Myers Nursing & Convalescent Center

Inspectors wroteBased on observation, interview and record review, the facility failed to prevent physical abuse for two sampled residents (Resident #1 and Resident #2) out of four sampled residents. On 5/25/26 Resident #1 hit Resident #2 on the head. Resident #2 struck Resident #1 with an aluminum cane, the cane broke and resulted in Resident #2 having an approximately 2-inch pink, unbroken area on his/her left upper thigh. The facility census was 84 residents. The Administrator was notified on 6/2/26 of the past noncompliance which began on 5/25/26. The facility immediately completed education for staff for Abuse and Neglect. Resident care plans were updated. Both residents had medical and psychological evaluations. Resident #2's anxiety medication was increased. Resident #1 moved to a new facility. The deficiency was corrected on 5/26/26. [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain the cleanliness in the kitchen there was dust build up on the overhead piping systems and exit sign that were over the preparation serving area, dust built up on the two big blue and black fans, the floor and wall behind the gray grease trap box under the three compartment sink had dirt and debris, the stove knobs that turn the burners on had residue built up on them, and the walk-in cooler had dust on the fan and there was debris on the floors. The floors under the refrigerators, eye was station, and stove had missing tiles and needed to be repaired. [...]

Inspectors wroteBased on observation and interview, the facility failed to do the following: maintain a fan in the activity area free from a heavy buildup of dust; failed to maintain one ceiling tile free of a black colored stain; failed to maintain the climate control unit in North resident room [ROOM NUMBER]-6 free from a dust buildup; failed to maintain the light fixture in North resident room free from a buildup of debris on the fixture; failed to maintain the handles of a shower chair in the North east Shower Room free from cracks which rendered those handles not easily cleanable; failed to maintain the ceiling vent in the restroom of resident room [ROOM NUMBER]-40, from a heavy buildup of dust; failed to maintain two sprinkler heads in the dining room free from a dust; failed to maintain a stand -up lift in the South [NAME] shower room free from a buildup of grime; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to properly store respiratory continuous positive airway pressure (C-PAP is a machine that uses mild air pressure to keep breathing airways open while you sleep) mask when not in use for one sampled resident (Resident #13) and failed to ensure oxygen equipment, nasal cannulas nasal cannula (a device used to deliver supplemental oxygen through a plastic tube into the nose in a sanitary manner; a lightweight tube which on one end splits into two prongs which are placed in the nostrils and from which a mixture of air and oxygen flows) and tubing was kept covered when not in use for two sampled residents (Resident #45 and #72) out of 18 sampled residents. The facility census was 76 residents. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure Hospice (is a special kind of care that focuses on a person's quality of life and dignity as they near the end of their life) physician orders were obtained and documented on the physician's order sheet for four sampled residents (Resident #52, #13, #45, and #58) out of 18 sampled residents. The facility census was 76 residents. Review of the facility's policy for Physician Order dated 2013 showed:Purpose:-To ensure the accuracy of transcribing order.-To have physician orders transcribed from the Physician Order Sheet (POS) to the appropriate administration record. Policy:-All nursing staff must follow the policy for transcribing medication, medication management and receiving physician order. All nursing staff must be compliant with this policy. [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain the drainage sink in the North Hall Janitor's closet free from being clogged; failed to ensure that there was not a heavy buildup of dust on the ventilation fan and blades in the laundry above the dryers; failed to maintain the hopper (sinks in soiled utility rooms which are used for the disposal of liquid clinical waste) in the South side soiled linen room close to the nurse's station free from being clogged; and failed to ensure that grime was removed from the hopper in the soiled utility room next to South rooms 13-14. This practice potentially affected at least 30 residents who resided close to or use the corridors adjacent to these areas. The facility census was 76 residents.1. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure there was adequate ventilation in the following areas: North resident rooms 21-24, 25-28, 15-16, 13-14, 29-32, 33-36, 9-10, South resident rooms 37-40, 1, 13-14, the soiled utility room close to South 13-14, and South 17-18. This practice potentially affected at least 20 residents who resided in those rooms or used corridors close to those areas. The facility census was 76 residents.**Note: Air flow was tested by holding one piece of tissue paper to the ceiling vent. If the paper was drawn to the vent, then negative air flow was present; if the paper fell, then negative airflow was absent.1. Observations on 10/7/25 with the Corporate Maintenance Person and the Housekeeping Supervisor, showed:At 12:41 P.M., there was the absence of negative airflow in the ceiling vent of Resident room North 21-24. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure to obtain and transcribe a physician order for self-administration of medication and failed to ensure nursing staff documented and completed a self-administration medication assessment for the resident's ability to store medication safely at bedside and to administer medication by himself/herself, for one sampled resident (Resident #13) out of 18 sampled residents. The facility resident census of 76 residents. Review of the facility's Self-Administration of medication dated 8/16/07 showed:-All bedside medication must be approved and ordered by the resident attending physician. -Each resident who desires to self-administer their own medication will be provided education about medication with return demonstration on proper administering or are adequately trained in the techniques of the medication. