Mirabella

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a foam pressure offloading dressing was consistently applied and changed per physician order to prevent pressure injury/pressure ulcer (PI/PU - localized damage to the skin and/or underlying soft tissue usually over a bony prominence as a result of intense and/or prolonged pressure), and to consistently complete weekly skin assessments for 1 of 3 residents (Resident 1), reviewed for PI/PU. Resident 1 experienced harm when they developed an unstageable pressure ulcer (injury occurs when the extent of tissue damage is obscured when slough [dead tissue forms over a wound] or eschar [a thick, dry, leathery layer of dead tissue that forms over a deep wound] on their left heel that required debridement by a wound care specialist. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure pharmacy services were provided to meet the needs of 1 of 4 residents (Resident 1), reviewed for medication administration. The failure to administer and/or document medication administration in accordance with professional standards of practice placed the resident at risk of negative outcomes and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food items were handled appropriately in accordance with professional standards of food safety for 1 of 1 Freezer (Kitchenette Freezer), 2 of 2 seasoning shelves (Kitchenette Seasoning Shelf & Spices in Process Shelf on the 9th floor) and 1 of 1 dry storage room (Dry Storage Room on the 9th Floor), reviewed for food services. The failure to date and discard expired food items placed the residents at risk for food borne illness (caused by the ingestion of contaminated food or beverages), cross contamination, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the daily nurse staffing form was accurately completed and posted with actual hours worked after the start of each shift for 4 of 4 days (06/24/2025, 06/25/2025, 06/26/2025 & 06/27/2025), reviewed for sufficient and competent staffing. This failure placed the residents and their representatives at risk of not being fully informed of current staffing levels, potentially affecting their understanding of staff availability and care delivery. Findings Included . Review of the facility's policy titled, Postings - Required for SNF [Skilled Nursing Facility], dated March 2025, showed, It is the policy of the Company to post information according to state specific and federal guidelines for Skilled nursing. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure Enhanced Barrier Precautions (EBP-precaution to protect residents from Multidrug-Resistant Organism [a germ that is resistant to medications that treat infections]) practices were followed for 1 of 5 residents (Resident 137), and failed to disinfect/sanitize medical equipment between resident use for 2 of 3 staff (Staff E & Saff F), reviewed for infection control. These failures placed the residents, staff, and visitors at an increased risk of infection and related complications.

Inspectors wroteRESIDENT 20 Review of a face sheet printed on 06/27/2025 showed that Resident 20 was admitted to the facility on [DATE]. Review of Resident 20's EHR on 06/26/2025 showed there was no copy of an Advance Directive or documentation that the resident was asked for or offered assistance in completing one. In an interview on 06/26/2025 at 3:32 PM, Resident 20 stated that they had a copy of their Advance Directive at home, and that the facility staff did not request a copy. A joint record review and interview on 06/26/2025 at 3:48 PM with Staff C, showed that there was no documentation in the EHR that an Advance Directive was requested, offered, or obtained. Staff C stated that it should have been requested during admission. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure timely reporting of an injury of unknown source to the State Agency for 1 of 1 resident (Resident 15), reviewed for abuse/neglect reporting. This failure placed the resident at risk for potential unidentified and ongoing abuse and lack of protection from abuse.

Inspectors wroteBased on interview and record review, the facility failed to accurately assess 1 of 3 residents (Resident 36), reviewed for closed records. The failure to ensure resident assessments were completed accurately on the Minimum Data Set (MDS-an assessment tool) regarding discharge status placed the resident at risk for unidentified and/or unmet care needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure Level II Preadmission Screening and Resident Review (PASARR-an assessment used to identify people referred to nursing facilities with Serious Mental Illness [SMI], Intellectual Disabilities [ID]; or Related Conditions are not inappropriately placed in nursing homes for long-term care) referral was made for 1 of 5 residents (Resident 23), reviewed for PASARR screening. This failure placed the resident at risk of not receiving the care and services appropriate for their needs.

