Maplewood Healthcare Center

Based on record review, resident interviews, and staff interviews, the facility failed to adequately deploy nursing staff across all shifts to properly care for residents and their safety. This was found to be true for 15 (fifteen) of 15 calendar days. Facility census: 74. Findings included: Nurse staffing postings review revealed the following: 11/02/24: Facility census: 74 LPN on night shift: 3 CNA on night shift: 2 CNA/resident ratio: 1:37 (one CNA for every 37 residents) 11/03/24: Facility census: 74 LPN on night shift: 4 CNA on night shift: 3 CNA/resident ratio: 1:25 11/07/24: Facility census: 73 LPN on night shift:3 CNA on night shift: 5 CNA/resident ratio: 1:11 11/09/24: Facility census: 74 LPN on night shift:3 CNA on night shift: 4 CNA/resident ratio: 1:18 11/10/24: Facility census: 74 LPN on night shift:2 CNA on night shift: 5 CNA/resident ratio: 1:15 12/25/24: Facility census: 74 LPN on night shift:2 CNA on night shift: 3 CNA/resident ratio: 1:25 12/31/24: Facility census: 75 LPN on night shift:2 CNA on night shift: 5 CNA/resident ratio: 1:15 2/26/25: Facility census: 76…

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 post nurse staffing with accurate information reflecting the actual hours worked, and total hours worked by category for nursing. This was true for 14 (fourteen) of 15 (fifteen) calendar days reviewed. The facility also failed to accurately reflect Facility census:75 Findings included: A) Record review 11/02/24: Nurse Staffing Report recorded a total of 191.50 hours worked for RNs, LPNs, and Certified Nurse Aides. Time and attendance report records a total of 221.88 hours worked for RNs, LPNs, and Certified Nurse Aides. 11/03/24: Nurse Staffing Report recorded a total of 337 hours worked for RNs, LPNs, and Certified Nurse Aides. Time and attendance report records a total of 227.5 hours worked for RNs, LPNs, and Certified Nurse Aides. 11/07/24: Nurse Staffing Report recorded a total of 240.5 hours worked for RNs, LPNs, and Certified Nurse Aides. Time and attendance report records a total of 260.5 hours worked for RNs, LPNs, and Certified Nurse Aides. 11/09/24: Nurse Staffing Report recorded a total of 307 hours worked…

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 each resident received medically related social services. The facility failed to assist the residents in the assertion of their right related to being free from abuse and or neglect and comprehensive person-centered care planning. This was random opportunity for discovery and has the potential to affect more than a limited number of residents. Resident identifiers: #75, #6, #77, #4, #54, #16, #32, #60, #78, #33, #29, #50, #73, #68, and #16. Facility Census: 74. Findings include: a) A review of the SOM found medically related social services include Advocating for residents and assisting them in the assertion of their rights within the facility in accordance with §483.10, Resident Rights, §483.12, Freedom from Abuse, Neglect, and Exploitation, §483.15, Transitions of Care, §483.20, Resident Assessments (PASARR), and §483.21, Comprehensive Person-Centered Care Planning. b) Care Plan with Interdisciplinary Team 1) State Agency Complaint 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 maintain an accurate and complete record for Resident #56. This was true for one (1) of five (5) residents reviewed under the care area of falls. Resident identifier: #56. Facility census: 74. Findings Include: a) Resident #56 On 05/07/25 at 12:30 PM, a record review was completed for Resident #56. The review found the resident had been transferred to an acute care facility. The transfer forms were noted with errors as follows: --Transfer date 11/01/24; incorrect date of 09/06/24 --Transfer date 11/25/24; incorrect date of 11/01/24 --Transfer date 03/04/25; incorrect date of 11/25/24 On 05/07/25 at 1:30 PM, the Administrator was notified and confirmed the dates on the transfer forms were incorrect.

