Orchards Skilled Nursing

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of 13 final sampled resident (Resident 2) remained free from accident hazards. * Resident 2's bilateral floor mats were not in place as ordered. This failure had the potential to put the resident at risk for further injury in the event of a possible fall.

Inspectors wroteBased on interview, medical record review, facility document review, and facility P&P review, the facility failed to ensure the pharmaceutical processes was followed. * The facility failed to ensure Resident 5 received a multivitamin with minerals medication as ordered by the physician. * The facility failed to ensure the incoming and outgoing licensed nurses signed the reconciled controlled medications sheet at shift change for Medication Cart A. * Resident 20's lidocaine 5% topical patch was removed as ordered by the physician. These failures had the potential to result in inaccurate controlled medication reconciliation and a delay in identifying potential drug diversion; and the potential to develop adverse outcomes to the residents due to not following medication orders.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to provide the necessary pharmaceutical services to one of five final sampled residents (Resident 13) reviewed for unnecessary medications. * The facility failed to hold Resident 13's BP medication per the physician's ordered parameters. This failure had the potential for the resident to develop significant adverse and side effects from the medication.

Inspectors wroteBased on observation, interview, facility document review, and facility P&P review, the facility failed to ensure the sanitary requirements were met in the kitchen as evidenced by: * The facility failed to ensure the kitchen utensils had smooth cleanable surface and in good condition. * The facility failed to ensure the cutting boards were kept in a sanitary condition and with cleanable surface. These failures had the potential for cross contamination and foodborne illnesses to the residents consuming the foods prepared in the facility's kitchen.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to ensure a copy of the advance directive was maintained in the medical record for one of three final sampled residents (Resident 5) reviewed for advance directives. This failure had the potential for Resident 5's decisions regarding his healthcare and treatment options to not be honored.

Inspectors wroteBased on observation, interview, medical record review, and P&P review, the facility failed to provide the necessary services to attain or maintain the highest practicable well-being for one nonsampled resident (Resident 41). * The facility failed to ensure a physician's order was obtained, a care plan was formulated, the assessment was completed, and the appropriate instructions were obtained to maintain the appropriate care of a heart monitoring machine for Resident 41. These failures had the potential for the residents to not receive the necessary care and services to maintain their highest physical well-being.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to provide the necessary respiratory care for one of 14 final sampled residents (Resident 2). * The facility failed to administer the oxygen therapy treatment as ordered by the physician for Resident 2. This failure had the potential for the resident to not receive oxygen as ordered and adequate respiratory care.

Inspectors wroteBased on observation, interview, facility document review, and facility P&P review, the facility failed to ensure the licensed nurses followed their P&P for medication administration for three of 14 final sampled residents (Residents 9, 10, and 36). * The facility failed to ensure the physician was notified when the medication, Biotene (medication spray to relieve dry mouth, tongue, and throat) was not available for Resident 9 and missed three doses on 4/5/25, and two doses on 4/6/25. The facility failed to ensure Resident 36's IV medication Ertapenem (antibiotic administered intravenously to treat serious infections) was administered on 3/12, 3/18, 3/19, and 4/16/25. * The facility failed to ensure the physician's orders for the route of medication administration for Resident 10 were accurate. The medication route was ordered to be oral instead of via the GT. [...]

Inspectors wroteBased on interview and facility document review, the facility failed to ensure the Facility Assessment addressed or included the following: 1. Active involvement of required individuals in developing the Facility Assessment; 2. A plan to maximize recruitment and retention of direct care staff; and 3. A contingency plan for staffing needs. These failures had the potential to not meet the residents' care needs if the assessed population's needs and resources were not comprehensively identified and addressed.

Inspectors wroteBased on interview, medical record review, facility document review, and facility P&P review, the facility failed to provide the necessary care and services to ensure one of 14 final sampled resident (Resident 2) attained and maintained their highest practicable well-being. * The facility failed to coordinate the care of Resident 2 with the contracted hospice. The hospice calendar did not show complete SN and HA visits were provided as per the physician's orders. Furthermore, the facility failed to ensure staff awareness of the facility's hospice designee/coordinator. These failures posed the risk of Resident 2 not receiving the necessary hospice care and services.

Inspectors wroteBased on observation, interview, medical record review, facility document review, and facility P&P review, the facility failed to implement the infection control practices designed to provide a safe and sanitary environment and help prevent the development and transmission of diseases and infections. * The facility failed to ensure the facility's monthly Infection Prevention and Control Surveillance Log was accurate. In addition, the facility failed to ensure the Surveillance Data Collection Form was complete and accurate to determine whether the resident's infection meet the McGeer's criteria for true infection. These failures posed the risk for not identifying resident infections and thereby, preventing the implementation of interventions to control the potential transmission of communicable diseases to other resident in the facility.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure the residents' medical records were safeguarded to protect the confidential health information of the residents in the facility. This failure had the potential for the residents' personal and health information to be accessed from the unauthorized users.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to ensure the medical record for one of 14 final sampled residents (Resident 7) was accurate. * The facility failed to ensure Resident 7's information on the POLST form related to the Advanced Directive was accurate. This failure had the potential for the resident's care needs not being met as their medical information was inaccurate.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure the food safety and sanitary requirements were met in the kitchen as evidenced by: * The facility failed to ensure the meat thawing process was followed. * The facility failed to ensure the expired food was discarded. * Time/Temperature Control for Safety (TCS) foods (food that required time and temperature controls to limit the growth of illness causing bacteria) were not monitored to ensure the proper cool down process was followed. * Two of two ice machines were not clean. * The facility failed to ensure hair and beard restraints were worn by dietary personnel inside the main kitchen. * The facility failed to ensure the food preparation equipment were in good condition. * The facility failed to ensure a storage container was free of a scoop. [...]

