Schnepp Senior Care and Rehabilitation Center

Inspectors wroteBased on observations, interviews, and record review, the facility failed to 1) provide adequate supervision/assistance and implement meaningful interventions to prevent falls and injuries for one Resident (R24) of four Residents reviewed for falls, resulting in R24 fractures and R68 having multiple unsupervised falls 2) safely transfer 1 Resident (R76) of 1 Resident reviewed for lift transfers.

Inspectors wroteBased on observation, interview, and record review, the facility failed to 1) ensure appropriate hand hygiene during perineal care and 2) ensure full implementation of their water management plan.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide medication according to professional standards of practice for 1 resident (R30) of 6 residents reviewed.

Inspectors wroteBased on interview and record review, the facility failed to ensure timely treatment of urinary tract infection (UTI) symptoms for one resident (R35) of one resident reviewed for urinary tract infections.

Inspectors wroteCitation related to intake #2575541Based on interview and record review, the facility failed to prevent physical abuse and neglect for two residents (R4, R6) of three residents reviewed for abuse, resulting in emergency hospitalization, injury and fearfulness.

Inspectors wroteBased on interview and record review, the facility failed to assess for physician ordered parameters during medication administration for one of three residents (Resident #7), reviewed for professional standards.

Inspectors wroteThis citation pertains to intake #2581979 and #2585133Based on interview and record review, the facility failed to report an allegation of sexual abuse that involved two of two resident's (Resident #1 and Resident #2).

Inspectors wroteThis citation is related to intake #2585133Based on observation, interview, and record review, the facility failed to accurately assess, document, and initiate treatment for one of three residents (Resident #7) reviewed for pressure ulcers, resulting in the worsening of a coccyx wound.

Inspectors wroteBased on interview and record review, the facility failed to provide personal care in a dignified manner for one Resident (R46) and failed to provide timely personal care and assistance for eight Residents (R40, R29, R55, R191, R32, R38, R13, & R43) of nine residents reviewed for dignity. R46 Review of an admission Record revealed R46 admitted to the facility on [DATE] with pertinent diagnoses which included Parkinson's disease (a disorder of the central nervous system that affects movement) and heart failure. Review of a Minimum Data Set (MDS) (a tool used for assessing a resident's care needs) assessment for R46, with a reference date of 4/9/2025 revealed a Brief Interview for Mental Status (BIMS) (a scale used to determine a resident's cognitive status) score of 14, out of a total possible score of 15, which indicated R46 was cognitively intact. [...]

Inspectors wroteThis citation pertains to intake MI00153208 Based on observation, interview, and record review, the facility failed to notify the responsible party of an event that may have mental or psychological disturbance for two Residents (R36 and R293) of two Residents reviewed for abuse.

Inspectors wroteThis citation pertains to intake MI00153208 Based on observations, interviews, and record review, the facility failed to report to the State Agency an allegation of abuse for two resident (R36 and R293) of two residents reviewed for abuse.

Inspectors wroteThis citation pertains to intake MI00153208 Based on observations, interviews, and record review, the facility failed to thoroughly investigate an allegation of abuse for two Residents (R36 and R293) of two Residents reviewed for abuse.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper Personal Protective Equipment (PPE) and hand hygiene for 1 resident (R294) of 1 resident reviewed for Transmission Based Precautions (TBP).

Inspectors wroteBased on interview and record review, the facility failed to accurately correlate and document Minimum Data Set (MDS) assessment information from the medical record for one Resident (R61) with a history of behaviors resulting in inaccurate assessments, the potential for care areas to not be triggered or identified impeding the development of an individualized Care Plan, and the potential for all facility residents to not be properly assessed and a corresponding plan of care be implemented to enable attainment of their highest potential physical, mental, and psychosocial well-being.

Inspectors wroteBased on observation, interview, and record review, the facility failed to 1) perform ordered pressure ulcer interventions and 2) adequately monitor and assess a pressure ulcer for 1 resident (Resident #33) of 2 residents reviewed for pressure ulcer care, resulting in the potential of worsening pressure ulcers and the potential for residents to not meet their highest practicable physical, mental, and psychosocial well-being.

Inspectors wroteBased on interview and record review, the facility failed to ensure the physician reviewed a pharmacy recommendation for 1 of 5 residents (R61) reviewed for monthly pharmacy medication reviews, resulting in the potential for the physician not being aware of a pharmacy recommendation and serious side effects of the combined use of a non-steroidal anti-inflammatory (NSAID) and an anticoagulant.

Inspectors wroteBased on interview and record review, the facility failed to ensure the medication regimen for 1 of 5 residents (R61) reviewed was free of unnecessary medications, resulting in the potential for R61 to receive unnecessary medications over an extended period.

Inspectors wroteBased on interview and record review, the facility failed to maintain complete and accurate medical records for 2 residents (Resident #33 and #61) of 19 residents reviewed for accuracy of medical records, resulting in the potential for miscommunication and an unclear picture of the resident's health care status.

Inspectors wroteThis citation pertains to intake # MI00142627 and MI00142701 Based on interview and record review, the facility failed to provide safe standards of care for a dependent resident (R2) of 2 Residents reviewed for death, resulting in R2 falling out of bed when she was being provided care and sustaining lacerations and fractures that resulted in her subsequent death.

Inspectors wroteThis citation pertains to intake #MI00141679 Based on observations, interviews and record review, the facility failed to provide timely care and services to 3 Residents (R3, R4 and R6) of 3 reviewed, resulting in pain and frustration.

Inspectors wroteThis citation pertains to intake # MI00142627 and MI00142701 Based on interview and record review, the facility failed to fully investigate and report an allegation of neglect for 1 of 2 Residents (R2) reviewed for deaths, resulting in R2 rolled out of bed while care was being provided, sustained lacerations and fractures.