Pine View Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and staff interview, the facility failed to ensure a written Notice of Transfer / Discharge was provided to the resident and the long-term care Ombudsman for one (1) of two (2) residents reviewed for hospitalizations during the long-term care survey process. This had the potential to affect all residents being transferred or discharged . Resident identifier: #27. Facility census: 47. Findings included: a) Resident #27 A medical record review was completed on 10/3024 at 12:04 PM. The record review revealed Resident #27 was transferred to the hospital on [DATE]. The record did not reflect the resident/resident's representative was provided with a written Notice of Transfer/Discharge indicating the reason for transfer, the effective date of transfer, the location to which the resident was being transferred, and a statement of the resident's appeal rights. There was also nothing in the electronic medical record to indicate the long-term care Ombudsman had been notified. During 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.

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 resident/resident's representative was provided with a written Bed Hold notice for an acute hospital transfer. This was true for two (2) out of two (2) residents reviewed under the hospitalization pathway in the annual Long-Term Care Survey Process. Resident identifiers: #27, and #16. Facility census: 47. Findings included: a) Resident #27 A medical record review was completed on 10/3024 at 12:04 PM. The record review revealed Resident #27 was transferred to the hospital on [DATE]. There was no evidence in the electronic medical record that the facility had provided Resident #27 or his representative with a written Bed Hold notice. During an interview, on 10/01/24 at 2:55 PM, the Administrator reported the facility could not produce evidence that a Bed Hold notice had been issued for Resident #27's hospitalization on 05/17/24. b) Resident #16 Record review, on 10/30/22 at 9:27 AM, revealed Resident #16 was…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, the facility failed to complete a new Pre-admission Screening and Resident Review (PASARR) for residents with newly evident or a possible serious mental disorder. This was true for two (2) out of two (2) residents reviewed under the category of PASARR, during the Long-Term Care Survey Process. Resident identifiers: #6 and #28. Facility census: 47. Findings included: a) Resident #6 A record review, completed on 10/29/24 at 1:50 PM, revealed Resident #6 had been admitted to the facility on [DATE]. Review of resident's diagnoses revealed a Major Depression diagnosis with an effective/active date of 11/01/23. There was only one (1) PASARR, dated 11/02/2022, on file. Section III MI/MR Assessment Question #30 had NONE selected regarding any pertinent diagnosis. Additionally, Section V Supplemental Questions #40 had NONE selected regarding any major mental illness (MI) or suspected MI. There was no evidence that a new PASARR had been done when the Major Depression diagnosis…

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 develop and implement a comprehensive person-centered care plan for one (1) of 24 residents reviewed in the Long-Term Care Survey process. The facility failed to address Resident #145's preferred bedtime preference. Facility identifier: #145. Facility census: 47. Findings included: a.) Resident #47 A record review, completed on 10/29/24 at 7:40 PM, revealed that Resident #145 was admitted to the facility on [DATE] A review of the Recreation Comprehensive Assessment completed for resident, dated 10/18/24, found that the resident had reported she liked to go to bed whenever she wanted. A review of the comprehensive person-centered care plan for Resident #145 showed a focused area of Resident #145 as, While in the facility, resident/patient states that it is important that s/he has the opportunity to engage in daily routines that are meaningful relative to their preferences. Additionally, Resident #145 had the following intervention listed in her…

