Tygart Valley Health & Rehabilitation

Based on observation and staff interview the facility failed to support the residents' rights, by not placing the name and contact information for the State Ombudsman in a location that was easily accessible for all residents to read. This was a random opportunity for discovery and had the potential to affect more than a limited number of residents. Facility census: 47. Findings included: a) During the Resident Council meeting, on 01/09/24 at 11:00 AM, the resident council members all said they did not know where the information was located for the Ombudsman. An observation, on 01/09/24 at 11:45 AM, of the posting for the Ombudsman information revealed the information was posted in a case mounted to the wall on 100 hall. The case was high on the wall and was not accessible for residents who were in wheelchairs. During an interview, on 01/10/24 at 10:28 AM, with Registered Nurse (RN) Assessment Coordinator, she stated, Well I can see it, if I was in a wheelchair I couldn't see it and especially with that glare off that glass.

Based on record review and staff interview, the facility failed to provide the required Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (SNF ABN) form to three (3) of three (3) residents reviewed for the facility's beneficiary protection notification practice. This failure placed residents at risk of not being informed of their rights prior to the end of Medicare Part A covered services. Resident identifiers: #38, #40, and #5. Facility census: 47 Findings Included: a. Failure to Issue a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) Form Form Instructions Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) Form CMS-10055 (2018) indicates Medicare requires Skilled Nursing Facilities to issue the SNF ABN to Medicare beneficiaries prior to providing care that Medicare usually covers, but may not pay for because the care is: - not medically reasonable and necessary; or - considered custodial. The SNF ABN provides information to the beneficiary so that he/she can decide whether or not to get the care that may not be paid 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.

Based on observation, resident interview and staff interview the facility failed to ensure the temperatures were within the required parameters, which is 71 degrees Fahrenheit (F) to 81 Degrees F. in the shower room. In addition, the facility failed to ensure Resident #1's room was clean. This failed practice has the potential to affect more than a limited number of residents. Resident Identifiers #1. Facility census 47. Findings Included: a) Resident #1 During an observation on 01/08/24 at 12:00 PM, in Resident #1's room, under the bed there is a very sticky substance with black dirt and dust buildup on it. There were also 6 caps of what appears to be tops to the tube feeding bolus under the bed. During an observation on 01/09/24 at 10:00 AM, of Resident #1's room under the bed there is a very sticky substance with black dirt and dust buildup on it. There were also 6 caps of what appears to be tops to tube feeding bolus under the bed. During an interview on 01/09/24 at 1:31 PM, with the facilities Maintenance Director, he stated, They clean these rooms daily. Yes, that is dirty…

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, staff interview observation the facility failed to develop and or implement the comprehensive person-centered care plan as required. This was true for four (4) of twenty-three (23) care plans reviewed during the long-term care survey. Resident identifiers: #195, #21, #15, #27 Facility Census: 47. Findings included: a) Resident 195 On 01/08/24 at 1:11 PM observation of Resident #195 sitting at his bedside. During our conversation a round tin of Grizzly long cut tobacco product was observed on his over the bed table. The surveyor questioned if he used tobacco, and he replied, I use snuff, (pointing to the tin) been using it since I was 11. The tobacco at bedside was confirmed with Licensed Practical Nurse #2. The facility was a smoke free facility; however, smokeless tobacco was permitted. On 01/09/24, record review shows a Safety Resident Evaluation dated 01/02/24, completed by Registered Nurse (RN) #29. Section #4 on the evaluation is for smoking safety. Question #1 for tobacco…

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 record review, observation, and staff interview, the facility failed to ensure it was free from accident hazards in which it had control. One (1) medication cart was left unlocked and unattended. Additionally, the facility failed to complete a safety assessment on Resident #195 related to his use of smokeless tobacco in his room. These were random opportunities for discovery and had the potential to effect more than a limited number of residents. Resident identifier: #195. Facility census: 47. Findings included: a) Unlocked Medication Cart on 3 [NAME] Hall The facility's Medication Storage policy states, Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others. On 01/10/24 at 11:33 AM, Surveyor observed the medication cart on the 3 [NAME] Hall was unlocked and unattended. The Regional Director of Clinical Operations #72 confirmed 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 and staff interview, the facility failed to ensure the staff posting was accurate and correct. This had the potential to affect more than a limited number of residents residing at the facility. Facility census: 47. Findings included: a) Staff posting During a random opportunity for discovery on 01/09/24, the staff posting had not been updated from 01/08/24 to 01/09/24. Also the staff posting was not in a prominent place readily accessible to residents and visitors. In an interview with the Director of Nursing (DON) on 01/10/24 at 11:00 AM, the DON verified the staff posting had not been updated and it was not posted in a prominent place accessible to residents and visitors.

