin for Resident #609 that was first observed on 12/23/2020. The injury of unknown origin was not reported to the director of nursing until 12/24/2020 and the director of nursing failed to immediately report the injury to the administrator. Resident #609's injury of unknown origin was not reported to the administrator until 12/28/20 and to the appropriate agencies or the responsible party until 12/28/2020. The findings include: Resident #609 was admitted to the facility with diagnoses included but were not limited to osteoarthritis (1) and dementia without behavioral disturbance (2). Resident #609's most recent MDS (minimum data set), a significant change assessment with an ARD (assessment…

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 resident interview, staff interview and clinical record review it was determined that the facility staff failed to submit an accurate MDS (minimum data set) assessment for one of 34 residents in the survey sample, Resident #49. Resident #49's quarterly MDS assessment with an ARD of 8/20/2021, in Section O failed to code Resident #49 as receiving oxygen during the assessment period. The findings include: Resident #49 was admitted to the facility with diagnoses that included but were not limited to congestive heart failure (1) and chronic obstructive pulmonary disease (2). Resident #49's most recent MDS, a quarterly assessment with an ARD of 8/20/2021, coded Resident #49 as scoring a 14 on the brief interview for mental status (BIMS) of a score of 0 - 15, 14 - being cognitively intact for making daily decisions. Section O failed to coded Resident #49 receiving oxygen during the assessment period. On 9/14/2021 at 2:08 p.m., an interview was conducted with Resident #49. Resident #49 was observed in bed wearing a nasal cannula attached to an oxygen concentrator. Resident #49…

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 follow professional standards of practice for one of 34 residents in the survey sample, Resident #42. The facility staff failed to clarify a physician's order to include the size of Resident #42's Foley urinary catheter (1). The findings include: Resident #42 was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #42's diagnoses included but were not limited to chronic kidney disease, bladder disorder and muscle weakness. Resident #42's significant change in status minimum data set assessment with an assessment reference date of 8/19/21, coded the resident's cognition as moderately impaired. Section H coded Resident #42 as having a urinary catheter. Review of Resident #42's clinical record revealed a physician's order dated 6/4/21 to change the resident's catheter as needed. Review of all physician's orders active as of 9/15/21 failed to reveal a physician's 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 observation, staff interview, facility document review and clinical record review, it was determined that the facility staff failed to implement bed rail requirements for one of 34 residents in the survey sample, Resident #51. The facility staff implemented bed rails for Resident #51 without a documented clinical need. The findings include: Resident #51 was admitted to the facility on [DATE]. Resident #51's diagnoses included but were not limited to muscle weakness, high blood pressure and malnutrition. Resident #51's significant change in status minimum data set assessment with an assessment reference date of 8/27/21, coded the resident's cognition as severely impaired. Section G coded Resident #51 as totally dependent on two or more staff with bed mobility. On 9/14/21 at 1:49 p.m. and 9/15/21 at 8:21 a.m., Resident #51 was observed lying on her back in bed with bilateral one forth bed rails in the upright position. Review of Resident #51's clinical record revealed a bed rail assessment dated [DATE],…

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 facility document review, it was determined that the facility staff failed to complete an annual CNA (certified nursing aide) performance review for one of five CNA record reviews. The facility staff failed to complete an annual performance review for CNA #3. The findings include: CNA #3 was hired on 8/8/18. Review of CNA #3's record revealed the last performance review was completed on 10/1/19. On 9/15/21 at 10:53 a.m., an interview was conducted with ASM (administrative staff member) #1 (the administrator) and ASM #2 (the director of nursing). ASM #1 stated usually the director of nursing is responsible for completing CNA's annual performance reviews. ASM #2 stated she had only been employed at the facility for approximately three weeks and had not completed performance reviews. ASM #1 stated annual performance reviews should be completed based on a monthly report ran by human resources and CNA #3's annual performance review was missed. ASM #1 was made aware this was a concern. On 9/15/21 at 1:00 p.m., ASM #1 stated the facility did not have a specific…

