Parkside Care

Inspectors wroteBased on interview and record review, the facility failed to provide copies of medical records within two working days as required for 1 of 1 resident (Resident 1), reviewed for access to medical records. Additionally, the facility failed to ensure its medical records policy was consistent with regulations pertaining to skilled nursing facilities. This failure placed the residents and/or representative at risk of not being fully informed of services and treatments provided and violated their rights.

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify hazards and risks to ensure the Resident's environment remained free of accident hazards and the Resident received adequate supervision 1 of 3 residents (37) reviewed for falls. Resident 37, who had severely impaired cognition, required maximum assistance for Activities of Daily Living (ADLs) and identified as a high fall risk, experienced harm when four of 14 falls occurred in the facility within a timeframe of less than a month; two of the falls resulted in injury that required hospital intervention.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure, A) staff prepared, distributed and served resident food in accordance with professional standards of practice along with the maintenance of a sanitary (relating to the conditions that affect hygiene and health) kitchen environment for 1 of 1 kitchen, reviewed for food safety requirements and, B) resident foods brought in from outside sources were stored, labeled and dated with opened by and expiration dates for 1 of 1 resident refrigerator located in the kitchen, review for food safety. This failure placed residents at an increased risk for cross contamination (the harmful spread of diseases) of food borne illnesses.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide meal services in a dignified manner for 4 of 4 residents (23, 31,33 and 18) reviewed for dignity related to Residents (23, 31,33 and 18) waited an hour for lunch to be served. This failure placed the residents frustrated and embarrassed.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide assistance with activities of daily living (ADL's) related to shower/bathing for 5 of 6 residents (Residents 6, 44, 24, 31, and 18) reviewed for ADL care. This failure placed the residents at an increased risk for poor hygiene, skin breakdown, an undignified existence, infection, and pain.

Inspectors wroteBased on observation, interview and record review, the facility failed to monitor and address nutritional needs for 4 of 5 residents (Residents 5, 10, 18 and 33) reviewed for nutrition. This failure placed the residents at risk for medical complications, nutritional weight loss, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure there were enough competent nursing staff to provide care and services for 6 of 9 residents (Residents 37, 6, 24, 31, 18, and 44) as evidenced by failures related to Activities of Daily Living (ADLs) and prevention of accidents. This failure placed residents at risk of not having their needs met and potential/actual negative outcomes to their physical and mental health.

Inspectors wroteBased on interview and record review, the facility failed to complete a thorough grievance process for 1 of 3 residents (Resident 3) reviewed for grievances. This failed practice placed residents at risk for unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to protect a resident's right to be free from verbal abuse for 1 of 3 resident's (Resident 64) reviewed for abuse/neglect. This failure placed residents at risk of experiencing fear, intimidation and mental anguish.

Inspectors wroteBased on interview and record review, the facility failed to implement their abuse/neglect prohibition policy for identification of verbal abuse for 1 of 1 resident (Resident 64) reviewed for abuse. This failure placed residents at risk of unidentified abuse/neglect, potential for continued exposure to abuse and psychological harm.

Inspectors wroteBased on interview and record review, the facility failed to develop a patient-centered discharge plan by the interdisciplinary team for 1 of 2 residents (Resident 37) reviewed for discharge planning. This failure placed residents at risk for unmet discharge care needs.

Inspectors wroteBased on interview and record review, the facility failed to issue a written notice of bed hold (holding or reserving a resident's bed while the resident was absent from the facility) for 1 of 3 residents (Resident 6), or provide a written notice of a hospital transfer or discharge to the Office of the State Long-Term Care Ombudsman (a representative who helps residents in long-term care facilities, such as nursing homes and assisted living, understand and exercise their rights) for 2 of 3 residents (Residents 6 and 62) reviewed for hospitalization and discharge. This failure placed the residents at risk for lack of knowledge regarding their right to hold their bed and any monetary charges associated with the bed hold and lack of discharge needs.