Based on staff interview, resident interview, and record review the facility failed to ensure food was served at a safe and appetizing temperature. This failed practice had the potential to affect more than a limited number of residents. Facility census 47. Findings included: a) Dining Services Based on anonymous resident interviews during the long term care survey process, multiple residents had complaints of the hot food being cold. During the resident council meeting on 01/09/23 at 11:00 AM, the resident council members made complaints that the food being served at meals is cold. Observation on 01/10/24 01:10 PM, found the temperatures of the last tray served on 300 hall were: noodles with meat sauce tempted at 122 degrees Fahrenheit and the vegetable barley soup tempted at 122 degrees Fahrenheit. During an interview on 01/10/24 at 1:15 PM, the facilities Dietary Manager (DM) stated, The food normally temps at 165 degrees before we serve the residents. When it is served to the residents it should be between 135 degrees and 140 degrees. Observation of the temperature log in 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 and staff interview the facility failed to store, prepare, and distribute food in accordance with professional standards for food service safety. It was discovered the ice machine was not draining properly, there was expired food found in walk-in cooler and food stored on the floor in the storage area. This had the potential to affect all residents receiving nutrition from the kitchen. Facility census: 47. Findings included: a) Ice machine During a random opportunity for discovery, on 01/09/23 at 2:10 PM, it was discovered the ice machine was not draining properly. The drain was located below the floor drain, which provided for a no stop gap of one (1) inch to prevent backflow. In an interview with the Director of Maintenance on 01/09/24 at 2:50 PM, verified the drain line did not have a stop gap between the floor and the drain. b) Initial tour of the kitchen At 11:45 AM on 01/08/24, a tour of the kitchen with Dietary Manager (DM) #25 found the following items in the walk-in refrigerator that were expired: A plastic container labeled as Lunch Meat, had two dates…

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 staff interview the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. This had the potential to affect more than an isolated number of residents. Resident Identifiers: #194 and #11. Facility Census: 47. Findings Included: a) 300 [NAME] hallway On 01/08/24 at 12:50 PM during observation of the lunch meal trays being passed on the 300 [NAME] hallway, no hand hygiene was provided to the residents prior to their meal. When Nurse Aide (NA) #69 and #27 were asked how they provide hand hygiene, they looked at each other and laughed. NA #27 stated, 'they use to put hand wipes on the trays, but they don't anymore. They both then continued to pass the remaining meal trays without providing hand hygiene. It was confirmed with NA #69 and #27 that they did not provide hand hygiene. This was confirmed with the Director of Nursing on 01/08/24 at 1:10 PM. b) Resident #194 On 01/08/24 at 2:38 PM…

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 staff interview the facility failed to promote a dignified dining experience by not providing meals to all residents seated at the same table at the same time. This failed practice was a random opportunity for discovery. Resident identifiers: #5 and #30. Facility census 47. Findings included: a) Resident #5 During an observation, on 01/08/24 at 1:00 PM, Resident #5 was seated at a dining room table for lunch. Two (2) other residents seated at the same table were served their lunch tray. Staff then served 2 residents seated at another table. Another resident seated by herself was served at another table. Resident #5 still did not have her tray. During an interview, on 01/08/24 at 1:10 PM, with the Activity Director, she stated, I'm not really sure how they have them , maybe the resident is at the wrong table. During an observation on 01/08/24 at 1:12 PM, Resident #5 received her lunch tray. During an interview on 01/08/24 1:12 PM, Nursing Assistant (NA)# 36 stated, She must have parked herself there. During an interview on 01/10/24 at 10:54 AM, with 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 record review and staff interview the facility failed to ensure [NAME] Virginia Physician Orders for Scope of Treatment (POST) forms were completed correctly for two (2) of twenty-three (23) residents in the long-term care survey sample. Resident identifiers: #18 and #15. Facility Census: 47. Findings included: a) Resident #18 On 01/08/24 at 2:51 PM, record review found the POST form for Resident #18, dated 03/31/23 with a verbal signature for the Medical Power of Attorney (MPOA). On 01/09/24 at 12:15 PM an interview with Social Worker (SW) #43 confirmed the POST form was not completed correctly because the MPOA had not physically signed the POST form in a timely manner. The POST form contained only verbal consent from the MPOA. The SW also confirmed that there was no documentation of reaching out to the MPOA to have the POST signed by her. According to the [NAME] Virginia Center for End-of-Life Care the following guidelines are to be followed. The signature section provides a declaration on behalf of the patient (or incapacitated patient's Medical Power of Attorney (MPOA)…

