Tuscany Gardens

Inspectors wroteBased on observations and interview with staff, the facility failed to ensure privacy was maintained during medication administration for Residents #21, #52, #77, #84, #85, and #88. This affected six residents (#21, #52, #77, #84, #85, and #88) of 14 observed for medication administration. Findings Include: 1. Review of the medical record for Resident #85 revealed an admission date of 01/05/26 and diagnoses of diabetes, muscle weakness, cognitive communication deficit, need for assistance with personal care, high blood pressure, constipation, and congestive heart failure. Observation of medication administration on 03/13/26 at 11:35 A.M. revealed Registered Nurse #201 prepared medication at the medication cart outside the room of Resident #85. [...]

Inspectors wroteBased on observation and interview with staff, the facility failed to ensure the medication carts were locked when unattended. This had the potential to affect 9 (#17, #34, #40, #50, #57, #59, #63, #87, and #93) cognitively impaired and independently mobile residents, on the 200 and 300 halls, identified during the survey. Findings Include: 1. Observation of medication administration on 03/13/26 at 11:35 A.M. revealed Registered Nurse #201 prepared medication at the medication cart outside the room of Resident #85. She proceeded to go into the room of Resident #85 without locking the medication cart. On 03/13/26 at 11:44 A.M. an interview with Registered Nurse #201 verified she had not locked the medication cart.2. Observation of medication administration on 03/13/26 at 11:42 A.M. revealed Registered Nurse #201 prepared medication at the medication cart outside the room of Resident #77. [...]

Inspectors wroteBased on observations, review of the medical record, review of the Controlled Drug record, and interview with the staff, the facility failed to ensure the Controlled Drug record and the narcotic count were maintained to identify the actual doses of oxycodone/acetaminophen (a controlled narcotic medication) in the facility and failed to ensure staff did not pre-pour narcotic medication prior to administration for Resident #9. This affected one Resident (#9) of 14 observed for medication administration. Findings Include:Review of the medical record revealed Resident #9 was admitted to the facility on [DATE]. Diagnoses included mood disorder, bipolar disorder, anemia, diabetes, mild cognitive impairment, chronic pain, dementia, insomnia, cataracts, absence of a spleen, and follicular disorder. [...]

Inspectors wroteBased on observation, review of the medical record, interview, and review of facility policy, the facility failed to maintain proper infection control during administration of tube feed medications for Resident #15. This affected one resident (Resident #15) of 14 observed during medication administration. Findings Include: Review of the medical record revealed Resident #15 was admitted to the facility on [DATE]. Diagnoses included Parkinson's disease, chronic obstructive pulmonary disease, anemia, hypothyroidism, gastrostomy, major depressive disorder, generalized anxiety disorder, hallucinations, schizoaffective disorder, adult failure to thrive, and dementia. Review of the Annual Minimum Data Set assessment dated [DATE] revealed Resident #15 had severely impaired cognition and had a feeding tube. Observation of tube feed medication administration on 03/13/26 at 9:58 A.M. [...]

Inspectors wroteBased on observation, record review, staff interview and facility policy review, the facility failed to change and date oxygen tubing and supplies as ordered and failed to store respiratory equipment in a safe and sanitary manner. This affected four residents (#38, #44, #71, #82) of four residents reviewed for respiratory care. The census was 99. Findings Include:1. Review of the medical record for Resident #44 revealed an initial admission date of 05/02/25 with the diagnoses including but not limited to chronic obstructive pulmonary disease (COPD), pulmonary embolism, congestive heart failure, hypertension, chronic kidney disease, hyperlipidemia, gastro-esophageal reflux disease, osteoarthritis, constipation, hypothyroidism, anxiety disorder and chronic respiratory failure. [...]

Inspectors wroteBased on observation, staff interview, and facility policy, the facility failed to ensure proper food storage, labeling, and staff hygiene in the kitchen. This had the potential to affect 93 out of 99 residents residing in the facility, with six residents on nothing by mouth (NPO) diets. The facility census was 99.

Inspectors wroteBased on observations, medical record review, and staff interview, the facility failed to ensure the call light was positioned within reach of one resident. This affected one (Resident #60) of one resident observed for call light placement. The facility census was 99.

Inspectors wroteBased on record review and interview the facility failed to ensure resident preferences were followed for medication administration. This affected one (Resident #103) out of one resident reviewed for choices. The facility census was 99.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure the signed advanced directive for Resident #4 was correct. This affected one (Resident #4) out of three residents reviewed for advanced directives. The facility census was 99.

