Maple Lane Nursing Home

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to provide a clean, comfortable, and homelike environment throughout the second floor of the building for 1 of 2 floors related to flooring and odor control. Findings include:Upon entrance to the facility on 4/26/2026 at 4:15 PM, a strong odor resembling urine was detected on the East Wing's second level. Upon further observation, the odor was concentrated in and around room [ROOM NUMBER]. Carpeting in the room was noted to have several large dark spots, one beside the bed closest to the door and three beside the bed closest to the window. Food particles and debris were observed on the floor throughout the room, with most notable on the side closest to the window. Per interview on 4/26/2026 at 4:35 PM, an LPN (Licensed Practical Nurse) confirmed that room [ROOM NUMBER] has an odor and noted that one of the residents often declines personal care, including toileting. The LPN described that the resident removes his/her brief and urinates 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 observations, interviews, and facility policy, the facility failed to ensure expired medications were removed from 1 of 1 sampled medication storage rooms and 1 of 2 sampled medication carts. The facility also failed to ensure medication carts remained locked when unattended during three observations. Findings include:1.) Per observation and interview on 4/26/26 at 4:50 PM, the following medications in a medication cart were confirmed to be expired by the Nursing Supervisor on the second floor: - Ibuprofen 200 milligram tablets that expired on 6/25 - Cranberry pills 450 mg that expired on 5/24 - Lorazepam 1 milligram tablets that expired on 9/16/25 - Liquid acetaminophen 160 milligram per 5 milliliters that expired on 11/25 2.) Per observations made on 4/26/2026 at 5:45 PM, the medication storage room on the first floor was found to have one bottle of liquid pain relief 160/5 ml cherry flavor (Tylenol) that had expired in November of 2025 (11/25). The Licensed Practical Nurse (LPN) who was present at the time of the observations confirmed that the liquid pain relief 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.

Based on observation, interviews, and record review, the facility failed to provide the resident with an environment free of physical restraints for 1 (Resident #36) of 3 residents in the sample. Findings include:Per record review, Resident #36 is care planned for wandering and elopement.Per observation made on 4/27/2026 at approximately 10:19 AM, Resident #36 was in their room yelling and was unable to open the mesh gate that was on their room door, preventing them from leaving their room. Per interview with Resident #25 on 4/28/2026 at 12:16 PM, they stated that sometime their roommate Resident #36 has a hard time opening the mesh gate and calls for help.Per interview with Licensed Practical Nurse (LPN) #1 on 4/28/2026 at 3:30 PM, she stated that residents who wander don't have the mesh gates on their doors.Per interview with the Director of Nursing (DON) on 4/28/2026 at 3:35 PM, some residents request the mesh gates to keep out other residents that wander into their room. The DON stated that both residents in a room should be able to access and open the mesh gate and should have…

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 observation, interview, and record review, the facility failed to ensure that a resident who is unable to carry out activities of daily living (ADLs) without assistance receives the proper level of assistance for 2 of 18 sampled residents (Resident #8 and Resident #20) related to nail care. Findings include: Per observation on 4/14/25 at 12:00 PM Resident #8 had very long fingernails. The nail on his/her left thumb was long and was curling over. His/her right thumb nail was black in color. His/her other nails were long with brown debris under his/her nails. Resident #8 discussed that s/he would like his/her nails cut and that s/he was afraid of accidentally cutting him/herself with his/her long nails. Per record review, Resident #8, who has diagnoses of Multiple Sclerosis, vascular dementia, COPD [Chronic Obstructive Pulmonary Disease], and peripheral vascular disease. Resident #8's care plan states, [Resident #8] requires assistance with ADL's and transfers related to unable to complete without assistance. Resident is dependent on staff for personal hygiene. Per observation…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure a sufficient number of skilled licensed nurses, nurse aides, and other nursing personnel to provide care and respond to each resident's basic needs and individual needs as required by the resident's diagnoses, medical condition, plan of care, and facility assessment. Findings include: 1. During an interview on 1/31/24 at 3:16 PM Resident #22 stated that he/she doesn't receive showers enough and would like to have showers more regularly. When asked how often showers are provided Resident #22 said when they can, sometimes I go two weeks without one. A calendar hanging on Resident #22's wall that is used to track how often he/she is provided a shower indicates that during the month of January 2024 he/she had showers on January 3rd and January 17th, every other week. When asked if he/she has spoken to administration about it he/she stated yes they know. Per interview with the Director of Nursing (DON) on 1/31/24 at 5:00 PM management…

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

Based on observation, interview, and record review, the facility failed to ensure sufficient nursing staff with appropriate competencies and skill sets to care for the resident's needs for 7 of 8 staff in the applicable sample. Findings Include: On 1/31/24 at 8:10 AM, a Licensed Practical Nurse (LPN) was observed doffing (removing) personal protective equipment (PPE) after administering medications and obtaining Vital Signs of a resident with COVID-19. The LPN stood in the open doorway of the resident's room and removed her gloves, first touching her soiled gown with her bare hands. S/he then removed the gown, placing her contaminated equipment between her knees while she put her soiled gown in a plastic bag. She then carried the contaminated equipment to the medication cart, placed it on the clean cart, and opened the cart's drawers without cleaning her hands. S/he stated that s/he had received brief video training on using PPE upon hire and had not received any follow-up training or demonstrated competency in performing the procedure correctly to prevent contamination. A 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.