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 Interview and record review, the facility failed to contact the physician; and request a re-assessment of resident's capacity; after a Brief Interview for Mental Status (BIMS) evaluation revealed severe impairment. Resident identifiers: #18. Facility census: 47. Findings included: a) Resident #18: During a brief interview, on 10/28/24, at approximately 11:40 AM, Resident #18 was unable to state when she had entered the facility, or how long she had been there. The resident responded to other questions with unrelated answers. Record review on 10/28/24 at approximately 3:15 PM revealed a document by the resident's physician dated 08/29/24, that stated the resident had capacity. Further record review revealed the following note on 8/23/24 at 10:44 AM by Social Worker (SW) #23: BIMS Summary score: 12.0 Record review further revealed that Resident #18 had been admitted to the hospital on [DATE] for an acute urinary tract infection (UTI). A note by Physician #62 on 9/21/2024 at 8:13 PM stated 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 observation, staff interview, and clinical record review, the facility failed to follow physician orders regarding oxygen administration, and did not monitor residents on oxygen therapy as prescribed. Resident identifiers: #5, and #11. Facility census: 47. Findings include: a) Resident #5 During a brief interview and inspection on 10/28/24 at approximately 11:40 AM, the resident was observed to be on oxygen therapy. The resident continued to be observed throughout the survey, and the following readings were obtained: On 10/28/24 at approximately 11:55 AM an oxygen concentrator was observed to be set to two (2) liters per minute. On 10/29/24 at approximately 3:11 PM the oxygen concentrator was observed to be set to deliver two (2) liters per minute. Record review revealed a physician's order dated 09/29/24 at 7:09 PM that stated: Oxygen at 3 L/min via Nasal Cannula PRN; notify MD if more than 3 shifts in a row below 90% O2 sat or having symptoms of respiratory distress. On October 29, 2024, at approximately 3:14 PM, LPN #29 confirmed that the oxygen was not set to 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on resident representative interview, record review, and staff interview, the facility failed to collaborate with resident trauma survivors, and as appropriate, the resident's family, to identify triggers which may re-traumatize the resident, and develop care plan interventions to minimize or eliminate the effect of the trigger on the resident. This was true for one (1) of two (2) residents reviewed with a Post Traumatic Stress Disorder (PTSD) diagnosis. Resident identifier: #27. Facility census: 47. Findings included: a) Resident #27 During a resident representative interview, completed on [DATE] at 11:02 AM, Resident #27's wife reported his PTSD diagnosis stemmed from a work event when he was in his mid-20's. She went on to report that there was a disaster in 1978 in (name) County when a cooling tower under construction at the power plant collapsed, killing 51 construction workers. Resident #27 remembered the incident vividly and recalled people going around and just collecting the severed left arms 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 personnel file record reviews review and staff interview, the facility failed to provide a completed performance review of every nurse aide at least once every 12 months. This failed practice had the potential to affect more than a limited number of residents. Employee identifiers: #49, #5. Facility census: 47. Findings included: a) Employee performance reviews were not available for #49 or #5. During an interview, on 10/30/2024 at 11:34 AM, the Scheduling/payroll Manager #35 confirmed the yearly performance reviews were not on file for employee #49 and #5.

Based on record review and staff interview, the facility failed to ensure the consulting pharmacist performed a medication regimen review, which included a review of the resident's medical record, at least monthly. This was true for two (2) of five (5) residents reviewed under the unnecessary medication's pathway throughout the Long-Term Care Survey Process. Resident identifiers: #27 and #28. Facility census: 47. a) Resident #27 A record review, completed on 10/29/24 at 1:33 PM, revealed there was no evidence in the electronic medical record that a monthly medication regimen review had been completed for Resident #27 during the months of November 2023 and December 2023. During an interview on 10/30/24 at approximately 3:15 PM , the Administrator reported the facility was unable to produce any evidence the monthly medication regimen reviews had been completed by the consulting pharmacist and/or reviewed by the attending physician. b) Resident #28 A record review, completed on 10/29/24 at 1:15 PM, revealed there was no evidence in the electronic medical record that a monthly…

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 a complete and accurate care plan was developed for four (4) of 14 residents reviewed in the long-term care survey sample. For Residents #13 and #20, the care plan was not developed for psychotropic medication. For Resident #7, the care plan was not developed for psychotropic medication and dementia care. For Resident #4, the care plan was not developed for Post-Traumatic Stress Disorder. Resident identifiers: #13, #20, #7, #4. Facility census: 24. Findings included: a) Resident #13 Review of Resident #13's physician's orders showed the resident was prescribed the antipsychotic medication quetiapine (Seroquel) upon admission [DATE]. Review of Resident #13's comprehensive care plan reviewed and revised 12/06/22 showed the problem psychotropic drug use. Approaches were to administer Seroquel and Risperidone (also an antipsychotic medication). Another approach was to assess for and incorporate non-pharmaceutical interventions. However,…

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 the physician identifed and reported medication irregularities for Residents #13, #20, and #7. Additionally, the physician failed to respond to the pharmacist's reported irregularity for Resident #9. These deficient practices had the potential to affect four (4) of five (5) residents reviewed for the care area of unnecessary medications. Resident identifiers: #13, #20, #7, #9. Facility census: 24. Findings included: a) Resident #13 Review of Resident #13's physician's orders showed the resident was prescribed the antipsychotic medication olanzapine (Zyprexa) on 11/24/22. The order did not include the reason Zyprexa was prescribed. Review of Resident #13's progress notes showed the resident had been having behaviors, including aggression. Further review of Resident #13's medical records showed the pharmacist had performed a monthly medication regimen review on 12/05/22. The pharmacist did not identify the lack of diagnosis for 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 staff interview and record review, the facility failed to ensure the required members attended the 4th quarter Quality Assessment and Assurance (QAA) meeting. This had the potential to affect more than a limited number of residents at the facility. Facility census: 24. Findings included: a) QAA meeting Review of the monthly sign in sheets by the members attending the meeting with the administrator on 01/05/23 at 10:02 AM, confirmed the required members did not attend the 4th quarter (October, November, and December 2022) meetings. The administrator, director of nursing, infection preventionist, and the physician attended the meetings. However, the facility did not meet the requirements for two (2) additional staff members to be in attendance, the facility had only one (1) additional staff member in attendance. .

