Harmony Village of Clawson

Inspectors wroteThis citation pertains to intake #3075905 Based on interview and record review, the facility failed to ensure an accurate accounting of administration of controlled substances for three residents (R904, R905 and R906) of four residents reviewed for pharmacy services.

Inspectors wroteBased on interview and record review, the facility failed to ensure Medicare liability notices were provided to the residents' court appointed legal representative responsible for finances for two (R15 and R16) of three residents reviewed for liability notices.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate infection control practices when handling ready-to-eat food for one resident (R59) of seven residents reviewed for infection control.

Inspectors wroteThis citation pertains to intake #'s 2688115 and 2682315. Based on observation, interview and record review, the facility failed to appropriately assess, supervise and ensure an environment was free of sexual abuse for two legally incapacitated residents with severely impaired cognition (R909 and R910) of ten residents reviewed for abuse, resulting in R909 and R910 being found unsupervised involved in a sexual encounter in R909's bed, both unclothed from the waist down, with R910 in between R909's legs with R909's legs up in the air. Applying the reasonable person concept standard, this deficient practice resulted in the increased likelihood of serious psychosocial harm, serious injury and/or death to occur.

Inspectors wroteThis citation pertains to incident: 2647112. Based on observation, interview and record reviews the facility failed to prevent a preventable fall for one (R901) of one resident reviewed for falls with injury, resulting in a preventable closed fracture of the distal end of the left femur and pain.

Inspectors wroteThis citation pertains to intake #'s 2636124 and 2638469. Based on observation, interview and record review, the facility failed to protect the resident's right to be free from physical abuse by another resident for five residents (R's 302, 303, 304, 305 and 306) of six residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake Number(s): 1278772. Based on observation, interview and record review, the facility failed to protect the resident's right to be free from physical abuse by a resident for two (R203 and R204) of four residents reviewed for abuse, resulting in R204 physically assaulting R203 (witnessed by R205 and R207) causing a scalp laceration that required three staples, a hematoma and swelling of the left eye, and expressions of fear of returning back to the facility from the hospital and R204 sustaining scratches to his nose, under right eye, and neck.

Inspectors wroteThis citation pertains to intake(s): MI00153082, MI00154080 & MI00154105. Based on observation, interview and record reviews the facility failed to conduct a thorough investigation into an injury of unknown origin for one (R202) of four residents reviewed for Abuse.

Inspectors wroteBased on interview and record reviews the facility failed to ensure a Certified Nursing Assistant (CNA) maintained an active CNA certification while working at the facility, for one (CNA A) of three CNA certifications reviewed.

Inspectors wroteBased on interview and record review, the facility failed to protect the resident's right to be free from neglect for 11 residents (R#'s 37, 41, 43, 7, 19, 18, 33, 40, 36, 21, and R25) of 19 residents reviewed for abuse/neglect/mistreatment.

Inspectors wroteBased on interview and record review, the facility failed to report an incident of neglect to the State Agency for 11 residents (R#'s 37, 41, 43, 7, 19, 18, 33, 40, 36, 21, and R25) of 19 residents reviewed for abuse/neglect/mistreatment.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was assessed for the safe self-administration of medication and to have medication kept at bedside for one (R8) of one resident reviewed for self-administration of medication.

Inspectors wroteBased on observation, and interview the facility failed to offer a shower for one of one resident (R39) reviewed for accommodation of needs, resulting in R39's bathing preferences to be unrecognized.

Inspectors wroteBased on interview and record review, the facility failed to ensure an updated annual review of a Do-Not-Resuscitate (DNR) order with a legal guardian was in place for one (R32) of three residents reviewed for advance directives.

Inspectors wroteBased on observation, interview and record review, the facility failed to protect residents personal privacy for two (R1 and R5) of two residents reviewed for privacy.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain a clean, comfortable, homelike environment for one (R44) of nine residents reviewed for environment.

Inspectors wroteBased on observations, interview, and record review the facility failed to transcribe medication orders correctly from the hospital resulting in one resident (R10) missing prescribed dosages of antibiotic medication (a medication used to treat infection).

