Salem Care Center

Inspectors wroteBased on observation, interview, and record review, facility staff failed to ensure the amount of liquid Lorazepam medication (a controlled substance) for one resident (Resident #1) out of three sampled residents was counted at each shift change, to identify any discrepancies or prevent potential misappropriation of the medication. Staff failed to complete controlled medication counts with two staff members at each shift change for two out of two sampled medication carts as directed by facility policy. The facility census was 49. [...]

Inspectors wroteBased on interview and record review, facility staff failed to purchase a surety bond in an amount sufficient to assure security of all resident funds the facility holds. The facility census was 44.1. Review of the resident's trust fund account for March 2025 through February 2026, showed an average monthly balance of $47,132.42 which required a surety bond of $75,000 or greater. Review of the Department of Health and Senior Services (DHSS) database, showed the facility has an approved non-cancelable Escrow Agreement Account in the amount of $70,000. During an interview on 03/27/26 at 3:47 P.M., the business office manager (BOM) said he/she is responsible for resident funds and ensuring the bond is sufficient. The BOM said he/she said was not aware their bond needed to be increased. [...]

Inspectors wroteBased on interview and record review, facility staff failed to ensure three Nurse Aide's ((NA) NA A, NA D, AND NA E) of three completed the nurse aide training program within four months of his/her employment in the facility. The census was 44.1. Review of the facility's Nurse Aide Qualifications and Training Requirements, revised 12/2011, showed nursing assistants failing to successfully complete the required training program within the first four (4) months of their date of employment may be terminated from employment or may be reassigned to non-nursing related services.2. Review of NA A's personnel change form, showed he/she transferred from housekeeper to NA on 8/15/25. The file did not contain documentation the NA completed a nurse aide training program. [...]