Inspectors wroteBased on interview ,record review and facility policy, the facility failed to have appropriate diagnosis to support the use of antipsychotic medication for residents and failed to complete labs per pharmacy recommendations and per physician orders. This affected three (Resident #11, Resident #13, and Resident #14) out of five residents reviewed for unnecessary medications. The facility census was 99.

Inspectors wroteBased on interview and medical record review the facility failed to ensure Resident #4 and Resident #99 had accurate Minimum Data Set (MDS) assessments. This affected two (Resident #4 and #99) of 34 medical records reviewed. The facility census was 99.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure timely follow-up for Resident #6's level II Preadmission Screening and Resident Review (PASARR) evaluation. This affected one (Resident #6) out of one resident reviewed for PASARRs. The facility census was 99.

Inspectors wroteBased on record review, resident interview, and staff interview, the facility failed to develop and implement a comprehensive care plan addressing Resident #8's contractures. This affected one (Resident #8) out of nine residents reviewed for activities of daily living. The facility census was 99.

Inspectors wroteBased on observation, record review, staff interview, and resident interview, the facility failed to provide appropriate Activities of daily living (ADL) care for resident's dependent on staff. This affected two (Residents #8 and #70) out of 9 residents reviewed for ADLs. The facility census was 99.

Inspectors wroteBased on medical record review, hospice record review and interview, the facility failed to ensure hospice information, including the hospice certification and plan of care for certification was up to date and available at the facility. This affected one resident (#44) of one resident reviewed for hospice services. The facility census was 99. Findings Include:Review of the medical record for Resident #44 revealed an initial admission date of [DATE] with the diagnoses including but not limited to chronic obstructive pulmonary disease, pulmonary embolism, congestive heart failure, hypertension, chronic kidney disease, hyperlipidemia, gastro-esophageal reflux disease, osteoarthritis, constipation, hypothyroidism, anxiety disorder and chronic respiratory failure. [...]

Inspectors wroteBased on observation, medical record review, interview and facility policy review, the facility failed to comprehensively assess pressure ulcers/injury upon admission/readmission to the facility. This affected two residents (#2 and #4) of seven residents reviewed for pressure ulcers. The facility census was 99.

Inspectors wroteBased on record review, observation, and staff interview, the facility failed to monitor and provide timely follow-up for Resident #8's bilateral wrist contractures. This affected one (Resident #8) out of two residents reviewed for mobility and range of motion. The facility census was 99.

Inspectors wroteBased on observations, staff interviews, medical record review to include hospital records, progress notes, and urology notes, and facility policy review, the facility failed to properly and safely maintain urinary catheters to include the timely address of urology recommendations for one resident's suprapubic catheter. This affected two residents (#60 and #81) of six residents reviewed for catheter care. The facility census was 99.

Inspectors wroteBased on observation, medical record review and interview, the facility failed to ensure residents were provided adaptive equipment to promote independence with eating. Additionally, the facility failed to ensure food residents disliked were not served to residents. This affected one resident (#79) of four residents reviewed for nutrition. The facility census was 99. Findings Include:Review of the medical record for Resident #79 revealed an initial admission date of 10/16/19 with the latest readmission of 11/30/24 with the diagnoses including but not limited to cerebral palsy, chronic respiratory failure, chronic pain syndrome, protein calorie malnutrition, anemia, anxiety disorder, gastro-esophageal reflux disease and neuropathy. [...]

Inspectors wroteBased on observation, medical record review, interviews and review of resident meal ticket, the facility failed to meet the nutritional needs of one resident. This affected one resident (#79) of four residents reviewed for nutrition. The facility census was 99. Findings Include:Review of the medical record for Resident #79 revealed an initial admission date of 10/16/19 with the latest readmission of 11/30/24 with the diagnoses including but not limited to cerebral palsy, chronic respiratory failure, chronic pain syndrome, protein calorie malnutrition, anemia, anxiety disorder, gastro-esophageal reflux disease and neuropathy. Review of the plan of care dated 10/25/19 revealed the resident had the potential for alteration in nutrition and hydration related to malnutrition, dysphagia, cerebral palsy, history of gastrointestinal bleed and anxiety. [...]