Inspectors wroteBased on interview and record review, the facility failed to ensure a Change in Condition level one screening Form DCH (Department of Community Health/3877) was submitted to the local Community Mental Health Services Program (CMHSP) for a level two OBRA (Omnibus Budget Reconciliation Act) evaluation upon a change in the resident's condition for one (R61) of two residents reviewed for Preadmission Screening/Annual Resident Review (PASARR).

Inspectors wroteBased on interview and record review the facility failed to ensure a Preadmission Screening/Annual Resident Review (PASARR) was submitted and completed by the local community mental health agency after the 30 day exemption period for one (R8) of two residents reviewed for PASARR screenings.

Inspectors wroteBased on interview and record review, the facility failed to ensure diagnostic practices met professional standards for one (R61) of two residents reviewed for psychotropic medications when R61 received a new diagnosis of schizophrenia.

Inspectors wroteBased on observation, interview and record review the facility failed to implement effective timely interventions for wounds and complete accurate assessments for one resident (R4) of two residents reviewed for Pressure Ulcers.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an environment free from accident hazards for two (R28 and R61) of five residents reviewed for accidents.

Inspectors wroteBased on interview and record review, the facility failed to ensure medically-related social services to address mental health needs and patient advocacy/guardianship for one (R61) of three residents reviewed for social services.

Inspectors wroteBased on interview and record review, the facility failed to ensure irregularities identified by the consultant pharmacist were available for review to identify what the irregularity was and the physician response to the irregularities for one (R61) of five residents reviewed for monthly medication regimen reviews.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a treatment/medication was secured for two residents (R19 and R37) of two residents reviewed for medication labeling and storage.

Inspectors wroteBased on interview and record review the facility failed to ensure a Physician ordered laboratory (lab) diagnostic was completed for one residents ( R58) of two residents reviewed for diagnostics.

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate and updated wound care evaluations/treatments were present in the medical record for one resident (R14) of one residents reviewed for accurate medical records resulting in the potential for misidentification/inappropriate wound care treatments.

Inspectors wroteBased on interview and record review the facility failed to ensure the appropriate Notice of Medicare Non-Coverage (NOMNC) and a Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN) were provided and completed for three (R44, R49 and R59) of three residents reviewed for beneficiary notification, resulting in the residents and/or representatives to be uniformed of the potential private pay charges for continued services at the facility, and the inability to file an appeal.

Inspectors wroteThis citation pertains to intake: MI00149343. Based on interview and record reviews the facility failed to ensure sufficient staffing was provided for multiple residents that resided on the second floor of the facility, approximately 43 out of a total census of approximately 68 residents, resulting in the potential for unmet care needs.

Inspectors wroteThis citation pertains to intake: MI00149372. Based on interview and record review, the facility failed to follow the facility's grievance policy and follow up on concerns from a family member for one (R901) of three residents reviewed for resident rights.

Inspectors wroteThis citation pertains to Intake Number(s): MI00146628, MI00146773, MI00146696 Based on observation, interview, and record review, the facility failed to protect the residents' right to be free from verbal abuse and physical abuse by a resident for four (R605, R606, R611, and R609) of 12 residents reviewed for abuse, resulting in R605 being slapped by R606 after R605 called R606 a derogatory name, R605 being pushed by R611 after R605 called R611 a derogatory name, and R609 being hit with a shoe by R610.

Inspectors wroteBased on interview, and record review, the facility failed to thoroughly investigate an allegation of resident to resident physical abuse for two (R605 and R608) of 12 residents reviewed for abuse.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement care planned interventions for bed mobility and toileting and develop a care plan to address combative behaviors and hearing deficits for one (R601) of seven residents reviewed for accidents, resulting in a skin tear to the left hand.

