Allied Services Center City Skilled Nursing

In the surveyor’s words

From the most serious findings on record at Allied Services Center City Skilled Nursing, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Jun 4, 2021

  Based on observation and staff interview, it was determined that the facility failed to maintain acceptable practices for the storage and service of food to prevent the potential for contamination and microbial growth in food, which increased the risk of food-borne illness. Findings include: Food safety and inspection standards for safe food handling indicate that everything that comes in contact with food must be kept clean and food that is mishandled can lead to foodborne illness. Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness. You cannot always see, smell, or taste harmful bacteria that may cause illness according to the USDA (The United States Department of Agriculture, also known as the Agriculture Department, is the U.S. […]

• No harm, potential for more than minimal, patternF558Nov 14, 2025

  Based on review of select facility policy, observations, and resident and staff interviews, it was determined that the facility failed to ensure that residents had reasonable and safe access to operate their over-the-bed lighting for four residents out of 21 residents reviewed (Residents 32, 50, 9, and 41). Findings include: The facility policy titled Environment last reviewed by the facility on October 1, 2025, indicated that the facility shall provide extra lighting to provide sufficient light to assist residents with tasks such as reading, and provide lighting for residents who need to find their way from the bed to the bathroom at night. […]

• No harm, potential for more than minimal, patternF692Nov 14, 2025

  Based on a review of clinical records, select facility policy, and resident and staff interviews, it was determined that the facility failed to timely identify weight loss, failed to ensure weekly weights were obtained as required by policy for prompt intervention for two of 21 sampled residents (Residents 15 and 22), and failed to implement individualized nutritional support measures based on a resident's stated preferences to maintain or improve nutritional parameters for one resident (Resident 8) out of three sampled residents for weight loss. Findings include: A review of the facility's policy titled Weighing Residents/Reporting Significant Weight Changes, last reviewed by the facility on October 1, 2025, revealed it is the facility policy to monitor weights on all residents. […]

• No harm, potential for more than minimal, patternF694Nov 14, 2025

  Based on a review of clinical records, select facility policy, observations, and staff interviews, it was determined that the facility failed to provide person-centered care as prescribed to meet the current clinical needs and failed to follow physician orders for the management of a Peripherally Inserted Central Catheter (PICC) line for three of 21 sampled residents (Residents 12, 75, and 76). Findings include: A review of the facility policy entitled Central Venous Catheter/PICC Care/Flush/Medication Administration, last reviewed October 1, 2025, indicated the facility is to provide dressing changes, medication, and flushes to residents with a PICC line access (a thin flexible tube that is inserted into a large vein to the heart to deliver medications and other therapies into the… […]

• No harm, potential for more than minimal, patternF761Nov 14, 2025

  Based on observation, review of select facility policy, and staff interviews, it was determined the facility failed to implement and adhere to procedures to ensure acceptable storage for medications on one of three nursing units (Nursing Unit 3).Findings include: A review of the facility policy titled Disposition of Medications: Discontinued Medications, last reviewed by the facility on October 1, 2025, revealed it is the policy of the facility that under circumstances where medications are discontinued by physician order, a resident is transferred or discharged and does not take medications with him or her, or in the event of a resident's death, the medications are marked as discontinued with a label closure. […]