Based on record review and staff interview, the facility failed to develop policies and procedures for immunization of residents against pneumococcal disease in accordance with national standards of practice. This deficient practice had the potential to affect more than a limited number of residents eligible to receive pneumococcal vaccination. Facility census: 24. Findings included: a) Pneumococcal vaccine review The facility's policy and procedure entitled Pneumococcal Vaccine with revision date January 2017 stated the facility would identify residents in need of vaccination with pneumococcal vaccine PCV-13. The PCV-13 vaccination is no longer recommended by the Center for Disease Control (CDC). During an interview on 01/04/23 at 1:54 PM, the Infection Preventionist provided documentation that the facility was providing the pneumococcal vaccine PCV-20 to residents eligible for vaccination. PCV-20 is one of the pneumococcal vaccines recommended by the CDC. The Infection Preventionist acknowledged the facility's policy and procedure regarding pneumococcal vaccines was not up-to-date…

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 the physician's orders correctly conveyed the resident's/resident's representative's wishes regarding end of life treatment for two (2) of 14 residents reviewed for the care area of advance directives. Resident identifiers: #223 and #125. Facility census: 24. Findings included: a) Resident #223 Record review found the resident was admitted to the facility on [DATE]. On 01/02/23, the physician wrote a Do Not Resuscitate (DNR) order. Review of the medical record found a copy of the [NAME] Virginia Physician's Orders for Scope of Treatment (POST) form had been completed and signed by the physician indicating the resident was a DNR, comfort focused treatment, and no artificial means of nutrition desired. The POST form had not been signed by the resident or responsible party indicating this was the advance directives desired. There was no indication the resident/responsible party conveyed these wishes for end of life care. On 01/03/23 at 3:18…

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, resident interview, and staff interview, the facility failed to ensure water temperatures were comfortable for bathing activities. This was a random opportunity for discovery. Facility census: 24. Findings included: a) Water temperatures On 01/03/23 at 12:02 PM, Resident #12 stated, she doesn't always want a shower because the water is too cold. On 01/04/23 at 8:43 AM, the resident's nurse aide (NA) #20 said, we have to turn the water on and let it run for half an hour before it gets warm. She said with the recent cold spell you really had to let the water run. On 01/04/23 at 9:00 AM, the facility's medical secretary #57 provided copies of the resident's bathing schedule and confirmed the Resident receives 2 showers a week, Tuesdays and Saturdays. In December 2022 the resident had 8 opportunities to receive a shower before being diagnosed with COVID-19. The resident received 6 showers. In November 2022 the resident had nine (9) opportunities for showers. The resident received six (6)…

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 one (1) of one (1) resident reviewed for the care area of discharge had a discharge planning process in place, involving the resident, which addressed the resident's discharge goals and needs. Resident identifier: #22. Facility census: 24. Findings included: a) Resident #22 Record review revealed the resident was admitted to the facility on [DATE]. The resident was discharged to his home on [DATE]. The admission minimum data set (MDS) with an assessment reference date (ARD) of 10/04/22 noted the resident participated in his discharge plan and was expected to return home. Review of the current care plan found the resident's discharge to the community was not care planned. On 01/04/23 at 12:00 PM, Registered Nurse (RN) #63 was unable to locate any discharge paperwork or verification the residents discharge was care planned with the resident. On 01/04/22 at 3:50 PM, the Director of Nursing (DON) verified no interdisciplinary team (IDT)…

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 complete a discharge residents recapitulation of stay, which included the course of treatment at the facility. This was true for one (1) of one (1) resident reviewed for the care area of discharge during the long-term care survey process. Resident identifier: #22. Facility census: 24. Findings included: a) Resident #22 Record review revealed the resident was admitted to the facility on [DATE]. The resident was discharged to his home on [DATE]. The admission minimum data set (MDS) with an assessment reference date (ARD) of 10/04/22 noted the resident participated in his discharge plan and was expected to return home. On 01/04/23 at 12:00 PM, Registered Nurse (RN) #63 was unable to locate any discharge paperwork including a recapitulation of the residents stay at the facility. On 01/04/22 at 3:50 PM, the Director of Nursing (DON) verified a recapitulation of the residents stay at the facility had not been completed. At the close of the survey, no…

