Rambling Oaks Courtyard Extensive Care Community

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the resident had a right to confidentiality of his or her personal and medical records for six (Residents #9, #11, #12, #25, #36, and #40) of eighteen residents reviewed for privacy and confidentiality. The facility failed to ensure LVN C secured Residents #9, #11, #12, #25, #36, and #40's medical information before leaving his nurse's cart on [DATE]. This failure could place the residents at risk of not having their private and medical information exposed to unauthorized individuals.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for 8 of 20 resident rooms (room [ROOM NUMBER], #2, #3, #4, #5, #6, #7, and #8) observed for cleanliness. The facility failed to ensure Rooms #1, #2, #3, #4, #5, #6, #7, and #8 were thoroughly cleaned and sanitized. This deficient practice could place residents at risk of living in an unclean and unsanitary environment which could lead to a decreased quality of life.

Inspectors wroteBased on observation, interview and record review the facility failed to provide pharmaceutical services, including procedures that assured the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals that met the needs of each resident for two (Resident #3 and Resident #15) of eighteen residents and one (LVN A) of three LVNs reviewed for pharmaceutical services.1. The facility failed to ensure LVN C did not leave Resident #3's medications inside the resident's room for the resident to administer unattended on 01/06/2026. 2. The facility failed to ensure Resident #15 was not self-administering her eye drops without an assessment on 01/06/2026.3. The facility failed to ensure LVN A did not put her personal beverage on top of the nurse's cart while passing medications on 01/06/2026.4. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for two (Resident #8 and Resident #26) of eighteen residents, for two (LVN C and LVN B) of three LVNs, for two (CNA D and CNA E) of six CNAs reviewed for infection control. 1. The facility failed to ensure LVN C would not walk the hallway with a glove to one hand after coming out of Resident #11's room on 01/06/2026. 2. The facility failed to ensure LVN B wore a gown when connecting Resident #8's IV on 01/06/2026. 3. The facility failed to ensure LVN B wore a gown while emptying Resident #8's catheter bag on 01/06/2026. 4. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for three (Resident #7, Resident #15, and Resident #27) of eighteen residents reviewed for reasonable accommodation of needs. The facility failed to ensure the call light system in Resident #7, Resident #15, and Resident #27's rooms was in a position that was accessible to the resident on 01/06/2026. This failure could place the residents at risk of being unable to obtain assistance when needed and help in the event of an emergency.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 6 residents (Resident #37) reviewed for care plan revisions. The facility failed to ensure Resident #37's care plan reflected the use of her BiPAP device. This failure could place residents at risk of their needs not being met.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that residents' environment remained free of accident hazards as was possible for one of five residents (Resident #36) reviewed for accident prevention. The facility failed to ensure Residents #36's bed was lowered to the lowest position possible while he was lying in the bed. This failure could result in the resident falling from his bed and sustaining an injury.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide appropriate treatment and services to prevent complications of enteral feeding for two (Resident #13 and Resident #39) of two residents reviewed for feeding tube (a way of providing nutrition directly to the stomach) management.1. The facility failed to ensure LVN A checked Resident #13's g-tube (gastrostomy tube: a tube inserted through the abdomen that delivers nutrition directly to the stomach) placement and residual before administering medication on 01/07/2026. 2. The facility failed to ensure Resident #39 had orders to flush the g-tube before, during, and after medication administration on 01/07/2026. These failures could place residents with g-tubes at risk for tube displacement, clogging, aspiration, and discomfort.

Inspectors wroteBased on observation, interview, and record review, the facility failed to administer parenteral fluids consistent with professional standards of practice and in accordance to physician orders for one (Resident #8) of eight residents reviewed for parenteral (delivery of medications through injection)/IV (intravenous: administering fluids or medications directly into a vein) fluids. The facility failed to ensure Resident #8 had orders to flush the IV before medication administration, to monitor for infiltration (fluid leaks from a vein to the surrounding tissues) and infections, and when to change the IV site dressing. This failure could place residents receiving IV medications at risk for injury, infections, IV infiltration, clogging, pain, which may result in required replacement of IV.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure that residents, who needed respiratory care, were provided care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one of four residents (Resident #37) reviewed for respiratory care. The facility failed to ensure Resident #37's BiPAP mask and nebulizer machine (breathing treatment device) was properly stored in a bag when not in use on 01/06/26. This failure could place the resident at risk for respiratory infection and not having his respiratory needs met.

Inspectors wroteBased on observation, interview and record review the facility failed to, in accordance with State and Federal laws, store all drugs and biologicals in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for four (Residents #2, #10, #15, #25) of eighteen residents and one (Nurse's Cart #1) of three nurses' carts reviewed for medication storage. 1. The facility failed to ensure that Resident #2's nystatin powder, antifungal powder, and zinc oxide were not on top of the resident's side table on 01/06/2026.2. The facility failed to ensure that a skin barrier was not left on top of Resident #25's overbed table on 01/07/2026. These failures could place the residents at risk of accidental overdose, misuse of medications, not receiving the medication's full therapeutic benefits, and possible adverse reactions.