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the correct code status (a medical designation that communicates a patient's wishes regarding resuscitation if their heart stops or they stop breathing) was documented on the resident physician's order sheet and was consistent throughout the resident's medical record for one sampled resident (Resident #43) out of 18 sampled residents. The facility census was 76 residents. Review of the Physician's Orders policy and procedure dated 2013, showed the purpose was to ensure the accuracy of the order and to have the physician's orders transcribed to the appropriate administration record. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the area next to the bed was clear of clutter including a siderail for one sampled resident (Resident #22) out of 18 sampled residents. The facility census was 76 residents. An Accident Hazards policy was requested but not provided by the exit date.1. Review of Resident 22's undated face sheet showed he/she admitted to the facility with diagnoses that included:-Left below knee amputation (left BKA a surgical procedure to remove the leg below the knee joint, keeping the knee intact).-Alcohol use, unspecified with intoxication.-Polyneuropathy (a disease affecting many peripheral nerves, causing symptoms like numbness, tingling, and weakness). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a physician ordered dietary supplement for weight loss was provided to one sampled resident (Resident #45) who had gradual weight loss out of 18 sampled residents. The facility census was 76 residents.1. Review of Resident #45's Face Sheet showed the resident was admitted with diagnoses including chronic obstructive pulmonary disease (COPD-a group of lung diseases that cause ongoing airflow obstruction and breathing problems) emphysema (a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to obtain and transcribe physician orders for dialysis (is a treatment used to remove waste products and excess fluid from the blood when the kidneys are not functioning properly) services to include name of dialysis clinic, days of treatment, and failed to obtain physician orders for daily monitoring of the resident's dialysis shunt site (is a surgical connection between an artery and a vein that allows for the flow of blood during dialysis treatment) to assess the thrill (a vibration) and bruit (a whooshing sound) that indicates proper blood flow of the access site and to assess for bleeding at shunt site for one sampled resident (Resident #2) out 18 sampled resident. The facility resident census of 76 residents. A policy for dialysis was requested and not received at the time of exit. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure two sampled residents (Resident #3 and Resident #5) medications were documented as administered as ordered by the physician out of 10 sampled residents. The facility census was 71 residents. Review of the facility's Medication Administration and Monitoring Policy dated 2025 showed: -To ensure quality of care delivery by instructing nursing staff to administer medications safely and appropriately. -Responsibility of nursing professional to: --Be aware of action, correct dosage and route, frequency and other considerations (pulse, blood pressure, meal) is required for administration of medications. --Notify physicians of any acute change in resident condition or status to obtain an order for holding or administering medication. --Coordinate communication between the pharmacy and the physician. [...]

Inspectors wroteBased on interview and record review, the facility failed to meet the required discharge requirements for one resident (Resident #1) out of three sampled residents. The facility census was 68 residents. Review of the facility's Protocol for Discharge Planned dated 2022 showed: -Residents who were admitted to the facility would be assessed for potentials upon admission, quarterly and whenever needed as wished or voice by the resident or facility professional staff. -The Quality Assurance (QA) committee discussed the potential discharge (immediate discharge, involuntary discharge) to investigate and analyze if the discharge was the best interest for the residents in the facility and/or for the resident who was discharged . [...]

Inspectors wroteBased on interview and record review, the facility failed to permit one sampled resident (Resident #1) to return to the facility out of three sampled residents. The facility census was 68 residents. 1. Review of Resident #1's admission Record face sheet showed he/he was admitted to the facility on [DATE] with the following diagnoses: -Anxiety disorder, (persistent and excessive worry about various aspects of life). -Depression, (a mental illness characterized by feelings of sadness, hopelessness and lack of interest or pleasure in activities once enjoyed). -Adjustment disorder, (a mental health condition characterized by emotional and behavioral symptoms in response to a stressor or group of stressors). -He/She was his/her own responsible party. Review of the resident's Care Plan dated 11/7/23 showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to have a Registered Nurse (RN) for eight consecutive hours a day for seven days a week, and failed to ensure the Director of Nursing (DON) did not serve as the charge nurse, when the facility maintained a daily census of more than 60 residents. This deficiency had the ability affect all residents. The facility census was 68 residents. Review of the facility's undated policy, titled Policy for Staffing showed: -A RN was required eight hours a day, seven days a week. -The DON was not to provide cares of treatments for residents unless the facility had 60 or less residents. 