The Lev at Winchester

Inspectors wroteBased on interview and record review the facility failed to ensure the residents were given the right to participate in the development and implementation of their plans of care for 1 of 9 residents (Resident #1) reviewed for participating in care planning. The facility did not conduct a meeting nor invite Resident #1 to participate in resident care planning meetings after his quarterly review assessments on 5/23/25, 8/22/25 and 10/29/25. This failure could place residents at risk for a loss of independence, psychosocial well-being and the opportunity for them to participate in the planning of their care. Findings Included: [...]

Inspectors wroteBased on record review and interview, the facility failed to use the services of a registered nurse for at least eight consecutive hours a day, 7 days a week for 4 of 5 months (January, February, April, and May of 2025) reviewed for nursing services. The facility failed to ensure a registered nurse worked on 1 day out of 31 days in January of 2025. The facility failed to ensure a registered nurse worked on 3 days out of 28 days in February of 2025 The facility failed to ensure a registered nurse worked on 1 day out of 30 days in April 2025. The facility failed to ensure that a registered nurse worked 2 days out of 31 days in May of 2025 These failures could place residents at risk by leaving staff without supervisory coverage for RN specific nursing activities and for coordination of events such as emergency care and disasters.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 (Resident #58) of 7 residents reviewed for quality of care. -Resident #58 developed a sacral (bone at the base of the spine and the surrounding area) wound on 08/01/25 and the facility did not get physician orders to treat the sacral wound until 08/05/25. This failure placed resident at risk for further skin breakdown to the sacral wound, infections, and pain.

Inspectors wroteBased on interview and record review, the facility failed to establish, maintain and implement identical policies and practices regarding transfer and discharge and the provision of services for all individuals regardless of source of payment for 1 (Resident #5) of 4 residents reviewed for equal access to quality care. The facility failed to ensure Resident #5's right to stay in the facility and he was transferred to the hospital because his payor source ended. The failure could place residents at risk of a loss of self-determination and dignity.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the assessment accurately reflected the resident's status for 2 (Resident#27 and Resident #31) of 14 residents reviewed for accuracy of assessments. The facility failed to ensure Resident#27's significant change MDS assessment dated [DATE] accurately reflected her lack of natural teeth in her oral cavity. The facility failed to ensure Resident #31's comprehensive MDS assessment dated [DATE] accurately reflected her decaying and lack of natural teeth in her oral cavity. This failure could place residents at risk for receiving inadequate care and services due to inaccurate assessments.

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 disease and infections for 1 (Resident #65) of 7 residents reviewed for infection control.-LVN F was carrying soiled linen in hand from Resident #65's room up the hallway and placed it inside of the soiled barrel on the hallway. This failure placed residents, staff members, and visitors at risk for cross contamination and infections.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure in accordance with State and Federal laws,all drugs and biologicals were stored in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for 3 of 3 nurse medication carts reviewed for medications . 1. The facility failed to ensure 2 of 3 nurses' medication carts did not contain expired oral medications. 2. The facility failed to ensure 1 of 3 nurse's medication carts did not contain expired suppository medication. These failures could place residents at risk for altered effectiveness of the medication and decreased therapeutic outcomes, requiring medical intervention.

Inspectors wroteBased on interview and record review the facility failed to ensure the services of a registered nurse were used for at least eight consecutive hours a day, seven days a week for 1 out of 30 days reviewed June 2024. The facility failed to ensure RN coverage for Sunday, 06/02/2024 . This failure could place residents at risk for not having adequate qualified personnel in case of a health crisis.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that a resident who needed respiratory care was provided with such care, consistent with professional standards of practice for 1 (Resident #8) of 2 resident reviewed for respiratory care, in that: -The facility failed to set the oxygen flow rate at 3 liters of oxygen per minute as ordered on 11/27/2023 for Resident #8. This deficient practice could place residents at risk of inadequate respiratory support or respiratory infections resulting in a decline in health.

Inspectors wroteBased on interview and record review the facility failed ensure, except when waived, to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. -The facility failed to ensure there was RN (Registered nurse) coverage on 1/8/23, 1/14/23, 1/21/23, 1/22/23, 2/4/23, 2/5/23, 2/26/23, 3/11/23, 3/12/23, 3/18/23, 3/19/23, 3/25/23, and 03/26/23. This failure could place residents at risk of not having their nursing and medical needs met. Findings Included: During an interview with the DON on 04/06/2023 at 10:05 AM, she stated she normally worked Monday- Friday, 8AM-5PM. She stated she works during the week and when available she works on the weekends. She stated the facility recently hired two RNs for the weekends. She stated for about 2 months, she was the only RN working at the facility. She stated during the times she was not physically at the facility; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in one of one kitchen reviewed for food service safety, in that: The failure could place residents at risk of foodborne illness. -Staff personal items were stored with resident's food.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection and prevention control program that included, at a minimum, a system for preventing and controlling infections for 1 of 1 resident observed for blood glucose monitor for (Resident #42) and 1 of 1 resident observed for feeding assistance (Resident #28). 1. LVN D failed to properly change gloves and wash or sanitize hands after providing blood glucose monitor to Resident #42. 2. CNA B failed to properly wash or sanitize her hands after scratching her head while providing feeding assistance to Resident #28. This deficient practice placed 1 of 1 resident who received frequent blood glucose monitoring and 1 of 1 resident require feeding assistance at risk for cross contamination and/or spread of infection.

Inspectors wroteBased on interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete and accurately documented for 1 of 2 residents (Resident #27) reviewed for indwelling catheter care. 1. Resident #27's indwelling catheter bag was undated. 2. Resident #27's electronic data chart had not record of indwelling catheter's last change or placement date. This deficient practice placed 2 residents who require indwelling catheter care and 86 residents who require electronic data charting at risk for errors in care and treatment.

Inspectors wroteBased on record reviews and interviews the facility failed to document if the resident received the pneumococcal immunization, Covid-19 vaccination, or the Mantoux tuberculin skin test due to medical contraindication or refusal for 1 of 9 residents (#83) whose medical records were reviewed for immunizations: 1. Resident #83's medical record had no immunization records being administered or refused. This deficient practice could affect 86 residents who were admitted since April 2021 and put them at risk for infection.