Inspectors wroteBased on observation, interview and record review the facility failed to provide pharmaceutical services, including procedures that assured the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals that met the needs of each resident for one (Resident #1) of eight residents reviewed for pharmaceutical services. The facility failed to ensure Resident #1 was not self-administering his nasal spray without an assessment and an order for nasal spray on 09/02/2025. This failure could place residents at risk for potential overdose and adverse effects.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the medications were stored properly in locked compartments or provided a safe and secured storage with limited access for three (Residents #1, #2, and #3) of eight residents reviewed for medication storage. 1. The facility failed to ensure Resident #1's nasal spray was not left inside the resident's room on 09/02/2025. 2. The facility failed to ensure Resident #2's zinc oxide (medicated cream used to prevent skin irritation) was not left on top of the resident's side table on 09/02/2025. 3. The facility failed to ensure Resident #3's zinc oxide was not left on top of the resident's side table on 09/02/2025. These failures could place residents at risk to have access to medications that could result to accidental ingestion and misuse of medications.

Inspectors wroteBased on interview and record review the facility failed to ensure that residents, who needed respiratory care, were provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one (Resident #1) of six residents reviewed for respiratory care. Based on interview and record review the facility failed to ensure that residents, who needed respiratory care, were provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one (Resident #1) of six residents reviewed for respiratory care. The facility failed to ensure Resident #1 had an order for oxygen administration when she was a resident at the facility from 07/10/2025 to 07/12/2025. [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 (Residents #25) of 6 residents reviewed for (ADL) care provided to dependent residents. The facility failed to ensure Resident #25 received scheduled bed baths according to reviews from October 1, 2024 - October 16, 2024. This failure placed the resident at risk of not receiving necessary services to maintain good personal hygiene and decreased self- esteem.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that residents' environment remained free of accident hazards as was possible for 2 (Resident #12 and #30) of 4 residents reviewed for accident prevention. The facility failed to obtain physician orders or a physician assessment as of 10/15/24 for Residents #12 and #30, for the usage of a scoop mattress prior to installing the mattress to assist in fall prevention. This failure could prevent residents from having an environment that was free and clear of accidents and hazards.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that residents, who needed respiratory care, were provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for three (Resident #2, Resident #5, and Resident #15) of eight residents reviewed for Respiratory Care. 1. The facility failed to ensure that Resident #2's breathing mask for nebulization was properly stored and his humidifier had water in it. 2. The facility failed to ensure that Resident #5's yankauer suction tip (a firm plastic suction tip used to suction secretions in the mouth) was properly stored. 3. The facility failed to ensure that Resident #15's nasal canula was properly stored in a sanitized container. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the medications for four (Resident #1, Resident #13, Resident #14, and Resident #35) of fifteen residents were provided a safe and secured storage with limited access. 1. The facility failed to ensure Resident 1's zinc oxide (ointment used to prevent skin irritation), Miralax, eye drops , and a nasal spray were not left on top of the resident's left side table. 2. The facility failed to ensure Resident 13's stoma powder was not left on top of the resident's left side table. 3. The facility failed to ensure Resident 14's zinc oxide was not left on top of the resident's left side table. 4. The facility failed to ensure Resident 35's zinc oxide was not left on top of the resident's TV stand. [...]

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to ensure food was stored, prepared, distributed, and served in accordance with professional standards for food service safety for the facility's only kitchen in skilled nursing, reviewed for food storage, labeling, dating, and kitchen sanitation. 1. The facility failed to ensure foods in the refrigerator were properly sealed . 2. The facility failed to ensure the ice machine, located in the kitchen area, was cleaned. 3 The facility failed to ensure the food stored in the refrigerator and freezer were labeled with the stored date. 4. The facility failed to ensure that they had a cleaning/sanitizing bucket (red bucket) under the serving table during lunch service to keep the serving table clean and sanitized. These failures could place residents at risk for cross contamination and other air-borne illnesses.

Inspectors wroteBased observations, interviews, and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for two (Resident #24 and Resident #35) of eight residents reviewed for Infection Control. 1. The facility failed to ensure that LVN A changed her gloves and performed hand hygiene while administering ointment to Resident #24's nose. 2. The facility failed to ensure that CNA C changed her gloves and performed hand hygiene while providing incontinent care to Resident #35. 3. The facility failed to ensure that LVN A performed hand hygiene while administering wound care to Resident #35. These failures could place the residents at risk of cross-contamination and development of infections.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that assessments accurately reflected the resident's status for one (Resident #5) of eight residents reviewed for Accuracy of Assessments. The facility failed to ensure Resident #5's Comprehensive MDS Assessment accurately reflected that Resident #5 had an impairment to her right upper extremity. This failure could place residents at risk for not receiving care and services to meet their needs, diminished function of health, and regressions in their overall health.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for a resident for one (Resident #13) of eight residents reviewed for Care Plans. The facility failed to ensure Resident #13 was care planned for her colostomy (Opening in the belly done surgically to create a new passageway for feces. One end of the large intestine would be redirected out of the abdominal wall and a colostomy bag would be in place to catch the feces). This failure could place the residents at risk of not receiving the necessary care and services needed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who needed colostomy care were provided such care, consistent with professional standards of practice for one (Resident #13) of two residents reviewed for Colostomy Care. The facility failed to ensure Resident #13 had physician orders for colostomy (Opening in the belly done surgically to create a new passageway for feces. One end of the large intestine would be redirected out of the abdominal wall and a colostomy bag would be in place to catch the feces) care. This failure could place residents with colostomy at risk for not receiving care or delay in treatment/care due to not having an order.