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 4. Resident # 73 was admitted to the facility with diagnoses that included but were not limited to high blood pressure and anxiety [1]. Resident # 73's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of [DATE], coded Resident # 73 as scoring a three on the brief interview for mental status (BIMS) of a score of 0 - 15, three - being severely impaired of cognition for making daily decisions. Review of Resident # 73's clinical record failed to evidence an advance directive. Further review of the clinical record revealed a Care Plan Conference Summary dated [DATE]. The Care Plan Conference Summary documented in part, Topics Discussed: Adv. Dir. [Advance Directive/Code Status: Discussed with Res. Rep [Resident Representative]. Comments DNR [Do Not Resuscitate]. Further review of the Care Plan Conference Summary failed to evidence a review was conducted to provide Resident # 73 and/or Resident # 73's representative with the opportunity to develop an advance directive.…

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 accurately complete a MDS (minimum data set) resident assessment for one of 42 residents in the survey sample, Resident #77. The facility staff failed to accurately complete the quarterly MDS (minimum data set) regarding the use of psychotropic medications for Resident #77 with the ARD (assessment reference date) of 01/31/2020. The findings include: Resident #77 was admitted to the facility on [DATE] with a readmission on [DATE] with diagnoses that included but were not limited to anxiety disorder (1), schizoaffective disorder (2) and major depressive disorder (3). Resident #77's most recent MDS, a quarterly assessment with an ARD of 01/31/2020, coded Resident #77 as scoring a 12 on the brief interview for mental status (BIMS) of a score of 0 - 12, 12 - being moderately impaired for making daily decisions. Review of the clinical record revealed a list of Resident #77's MDS assessments. The list revealed that 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 resident interview, staff interview, clinical record review, and facility document review, it was determined that facility staff failed to review and revise the comprehensive care plan for one of 42 residents in the survey sample, Residents # 23. The facility staff failed to revise Resident #23's comprehensive care plan to include the use of a spirometer. The findings include: Resident # 23 was admitted to the facility with diagnoses that included but were not limited to: pulmonary edema [2], chronic obstructive pulmonary disease [3]. Resident # 23's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 12/06/19, coded Resident # 23 as scoring a 15 on the staff assessment for mental status (BIMS) of a score of 0 - 15, 15- being cognitively intact for making daily decisions. Resident # 23 was coded as requiring supervision of one staff member for activities of daily living. On 02/11/20 at 11:40 a.m., 02/11/20 at 1:00 p.m., and 02/12/20 at 8:10 a.m.,…

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, clinical record review, facility document review and in the course of a complaint investigation, it was determined that the facility staff failed to follow professional standards for two of 42 residents in the survey sample, Resident # 79, and Resident #50. The facility staff obtain a physician's order for the use of an [NAME] machine post Resident #79's total knee replacement, and failed to administer the prescribed dosage of the scheduled Calcium/Vitamin D during the medication administration observation for Resident #50 on 02/12/2020 at 8:00 a.m. The findings include: 1. Resident # 79 was admitted with diagnoses that included but were not limited to: aftercare following joint replacement [knee] surgery, and muscle weakness. Resident # 79's admission MDS (minimum data set), could not be completed before they were discharged to another facility. The facility's nursing admission assessment for Resident # 79 documented in part, admission: [DATE]. 16:55 [4:55 p.m.]. Cognitive…