Inspectors wroteThis citation pertains to Intake: MI00146570 Based on observation, interview, and record review, facility failed to provide supervision needed for one (R607) of five residents reviewed for with elopement. This deficient practice resulted in R607 with severe cognitive impairment exiting the facility unbeknownst to facility staff with potential for serious injury from the resident being outside and unsupervised, with access to a five a lane road. R607 Record review revealed R607 was a long-term resident of the facility, originally admitted to the facility on [DATE]. R607's admitting diagnoses included dementia, mood disturbance, anxiety, stroke, muscle weakness, history falls, and malnutrition. Based on the Minimum Data Set (MDS) assessment dated [DATE], R607 had a Brief Interview for Mental Status (BIMS) score of 6/15, indicative of severe cognitive impairment. [...]

Inspectors wroteThis citation pertains to intake: MI00145934. Based on observation, interviews and record reviews the facility failed to implement interventions to prevent injury for one (R403) of three residents reviewed for an injury of unknown origin, resulting in pain and a right subtle nondisplaced medial malleolus (break of the tibia, at the inside of the lower leg) fracture.

Inspectors wroteThis citation pertains to Intake MI00145934 Based on observation, interview and record review, the facility failed to develop and/or implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act when failing to report a black eye of unknown source and failed to report information accurately regarding an ankle fracture to the State Agency (SA) for two (R405 and R403) of three residents reviewed for injuries of unknown source.

Inspectors wroteThis citation pertains to intake: MI00145315. Based on interview and record review the facility failed to ensure the required documentation for the transfer of one (R401) of one resident reviewed for a facility transfer, was noted in the medical record.

Inspectors wroteThis citation pertains to intake: MI00145315. Based on interview and record reviews the facility failed to ensure a medication ordered by the physician was obtained and administered for one (R401) of three residents reviewed for quality of care.

Inspectors wroteThis citation pertains to Intake Number(s): MI00145225. Based on observation, interview, and record review, the facility failed to protect the resident's right to be free from physical abuse by another resident resulting in R605, who had a history of aggressive and agitated behavior, pushing one (R606) of six residents reviewed for abuse to the ground and hitting their head, sustaining a laceration, and being transferred to the hospital.

Inspectors wroteThis citation pertains to Intake Number(s): MI00145225. Based on observation, interview, and record review, the facility failed to report an injury of unknown origin to the Administrator in a timely manner and to the State Agency for one (R608) of six residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake Number(s): MI00145225. Based on observation, interview, and record review, the facility failed to thoroughly investigate an injury of unknown origin to rule out abuse for one (R608) of six residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake # MI00144190 Based on observation, interview, and record review, the facility failed to provide ongoing facility sponsored individual activities for one (R604) of one resident reviewed for activities, resulting in the potential for feelings of isolation, depressingly impacting physical, mental, and psychosocial well-being. Findings Include: A complaint was filed with the State Agency that alleged the resident does not have any activities to keep them occupied. Clinical record review revealed that R604 was admitted to this facility on 6/22/23 with a diagnosis of nontraumatic subdural hemorrhage (bleeding in the brain), dementia, receptive-expressive language disorder, and bilateral upper and lower contractures (permanent shortening and tightening of the muscles) which requires full assistance with all activities of daily living. [...]

Inspectors wroteThis citation pertains to intake #MI00143854 Based on interview and record review the facility failed to ensure an environment free from sexual abuse for two cognitively impaired residents (R49 and R75) lacking the ability to consent for physical intimacy of six residents reviewed for abuse/neglect/mistreatment.

Inspectors wroteThis citation pertains to intake #MI00143854 Based on interview and record review the facility failed to submit their abuse investigation within the mandatory five business day time-frame for two residents (R49 and R75) of six residents reviewed for abuse.

Inspectors wroteThis citation pertains to intake# MI00143166. Based on observation, interview and record review, the facility failed to protect the resident's right be free from sexual abuse by R702, resulting in R701 to have experienced humiliation, anxiety and feelings of being violated during and after unwanted sexual touching using the reasonable person concept.