Based on record review and staff interview the facility failed to ensure the resident and/or resident representative were afforded the right to participate in the care planning process with all required members of the interdisciplinary team. This was true for two (2) of two (2) sampled residents reviewed during a complaint survey. Resident Identifiers: #6 and #75. Facility Census: 74. Findings Include: a) State Agency Complaint The state agency received a complaint on 11/18/24 which indicated the following: The complainant was contacted by the facility's Social Worker about a care plan meeting for her mom. She said that the social worker normally only contacts her the day before or the day of the meeting but on this occasion, she did contact her a few days prior. This was helpful because she wanted to review her mom's care plan prior to the meeting. The complainant stated the social worker was the only staff member present on the care plan meeting that was held on the phone. She said she knew there was no interdisciplinary team there when this was going on. b) Facility's Process 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, record review and staff interview, the facility failed to maintain infection control standards Resident #53's urinary catheter. This was a random opportunity for discovery. Resident identifier: #53. Facility Census: 74. Findings include: a) Resident #53 On 05/07/25 at 3:24 PM, Resident #53's urinary catheter drainage bag was touching the floor. On 05/07/25 at 3:28 PM, Licensed Practical Nurse (LPN) #55 raised the resident's bed up to keep the urinary catheter drainage bag from touching the floor. On 05/07/25 at 3:35 PM, the Administrator was notified of the infection control breach. The Administrator stated, it should not be touching the floor. On 05/07/25 at 4:20 PM, the facility policy entitled, Catheter Care was reviewed. Section V under the heading of procedure states, Check that collection bag is not on the floor and is draining properly and secured allowing for no reflux of urine back to the bladder. (Typed as written.)

Based on staff interview and record review, the facility failed to ensure a qualified staff person assessed each resident's activity pursuits by not providing a qualified activity professional. This failed practice was a random opportunity for discovery and had the potential to affect more than a limited number of residents residing in the facility. Facility census: 76. Findings included: a) During an interview, on 03/05/24 at 01:00 PM, with Activity Director (AD), she stated she was currently enrolled in the Modular Education Program for Activity Professionals (MEPAP) class and had been employed since May of 2023. On 03/05/24 at 01:30 PM, the Executive Director (ED) confirmed the Activity Director (AD) had been employed since May of 2023 and had worked for eight (8) months without a qualified activity professional overseeing the facility's activity department. A record review, on 03/05/24 at 2:45 PM, revealed the resident's activity assessments are being completed by the AD who is not a Qualified Activity Professional, and the facility did not have a qualified activity professional…

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 correct alternative menus were posted to be available if the primary menu or immediate selections for a particular meal are not to a resident's liking. This was a random opportunity for discovery, and currently no residents are receiving enteral tube feedings in the facility, therefore; this failed practice had the potential to affect all residents residing in the facility. Facility Census: 76 Findings include: On 03/05/24 at 10:00 AM an Always available menu was observed posted by the daily menus near the dining room showing the following substitutes. -Hot or cold cereal- maple brown sugar oatmeal or variety of cold cereal -Gelatin, pudding, yogurt - variety -fruit cup- Mandarin oranges or peaches -sandwiches Deli meat, meat salad of the day, PB&J, ad grilled cheese -soup- Chicken noodle, tomato, or vegetable -cottage cheese and fruit plate -chef salad (mixed greens with assorted meats, cheese, tomato, and boiled egg) -Tossed salad ( lettuce, cheese, tomato) - Pickled Beets On 03/06/24 at 9:45AM the…

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

Based on resident interview and staff interview, the facility failed to review resident rights during the residents stay. This was a random opportunity for discovery during the Long-Term Care Survey process and had the potential to affect more than a limited number of residents in the facility. Facility census: 76. Resident identifiers: #54, #3, #59, #22, #43, #25, #76. Findings included: a) During the Resident Council meeting on 03/05/24 at 1:20 PM, Residents #54, #3, #59, #22, #43, #25, #76 stated no one has gone over resident rights with them. On 03/05/24 at 2:54 PM, the Administrator confirmed resident rights had not been reviewed with residents regularly after admission to the facility.

Based on staff interview and record review, the facility failed to provide a qualified activity professional for recreational services. This failed practice was a random opportunity for discovery and had the potential to affect more than a limited number of residents residing in the facility. Facility Census: 76 Findings included: During an interview, on 03/05/24 at 1:00 PM, with Activity Director (AD), she stated she was currently enrolled in the Modular Education Program for Activity Professionals (MEPAP) class and has been employed since May of 2023. On 03/05/24 at 01:30 PM, the Executive Director (ED) confirmed the Activity Director (AD) has been employed since May of 2023 without a Qualified Activity Professional overseeing the facility's AD.