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 an indwelling catheter for one of 42 residents in the survey sample, Residents # 75. The findings include: Resident # 75 was admitted to the facility with diagnoses that included but were not limited to: sacral [tail bone] pressure ulcer and obstructive uropathy [2]. Resident # 75's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 01/31/2020, coded Resident # 75 as scoring a 15 on the brief interview for mental status (BIMS) of a score of 0 - 15, 15 - being cognitively intact for making daily decisions. Resident # 75 was coded as requiring extensive assistance of one staff member for activities of daily living. Section H Bladder and Bowel coded Resident # 75 as having an indwelling catheter. On 02/11/20 at 11:46 a.m., an observation of Resident # 75 revealed the resident was in bed. Observation of the bed revealed 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 resident interview, staff interview, clinical record review, and facility document review, it was determined that facility staff failed to ensure respiratory care and services consistent with professional standards of practice for one of 42 residents in the survey sample, Residents # 23. The facility staff failed obtain a physician's order for Resident #23's use of an incentive spirometer and failed to store the resident's incentive spirometer in a sanitary manner. The findings include: Resident # 23 was admitted to the facility with diagnoses that included but were not limited to: pulmonary edema [2], chronic obstructive pulmonary disease [3]. Resident # 23's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 12/06/19, coded Resident # 23 as scoring a 15 on the staff assessment for mental status, of a score of 0 - 15, 15- being cognitively intact for making daily decisions. Resident # 23 was coded as requiring supervision of one staff member for…

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 ensure a drug regimen free from unnecessary medication for one of 42 residents in the survey sample, Resident # 73. The facility staff failed to implement non-pharmacological interventions prior to the administration of the prn [as needed] pain medications Hydrocodone-Acetaminophen and Tylenol to Resident #73. The findings include: Resident # 73 was admitted to the facility with diagnoses that included but were not limited to high blood pressure and chronic pain. Resident # 73's most recent MDS (minimum data set), an quarterly assessment with an ARD (assessment reference date) of 01/30/2020, coded Resident # 73 as scoring a three on the brief interview for mental status (BIMS) of a score of 0 - 15, three - being severely impaired of cognition for making daily decisions. Section J Health Conditions coded Resident # 73 as having frequent pain with a pain level of seven on a scale of zero to ten with ten being…

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 facility staff failed to ensure an expired three milliliter multi-dose vile of Humalog [1] was not available for use for one of 42 residents in the survey sample, Resident # 47. The findings include: Resident # 47 was admitted to the facility with diagnoses that included but were not limited to: diabetes mellitus without complications [2]. Resident # 47's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 01/04/2020, coded Resident # 47 as scoring a 15 on the brief interview for mental status (BIMS) of a score of 0 - 15, 15 - being cognitively intact for making daily decisions. Section N Medications coded Resident # 47 as 0 [zero] under N0300 Injections. Record the number of days that injections of any type were received during the last 7 [seven] days or since admission/entry or reentry if less than 7 days. If 0 ---skip to N0410 Medications Received. Under N0350 Insulin…

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 facility staff failed to store food in a sanitary manner and discard food past its expiration date in two of two facility nourishment rooms observed. The findings include: On 2/11/20 at 3:15 p.m., an observation was made of the South unit nourishment room was conducted with ASM (administrative staff member) #2, the director of nursing. Observation of the refrigerator revealed a white paper bag inside of the bottom drawer. There was no name or date observed to be on the bag. Upon inspection by ASM #2 it was determined that the bag contained a white Styrofoam bowl with potato written on the lid. The bowl was observed to not contain a date or name on it. Further observation of the drawer revealed a second white paper bag without a date or a name. Upon inspection by ASM #2 it was determined that the bag contained a white Styrofoam bowl with vegetable beef written on the lid. The bowl was observed to not contain a date or name 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 resident interview, staff interview, clinical record review and facility document review, it was determined that facility staff failed to implement infection control practices to prevent the development and spread of infection for two of 42 residents in the survey sample, Resident #23 and Resident #42. Resident #73's incentive spirometer was observed stored in an unsanitary manner. The spirometer was observed uncovered on the residents over the bed table during separate observations. Resident #42's catheter bag was observed resting directly on the floor during separate observations. The findings include: 1. Resident # 23 was admitted to the facility with diagnoses that included but were not limited to: pulmonary edema [2], chronic obstructive pulmonary disease [3]. Resident # 23's most recent MDS (minimum data set), a quarterly assessment with an ARD (assessment reference date) of 12/06/19, coded Resident # 23 as scoring a 15 on the staff assessment for mental status (BIMS) of a score of 0 - 15, 15-…

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.