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 record review and staff interview, the facility failed to report the results of a thorough investigation of a fall with serious bodily injury to Adult Protective Services and the State Survey Agency, within five (5) working days of the incident in accordance with State law. This was true for two (2) of two (2) residents reviewed under falls in the Long-Term Care Survey Process. Resident identifiers: #3 and #144. Facility census: 47. Findings included: a) Resident #3 A record review of the facility reportables, completed on 01/10/24 at 9:20 AM, demonstrated that Resident #3 had experienced a fall with serious bodily injury on 11/05/23 and an Immediate Fax Reporting was sent to the appropriate state agencies. There was no evidence the facility shared the Five (5) Day Follow-Up / Investigation Details with Adult Protective Services (APS). During an interview on 01/10/24 at 9:55 AM, the Social Worker reported he could not produce any evidence results of the Five (5) Day Follow-Up was shared with APS in accordance with State Law. b) Resident #144 A record review of the facility…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and staff interview, the facility failed to provide evidence a copy of the notice of transfer/discharge was sent to the Ombudsman. This was true for one (1) of four (4) residents reviewed under the Hospitalization pathway in the Long-Term Care Survey Process. Resident identifier: #144. Facility census: 47. Findings included: a) Resident #144 A record review, completed on 01/09/24 at 11:40 AM, revealed Resident #144 was transferred to the hospital on [DATE]. There was no evidence in the electronic medical record that a copy of the Notice of Transfer/Discharge was sent to the long-term care Ombudsman. During an interview on 01/09/24 at 2:21 PM, the Social Worker reported he could not produce evidence the Notice of Transfer/Discharge form had been faxed to and received by the Ombudsman.

Based on record review, observation, staff interview and resident interview, the facility failed to ensure two (2) of 23 residents had an accurate Minimum Data Sets (MDS) which reflected the resident's status at the time of the assessment. Resident identifiers: #12 and #21. Facility census: 47. Findings included: a) Resident #12 On 01/08/24 at 2:16 PM, the resident said, I need some false teeth so I can eat. My teeth hurt and I need them pulled. I was supposed to have an appointment but I don't know what's going on. I don't think I have any appointments to see a dentist. Review of the last annual MDS with an assessment reference date (ARD) of 07/12/23 coded the resident as having no dental issues. At 8:33 AM on 01/10/24, the Director of Nursing (DON) was asked about the Resident's dental status. The DON said, She wants dentures but she doesn't want to pay for them. At 8:45 AM on 01/10/24, the DON and the surveyor observed the resident's dental status. The Resident said I have a toothache. The cardiologist I saw yesterday said those teeth need to come out. Review of the Resident's…

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 staff interview, the facility failed to ensure Resident #35 had a baseline care plan developed within 48 hours of admission which addressed a Urinary Tract Infection (UTI) treated with an antibiotic. This was true for one (1) of three (3) residents recently admitted to the facility. Resident identifier: #35. Facility census: 47. Findings included: a) Resident #35 Record review found the Resident was a new admission to the facility on [DATE]. The resident was admitted to the facility from the hospital with a UTI. She was being treated with the antibiotic: Doxycycline Hyclate Oral Tablet 100 MG (Doxycycline Hyclate), 1 tablet two (2) times a day. The Resident received the antibiotic at the facility through 12/22/23. At 10:55 AM on 01/10/24, the Director of Nursing (DON) reviewed the baseline care plan triggers created on 12/14/23 with the surveyor. The DON confirmed the antibiotic usage and the UTI was never care planned for Resident #35.

Based on record review and staff interview the facility failed to involve the resident and/or resident representative when developing a comprehensive person-centered care plan for discharge planning for Resident #42. This was true for one (1) of one (1) resident reviewed for discharge planning during the Long-Term Care Survey Process. Resident identifier: #42. Facility census: 47. Findings included: a) Resident #42 Medical record review, on 01/09/24, revealed during an interdisciplinary team meeting on 10/27/23 there was discussion of the upcoming discharge. Resident #42 had self initiated a discharge to return home. The progress note did not indicate the resident was present during the meeting. In an interview with, the Licensed Social Worker (LSW) on 01/09/24 at 2:10 PM, the LSW reported he was unable to provide any verification that Resident #42 had attended the discharge meeting on 10/27/23.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview the facility failed to complete the discharge/physician's recapitulation of residents stay. This was true for two (2) of two (2) residents reviewed for the area of discharges during the Long-Term Care Survey Process. Resident #42 had no recapitulation for a community discharge and Resident #43 expired at the facility and also had no physician's recapitulation. Resident identifiers: #42 and #43. Facility census: 47. Findings included: a) Resident #42 During a medical record review on [DATE], it revealed there was no discharge summary or physician's recapitulation completed for Resident #42 when he was discharged to the community on [DATE]. In an interview with the Director of Nursing (DON) on [DATE] at 2:48 PM, verified there was no discharge summary or physician's recapitulation for Resident #42's discharge. b) Resident #43 During a medical record review on [DATE], it revealed there was no discharge summary or physician's recapitulation completed for Resident #43 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.