Inspectors wroteBased on observation, record review, and interview, facility staff failed to maintain a comfortable and homelife. The facility census was 441. Review of the facility policy titled, Environment/Homelike, dated 01/01/2025, showed it is the policy of this facility to provide a safe, clean, comfortable and homelike environment.2. Observation on 03/24/26 at 11:30 A.M., showed 13 light bulbs need replacement in the main dining hall and four of the ceiling light fixtures missing covers.3. Observation on 03/24/26 at 11:40 A.M., showed the ceiling light fixture in the egress between the lobby and the nurse's desk missing its cover.4. Observation on 03/25/26 at 3:15 P.M., showed one ceiling light fixture on the 200 hall, one ceiling light fixture on the 300 hall missing covers and two light bulbs need replacement in the ceiling light fixtures at the end of the 100 hall.5. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to store medications in a safe and effective manner, when staff did not store insulin pens separately according to facility policy. The facility census was 44.1. Review of the facility policy titled, Policy and Procedure; Medication Storage' dated 11/1/2013, showed the purpose of the policy is to ensure medications and biologicals are stored in a safe, secure storage and safe handling. Each resident is assigned a cubicle or drawer to prevent the possibility of a drug for one resident being given to another.2. Observation on 03/24/26 at 11:45 A.M. showed the insulin cart contained 13 separate insulin pens belonging to 13 different residents stored together in one basket.3. Observation on 03/26/26 at 1:05 P.M. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to ensure residents received food at safe and appetizing temperatures when the staff failed to ensure the internal temperature of pureed food placed in hot holding remained at least 140 degrees Fahrenheit ( F) to prevent the growth of food-borne pathogens and prevent food-borne illness and. The facility census was 44.1. Review of the facility's policy titled, Preventing Foodborne Illness - Food Handling, undated, showed potentially hazardous foods will be cooked to the appropriate internal temperatures and held at the designated temperature for the appropriate length of time to destroy pathogenic organisms. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed sanitize kitchen wares in a manner to prevent contamination. Facility staff failed to ensure the dish machine was operating according to manufacturer's instructions in a manner adequate to prevent cross contamination of kitchen wares. The facility census was 46. 1. Review of the facility's Steps to Clean and Sanitize in a 3-Compartment Sink policy, undated, showed staff were directed to: -Clean items in the first sink; -Rinse items in the second sink; -Sanitize items in the third sink. Read the label for time and temperature requirements for the sanitizer you are using. Review of the sanitizer directions for use showed: -Thoroughly wash equipment and utensils in hot detergent solution; -Rinse utensils and equipment thoroughly with potable water; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to develop, implement and educate on an enhanced barrier precautions (EBP) system for four (Resident #12, #17, #38, and #200) of four sampled residents when facility staff failed to post signage or other system to alert staff of resident's who required EBP and place appropriate personal protective equipment (PPE) in close proximity. The facility census was 46. 1. Review of the facility's policies showed staff did not provide a policy for EBP. Review of the Centers for Disease Control (CDC) website https://www.cdc.gov/hicpac/workgroup/EnhancedBarrierPrecautions.html article, Consideration for Use of Enhanced Barrier Precautions in Skilled Nursing Facilities, dated June 2021, showed: [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to provide a clean and homelike environment when staff failed to provide housekeeping and maintenance services to maintain a sanitary, orderly and comfortable environment. The facility census is 46. 1. Review of the facility's Environment/Homelike policy, undated, showed: -The facility will remain clean and sanitary; -The facility will maintain clutter and remove it if it poses a hazard; -Equipment will be in good repair; -The safety of the residents and staff will take precedence over resident choice. Review of the facility's Work Orders/Repairs policy, undated, showed: -To prioritize repairs, work orders are to be completed and forwarded to the maintenance director; -The maintenance director will review and address all work order concerns; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to keep the environment free of accident hazards when staff failed to keep chemicals and razors behind locked doors and inaccessible to residents. The facility census was 46. 1. Review of the facility's hazardous storage policy, undated, showed hazardous items must be stored behind locked doors. Items include but not limited to razors, scissors, cleaning chemicals, toe-nail clippers, and etc. 2. Observation on 08/06/24 at 11:06 A.M. and 2:53 P.M., showed the 300 hall shower room unlocked and unattended. Observation showed a large, unlocked cart and a large grey unlocked cabinet contained loose razors and a bag of ice melt chemical on the floor. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to destroy medications in a timely manner for ten current residents (Resident #1, #2, #12, #16, #20, #34, #35, #39, 43, and #44) and discharged residents (Resident #300, #301, #302, and #303). Staff failed to discard expired medications from one of one over the counter medication storage cabinet and two of two medication carts. The facility census was 46. 1. Review of the facility's Medication and Storage policy, revised November 2013, showed: -No discontinued, outdated, or deteriorated medications should be available for use in the facility. All medications are destroyed per policy; -Expired medications are to be removed from areas medication carts prior to or at the time of expiration; [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to serve pureed food in accordance with the nutritionally calculated recipes and menus. Facility staff failed to ensure meal substitutions were reviewed by the facility's dietitian or other clinically qualified nutrition professional for nutritional adequacy. The census was 46. 1. Review of The facility's Pureed Foods instructions, dated November 2005, which were posted on the wall in the food prep area showed staff were instructed to puree: -Three ounces of cooked entrees with 1/2 slice of bread and broth, beginning with 1/2 cup of liquid and adding liquid until product is correct consistency; -One half cup of side dishes of potato, rice and noodles with milk or melted margarine and adding liquid until product is correct consistency; [...]

Inspectors wroteBased on interview and record review, facility staff failed to prevent the misappropriation of one resident's (Resident #4) debit card which was used without authorization of the resident. The debit card was used between the dates of 05/06/24 and 06/26/24 with total charges to the card of $755.00. The facility census was 46. The Administrator was notified on 08/09/24 of Past Non-Compliance which occurred on 07/09/24. On 07/09/24, the Administrator identified Certified Nurse Aid (CNA) M misappropriated resident funds. Upon discovery staff suspended the employee, conducted an investigation, notified appropriate parities, educated staff and terminated the CNA. Staff corrected the deficient practice on 07/15/24. 1. Review of the facility's policy Abuse, Prevention and Prohibition Policy, dated 11/2018, showed staff were directed as follows: [...]