Inspectors wroteBased on observations and staff interview, the facility failed to ensure adequate bath linens were available as needed for resident care. This had the potential to affect 48 (#2, #3, #7, #8, #12, #13, #14, #15, #19, #22, #23, #24, #29, #32, #33, #35, #37, #39, #41, #42, #43, #44, #47, #51, #52, #53, #54, #61, #65, #69, #70, #72, #74, #75, #79, #82, #87, #88, #89, #91, #95, #96, #99, #100, #101, #105, #107, and #108) residents residing on the 400 and 500 units of 110 total residents in the facility. The census was 110. Findings Include:Observations on 07/23/25 from 8:00 A.M. to 12:30 P.M. revealed the following there were no washcloths available for resident care in either of the clean linen closets on the 400 unit and there were only five (5) towels available for resident care on the 500 unit. [...]

Inspectors wroteBased on medical record review, review of an incident report, staff interview, and facility policy review, the facility failed to complete a thorough investigation to determine potential neglect of a resident. This affected one (#114) of three residents reviewed for neglect. The census was 110. Findings Include:Review of the medical record revealed Resident #114 was admitted to the facility on [DATE]. Diagnoses included urinary tract infection, enterocolitis, pulmonary fibrosis, muscle weakness, difficulty walking, cognitive communication deficit, morbid obesity, obstructive sleep apnea, major depressive disorder, hereditary and idiopathic neuropathy, repeated falls, hypocalcemia, hyperkalemia, acute kidney failure, hypertension, obstructive and reflux uropathy, chronic obstructive pulmonary disease, atherosclerotic heart disease, and lymphedema. [...]

Inspectors wroteBased on medical record review and staff interview, the facility failed to complete the physician order for a urine culture in an appropriate timeframe for one (#27) of three residents reviewed for orders for urine cultures. The facility census was 110.

Inspectors wroteBased on medical record review, staff interview and resident interview,the facility failed to protect the resident from abuse by staff. This affected one (Resident #54) of four resident records reviewed for abuse. The census was 105.

Inspectors wroteBased on medical record review, resident interview, and staff interview, the facility failed to ensure residents were provided with necessary transportation to attend outside appointments as scheduled. This affected one (Resident #150) of three residents reviewed for transportation to outside appointments. The facility census was 112 residents.

Inspectors wroteBased on interview and medical record review the facility failed to report an allegation of resident-to-resident sexual abuse. This affected one (Resident #12) of three residents reviewed for abuse. The facility census was 112.

Inspectors wroteBased on interview and medical record review the facility failed to thoroughly investigate an allegation of resident-to-resident sexual abuse. This affected one (Resident #12) of three residents reviewed for abuse. The facility census was 112.

Inspectors wroteBased on interview and record review the facility failed to ensure an investigation and appropriate corrective action was implemented after staff used a mechanical lift incorrectly. This affected one (Resident #13) of three residents reviewed for accidents. The facility census was 112.

Inspectors wroteBased on observation, interview, and review of manufacture guidelines the facility failed to remove five expired tuberculin (TB) solution vials from circulation. This had the potential to affect all 108 residents residing in the facility. The facility census was 108. Findings Include: Observation on [DATE] at 1:20 P.M. of unit 400 medication storage refrigerator revealed an opened Aplisol tuberculin (TB) solution vial received from pharmacy on [DATE] with an opened date of [DATE]. Registered Nurse (RN) #212 confirmed the expired opened Aplisol TB solution vial. Observation on [DATE] at 1:30 P.M. of unit 200 medication storage refrigerator revealed an opened Aplisol TB solution vial received from the pharmacy on [DATE] with no opened date. Further observation revealed another opened Aplisol TB solution vial received from the pharmacy on [DATE] with no opened date. [...]

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to implement infection control measures for the cleaning of glucometers (blood sugar meters) and proper hand hygiene during wound dressing change procedures. This affected two residents (Residents #26 and #108) out of eleven residents requiring blood sugar checks on Units 200 and 300, and one resident (Resident #6) out of three residents reviewed for skin pressure injuries. The facility census was 108. Findings Include: 1. Review of Resident #108's medical record revealed Resident #108 was admitted to the facility on [DATE] with the admitting diagnoses including Diabetes Mellitus type two, high blood pressure, hypothyroidism, and weakness. Resident #108 required limited assistance from staff for activities of daily living (ADL) tasks. [...]