Based on observations and staff interviews, the facility failed to maintain the kitchen in a safe and sanitary manner in accordance with professional standards of practice. During the kitchen tour it was discovered food was not stored properly and a treatment mask was found in the supply room. These deficient practices had the potential to affect any resident receiving nourishment from the kitchen. Facility census: 76. Findings included: a) Kitchen tour During the kitchen tour, on 03/04/24 at 11:42 AM, it was discovered a box of hamburger patties were opened and exposed in the walk-in freezer and in the storage room there was a treatment mask on a shelving unit. Observation with the Dietary Manager on 03/04/24 at 11:50 AM, verified the hamburger patties were open and exposed to the elements in the walk-in freezer and the treatment mask was lying on a shelf in the storage room.

Based on observation and staff interviews the facility failed to maintain the garbage storage area in a sanitary condition. It was discovered the dumpster had a trash bag wedged under the dumpster. Facility census: 76. Findings included: a) Garbage refuse receptacle During an observation of the outside garbage receptacle on 03/07/24 at 11:40 AM, it was discovered a clear garbage bag was wedged under the dumpster. The garbage bag contained treatment masks and absorbent bed pads used for incontinence. An observation with the Nursing Home Administrator (NHA) on 03/07/24 at 1:45 PM, verified the garbage bag did not allow for sanitary conditions in the dumpster area.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, the facility failed to notify the resident's representative/family member in a timely fashion of a significant change and the need to alter treatment. The facility transferred Resident #15 and Resident #35 to the hospital. However, their representatives/family members were not notified of the transfer. This was true for two (2) of six (6) residents reviewed for hospitalizations during the Long-Term Care Survey Process. Resident identifiers: #15 and #35. Facility census: 76. Findings included: a) Resident #15 A medical record review, completed on 03/05/24 at 9:22 PM, revealed the following details: -An electronic Medication Administration Note, dated 04/26/23 at 11:03 AM, documented Resident #15 was experiencing a decreased level of consciousness. It also noted, Resident unable to safely swallow medications at this time. NP [Nurse Practitioner] aware. -A second Nurses Note, dated 04/26/23 at 3:57 PM, documented the nurse practitioner had visited the resident to assess…

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 resident/resident's representative were provided a written Notice of Transfer for an acute hospital transfer. This was true for two (2) out six (6) hospital transfers reviewed during the long-term care process. Resident identifiers: #15, and #35. Facility census: 76. Findings included: a) Resident #15's Hospital Transfer on 04/26/23 A medical record review was completed on 03/05/24 at 9:22 PM. The record review revealed Resident #15 was transferred to the hospital on [DATE]. The record did not reflect the resident/resident's representative was provided a Notice of Transfer. During an interview, on 03/06/24 at 12:00 PM, the Administrator reported the facility had no evidence a Notice of Transfer was provided. b) Resident #35's Hospital Transfer on 01/31/24 A medical record review was completed on 03/05/24 at 9:39 PM. The record review revealed Resident #35 was transferred to the hospital on [DATE]. The record did not…

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 that the resident's Pre-admission Screening (PAS) reflected pre-admission diagnoses for one (1) of two (2) residents reviewed for the category of PASARR (Pre-admission Screening and Record Review), during the Long-Term Care Survey process. Resident identifiers: #15. Facility census 76. Findings included: a) Resident #15 A record review, completed on 03/04/24 at 2:34 PM, revealed Resident #15 had an admitting diagnosis of bipolar. A PASARR, dated 10/03/22, did not identify Resident #29 had a bipolar diagnosis on Section III, Question 30 of the PAS. This PASARR indicated no Level II was required. A continued record review also revealed there was never a new PAS completed to reveal resident's bipolar diagnosis in order to address whether or not specialized services were needed. During an interview on 03/06/24 at 12:20 PM, the Social Worker acknowledged the 10/03/22 PAS failed to identify the resident's bipolar diagnosis. The Social Worker noted the facility had recently identified the need to review new resident…

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

Based on record review and staff interview, the facility failed to revise a resident's person-centered, comprehensive care plan for urinary catheter services. This was true for one (1) of two (2) residents reviewed for urinary catheter care during the Long-Term Care Survey Process. Resident identifier: #37. Facility census: 76. Findings included: a) Resident #37 A record review on 03/06/24 revealed there was an order for the removal of a urinary catheter on 01/05/24. The current care plan had not been revised to reflect the removal of the urinary catheter. In an interview with the Director of Nursing (DON) on 03/06/24 at 12:35 PM, the DON verified the urinary catheter for Resident #37 had been removed on 01/05/24 and the care plan had not been revised to reflect the catheter removal.