Inspectors wroteBased on interview and record review the facility failed to ensure a Preadmission Screening and Resident Review (PASRR-an assessment used to identify people referred to nursing facilities with Serious Mental Illness [SMI], Intellectual Disabilities [ID]; or Related Conditions [RC] are not inappropriately placed in nursing homes for long-term care) Level I form was completed after a 30-day exempt hospital discharge (EHD-an expected stay to be less than 30 days at a nursing home) for 2 of 5 residents (Residents 1 and 10) reviewed for PASRR. This failure placed residents at risk for inappropriate nursing home placement, and/or not receiving necessary services for mental health needs.

Inspectors wroteBased on interview and record review the facility failed to ensure the nature/terms of entering into a binding arbitration agreement (an alternative means of settling disputes without a jury by trial) were explained to residents in a form and manner in which they could understand for 1 of 4 residents (Resident 64) reviewed for arbitration. This failure placed the residents at risk for a lack of understanding concerning the legal contract that had been signed/entered into and being fully informed regarding the resident's choice in the event of a dispute with the facility.

Inspectors wroteBased on interview and record review, the facility failed to implement, maintain, and enforce an effective compliance/ethics program that utilized monitoring/auditing systems designed to be effective in preventing/detecting criminal, civil, and administrative violations of the Social Security Act S 1819 (Title 42 United States Code 1395i-3, a set of laws that identifies the requirements for and assuring the quality of care in skilled nursing facilities) to promote residents quality of care for 2 of 2 staff (Staff A and Staff W) reviewed for compliance and ethics. This failure placed residents at an increased risk of negative outcomes related to care and services provided by the facility.

Inspectors wroteBased on observation and interview the facility failed to provide a safe, functional and sanitary (relating to the conditions that affect hygiene and health) Laundry room environment for 1 of 2 washing machines (WM1) and 1 of 1 drainage system (DS1), reviewed for environmental conditions. This failure placed residents and staff at an increased risk of cross-contamination (the harmful spread of diseases).

Inspectors wroteBased on interview and record review, the facility failed to provide thorough skin assessments to develop pressure offloading interventions and notify the provider timely of change in skin condition for treatment to prevent the worsening of pressure injuries (PI, localized damage to the skin and underlying soft tissue usually over a bony prominence) for 1 of 3 residents (Resident 1) reviewed for pressure injuries. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure a comprehensive person-centered care plan was followed related to transfer guidelines for 1 of 3 residents (Resident 1) reviewed for implementation of the care plan. This failure placed the resident at risk for injury and unmet care needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure proper sanitization and food handling practices in accordance with standards of practice for 1 of 1 kitchen reviewed for food safety. The failure to maintain a clean/sanitary kitchen and complete Hand Hygiene (HH, washing or sanitizing hands) as required, placed residents at risk for foodborne illnesses.

Inspectors wroteBased on interview and record review the facility failed to ensure that direct care staffing information was electronically submitted to the Centers for Medicare and Medicaid Services (CMS) for 1 of 3 quartersof 2024 reviewed for Payroll Based Journal (PBJ a mandatory report for staffing based on payroll data submission). This failure caused CMS to have inaccuraterelated to Nursing home staffing levels and the potential impact on care and services provided by direct care staff.

Inspectors wroteBased on interview and record review the facility failed to ensure management staff only attended Resident Council meetings (a group at the facility comprised of and ran by residents) with a specific invitation to attend. This failure resulted in 2 of 4 residents (Resident's 11 and 35) expressed discomfort with voicing their concerns in the presence of management staff during their Resident Council meeting. This failure placed residents who attended Resident Council meetings at risk for discomfort and fear of reprisal (an act of retaliation) if bringing up issues that concerned them.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately assess 2 of 5 residents (Residents 1 and 26), reviewed for Minimum Data Set (MDS, a standardized assessment tool used in long-term care facilities that assesses functional, medical, psychosocial, and cognitive status) accuracy. The failure to ensure accurate assessments regarding end-of-life care to guide the development of the comprehensive care plan placed the residents at risk for unmet care needs.