Inspectors wroteThis citation pertains to intake: MI00143015 & MI00143012. Based on observations, interviews, and record reviews, the facility failed to protect a vulnerable resident (R702) who lacks cognitive ability to consent to sexual activity, from a sexual incident initiated by R703 a cognitively intact resident for two of six residents reviewed for abuse, resulting in the failure of the facility to protect R702 and other vulnerable residents who resided in the facility on the day of the incident, the failure to conduct a thorough investigation, the failure to preserve potential criminal evidence and the failure to notify law enforcement of the incident, which resulted in an Immediate Jeopardy (IJ). The IJ was identified on 3/6/24 at 9:15 AM. The IJ began on 2/27/24. The Administrator was notified of the IJ on 3/6/24 at 11:59 AM and a plan of removal was requested to remove the immediacy. [...]

Inspectors wroteThis citation pertains to intake: MI00143015 & MI00143012 Based on observation, interviews, and record reviews the facility failed to prevent an incident of resident-to-resident sexual abuse with two (R's 702 and 703) of seven residents reviewed for abuse, resulting in the reasonable person to have experienced inappropriate, unwanted sexual contact and would have experienced humiliation, embarrassment, feelings of being violated, anxiety and helplessness after being the victim of resident-to-resident sexual abuse.

Inspectors wroteThis citation pertains to intake: MI00143015 & MI00143012 Based on observations, interviews, and record reviews the facility failed to develop and/or implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act when the facility failed to ensure an allegation of sexual abuse was reported within the required time frame to the State Agency (SA) and reported the suspected crime to law enforcement, resulting in a delay in notification to the SA (when R703 was found naked with R702), the delay in notification to law enforcement and the inability for law enforcement and health officials to obtain and process evidence and resulting in the reasonable person to have felt fear, guilt, shame, anger, hurt, and anxiety as a victim of an unconsented sexual act.

Inspectors wroteThis citation pertains to intake #MI00142062, MI00139621 Based on observation, interview, and record review, the facility failed to maintain a clean, comfortable, and homelike living environment for 18 residents (R1, R8, R10, R19, R24, R26, R28, R31, R38, R47, R60, R87, R96, R98, R204, R252, R256 and R504) and seven of seven anonymous residents who attended the resident council interview. This had the potential to affect all 99 residents who resided in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an ongoing activities program for five (R32, R47, R86, R93, and R98) of five residents reviewed for activities, seven of seven residents who attended the confidential resident council interview, and six additional residents (R50, R94, R75, R57, R84, R1) resulting in behaviors, expression of boredom, and diminished quality of life. This had the potential to affect all 99 residents who resided in the facility.

Inspectors wroteThis citation pertains to intake #'s MI00138924, MI00139621, MI00142062, and MI00142469 Based on observation, interview, and record review, the facility failed to ensure there was sufficient nursing staff for the residents on the second floor to address wandering residents, residents who required toileting assistance, and residents with dementia and behaviors for seven (R32, R47, R75, R86, R57, R84, and R1) residents reviewed for staffing , resulting in incontinence, negative resident to resident interactions, residents wandering into potentially unsafe areas, and poor infection control. This had the potential to affect all residents who resided on the second floor.

Inspectors wroteThis citation pertains to intake #MI00138924, MI00140002, and MI00140828. Based on observation, interview, and record review, the facility failed to provide meals that were palatable and attractive, resulting in resident food complaints and dissatisfaction with the meals provided.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain sanitary conditions in the kitchen. This deficient practice had the potential to affect all residents that consume food from the kitchen.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the facility was administered in a manner that maintains the safety and care of residents so residents may reach their highest practicable physical, mental, and psychosocial well-being for all 99 residents who reside at the facility, resulting in quality care not being provided to residents, an un-homelike environment, no ongoing program of meaningful activities, inadequate staffing to meet resident's needs, palatable food being not being served, food not served under sanitary conditions, and ineffective infection control and antibiotic stewardship programs.

