Polaris Rehabilitation and Care Center

Based on observation, medical record review, resident representative and resident interview, review of resident council minutes, and concern forms, and staff interview, the facility failed to ensure sufficient nursing staff was available to provide the highest practicable physical, mental, and psychosocial well-being on 2 of 2 resident care units (North hall, South hall). The census was 71. The findings were: 1. Review of the 8/7/25 significant change MDS assessment for resident #1 showed s/he was determined to be severely cognitively impaired and exhibited inattention and disorganized thinking on a continuous basis, and suffered from delusions. The resident was totally dependent on staff for all areas of self-care and mobility. Review of the resident's ADL care plan, last revised 9/15/25, showed the resident was a 1 to 2 person assist with bathing and preferred showers on Tuesdays and Fridays. The following concerns were identified: a. Observation on 10/21/25 at 4:58 PM showed resident #1 was brought to the dining room and placed at the dining table with nothing in front 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, and resident and staff interview, the facility failed to ensure residents were treated with dignity and respect during 4 random observations which affected residents #1 and #5. The census was 71. The findings were:1. Review of the 8/7/25 significant change MDS assessment for resident #1 showed s/he was determined to be severely cognitively impaired and exhibited inattention and disorganized thinking on a continuous basis, and suffered from delusions. The resident was totally dependent on staff for all areas of self-care and mobility. The following concerns were identified: a. Observation on 10/21/25 at 4:58 PM showed resident #1 was brought to the dining room and placed at the dining table with nothing in front of him/her. The resident was observed picking at the tablecloth. Meal service began at 5:07 PM and resident #1 was served his/her meal at 5:35 PM with assistance provided by CNA #2. CNA #2 was observed assisting resident #9 at 5:07 PM before moving to assist…

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, resident representative interview, staff interview, and policy and procedure review, the facility failed to ensure a notification of change of condition was given for 1 of 8 sample residents (#6) reviewed. The findings were:1. Review of the 10/9/25 admission MDS assessment for resident #6 showed the resident had a BIMS score of 12 out of 15 (moderately cognitively impaired), required partial to moderate assistance for toileting, showers, upper and lower body dressing, and putting on and taking off footwear. The resident had diagnoses which included diabetes mellitus type 2 (DM2), transient cerebral ischemic attack, Parkinson's disease, muscle weakness, and dysphagia. Review of the care plan showed NUTRITIONAL STATUS: [resident name] is at risk for nutrition related problems r/t [related to] Parkinson's, DM2, PNA [pneumonia], dysphagia, anemia, HTN [hypertension], chronic respiratory failure, transient cerebral ischemic attack, AOC respiratory failure, falls. Resident/family decline recommended NPO diet and request regular chopped textures. They have…

