The Orchards at Canterbury on the Lake

Inspectors wroteThis citation pertains to Intake 2698293Based on interview and record review, the facility failed to ensure proper positioning and to maintain proper bed mobility for one (R701) of two residents reviewed for accidents resulting in R701 falling out of bed during activity of daily living [ADL] care and being transferred to the hospital.

Inspectors wroteThis citation pertains to Complaint #2649498Based on interview and record review, the facility failed to notify the resident's responsible party of a change of condition after a fall and a subsequent emergent transfer to the hospital for one (R801) of one resident reviewed for notification of changes.

Inspectors wroteThis citation pertains to intake 2643927Based on observation, interview and record review, the facility failed to ensure medications were available to administer per the Physician's orders for two residents (R901 and R902) of two residents reviewed for medication administration.

Inspectors wroteThis citation pertains to intake 2643927Based on observation interview and record review, the facility failed to ensure sufficient staffing was provided to meet resident needs for two residents (R901 and R903) of three residents reviewed for staffing.

Inspectors wroteThis citation pertains to intake 2643927Based on observation, interview and record review, the facility failed to ensure enhanced barrier precautions were provided for one resident (R901) of two residents reviewed for infection control.

Inspectors wroteThis citation pertains to Intake Number MI001227212. This citation has two deficient practice statements (DPS). DPS #1 Based on observation, interview, and record review, the facility failed to assess a new skin impairment and implement treatments in a timely manner and according to physician's orders for two (R55 and R49) of four reviewed for non-pressure skin impairments, resulting in a wound to R55's arm becoming infected with delayed healing.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prepare food in accordance with professional standards for food service safety. This deficient practice has the potential to result in food borne illness among all residents that consume food from the kitchen.

Inspectors wroteBased on observation, interview and record review the facility Quality Assurance and Quality Improvement (QAPI) program failed to identify and implement plans to address systemic issues regarding Infection Control and Pest Control which had the ability to affect the health, safety and quality of life for all residents who resided in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an effective pest control program by eliminating harborage conditions and provision of routine and/or as needed pest control which had the potential to affect all residents (including R8) in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure safe and appropriate storage for three medication (med) carts and one medication (med) storage room of four med carts and two med storage rooms that were reviewed for medication storage and labeling.

Inspectors wroteBased on observation, interview and record reviews the facility failed to ensure infection control standards, practices and protocols were followed consistently, failed to ensure an effective infection control surveillance program and failed to follow the county's health department guidance regarding the monitoring of legionella that included seven (R's 57, 5, 34, 142, 143, 63 & 144) of seven residents reviewed.

Inspectors wroteBased on interview and record reviews the facility failed to ensure an effective system to monitor antibiotic use in the facility for four (R's 145, 14, 8 & 126) of four residents reviewed.

Inspectors wroteBased on observation, interview and record reviews the facility failed to ensure a dignified dining experience for one (R14) of one resident reviewed for dining, which had the ability to affect multiple residents who dined in the second floor dining room.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure call lights were within reach for two residents (R#'s 49 and 20), of two residents reviewed for accommodation of needs, resulting in the potential for delayed attention to resident care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure two (R55 and R30) of three residents reviewed for Advance Directives were educated and given the opportunity to formulate an advance directive for their health care wishes.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure resident equipment was maintained in good repair for one (R8) of three residents reviewed for a homelike environment.

Inspectors wroteBased on observations, interview and record review the facility failed to protect the resident's right to be free from neglect for one (R141) of five residents reviewed for abuse resulting in R141 being left on a bedpan for four hours.

Inspectors wroteBased on observation, interview and record review the facility failed to protect a resident from exploitation for one (R124) of five residents reviewed for abuse.

Inspectors wroteBased on interview and record review, the facility failed to ensure a stop-date for a PRN (as needed) order for anti-anxiety medication for one resident (R120), of five residents reviewed for unnecessary medications.

