Fayetteville Healthcare Center

Based on observation and staff interview the facility failed to ensure the safe food handling practices was used. A glass was held barehanded by the rim during mixing for a thickened diet. This was a random opportunity for discovery identified during the long term care survey process and had the potential to affect a limited number of residents. Facility Census: 56. Findings include: a) Thickened drink. On 08/20/24 at 08:15 AM during an observation of the dining room breakfast prep it was observed that Certified Nursing Assistant (CNA) #45 was mixing thickened juice drink for a resident. It was further observed that CNA #45 was holding the glass with her bare hand. She had placed her pointer finger and thumb on the top rim of the glass as she stirred the liquid with the opposite hand. When asked if the resident would be drinking from the rim of the glass she stated yes and that she would re-mix another drink. During an interview with the Clinical Manager Registered Nurse (CM RN) #12 on 08/20/24 at approximately 8:19 AM, CM RN #12 stated that the CNA's know better than that and CM RN…

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 and staff interview the facility failed to formulate an advance directive by not obtaining the signature of the Medical Power of Attorney. This was true for one (1) of four (4) residents whose advanced directives were reviewed during the long term care survey process. Resident identifier: Resident #10. Facility Census: 56. Findings include: a) Resident #10 During a medical record review on 08/19/24 at 2:33 PM a review of the [NAME] Virginia Physician Order for Scope of Treatment (WV POST) form for Resident #10 it was identified the facility obtained a verbal confirmation of agreement from the residents Medical Power of Attorney (MPOA) on 06/09/22. It is further identified the signature of the MPOA had not been obtained. In review of the WV Post Using the Post Form Guidance for Health Care Professionals it is identified on page 20 the verbal confirmation of agreement from the patient's MPOA representative can be obtained and the form should then be signed at the earliest available opportunity. During an interview with the Assistant Director of Nursing…

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 provide a homelike environment. This was true for two (2) of fifty-six (56) residents observed during the long term care survey process. Resident Identifiers: #21, #112 Facility Census: 56 Findings include: a) Resident #21 On 08/19/24 at 9:23 AM observation of Resident #21's wardrobe found the face of the drawer in the bottom of the wardrobe was missing. This was confirmed with Registered Nurse Unit Manager #76 on 08/19/24 at 9:45 AM. b) Resident #112 On 08/19/24 at 9:23 AM observation of Resident #112's room found there were three (3) curtain hooks missing from the privacy curtain between the entrance door and the bed. This caused the curtain to hang down on one corner. This was confirmed with the Registered Nurse Unit Manager #76 on 08/19/24 at 9:45 AM.

Based on a review of the facility policy and procedure for Abuse, Neglect and Misappropriation, facility record review, medical record review and staff interview the facility failed to implement and ensure actions were in place to prevent further potential abuse. This was a random opportunity of discovery during the long term care survey process. This had the ability to affect a limited number of residents. Resident Identifier: Resident #34. Facility Census: 56. Findings include: a) Resident #34 During a review of the facility policy and procedure for Abuse, Neglect and Misappropriation it was identified on page 6 (six) of 20, (written as typed); In the event an allegation is made, the facility will take measures to protect residents from harm during an investigation. Accurate and timely reporting of incidents, both alleged and substantiated, will be sent to officials in accordance with the state law. If the alleged violation is verified, appropriate corrective actions will be taken by the facility. On 08/21/24 at approximately 10:30 AM during a facility record review of a facility…

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

Based on record review and staff interview, the facility failed to report an alleged incident of resident to resident abuse involving Resident #3 and an unknown resident. This was true for one (1) of three (3) residents reviewed for abuse during the survey process. Resident identifier: #3. Facility census: 56. Findings include: a) Resident #3 At approximately 2:15 PM on 08/20/24, a review of Resident #3's progress notes was conducted, related to behaviors the resident exhibited. It was noted on 03/18/24, Resident #3 was witnessed throwing a cup of water in the face of another resident who was not identified. Upon review of the incidents and reportables logs supplied by the facility, it was determined the incident was not listed on either log. At approximately 3:15 PM on 08/20/24, a copy of the reportable incident and investigation, if available, was requested from the Administrator. At approximately 3:45 PM, the Administrator confirmed the incident was not reported and an investigation was not started. Review of Resident #3's care plan discovered a note under the focus area…