Inspectors wroteBased on medical record review, staff interview, observation of wound care, and facility policy review, the facility failed to ensure resident room door and window blind was closed during wound care. This affected one (Resident #6) of one resident reviewed for privacy during wound care. The facility census was 108.

Inspectors wroteBased on record review, resident representative and staff interviews, review of laboratory test results, and facility policy review, the facility failed to notify one resident's representative (Resident #7) of laboratory test results. The facility also failed to notify one resident's (Resident #7) physician/nurse practitioner/physician assistant or resident representative a lab was not completed as ordered. This affected one (Resident #7) of one reviewed for notification of change. The facility census was 108. Findings Include: Review of the medical record for Resident #7 revealed an admission date on 11/16/21. Medical diagnoses included spinal stenosis, chronic obstructive pulmonary disease (COPD), chronic kidney disease Stage 3, and dysphagia (difficulty swallowing) oropharyngeal phase. [...]

Inspectors wroteBased on observation, interview, record review and facility policy review, the facility failed to implement preventative skin interventions to prevent repeated skin infections for Resident #85. Additionally, the facility failed to timely assess a bruise for one resident (Resident #4) and failed to implement physician order for a back brace for one resident (Resident #96). This affected two residents (Resident #4 and #85) out of four residents reviewed for skin integrity and one resident (Resident #96) out of three residents reviewed for positioning devices. The facility census was 108. Findings Include: 1. Review of the medical record for Resident #85 revealed Resident #85 was admitted to the facility on [DATE] with admitting diagnoses including Huntington's Disease, depressive disorder, disorders of the bladder, overactive bladder, impaired communication, and anxiety. [...]

Inspectors wroteBased on medical record review, staff interview, observations, and facility's fall policy, the facility failed to ensure ordered fall interventions were in place. This affected one (Resident #86) of the eight residents reviewed for falls. The facility census was 108.

Inspectors wroteBased on medical record review, staff interview, observations, and facility policy review, the facility failed to assist residents with eating and implementing nutritional interventions with a noted significant weight loss. This affected two (Resident #2 and #70) of the three residents reviewed for nutritional support. The facility census was 108.

Inspectors wroteBased on interview, record review, and observation the facility failed to post safety signs indicating the use of oxygen outside of oxygen-dependent residents' rooms as required. This affected one resident (Resident #20) who receives oxygen. The facility census was 108. Findings Include: Review of the medical record for Resident #20 revealed the resident was admitted on [DATE] for Urinary Tract Infection, Respiratory disorder, and Acute Respiratory Failure. Review of the Care Plan dated 12/23/23 for Resident #20 indicated the resident receives oxygen therapy. Resident #20 suffers from respiratory deficits caused by a history of Coronavirus disease 19, which includes persistent shortness of breath, pneumonia, and respiratory failure. [...]

Inspectors wroteBased on medical record review, staff interview, and facility policy review, the facility failed to administer blood pressure medication according to the physician's order for one resident (Resident #75). This affected one (Resident #75) of five reviewed for unnecessary medications. The facility census was 108. Findings Include: Review of the medical record for Resident #75 revealed an initial admission date on 03/03/20 and a readmission date on 03/30/23. Medical diagnoses included cerebral palsy, chronic atrial fibrillation, presence of cardiac pacemaker, and hypotension (low blood pressure). Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #75 had mildly impaired cognition and scored a 12 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. [...]

Inspectors wroteBased on record review, staff interviews, and facility policy review, the facility failed to obtain a laboratory test as ordered by a physician for one resident (Resident #7). This affected one (Resident #7) of one reviewed for laboratory tests. The facility census was 108. Findings Include: Review of the medical record for Resident #7 revealed an admission date on 11/16/21. Medical diagnoses included spinal stenosis, chronic obstructive pulmonary disease (COPD), chronic kidney disease Stage 3, and dysphagia (difficulty swallowing) oropharyngeal phase. Review of the annual Minimum Data Set (MDS) 3.0 assessment revealed Resident #7 had impaired cognition and scored a 7 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. Resident #7 required assistance ranging from partial assistance to dependence on staff to complete Activities of Daily Living (ADLs). [...]

Inspectors wroteBased on review of facility infection control logs and infection control documentation, staff training records and interview the facility failed to develop and implement a comprehensive and effective infection control program to timely identify and implement corrective measures when trends and increased numbers of infection were identified to prevent the spread of infection including COVID-19. This had the potential to affect all 105 residents residing in the facility.