1. Review of DON's time sheet from 1/1/23-11/31/23 showed he/she did not work eight consecutive hours for 184 days out of 334 days. 2. Review of the facility's daily census showed the facility had greater than 60 residents during the survey. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure Certified Nursing Assistants (CNAs) received yearly evaluations and education based on the result of those findings. This had the potential to affect all residents. The facility census was 68 residents. A copy of the facility's CNA yearly evaluation policy was requested and not received at time of exit. 1. A request for the evaluations and education of CNAs was made to the Administrator and not received at time of exit. During an interview on 12/6/23 at 11:00 A.M., the Administrator said: -He/she did not perform staff evaluations yearly. -He/she performed evaluations only when there was a problem. During an interview on 12/8/23 at 9:28 A.M., CNA B said: -He/she had worked at the facility for two years. -He/she had never had an evaluation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staffing was posted correctly at the beginning of each shift including facility name, date, census, and the total number and actual hours worked per shift which could have the potential to affect all residents in the facility. The facility census was 68 residents. The facility's undated policy, titled Policy for Staffing showed a staffing board was required to be displayed in a public area. 1. Observation on 12/4/23 at 8:52 A.M. showed no staffing sheets posted at the front desk or either nurse station. Observation on 12/5/23 at 9:04 A.M. showed: -Staffing sheets were taped under the counter of both nurse stations, facing the staff, unable to be seen by residents or visitors. -Staffing sheets did not include the resident census or number of hours for each discipline. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow the menu for breakfast on 12/7/23, by not serving cinnamon rolls according the menu for that day. This practice potentially affected all residents who received food from the kitchen. The facility census was 68 residents. 1. Record review of the Week 2 Week-at-a-Glance Menu, dated 2023, showed the following items for breakfast: - Assorted juice. - Choice of hot or cold cereal. - Egg of choice. - Bacon. - Cinnamon Roll. - Margarine. - Milk/Beverage. Observation on 12/7/23 from 8:15 A.M. through 8:42 A.M., during the breakfast meal service showed no cinnamon rolls were served with breakfast to any resident and no substitution was served to the residents. During an interview on 12/7/23 at 8:44 A.M., Dietary Aide (DA) C said there were no cinnamon rolls to serve during the breakfast meal that morning. [...]

Inspectors wroteBased on interview and record review, the facility failed to submit accurate information to the Payroll Based Journal data (PBJ-a report that provides staffing dataset information submitted by nursing homes on a quarterly basis) for two of the last four quarters, which had the potential to affect all residents. The facility census was 68 residents. A copy of the Centers for Medicare and Medicaid (CMS) policy, dated August 2015, titled Electronic Staffing Data Submission Payroll-Based Journal showed: -Staff were required to submit accurate and timely information. -The nursing home was ultimately responsible for accuracy of each submission, even if the facility used a third party vendor to submit information on behalf of the nursing home. 1. Review of the facility's PBJ Quarter One (2023) from 10/1/22-12/31/22 showed no licensed nurse coverage 24 hours a day. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the infection control tracking and trending was completed monthly. This had the potential to affect all residents in the facility. The facility census was 68 residents. Review of the facility's policy titled Infection Control Program-Surveillance dated from 2006 showed: -A system for surveillance was designed to establish and maintain a data base which describes endemic rates of nosocomial (facility-acquired) infections. -A systematic observation on the occurrence and distribution of facility-acquired infections among the residents for the purpose of prevention and control. -The term surveillance implies that the data has been compiled to be examined and reviewed in order to determine problems that may exist within a certain environment. -The process of surveillance: --Documenting baseline rates of endemic infections. [...]

Inspectors wroteBased on observation and interview, the facility failed to remove a buildup of dust from the ceiling tiles and ceiling vents in the north section of the dining room; to remove a buildup of dust from the ceiling vent in the North Hall shower room; to maintain a fan in resident room North Hall 21-24 free of a buildup of dust; and to remove a buildup of dust on the sprinkler head in North 19-20. This practice potentially affected at least 40 residents who used or resided in those areas. The facility census was 68 residents. 1. Observation on 12/5/23 at 10:31 A.M., with the Maintenance Director and the Regional Maintenance Director showed the presence of dust on the ceiling tiles and around the ceiling vents in the north section of the dining room. During an interview on 12/5/23 at 10:33 A.M. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure staff were aware of which employees were certified in cardiopulmonary resuscitation (CPR-a lifesaving technique useful in many emergencies, in which someone's breathing or heartbeat has stopped). This had the potential to affect all residents who required CPR. The facility census was 68 residents. A policy regarding staff CPR certification and staff scheduling was requested and not received at time of exit. 1. During an interview on [DATE] at 10:50 A.M., Certified Nursing Assistant (CNA) D said: -He/she was unsure what staff were CPR certified. -He/she did not know how he/she would know who was CPR certified. During an interview on [DATE] at 10:52 A.M., CNA A said: -He/she knew the people that attended CPR training with him/her were certified. -The facility did not have a list of what staff was certified. [...]