Inspectors wroteBased on interview and record review, the facility failed to facilitate quarterly care conferences or care plan meetings for 1 of 13 residents (Resident 6), reviewed for care planning. This failure placed the residents at risk for unidentified and unmet care needs, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper labeling and storage of respiratory equipment were followed for 1 of 3 residents (Resident 237), reviewed for respiratory care. This failure placed the resident at risk for respiratory infections, related complications, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure assessment and care plan were in place for side rail use, and/or inform the resident and/or their representative the risks and benefits prior to side rail use/installation for 1 of 4 residents (Resident 9), reviewed for side rails. This failure placed a resident at risk for entrapment, injury, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure Medication Regimen Review (MRR- a comprehensive assessment of resident's medications, performed by a pharmacist [a qualified professional to provide expert advice on medication management, safety, and regulatory compliance] to identify and address potential problems) was completed for 1 of 5 residents (Resident 1), reviewed for unnecessary medications. This failure placed the resident at risk of receiving unnecessary medications and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were properly labeled with open date in accordance with current accepted professional standards for 1 of 2 medication carts (Health Center 2 [HC 2]), reviewed for medication storage and labeling. This failure placed the residents at risk for receiving compromised or ineffective medications, unsafe medication administration, and potential adverse side effects.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure bed controls were in a safe operating condition for 1 of 4 residents (Resident 6), reviewed for environment. This failure placed the resident at risk for injury and a decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure the facility assessment (document describing resident population and needs to determine staff and other resources necessary to competently care for residents) was updated to include and consider specific staffing needs for each resident unit/each shift and plans to maximize direct care staff recruitment and retention. This failure placed the residents at risk for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide adequate supervision to prevent avoidable accidents during mechanical lift transfers for 1 of 2 residents (Residents 1), reviewed for falls. Resident 1 experienced harm from an avoidable fall when left unsupervised on edge of their wheelchair after staff attempted applying a mechanical lift sling under the resident, subsequently falling out of their wheelchair and sustained a broken tibia (shin bone fracture) requiring a transfer to the emergency room (ER). This failure placed all residents at risk for avoidable falls, physical injuries, functional decline, and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to conduct a thorough investigation for 1 of 2 residents (Resident 1), reviewed for abuse and/or neglect investigations. This failure placed the residents at risk for repeated incidents, unidentified abuse and/or neglect, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to obtain registry verification to ensure staff met competency evaluation requirements before allowing to serve as a nurse aide for 2 of 3 staff (Staff F and Staff G), reviewed for nursing aide registry. This failure placed the residents at risk for potential abuse, neglect and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to implement abuse and neglect policies and procedures to protect residents from misappropriation of property during the investigation of allegation for 1 of 3 residents (Resident 1), reviewed for abuse investigation. This failure placed the resident at risk for unidentified misappropriation/exploitation and lack of protection from abuse.

Inspectors wroteBased on interview and record review, the facility failed to ensure allegation of misappropriation of property was reported timely to the State Agency for 1 of 3 residents (Residents 1), reviewed for abuse allegation. This failure placed the residents at risk for potential unidentified misappropriation/exploitation and lack of protection from abuse.

Inspectors wroteBased on interview and record review, the facility failed to timely initiate and/or thoroughly investigate allegation of misappropriation of property for 1 of 3 residents (Resident 1), reviewed for abuse investigation. This failure placed the residents at risk for potential unidentified misappropriation and lack of protection from abuse.