Based on record review, staff interview, and observation, the facility failed to provide the communication book and dry erase board used as assistive device to communicate with staff. This was true for one (1) of one (1) residents reviewed for communication during the Long-Term Care Survey Process. Resident identifier: #27. Facility census: 47. Findings included: a) Resident #27 A medical record review on 01/09/24 for Resident #27,with a hearing deficit had a comprehensive care plan with an intervention for the resident to have a communication book to assist her in communicating with the staff. In an interview on 01/09/24 at 1:35 PM, with the Licensed Social Worker (LSW), explained Resident #27 used a dry erase board, when she was unable to read your lips. During an observation on 01/09/24 at 1:40 PM, the LSW and the Minimum Data Set (MDS) Coordinator, both were unable to locate the communication book or dry erase board used as assistive devices to communicate with staff.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, and staff interview the facility failed to provide an ongoing program of activities to meet the interests of and support the physical, mental, and psychosocial well-being for one (1) of three (3) residents. Resident identifier: # 32. Facility census 47. Findings included: a) Resident #32 During an observation on 01/08/24 at 11:30 AM, Resident #32 was sitting in the dining room by herself with no music, television or interaction from staff or other residents. During an observation, on 01/08/24 at 2:00PM, Resident #32 was sitting at the nurses station, there was an activity going on in the facility chapel but Resident #32 was not in attendance. During an observation, on 01/09/24 at 1:00 PM, Resident #32 was sitting at nurses station with no interaction from staff or residents. During an observation, on 01/09/24 at 3:32 PM, Resident #32 was sitting at nurses station with no interaction from staff or residents. During an interview, on 01/09/24 at 03:35 PM, with the facilities Activity Director,…

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, observation, record review, and staff interview, the facility failed to provide care and services in accordance with professional standards of practice for three (3) of 23 residents reviewed during the long term care survey. Resident #36 did not have an Unna boot as ordered by the physician. For Resident #12 the facility did not follow the physician ordered parameters for medication administration. For Resident #28 the facility failed to notify the physician when the resident refused medication. Resident identifiers: #36, #12, and #28. Facility census: 47. Findings included: a) Resident #36 Observation of the Resident on 01/08/24 at 3:08 PM, found both lower legs were a variation of red and purple and both lower legs were swollen. The left lower leg was dry and scaly. When asked about the observation, the Resident said, I was supposed to have an Unna boot on my right leg but the nurse told me they don't have any. The resident said he had been several days without the boot but he could not recall exactly how long and he could not recall the name of the…

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

Based on observation and staff interview the facility failed to ensure pressure ulcer treatments and care were performed within professional standards of care. This was true for two (2) of two (2) wound dressings observed during the long term survey process. Resident Identifiers: #194 and #11 Facility Census: 47. Findings Included: a) #194 On 01/08/24 at 2:38 PM record review shows Resident #194 has a stage 2 pressure ulcer to the right buttock. There is a dressing change order as follows: Cleanse stage 2 with soap and water. Pat dry. Cover with border dressing daily and porn if loose or soiled until clear one time a day for Stage 2 pressure Ulcer related to PRESSURE ULCER OF RIGHT BUTTOCK, STAGE 2 until clear and as needed for of loose or soiled related to PRESSURE ULCER OF RIGHT BUTTOCK, STAGE 2 until clear. On 01/09/24 at 01:50 PM wound care was observed with Licensed Practical Nurse (LPN) #1 performing the care. The Resident was in bed on her side and had a brief on, she had had a bowel movement. The LPN placed her gloves on, removed the old dressing in place and cleaned 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 record review and staff interview the facility failed to address a resident receiving nutrition via peg tube when weight loss occurred. This failed practice was true for 1 of 2 residents reviewed for tube feeding during the long term care survey process. Resident Identifier: #1. Facility census 47. Findings included: a) Resident #1 An record review on 01/08/24 at 2:56 PM, revealed Resident #32 who receives all nutrition via peg tube weighed 100.6 lbs on 6/02/23, 96.8 lbs on 10/31/23, 93 lbs on 12/14/23 and 89.8 lbs on 01/02/24. This calculated out to be a 10.74% weight loss in the past 6 months. During a record review on 01/08/24 at 3:15 PM, of Resident #32's last 3 quarterly nutritional assessments it reads that resident is tolerating his tube feeding well and shows the calculation of the weight loss. It also revealed that the weight loss was not addressed in no other way but to add him to weekly weights. During a record review on 01/08/24 at 3:30 PM, the surveyor found no notes in Resident #32's medical chart from the doctor addressing the weight loss. During an interview…

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, record review, and staff interview, the facility failed to ensure the oxygen humidifier bubbler on the oxygen concentrator was working. This was true for one (1) of one (1) resident reviewed for respiratory care during the long term care survey process. Resident identifier: #12. Facility census: 47. Findings included: a) Resident #12 On 01/08/24 at 12:25 PM, the Resident said the water bottle on her oxygen tank was empty. She said they only fill it once a week and that is not enough, it runs dry. She said the water makes her nose not dry out so quickly. She said she is supposed to use oxygen all the time and she receives 2 liters of oxygen. On 01/08/24 at 12:29 PM, the Resident's Licensed Practical Nurse (LPN) #1 observed the humidifier bubbler and said the water level is too low for it to work. I will take care of it right now. Review of the Resident's physician's orders found an order for: Oxygen at 2 liters per minute (LPM) per nasal cannula via O2 concentrator and/or tank as needed Change Bubbler and fill to maximum fill line 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.

