Plum City Care Ctr

Based on observation, interview and record review, the facility did not ensure that food was stored, prepared, distributed, and served food in accordance with professional standards for food service safety. The facility did not label opened dry goods with an open date to ensure food safety for residents. This has the potential to affect all 37 of 37 residents (R) residing in the facility. Findings include: Facility policy titled, Food Storage Standards revised November 2024, states, The dietary director shall ensure that standards for refrigerated, frozen, and dry foods are followed . Policy: follow the criteria below for all types of food storage . 3. Criteria for Dry Food Storage: . A dry food storage timeline chary is available and followed. (http://www.ag.ndsu.edu/pubs/yf/foods/fn579.pdf) . Dry food stock rotation follows the FIFO [First In First Out] principle . Staff receive training on the proper dry food storage time and temperature. North Dakota State University (NDSU), FN579 titled, Food Storage Guide reviewed January 2023, states, Many staples and canned foods have 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 observations, interviews and record reviews, the facility did not ensure 4 of 4 residents (R5, R34, R28 and R3) reviewed for moderate to high risk of Pressure Injury (PI) development received the necessary treatment and services to promote healing of existing skin impairments or prevent new pressure injuries from developing. -R5 is at moderate risk for the development of PIs. R5 was observed for 5 hours and 13 minutes sitting in a Broda chair without staff offering or attempting to offload body surface. -R34 was admitted with multiple PIs and was at risk for PI development. The facility did not reposition R34 for several hours and did not provide repositioning to off-load the coccyx and hip as ordered. -R28 was at risk for PI development. The facility failed to evaluate the effectiveness of current interventions R28 had in place. The facility did not apply prevalon boot to R28's right heel as ordered to off-load heels. -R3 was at moderate risk for PI development. R3 was not repositioned for 5.5 hours…

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 record review and interview, the facility did not ensure that 1 of 1 resident (R) reviewed received appropriate respiratory care during administration of respiratory therapy (R32). Facility did not perform pre and post respiratory assessments for R32 when administering nebulizer treatments. Findings include: On 01/06/25, Surveyor reviewed R32's medical record. R32 was admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease (COPD), anxiety disorder, pneumonia, and chronic respiratory failure with hypoxia. R32's Minimum Data Set (MDS) assessment, dated 11/20/24, had a Brief Interview for Mental Status (BIMS) score of 15 out of 15 which indicated R32 had intact cognition. Surveyor reviewed R32's physician orders, stated in part: -Albuterol Sulfate HFA 90 mcg, give two puffs inhalation every four hours as needed for COPD and breathing comfort. -Ipratropium-Albuterol neb 0.5mg/3ml give every six hours with pre-neb and post-[NAME] assessment. -May take medications…

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 and interview, the facility did not ensure the accurate receiving and dispensing of all drugs and biologicals. Expired medications were observed in 1 of 4 medication storage areas medicine carts/rooms inspected. The facility did not administer medications accurately for 1 resident (R) (R32) of 1 sampled resident observed. -Facility did not destroy R15's Lorazepam after medication was discontinued. -Facility did not destroy R35's Lorazepam after medication was discontinued. -R32 had medications left at bedside and did not have an assessment to self-administer medication. Findings include: Example 1 The facility policy, titled Destruction of Medications, reviewed July 2024, states: .3. Disposal of all drugs will occur within 72 hours of a physician's order discontinuing its use, the resident's death or passage, its expiration date or as outlined in state specific policy . Surveyor reviewed R15's physician orders, which stated in part: -On 11/14/24, ordered Lorazepam 2mg/ml Give 0.25ml orally…