Based on observation and staff interviews the facility failed to provide an environment as free of accident hazards as possible. This was a random opportunity for discovery. Resident identifiers: #48 and #228 Facility census: #76 Findings include: a) Resident #48 On 03/04/24 at 12:15 PM an observation revealed a spray bottle of Clorox cleaner and a spray bottle of Bio-enzymatic odor eliminator left unattended on the window ledge in Resident #48's room. This was accessible to any resident that may happen to wander into the room. There were multiple residents that went throughout the facility either walking or in their wheelchair. During the long-term survey process Resident #55 was observed daily ambulating without supervision throughout A Hall, where the cleaner spray bottles were found. Resident #55 had an active diagnosis of dementia and wandering. The above was confirmed, on 03/04/24 at 12:33 PM, with Certified Nurse Aide #60 who agreed the bottles should not be left unattended. It was also confirmed with the Administrator on 03/05/24 at 11:10 AM. b) Resident #228 On 03/04/24 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 record review and staff interview, the facility failed to maintain an accurate medical record for one (1) of three (3) records reviewed for accurate POST (Physician Orders for Scope of Treatment) forms during the Long-Term Care Survey process. Resident identifier: #51. Facility census: 76. Findings included: a) Resident #51 A brief record review, completed on 03/04/24 at 1:28 PM, identified the resident had a Physician Orders for Treatment (POST) form on file. The facility had obtained verbal consent from the resident's legal representative on 05/19/22. The 2021 POST Form Guidance instructs, If the incapacitated patient's MPOA (Medical Power of Attorney) representative or Health Care Surrogate is unavailable at the time of form completion, this section can be signed by two witnesses for verbal confirmation of agreement from the patient's MPOA representative or health care surrogate. The form should be signed at the earliest available opportunity. During an interview on 03/06/24 at 12:40 PM, the Social Worker acknowledged verbal consent had been accepted almost two (2) years…

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 was a random opportunity of discovery. Resident Identifiers: #39, #48 and #228. Facility Census: 76 Findings Included: a) Resident #39 On 03/04/24 at 12:33 PM observation was made of Certified Nurse Aid (CNA) #60 passing lunch meal trays on A hall. The CNA passed Resident #39's meal tray without offering the resident any hand hygiene prior to eating her meal. When confirming with the CNA that no hand hygiene was performed and asking if they usually provide hand hygiene she stated, we usually do, you just caught me on an off day, they are up on the meal cart. On 03/04/24 at 12:36 PM CNA #60 confirmed that she should have given the residents their hand hygiene wipes prior to passing their meal tray. This was also confirmed with the Administrator on 03/05/24 at 11:50 AM. b) Resident #48 On 03/04/24 at 12:33 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 record review and staff interview, the facility failed to notify the resident's physician, or designee, when there was a need to alter treatment for three (3) of three (3) residents reviewed, when the facility failed to administer medications or failed to obtain laboratory services ordered by the physician. This deficient practice was found to be true for Resident #55 who failed to have laboratory values drawn per physician order , Resident #15 who failed to have laboratory services obtained and failed to receive medication ordered by the physician, and Resident #24 who failed to receive medications ordered by the physician. Resident identifiers: Resident #24, #55, and #15. Census: 76. Findings included: a) Resident #24 A record review, conducted on 11/06/23, for Resident #24, found a physician's order, written on 10/06/23, for Gabapentin oral tablet 600 mg, give one (1) tablet by mouth, two (2) times a day for pain. Further review of the record showed staff had documented the medication, Gabapentin was not available on 10/06/23 starting at 8:33 pm, 10/07/23, 10/08/23, and…