Based on record review, resident interview, observation and staff interview, the facility failed to ensure follow up dental services were provided to one (1) of two (2) Resident's reviewed for the care area of dental services during the long-term care survey. Resident identifier: #12. Facility census: 47. Findings included: a) Resident #12 On 01/08/24 at 2:16 PM, the Resident said, I need some false teeth so I can eat. My teeth hurt and I need them pulled. I was supposed to have an appointment, but I don't know what's going on. I don't think I have any appointments to see a dentist. The last annual minimum data set (MDS) with an assessment reference date (ARD) of 07/12/23 coded the resident as having no dental issues. At 8:33 AM on 01/10/24, the Director of Nursing (DON) was asked about the Resident's dental status. The DON said, She wants dentures, but she doesn't want to pay for them. Review of the medical record found the resident's payer source was Medicaid and had been since 01/25/21. At 8:45 AM on 01/10/24, the DON and the surveyor visited the resident in her room. 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, record review, and staff interview, the facility failed to ensure Resident #35 had physician ordered assistive devices available to improve her ability to drink. This was a random opportunity for discovery. Resident identifier: #35. Facility census: 47. Findings included: a) Resident #35 Record review found a physician's order for, Kennedy cups at all meals, dated 12/18/23. Observation on 01/09/24 at 12:37 PM, with Occupational Therapist (OT) #47 found the resident had two (2) Kennedy cups on her lunch tray, one filled with water and one with punch. However, the resident also had a glass of tomato juice and a carton of milk. The Resident was observed trying to drink her tomato juice from the glass. OT #47 said the Resident needed a Kennedy cup for each of her liquids. On 01/09/24 at 1:05 PM, the Director of Nursing was advised of the above observation with OT #47. No further information was provided.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on record review, policy review and staff interview the facility failed to ensure staff maintained current Cardiopulmonary Resuscitation (CPR) certification for healthcare providers through a CPR provider whose training includes hands-on practice and in-person skills assessment. This was true for four (4) licensed nursing staff. This was a random opportunity of discovery. Employee Identifiers: Registered Nurse (RN) #35, Licensed Practical Nurse (LPN) #12, #40, and #27. Facility Census: 48 Findings Included: a) On [DATE] at 12:29 PM during a review of records of active CPR certified nursing employees, it was found that four (4) nursing employees were not certified in CPR. Registered Nurse (RN) #35 was not certified through the American Red Cross or The American Heart Association. Her certification was from the national CPR foundation making it invalid. According to the facility's Cardiopulmonary Resuscitation Certification Requirements policy dated [DATE] The only two recognized providers are the American…

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 record review and staff interview the facility failed to meet professional standards of practice in providing the medical needs of the resident. Resident #11's physician was not notified of a weight gain as directed by the physicians orders. For Resident #4 and Resident #41 neurological checks were not performed as required following falls. This was true for three (3) of 26 sampled residents. Resident Identifiers: # 11, #4, #41. Facility Census: 48 Findings Included: a) Resident #11 Resident #11 has a history of Congestive Heart Failure. There is a Physicians order to weigh the resident daily and call the Physician if the weight gain is greater than three (3) pounds in 24 hours. There were four (4) instances that the Residents' weight reflected a gain of three (3) or more pounds in 24 hours and the Physician was not notified. The following dates indicated the weight gain and need to notify the physician. On 3/30/22 he weighed 224.6 pounds and on 3/31/22 he weighed 227.8 pounds indicating a 3.2 pound weight gain in 24 hours. Weighed by Certified Nursing Assistant (CNA) #70.…