Inspectors wroteBased on interview and record review, the facility failed to ensure 4 of 5 residents (Residents 20, 12, 10, & 21), had a completed and an accurate Preadmission Screening Resident Review (PASRR) (an assessment used to identify people referred to nursing facilities with Serious Mental Illness (SMI), intellectual disabilities; or related conditions are not inappropriately placed in nursing homes for long term care) on admission. This failure placed these residents at risk for unmet care needs, unmet mental needs, and a decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to develop person-centered comprehensive care plans for 5 of 11 residents (Residents 230, 4, 19, 21, & 20) whose care plans were reviewed. The facility's failure to develop individualized, comprehensive care plans left residents at risk for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure necessary respiratory care and services were provided in accordance with professional standards of practice for 3 of 3 residents (Residents 5, 19, & 230), reviewed for respiratory care. Specifically, oxygen (O2) equipment was not maintained to include care of O2 tubing and nasal cannula (flexible tubing that sits inside the nostrils and delivers O2) and did not have signage for when oxygen was in use. This failure had the potential to affect the resident's respiratory status, including respiratory infections and related complications and the potential to create a hazardous environment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain the medication room refrigerator temperature logs in 1 of 3 medication room refrigerators (Medicine Refrigerator) reviewed for medication storage and labeling. This failure placed the residents at risk for receiving compromised or ineffective medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to keep the kitchen refrigerator and storage free of expired food and staff failed to demonstrate handwashing while preparing lunch for all residents. These failures placed all residents at risk for a food borne illness by potentially serving expired food products and cross contamination from poor hand hygiene during food preparation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the facility's water management program included a flow diagram to assess or monitor the potential growth of legionella (a water-borne bacteria that can cause pneumonia [a lung infection]) or other waterborne pathogens (an organism that can cause disease), and to review infection prevention and control policy (IPCP) at least annually. Additionally, the facility failed to ensure proper hand hygiene practices were followed during room tray and activity flyer delivery for 2 of 6 staff (Staff H & I) and failed to put isolation precautions for Aerosolizing Generating Procedure (AGP-a medical procedure that produce minute particles that become suspended in the air) for 1 of 2 residents (Resident 4), reviewed for infection control. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure informed consent for psychotropic medication (a drug that affects behavior, mood, thoughts, or perception) was completed prior to administration for 2 of 5 residents (Residents 15 & 20), reviewed for unnecessary medications. This failure placed the residents and/or their representatives at risk of not being fully informed of the risks and benefits before making decisions about medications prior to administration.

Inspectors wroteBased on interview and record review, the facility failed to ensure an advance directive (a written instruction, such as a living will or Durable Power of Attorney [DPOA] for health care) was obtained from the resident and/or their representative and ensure a copy was readily available in the medical records for 2 of 3 residents (Residents 4 & 21), reviewed for advance directives. This failure placed the resident and/or their representative at risk for losing their right to have their preferences honored to receive care according to their choice.

Inspectors wroteBased on interview and record review, the facility failed to issue Notification of Medicare Non-Coverage (NOMNC- a required form notifying the resident that their skilled services coverage was ending and would no longer be covered by their Medicare A benefits) at least two calendar days before the Medicare coverage ended for 1 of 3 residents (Resident 331), reviewed for beneficiary notification. This failure placed the resident and/or their representative at risk for not being fully informed and losing their right to an appeals process.

Inspectors wroteBased on interview and record review, the facility failed to provide a written transfer/discharge notice to the residents/representatives and to the Office of the State Long-Term Care Ombudsman (an advocacy group for residents in a nursing home) for 2 of 3 residents (Residents 230 & 10), reviewed for hospitalization. These failures placed the residents at risk for not having an opportunity to make informed decision about transfers/discharges.

Inspectors wroteBased on interview and record review, the facility failed to ensure bed hold (the opportunity to pay for the bed the resident currently occupied while out of the facility in order to ensure their bed/room was available when they are ready to return) notices were offered to residents who were hospitalized for 2 of 3 residents (Residents 230 & 10), reviewed for hospitalization. The failure to offer bed holds placed residents at risk for unwanted, avoidable room changes upon readmission, and frustration.