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 accurately complete the Minimum Data Set (MDS) Assessment for Resident #60 upon discharge. This was true for one (1) of one (1) residents reviewed for discharge during the survey process. Resident identifier: 60. Facility census: 56. Findings include: a) Resident #60 At approximately 9:15 AM on 08/20/24, during a record review for Resident #60, the following note, entered by the Social Worker (SW) was discovered (typed as written): 7/1/24 14:56 Social Services Note: Note Text: (Resident #60's name)'s family would like (Resident #60's name) to discharge on [DATE] related to progress made on goals. They plan on picking her up sometime after 4:00p.m. No equipment needs. Home health will be arranged with (Home Health Provider). Per daughters the family all take turns staying with (Resident #60's name) and she has 24 hour care at home. According to the discharge summary provided by the facility, Resident #60 was discharged home on [DATE]. Upon…

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 update the [NAME] Virginia Department of Health and Human Resources Pre-admission Screening (PASARR) with new qualifying diagnoses of major depressive disorder. This was true for two (2) of three (3) residents whose PASSARR's were reviewed during the long term survey process. Residents identifiers: #34, #39. Facility Census: 56. Findings included: a) Resident # 34 During a medical record review [NAME] Virginia Department of Health and Human Resources Pre-admission Screening (PASSARR) on 08/21/24 at 12:00 PM, it was identified the PASSARR was completed on 11/25/22. During a further medical record review it was identified on 03/20/24 the resident was diagnosed with Major Depressive disorder. An updated PASSARR could not be found for this new diagnosis. During an interview with the Social Worker (SW) #77 on 08/21/24 at 12:21 PM, SW #77 agreed that the PASSARR should have been updated at the time of the new diagnosis of major depressive…

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 a Preadmission Screening and Review (PASARR) form had the appropriate diagnoses present. This was true for one (1) of three (3)PASSr's reviewed during the long term care survey process. Resident Identifier: #20 Facility Census: 56 Findings Include: a) Resident #20 On 08/20/24 at 10:29 AM record review of the transfer PASARR provided by Social Worker #77, dated 04/15/24 found that the only diagnosis listed was dementia. A review of Resident #20 medical diagnosis found the following diagnosis: Dementia, upon admission Bipolar, upon admission Depression, upon admission Generalized Anxiety Disorder, upon admission On 08/20/24 at 3:10 PM this was confirmed with Social Worker #77 who agreed all the listed diagnosis should be on the PASARR.