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, policy review and staff interview the facility failed to store food in accordance with professional standards for food safety. The facility failed to label and date food items that were open and failed to dispose of expired food items. The facility also failed to maintain an accurate dishwasher and resident refrigerator temperature log. The facility also stores other food in the resident's refrigerator. This failed practice had the potential to affect more than a limited number of residents currently receiving nourishment from the facility's kitchen and the Resident's refrigerator. Facility Census: 48 Findings Included: a) Walk-in Freezer A review of a facility policy titled date marking-food and nutrition with a revision date of 05/03/22 found the following. Procedure: .2 a 1) The date/time the original container is opened 2) The date or day by which the food shall be consumed on the premised, or discarded. An initial tour of the kitchen with the Nutrition and Food Service Supervisor (NFSS) beginning on 9/19/22 at 11:25 AM the walk-in refrigerator revealed 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, resident interview, staff interview and resident council meeting, the facility failed to provide care and treatment in a dignified manner for Resident #28 and Resident #43. This was a random opportunity for discovery. Resident Identifiers: Resident #28 and Resident #43. Facility Census: 48. Findings Included: a) Resident #28 During an interview on 09/19/22 at 1:17 PM, Resident #28 stated I need help, nobody will help you here, I will not come back to this place again. When you don't feel good, and you just want to lay down. The resident then started crying and stated, The girl brought me back from the dining room and just left me and I just wanted to go to bed. Resident #28 pulled her call light at 1:20 PM. A nurses Aide came into the room and turned off the call light at 1:22 PM. Resident stated she wanted to lay down, a Nurse aide, stated I will ask your aide and left the room. At 1:25 PM Two nurse aides came into the Residents room with a sit to stand lift to assist the resident to bed. Resident #28 stated thank you, I am not sure how long I would 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 on observation, record review, resident and staff interview, the facility failed to ensure when a resident self administered medications, the interdisciplinary team had determined this practice was clinically appropriate. This deficient practice was identified during a random opportunity for discovery when Resident #36 was observed in the dining room to have a medication cup with medications present. The licensed nurse passing the medications was not present to supervise the administration and left the medications with the resident. Resident identifier: Resident #36. Census: 48. Findings included: a.) Policy review A review of the policy, Resident Self-Administration of Medication, revision date: 10/15/22, noted staff were required to complete a process to determine if the resident could safely administer medications. After a determination was made to allow self- administration, a physicians order would be obtained, and that determination of self-administration of medication would be included in the care plan process. b) Resident #36 Observation An observation on 09/26/22 at…

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

Based on resident council minutes, policy review, resident interview and staff interview, the facility failed to consider the voiced concerns of residents in resident council as grievances. The facility failed to act promptly to investigate resident grievances concerning issues of Television and meal delivery. This had the potential to affect a limited number of residents living in the facility. Facility census: 48. Findings Included: a) Policy Review A review of the facility policy titled Grievances, Suggestions or Concerns-Rehab/Skilled with a revision date of 09/16/21 found the following. .4. The grievance will be documented on the Suggestion or Concern (GSS #213) and submitted to the grievance official. 5. The grievance official will route the GSS #213 to the appropriate department manager as soon as is reasonably possible. 6. An investigation must be completed for all grievances b) Resident Council Meeting During a Resident Council meeting held on 09/20/22 at 10:00 AM the following concerns were presented: Confidential interviews with the Resident group found the following…

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 medical record review, policy review and staff interview the facility failed to notify the physician or resident representative in a timely manner when the resident suffered a change in condition. Resident #4 suffered side effects from the medication Seroquel and the physcian was not notified of the side effects. The facility also failed to notify Resident #8's representative when they had an incident involving a medicated cream. This was a random opportunity for discovery. Resident Identifiers: Resident #4 and Resident #8. Facility census: 48. Findings Included: a) Resident #4 A review of the facility policy titled Medication Documentation-R/S, LTC with a revision date of 09/22/22 found the following. .7. Notify physician of any side effects, adverse reaction, medication error, corrective action taken, consequences or any reading outside the parameters established by the physician. A review of Resident #4's medical record on 09/27/22 revealed a physician order dated 04/06/22 for Quetiapine Fumarate Tablet (Seroquel) 100 MG Give 1 tablet by mouth one time a day. A review of…

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

Based on observation and staff interview, the facility failed to promote privacy during medical treatments for two (2) of six (6) treatments observed during the Long Term Care Survey Process (LTSP). This deficient practice was identified for Resident #43 during two (2) separate wound treatments. Resident identifier: Resident #43. Census: 48. Findings included: a) Resident #43 During a treatment observation, on 9/19/22 at 04:45 PM, Registered Nurse (RN) #35 entered Resident #43's room to complete a dressing change to the residents upper legs. RN #35 did not close the door or pull the privacy curtain to provide privacy to the resident during the dressing change. RN #35 assisted the resident with removal of clothing exposing the groin and thigh area where the area was being treated. At this time, residents and staff were observed in the hallway while the treatment was being done. An interview with RN #35, on 09/20/22 at 10:14 AM, verified the door remained open during the treatment and the curtain was not pulled to provide privacy during the treatment. RN #35 further stated, during 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 record review, resident interview and staff interview, the facility failed to ensure that all alleged violations of abuse and neglect, including serious bodily injury, were reported immediately, and failed to ensure the results of the investigations were reported to other officials (including to the State Survey Agency and Adult Protective Services (APS) where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. Resident #4 sustained serious bodily injury in the facility and the injury was not reported within two (2) hours of staff's knowledge of the severity of the resident's injuries sustained from a fall. This deficient practice was identified through a random opportunity for discovery and had the potential to affect a limited number of residents. Resident identifier: Resident #4. Census: 48. Findings included: a) Resident #4 An interview, with Resident #4, on 09/19/22 at 12:49 PM, revealed the resident stating she had fallen in the facility and broke her face. A review of 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on medical record review and staff interview, the facility failed to provide evidence that a copy of the Notice of Transfer was sent to to the Office of the State Long-Term Care Ombudsman. This was true for one (1) of two (2) reviewed for the care area of hospitalization during the Long-term care process. Resident Identifiers: Resident # 249. Facility Census: 48 Findings Included: a) Resident # 249 During an interview on 09/19/22 at 1:37 PM Resident # 249's Husband stated She has been in the hospital a few times. A medical record review on 09/19/22 revealed Resident #249 was transferred to the hospital on [DATE]. The records did not reveal a notification of Transfer was sent to the Ombudsman. During an interview on 09/19/22 at 11:20 AM the Social Worker stated Resident # 249's transfer to the hospital on [DATE] was not reported to the office of the State of the Long-term Care Ombudsman. .