Inspectors wroteBased on interview and record review the facility failed to ensure residents ' Preadmission Screening and Resident Reviews ([PASARR], an assessment to ensure individuals with serious mental illness [SMI] or intellectual/developmental disabilities [ID/DD] were not inappropriately placed in nursing homes for long term care) were accurately completed prior to admission and updated when new SMIs were identified and had the required Level II (a comprehensive evaluation by the appropriate state-designated authority) referral if residents had a positive Level I (a pre-screening evaluation for identifying SMI/ID/DD) PASARR for 4 of 9 residents (Residents 12, 42, 14 and 48) reviewed for PASARR. This failure placed the residents at risk of not receiving the mental health care and services appropriate for their needs. Findings Included . [...]

Inspectors wroteBased on interviews and record review the facility failed to ensure staff followed accepted standards of clinical practice for 6 of 7 residents (Residents 16, 26, and 34) reviewed for end of life care( EOL, six months or less to live) and 3 of 6 residents (Resident's 12, 35 and 48) reviewed for Post Traumatic Stresss Disorder (PTSD, a mental health condition where someone continues to experience intense negative feelings and memories from a tramatic life event). All six residents were identified based on information provided on the Matrix (a form provided to the facility to be completed at the beginning of a Standard Re-Certification Survey to identify resident care categories) form. Residents 16, 26, and 34's medical records did not have supporting documentation to support the resident required EOL care nor were there diagnoses given by a physician. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement components of their infection prevention and control precautions for hand hygiene and glove change for 2 of 3 residents (Residents 14 and 48) reviewed during wound care treatment, and utilizing appropriate Personal Protective Equipment (PPE, clothing and equipment that is worn and used to provide protection against hazardous substances or environments) and the sanitation of blood glucose testing (a blood test that measures the level of sugar in your blood) equipment for 2 of 2 Licensed Nurses (Staff BB and Staff CC) reviewed for medication administration. These failures placed residents at an increased risk for exposure to cross contamination (harmful spread of diseases) and transmission of infectious diseases.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure 1 of 3 residents (Resident 17) reviewed for resident rights, was treated with respect and dignity. The facility developed the resident's care plan with inaccurate information which labeled the resident in a negative manner. The inaccurate information had the potential to create an environment that did not promote Resident 17's quality of life. Additionally, the facility did not identify appropriate interventions based on Resident 17's individualized care needs to ensure their right to a dignified existence.

Inspectors wroteBased on interview and record review the facility failed to fully inform the Resident Representative (RR) of benefits, options and treatment alternatives to receive hospice services (a program that gives special care to people who are near the end of life offering physical, emotional, social, and spiritual support for residents and their family) when a resident experienced a significant change in medical condition and placed on end-of life care (medical and supportive services provided for individuals nearing the end of their life due to a terminal illness or advanced age) for 1 of 6 residents (Resident 1) reviewed for resident rights. This failure prevented the resident and their representative from making an informed decision regarding their treatment alternatives.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the physical environment accommodated the individualized needs of 2 of 2 residents (Residents 32 and 12) reviewed for accommodation of needs. The failure to make needed adjustments to the resident's living space, placed the residents at risk for frustration, lack of desired independence, and injury.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure pooled resident funds had separate accounting with separate statements maintained showing deposits and withdrawals for 3 of 5 resident ' s (Resident 12, 40 and 43) reviewed for personal funds. This failure placed residents at risk of not having an accurate accounting of their personal funds held in trust.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a warm and comfortable, homelike environment for 6 of 12 residents (Residents 35, 42, 16, 13, 31, and 41) reviewed for heat and adaptive equipment maintenance. This failure placed residents at risk for unmet care needs, discomfort, and a non-homelike environment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to complete care conferences for 1 of 3 residents (Resident 1) reviewed for resident/resident representative participation in care conferences. The failure to complete care conferences and allow resident participation in planning their care placed residents at risk for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure restorative therapy services (a personalized training program to help people maintain or regain their ability to do every day tasks, like walking, dressing, and eating) were consistently implemented to prevent avoidable reduction of range of motion (ROM, how far you can move a joint in any direction) for 1 of 4 residents (Resident 35), reviewed for restorative therapy and limited ROM. This failure placed the resident at risk for loss of ROM, deconditioning, and loss of independence.