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

Based on medical record review, resident representative interview, and staff interview, the facility failed to ensure routine bathing was provided for 2 of 8 sample residents (#1, #5) reviewed for activities of daily living. The findings were: 1. Review of the 8/7/25 significant change assessment for resident #1 showed s/he was determined to be severely cognitively impaired and exhibited inattention and disorganized thinking on a continuous basis and suffered from delusions. The resident was totally dependent on staff for all areas of self-care and mobility. Review of the resident's ADL care plan, last revised 9/15/25, showed the resident was a 1 to 2 person assist with bathing and preferred showers on Tuesdays and Fridays. The following concerns were identified: a. Review of the October 2025 bathing documents, provided by the facility on 10/23/25 at 5:23 PM, showed the resident was given a bed bath on 10/8/25 at 11 PM and a shower on 10/16/25 (2 baths in 22 days). Interview with LPN #1 on 10/23/25 at 5:30 PM confirmed the bathing sheets were correct. b. Interview with the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, staff interview, and policy review the facility failed to ensure interventions to prevent ulcers development were implemented for 2 of 4 residents (#1, #2) reviewed for pressure ulcers. The findings were:1 Review of the 2/17/25 admission MDS assessment, showed resident #1 was coded as being severely cognitively impaired and had diagnoses which included non-traumatic brain dysfunction, dementia, severe, with mood disturbance, deep vein thrombosis, diabetes mellitus, thyroid disorder, arthritis, non-Alzheimer's dementia, malnutrition, post traumatic stress disorder, anxiety, depression, disorder of bone density and structure, and other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain. The assessment showed the resident required assistance of supervision or setup for toileting, showers, upper body dressing, lower body dressing, putting on footwear, and personal hygiene. Further, review showed the resident was at risk 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 medical record review, resident and staff interview, and review of concern forms, the facility failed to provide timely incontinence care to 2 of 8 sample residents (#1, #5). The findings were:1. Review of the 8/7/25 significant change assessment for resident #1 showed s/he was determined to be severely cognitively impaired and exhibited inattention and disorganized thinking on a continuous basis, and suffered from delusions. The resident was totally dependent on staff for all areas of self-care and mobility. The following concerns were identified: a. Observation on 10/23/25 at 7:58 AM showed the resident was seated at a small table in the dining room, which faced the back wall, and had a glass of water in front of him/her. At 9:28 AM the resident was removed from the table and was moved to the hallway in front of the North nurses' station where s/he sat until 10:53 AM when s/he was approached by a therapist and taken to the therapy room. The resident remained in the therapy room and was a passive participant until 11:50 AM when s/he was taken back to the dining room 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, medical record review, staff and resident interview, facility staffing review, grievance review, facility assessment review, and policy and procedure review, the facility failed to ensure sufficient nursing staff to provide the highest practicable physical, mental, and psychosocial well-being on 2 of 2 resident care units (North unit, South unit). The census was 69. The findings were:1. Review of the quarterly MDS assessment dated [DATE] showed resident #2 had a BIMS score of 15 out of 15, which indicated the resident was cognitively intact, and had diagnoses which included morbid obesity, acute respiratory failure, and disorder of skin and subcutaneous tissue. Further review showed the resident had bilateral lower extremity impairment and required partial/moderate assistance with personal hygiene and substantial/maximal assistance with bathing/showering. The following concerns were identified:a. Interview with the resident on 8/28/25 at 11:52 AM revealed the facility did not have enough…

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 and staff interview, medical record review, resident grievance review, and policy and procedure review, the facility failed to ensure routine bathing was provided for 5 of 10 sample residents (#1, #2, #3, #4, #6) reviewed for activities of daily living. The findings were: 1. Review of the quarterly MDS assessment dated [DATE] showed resident #2 had a BIMS score of 15 out of 15, which indicated the resident was cognitively intact, and had diagnoses which included morbid obesity, acute respiratory failure, and disorder of skin and subcutaneous tissue. Further review showed the resident had bilateral lower extremity impairment and required partial/moderate assistance with personal hygiene and substantial/maximal assistance with bathing/showering. The following concerns were identified: a. Interview with the resident on 8/28/25 at 11:52 AM revealed the facility did not have enough staff and call lights could take between 15 and 30 minutes to be answered. The resident revealed s/he did not receive…

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 daily staff posting review and staff interview the facility failed to ensure the total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: RN, LPN, CNA were documented on the posting. The census was 69. The findings were:1. Review of the daily staff postings from 7/28/25 through 8/28/25 showed staff names, position worked, and number of hours individual staff worked; however, the posting failed to identify the total hours worked for all RNs, LPNs, and CNAs.2. Interview with the administrator on 8/28/25 at 2:47 PM confirmed the daily staff posting did not give the total number of hours for the RNs, LPNs, and the CNAs.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident interview, staff interview, facility investigation notes review, and policy and procedure review the facility failed to protect the resident's right to be free from physical abuse by a resident for 1 of 2 sample residents (#4) reviewed with abuse allegations. The finding were: 1. Review of the annual MDS assessment dated [DATE] showed resident #4 had a BIMS score of 7 out of 15, which indicated severe cognitive impairment, and had diagnoses which included alcohol dependence with withdrawal, anxiety disorder, depression, and psychotic disorder. Review of the quarterly MDS assessment dated [DATE] showed resident #5 had a BIMS score of 11 out 12, which indicated moderate cognitive impairment, and had diagnoses which included anxiety disorder, and depression. The following concerns were identified:a. Review of a facility incident report dated 4/1/25 and timed 12:48 PM showed a witness entered the room of resident #4 and resident #5 and found resident #5 gripping resident #4's…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the facility's COVID-19 infection control outbreak records, staff interview, and policy and procedure review, the facility failed to ensure a system was in place for documenting resident and staff SARS-CoV-2 test results during an outbreak. The census was 81. The findings were: 1. Review of the facility's COVID-19 infection control outbreak records showed one staff member tested positive for SARS-CoV-2 on 9/12/24 and another on 9/13/24. Further review showed residents were tested on [DATE], 9/17/24, 9/20/24, 9/23/24, 9/26/24, 10/1/24, 10/4/24, and 10/7/24. One resident tested positive on 9/20/24, one resident on 9/23/24, two residents on 10/1/24, and three residents on 10/4/24 (7 total). Further review of the facility's documentation showed staff were screened for symptoms and tested from 9/13/24 through 10/7/24. Two staff members tested positive on 9/26/24. There was no further documentation available. 2. Telephone interview with the former infection preventionist on 10/24/24 at 9:35 AM…