Inspectors wrote4. Review of Resident #9's Face Sheet showed he/she was admitted on [DATE], with diagnoses including Alzheimer's Disease (progressive mental deterioration due to generalized degeneration of the brain), dementia (progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change), high blood pressure, diabetes (a disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine), depression, seizure disorder (seizure is a sudden, uncontrolled burst of electrical activity in the brain) and arthritis(the swelling and tenderness of one or more joints). Review of the resident's annual MDS dated [DATE], showed the resident: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all narcotics were accounted for by not having the on-going and off-going nurses sign the Controlled Substance Log during shift change or document the amount of each medication left. This had the potential to affect all residents that received narcotics. The facility census was 68 residents. Review of the facility's policy, dated 6/9/22, titled Protocol for Managing the MAR (Medication Administration Record)/Narcotics Records showed: -At shift change, both the on-going and off-going nurse were to review the medication cards and sign out sheets. -Every pill was to be accounted for on the sign-out sheet. 1. Review of the facility's Shift Change Controlled Substance Check Sheet for November 2023 for the North Hall showed: -Missing signatures 9 out of 40 opportunities. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the medication error rate was less than 5% with a medication error rate of 8.82% which affected one sampled resident (Resident #60) and one supplemental resident (Resident #66) out of 21 sampled residents and nine supplemental residents. The facility census was 68 residents. A policy related to medication administration was requested and not received at the time of exit. Review of the facility's policy titled Insulin Administration dated from 2007 showed no policy or procedure for the use of insulin pens. 1. Review of Resident #66's admission Minimum Data Set (MDS-a federally mandated assessment tool to be used for care planning), dated 10/9/23, showed: -The resident had moderate cognitive impairment. -The resident had Diabetes Mellitus (a disease that results in too much sugar in the blood). [...]

Inspectors wroteBased on observation and interview, the facility failed to remove a buildup of dust on the baffle vents (metal devices which trap oil and grease that makes it into the kitchen's atmosphere by passing air through a series of interlocking baffles) of the range hood (an open metal enclosure over cooking surfaces through which air is drawn in from the surrounding spaces to exhaust heat and grease, and to control the flow of rising hot air into the range hood and filter grease ); to remove a buildup of dust on the walls ceiling and pipes of the kitchen including over food preparation areas; to remove food debris from the floor under the Refrigerators #1 and #2 and Freezer #2; to ensure Dietary Aide (DA) A did not handle clean dishes after handling soiled dishes without washing/his/her hands or changing gloves; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the infection control antibiotic stewardship (the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients/residents) was completed monthly. This had the potential to affect all residents in the facility. The facility census was 68 residents. A copy of the facility's policy related to antibiotic stewardship was requested and not received at the time of exit. 1. Review of the facility's infection control log dated March 2023 showed no documentation of antibiotic stewardship for that month. Review of the facility's infection control of dated October 2023 showed: -A list of two residents that were on antibiotics. -The antibiotics that each resident was on. -There was no documentation related to why the antibiotics were prescribed. [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain the fan in the laundry room free of a buildup of dust; to remove a buildup of dust from under the vending machines in the dining room; to ensure the light fixture in the North Hall shower room was installed properly; to maintain the mirror in North room [ROOM NUMBER]-24; and to maintain the light fixture in North 1-2 in good repair. This practice potentially affected 50 residents who resided on the North Hall and used the dining room. The facility census was 68 residents. 1. Observation on 12/5/23 at 10:03 A.M., with the Maintenance Director and the Regional Maintenance Director showed a buildup of dust on the fan in the laundry. During an interview on 12/5/23 at 10:03 A.M., the Regional Maintenance Director said the fan was not cleaned in the past, but the fan would be cleaned going forward. [...]

Inspectors wroteBased on observation and interview, the facility failed to prevent the existence of mice and mouse droppings in the following resident rooms: North Hall room [ROOM NUMBER]-28, North Hall room [ROOM NUMBER]-20, North Hall 13-14, North Hall room [ROOM NUMBER]-8, South room [ROOM NUMBER]-44, South room [ROOM NUMBER]-36, South room [ROOM NUMBER]-12, South room [ROOM NUMBER]-32, South room [ROOM NUMBER]-28, South room [ROOM NUMBER]--20, and South room [ROOM NUMBER]-24. This practice potentially affected 26 residents who resided in those rooms. The facility census was 68 residents. 1. Observation on 12/5/23, with the Maintenance Director and the Regional Maintenance Director, showed: - At 12:48 P.M., mouse droppings were present on the floor behind the bed in North Hall room [ROOM NUMBER]-28. - At 1:05 P.M. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure Certified Nursing Assistants (CNAs) received 12 hours of in-service education (which was to include abuse, neglect, and dementia training) per year by not being able to produce documentation for all CNAs, not providing adequate training, and not monitoring what education CNAs had received. This had to potential to affect all residents. The facility census was 68 residents. Review of the facility's undated policy titled Abuse/Neglect Training and Orientation showed: -All current and newly hired employees were to be in-serviced with the Abuse/Neglect Hot Topic In-Service recommended by the Department of Aging and the pages in the CNA Course Manual currently used by the state. -Employees were to receive training upon hire and a minimum of twice a year. -Copies were to be placed in the employee's file. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a call light was within reach for two sampled residents (Resident #41 and #15) out of 21 sampled residents. The facility census was 68 residents. Review of the facility's policy, dated 2/21/12, titled Answering of Call Lights and Alarms showed the policy did not address resident access to call lights. 