Inspectors wroteBased on record review, facility policy and procedure review and interview the facility failed to obtain written authorization to manage personal funds and failed to ensure funds were maintained in an interest-bearing account for a Medicaid recipient. This affected one resident (#38) of nine residents reviewed for resident funds.

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to establish a system that assures the full, complete and separate accounting, according to generally accepted accounting principles related to funds being held by the facility for Resident #38. This affected one resident (#38) of nine residents reviewed for resident funds.

Inspectors wroteBased on observations, resident interview, and staff interview, the facility failed to ensure a resident was provided with personal privacy. This affected one resident (#17) of one resident reviewed for privacy.

Inspectors wroteBased on record review and staff interview the facility failed to update and submit Preadmission Screening and Resident Reviews (PASARR) for Resident #95 and Resident #104 to include all mental health diagnoses. The affected two residents (#95 and #104) of four residents reviewed for PASARR screenings. Findings Include: 1. Review of the medical record for Resident #104 revealed an original admission date on 02/20/18 and a recent readmission date on 02/20/22. Medical mental health diagnoses included generalized anxiety disorder (04/30/18), schizoaffective disorder (09/14/18), major depressive disorder (03/02/18), and unspecified psychosis not due to a substance or known physiological condition (02/20/18). Review of the PASARR screening for Resident #104 dated 03/15/18 revealed mood disorder and psychotic disorder were included on the PASARR. [...]

Inspectors wroteBased on observation, record review and interview facility failed to ensure Resident #36's plan of care was implemented and updated to reflect the resident's dental care needs. This affected one resident (#36) of 27 residents whose care plans were reviewed.

Inspectors wroteBased on closed record review, facility policy and procedure review and interview facility failed to provide a safe discharge for Resident #111. This affected one resident (#111) of one resident reviewed for discharge.

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to ensure residents dependent on staff received assistance with hygiene including shaving, and nail care. This affected one resident (#15) of the four residents reviewed for activities of daily living (ADL) care.

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to ensure all residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan and/or the residents' choices. The facility failed to ensure Hospice communication documentation was kept readily available for review at the facility or in the resident's medical record for Resident #16 and failed to ensure the Hospice provider was notified timely of changes in the resident's condition. The facility failed to monitor bruising following a fall for Resident #47. The facility failed to schedule and complete an ordered Magnetic Resonance Image (MRI) timely for Resident #104. This affected three residents (Residents #16, #47 and #104) of four residents reviewed for quality of care.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure Resident #38, who developed a pressure ulcer in the facility received the necessary treatment and services to promote healing and prevent new ulcers from developing. This affected one resident (#38) of five residents reviewed for pressure ulcers.

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to ensure fall interventions were in place for residents at risk for falls and/or with history of falling. This affected two residents (#16 and #73) of four residents reviewed for accidents.

Inspectors wroteBased on record review and interview the facility failed to ensure laboratory testing to rule out a possible urinary tract infection was completed timely and as ordered for Resident #362 who had a history of urinary tract infections. This affected one resident (#362) of four residents reviewed for quality of care.

Inspectors wroteBased on record review, facility policy and procedure review and interview the facility failed to ensure adequate monitoring was completed related to the administration of cardiac medication for Resident #36 to ensure the medication was necessary and administered at the most effective dosage. The facility also failed to ensure adequate justification for the use of Tagamet prescribed to treat sexual behaviors for Resident #100 and failed to ensure staff documented and monitored for target behaviors to ensure the justification of the continued use of the medication. This affected two residents (#36 and #100) of four residents reviewed for unnecessary medication use.

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to obtain or provide timely dental services to meet the needs of each resident. This affected two residents (#36 and #55) of four residents reviewed for dental services.

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to ensure Resident #36's medical record was maintained in a complete and accurate manner. This affected one resident (#36) of 27 residents whose medical records were reviewed.

Inspectors wroteBased on record review, facility policy and procedure review and interview the facility failed to implement an effective antibiotic stewardship program to ensure the appropriate use of antibiotics to reduce the development of antibiotic-resistant infections/organisms. This affected one resident (#38) of five residents reviewed for urinary tract infections.

Inspectors wroteBased on record review, facility policy and procedure review and interview facility failed to ensure the flu vaccine was offered and provided to Resident #72. This affected one resident (#72) of five residents reviewed for vaccines.