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, staff interview, and resident representative interview, the facility failed to have a system in place to ensure changes in health care appointments were communicated to the resident or the resident's representative for 2 of 4 residents (#1, #8) reviewed for post-hospitalization follow-up appointments. The findings were: 1. Interview with resident #1's representative on 10/24/24 at 10:53 AM revealed the resident was admitted to the facility on [DATE] from an out-of-state acute care hospital. Following discharge, the resident had an appointment with a urologist scheduled for 4/1/24 (Monday). The resident's representative revealed she had confirmed the appointment with the resident's nurse the weekend before the appointment and an arrangement had been made for a family member to meet the resident at the appointment; however, when the family member arrived for the follow-up appointment, she was told the appointment had been rescheduled by the facility for patient convenience to…

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

Based on observation, medical record review, resident and staff interview, review of staff training records, and review of the facility's policy, the facility failed to ensure tracheostomy care was performed as ordered for 1 of 1 resident with a tracheostomy (#4). The findings were: 1. Observation of resident #4 on 8/22/24 at 9:39 AM showed the resident had a capped tracheostomy and was wearing oxygen per nasal cannula. There were a number of various supplies piled on the additional bed in the room and by 9:44 AM the supplies were organized and included the items needed to provide tracheostomy care to the resident. There was a suction machine with a suction catheter attached on the bedside table. The resident made gestures and could whisper words to communicate. Review of the medical record for resident #4 showed an admission date of 7/21/24 and diagnosis which include acute respiratory failure with tracheostomy placement, pneumonitis, chronic obstructive pulmonary disease and multiple comorbidities. Review of the care plan for resident #4 showed an admission date of 7/21/24 that…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and staff interview, the facility failed to have a system in place to ensure communication with the dialysis center was documented in the medical record for 3 of 4 residents (#11, #35, #117) who received dialysis services. The findings were: 1. Review of the medical record showed resident #11 was admitted to the facility on [DATE], discharged with return anticipated on 5/20/24, and readmitted to the facility on [DATE]. Review of the resident's care plan showed the resident was to receive dialysis from an offsite dialysis center every Monday, Wednesday, and Friday. Review of the 2024 May and June Dialysis Communication Record forms between the dialysis center and the facility showed no documentation for the 5/17, 5/31, 6/12, 6/17, 6/19, 6/21, and 6/24 treatments. 2. Review of the 3/31/24 quarterly MDS assessment showed resident #35 was admitted to the facility on [DATE] and received dialysis services. Review of the physician orders showed the resident was to receive dialysis from 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 medical record review and staff interview, the facility failed to develop a baseline care plan which addressed the immediate needs of the residents for 1 of 5 (#117) newly admitted residents reviewed. The findings were: 1. Review of the medical record for resident #117 showed the resident was admitted from the hospital on 6/6/24 and had diagnoses which included hypertensive chronic kidney disease with stage 5 chronic kidney disease and dependence on renal dialysis. Review of the resident's 6/7/24 baseline care plan showed the focus area of dialysis was left blank. 2. Interview on 6/26/24 at 10:40 AM with the DON confirmed the resident's baseline care plan was incomplete.