1. Review of Resident #41's Quarterly Minimum Data Set (MDS-a federally mandated tool used for care planning), dated 9/15/23, showed: -The resident had moderate cognitive impairment. -The resident had a diagnosis of paraplegia (the loss of muscle function in the lower half of the body, including both legs). Review of the resident's undated care plan showed: -The resident was totally dependent on staff for dressing. -The resident required a mechanic lift for transferring. -The resident was non-weight bearing. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the emergency contact was notified of one sampled resident's transfer to the hospital when the resident had a change in condition for one closed record sample (Resident #39) out of 21 sampled residents. The facility census was 68 residents. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a Pre admission Screening and Resident Review (PASARR-a federally mandated screening process for individuals with serious mental illness and/or intellectual disability/developmental disability related diagnosis who apply or resident in Medicaid Certified beds in a nursing facility regardless of the source of payment) was completed for one supplemental Resident (Resident #4) out of 21 sampled residents and 8 supplemental residents. The facility census was 68 residents. Review of the facility's undated policy titled PASARR Policy showed: -The screening assures appropriate placement of persons known or suspected of having mental impairment(s) and also that the individual needs of mentally impaired persons can be and are being met in the appropriate placement environment. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a recapitulation of the resident's stay (describes the resident's course of treatment while at the facility) was completed for one sampled resident (Resident #72) out of 21 sampled residents. The facility census was 68 residents. A policy for Recapitulation of Stay was requested and not received at the time of exit. 1. Review of Resident #72's Face Sheet showed he/she admitted to the facility on [DATE] with the following diagnoses: -Seizures (a sudden, uncontrolled burst of electrical activity in the brain causing changes in behavior, movements, feelings, and levels of consciousness). -Hypertension (High Blood Pressure) -Obsessive Compulsive Disorder (OCD- a personality disorder characterized by excessive orderliness, perfectionism, attention to details, and need for control in relating to others). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one sampled resident (Resident #15) was bathed a minimum of twice a week to maintain adequate hygiene, out of 21 sampled residents. The facility census was 68 residents. A policy regarding bathing was requested and not received at time of exit. 1. Review of Resident #15's Discharge Assessment Minimum Data Set (MDS-a federally mandated tool used for care planning), dated 11/10/23, showed the resident was transferred to the hospital. Review of the resident's Entry Tracking Record MDS, dated [DATE], showed the resident returned from the hospital. Review of the resident's Significant Change MDS, dated [DATE], showed: -The resident was now on hospice services (end of life care). -The resident was rarely/never understood. -The resident was always incontinent of bowel and bladder. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure skin assessments were being completed and documented for one sampled resident (Resident #66) out of 21 sampled residents. The facility census was 68 residents. A facility policy on skin assessments was requested and not received at the time of exit. 1. Review of Resident #66's Face Sheet showed he/she admitted to the facility with the following diagnoses: -Hemiplegia (paralysis to one side of the body) following Unspecified Cerebrovascular (relating to the brain and its blood vessels) Disease Affecting the Right Dominant Side. -Coronary Artery Disease (CAD- plaque build-up in the wall of the arteries that supply blood to the heart) without Angina Pectoris (chest pain). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the treatments were being completed and documented for one sampled resident (Resident #12) who had a newly developed pressure ulcer (an injury to the skin and underlying tissue resulting from prolonged pressure on the skin) out of 21 sampled residents. The facility census was 68 residents. Review of the facility's undated policy titled Ulcer Documentation showed proper documentation is necessary for medical, legal, and reimbursement reasons. Review of the facility's Weekly Wound Assessment Sheet dated from 2007 showed: -The following were Nursing Interventions to be completed: --Follow the treatment order and document the wound description. --Monitor the healing process. --Support pressure relieved position and provide pressure relieved devices. -Document on the wound daily/weekly until healed. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow physician's orders for providing health shake supplements, to complete Dietary/Nutritional Assessments annually and to monitor the resident's dietary needs as needed for one sampled resident (Resident #9) who had a history of weight loss out of 21 sampled residents. The facility census was 68 residents. Review of the facility Physician's Orders policy and procedure dated 2013, showed: -Nursing was to transcribe all physician's orders to the Physician Order Sheet (POS) and note the medication, dosage, route, resident, and time. -Transcribe the order to the appropriate administration record. Requested facility dietary policy was not received at the time of exit. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a physician's order for oxygen was documented on the resident's Physician's Order Sheet (POS) that included the amount and duration oxygen should be administered, when tubing and supplies should be changed for one sampled resident (Resident #45); to ensure oxygen tubing, nasal cannula, and nebulizer (a drug delivery device used to administer medication in the form of a mist inhaled into the lungs) mouthpiece were kept covered when not in use to prevent contamination for one sampled resident (Resident #45) and one supplemental resident (Resident #32); and to monitor to ensure the humidifier bottle was kept clean and sanitary for one sampled resident (Resident #45) out of 21 sampled residents. The facility census was 68 residents. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications kept in one resident room were stored in a locked compartment; and to ensure the resident that had medication in his/her room had an order to self-administer the medication for one sampled resident (Resident #68) out of 21 sampled residents. The facility census was 68 residents. Review of the facility's policy, dated 6/5/23, titled Storage of Medication at the Resident's Bedside showed: -The physician was required to write may keep at bedside for each medication that the resident was allowed to keep in his/her room. -Staff were to ensure any medications kept at bedside were stored in a locked drawer or box to prevent other residents from having access to the medication. 1. Review of Resident #68's Face Sheet showed he/she was admitted on [DATE]. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the pureed (cooked food, usually vegetables, fruits or legumes, that has been ground, pressed, blended or sieved to the consistency of a creamy paste or liquid) chicken was processed according to the recipe on 12/4/23; to monitor the temperature of the pureed chicken to ensure the chicken was served at a temperature of 120 ºF (degrees Fahrenheit) on 12/4/23; and to follow the recipe for pureed eggs and pureed sausage on 12/7/23. This practice potentially affected one sampled resident (Resident #15) out of 21 sampled residents who had physician's orders for a pureed diet. The facility census was 68 residents. 1. Review of Resident #15's Physician's Order Sheet (POS) dated 12/23, showed a physician's order for the resident to have a diet of pureed food consistency. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one Nursing Assistant (NA) (Employee K) completed the Certified Nurse Assistant (CNA) training program within four months of his/her employment in the facility. The facility census was 66 residents. 1. During an interview on 6/6/22 at 11:37 A.M., Employee K said he/She had taken some CNA training and needs to finish. Record review of the facility staffing roster on 6/7/22 showed: -Employee K's date of hire was 5/15/20. -He/she worked on the following days: --6/1/22 day shift. --6/2/22 day shift. --6/3/22 day shift. --6/6/22 day shift. --6/7/22 day shift. Observations from 6/1/22 to 6/7/22 of Employee K showed: -He/she was going in and out of resident's rooms. -He/she would take clean briefs (underwear for incontinence) into resident's rooms. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the annual 12 hours of in-service training and staff competencies for the nursing staff including the Certified Nurse Assistant's (CNA) required 12 hours of in-service education and based on performance reviews annually. The facility census was 66 residents. Requested the facility policy for In-services and at the time of exit had not received it. 1. Record review of the facility's Facility assessment dated 2022 showed: -To determine what resources were necessary to care for residents competently during both day-to-day operations and emergencies. -The Assessment helped to make the decisions about the facility's capacity and needs to provide services to residents, including the staff competencies (specific training). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to keep the kitchen, Dry Storage, and walk-in refrigerator floors clean; failed to retain operable thermometers in all refrigerators/freezers to confirm adequate temperature ranges; failed to maintain sanitary utensils and food preparation equipment; and failed to keep trash and garbage receptacles lidded. These deficient practices potentially affected all residents, visitors, volunteers, or staff who ate food from the kitchen. The facility's census was 66 residents with a licensed capacity for 84 residents. 1. Observations during the initial kitchen inspection on 6/1/22 between 9:00 A.M. and 11:56 A.M. showed the following: -The walk-in refrigerator off the Dry Storage room had onion peels, dried food debris, and a bread wrapper clip on the floor. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to meet the requirements for a comprehensive, facility-specific infection prevention and control program designed to help prevent the development and transmission of water-borne pathogens (a bacterium, virus, or other microorganism that can cause disease), including documented assessments for such an outbreak and a plan to deal with them, in accordance with Centers for Medicare and Medicaid Services (CMS) guidelines. This deficient practice had the potential to affect all residents, visitors, volunteers, and staff who reside, visit, use, or work in the facility; to ensure staff used proper hand hygiene techniques during medication pass; failed to document whether a resident had signs or symptoms of tuberculosis for one sampled resident (Resident #12) out 17 sampled residents; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow standard trash and garbage disposal practices to mitigate the presence of common household pests (for example, bed bugs, lice, roaches, ants, mosquitoes, flies/gnats, mice, and/or rats), and to maintain an effective pest control program with adequate measures to eradicate those pests when present. These deficient practices potentially affected all residents, visitors, volunteers, and staff who resided, visited, used, or worked in the facility. The facility's census was 66 residents with a licensed capacity for 84 residents. 1. Record review of the last three exterminator's invoices to the facility provided by the Corporate Maintenance Director (CMD), showed the following: -The treatment dates were 3/22/22, 4/20/22, and 5/11/22. -The invoice for 3/22/22 listed the service as Monthly Pest Control. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the residents had the ability to participate in a resident council where they would be able to express grievances and make recommendations concerning issues of resident care and life in the facility for five sampled residents (Resident's #2, #40, #45, #65 and #58) out of 17 sampled residents. This deficiency has the potential to affect all cognitively intact residents. The facility census was 66 residents. Record review of Centers for Medicare and Medicaid services (CMS) guidance for activities showed: -August 31, 2020: --Phase 1: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure resident safety by not conducting appropriate background screenings for new employees to include the checking of the Nurse Aide Registry (a data base that provides the list of eligible nursing assistants who can be employed by long-term care facilities as health workers) for possible Federal Indicators (FI) for six out of nine new employees. This practice had the potential to affect all residents, employees and visitors to the facility. The facility census was 66 residents. Record review of the facility's undated Policy on Employee Disqualification List (EDL) and Criminal Background Check (CBC) for Employees showed: -All CBC and EDL shall be completed no longer that five days prior to the first employment day. [...]