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

Based on record review and staff interview, the facility failed to report alleged neglect within the required timeframe. This was a random opportunity for discovery. Resident identifier: #15. Facility census: 76. Findings included: a) Resident #15 The facility's policy titled Abuse, Neglect and Exploitation Policy with effective date 05/01/2017 and revision date 10/27/23 showed the following procedures: - All alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately to the Executive Director/designee of the facility. - All alleged violations involving abuse, neglect, exploitation or mistreatment, are reported immediately, but not later than two (2) hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury. - If the events that cause the allegations do not result in serious bodily injury, reporting to the administrator (Executive Director) and to other reporting regulatory bodies must occur within…

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 the timeliness of laboratory services to meet the needs of their residents. This was found true for two (2) of three (3) residents reviewed in which laboratory services were not obtained in a timely basis for Resident #55 and Resident #15. This deficient practice had the potential to affect more than a limited number of residents residing in the facility. Resident identifiers: Resident #55 and Resident #15. Census: 76. Findings included: a) Resident #55 A record review on 11/06/23, showed Resident #55 to have a diagnosis of Hypomagnesmia (Low Magnesium) and was ordered to have a laboratory study of a magnesium level ordered to be conducted on 06/15/23. A review of the progress notes for Resident #55, showed a progress note, written on 06/16/23 at 1:39 pm, noting the lab was not drawn. Further record review, showed no evidence the laboratory study had been drawn for this order date. An interview, with the Director of Nursing (DON), on 11/07/23 at 9:15 AM, verified the order for the laboratory study for 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 and staff interview, the facility failed to display the most recent State inspection survey results in a readily accessible area frequented by residents. It was discovered the State inspection was not posted in an area frequented by residents. This had the potential to affect a limited number of residents. Facility census: 75 Findings included: a) State inspection survey results posting During an observation on 07/20/22 at 1:30 PM, it was discovered the State inspection survey results were located under a shelf at the Nurse's desk, which was not accessible to residents. At 1:56 PM on 07/20/22 the Nursing Home Administrator (NHA) verified the State inspection survey results were not located in an area accessible to residents. .

Based on record review and staff interview, the facility failed to maintain appropriate standards for completing the Advanced Directives. This was true for one (1) of 20 residents reviewed during the long-term survey process. Resident Identifiers: #52. Facility Census: 75. Findings included: a) Resident #52 On 07/19/22 at 1:38 PM, a record review of the Physician Orders for Scope of Treatment (POST) form was completed. The POST form was missing the date when the verbal consent was obtained from the Medical Power of Attorney (MPOA). The POST form also had only one (1) witness's signature verifying the verbal consent was obtained from the MPOA. The POST form requires two (2) witnesses for a verbal consent. The MPOA section was left blank and did not contain the MPOA's name, address and phone number. On 07/20/22 at 3:15 PM, the Administrator confirmed the POST form was missing the date the verbal consent was obtained and had only one witness's signature verifying verbal consent was obtained from the MPOA. The MPOA section was left blank with no name, address or telephone number listed.…

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

Based on staff interview and medical record review, the facility failed to develop comprehensive person-centered care plans to meet the psychosocial needs of the residents. Resident (R) #54 and R #6's care plans lack person centered non-pharmacological interventions to assist in dealing with anxiety and depression. This is true for two (2) of five (5) residents reviewed for unnecessary medications. Resident identifiers: R#54 and #6. Facility census: 75. Findings included: a) Resident #54 Review of the medical record on 07/20/22, revealed R #54 is receiving Ativan (anti-anxiety medication) at bed time when needed for anxiety. R #54 is also taking Duloxetine hydrochloride (anti-depressant) twice a day for depression. The care plan identifies the Ativan for anxiety and states under the interventions Patient specific non-pharmacological intervention such as fluids, snacks, rest periods. The care plan is silent for non-pharmacological interventions related to the use of an antidepressant. Registered Nurse Assessment Coordinator (RNAC) #66 confirmed the care plan lacks resident specific…