Inspectors wroteThis citation pertains to intake #1227216 Based on interview and record review the facility failed to report an allegation of neglect and an injury of unknown origin to the State Agency for two residents (R138 and R141) of five residents reviewed for abuse, neglect and mistreatment.

Inspectors wroteThis citation pertains to intake #1227216Based on interview and record review the facility failed to complete and document a thorough investigation into an injury of unknown origin for one resident (R138) of five residents reviewed for abuse/neglect/mistreatment.

Inspectors wroteBased on interview, and record review, the facility failed to ensure a Minimum Data Set (MDS) Assessments was completed accurately for one (R120) of three reviewed for the resident assessment task.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a comprehensive resident centered care plan was developed and implemented for an anxiety disorder for one (R30) of five residents reviewed for unnecessary medications.

Inspectors wroteThis citation pertains to intake #1227212Based on observation, interview, record review the facility failed to consistently provide bathing assistance/services for one (R63) of seven residents reviewed for Activities of Daily Living (ADL).

Inspectors wroteBased on observation, interview and record review the facility failed to ensure bed mobility was performed in a safe manner for one (R105) of three residents reviewed for accidents.

Inspectors wroteBased on observation, interview and record reviews the facility failed to ensure timely reviewal of the pharmacist recommendations, physician review/documented response of the pharmacist recommendations, maintain documentation of the pharmacist recommendations in the medical record and establish and implement a facility policy for drug regimen reviews for two (R's 30 & 121) of five residents reviewed for unnecessary medications.

Inspectors wroteBased on interview and record review, the facility failed to maintain complete and accurate medical records for one (R96) of one residents reviewed for medical records.

Inspectors wroteBased on interview and record review the facility failed to ensure facility staff had a clear understanding of the Binding Arbitration agreement and residents received a clear explanation of the agreement prior to signing a legal document for two (R84 and R80) of three residents reviewed for the Arbitration Task.

Inspectors wroteThis citation pertains to intake #MI00152409. Based on interview and record review the facility failed to address grievances for one resident, (R702) of two residents reviewed for grievances, resulting in verbalized frustrations with quality of care.

Inspectors wroteThis citation pertains to Intake Number(s): MI00151836. Based on observation, interview, and record review, the facility failed to thoroughly investigate multiple falls to determine the root cause and implement effective interventions that included adequate supervision for one (R805) of two residents reviewed for falls, who had repeated falls, resulting in the resident falling 15 times in three months and sustaining a head injury and forehead laceration.

Inspectors wroteThis citation pertains to Intake Number(s): MI00151890. Based on interview and record review, the facility failed to report an allegation of misappropriation of property to the Administrator and/or State Survey Agency for one (R802) of three residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake Number(s): MI00151836. Based on observation, interview, and record review, the facility failed to ensure medications were stored properly and discarded by the expiration date for two of two medication carts reviewed.

Inspectors wroteThis citation pertains to intake #MI00149313. Based on interview and record review the facility failed to ensure regularly scheduled bathing was provided for one resident (R902) of two residents reviewed for activities of daily living (ADL's).

Inspectors wroteThis citation pertains to intake #'s MI00147613 and MI00147486. Based on observation, interview and record review, the facility failed to protect the resident's right to be free from physical and verbal abuse by Certified Nursing Assistant C (CNA C) for one resident (R901) of two residents reviewed for abuse/neglect/mistreatment, resulting in R901 being in pain from being punched, kicked and the target of derogatory language.

Inspectors wroteThis citation pertains to intake #MI00147486. Based on observation, interview and record review the facility failed to develop and/or implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act resulting in a delay in notification of the allegation to the abuse coordinator and delay in reporting the allegation to the State Agency for one resident (R901) of two residents reviewed for abuse/neglect/mistreatment.

Inspectors wroteThis citation pertains to intake #s MI001146438, MI00146642, and MI00146819. Based on observation, interview, and record review facility failed to provide sufficient nursing staff to meet the needs of residents, including four (R802, R804, R805, and R806) of four residents reviewed for sufficient nursing staff. This deficient practice has the potential to affect all residents that reside at the facility.