Inspectors wroteBased on interview and record review, the facility failed to reassess the effectiveness of interventions, review and revise the resident's care plan with input from the resident or resident representative for three sampled residents (Resident's #45, #2, and #13) out of 17 sampled residents. The facility census was 66 residents. 1. Record review of Resident #45's face sheet, dated 9/13/21, showed: -The resident was admitted to the facility on [DATE]. -The resident had a legal Guardian. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident's medications had a documented diagnosis or symptom on the Physician's Order Sheet (POS) for each medication for two sampled residents (Resident's #58 and #13) and to ensure one sampled resident (Resident #64) had an order to keep his/her inhaler at his/her bedside and self administer the inhaler out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's policy for physician order showed: -A licensed nurse was responsible for reviewing the last month's POS, Medication Administration Records (MARs), Treatment Administration Records (TARs), physician telephone orders, etc. to the new month's documents for accuracy). -The policy did not include a requirement of having an appropriate diagnosis for each prescribed medication. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide an ongoing activity program based on a comprehensive assessment and care plan of each resident's interests for nine sampled residents (Resident's #13 #58, #41, #45, #2, #34, #56, #60, and #65) out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's Activity Policy dated 2000 showed: -Activities were any activity other than Activities of Daily Living (ADLs-dressing, grooming, bathing, eating, and toileting) that a resident pursued in order to enhance a sense of well-being. -The activity program should be revised, reviewed often and tailored to each resident's individual needs. -Activities provide increased self-esteem, pleasure, comfort, education, creativity, success and financial or emotional independence. -Activities can provide stimulation or solace. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staffing information was posted in a prominent place, readily accessible to residents and visitors of the daily resident census, or the number of nursing staff for each shift. This practice had the potential to affect residents and visitors who were inquiring about the facility staffing hours. The facility census was 66 residents. A copy of the facility staffing policy was requested. The facility provided a copy of the Facility Assessment only. Record review of the Facility assessment dated 2022 showed: -The Facility Wide Assessment helps to make decisions about the facility's capacity and needs to provide services to residents. -Resources to provide care included staffing plan and staff types. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the narcotic count sheet was signed by both the on-coming and the off-going staff; to verify the correct count of narcotics; and to ensure the narcotic count sheet was not pre signed before the end of a shift, resulting in an error in the count for one resident (Resident #53). The facility census was 66 residents. Record review of the facility Policy for Management of Schedule II medication (medications with a high potential for abuse, with use potentially leading to severe psychological or physical dependence) dated 2010 showed: -All controlled medications shall be checked and counted each shift by two licensed nurses. -The counting record shall be kept separately from other medication records. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medication refrigerators which held residents' insulin pens and stock vaccines were checked by the nursing staff to ensure the temperature was within range: to ensure the medication refrigerator was clean; to ensure the sink in the medication room was clean; to ensure staff was not pre setting medications prior to medication pass, and to ensure the medication carts were kept locked when staff were not actively working with the mediation cart and did not have direct eyesight of the cart. The facility census was 66 residents. Record review of facility's policy Medication Storage, Handling and labeling Daily Practice Standards dated 3/13 showed: -The medication room was to have been kept clean. [...]

Inspectors wroteBased on interview and record review, the facility failed to obtain a Durable Power of Attorney (DPOA-a person previously identified to make decisions for an individual in the event of inability to make wishes known) or have a plan in place for two cognitively impaired residents (Resident's #34 and #60) who were unable to make day to day decisions due to cognitive impairment out of 17 sampled residents. The facility census was 66 residents. 1. Record review of Resident #34's admission Record showed: -He/she was admitted on [DATE]. -He/she was listed as a Full Code (allows all interventions needed to restore breathing or heart functioning). -He/she was listed as his/her own responsible party (a person who has responsibility for all or a portion of the patient's healthcare and can include the patient, a guardian or other guarantor (responsible party)). -He/she had no contacts listed. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to investigate the missing narcotic medication Tramadol HCl(a controlled opioid used to treat moderate to severe pain in adults) for one sampled resident (Resident #53) out of 17 sampled residents. The facility census was 66 residents. Record review of the facility Policy for Management of Schedule II medication dated 2010 showed: -All controlled medications shall be checked and counted each shift by two licensed nurses. -The counting record shall be kept separately from other medication records. -The licensed nurse will count the medications with the on-coming shift licensed nurse and document on the provided sheet with both licensed signatures. -A missing or discrepancy in counting shall be notified immediately to the Director of Nursing (DON) or the Administrator. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure there were physician's orders for full side rails, that were documented as a restraint (a device or other means of limiting movement) on both sides of the bed and per facility policy, to have a nurse or physical therapist re-assess when the resident could no longer assist with bed mobility and the continued use of full side rails on both sides of the bed for two sampled residents (Resident's #41 and #23) out of 17 sampled residents. The facility census was 66 residents. Record review of facility's physical restraint policy dated 2007 showed: -If a restricted device is needed to enhance resident mobility and serve as an enabler, for positioning and/or supporting posture, an evaluation shall be completed by a licensed nurse. [...]

