St. Martin's in the Pines

Inspectors wroteBased on observation, interview, record review, and facility document and policy review, the facility failed to prevent a fire in a kitchen near residents. Specifically, kitchen staff placed plastic and foam containers in an oven on the second and third floor kitchens of Cottage B, causing the containers to melt and excessive smoke to [NAME] out of the oven into an area near residents. It was determined the facility's non-compliance with one or more requirements of participation caused, or was likely to cause, serious injury, harm, impairment, or death to residents. The Immediate Jeopardy (IJ) was related to 483.25(d)(1) (Accidents). The IJ began on 06/23/2025 at 11:46 AM when Food Service Worker (FSW) #24 placed five plastic containers and one foam to-go container holding food for a lunch meal into an oven set to the warm setting on the second floor of Cottage B. [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure residents were provided baths/showers for 2 (Resident #70 and Resident #77) of 11 residents reviewed for activities of daily living (ADLs).

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to have an effective pain management program for 1 (Resident #98) of 1 resident reviewed for pain management.

Inspectors wroteBased on observation, interviews and review of a facility policy titled Section: SANITATION AND INFECTION CONTROL Subject: HAND HYGIENE, the facility failed to ensure the Certified Nursing Assistant (CNA) in the 3rd floor kitchen of Cottage A washed her hands before returning to the kitchen after assisting a resident. This had the potential to affect all 9 residents residing on the 3rd floor of Cottage A. Findings Include: A review of a facility policy Section: SANITATION AND INFECTION CONTROL Subject: HAND HYGIENE, revised 1/15, revealed: Policies: In the Food & Nutritional Services Department: All associates associated with the handling of food shall wash hands. Hands are washed with soap and water at the following times: . Before putting on gloves . After taking a break/when returning to the kitchen . After any other activity that may contaminate the hands . [...]

Inspectors wroteBased on observations, record review, interviews, and review of Fundamentals of Nursing, Ninth Edition, the facility failed to ensure Resident Identifier (RI) #4's tube feeding bottle was labeled. This affected one of one resident sampled for tube feeding. Findings Include: Review of Fundamentals of Nursing, Ninth Edition, copyright 2017, Chapter 45 Nutrition, page 1082, revealed: . SAFETY GUIDELINES FOR NURSING SKILLS . When performing the skills in this chapter, remember the following points to ensure safe, individualized patient care. * Label enteral equipment with patient name and room number; formula name, rate, and date and time of initiation; and nurse initials . RI #4 was readmitted to the facility on [DATE] with a diagnosis of Dysphagia, oropharyngeal phase. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident Indentifier (RI) # 104's hospice care plan was revised when he/she was discharged from Hospice services. This affected Resident Identifier (RI) #104, one of 26 sampled residents for whom care plans were reviewed. Findings Include: RI #104 was re-admitted to the facility on [DATE] with the diagnosis of Vascular Dementia Without Behavioral Disturbance. A review of RI #104's Discharge Summary from Hospice revealed that the hospice start date was 12/11/2017, and the end date was 08/03/2018. A review of RI #104's Physician Order dated 08/03/2018 revealed: Discharge from Hospice due to prolonged prognosis. On 09/26/18 at 03:10 p.m., the surveyor reviewed RI #104's care plans, including the hospice care plan. There was no revision indicating RI #104 had been discharged from hospice services. [...]

Inspectors wroteBased on observation, interview, and review of the facility's policy titled, FOOD AND SUPPLY STORAGE PROCEDURES, the facility failed to ensure: 1. the kitchen staff air dried dishes, pots and pans; and 2. 17 four fluid ounce prune juice cups with a manufactured use by date of 09/07/2018 were not expired. These findings had the potential to affect all 9 residents living on the second floor in Cottage B and all ten residents living on the second floor in Cottage A. Findings Include: 1. On 9/25/18 at 9:55 a.m., Employee Identifier (EI) #5, Certified Nursing Assistant, hand dried with a paper towel three pots and pans, a metal bowl, a divided plate, four bowls and four plates, a serving tray, then placed them into the cabinets. On 9/26/18 at 1:32 PM EI #5 was interviewed. [...]

