Markley Rehabilitation and Healthcare Center

Inspectors wroteBased on review of clinical records, review of facility documentation, and interview with resident and staff revealed the facility failed to ensure residents received adequate supervision and assistance to prevent accidents for one of 24 resident records reviewed (Resident R10).

Inspectors wroteBased on review of facility policy, review of clinical records, and interviews with staff it was determined that the facility failed to ensure that a resident at risk for malnutrition maintained acceptable parameters of nutritional status for usual body weight or desirable body weight for one of 23 residents reviewed (Resident R11). Findings Include: Review of the facility's policy titled, Weight revised December 2022 states, It is the policy of this facility to weigh each resident on admission, then weekly for (4) four weeks, then monthly thereafter, unless otherwise ordered by physician/IDT team. The facility will utilize a consistent procedure for monitoring weights and prevent unnecessary weight loss/gain in our residents. Residents are weighed upon admission and at intervals established by the Interdisciplinary team and/or as ordered by the physician. [...]

Inspectors wroteBased on observation, interview with staff, and review of resident records and facility policy, it was determined that the facility failed to implement an infection prevention and control program in accordance with standards of professional practice for two of 23 residents reviewed (Resident R121 and R51). Review of the facility policy titled, Enhanced barrier precautions (EBPs) revised December 2024 states it is used for, Infection prevention and control interventions designed to reduce the transmission of multi-drug-resistant organisms (MDROs) during high contact resident care activities. Enhanced barrier precautions apply when resident is infected or colonized with a CDC-targeted MDRO, but does not have a wound or indwelling medical device, and does not have secretions or excretions that cannot be covered or contained; [...]

Inspectors wroteBased on review of facility policy, review of facility documentation, review of clinical records, and staff interviews it was determined the facility failed to ensure residents were free from significant medication errors for three of five residents reviewed (Resident R1, R2, and R3). Findings Include:Review of undated facility policy Administering Medications revealed medications should be administered in a safe and timely manner, and as prescribed. The individual administering the medication checks the label three times to verify the right resident, right medication, and right dosage before giving the medication. The individual administering medications should verify the resident's identity before giving the resident his/her medication. [...]

Inspectors wroteBased on review of facility policy, review of resident clinical record, observations and interviews with residents and staff, it determined that the facility did not timely update a resident's care plan to incorporate evolving clinical findings, resident preferences, and refusals of care for one of ten residents reviewed (Resident R1)

Inspectors wroteBased on observations, staff interviews, and review of facility policy, it was determined that the facility failed to ensure that all drugs and biologicals used in the facility were stored in accordance with professional standards for two of two medication carts. (carts 3a and 3b+c)

Inspectors wroteBased on review of facility policy, facility documentation, and staff interviews, it was determined that the facility failed to implement appropriate tracking and surveillance of infection for three of three months of infection surveillance data reviewed. ([DATE] through [DATE])

Inspectors wroteBased on review of facility policies, review of facility documentation, clinical record reviews and interviews with residents and staff, it was determined that the facility failed to maintain an effective antibiotic stewardship program for three of five of residents reviewed for antibiotics (Residents R53, R63, and R61).

Inspectors wroteBased on clinical record review and interviews with resident and staff, it was determined that the facility failed to accommodate a resident's preference for morning care for one of 24 resident records reviewed (Resident R9).

Inspectors wroteBased on review of facility policies, clinical record review and interviews with staff, it was determined that the facility failed to develop a baseline care plan related to antibiotics, within 48 hours of admission that includes the minimum healthcare information necessary to properly care for a resident, for one of 31 residents reviewed (Resident R53).

Inspectors wroteBased on interviews and review of clinical records and facility policy it was determined that the facility did not ensure a resident's care plan was developed to meet the care and assistants needed for dental services for one of 24 resident records reviewed (Resident R11).

Inspectors wroteBased on clinical record review, staff interview and review of facility policy, it was determined that that facility failed to provide timely assistance with activity of daily living for one of 24 residents reviewed. (Resident R9)

Inspectors wroteBased on staff interviews and review of clinical records, it was determined the facility did not ensure physicians were notified of a dental recommendation for one of 24 residents reviewed (Resident R11).

Inspectors wroteBased on review of facility policies, clinical record review and interviews with residents and staff, it was determined that the facility failed to provide dental services to meet the needs residents for one of 31 residents reviewed (Resident R112).

Inspectors wroteBased on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that residents had the capacity to understand the terms of a binding arbitration agreement for three of five residents reviewed (Resident R39).