Based on record review, family interview, observation and staff interview the facility failed to develop a comprehensive care plan for Resident #44 related to diet restrictions associated with a medical condition. This was true for one (1) of four (4) residents reviewed for the care area of nutrition during the long term care survey process. Resident Identifier: # 44. Facility Census: 56. Findings Include: a) Resident #44 Observation of the noon time meal on 08/21/24 at 12:47 PM found Resident #44 was sitting in the dining room. She was served her meal and on her plate was a serving of corn. Resident #44 immediately stated, I can not eat corn, they know that. She then pushed her plate to the side. A few minutes later Resident #44's family member entered the dining room and said, oh we can just take that corn off your plate. She then helped Resident #44 remove the corn from her plate. An interview with Resident #44's family at this time found, the facility always gives her stuff she should not eat due to her ileostomy. A review of Resident #44's tray ticket found she was supposed 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 record review and staff interview the facility failed to revise the comprehensive care plan in a timely manner. Revisions required for new diagnosis and medication changes. This was true for three (3) of twenty three (23) residents reviewed during the long-term care survey process. Resident Identifier: Resident #34, Resident #14 and Resident #24. Facility Census: 56. Findings Include: a) Resident #34 During a medical record review 08/21/24 at approximately 12:21 PM, it was found Resident #34 diagnosis includes a diagnosis of major depression disorder with the onset date of 03/20/24. Further review of the residents care plan the diagnosis of major depression disorder is not identified. During an interview with the Director or Nursing (DON) on 08/21/24 at 1:29 PM the DON stated the comprehensive care plan had not been revised to reflect the diagnosis of major depression disorder with the onset date of 03/20/24. b) Resident #14 On 08/20/24 at 2:24 PM a record review found that Resident #14 was care planned for antipsychotic medications and listed Seroquel related 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 record review and staff interview the facility failed to act on a Physician's order which caused a delay in treatment. This was true for one (1) of twenty three (23) resident records reviewed during the long term care survey process. Resident Identifier: #53 Facility Census: 56 Findings Include: a) Resident #53 On 08/20/24 record review found Resident #53 had an active order dated 07/26/24 to hemoccult stools (a screening test that checks for hidden blood in stool) X 3 samples for an abnormal lab result. As of 08/20/24 the staff had only obtained one stool sample. The one sample which was retrieved on 08/17/24 returned with a positive result for blood being present. Upon notifying the off hours physician (Never Alone) new orders were received to continue monitoring. Resident to also follow up with in house physician for a possible Gastrointestinal (GI) referral. There was no documentation to show the in house physician had been notified. There were no stool samples retrieved after 08/17/24. On 08/20/24 at 3:34 PM when it was discussed with the Director of Nursing it took…

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 resident and staff interviews, the facility failed to ensure sufficient nursing staff was deployed to meet the needs of each resident. This was a random opportunity for discovery. Resident identifiers: #44, #34. Facility census: 56. Findings include: A) Resident #44 At approximately 1:30 PM on 08/20/24, during resident council, Resident #44 stated they rang their call light last night (08/19/24) at approximately 4:20 AM. Resident #44 stated her light was finally answered at approximately 5:00 AM, at which time, the employee who answered the light stated staff was unable to answer the call light earlier because her assigned aide had been pulled to do one on one (1:1) care with Resident #34. At approximately 10:00 AM on 08/21/24, an interview was conducted with Resident #44. During the interview, the resident stated, I waited from about 4:20 in the morning until a little after 5:00 in the morning for someone to answer my light. When the aide finally answered my light, she told me the aide that was assigned to me at the beginning of the evening couldn't…

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 monitor Resident #3 for side effects of antianxiety, antidepressant, and mood stabilizing medications as ordered, as well as monitoring for behaviors as ordered, per shift. This was true for one (1) of one (1) residents reviewed for psych/opioid side effects during the survey process. Resident identifier: #3. Facility census: 56. Findings include: a) Resident #3 At approximately 11:00 AM on 08/19/2024, a record review was conducted concerning side effects of psychotropic medications and opioids for Resident #3. During the review, it was noted Resident #3 had the following orders (typed as written): ANTIANXIETY side effect monitoring but not limited to: Dystonia: torticollis(stiffness of neck), Anticholinegic symptoms: Dry mouth, blurred vision, constipation, urinary retention. Hypotension, Sedation/drowsiness, increased falls/dizziness, Cardiac abnormalities (tachycardia, bradycardia, irregular H.R;NMS). Anxiety/agitation, blurred vision,…

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 significant medication errors did not occur. This was a random opportunity for discovery. Resident identifier: #43 Facility Census: #56 Findings included: a) Resident #43 On 08/20/24 at 9:52 AM a record review found Resident #43 had a medication error on 08/12/24 at 1:41 PM . Further review of the Record found Resident #43 had the following medications ordered: Atorvastatin 40 mg at bedtime (for hyperlipidemia) Buspirone 30 mg twice a day (for anxiety and depression) Colestid 1 gram two times a day (for diarrhea) Dicyclomine 10 mg three times a day (for diarrhea) Empagliflozin 10 mg daily (for diabetes) Loratadine 10 mg daily (for allergies) Losartan Potassium 50 mg daily (for hypertension) Magnesium Oxide 400 mg twice a day (for supplement) Metformin 1000 mg twice a day( for diabetes) Metoprolol Succinate ER 25 mg daily (for hypertension) Omeprazole 20 mg daily (for GERD) Remeron 15 mg at bedtime (for insomnia) Sertraline 100 mg twice a day(for depression) Tylenol 500 mg every 6 hours as needed (for pain)…