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 administer a medication used to treat high blood pressure per the physician's orders for one (1) of five (5) residents reviewed for unnecessary medications. Resident identifier #7. Facility census: 24. Findings included: a) Resident #7 Record review found a physician order, dated 12/30/22 for Metoprolol tartrate 25 milligrams. Give 1 table twice a day, hold if heart rate is less than 50. The medication administration record (MAR) was reviewed with the Director of Nursing (DON) on 01/05/23 at 9:25 AM, who verified the following information: On 12/31/22 the nurse did not administer the 8:00 PM dose of medication. There MAR did not include the resident's pulse/heart rate was obtained. On 01/01/23 the 8:00 AM dose was again held for a pulse/heart rate of 60. The DON confirmed holding the medication is not per the physician's orders, the medication should have been administer. On 01/02/23 the 8:00 AM dose was held. The nurse made the comment of the MAR, b/p (blood pressure) below parameter. The DON confirmed again 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 that residents who are trauma survivors receive trauma-informed care in accordance with professional standards of practice. This was true for one (1) of two (2) residents reviewed for the care area of mood and behavior. Resident identifier: #20. Facility census: 24. Findings included: a) Resident #20 Review of Resident #20's physician's orders showed an order for paroxetine (Paxil) for post-traumatic stress disorder (PTSD). The resident was on this medication since admission to the facility. The medical records contained no assessment of Resident #20's PTSD experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization to the resident. Additionally, Resident #20's comprehensive care plan did not contain a focus/problem related to PTSD. During an interview on 01/05/23 at 08:33 AM, the Director of Nursing (DON)confirmed Resident #20's medical records contained no assessment of the resident's PTSD. The DON also confirmed Resident #20's comprehensive care plan was 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 one (1) of five (5) residents reviewed for the care area of unnecessary medications was free from antipsychotic medication use. Resident identifier: 7. Facility census: 24. Findings included: a) Resident #7 Record review found the resident was admitted to the facility from the hospital on 1/28/22 with instructions to administer the antipsychotic medication, Olanzapine 2.5 milligrams at bedtime for 30 days. The hospital did not inform the facility of the diagnosis for the use of the medication. The medication was given for 30 days and a new prescription was written on 12/30/22 by the facility physician to continue the medication with no time limits. On 12/01/22 the facility physician saw the resident and noted the antipsychotic, Olanzapine was being given for a diagnosis of anxiety. The facility physician noted the medication was used at the hospital for acute delirium (acute delirium is temporary confusion and a change in consciousness.) When the physician continued the medication on 12/30/22 the resident had…

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

Based on record review and staff interview, the facility failed to ensure medications in the medication storage room were stored and labeled in accordance with currently accepted professional principles. One (1) vial of insulin was not dated to indicate when opened. Additionally, several medications in the intravenous cart were past the manufacturer's expiration date. Facility census: 24. a) Medication storage and labeling On 01/04/23 at 8:45 AM, inspection of the medication storage room was conducted with Licensed Practical Nurse (LPN) #43 in attendance. The refrigerator in the medication storage room contained a vial of insulin that had not been dated when opened to indicate when the insulin should be discarded. LPN #43 stated she thought the insulin had been opened last night, but confirmed the vial was not dated. Additionally, the cart containing floor-stock intravenous medication and supplies contained the following medications that were past the manufacturer's expiration dates: - Six (6) vials of the antibiotic Ceftriaxone containing powder for reconstitution, expiration date…

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's Physician Orders for Scope of Treatment (POST) were complete and accurate. This was discovered for two (2) of 14 POST forms reviewed during the Long Term Care Survey Process. The POST forms for Residents #18 and #4 were incomplete. Resident identifiers: #18 and #4. Facility census: 24. Findings included: a) Resident #18 During a medical record review on 01/04/23, the POST form completed on 11/17/22 for Resident #18 did not have the physician's phone number or the resident's name on the second page. An interview with the Director of Nursing (DON) on 01/04/23 at 11:45 AM, verified the POST form did not have the physician's phone number or the resident's name on the second page. b) Resident #4 During a medical record review on 01/05/23, the POST form completed on 11/16/20 for Resident #4 did not have a trial period for intravenous (IV) fluids or the name and signature of the preparer. An interview with the DON on 01/0/23 at 11:45 AM, verified the POST form was incomplete and did not include a time frame…

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.