Inspectors wroteBased on interview and record review, the facility failed to ensure dialysis (the kidneys no longer function and require a mechanical process to remove waste and excess fluids from the blood stream) services met professional standards of care for 1 of 2 residents (Resident 17), reviewed for dialysis. The facility did not have an effective or coordinated process for communication between the facility and the offsite dialysis center for continuity of care. This failure placed residents receiving dialysis at risk for complications and unmet care needs.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure 1 of 3 residents (Resident 17) received cultural, competent, trauma informed care in accordance with professional standards, reviewed for trauma care. The facility failed to implement identified care plan interventions related to Resident 17's Post Traumatic Stress Disorder (PTSD, a mental health condition that develops after an extremely traumatic event). This failure placed Resident 17 at risk for re-experiencing past trauma.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free of unnecessary psychotropic medications (medications capable of affecting the mind, emotions, and behavior) for 2 of 5 residents (Residents 12 and 42) reviewed for unnecessary medications. The facility failed to consistently develop, monitor, and document specific person-centered targeted behaviors, interventions, and adverse side effects of medication. Additionally, they failed to assess for abnormal involuntary movements with the Assessment Involuntary Movement Scale (AIMS, a scale that assesses the presence and severity of abnormal movements of the face, limbs, and body in patients with tardive dyskinesia [abnormal and uncontrollable movements caused by antipsychotic medications] prior to starting a psychotropic medication and periodically thereafter). [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure medications and wound supplies were discarded when expired and labeled correctly for 1 of 1 medication storage rooms and 1 of 1 treatment storage rooms. This failure placed residents at risk for receiving expired medication and/or experiencing compromised or ineffective medications and treatments.

Inspectors wroteBased on interview and record review, the facility failed to implement key components of their immunization program regarding the pneumococcal vaccine (a vaccine that protects against pneumococcal infections that can lead pneumonia and blood infections) by not ensuring residents were thoroughly screened for the pneumococcal vaccination status on admission and were administered the pneumococcal vaccines as required per current Center for Disease Control and Prevention (CDC) and Advisory Committee on Immunization practices guidance for 2 of 5 residents (Residents 2 and 21) reviewed for immunizations. This failure placed residents at risk of exposure to contagious diseases and an increased the risk for respiratory complications.

Inspectors wroteBased on observation and interview, the facility failed to provide a safe and sanitary environment for 2 of 2 storage rooms reviewed for environment. This failure placed residents at risk of injury and potential illness from unsanitary equipment storage.

Inspectors wroteBased on interview and record review, the Governing Body failed to ensure financial systems were in place to pay facility vendors who supplied essential care, services and/or necessary supplies for the residents. The facility staff had to resort to utilizing their own funds for the vendor payments which placed the residents at risk of not having necessary supplies,care and services, and potential psychological harm and distress due to the fear of becoming displaced in the event the facility was unable to meet their basic and immediate care needs. The lack of a reliable financial system was determined to be an immediate jeopardy. On 10/15/2024, the facility was notified of an Immediate Jeopardy (IJ) at F837 §483.70(d)(1), Governing Body, when the Governing Body failed to have processes in place to ensure bills were paid in a timely manner. [...]

Inspectors wroteBased on interview and record review, the facility Administration failed to effectively, efficiently, and in accordance with acceptable standards of practice, manage its resources to ensure continued services were secured for the facility. This failure placed the residents at risk for disruptions in care and services.

Inspectors wroteBased on interview and record review, the facility failed to review and update the Facility Assessment [(FA) - an evaluation that determines the resources required to meet each resident's care and services needs] with substantial modifications for vendor services, did not include input from a member of the governing body, medical director, and residents and/or their representatives when developing the FA, and was inaccurate regarding the provision of compliance and ethics training. These failures placed the residents at risk of unidentified and/or unmet care and services.