Based on record review, staff interview and resident interview the facility failed to implement the care plan for Residents #36 and #38. This was true for two (2) of 26 sampled residents. Resident identifiers: #36 and #38. Facility Census: 48 Findings Included: a) Resident #36 An interview with Resident #36 on 09/19/22 at 1:30 PM, revealed the resident stating he/she had not been receiving rehabilitation services that had been ordered to help with physical limitations identified. A review of the comprehensive person centered care plan for Resident #36 showed the resident had a problem / focus area identified for the need for restorative intervention due to Activities of Daily Living (ADL) self-care performance deficit / limited physical mobility related to hemiplegia as evidenced by limited mobility. The approaches for Resident #36 included the following restorative measures to assist the resident with the identified problem: - Omnicycle level 2 up to 15 minutes to bilateral lower extremities 3-6 times weekly PRN (as needed )to help maintain strength. - Active range of motion to…

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, medical record review, family interview and staff interview the facility failed to provide care required to maintain proper nail care to a resident who is dependent for Activities Of Daily Living (ADL) care. This was true for one (1) of one (1) reviewed for ADL's during the long term care survey process. Resident Identifiers: Resident #249 Facility Census: 48 Findings Included: a) Resident #249 During a resident representative interview on 09/19/22 at 1:37 PM Resident #249's Husband stated my only concerns are her jagged toenails and fingernails. They look awful, just look at them. An observation on 09/19/22 at 1:39 PM Resident #249's toenails were long and jagged and fingernails were broken and jagged and fingernail polish was faded. A medical record review on 09/20/22 revealed on 05/05/22 a physician order which stated: Foot Assessment: Assess both feet for abnormalities and clean and trim nails Q(every) month. every day shift every 4 weeks on Tuesday for Foot Assessment. A review of Treatment Administration Record (TAR) was void of evidence of documentation…

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 staff interview, the facility failed to provide care to residents with pressure ulcers consistent with professional standards of practice to promote healing, prevent infection and prevent new pressure ulcers from developing for one (1) of six (6) residents reviewed for pressure ulcers during the LTCSP. Resident identifier: Resident # 41 Findings included: a) Resident #41 A review of the electronic medical record for Resident #41, showed a physician's order for the resident to have bilateral heel boots while in bed because of an identified risk for pressure ulcer development and a history or pressure ulcers. An observation, on 09/21/22 at 09:37 AM, revealed the resident lying in bed with no heel boots in place as ordered by the physician. An interview with Registered Nurse (RN) #35, on 09/21/22 at 09:37 AM, verified Resident #41 did not have the heel boots in place during the observation made. An additional interview with RN #35 , on 09/21/22 at 09:42 AM, revealed staff had removed the heel boots and had forgotten to put them back 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.

ensure the environment over which it had control was as free from accident hazards as possible. This was a random opportunity for discovery. Resident Identifiers: Resident # 8. Facility Census: 48. Findings Included: a) Resident #8 A review of facility policy titled Incident Report-Rehab/Skilled with a revision date of 04/05/22 found the following. .Procedure .4 The investigation will be initiated by a supervisor or a member of the investigation team as soon as possible after the incident occurred. 5. The investigation team consisting of the administrator, the director of nursing services and social services will review each incident no later than the next business day. Ensure that someone is assigned to complete the investigation and that the care plan has been update with new interventions put into place. A Review of Resident #8's medical record on 09/27/22 revealed an incident that occurred on 09/14/22. A incident report/note dated on 09/14/22 at 8:05 PM by Licensed Practical Nurse (LPN) #40 (typed as written) stated: Nursing Description: CNA staff reported to this nurse 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.

