Majestic Care of North Vernon

Inspectors wroteBased on interview and record review, the facility failed to report a resident's allegation of abuse for 1 of 3 resident's reviewed for abuse allegations reviewed. (Resident C)

Inspectors wroteBased on observation, interview, and record review the facility failed to dispose of medications after discharge for 2 of 9 residents reviewed for pharmacy services. (Resident G and Resident H)

Inspectors wroteBased on observation, interview, and record review, the facility failed to appropriately store medications for 1 of 2 medication storage areas reviewed for Drug and Biologicals storage. (Director of Nursing Office)

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide safe water temperatures for 5 of 9 resident bathrooms and 1 of 2 common area bathrooms observed. (Rooms C 101, C 102, D 114, D 115, D 116, and Women's Visitor Restroom)

Inspectors wroteBased on observation, record review, and interview, the facility failed to meet the needs of a resident related to image acquisition by a contracted x-ray staff member. The resident's arm was improperly positioned and she cried out for 1 of 3 residents reviewed for diagnostic services. The resident's arm resulted with a fracture. (Resident B)

Inspectors wroteBased on interview, and record review, the facility failed to ensure staff treated a resident with respect and dignity for 1 of 3 residents reviewed. (Residents C)

Inspectors wrote2. The D-Hall Dining room meal service was observed on 06/08/25 at 11:51 A.M. Certified Nurse Aide (CNA) 9 pushed a chair in the dining room using her hands, touched her nose with her left hand, sat down in a chair by three residents sitting at the table nearest the kitchen door, touched her face and ear with her right hand, then served a meal tray to Resident 6. CNA 9 touched the resident's plate and napkin, unrolled the napkin, took out the silverware, removed the foil from the resident's baked potato, chopped it up with the resident's fork holding the fork in her right hand, opened the resident's sour cream packet, and squirted the sour cream on the resident's potato. The resident picked up the fork and fed herself. CNA 9 used hand sanitizer then served a tray to another resident. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow appropriate infection control guidelines during a wound dressing change, and for indwelling urinary catheter management for 4 of 21 residents reviewed for infection control. (Residents 2, 100, 101, and 15)

Inspectors wrote2. During an observation and interview, on 06/08/25 at 10:19 A.M., Resident 37 was sitting on the side of the bed in her room. There were three medication cups sitting on the resident's bedside table. One medication cup contained three small white capsules, the second one contained a large white capsule, and the third one contained a large round pill broke in half, a medium round peach colored pill, one large round pill, one medium round white pill. The resident indicated the medications were hers and the nurse had left them for her to take. No staff members were in or near the resident's room or in the hallway outside the resident's room. The clinical record was reviewed on 06/10/25 at 11:03 A.M. A Quarterly MDS assessment, dated 04/21/25, indicated the resident was cognitively intact. [...]

Inspectors wroteBased on record review and interview, the facility failed to revise a resident's care plan related to prophylactic antibiotic usage for 1 of 21 residents reviewed for care plans. (Resident 58)

Inspectors wroteBased on record review and interview, the facility failed to follow physician's orders related to hold parameters for cardiac medications for 3 of 21 residents reviewed for quality of care. (Residents 58, 15, and 7)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper placement of a urinary catheter drainage bag for a resident that received prophylactic antibiotics for Urinary Tract Infections (UTIs) for 1 of 4 residents reviewed for indwelling urinary catheters. (Resident 58)

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician's orders related to medication administartion for 1 of 21 residents reviewed for pharamcy services. (Resident 23)

Inspectors wroteBased on observation and interview, the facility failed to store medications appropriately related to outdated/undated medications for 3 of 4 medication carts observed. (A, B, and C Hall medication Carts)

Inspectors wroteBased on record review and interview, the facility failed to notify the physician of a change in condition for 1 of 3 residents reviewed for Notification of changes. (Resident B)

Inspectors wroteBased on interview and record review, the facility failed to report an allegation of verbal abuse in a timely manner for 1 of 3 residents reviewed for reporting of alleged violations. (Resident C)

Inspectors wroteBased on interview and record review, the facility failed to appropriately investigate an allegation of abuse for 1 of 3 residents reviewed for abuse. (Resident C)

Inspectors wroteBased on observation and interview, the facility failed to maintain residents' snack refrigerators related to the storage of non-food items and unlabeled food items, for 3 of 4 resident snack refrigerators reviewed. (C-Hall, A-Hall, and D-Hall snack refrigerators)

Inspectors wroteBased on observation and interview, the facility failed to provide a homelike environment related to odors for 1 of 4 Hallways reviewed. (B- Hall)

Inspectors wroteBased on interview and record review, the facility failed to prevent a resident from being physically restrained for 1 of 3 residents reviewed for restraints. (Resident B)

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent pressure ulcers that resulted in the development of Stage 3 pressure ulcers (Residents 16 and 103) and follow a physician's order (Resident 91) for 3 of 7 residents reviewed for pressure ulcers.

Inspectors wroteBased on record review, interview, and observation, the facility failed to complete Neurological Evaluations/Checks following falls for 3 of 22 residents reviewed for Quality of Care. (Residents 32, 22, and 69)

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement Care Plan interventions for 1 of 5 residents reviewed for falls in the facility. (Resident 32)

Inspectors wroteBased on observation, interview, and record review, the facility failed to administer oxygen as ordered by the physician for 1 of 2 residents reviewed for Respiratory Care. (Resident 32)

Inspectors wroteBased on observation, interview, and record review, the facility failed to appropriately follow the physician's orders related to once a day medication administration for 1 of 6 residents reviewed for pharmacy services. (Resident 98)

Inspectors wroteBased on observation and interview, the facility failed to store medication appropriately for 3 of 4 medications carts and 1 of 1 medication rooms observed. (A-Hall, B-Hall, and D-Hall medication carts and the facility medication room)

Inspectors wroteBased on observation and interview, the facility failed to maintain residents' snack refrigerators related to unlabeled items, outdated items, and the storage of non-resident food items for 2 of 3 resident snack refrigerators reviewed. (Dementia unit and C-Hall snack refrigerators)

Inspectors wroteBased on record review and interview, the facility failed to demonstrate that ongoing corrective actions were in place to address unresolved quality deficiencies related to pressure ulcers, that were previously cited on the last annual survey, for 4 of 7 residents reviewed for pressure ulcers.

Inspectors wroteBased on observation and interview, the facility failed to ensure resident rights were posted and readily accessible to 107 residents who resided in the facility.