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, family interview and staff interview the facility failed to provide Resident #44 with a diet that met her special dietary needs related to her ileostomy. This was true for one (1) of four (4) residents reviewed for the care area of nutrition during the long term care survey process. Resident Identifier: 44. Facility Census: 56. Findings Include: a) Resident #44 Observation of the noon time meal on 08/21/24 at 12:47 PM found Resident #44 was sitting in the dining room. She was served her meal and on her plate was a serving of corn. Resident #44 immediately stated, I can not eat corn they know that. She then pushed her plate to the side. A few minutes later Resident #44's family member entered the dining room and said, oh we can just take that corn off your plate. She then helped Resident #44 remove the corn from her plate. An interview with Resident #44's family at this time found, the facility always gives her stuff she should not eat due to her ileostomy. A review of Resident #44's tray ticket found she was supposed to be served the alternate…

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 accurately document the discharge of a resident and the facility failed to accurately complete a residents capacity form. This was true for two (2) of 23 residents reviewed during the long term care survey process. Resident Identifiers: Resident #5, and #35. Census: 56. a) Resident #59 During a review of the medical record review of 08/20/24 at 9:09 AM of Resident #59 a Social Service note identified the resident had went on a therapeutic leave with his daughter. It was further identified the daughter notified the facility he would not be returning to the facility. During this medical record review a physician note entry for the discharge to family could not be identified. Further review of the Minimum Data Set (MDS) dated [DATE] it is identified under section A, under (f) the resident had discharged and was not expected to return it is further identified under (g) the discharge was unplanned. During an interview with the Director of…

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

Based on record review and resident interview, the facility failed to ensure residents entering into a binding arbitration agreement were able to understand the agreement prior to signing. This was true for two (2) of two (2) residents reviewed for arbitration during the survey process. Facility Census: 56. Findings include: A) Arbitration Agreements At approximately 9:20 AM on 08/22/24, a list of residents entering into the facility's binding arbitration agreement was reviewed. It was determined Residents #112 and Resident #34 were the only two (2) residents in the facility who signed the agreement. At approximately 9:30 AM on 08/22/24, an interview was conducted with Resident #112 regarding the arbitration agreement. Resident #112 stated, I don't recall signing anything like that. They brought something in here the day after I got here and had me sign it, but I don't know what it was I even signed. I signed so many things when I got here. The arbitration agreement was explained to Resident #112 and she stated I don't remember anything like that. They just handed me papers and told…

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 resident and staff interview, the facility failed to have sufficient nursing staff available to meet the needs of each resident residing in the facility. This was true for three (3) of three (3) residents interviewed during the survey process, as well as resident council members. This had the potential to affect more than a limited number of residents. Resident identifiers: #8, #32, #36, #41, #52. Facility census: 60. Findings include a) Resident #8 At approximately 10:05 AM on 06/10/24, an interview was conducted with Resident #8. During the interview, Resident #8 stated, There have been several times that I have needed up, or needed changed, and I was told it was going to be a while because they were working short. There are a lot of days they will say 'We just don't have enough people ' and you will have to wait a long time on your light to be answered, or if they answer it, they'll say, 'We will be right back' but they never come back. b) Resident #52 At approximately 10:13 AM on 06/10/24, an interview was conducted with Resident #52.…