Inspectors wroteBased on interview and record review, the facility failed to accurately assess 1 of 3 residents (Resident 28) reviewed for hospitalization. The failure to ensure accurate assessment regarding discharge status resulted in inaccurate information in the resident's clinical record and placed the resident at risk for unidentified care needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure appropriate treatment and services related to gastrostomy tube (G-tube - a medical device used to provide nutrients through a tube directly into the stomach) were followed for 1 of 1 resident (Resident 21), reviewed for tube feeding management. The failure to check for G-tube placement by visual inspection of aspirated stomach content prior to medication administration placed the resident at risk for medical complications and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to conduct routine maintenance to ensure side rails were safe to use for 1 of 6 residents (Resident 4) reviewed for accident hazards. This failure placed the residents at risk for injury and/or entrapment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure foods stored in 2 of 3 freezers were labeled/dated with use by date and food products discarded on or before the use by date. These failures placed the residents at risk for food borne illnesses (an illness caused by the ingestion of contaminated food or beverages) and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services in a manner that maintained and promoted dignity while dining for 2 of 3 Residents (Residents 18 & 24) and failed to remove mechanical lift (Hoyer lift - a device used to assist with transfers and support mobility) slings from underneath the residents for 3 of 3 residents (Resident 13, 18 & 24) reviewed for dining. The failure to provide a dignified experience during dining placed the residents at risk of diminished self-worth and over-all well-being.

Inspectors wroteBased on observation, interview and record review, the facility failed to inform the resident and/or their designated representatives before administering psychotropic (mind altering) medications for 2 of 7 residents (Residents 16 & 18) reviewed for unnecessary medications. In addition, the facility failed to inform the residents and/or their representatives before the use of reclining wheelchair and bed/chair alarms for 2 of 2 residents (Resident 18 & 23) reviewed for assistive devices. These failures placed the residents and/or their representatives at risk of not being fully informed of the risks and benefits before making decisions about their medications and the appropriate use of assistive devices.

Inspectors wroteBased on interview and record review, the failed to conduct a timely significant change in status Minimum Data Set (MDS) assessment for 2 out of 3 residents (Residents 18 & 21) reviewed for significant change in status assessment. The failure to complete a significant change in status assessment within 14 days placed the residents at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to accurately assess 3 of 15 residents (Residents 22,16, and 31) reviewed for Minimum Data Set (MDS) assessment. The failure to ensure accurate assessments regarding alarms and diagnosis placed the residents at risks for unidentified or unmet care needs and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to develop a baseline care plan and/or provide written summary of the baseline care plan to the residents and/or their representatives within 48 hours of admission for 3 of 3 residents (Residents 182, 10 and 332) reviewed for baseline care plans. This failure placed newly admitted residents at risk of not receiving necessary care and services, not being informed of their initial plan for delivery of care and services, and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop a comprehensive care plan (CP) for 3 of 15 residents (Residents 23, 18 and 22) reviewed for comprehensive CPs. The failure to develop CPs for residents' eating preference, use of tilt-in-space wheelchair (a type of wheelchair that can lower the seated person's head and raises their feet at the same time) and bed rails placed residents at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident-centered care and treatment were provided in accordance with professional standards of practice when facility staff failed to follow physician bowel medication orders for 1 of 3 residents (Resident 14) reviewed for constipation. This failure placed the resident at risk for discomfort or bowel impaction and a diminished quality of care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper care of suction machine (a medical device used to remove mucus/saliva secretions/blood obstruction from a person's airway) including the suction tubing and suction tip (Yankauer) for 1 of 1 resident (Resident 12) and failed to cover the Continuous Positive Airway Pressure (CPAP - a therapy that pumps air into the lungs through the nose or nose and mouth that keeps the airway open) tubing and mask when not in use and label the distilled water (a type of purified water) used for CPAP for 1 of 1 resident (Resident 21). These failures placed the residents at risk for respiratory infections and related complications.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a bed rail was placed on a resident's bed with resident knowledge, consent, education, assessment, and care plan developed to meet the needs of 1 of 4 residents (Resident 10) reviewed for bed rail use. This failure placed the resident at risk for entrapment, injury, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 6 residents (Resident 14) reviewed for unnecessary medications were free from unnecessary use of antibiotic ointment. This failure placed the resident at risk for receiving unnecessary medication and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure Gradual Dose Reduction (GDRs) for the use of psychotropic (mind altering) medications were followed for 1 of 6 residents (Resident 12) reviewed for unnecessary medications. The failure to attempt a GDR for the administration of psychotropic medications placed the resident at risk to receive unnecessary medications and/or experience adverse side effects.