Inspectors wroteBased on observation, interview, clinical record review, and facility P&P review, the facility failed to ensure one of 13 final sampled residents (Resident 33) was accurately assessed as being capable to self-administer the medications. * Resident 33 had the nasal spray bottle left on his overbed table and self-administered the nasal spray. This failure had the potential for unsafe medication administration.

Inspectors wroteBased on interview, medical record review, and the facility P&P review, the facility failed to ensure the notification of change for one of one resident reviewed for weight loss (Resident 14). This failure resulted in a delay of Resident 14's significant weight loss being communicated to the resident's physician, responsible party, and RD, which had the potential to negatively impact the resident's well-being.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure services provided met the professional standards of care for one when LVN 4 failed to properly take a blood pressure for one nonsampled resident (Resident 543). This failure posed the risk for not obtaining accurate blood pressure reading for this resident.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to ensure the timely intervention for one of one resident reviewed for weight loss (Resident 14). This failure had the potential to result in continued nutritional decline and negative outcomes.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of one final sampled resident (Resident 26) reviewed for oxygen use was provided with the appropriate respiratory care. The facility failed to ensure Resident 26's oxygen tubing was labeled and not touching the floor. These failures had the potential to affect the respiratory health and well-being of Resident 26.

Inspectors wroteBased on observation, interview, medical record review, facility document review, and facility P&P review, the facility failed to provide the pharmaceutical services to meet the resident's needs for one of 13 final sampled residents (Resident 13). * The facility failed to ensure Resident 13's oxycodone-acetaminophen (narcotic pain medication) was accurately reconciled. The oxycodone-acetaminophen tablets removed as shown on the Controlled Drug Record was not recorded as administered on the electronic MAR. This failure had the potential for drug diversion.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure the proper disposal and storage of medications as evidenced by: * The facility failed to ensure the medications administered orally were stored separately from the externally used medications in one of two medication carts (Medication Cart A). * The facility failed to ensure the discontinued medications were properly disposed in one of one medication room (Medication Room A). In addition, the facility failed to ensure the medications administered orally were stored separately from the externally used medications in Medicaiton Room A. * The facility failed to ensure safe storage of one Theraworx Muscle Cramp (use to relieve muscle cramps and spasms) foam found at Resident 639's bedside cabinet. [...]

Inspectors wroteBased on observation, interview, facility personnel file, and facility document review, the facility failed to ensure the Food and Nutrition Services Director who was responsible to oversee the main kitchen which produced food for the skilled nursing facility was competent in managing the day-to-day functions of the food services department. The failure to employ staff with the skills and abilities to effectively implement departmental processes in accordance with standards of practice, may jeopardize the health and well-being of the 40 residents who received food prepared in the kitchen.

Inspectors wroteBased on observation, interview, and facility document review, the facility failed to ensure the resident menu was followed when the puree procedure for meat and vegetables was not followed. This failure posed the risk for an inconsistent product and to not meet the nutritional needs of the five residents who received puree diets.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to honor the food preference for one of two sampled residents (Resident 17) reviewed. This failure had the potential for inadequate nutrition.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure the P&P for the resident's food brought by the visitors was followed. * The facility failed to ensure the safe food handling guidelines were communicated to the resident's family/visitors who brought the resident food from the outside. This failure had the potential to cause foodborne illness to the residents who received food brought by the visitors.

Inspectors wroteBased on interview and record review, the facility failed to ensure the complete and accurate medical records for three of six residents reviewed for advanced directives (Residents 14, 26, and 35). * Residents 14, 26, and 35's POLST were incomplete. This failure had the potential for the resident's advanced directive status not being communicated to the health care staff in the event of an emergency for these residents.

Inspectors wroteBased on observation, interview, facility document review, and facility P&P review, the facility failed to establish and maintain the infection prevention and control program designed to provide a safe and sanitary environment to help prevent the transmission of communicable diseases and infections. * The facility failed to ensure the water management program was established and implemented to include the implementation of measures to prevent the growth of Legionella and other opportunistic pathogens; and a way to monitor the measures they had in place * The facility failed to ensure the staff changed gloves after touching the bedside table and prior to administering eye drop medications for Resident 543 * CNA 4 failed to perform hand hygiene after touching the floor mat with bare hands in Room A These failures had the potential to increase the risk for the spread of infection.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to ensure the comprehensive plan of care reflected the residents' current care needs and interventions for one of 13 final sampled residents (Resident 12). This failure had the potential to negatively impact the resident's well-being.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to ensure the comprehensive plan of care for one of one sampled resident (Resident 639) was revised to address the resident's specific care needs and interventions. This failure posed the risk for the resident to not receive the care and services required to attain or maintain their highest level of physical and mental well-being.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to store trash in a sanitary manner as evidenced by: * The facility failed to ensure the green organic trash container and one of three dumpsters were properly covered. This failure had the potential to harbor pests.