Based on medical record review, staff and resident interview, and policy and procedure review, the facility failed to ensure the comprehensive care plan was revised as needed to reflect the resident's current needs for 1 of 5 sample residents (#58) reviewed for smoking. The findings were: 1. Review of the 3/10/24 MDS assessment showed resident #58 had a BIMS score of 5 out of 15 which indicated severe cognitive impairment. Interview with the resident on 6/25/24 at 8:19 AM revealed s/he smoked on a regular basis. Review of the 6/17/24 safe smoking assessment showed the resident was required to wear a smoking apron. The following concerns were identified: a. Review of the resident's care plan showed the care plan had not been revised to include goals and interventions related to the use of tobacco. 2. Interview with the DON on 6/25/24 at 2:15 PM confirmed the care plan had not been updated to reflect the resident's use of tobacco. 3. Review of the 5/2/24 Resident Smoking Policy showed .8. Any resident who is deemed safe to smoke, with or without supervision, will be allowed to smoke…

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, staff interview, medical record review, and policy and procedure review, the facility failed to ensure the environment was free of accident hazards for 1 of 5 sample residents (#117) reviewed for smoking. The findings were: 1. Review of the 6/9/24 admission MDS assessment showed resident #117 had a BIMS score of 15, which indicated the resident was cognitively intact, and was coded as not using tobacco. The findings were: a. Observation on 6/23/24 at 11:36 AM showed the resident was smoking in the designated outdoor smoking area under staff supervision. b. Interview with the resident on 6/25/24 at 7:56 AM revealed the s/he did not start smoking until 2 weeks after s/he was admitted . The resident stated s/he wore a smoking apron while smoking but otherwise did not have any restrictions. c. Review of the smoking assessment dated [DATE] showed the resident was a non-smoker. There was no evidence a safe smoking assessment had been completed after the resident had chosen to begin smoking. 2.…

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, staff interview, and review of facility policies, and review of the CDC immunization recommendations, the facility failed to ensure residents received the pneumococcal immunization based on CDC recommendations for 1 of 5 sample residents (#43) reviewed for immunizations. The findings were: 1. Review of the medical record showed resident #43 was [AGE] years old. Further review showed the resident received the Prevnar 23 vaccine on 1/18/17 and had signed a consent form on 9/11/23 to receive the PCV20 vaccine. There was no evidence the resident had received the vaccination. 2. Interview with the infection preventionist on 6/26/24 at 11:09 AM revealed the resident had not been administered the PCV 15 or PCV20 vaccine due to an oversight. 3. Review of the 9/8/23 Pneumococcal Vaccine policy showed .The type of pneumococcal vaccine (PCV15, PCV20, or PPSV23) offered will depend upon the recipient's age and susceptibility to pneumonia, in accordance with current CDC guidelines 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 observation, staff interview, and facility policy and procedure review, and review of the Food Code, the facility failed to ensure staff used beard restraints in accordance with professional standards during 1 of 3 meals. The facility census was 74. The findings were: 1. Observation on 1/17/24 at 11:50 AM showed cook #1, in the kitchen serving window, standing in the food distribution area, and dispensing resident meals on plates wearing a hat on his/her head, gloves and a long sleeve shirt. Further observation showed resident #4 received a meal at 12:01 PM. The following concerns were identified: a. Observation on 1/17/24 at 11:50 AM showed cook #1 had a short beard, but was not wearing a beard restraint. b. Interview on 1/17/24 at 12:05 PM with the HR Director confirmed staff members were expected to wear a beard restraint and hair nets when distributing food to residents. c. Interview on 1/17/24 at 2:02 PM with the dietary manager revealed cook #1 should have worn a beard restraint. d. Interview on 1/18/24 at 4 PM with resident #4's representative revealed a concern 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident representative and staff interview, facility policy and procedure review, and review of facility corrective action documentation, the facility failed to prevent an avoidable accident for 1 of 3 sample residents (#2) reviewed for accidents. This failure resulted in past non-compliance for resident #2 who had a fall as a result of staff error. Corrective measures were implemented by the facility prior to the survey and compliance was determined to be met on 12/21/23. The findings were: 1. Review of the Nursing admission Data Collection for resident #2 showed the resident was admitted to the facility on [DATE] for rehabilitation due to a right hip fracture, Further review showed a summary AROM and PROM limited on right side due to pain and weakness from surgery. Currently toe touch weight bearing on right leg. Review of the Transfer Evaluation dated 12/11/23 showed the resident was Currently toe touch weight bearing on right. The transfer evaluation scored the resident at 9,…

