Sienna Skilled Nursing & Rehabilitation

Inspectors wroteBased on temperature logs, policy and interview, the facility failed to consistently monitor food and drink serving temperatures. This affected all but one Resident #15 who did not receive nutrition from the kitchen. The census was 80.

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure medications were stored to prevent access by unauthorized persons. This had the potential to affect 23 (Residents #3, #16, #19, #23, #24, #26, #27, #28, #31, #33, #35, #39, #47, #49, #50, #51, #54, #64, #65, #67, #71, #72, and #73) residents who the facility identified as cognitively impaired and independently mobile. The census was 80.

Inspectors wroteBased on closed medical record request, medical request fee schedule and interview, the facility failed to ensure ease of access in obtaining medical records. This affected one (Resident #83) of three residents reviewed for medical record request. The facility census was 82.

Inspectors wroteBased on observation, medical record review, interview and policy review the facility failed to provide a summary of baseline care plans to residents and/or responsible parties. This affected two (Residents #13 and #44) of three residents reviewed for care planning.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure physician ordered interventions were implemented for the treatment of edema. This affected one (Resident #44) of three residents reviewed for skin impairment. The census was 80.

Inspectors wroteBased on observation, record review and interview, the facility failed to maintain an accurate medical record. This affected one (Resident #44) of eight records reviewed. The census was 80.

Inspectors wroteBased on medical record review, observation, interviews, review of the National Pressure Injury Advisory Panel (NPIAP) guidelines and facility policy review, the facility failed to ensure comprehensive and accurate pressure ulcer assessments. The facility also failed to ensure treatments were implemented timely and pressure-relieving interventions were implemented per the care plan. This affected one (Resident #7) of three residents reviewed for pressure ulcers. The facility census was 75.

Inspectors wroteBased on observation, staff interview and facility policy review the facility failed to store food in a sanitary manner. This had the potential to affect all 79 residents residing in the facility, as the facility identified zero residents with an order for nothing by mouth (NPO). The facility's census was 79. Findings Include: During the initial kitchen tour conducted on 08/04/25 from 8:30 A.M. to 8:50 A.M. observations revealed in the dry food/canned food storage three cans of 66.5 ounces (oz) of tuna each were dented along the seal and stored in the main storage area for resident foods to be used for meal preparation. In the walk-in freezer there was an opened box of beef patties with the plastic storage bag opened exposing approximately 20 frozen beef patties to the cardboard box and the freezer air. [...]

Inspectors wroteBased on record review, observations, staff interviews, and facility policy review the facility failed to maintain the dignity of three residents (Resident #42, #64, and #75) during the lunch service in the dining room, and failed to ensure dignity of a resident was maintained by not removing facial hair for one resident (Resident #66) out of four residents reviewed for dignity. The facility census was 79.

Inspectors wroteBased on record review and interview, the facility failed to ensure the surety bond was greater than the personal funds managed by the facility. This had the potential to affect all 53 residents (Residents #2, #3, #4, #5, #8, #9, #11, #14, #16, #18, #19, #20, #22, #25, #26, #28, #29, #31, #32, #35, #36, #38, #40, #42, #43, #44, #45, #47, #48, #50, #52, #53, #54, #55, #56, #58, #59, #63, #64, #65, #66, #68, #70, #72, #73, #74, #76, #77, #80, #83, #86, #88 and #97) who had their funds managed by the facility. The facility census was 79.

Inspectors wroteBased on record review and interview, the facility failed to ensure pharmacy recommendations were addressed by the physician for four (Residents #2, #5, #24, #54) of five residents reviewed for unnecessary medications. The facility census was 79.

Inspectors wroteBased on observation, interview, record review and review of facility policy, the facility failed to ensure infection control was maintained during medication administration for Resident #2 and #72, during incontinence care for Resident #61 and when caring for Resident #75 during contact isolation. This affected four residents (#2, #72, #61 and #75) of 24 residents observed for infection control. The facility census was 79.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident #86's personal funds were forwarded to the resident's estate within 30 days. This affected one (Resident #86) of one resident reviewed for personal funds after death. The facility census was 79.

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on observation, staff interview and facility policy review the facility failed to maintain a clean homelike environment in resident's rooms by leaving visibly soiled privacy curtains hanging. This affected five residents (Residents #24, #45, #59, #66 and #78) out of 79 residents reviewed for environment. The facility's census was 79. Findings Include: Observation on 08/06/25 at 1:25 P.M. revealed Resident #24's privacy curtain was soiled with several large dark circular stains visible from the doorway and from the bed, where Resident #24 was lying. Interview on 08/06/25 at 1:30 P.M. with Certified Nursing Assistant (CNA) #235 confirmed the visibly soiled privacy curtain in Resident #24's room. CNA #235 stated housekeeping usually will change out the soiled privacy curtains for clean ones as needed. [...]

