Aegis Health and Rehabilitation

In the surveyor’s words

From the most serious findings on record at Aegis Health and Rehabilitation, in the surveyor’s own words.

• Immediate jeopardy, widespreadF725Dec 11, 2023

  Based on interview and record review, the facility failed to provide sufficient staffing to meet the needs of the residents. On [DATE] from approximately 8:17 P.M. until [DATE] at approximately 5:27 A.M., only one staff person, the Director of Nurses (DON), was present and working in the facility. The DON contacted the Acting Administrator (Administrator #1) and Administrator in Training (AIT) for assistance. The AIT called sister facilities for assistance with staffing. Administrator #1 and the AIT did not come into the facility. One of the facilities could not provide any staff, and the other two did not respond. The census on [DATE] was 50 residents. […]

• Immediate jeopardy, patternF678Dec 11, 2023

  Based on interview and record review, the facility failed to ensure five residents (Residents #9, #8, #7, #11 and #10) had a code status in their medical record and had a code status recorded in the code status book, which staff would refer to in the event their heart stopped. Residents #9 and #8, both alert and oriented residents, did not want Cardiopulmonary Resuscitation (CPR, an emergency procedure consisting of chest compressions often combined with artificial ventilation, or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest) administered in the event of cardiac arrest, however staff said they would perform CPR on them in accordance with the… […]

• Immediate jeopardy, isolatedF684Dec 11, 2023

  46104 Based on interview and record review, the facility failed to ensure residents receive treatment and care in accordance with professional standards of practice, for one resident (Resident #25) who received a kidney transplant, when staff failed to obtain labs and administer anti-rejection medication as ordered by the physician. The resident was admitted to the facility on [DATE] and taken to the emergency room by family on [DATE] when the resident's blood work taken on the date of discharge showed critical. The resident was admitted to the hospital on [DATE] and passed away on [DATE]. The facility also failed to administer medication to one resident as ordered by his/her physician who was diagnosed with depression (Resident #27). […]

• Actual harm, patternF697Dec 11, 2023

  Based on observation, interview and record review, the facility failed to ensure scheduled pain medication was available and/or administered as ordered, failed to document the reason the residents missed doses and failed to document the measures they took to obtain the medication, for four of 28 sampled residents (Residents #6, #27, #21 and #1). Resident #6 experienced pain resulting in the resident crying out and rocking back and forth and calling family members crying. Resident #27 was unable to get out of bed because he/she was in so much pain he/she could not sit up in his/her wheelchair. Resident #21 described their pain as excruciating. The facility also failed to administer pain medications to Resident #1 prior to completing wound care. […]

• Actual harm, isolatedF686Dec 11, 2023

  Based on observation, interview and record review, the facility failed to ensure residents with pressure ulcers received necessary treatments and services to promote healthy healing by failing to follow orders for antibiotics for one resident (Resident #1). Additionally, the facility failed to complete wound treatments, failed to complete skin assessments upon admission, re-admission and weekly and failed to complete weekly wound assessments for two residents (Residents #1 and #26). The sample size was three. […]