Based upon observation, interview, and record review, the facility failed to implement infection control measures related to transmission-based precautions regarding 1 staff member and 2 residents [Res.#43 & Res.#65] of 28 sampled residents on transmission-based precautions, and related to wound care treatment for 1 resident [Res. #219] of 1 sampled resident with identified wounds. Findings include: 1). Per observation on 1/31/2024 at 8:12 AM a Licensed Practical Nurse [LPN] was observed exiting the room of a resident on transmission-based precautions after administering medications and obtaining vital signs. [Per the Centers for Disease Control and Prevention [CDC]: Transmission-Based Precautions are the second tier of basic infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission]. While removing their gown and gloves outside of the precautions room, s/he was observed placing the soiled equipment (Blood pressure…

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

Based on observation, interview, and record review the facility failed to ensure that the residents maintained the right to a dignified existence related to providing privacy during incontinence care for 1 of 27 residents sampled. (Resident #7). Findings include: Per observation on 1/29/24 at 3:00 p.m. of two Licensed Nurse Aides (LNA) providing incontinence care to Resident # 7, the resident had to be transferred back to bed via a Hoyer lift to receive incontinence care. [A Hoyer lift is a mechanical lift that transfers a resident from one surface to another without using the physical power of the staff. It is commonly used for residents who cannot bear the weight to participate in a transfer.] Both LNAs had on isolation gowns, gloves, and masks as Resident #7 and roommate were both positive for COVID-19. Resident #7's roommate was in the room as well, sitting in a wheelchair on their side of the room. The roommate was able to communicate and was able to see Resident #7 from where he/she was sitting. The privacy curtain was not pulled at any time during this procedure. Privacy 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.

Based on interview and record review the facility failed to provide weekly showers based on resident preference for 1 of 27 residents sampled (Resident #22). Findings include: During an interview on 1/31/24 at 3:16 PM, Resident #22 stated that he/she doesn't receive showers enough and would like to have showers more regularly. When asked how often showers are provided Resident #22 said when they can, sometimes I go two weeks or more without one. A calendar hanging on Resident #22's wall that is used to track how often he/she is provided a shower indicates that during the month of January 2024 he/she had just two showers one January 3rd and one on January 17th. When asked if he/she has spoken to administration about it he/she stated yes they know. Per record review a care plan focus of Preferences states Resident #22's goal is preferences will be honored and used to help [him/her] support [their] daily routine based on [their] preferences. Per care plan interventions the Resident #22 reported that he/she would like to receive a shower weekly. Per interview with the Director 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 observations, interviews, and record review the facility failed to develop and implement a care plan related to a leg brace and to foot care for 2 of 27 residents sampled.(Resident #26 and Resident #219) Findings include: 1. An interview with Resident #26 on 1/29/24 at 4:55 p.m. reveals that the Resident uses a brace for his/her left foot/leg, it was observed that the brace was not on the Resident's left foot/leg at the time of the interview. Resident #26 states The nurses tell me that they do not know how to put it on so, I put the brace on myself, or it does not get put on. Per record review, there was no order on the Electronic Medical Record (EMR) for the Left foot/leg brace. On review of the resident's care plan, the brace for the Left foot/leg was not found on the care plan. Per interview with a staff Registered Nurse (RN) on 1/31/24 at 2:55 p.m., the RN confirmed that the brace is not on Resident # 26 care plan and that he/she would expect that it would be. Per an interview with the Director of…

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

Based on observation, interview, and record review the facility failed to ensure that residents received proper treatment and care to maintain good foot health for 1 of 27 residents sampled. (Resident # 219) Findings include: Per observation on 1/30/24 at 12:35 p.m., Resident # 219's feet have a large amount of edema (swelling caused by too much fluid trapped in the body's tissues.) The skin on the bilateral feet and extending up above his/her ankles has copious amounts of dry scaly skin that is yellow/brown in color. It is noted that the dry skin flakes fall off and can be seen on the carpet in front of the resident's chair. Resident #219's toe nails are long, thick, and jagged on the top and edges. At the time of the observation, the Licensed Practical Nurse (LPN) gently separated the resident's toes so the skin between the toes could be observed. The skin between all the toes on the right foot is noted to be red, very moist, and has a foul odor when separated. Per record review of a discharge summary from an acute care facility for Resident #219 dated 1/18/24 reveals under…

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 assess the residents' expressions or indications of distress to determine if services were needed for 1 of 5 sampled residents. (Resident # 25) Per record review, Resident # 25 was admitted to the facility on [DATE] with the following diagnoses: post-traumatic stress disorder and vascular dementia. A nursing note dated 1/5/24 indicated Resident #25 voiced that s/he would like to die by suicide, a plan was not identified, and the nursing supervisor was to contact Resident #25's counselor for assistance. A review of her/his care plan indicates Staff will either stay with [Resident #25] or monitor [him/her] closely during times of triggered flashbacks and fear to return [him/her] to a sense of safety and calm. Staff should utilize a gentle approach to re-orienting [him/her] back to the present. It could take some time and several attempts over the course of a day or more to get [him/her] back to the here and now. A review of a 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.