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, observation, staff and resident representative interview, and facility policy and procedure review, the facility failed to ensure residents were offered choices during meal times for 1 out of 6 (#4) sample residents related to resident rights. The findings were: 1. Review of the care plan last revised 1/16/24 for resident #4 showed interventions of: offer preferred foods, HELP resident #4 with choices as needed. S/he may need only a few options to avoid overwhelming him/her. Review of the 11/30/23 Brief Interview for Mental Status (BIMS) showed the resident had a score of 5 out of 15 indicating severe cognitive impairment. Review of the CNA charting for how the resident eats and drinks showed the resident needed Oversight, encouragement or cueing from 12/19/23 to 1/17/24. Review of the meal preference ticket for resident #4 showed Salt, pepper each tray, and condiments with burgers Mightyshake .at each meal . Add milk to Oatmeal. Salt/Pepper with all meals. The following concerns were identified: a. Observation on 1/17/24 at 4:25 PM showed customer…

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, staff interview, facility incident report review, and policy and procedure review, the facility failed to honor residents' right to refuse treatment for 1 of 18 sample residents (#57). The findings were: 1. Review of the significant change MDS assessment dated [DATE] showed resident #57 had a BIMS score of 0 out 15, indicating severe cognitive impairment, and diagnoses which included non-Alzheimer's dementia and psychotic disorder other than schizophrenia. Further review showed the resident exhibited no behavioral symptoms and no restraints or alarms were in use. The following concerns were identified: a. Review of the facility incident report dated 5/9/23 showed the administrator was notified RN #1 and RN #2 attempted to provide medication to resident #57 while the resident was combative. The report indicated the nurses held the resident's hands against his/her body and braced the resident's jaw to keep him/her from moving away during medication administration. Further review…

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, staff interview, facility incident report review, and policy and procedure review, the facility failed to ensure residents were free from physical restraints for 1 of 2 sample residents (#57) reviewed for restraint use. The findings were: 1. Review of the significant change MDS assessment dated [DATE] showed resident #57 had a BIMS score of 0 out 15, indicating severe cognitive impairment, and diagnoses which included non-Alzheimer's dementia and psychotic disorder other than schizophrenia. Further review showed the resident exhibited no behavioral symptoms and no restraints or alarms were in use. The following concerns were identified: a. Review of the facility incident report dated 5/9/23 showed the administrator was notified RN #1 and RN #2 attempted to provide medication to resident #57 while the resident was combative. The report indicated the nurses held the resident's hands against his/her body and braced the resident's jaw to keep him/her from moving away during medication…

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, staff interview, and review of policy and procedure, the facility failed to ensure appropriate behavior monitoring and interventions were in place for 2 of 6 sample residents (#5, #11) who received psychotropic medications. The findings were: 1. Review of the quarterly MDS assessment dated [DATE] showed resident #5 had a BIMS score of 12 out of 15, indicating the resident was cognitively intact, and diagnoses which included anxiety, bipolar disorder, and attention deficit hyperactivity disorder. Review of section N, Medications, showed the resident received antipsychotic medications and antianxiety medications on 7 days during the look-back period. Review of physician orders showed the resident received Klonopin (antianxiety) 0.5 milligram (mg) for anxiety, lithium carbonate (mood stabilizer) 300 mg two times per day related to bipolar disorder, quetiapine fumarate (antipsychotic) 25 mg two times a day related to bipolar disorder, and Topamax (anticonvulsant) tablet 50 mg three…

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

Based on observation, medical record review, staff interview, and policy and procedure review, the facility failed to ensure infection control techniques were implemented for 1 of 5 residents (#177) reviewed for wounds. The findings were: 1. Review of the current physician orders showed resident #177 received amoxicilillin-pot clavilanate (antibiotic) 875-125 mg by mouth every 12 hours for a bacterial infection of the left forearm. The following concerns were identified: a. Observation on 6/21/23 at 9:52 AM showed LPN #1 entered the room of the resident, donned gloves and prepared supplies to apply a dressing to the resident's left forearm. At that time, the wound on the resident's left forearm was open to air. The LPN cleaned the wound, applied silvadene cream, applied non-adherent pads, and then applied a clean rolled gauze over the wound. Upon completing the dressing application, she doffed her gloves. No hand hygiene or glove change was performed between cleaning the wound, and applying the dressing. Interview with the LPN on 6/21/23 at 9:58 AM revealed she normally performed…

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.