Inspectors wroteBased on interview and record review, the facility failed to have an effective Quality Assurance/Performance Improvement (QAPI) Committee that self-identified deficient practices which led to a pattern of widespread deficiency systems issues within the facility related to the Administration, Governing Body, compliance and ethics, Facility Assessment and financial instability. The failure to utilize the facility's QAPI procedures to sustain compliance with regulations for the facility, placed residents at risk for unsafe conditions, a delay in necessary care and services, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to design, implement, maintain, and enforce a compliance and ethics program aimed at preventing and identifying criminal, civil, and administrative violations of the Social Security Act § 1819 (a set of laws that identifies the requirements for and assuring the quality of care in skilled nursing facilities), and promoting quality of care. This failure placed the residents at risk of negative outcomes related to care and services provided by the facility.

Inspectors wroteBased on interview and record review, the facility failed to return the balance of funds to the Office of Financial Recovery [(OFR) responsible for the recovery of financial, medical, social services, and food assistance overpayments from the Department of Social and Health Services clients] for 4 of 4 residents (Residents 1, 2, 3 and 4) reviewed for conveyance of personal funds. This failure placed the state department of risk for loss of funds and interest accumulated.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide behavioral health services for 1 of 3 residents (Resident 5) reviewed for behavioral health services. The failure to provide behavioral health services placed Resident 5 and other residents at risk for not receiving necessary services to meet their mental health needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent an avoidable accident by ensuring the care plan regarding transfers was followed for 1 of 2 residents (Resident 1) reviewed for accidents. The failure to safely transfer Resident 1 using two-person assist resulted in actual harm when Resident 1 sustained a skin tear to their lower left extremity [leg (LLE)] requiring evaluation and intervention by the local emergency room (ER), and later required antibiotic (medications that treat infections caused by bacteria) therapy when the skin tear became infected.

Inspectors wroteBased on observation, interview, and record review, the facility failed to effectively implement infection control interventions intended to mitigate and contain infestations of bed bugs (small insects that feed on blood) for 4 of 6 Sampled residents (Residents 1, 2, 3, and 4) reviewed for infection control and communicable disease outbreaks. This deficient practice placed all residents at risk for the spread and development of a bed bug infestation with the potential for impaired skin integrity and physical discomfort.

Inspectors wroteBased on observation, interview, and record review, the facility failed to employ sufficient and qualified staff that were adequately trained and supervised to prepare/provide and safely carry out the functions of meal preparation (food temperatures, portion sizes, and recipes) and kitchen sanitation practices (dishwasher maintenance and sanitizing buckets) for 5 of 6 kitchen staff (Staff R, S, Q, T, and U), reviewed for food service. These failures placed the residents at risk for improperly prepared meals, less than palatable meals, and risk for food borne illnesses.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide meals that were flavorful, palatable, attractive, and served at an appetizing temperature for 12 of 12 residents (Residents 4, 249, 11, 15, 5, 43, 16, 20, 2, 21, 22, and 32) reviewed for food. This failure placed the residents at risk for a diminished dining experience, dissatisfaction with meals, and a less than adequate nutritional intake leading to weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the kitchen followed proper sanitation and food handling practices for 1 of 1 kitchen reviewed for food safety. The failure to handle and prepare food in a sanitary manner, obtain and record food temperatures, refrigerator and freezer temperatures, and dishwasher water temperatures, test and record sanitation solution levels, and monitor and follow a cleaning schedule for the kitchen placed all residents at risk for food borne illness.

Inspectors wroteBased on interview and record review the facility failed to support the resident right to voice concerns nor have timely follow up regarding grievances for 8 of 8 residents (Resident 13, 21, 32, 37, 38, 39, 41 and 42) reviewed for grievances. This failure placed the residents at risk for unmet dietary needs, care needs and resolution of voiced concerns.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently offer substantial nutritional snacks in the evening for 5 of 5 residents (Residents 4, 21, 22, 32, and 200) reviewed for evening snacks. This failure placed the residents at risk for hunger and unmet nutritional needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection control practices for 1 of 1 resident (Resident 18) were implemented related to hand hygiene and glove changes between dirty and clean tasks (after touching the resident and/or the resident's environment) and 2 of 2 staff (Staff DD and EE) observed for infection control during meal tray delivery. These failures placed the residents at an increased risk for exposure to cross-contamination (harmful spread of diseases) and transmission of infectious diseases.