Inspectors wroteBased on interview and record review the facility failed to ensure the facility assessment was reviewed and revised in accordance with current regulatory requirements including changes in resident care needs (R805) and administrative changes, resulting in insufficient resources to provide for resident care and emergency/disaster needs for all 97 residents.

Inspectors wroteThis citation pertains to intake #MI00146443. Based on observation, interview and record review, the facility failed to protect the resident's right to be free from physical abuse by another resident between two (R803 and R804) of 11 residents reviewed for abuse.

Inspectors wroteThis citation pertains to intake #s: MI00146438, MI00146642, and MI00146819. Based on observation, interview, and record review, the facility failed to provide one-to-one feeding assistance for one resident (R806) of three residents reviewed for activities of daily living.

Inspectors wroteThis citation pertains to intake #s: MI00146642 and MI00146819. Based on observation, interview, and record review, the facility failed to provide drink and adaptive utensils per assessment and individualized care plan for one (R806) of three residents reviewed for dining.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure enough kitchen staff were available to prepare and serve meals in a timely manner. This deficient practice had the ability to affect multiple residents who received meals at the facility, including but not limited to R5, R28 and R64.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a sanitary kitchen, maintain equipment in good repair, and safely store and handle food, resulting in an increased risk of foodborne illness, affecting all residents in the facility.

Inspectors wroteBased on observations, interview and record review, the facility failed to ensure all staff followed proper infection control practices and protocols including transmission-based precautions and Enhanced barrier precautions for five (R7, R18, R49, R63, R298) of five residents reviewed for Infection Control.

Inspectors wroteThis citation pertains to intake: MI00145365. Based on observation, interview, and record review the facility failed to protect the rights of one resident (R26) to be free from resident-to-resident verbal and physical abuse by R67 resulting in continued abuse to have occurred.

Inspectors wroteThis citation has two deficient practices (DPS). DPS #1 Based on observation, interview and record review the facility failed to implement Physician treatment orders in a timely manner for one resident (R28) of three residents reviewed for pressure ulcers.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide timely meals, resulting in late meal times outside of resident preferences and needs, affecting residents on the 2nd floor and in resident council.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Infection Control Preventionist attended the QAPI (Quality Assurance and Performance Improvement) meetings at least quarterly, resulting in the potential for lack of coordination of resident care policies and overall medical care that could affect all 101 residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to implement an antibiotic stewardship program that consistently identified signs and symptoms of infection and failed to provide clinical justification for the use of antibiotic medications with the potential to affect all residents (including R88) requiring antibiotics in the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate advance directive information, including social service assessment and a physician order for a Do-Not-Resuscitate (DNR) was in place for one (R83) of five residents reviewed for advance directives.

Inspectors wroteBased on interview and record review, the facility failed to complete an annual OBRA (Omnibus Budget Reconciliation Act) Level I evaluation to determine if a Level II Evaluation was needed, or if exemption was identified for one (R31) of one resident reviewed for PASARR (Preadmission Screen and Resident Review).

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a care plan for oxygen use and specific transmission-based precautions for one (R18) of 25 residents reviewed for comprehensive care plans.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a shower for one (R349) of three residents reviewed for activities of daily living.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was transferred appropriately to prevent injury and ensure a thorough investigation was completed for one (R26) out of three residents reviewed for accidents/falls.

Inspectors wroteBased on interview and record review, the facility failed to ensure medication regimen reviews were conducted by the consultant pharmacist monthly for one (R18) of five residents reviewed for medication regimen reviews.

Inspectors wroteBased on observation, interview, & record reviews the facility failed to ensure residents were free from significant medication errors in regard to seizure medications for two (R18 and R88) of two residents reviewed for medication errors, resulting in delayed administration, delayed physician notification, and increased seizure risk.

Inspectors wroteBased on observation, interview and record review, the facility failed to timely notify the physician of abnormal laboratory results for one (R26) of two reviewed for laboratory services.