Based on observation and staff interview, the facility failed to ensure a resident with a urinary catheter received care and treatment to prevent infections. This was true for one (1) of two (2) residents reviewed with urinary catheters. Resident #43 was observed to have the catheter bag laying on the floor. Resident identifier: Resident #43. Census: 48 Findings included: a) Policy and Procedure for Catheter Care A review of the Policy and Procedure for Catheter: Insertion and Removal, Drainage Bags, Irrigation and Specimen, dated 08/24/22, showed under the area of Catheter tubing/drainage bags : Catheter tubing should never be allowed to touch the floor. Non-obstructed downhill flow is maintained at all times. b) Resident #43 An observation on 09/20/22 at 08:13 AM, revealed the catheter bag for Resident #43 was found to be laying on the floor. An interview, on 09/20/22 at 08:13 AM, with Registered Nurse (RN) #35, verified the urinary catheter bag was laying on the floor and should have been hanging from the bed off the floor, in accordance with facilty policy for catheter care. An…

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

Based on observation, policy review and staff interview the facility failed to provide necessary respiratory care and services that were in accordance with professional standard practice. A Nebulizer treatment T-piece was hanging from the residents' bed railing. This observation was a random opportunity for discovery. Resident identifier: Resident #27. Facility census: 48. Findings Included: a) Resident #27 A review of the facility policy titled Oxygen Administration, Safety, Mask Types- R/S, LTC, Therapy & Rehab with a revision date of 06/29/22 found the following. .11. When not in use, store in zip lock/plastic bag . During initial tour of the facility on 09/19/22 at 12:08 PM Resident # 27's Nebulizer treatment T-piece was hanging from the resident's bed railing. During an interview on 09/19/22 at 12:12 PM Registered Nurse #9 acknowledged the Nebulizer treatment T-piece should have been stored in a bag and not hanging from the bed railing. .

Based on medical record review and staff interview the pharmacist failed to identify and report the irregularity of Resident #4 Seroquel, as evidenced by documentation of side effects by nursing. This was true for one (1) of five (5) reviewed for unnecessary medications during the long term care survey process. Resident identifier: Resident #4. Facility Census: 48 Findings Included: a) Resident # 4 A review of Resident #4's medical record on 09/27/22 of revealed a physician order dated 04/06/22 Quetiapine Fumarate Tablet (Seroquel) 100 MG Give 1 tablet by mouth one time a day. A review of Resident #4's Medication Administration Record (MAR) for 09/2022 revealed from 09/01/22 to 09/12/22 had documented yes for side effects daily. A review of the Resident #4's MAR for 08/2022 revealed on 08/31/22 Resident #4 had side effects from the medication. During an interview on 09/27/22 at 10:26 AM the Minimum Data Set Nurse (MDSN) stated the (SE) on Resident #4's MAR is a code for side effects and when a resident has a side effect the nurse marks yes/no. When they answer yes it triggers 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.

Based on observation, policy and procedure and staff interview the facility failed to ensure the medication room controlled substance box was double locked. This failed practice had the potential to affect a limited number of residents. Facility Census: 48 Findings Included: a) On 9/20/22 at 9:10 AM while observing the medication storage room, the controlled medication double lock box in the refrigerator was not locked. This was confirmed on 9/20/22 at 9:10 AM with Registered Nurse #9. According to their Policy for Medications: Acquisition Receiving Dispensing and Storage dated 2/08/22 If the medication requires a refrigerator, these need to be locked in a separate container which they failed to do. .

Based on observation, record review and staff interview the facility failed to provide nutritional adequacy by providing inconsistent portions of the food to maintain perimeters of health. This failed practice had the potential to a limited number of residents currently receiving nourishment from the facility's kitchen. Facility Census: 48. Findings Included: a) Resident #41 During a dining observation of the main dining room on 09/26/22 at 12:09 PM, Resident # 41 received a very small amount of ground meat with gravy, a small portion of mashed potatoes. Resident #41's meal tray ticket diet order level 2 no restrictions did not have an order for smaller portions of meat/protein. An observation on 09/26/22 of several other residents' lunch tray no portions on the lunch trays were consistent. During an interview on 09/26/22 at 12:20 PM the Nutrition Food and Service Supervisor was asked the question about portion sizes? She stated we use a specified scoop size, we have a spreadsheet with the menu and diets and it states what size scoop to use. Resident #41 should be getting a four (4)…

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 medical record review and staff interview the facility failed to ensure Resident #249, and #46 medical record was complete and accurate. The Physician Orders for Scope of Treatment (POST) forms were not completed per directions specified by the [NAME] Virginia Center for End of Life Care. This is true for three (3) of 18 reviewed for the Long-Term Care Survey Process . Resident Identifiers: Resident #249 and Resident #46. Facility Census: 48. Findings Included: a) Resident #249 A medical record review on 09/19/22 revealed a POST form on Resident # 249's chart signed and dated by the physician on 09/12/22 which was void of the following: Section F entitled Signature Health Care Provider Printed Full Name: required; was void of physician's name During an interview on 09/20/22 at 8:21 AM the Social Worker acknowledged the POST form did not contain the physician's printed name which is required. During an interview on 09/20/22 at 8:32 AM the Unit Secretary #41, acknowledged the POST form did not contain…

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.