Inspectors wroteBased on interview and record review the facility failed to establish an effective Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement (QAPI) plan that identified system issues that resulted in sub-standard quality of care. This deficient practice had the potential to affect all 99 residents in the facility. A review of a facility provided policy titled, Quality Assurance and Performance Improvement revised 10/2022 was conducted and read, Policy: It is the policy of this facility to develop, implement, and maintain an effective, comprehensive data driven Quality Assurance Performance Improvement (QAPI) program that focuses on indicators of the outcomes of care and quality of life . On 2/15/24 at 10:34 AM, an interview was conducted with the facility's Administrator regarding various systemic failures identified during the survey. [...]

Inspectors wroteThis citation has two deficient practices. Deficient Practice #1 Based on interview and record review, the facility failed to have an active plan for reducing the risk of Legionella and other opportunistic pathogens of premise plumbing (OPPP). This deficient practice has the increased potential to result in water borne pathogens to exist and spread in the facility's plumbing system and an increased risk of respiratory infection among any or all of the 99 residents in the facility.

Inspectors wroteBased on interview and record review, the facility failed to maintain an effective Antibiotic Stewardship program that included consistent implementation of protocols to ensure that an antibiotic is prescribed for the correct indication, dose, and duration to appropriately treat infection for one resident (R21) of one resident reviewed for antibiotic medications.

Inspectors wroteThis citation pertains to intake #'s MI00138924, MI00140828 and MI00142062 Based on observation, interview, and record review, the facility failed to ensure treatment in a dignified manner for two residents (R#'s 257 and R29) of eight residents reviewed for dignity.

Inspectors wroteR19 and R36 Review of a FRI submitted to the State Agency revealed on 1/22/24 alleged R19 hit R36 in the stomach. On 2/12/24 at 10:25 AM, R19 was observed lying in bed. R19 appeared disheveled. When queried about any issues he had with other residents in the facility, R19 pointed in the direction of his roommate and reported he did not like that he turned on the air conditioning. When queried about whether he had been in any fights with any other residents in the facility, R19 denied any fights and stated, Do you mean at the other facility?. On 2/12/24 at 11:36 AM, R36 was observed lying in bed. When queried about any issues he had with other residents in the facility, R36 stated, I was assaulted two times by R19 who was a previous roommate. R36 stated, He (R19) spit on me. He aimed for my face and it landed on my shoulder. Then he punched me in the stomach and rib cage. [...]

Inspectors wroteThis citation pertains to intake #'s MI00139287,MI00141773, and MI00141879, MI00142355. Based on interview, and record review, the facility failed to thoroughly investigate allegations and instances of abuse for nine residents (R#'s 93 86, 83, 352, 35, 50, 74, 92, and 552) of 28 residents reviewed for abuse investigations.

Inspectors wroteThis citation pertains to intake #'s MI00139089, MI00140275, MI00142584 Based on observation, interview, and record review, the facility failed to provide adequate supervision for six (R37, R47, R84, R86, R302, and R505) of 11 residents reviewed for accidents, four of seven residents who wished to remain anonymous who attended the resident council group interview, and one (R1) additional resident, resulting in resident to resident altercations and negative interactions, falls, poor infection control, residents feeling unsafe, invasion of privacy, and wandering into potentially unsafe spaces.

Inspectors wroteBased on interview and record review the Facility failed to ensure that the regular in-service/training and competency evaluations based on performance review every 12 months for the 8 Certified Nursing Assistants (CNA) (N, Q, T, LL, MM, OO, PP and RR) resulting in the potential for unmet resident care needs.

Inspectors wroteBased on observation and interview the facility failed to ensure appropriate medication storage for one of three medication rooms and one of six medication carts resulting in the potential for unauthorized access to medication storage areas.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program, resulting in gnats in R87's room and throughout the facility.

Inspectors wroteBased upon interview and record review, the facility failed to complete/document the 12-hour annual in-service training requirement for eight of eight Certified Nurse Assistant's (CNA) (CNAs N, Q, T, LL, MM, OO, PP and RR) reviewed for required training resulting in the potential for staff being unaware of best practice guidelines when caring for residents and provision of inadequate resident care.

Inspectors wroteBased on interview and record review the facility failed to ensure visitation rights for one resident (R601) of one resident reviewed for visitation rights.