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

Based on observation, record review, and staff interview, the facility failed to ensure a resident with limited range of motion received appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion. Splints had not been applied as ordered by the physician. This was true for one (1) of two (2) residents reviewed for the care area of position and mobility. Resident identifier: #22. Facility census: 75. Findings included: a) Resident #22 Review of Resident #22's physician's order found an order written on 11/26/19 for a left hand splint from breakfast to dinner time as tolerated and an order written on 01/17/20 for a left elbow splint from breakfast to dinner time as tolerated. During observation on 07/20/22 at 11:33 AM, Resident #22 was observed to not be wearing the left hand and left elbow splints. Licensed Practical Nurse (LPN) #82 confirmed Resident #22 was not wearing the splints. LPN #82 stated she would have the Nurse Aid (NA) apply the splint. During an interview on 07/20/22 at 12:03 PM, the Director of Nursing (DON)…

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, respiratory procedure policy, and staff interview the facility failed to provide respiratory services in accordance with professional standards of practice. This was discovered for one (1) of one (1) residents reviewed for respiratory care. Resident identifier: #59 Facility census: 75 Findings included: a) Resident #59 During a review of the Treatment Administration Record (TAR) for Resident #59, which verified the face mask for the continuous positive airway pressure (CPAP) was being cleaned daily, but the tubing was not being cleaned weekly as recommended. A review of the CPAP procedure policy recommended the face mask to be cleansed daily with soap and water and the tubing was to be cleansed weekly with soap and water. In an interview with the Director of Nursing (DON) on 07/20/22 at 12:30 PM, the DON reported their standard of practice was to clean the CPAP tubing once weekly and the face mask was to be cleaned daily. The DON verified the CPAP tubing was not be cleaned weekly. .

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . The facility failed to provide pharmaceutical services to meet residents' needs. Resident #71's medications were not received in a timely manner following her admission. This was true for one (1) of two (2) closed record reviews. Resident identifier: #71. Facility census: 75. Findings included: a) Resident #71 Review of Resident #71's medical records showed the resident was admitted on [DATE] at 4:52 PM. Review of Resident #71's Medication Administration Record showed the resident had not received the following medications after admission: --06/22/22: Insulin Glargine Solution Pen-injector, 35 units, subcutaneously at bedtime related to type 2 diabetes mellitus without complications, scheduled to be given at 9:00 PM --06/23/22: Isosorbide Mononitrate, 60 mg, one time a day related to essential hypertension, scheduled to be given at 9:00 AM --06/23/22: Januvia Tablet, 50 mg, one time a day related to type 2 diabetes mellitus without complications, scheduled to be given at 9:00 AM --06/23/22: 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 record review and staff interview, the facility failed to ensure Resident #54's as needed anti-anxiety medication was limited to 14 days. This is true for one (1) of five (5) reviewed for unnecessary medications. Resident identifier: #54. Facility census: 75. Findings include: a) Resident (R) #54 Review of the medical record on 07/20/22 found R #54 was prescribed Ativan as needed for anxiety at bed time. The order written on 07/15/22 states: Ativan Tablet 0.5 mg Give 0.5 mg by mouth as needed for anxiety at bedtime. The order lacks a stop date to identify the 14 day limit. During an interview on 07/20/22 at 11:00 AM, the administrator acknowledged R #54's Ativan order lacks a 14 day stop date. .

Based on observation and staff interview, the facility failed to ensure medications were stored and labeled in accordance with currently accepted professional principles. Expired medications were found in the medication preparation room floor stock. Facility census: 75. Findings included: a) Medication Storage and Labeling Facility Task On 07/20/22 at 2:03 PM, inspection of the medication preparation room was made under the observation of Licensed Practical Nurse (LPN) #31. Two (2) bottles of UTI-stat liquid were found to have expired in April 2022 and two (2) bottles of UTI-stat liquid were found to have expired in June 2022. LPN #31 confirmed the four (4) bottles of UTI-stat had expired. No further information was provided through the completion of the survey. .

Based on observation and staff interview the facility failed to store food in accordance with professional standards for food service safety. During the kitchen tour, food was found not dated after opening. This had the potential to affect a limited number of residents receiving nourishment from the kitchen. Facility census: 75 Findings included: a) Kitchen tour During the kitchen tour on 07/19/22 at 11:07 AM, the freezer contained a package of chicken patties, which had not been dated after opening. An interview with the Dietary Manager (DM) on 07/19/22 at 11:09 AM, verified the package of chicken patties had not been dated when opened. .