Inspectors wroteBased on review of clinical records and interviews with staff it was determined the facility did not ensure documented communication and collaboration with one resident's hospice agency related to the resident's condition were obtained for one of 24 resident records reviewed. (Resident R2)

Inspectors wroteBased on observations, and staff and resident interviews, it was determined that the facility failed to maintain a comfortable environment for two of six nursing units observed (3rd floor common room, and Unit C). Findings Include: A tour of the facility was conducted on July 8, 2025, at approximately 9:30 a.m. and 12:30 p.m. with Nursing Home Administrator (NHA), Employee E 1 and Regional Maintenance Director, Employee E3, to monitor the temperatures of the building and resident care areas. Temperatures taken by NHA, Employee E1, on July 8, 2025, 2025, at 12:30 p.m. in the 3rd floor multipurpose room revealed temperatures reached up to 83 degrees Fahrenheit. Temperature of the room felt hot, humid, and uncomfortable. Observations on July 8, 2025, at 12:30 p.m. [...]

Inspectors wroteBased on review of facility policies, clinical records, facility documentation, and staff interviews, it was determined that the facility failed to ensure that residents were free from neglect during a mechanical lift transfer for one of seven residents reviewed (Resident R1). Findings Include: Review of facility policy titled, Abuse, Neglect, Exploitation and Misappropriation Prevention Program revised April 2021 states, Policy Statement- Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. [...]

Inspectors wroteBased on review of clinical records, interview with staff it was determined the facility did not maintain medical records according to professional standards for one of seven residents reviewed. (Resident R2). Findings Include: Review of facility policy Guidelines for Charting and Documentation with a revision date of April 2021 states, Purpose- The purpose of charting and documentation is to provide: 1. A complete account of the resident's care, treatment, response to the care, signs, symptoms, etc., and the progress of the resident's care; 2. Guidance to the physician in prescribing appropriate medications and treatments; 3. The facility, as well as other interested parties, with a tool for measuring the quality of care provided to the resident; 4. Nursing service personnel with a record of the physical and mental status of the resident; 5. [...]

Inspectors wroteBased on review of personnel records and interviews with staff, it was determined that the facility failed to ensure that nurse aides received at least 12 hours of in-service education per year as required for two of six nurse aide personnel files reviewed (Employee E3 and Employee E8). Findings Include: Review of facility employee record for nurse aide Employee E3 revealed the employee was hired on July 23, 2004. Review of Employee E3 record revealed the resident did not have a total of twelve hours of continued education for the year 2024 and 2025. Further review of the employees training record revealed Employee E3 had not had Abuse training completed since March 16, 2024. Review of nurse aide Employee E3's personnel file revealed that the employee was hired on on July 23, 2004. , as a nurse aide. [...]

Inspectors wroteBased on observations, and staff interview, it was determined that the facility failed to ensure the availbility of disposable paper towels on one of two floors. (Second floor)

Inspectors wroteBased on review of facility provided documentation and interview with staff, it was determined facility did not have evidence that alleged violations were thoroughly investigated for one of 23 residents reviewed related to fracture of left lower extremity. (Resident R27)

Inspectors wroteBased on interview with resident and staff, review of facility policy and review of clinical record, it was determined facility did not ensure that a comprehensive, resident-centered care plan was developed related to hand splint and dementia care for two out of 23 residents reviewed (Resident R85, R77)

Inspectors wroteBased on interview with staff and review of facility provided documentation, it was determined that facility did not provide adequate supervision related to transfer for one of 23 residents reviewed. (Resident R27)

Inspectors wroteBased on clinical record review and interviews with staff, it was determined that the facility did not maintain complete and accurate medical records for two of 22 clinical records reviewed related to medication regimen reviews and advanced notice of a room change. (Resident R15 and Resident R60) Findings Include: Review of Resident R15's clinical record revealed the resident was admitted to the facility on [DATE] with the following diagnoses: Huntington's disease, Cerebral Infarction, Lupus, Dysphagia, Major Depressive Disorder, Dementia, and Hypothyroidism. Review of clinical documentation for Resident R15 revealed medication regimen review pharmacy consultant progress notes from the last six months (April, May, June, July, August, and September 2024) only indicated MRR completed by pharmacist. [...]

Inspectors wroteBased on observations, review of facility policies, review of clinical record, review of facility documentation and interviews with staff, it was determined that the facility failed to ensure that one of six residents reviewed (Resident R1) remained free from neglect, which resulted in actual harm to Resident R1 who sustained an acute avulsion fracture of the tibial tuberosity (separation of the kneecap from the shin bone).

Inspectors wroteBased on observations, review of facility policy, review of resident records, review of facility documents, and interviews with staff, it was determined that the facility failed to make certain that all allegations of abuse and neglect were timely reported to the Administrator of the facility for one of six residents reviewed (Resident R1). This delay in reporting a fall incident sustained by Resident R1, resulted in actual harm to Resident R1 who experienced a delay of treatment and was diagnosed with an acute avulsion fracture of the right tibial tuberosity (separation of the kneecap from the shin bone).

Inspectors wroteBased on review of facility policies, review of facility documentation, personnel files and interviews with staff, it was determined that the facility failed to have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services to care for residents' needs and assure resident safety for two of three personnel files reviewed (Employees E7 and E8).