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 and interview, the facility did not ensure all drugs and biologicals were stored in accordance with currently accepted professional principles. This occurred for 1 of 7 resident (R32) medication administration/storage observed. During the three-day survey, 1 of 7 observations were made of medications left unattended and out of view of staff. Findings include: On 01/06/25, Surveyor reviewed R32's medical record. R32 was admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease (COPD), anxiety disorder, pneumonia, and chronic respiratory failure with hypoxia. R32's Minimum Data Set (MDS) assessment, dated 11/20/24, had a Brief Interview for Mental Status (BIMS) score of 15 out of 15 which indicated R32 had intact cognition. Surveyor reviewed R32's physician orders, which stated in part: -Ipratropium-Albuterol neb 0.5mg/3ml give every six hours with pre-neb and post-[NAME] assessment. -Do not leave at bedside. Observe taking all medications. On 01/06/25…

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, record review and interview, the facility staff did not conduct hand hygiene during resident (R) cares for 1 out of 5 (R34) observations. Certified Nursing Assistant (CNA) E did not perform hand hygiene when warranted when providing peri care to R34. This is evidenced by: The facility policy, titled Infection Prevention and Control dated 2/2024 states: 5. Hand Hygiene a. The World Health Organization (WHO) guidelines are followed for hand hygiene for all employees. The WHO Guidelines, titled WHO Guidelines on Hand Hygiene in Health Care dated 01/15/2009 states on page 92 under the section Indications for hand hygiene: My five moments for hand hygiene. Moment 1- Before touching a patient. Moment 2- Before a procedure. Moment 3- After a procedure or body fluid exposure risk. Moment 4- After touching a patient. Moment 5- After body fluid exposure risk The WHO Leaflet, titled Glove Use Information Leaflet states under section Inappropriate glove use: The use of contaminated gloves caused by inappropriate storage, inappropriate moments, and techniques for donning…

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 did not ensure all drugs and biologicals were stored in accordance with currently accepted professional principles and did not ensure only authorized personnel had access to medication carts. This had the potential to affect 1 of 12 sampled residents (R) R138. Findings include: The facility policy entitled, Controlled Substance Policy, dated 12/21 stated in part: 3. MEDICATION STORAGE & SECURITY a. All carts must be locked when not in visual presence of the nurse. b. Nurse must have the medication keys in their control at all times . R138 was admitted to the facility on [DATE] with a Brief Interview of Mental Status (BIMS) score of 15. Diagnoses include atrial fibrillation, congestive heart failure and hypertension. On 12/06/23 at 8:30 AM, Surveyor observed a medication cart sitting in the dining room. The medication cart was unlocked with the keys lying on top of the medication cart. Surveyor also observed a medication card for R138 for Metoprolol…

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 did not maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and help to prevent the development and transmission of communicable diseases and infections. Staff did not wear appropriate Personal Protective Equipment (PPE) during observation of incontinence care for R15 who is on Enhanced Barrier Precautions (EBP). Staff did not change gloves or perform hand hygiene during observation of incontinence cares for R15 and R26. Findings include: Surveyor reviewed policy entitled Standard and Transmission-Based Precautions which states in part .Enhanced barrier precautions expands the use of PPE and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of multidrug resistant organisms (MDRO) to staff hands and clothing. Examples of high-contact resident care activities requiring gown and glove use for enhanced barrier precautions include dressing, providing hygiene, changing briefs, or assisting…

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 and interview, the facility did not store, prepare, distribute and serve food in a safe and sanitary manner. This has a potential to affect all 39 residents. Kitchen staff did not test the dishwashing machine's chemical sanitization solution to ensure it is maintained at the correct concentration to prevent a potential chemical contamination of the food served to the residents. This is evidenced by: The following are general recommendations according to the U.S. Department of Health and Human Services, Public Health Services, Food and Drug Administration Food Code for each method. Low Temperature Dishwasher (chemical sanitization): o Wash - 120 degrees F; and o Final Rinse - 50 ppm (parts per million) hypochlorite (chlorine) on dish surface in final rinse. The chemical solution must be maintained at the correct concentration, based on periodic testing, at least once per shift, and for the effective contact time according to manufacturer's guidelines. On 10/24/22 at 10:50 a.m., Surveyor conducted the initial tour of the kitchen. Surveyor observed the dishwasher…

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.