Inspectors wroteBased on observation, interview and record review, the facility failed to immediately inform the resident's physician and notify, consistent with his or her authority, notify a resident's representative when there was an accident involving the resident and/or when there was a significant change in the resident's physical, mental, or psychosocial status for 1 of 5 residents (Resident #1) reviewed for notification of changes in that: The facility failed to promptly notify Resident #1's physician and responsible party when Resident #1 exhibited cries of pain on 6/8/24 and verbally stated ow, my leg while crying in pain again on 6/9/24 after falling and suffering from a fracture of the right femoral/femur neck on the right hip on 6/07/24. She did not receive an X-ray until 06/10/2024 when Resident #1's responsible party sent a video recording of her crying in pain to the hospice provider. [...]

Inspectors wroteBased on observation, interviews and record reviews the facility failed to ensure food was stored, prepared, distributed and served in accordance with professional standards for food service safety for the facility's only kitchen reviewed for kitchen sanitation. The facility failed to ensure foods in the facility's dry storage area, refrigerator, and freezer were stored and dated according to guidelines. The facility failed to ensure proper discarding of expired food stored in the refrigerator and dry storage area. The facility failed to ensure all kitchen staff were wearing proper hair and/or beard coverings, while preparing food in the kitchen area. These failures could place residents at risk for cross contamination and other air-borne illnesses.

Inspectors wroteBased on observations, interviews and record reviews the facility failed to provide a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for areas in the facility (Rooms 302, 304, 305, 306, 307, and 309) observed for a clean environment. The facility failed to provide housekeeping Services necessary to maintain a sanitary, orderly and comfortable interior for 6 of 6 rooms (Rooms 302, 304, 305, 306, 307, and 309) observed. This deficient practice could negatively impact the facility's ability in preventing the spread of disease-causing organisms in residents' living areas and does not present a Clean Homelike Environment.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 3 of 6 residents (Residents #26, #28, and #143) reviewed for Activities of Daily Living (ADLs) care provided to dependent residents. The facility failed to ensure Residents #26, #28, and #143 received baths or showers consistently for past 30 days of records reviewed for documented resident showers. This failure placed residents at risk of not receiving necessary services to maintain good personal hygiene, skin integrity, or decreased self- esteem. Findings Included: Record review of Resident #26's Face Sheet, dated 09/14/23, revealed she was a 75 -year-old female admitted on [DATE]. [...]

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to ensure that a resident who needed respiratory care was provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 (Resident #16) of 2 residents reviewed for respiratory care. The facility failed to ensure Resident #16's oxygen concentrator had a humidifier. The facility failed to ensure that Resident #16 has Physician orders for oxygen and CPAP. These failures could place the resident at risk of not having their respiratory needs met.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents had physician's orders for the resident's immediate care for one (Resident #16) of two residents reviewed for admission orders. The facility failed to provide physician's orders for oxygen supplement for Resident #16 at the time of admission. The facility failed to provide physician's orders for CPAP for Resident #16 at the time of admission. These failures could place the resident at risk of not receiving necessary care and services upon admission that could result to worsen condition.

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for a resident for 2 of 6 residents (Resident #16 and #28) reviewed for Care Plans. The facility failed to ensure Resident #28's diagnosis and treatment for epilepsy was care planned. The facility failed to ensure Resident #16's diagnosis and treatment for the use of oxygen supplement was care planned. These failures could place residents at risk of needs not being met.

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to ensure the timeliness of each resident's person-centered, comprehensive care plan, and to ensure that the comprehensive care plan is reviewed and revised by an interdisciplinary team composed of individuals who have knowledge of the resident and his/her needs, and that each resident and resident representative, if applicable, is involved in developing the care plan and making decisions about his or her care for 1 of 6 residents (Resident #9) reviewed for revised Care Plans. The facility failed to ensure Resident #9's discharge from Hospice on 09/24/21 was removed from the care plan. This failure placed residents at risk of needs not being met.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 (Resident #16) of 3 residents observed for infection control. The facility failed to ensure that the two prongs of Resident #16's nasal cannula (a device used to deliver supplemental oxygen to an individual. It consists of a lightweight tube on which one is connected to the oxygen source and the other end splits into two prongs and are placed in the nostrils) was not touching the back of the wheelchair when not in use. [...]