Inspectors wroteBased on interview and record review, facility staff failed to electronically submit to Centers for Medicare and Medicaid Services (CMS), a complete and accurate direct care staffing information to the Payroll Based Journal (PBJ) data from January 1, 2024 through March 31, 2024. The facility census was 46. 1. Review of the facility's policies showed the facility did not provide a PBJ policy. 2. Review of the CMS PBJ Staffing Data Report, dated 08/01/24, showed the report did not contain a report for the period of January 1, 2024 through March 31, 2024. During an interview on 08/09/24 at 11:14 A.M., the Administrator said it is the responsibility of the corporate office to submit PBJ data. He/She said the office staff did not report even when informed of the need. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement complete policies and procedures for the inspection, testing and maintenance of the facility water systems to inhibit growth of waterborne pathogens and reduce the risk of an outbreak of Legionnaire's Disease (LD). [...]

Inspectors wroteBased on interview and record review, the facility failed to deposit funds in excess of $100 in an interest bearing account and credit all interest earned on resident's funds to that account from February 2023 through August 2023. The deficient practice affected 22 residents. The facility census was 40. 1. Review of the facility's Resident Trust Fund policy, undated showed: -Upon written authorization of a resident, the facility will hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility; -Funds in excess of fifty dollars will be deposited in an interest bearing account, which will remain separate from any facility operating accounts; -All interest earned on the account will be credited to the individual resident account; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to establish and maintain a process to follow generally accepted accounting principles to reconcile the Resident Trust Fund Account monthly. The deficient practice affected 22 residents. The facility census was 40. 1. Review of the facility's Resident Trust Fund policy, undated showed it did not contain direction on when or how to reconcile the trust fund accounts. Review of the Resident Trust Fund (RTF) documentation, showed the reconciliation sheets do not match the adjusted bank balance for the months of February 2023 and May 2023 through July 2023. During an interview on 10/04/23 at 2:27 P.M., the Business Office Manager said he/she is responsible to reconcile the bank statement's monthly. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to provide a clean, homelike and comfortable environment when staff failed to maintain the facility's exterior, resident rooms and common areas clean and in good repair. The facility census was 40. 1. Review of facility policies showed staff did not provide an environmental policy. 2. Observation on 10/02/23 at 10:49 A.M., showed the shared bathroom between room [ROOM NUMBER] and 302 contained bathroom tile that was covered with a black raised substance around the toilet. The toilet bowl base caulking sealant was covered with a black substance. The toilet seat was cracked in two and taped together with clear tape. Observation on 10/02/23 at 11:00 A.M., showed room [ROOM NUMBER] had a urine smell. The flooring in the room had damaged tiles. [...]

Inspectors wroteBased on interview and record review facility staff failed to check the Federal Care Safety Registry (FCSR) (a registry established by law to promote family and community safety) for one employee (Minimum Data Set (MDS) Coordinator), the Employee Disqualification List (EDL) (a list of individuals who have been determined to have abused or neglected a resident or misappropriated funds or property belonging to a resident) for two employees (Certified Nurse Aide (CNA) J and CNA H), and the CNA Registry for one employee (Licensed Practical Nurse (LPN) I in accordance with the facility's policy. There were seven employees sampled. The facility's census was 40. 1. Review of the facility's policy titled Pre-Employment Screening, revised 07/10/23, showed staff were directed to do the following: [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to develop a comprehensive person-centered care plan for each resident to meet the resident's medical and nursing needs when staff failed to include direction to check a catheter (tube to drain the bladder) anchor and placement for one resident (Resident #31), behaviors for one resident (Resident #2); blood thinners, code status and anti-anxiety medications for one resident (Resident #8), psychotropic medications for one resident (Resident #11), and anti-depressants and activity interests for one resident (Resident #27). The facility census was 40. 1. Review of the facility's Comprehensive Care Plan policy, dated 08/15/23 showed: [...]

Inspectors wroteBased on observation, interviews, and record review facility staff failed to provide safe mechanical lift transfer for two residents (Residents #1, and#8), failed to lock unattended treatment carts, failed to safely propel three residents (Resident #12, #9, and #3) in wheelchairs, and safely store razors and hazardous chemicals in resident showers. The facility census was 40. 1. Review of the facility's Mechanical Lift (Hoyer) policy, undated showed staff were directed to: -Place the lift pad under the resident's buttocks and thighs, so that the lower edge of seat was under the knees; -Move lift to bedside with base under the bed. Be sure to widen the base. Attach the sling to the lift; -Position wheelchair and lock brakes. Swing resident's feet off the bed. When resident has been lifted clear of the bed, grasp and move the Hoyer to the chair; [...]