Inspectors wroteThis citation pertains to intake #MI00145467. Based on observation, interview and record review, the facility failed to ensure resident food preferences were honored for six residents (R28, R36, R49, R56, R72, R74, and R78) as well as multiple attendees at the confidential resident council meeting, resulting in verbalized complaints and dissatisfaction with meals.

Inspectors wroteBased on observation, and record review, the facility failed to eliminate pest harborage conditions, resulting in a presence of flying pests, affecting all residents in the facility.

Inspectors wroteThis citation pertains to intake(s): MI00144553 & MI00144307. Based on observation, interviews, and record reviews the facility failed to document follow-up and addressed concerns per the facility's Concern/Complaint Policy and Procedure for two (R's 901 & 902) of two residents reviewed for quality of care.

Inspectors wroteThis citation pertains to intake #MI00143969. Based on observation, interview and record review, the facility failed to maintain a clean, comfortable, safe, and homelike environment, as evidenced by offensive odors, soiled floors, walls, and trash/debris left in the main dining rooms. This deficient practice has the potential to affect multiple residents throughout the facility.

Inspectors wroteThis citation pertains to intake #MI00143969. Based on observation, interview, and record review, the facility failed to ensure infection control protocols (handwashing and/or use of hand sanitizer) were followed for a resident on enhanced barrier precautions (EBP) for one (R904) resident reviewed for infection control.

Inspectors wroteBased on interviews/record review, the facility failed to develop and/or implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act for one (R900) of one resident reviewed for abuse.

Inspectors wroteThis citation pertains to Intake#: MI00138928 Based on interviews and record review, the facility failed to (1) consistently monitor the change in condition for a Resident (R905) with Congestive Heart Failure (CHF - inability of the heart to pump blood efficiently, causing shortness of breath, fatigue, leg and foot swelling, and weakness) and transfer to hospital per advance directives and (2) failed to communicate/coordinate and follow up on the orders by the specialist (cardiologist) timely, resulting in a 9.4 lb.(pound) weight gain (in 4 days), difficulty breathing, discomfort, and death in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure resident dignity for 10 residents (R#'s 58, 6, 82, 73, 52, 56,68,64, 307, and 11) of 10 residents reviewed for dignity, resulting in the potential for embarrassment and decreased feelings of self worth.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a clean, comfortable, and homelike environment for four residents, (R#'s 52, 58, 82, and 10) of four residents reviewed for physical environment. Facility also failed to maintain a clean comfortable home like environment in the dining room on the second floor that had the potential to impact all residents who were using the dining room for their meals and other activities.

Inspectors wroteBased on interview and record review, the facility failed to ensure annual competencies/performance reviews for five of five Certified Nurse Aides (CNA's) reviewed for annual competencies. This deficient practice had the potential to affect all residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to report an allegation of abuse to the Abuse Coordinator and/or State Agency for one (R86) of two residents reviewed for abuse.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an updated/revised plan of care was in place for a contracture for one resident (R38) of four residents reviewed for range of motion/positioning.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide timely and appropriate assistance with Activities of Daily Living (ADL) for two (R6 and R8) of six Residents reviewed for ADL care with potential for negative physical, psychosocial outcomes, and potential loss of dignity for residents who are dependent on staff for assistance.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow up timely with the physician and/or to transfer a resident who had a change of condition to an acute care setting for one (R355) of one reviewed for change of condition resulting in the potential for a decline in health.

Inspectors wroteThis citation has two deficient practices Deficient practice #1 Based on observation, interview, and record review, the facility failed to properly transfer one resident (R6) who required a mechanical lift of four residents reviewed for accidents.

Inspectors wroteThis citation has two deficient practices Deficient Practice #1 Based on observation, interview and record review, the facility failed to ensure assistance with eating was provided to one resident (R60) of five residents reviewed for Nutrition.

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident who was prescribed as needed (PRN) psychotropic medication had adequate behavior monitoring and identification of the resident specific targeted behaviors and non-pharmacological approaches at the time of medication administration for one (R5) of five residents reviewed for unnecessary medication