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 and staff interview, the facility failed to ensure each resident received proper hydration due to no water being passed to Resident #52 and other residents present during a resident council meeting. This was a random opportunity for discovery. This has the potential to affect more than a limited number of residents. Resident identifiers: #52, #7, #32, #36, #41, #48, #54. Facility census: 60. Findings include: a) Resident #52 At approximately 10:13 AM on 06/10/24, an interview was conducted with Resident #52. During the interview, Resident #52 stated she did not feel the facility had enough staff because the water pass was so inconsistent. Resident #52 stated, I didn't get any water last night and kept asking for it. They told me 'We are getting it now ' but they would never come back with water. That happens a lot. There are times that I get nauseous and would like some cold water, but I don't always have it. They are supposed to pass it at seven in the morning and seven in the evening, but that rarely happens, they just don't pass it at night. Resident #52 said,…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, record review, and staff interview the facility failed to ensure the resident environment over which it had control was as free from accident hazards as possible. The facility failed to ensure the door to the janitor's closet located in the dining room remained locked. This failed practice had the potential to affect more than an isolated number of residents currently residing in the facility. Facility Census: 55. Findings included: a) An observation of the janitor closet located in the dining room in the afternoon of 03/11/24 found the door was not locked and it could be easily pushed open despite the fact it had an electronic locking keypad. An additional observation on 03/12/24 at 2:30 PM found the door to the janitor closet in the dining room was again not locked. The door could easily be pushed open. An interview with the Maintenance Director at 2:30 PM on 03/12/24 confirmed the door was not locked. He removed the [NAME] and the [NAME] hanger which was hanging on the door. He stated…

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 thoroughly investigate an incident of physical abuse between Resident #52 (the victim) and Resident #42 (the perpetrator). The incident occurred on night shift, and the facility failed to obtain statements from staff who were working at the time of the incident. This was a random opportunity for discovery and was true for Resident #52. Resident Identifiers: #52. Facility Census: 55. Findings Include: a) Resident #52 A review of the facility's reportable's for the previous six (6) months found a reportable dated 12/30/23 which reported and incident where Resident #42 entered the room of Resident #52 while he was sleeping. When Resident #52 told Resident #42 that he was in the wrong room Resident #42 began throwing things about the room and struck Resident #52 in the head multiple times. A review of the facility's investigation found there were three (3) statements obtained from staff and they were as follows: Statement from Licensed Practical Nurse (LP) #3 read as follows typed as written: CNA (Certified Nurse Aide)…

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 provide each resident with the goods and services to enable them to maintain and or attain their highest practicable physical and mental well being. The facility failed to initiate neurological assessments on Resident #52 when another resident reportedly hit him in the head more than once. This was a random opportunity for discovery for Resident #52. Facility Census: 55 Findings included: a) Resident #52 A review of the facility's reportable incidents found a reportable incident dated 12/30/23 at 12:30 PM. The description of the incident indicated Resident #52 was in his room asleep and another resident entered his room and woke him up. When Resident #52 advised the other resident that he was in the wrong room the other resident became agitated and threw items about the room. Resident #52 also stated the other resident then began hitting him in the head several times. A review of Resident #52's medical record found no neurological assessments had been completed after this incident was reported to the staff. 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 and staff interview, facility failed to ensure the resident environment over which it had control was as free from accident hazards as possible. The central supply, clean utility, and dirty utility rooms were found unlocked. This had the potential to affect more than a limited number of residents. Additionally, Resident #39 was observed eating a table decoration. These were random opportunities for discovery. Resident identifier: #39. Facility census: 53. a) unlocked clean and dirty utility rooms On 10/17/22 at 11:17 AM, the clean utility room located in the C hallway was found to be unlocked. The room contained resident hygiene items, including razors. Nursing Assistant #18 verified the clean utility room was unlocked and she locked the door. On 10/17/22 at 11:35 AM, the clean utility room located in the C hallway was again found to be unlocked. The dirty utility room located in C hallway was also found to be unlocked at this time. The dirty utility room contained a container for disposal of needles and other sharp items. Items had been placed in the container.…

