Mohun Health Care Center

Inspectors wroteBased on interview and record review the facility failed to ensure resident care plans included use of hospice services. This affected one (Resident #8) out of eight residents reviewed for care plans. The facility census 62.

Inspectors wroteBased on interview and record review the facility failed to ensure physician ordered medications were administered under specified parameters, physician was notified of administration and weight changes. This affected one (Resident #1) out of seven resident records reviewed. The facility census was 62.

Inspectors wroteBased on medical record review, staff interview, and facility policy review, the facility failed to ensure antibiotic stewardship protocol was followed for the use of an antibiotic medication. This affected one (Resident #35) of one residents reviewed for the use of antibiotics. The census was 62. Findings Include: Resident #35 was admitted to the facility on [DATE]. Her diagnoses were Type II Diabetes, functional urinary incontinence, blepharitis, hypothyroidism, hyperlipidemia, vitamin D deficiency, decreased white blood cell count, anemia, dysphagia, venous insufficiency, kyphosis, anxiety disease, muscle wasting and atrophy, cognitive communication deficit, muscle weakness, depression, dorsalgia, and osteoarthritis. Review of her minimum data set (MDS) assessment, dated 01/15/26, revealed she was cognitively intact. [...]

Inspectors wrote2. Observations on a tour of the facility's kitchen on 03/31/25 between 8:35 A.M. and 8:59 A.M. revealed a red and black substance inside the white plastic backboard of ice machine which was easily removed with a cleansing towel. A crate of bananas on floor of the dry storage room. A fuzzy gray and brown substance on the walk-in refrigerator's ceiling, near the internal fans. In the walk-in freezer there were opened and undated packages of crinkle carrots. There was also an unlabeled and undated cup of a brown substance. On the freezer floor there were two crates of bread loaves, a package of fire roasted sweet potatoes and a bag of tater tots. In the walk-in freezer ceiling there were icicles present, and evidence of ice formed on one package of frozen cheese manicotti. On 03/31/25 at 8:37 A.M. [...]

Inspectors wrote5. Review of Resident #4's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses osteoarthritis, high blood pressure, and major depressive disorder. Review of Resident #4's physician orders and medication administration records revealed the resident received Clindimycin HCL, an antibiotic, prior to any dental appointments. Review of Resident #4's care plan revealed no focus areas, goals, or interventions for the antibiotic medication. Interview on 04/03/25 at 11:03 A.M. with ADON confirmed Resident #4's care plan did not reflect the antibiotic medications the resident was receiving. 3. Review of the medical record for Resident #65 revealed she was admitted to the facility on [DATE] with diagnoses that included intracranial cerebral hemorrhage, disorder of the urinary system, and need for assistance with personal care. [...]

Inspectors wroteMedical record review revealed Resident #4 was admitted to the facility on [DATE]. Diagnoses included, major depressive disorder, polyoteoarthritis and hypertension. Review of the comprehensive Minimum Data Set assessment, dated 03/25/25, revealed the resident's cognition was intact. Review of a physician order, dated 03/20/24, revealed Resident #4 was ordered Nortriptyline (an antidepressant medication) three capsules daily at bed time for neck pain. Review of the Resident #4's Medication Administration Record (MAR) revealed the resident received Nortriptyline, as ordered, beginning 03/20/24. Review of Resident #4's medical record revealed there was no monitoring the resident for depressed and withdrawn behaviors. Interview on 04/03/25 at 3:09 P.M. with LPN #50 confirmed behavior monitoring was not being tracked and/or documented for Resident 's depression and behaviors. 3. [...]

Inspectors wroteBased on observation and staff interview the facility failed to ensure medications were properly stored to ensure medications did not exceed the expiration date on stock medication supplies. This affected 28 residents living on the first and second floor. The facility census was 68.

Inspectors wroteBased on medical record review, financial record review, resident interview, staff interview, facility/resident handbook review, and facility policy review, the facility failed to ensure residents/representatives were aware and agreed to the donation of money from their resident fund accounts. This affected two (Residents #21 and #37) of five resident financial accounts reviewed. The census was 68. Findings Include: 1. Resident #21 was admitted to the facility on [DATE]. Her diagnoses were encephalopathy, Parkinson's disease, sciatica, congestive heart failure, muscle weakness, vitamin D deficiency, polyneuropathy, chronic kidney disease, GERD, hypertension, hyperlipidemia, Alzheimer's disease, hypothyroidism, dysphagia, hypokalemia, Parkinsonism, cognitive communication deficit, lack of coordination, and peripheral vascular disease. [...]

Inspectors wroteBased on medical record review, staff interview, staff attestation statements and time clock record review, the facility failed to keep an accurate medical record for one resident. This affected one resident (Resident #5) and had the potential to affect 28 residents (Resident #37, #4, #65, #29, #66, #21, #45, #47, #171, #68, #39, #55, #54, #40, #59, #53, #26, #5, #69, #33, #22, #8, #64, #58, #38, #56, and Former Residents #200 and 201) that were residing on the first and second floors of the facility on 01/9/25.

Inspectors wroteBased on medical record review and staff interview, the facility failed to have accurate Minimum Data Set (MDS) assessments for four (Resident #3, #36, #44, and #61) of 10 residents who received injectable hyperglycemic medication and for one (Residents #13) of 20 residents whose records were reviewed that required assistance for eating. The census was 67.

Inspectors wroteBased on record review and staff interview the facility failed to ensure accurate advanced directive information was present throughout the medical record. This affected one (Resident #41) of one resident reviewed for advanced directives. The facility census was 67.

Inspectors wroteBased on observation, interview and record review, the facility failed to serve food at the proper portion size to meet the nutritional needs of residents who received the alternate entrée. This affected two residents (#13 and #24) out of eleven (Residents #6, #13, #21, #24, #33, #37, #46, #51, #52, #56 and #119) who selected to receive a full portion of the alternate. The facility census was 67.