Inspectors wroteBased on interview and record review, the facility failed to send a transfer/discharge notice in writing to one sampled resident (Resident #50) or his/her family when he/she was transferred to the hospital out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's undated policy, Transfer/Discharge, showed: -A transfer or discharge from the facility would take place when the transfer was necessary to meet the resident's welfare the and resident's welfare could not be met in the facility. -The resident was given the reason for transfer and the effective date of transfer. -If known, the family member, surrogate, or legal representative would be notified. -A written notice of transfer was made so as to allow appropriate arrangement. [...]

Inspectors wroteBased on interview and record review, the facility failed to send a bed hold policy in writing to one sampled resident (Resident #50) or his/her family when he/she was transferred to the hospital out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's policy, Bed-hold and readmission dated 2018 showed: -At the time of a transfer of a resident for hospitalization the facility would provide to the resident and a family member or legal representative written notice which specifies the duration of the bed-hold policy. 1. Record review of Resident #50's face sheet showed he/she was admitted on [DATE] and was his/her own person had the following diagnoses: -Polyosteoarthritis (a joint disease involving at lest five joints). -History of traumatic fracture (broken bones caused by impact or falls). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the accuracy of the Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff and used for care planning) for two sampled residents (Residents #41 and #58) out of 17 sampled residents. The facility census was 66 residents. 1. Record review of Resident #41's care plan last reviewed 1/17/22 showed he/she had side rail restraints (any manual method or physical or mechanical device, material or equipment attached to or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or normal access to one's body) for movement assistance and fall prevention. Record review of the resident's quarterly MDS dated [DATE] showed two side rail restraints were used daily and the resident was totally dependent upon staff for bed mobility. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure current orders were documented on the Physician Order Sheet (POS) and Medication Administration Record (MAR) and to clarify orders with the physician after the Pharmacists review/recommendation for one sampled resident (Resident #14); and to administer pain medication as ordered for one sampled resident (Resident #53) out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's Policy for Physician Order dated 2013 showed: -To ensure the accuracy of transcribing an order. -To have physician orders transcribed from the POS to the appropriate administration record. -The POS will be reviewed by a licensed nurse monthly during the changeover (assuring all orders are correct on the POS for the following month) to capture all information for the next month. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one sampled resident (Resident #41) was provided with staff supervision, a smoking apron and assistance while smoking out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's smoking policy dated 2018 showed: -Smoking was permitted under the supervision of facility staff only in the designated smoking areas in the building, where posted, and during designated smoking times for those residents that exhibit risk behaviors. -Residents who were with physical limitation should be assessed for safely smoking with or without assistance and monitor. -Safe smoking ability is completed yearly or on quarterly assessment and when the resident has a change in condition to ensure the resident's smoking ability to be safe. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure non-pharmacological interventions were documented as used prior to pain medications being documented as given for one sampled resident (Resident #55) out of 17 sampled residents. The facility census was 66 residents. Record Review of the facility Pain Assessment Policy dated 2013 showed: -Nursing staff were responsible for pain management. -Pharmacological management included the scheduled pain medication and as needed (PRN) pain medication. -Non-Pharmacological interventions included activities, massage, soft pillow or mattress, relaxation, and breathing techniques. -Staff were to complete pain assessments. -Staff were to review pain medications and contact the physician if the resident continued to complain of pain. -Staff were to provide non-pharmacological techniques to help alleviate pain. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one sampled resident (Resident #40) was provided with lab services and was able to have his/her labs drawn twice a week in order to maintain a therapeutic level of Coumadin (an anticoagulant (blood thinner) used to treat or prevent blood clots) and to notify the resident's physician regarding the resident's labs and to ensure one sampled resident's (Resident #14) order for Lorazepam (Ativan-a controlled medication used to treat anxiety) was transcribed from the April 2022 monthly Physician Order Summary (POS) to the May and June POS and the Medication Administration Record (MAR) or have a discontinued order written out of 17 sampled residents. The facility census was 66 residents. Record review of the facility's laboratory services policy dated 12/2/04 showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to fully develop and implement their COVID-19 vaccination policy when they failed to ensure all required components were included in the policy. The policy did not include a process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19 for all staff who are not fully vaccinated for COVID-19. The facility census was 66 residents. Record review of the facility's Mandatory Vaccination Policy dated 11/8/21 showed: -Centers for Medicare and Medicaid Services (CMS) is requiring workers at health care facilities participating in Medicare or Medicaid to have received the necessary shots to be fully vaccinated by January 4. -All employees are required to be fully vaccinated as a term and condition of employment. [...]