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 and staff interviews, the facility failed to ensure that resident has the right to personal privacy of not only his or her own physical body, but of his or her personal space. This was true for one (1) of (1) resident reviewed for the care area of privacy during the long term care survey. Resident identifier: #14. Facility census: 53. Findings included: a) Resident #14 On 10/17/22 at 11:35 AM, the resident said she feels that privacy is a concern when her roommate's visitors come into the room during meal times. Sometimes six (6) or seven (7) people come to visit in the room at a time. She said it is an invasion of her personal space and there is no ability to really eat with all of those people in there during meals. She said she likes to eat in her room in her wheelchair. The roommates visitors are pushed up against her when eating and bumping into her at times. She likes her roommate but all the roommates visitors take up her space. On 10/18/22 at 10:08 AM, the Activity Supervisor (AS) #2 stated the roommate of Resident #14 does receive large numbers 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 record review, observation and staff interview the facility failed to ensure Resident #49's care plan was implemented in the area of accident hazards and fragile skin this was true for one (1) of one (1) residents reviewed for the care area of accident hazards and one (1) of three (3) residents reviewed for skin conditions non pressure related during the long term care survey process. Resident Identifier: #49. Facility Census: 53. Findings Included: a) Resident #49 1) Accident Hazards A review of resident #49's care plan on 10/18/22 found the following care plan focus statement: -- Ms. (Last name of Resident #49) is at risk for falls r/t (related to) Deconditioning, weakness, history of falls, hospice and actual falls. The goal associated with this focus statement read as follows: -- Patient will be free of falls with major injury through the review date. The Interventions associated with this focus statement included: --Non Skid Socks Observations of Resident #49 with the Director of Nursing (DON) and the Registered Nurse Assessment Coordinator (RNAC) at 2:03 PM on…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based or resident interview, staff interview, and record review, the facility failed to include the resident in the care plan meetings and/or provide an explanation in the resident's medical record as to why the participation of the resident was determined not practicable for the development of the resident's care plan. This was true for one (1) of one (1) resident reviewed for participation in care plan during the long -term care survey process. Resident identifier: 34. Facility census: 53. Findings included: a) Resident #34 On 10/17/22 at 11:10 AM, the resident said she had never attended a care plan. When asked if she would like to attend a care plan the resident said, yes. Review of the most recent Minimum Data Set (MDS), a quarterly with an Assessment Reference Date (ARD) of 09/08/22 revealed the resident scored a 12 on the Brief Interview for Mental Status (BIMS.) A score of 8 to 12 indicates moderately impaired judgement. Record review found the following quarterly notes related to the care plan…

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 respiratory services were being provided in accordance with professional standards of practice. This was true for one (1) of one (1) residents reviewed for respiratory care. Resident identifier: #50. Facility census: 53. Findings included: a) Resident #50 During an observation on 10/17/22 at 1:01 PM, it was noted the mask for Resident #50's continuous airway pressure (CPAP) machine was laying on the night stand and not stored properly in a plastic bag to keep it clean. In an interview with Resident #50 on 10/17/22 at 1:11 PM, the resident reported she has never received a plastic bag to store her mask in, when not in use. During an observation on 10/18/22 at 3:20 PM, it was noted there was still no plastic bag to store Resident #50's CPAP mask in. An interview with the Director of Nursing on 10/17/22 at 3:25 PM, verified there should be a plastic bag at bedside to store Resident #50's Trilogy CPAP mask in, when not in use. .

Based on observation, record review, and staff interview, the facility failed to ensure medications were stored in accordance with currently accepted professional principles. A multi-use medication vial stored in the medication preparation room had not been discarded after opening in the time frame recommended by the manufacturer. This was a discovery during the facility task of medication storage. Facility census: 53. Findings included: a) Medication preparation room During investigation of the medication preparation room on 10/18/22 at 8:40 AM, a multi-dose vial of tuberculin purified protein derivative (PPD) stored in the room refrigerator was noted to have an opening date of 09/01/22. Tuberculin purified protein derivative is given by injection to aid in the diagnosis of tuberculosis. Licensed Practical Nurse (LPN) #36 stated she did not know how long a tuberculin PPD vial could be used after opening. The vial package insert was reviewed and showed vials in use for more than 30 days should be discarded. LPN #36 verified the tuberculin vial with date of opening 09/01/22 was past…

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.