Inspectors wroteBased on record review and interview, the facility failed to provide showers per resident preference and shower schedule. This affected one (Resident #27) of four residents reviewed for activities of daily living (ADL's). The facility census was 79.

Inspectors wroteBased on record review,staff interviews, and facility policy review, the facility failed to complete weekly skin assessments for Resident #39 who the facility identified as having surgical wounds upon admission. This affected one Resident (Resident #39) out of one resident reviewed for skin impairment. The facility census was 79. Findings Include: Review of the medical record for Resident #39 revealed admission date of 06/06/25 with diagnoses of aftercare for surgical repair of fracture to right ankle, atrial fibrillation (an irregular heartbeat), diabetes mellitus type two, chronic osteomyelitis, esophageal varices (bleeding of small blood vessels in the esophagus, liver cirrhosis (chronic liver damage), and congestive heart failure. [...]

Inspectors wroteBased on observation, record review and interview, the facility did not ensure appropriate treatment and equipment were provided to Resident #54 for bilateral hand contractures to prevent further decrease in range of motion. This affected one resident (#54) of one resident reviewed for range of motion/mobility. The facility census was 79. Findings Include:Review of the medical record for Resident #54 revealed admission to facility on 11/22/23 and reentry on 10/09/24. Pertinent diagnoses included bilateral hand contractures and Amyotrophic Lateral Sclerosis (ALS). Review of the physician orders from 11/22/23 to 08/07/25 for Resident #54 revealed there were no orders for bilateral hand splints. Further review revealed an order dated 04/14/2 for referral to a hand specialist for bilateral hand contractures. [...]

Inspectors wroteBased on interview, record review and review of the facility policy, the facility failed to ensure a thorough investigation was completed for a fall. This affected one (Resident #5) out of one resident reviewed for falls. Facility census was 79.

Inspectors wroteBased on record review, observation, interview and review of facility policy, the facility failed to provide respiratory care per physician order for Resident #77. This affected one resident (Resident #77) of three residents reviewed for Respiratory Care. The facility identified 23 additional residents (#8, #22, #2, #20, #36, #92, #88, #1, #58, #18, #27, #33, #28, #6, #5, #63, #21, #14, #54, #55, #70, #78 and #44) as receiving oxygen therapy. The facility census was 79.

Inspectors wroteBased on record review, staff interview and facility policy review the facility failed to implement non-pharmacological interventions for pain management. This affected one resident (Resident #24) out of two residents reviewed for pain management. The facility census was 79. Findings Include: Review of the medical record for Resident #24 revealed an admission date 02/10/25 with diagnoses including osteomyelitis of vertebra, Multiple Sclerosis (MS), heart failure, sepsis, and depression. Resident #24 had intact cognition and was non-ambulatory. Review of Resident #24's physician orders revealed an order dated 07/18/25 for pain medication of Tramadol 50 milligram (mg) give one tablet by mouth every eight hours as needed for pain and an order dated 07/18/25 for pain medication of Tylenol 325 mg give two tablets (650 mg) by mouth every six hours as needed for pain. [...]

Inspectors wroteBased on observation, medical record review, interview, and policy review the facility failed to ensure urinary catheter care was provided and failed to assess the resident's urinary status and condition when the resident experienced no urinary output for two days and minimal output the third day resulting in transfer to the hospital for treatment of a clogged urinary catheter. This affected three residents (#14, #66, and #80) of three residents reviewed for urinary catheters. Actual Harm occurred on 02/12/25 when the facility failed to provide timely and necessary indwelling urinary catheter care to Resident #80 resulting in increased pain and the resident being transferred to the hosptial. [...]

Inspectors wroteBased on review of email communication, observation, and interview the facility failed to ensure the facility units for heating and cooling (packaged terminal air conditioner/PTAC) were maintained. This was observed in four rooms (Rooms 101, 215, 303, and 412) out of five heating and cooling units observed.

Inspectors wroteBased on closed medical record review, review of photos, and interview the facility failed to ensure podiatry services and foot care were provided. This affected two residents (#81 and #82) of three closed records reviewed.

Inspectors wroteBased on medical record review, review of fall investigation, observation, and interview the facility failed to ensure fall interventions were in-place per the resident's plan of care. This affected one (Resident #66) of three records reviewed for falls.

Inspectors wroteBased on closed medical record review, review of drug information, and interview the facility failed to ensure a resident's drug regimen was free from unnecessary medication when the resident was administered morphine not in accordance with hospice orders. This affected one resident (#81) of three resident records reviewed for death.