Inspectors wroteBased on observation, interview, review of the 2013 Food Code, review of the facility's policies for Cleaning of Food and Nonfood Contact Surfaces, and Sanitizing Food Contact Surfaces, and review of the manufacturer's instructions for Oasis 146 Multi-Quat Sanitizer; the facility failed to ensure: 1.) Food was frozen solid in the kitchenette freezer of Cottage A on the second floor, as observed on two of three days of the survey. This had the potential to affect 10 of 10 residents receiving meals from this kitchenette. 2.) The sanitizer concentration in the three-compartment pot and pan sink was verified on 8/23/17 per the manufacturer's instructions. This had the potential to affect all 116 residents receiving food from the main kitchen, 116 of 117 residents in the facility. [...]

Inspectors wroteBased on observations, staff interview, a review of the 2013 Food Code, and a review of the facility's policy for Solid Waste Disposal, the facility failed to ensure the lid to one of two dumpsters was closed on 8/23/2017, which could result in the harborage and feeding of pests. The facility further failed to ensure that food residue, food-related trash, clutter, weeds, pinestraw, foul odor, and flies were not present in the area surrounding the dumpsters and oil refuse container. In addition, three of four side doors on the two dumpsters had a build-up of food residue under the side doors on the exterior walls of the dumpsters. This had the potential to affect 117 of 117 residents residing at the facility. Findings Include: A review of the 2013 Food Code by the United States Public Health Services (USPHS) and the Food and Drug Association (FDA) included the following: . [...]

Inspectors wroteBased on record review, a facility policy titled, Baseline Care Plan, and interviews, the facility failed to ensure care plans were developed for: 1. incontinence care for RI (Resident Identifier) #s 4, 6, and 8. 2. the use of the Bi-pap machine for RI #s 1 and 4. 3. catheter care for RI #4. 4. the use of an antipsychotic medication for RI #6. 5. the managment of anxiety for RI #6. This affected RI #s 1, 4, 6, and 8, four of twenty four sampled residents. This was observed in three of four units of the facility that housed residents. Findings Include: A review of a facility policy titled, Baseline Care Plan, with a revision date of 2017, revealed: . Policy: The facility will develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. 1. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a care plan was followed for a sippy cup as ordered by the physician. This affected RI (Resident Identifier) #8, one of fourteen sampled residents. Findings Include: RI #8 was readmitted to the facility on [DATE] with diagnoses including Hypertension, Diabetes Mellitus Type 2, Vascular Dementia, and Dysphagia. A review of RI #8's Annual MDS (Minimum Data Set), with an assessment reference date of 5/16/17, revealed RI #8 required extensive assistance with ADLs (Activities of Daily Living). RI #8 required limited assistance with eating. RI #8's Care Plan with a review date of 8/14/17 revealed, Nutrition/hydration risk related to chewing/swallowing difficulty, dx (diagnosis) of dysphagia, needs assistance/cueing at meals, dependence on staff for the provision of fluid intake and eating . [...]

Inspectors wroteBased on observations, interviews, and record reviews, including a facility policy titled, Section: RESIDENT FOOD SERVICES Subject: ADAPTIVE EATING EQUIPMENT, the facility failed to ensure an assistive device of a sippy cup ordered by the physician was provided for RI (Resident Identifier) #8. This was observed on 2 of 3 survey days. This affected RI #8, one of fourteen sampled residents. Findings Include: A facility policy with a revised date of 9/13 and titled, Section: RESIDENT FOOD SERVICES Subject: ADAPTIVE EATING EQUIPMENT, revealed, POLICY: Adaptive eating equipment will be available to any resident for whom the equipment would be beneficial in assisting the resident's ability to self-feed. [...]

Inspectors wroteBased on observation, interviews, and a review of a the facility policy titled, Perineal Care, the facility failed to ensure staff removed soiled gloves and washed hands before placing a clean adult brief on RI (Resident Identifier) #12, opening blinds, and opening RI #12's door to leave RI #12's room. This affected RI #12, one of six residents observed for incontinence care. Findings Include: A review of the facility's policy titled, Perineal Care, with a REV. 6/02, 3/08, 7/12. POLICY Peri-Care is to be performed after each incontinent episode, EQUIPMENT . PROCEDURE . FEMALE ELDER . 3. Apply brief if needed. 4. Bag soiled items for laundry and place ., 5. Bag all throw-away items ., 6. Remove soiled gloves. 7. Reposition elder and re-open blinds, curtains, and door. NOTES: .Remember to remove gloves before touching linens, call light, or other items in the room. [...]