Inspectors wroteBased on interview and record review, the facility failed to have a complete facility-wide assessment to determine what resources were necessary to care for its residents competently during both day-to-day operations and emergencies. The facility census was 40. 1. Review of the facility's Facility Assessment policy, dated April 2019 showed: -The team responsible for conduction reviewing and updating the facility assessment includes: the administrator, representative of the governing body, the medical director, the director of nursing, the director of maintenance, director of dietary, social services, activities and rehabilitation; [...]

Inspectors wroteBased on interview and record review, the facility failed to electronically submit to Centers for Medicare and Medicaid Services (CMS) a complete and accurate direct care staffing information to the Payroll Based Journal (PBJ) data from April 1, 2023 through June 30, 2023. The facility census was 40. 1. Review of the facility's policies showed the facility did not provided a PBJ policy. Review of the CMS PBJ Staffing Data Report, dated 09/27/23 showed the report did not contain a report for the period of April 1, 2023 through June 30, 2023. During and interview on 10/05/23 at 10:18 A.M., the Administrator and the Director of Nursing said the facility's corporate offices did not submit PBJ data during the quarter shown on the report. Corporate staff told them it was not necessary due to the facility's structure of payment. Facility staff do not self report the PBJ data themselves.

Inspectors wroteBased on interview and record review, the facility failed to document the administration or refusal of the pneumococcal (lung inflammation caused by bacterial or viral infection) vaccine for five of seven sampled residents. (Resident #1, #2, #31, #35, and #341). The facility census was 40 residents. 1. Review of the facility's Pneumococcal Vaccine Policy, dated 2019, showed: -The pneumococcal guidelines are as recommended by the Center for Disease Control (CDC-the nation's health protection agency responsible for controlling the introduction and spread of infectious diseases); -The primary care physician will be asked that all new admissions be screened and given both pneumococcal vaccines according to Advisory Committee on Immunization Practices (ACIP) recommended schedule, unless specifically ordered otherwise by the Primary physician on admission orders; [...]

Inspectors wroteBased on interview and record review, facility staff failed to document, maintain and follow current guidance and procedures for immunizations of residents against COVID-19 for five (Residents #1, #31, #35, #340, and #341) of seven sampled residents. The facility census was 40. 1. Review of the Centers for Disease Control (CDC) COVID-19 Long-Term Care (LTC) Residents guidance, dated 9/25/23, showed: -CDC recommends everyone aged five years and older including people who live in long term care settings, get 1 updated COVID-19 vaccine; -People who are moderately or severely immunocompromised can get additional COVID-19 vaccines; -People who live in LTC settings must give consent, or agree to a COVID-19 vaccine. Review of the facility's COVID vaccination policy, undated, showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to maintain professional standards of documentation for falls and neurological checks of two residents (Resident #11, and 13), and smoking assessments of one resident (Resident #13). The facility census was 40. 1. Review of the facility's policy titled, Neurological Assessment, revised October 2010, showed staff were directed to do the following: -Neurological assessments will be completed upon physician's order, following an unwitnessed fall, following a fall or other accident/injury involving head trauma, or when indicated by resident's condition; -Neurological assessment (neuro checks) will be done every 15 minutes for the first hours, then every 30 min X2, every hour X6, every 4 hours X2, every 8 hours X7 for a total of 72 hours; [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide the residents with written actions, responses and rationales to their concerns. The facility census was 40. 1. Review of the facility's Grievance policy, dated January 2017, showed: -Utilization of the grievance form offers residents, families or resident representatives an opportunity to make written accounts of their concerns utilizing the grievance form; -Any resident or their representative may complete a grievance concerning his or her treatment, medical care, safety or other issues without fear of reprisal of any type; -The Administrator/Executive Director, will act as the facility/community designated grievance official. The Administrator, with the assistance of the Social Service designee, will be responsible for the oversight of the grievance process. [...]