Inspectors wroteBased on observation, taste tray, food temperature, policy review, and interview, the facility failed to prepare food to enhance texture and serve at an appetizing temperature. This affected all 83 of 83 residents in the facility. The facility census was 83.

Inspectors wroteBased on observation and interview, the facility failed to ensure food was stored, prepared and held under sanitary conditions. This affected all 83 of 83 the residents in the facility The facility census was 83.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to clearly identify rooms of residents on isolation precautions to prevent the spread of infection. This had the potential to affect all 86 residents.

Inspectors wroteBased on observation, staff interviews, and facility policy review, the facility failed to ensure staff members were properly washing their hands in the kitchen to prevent contamination. This had the potential to affect all 81 residents who received food from the kitchen. The facility identified all residents as receiving food from the kitchen. The facility census was 81.

Inspectors wroteBased on observation, staff interview, and review of facility spreadsheets and recipes, the facility failed to ensure the recipe for puree chicken and dumplings was followed and the correct portion size of chicken and dumplings was served to those residents on a regular and puree diet. This had the potential to affect 60 residents who were on either a regular or puree consistency diet. The facility identified 21 residents as being on a mechanical soft diet, and there were no residents who didn't receive food from the kitchen. The facility census was 81.

Inspectors wroteBased on medical record review and staff interview, the facility failed to adequately inform/specify in writing, services that would be discontinued. This affected three residents (#22, #234, and #235) of three residents reviewed for beneficiary notices. The census was 81. Findings Include: 1. Medical record review revealed Resident #22 was admitted to the facility on [DATE] with diagnoses including respiratory failure, chronic kidney disease, pneumonia, and muscle weakness. Review of Resident #22's Notice of Medicare Non-Coverage (NOMNC) form, dated 11/17/23, revealed services would discontinue on 11/20/23. The NOMNC form did not specify which services would be discontinued. The form stated, the effective date coverage of your current skilled nursing facility will end: 11/20/23. [...]

Inspectors wroteBased on record review, staff interview and facility policy review, the facility failed to send a written transfer/discharge notice for Resident #57 and #76 reviewed for hospitalization and failed to notify the ombudsman of discharge for Resident #26, #57 and #76. This affected three residents (#26, #57, and #76) of three residents reviewed for transfer/discharges. The facility census was 81.

Inspectors wroteBased on record review, staff interview, and facility policy review, the facility failed to ensure written bed hold notices were provided for Resident #57 and Resident #76 at the time of transfer. This affected two residents (#57 and #76) of three residents reviewed for hospitalizations. The facility census was 81.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure all resident Pre-admission Screening and Resident Review (PASARR) documents were accurate to reflect resident current conditions and diagnoses. This affected three residents (#52, #54, and #66) of four residents reviewed for PASARR documents. The census was 81. Findings Include: 1. Medical record review revealed Resident #52 was admitted to the facility on [DATE] with diagnoses including heart failure, emphysema, protein calorie malnutrition, psychotic disorder with hallucinations, depressive disorder, and anxiety disorder. Review of Resident #52's PASARR document, dated 10/29/21, revealed under Section E, there were no diagnoses listed. [...]

Inspectors wroteBased on observation, record review, facility policy review, and interview, the facility failed to ensure residents were free from accident hazards and received adequate assistance to prevent accidents. This affected two residents (#29 and #58) of five residents reviewed for accidents. The facility census was 81.

Inspectors wroteBased on medical record review and staff interview the facility failed to ensure staff members documented resident care provided appropriately. This affected one resident (#74) of one resident reviewed for nephrostomy tubes. The facility census was 81.

Inspectors wroteBased on record review and interview, the facility failed to provide a skilled nursing facility advanced beneficiary notice form to Resident #19 and #40 when they were cut from skilled nursing care and remained in the building. The facility also failed to ensure Resident #177 received notification of medicare non-coverage prior to being cut from skilled therapy services and discharged to the community. This affected three residents (Resident #19, #40 and #177) of three residents reviewed for beneficiary protection notification (cut letters).

Inspectors wroteBased on interview and record review, the facility failed to ensure Resident #40 received an accurate Preadmission Screening and Resident Review (PASRR) screen upon admission to the facility. This affected one resident (Resident #40) out of one resident reviewed for PASRR to the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure therapy recommendations for a functional maintenance ambulation program and a Range of Motion (ROM) restorative nursing program were implemented for Resident #39. This affected one resident (Resident #39) of two residents reviewed for therapy.

Inspectors wroteBased on medical record review, policy review, and staff interview, the facility failed to ensure appropriate indication for use of an indwelling urinary catheter and catheter care was documented as completed. This affected one (Resident #15) of two residents reviewed for indwelling urinary catheters.