Inspectors wroteThis citation pertains to intake #MI00138924. Based on interview and record review the facility failed to ensure personal funds were readily accessible for one resident (R11), of one resident reviewed for personal funds resulting in the resident expressing anger and frustration of not having control over their personal funds.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an environment free from physical restraints for one resident, (R70) of one resident reviewed for restraints resulting in the likelihood for physical discomfort and psychosocial distress utilizing the reasonable person concept. R70 was originally admitted on [DATE] from another skilled nursing facility for long term care. R70's admitting diagnoses included: protein calorie malnutrition, dementia, contracture of both knees, history of falls and suicidal ideations. Based on the Minimum Data Set (MDS) assessment dated [DATE], R70 had Brief Interview for Mental Status (BIMS) score of 3/15, indicative of severe cognitive impairment. R70 needed 2-person assistance with their mobility/repositioning in bed, 1-person assist with eating, and 2-person assist for transfers to their Geri (recliner with wheels) chair. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure allegations of abuse and injuries of unknown origin were reported to the State Agency in a timely manner for four residents (R2, R22, R37 and R44) of 31 residents reviewed for abuse/neglect/mistreatment.

Inspectors wroteThis citation pertains to intake #'s #MI00139436 Based on interview and record review the facility failed to document an involuntary discharge, notify the ombudsman and allow the resident to stay at the facility through the appeals process for one (R503) of one residents reviewed for involuntary discharge.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure a comprehensive plan of care was revised and modified to reflect a resident centered and individualized behavior plan of care for one (R57) of ten residents reviewed for accidents/supervision.

Inspectors wroteThis citation pertains to intake #'s MI00142029 and MI00142062 Based on observation, interview and record review the facility failed to ensure appropriate Nursing standards were utilized for two residents (R28 and R38) of two residents reviewed for Medication administration.

Inspectors wroteThis citation pertains to intake #'s MI00139621 and MI00142062. Based on observation, interview, and record review, the facility failed to ensure activities of daily living (ADLs) showers and baths were provided to one (R18) of five Residents reviewed for ADL care with potential for negative physical, psychosocial outcomes, and loss of dignity for residents who are dependent on staff for assistance.

Inspectors wroteThere are two deficient practices. Deficient Practice Statement #1 This citation pertains to intake #'s MI00142170 and MI00142532. Based on interview and record review the facility failed to address a change in condition timely for one resident (R502) of one resident reviewed for a change in condition resulting in a delay of acute care treatment.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that resident weights were obtained timely and nutritional interventions by the dietician were implemented timely for two (R70 and R82) of seven residents reviewed for nutrition resulting in the potential for weight loss with decline in nutritional and overall functional status.

Inspectors wroteBased on observation, interview, and record review facility failed to appropriately position the resident while administering the enteral tube feeding (liquid nourishment and water administered directly into the stomach through a PEG [Percutaneous Endoscopic Gastrostomy] tube) for one (R4) of two residents reviewed for tube feeding resulting in the potential of aspiration pneumonia, respiratory distress and rehospitalization.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement a resident centered care plan regarding dialysis care and failed to ensure consistent ongoing communication with the dialysis entity for one (R6) of one resident reviewed for dialysis.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure irregularities identified by the pharmacist was reviewed by the physician for two (R's 25 & 20) of five residents reviewed for the pharmacist drug regimen review.

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate administration and indication for use of an antibiotic medication for one resident (R21) of five residents reviewed for unnecessary medication resulting in the potential for adverse side effects and antibiotic resistance.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain a medication error rate of less than five percent. Six medication errors were observed from a total of 29 opportunities for four out of five residents (R38, R69, R82, R62) resulting in an error rate of 20.69%.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide timely laboratory services as ordered by the physician for one (R18) of one resident reviewed for laboratory services.

Inspectors wroteBased on interview and record review, the facility failed to implement their policy and ensure accurate education, tracking and administration of the pneumococcal vaccine for one (R38) of five residents reviewed for the pneumococcal vaccination.