Inspectors wroteBased on observation and interview the facility failed maintain safe operating conditions for washing machine used for laundry of residents' personal care items and kitchen laundry for 1 of 3 washing machines (Washer 1) reviewed for laundry equipment. This failure placed the residents at risk for ineffective cleaning of laundry and cross contamination of infectious diseases.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were treated with dignity and respect for 2 of 2 residents (Resident 11 and 15) reviewed for care and services. This failure placed the residents at risk for embarrassment and low self-esteem.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents, or their representatives, were provided with quarterly personal fund statements for 1 of 2 residents (Resident 37) reviewed for trust accounts. This failure placed the residents at risk of not having an accurate accounting of their personal funds held in trust accounts by the facility and financial exploitation.

Inspectors wroteBased on interview and record review, the facility failed to ensure an active surety bond (a written agreement wherein the facility and their insurance company agree to compensate the resident for any loss of resident funds that the facility holds, safeguards, manages, and accounts for) covered an amount greater than or equal to the value of resident funds deposited in the facility's resident trust account. This failure placed 31 of 48 residents, who had trust accounts with the facility, at risk to be unable to recover their money in the event of loss of funds from their account.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had a safe, homelike environment for 9 of 12 residents (Residents 29, 7, 37, 6, 11, 22, 32, 28, and 25) reviewed for homelike environment. This failure placed the residents at risk for compromised dignity and a less than homelike living environment.

Inspectors wroteBased on interview and record review, the facility failed to implement the plan of care for 1 of 1 resident (Resident 5), reviewed for activities of daily living (ADLs). The failure to follow the plan of care intervention for transfers placed the resident at risk for injury.

Inspectors wroteBased on interview and record review, the facility failed to ensure that residents who were trauma survivors received culturally competent, trauma-informed care in accordance with professional standards of practice for 1 of 1 resident (Resident 18) reviewed for mood and behavior. The facility failed to assess and monitor, a resident with a traumatic history and diagnosis of post-traumatic stress disorder (PTSD, a disorder that develops when a person has experienced or witnessed a scary, shocking, terrifying, or dangerous event) for potential triggers that may cause re-traumatization. This failure placed the resident at risk for unidentified triggers and re-traumatization.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free of unnecessary psychotropic medications (drugs that affect brain activities associated with mental processes and behavior) for 1 of 5 residents (Residents 20) reviewed for unnecessary medications. The facility failed to monitor individualized targeted behaviors, ensure as needed (PRN) psychotropic medications were limited to 14-days or had a documented rationale for the extended use of the PRN psychotropic, nor consistently attempted non-pharmacological interventions (alternative treatment of a resident's symptoms that do not involve medications and directed toward understanding, preventing and relieving a resident's distress or loss of abilities) prior to psychotropic medication administration. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to provide prompt routine dental services for 1 of 2 resident (Resident 16) reviewed for dental services. The failure to address Resident 16's concerns around dental care needs and placed Resident 16 at increased risk for dental impairment/nutritional needs.

Inspectors wroteBased on observation and interview, the facility failed to ensure the proper disposal of trash for 1 of 1 dumpster (Dumpster 1) reviewed for outdoor refuse storage. The failure to ensure Dumpster 1 was covered with a lid placed the facility at risk of attracting bugs, rodents, and an unsanitary environment.

Inspectors wrote<Resident 44> Review of the resident's medical records showed they were admitted to the facility on [DATE] with diagnoses including fusion of the lower spine bones, UTI, and kidney stones. Review of the resident's comprehensive assessment, dated 12/24/2023, showed the resident had a moderately impaired cognition, was able to make their needs known to nursing staff, and required substantial to maximal assistance of one to two staff members for toileting hygiene (actions performed daily tasks like perineal care [cleaning of the private areas of the body], and management of an indwelling urinary catheter [IUC, a tube that drains urine from the bladder] or adjustment of clothes after going to the bathroom). Additionally, the comprehensive assessment showed the resident had an IUC and had been receiving antibiotics. [...]