Every finding on record at Alternative Healthcare Solutions LLC

Based on observations made in the kitchen in the company of the kitchen coordinator (employee #6), it was determined that the nutritional value of the food was not being ensured due to improper storage in the refrigerator which can affect all admitted residents. Findings include:1. During the kitchen visit, the following food storage practices were observed in the refrigerator:a. On May 20, 2026, at 9:02 AM, food was observed stored in cardboard boxes and placed less than 18 inches from the ceiling, causing condensation and affecting food safety.b. The institution's policy, titled Safety in Receiving and Storing Food, refers to the correct distance from the ceiling and proper use and storage in the refrigerator, but it does not specify that food cannot be left stored in cardboard boxes.

Based on observation, interviews, and food temperature measurements, it was determined that the facility failed to maintain proper food handling practices for disease prevention and food safety which can affect 13 out of 13 residents admitted . Findings include:Observations made on 05/21/2026 at 11:00 AM In the production process, the proximity of the [NAME] table when placing cold foods affects them and they presented a temperature of 46 degrees Fahrenheit. It affects food safety.In the dry storage area, the following were observed: Dust particles and poor organization are identified in the dry warehouse. In an interview conducted on May 20, 2026, at 2:28 PM with the clinical dietitian (employee #8), the possibility of relocating the production area was discussed. The plan was to place hot food on the right and cold food on the left. The dietitian consulted with the engineer, who confirmed the feasibility of the relocation, and a plan was submitted because a shorter refrigerator was required. The dietitian immediately instructed that cold foods be placed last so that the heat would not affect their integrity

Based on review of Quality Assessment Performance Improvement-QAPI and interview with facility QAPI officer (employee #2) on 05/21/26 at 11:55 am, it was determined that the facility failed to assure QAPI program feedback and data system monitoring performed by the Director of Nursing and Administrator are included in every committee meeting.Findings include:During review of trimestral QAPI committee meeting 2025 and 2026 on 05/21/26 at 11:55 am, the following was identified:1.QAPI committee meeting performed on 09/25/25 did not evidence the participation of the Director of Nursing. There is no evidence that feedback and data system monitoring performed by the Director of Nursing is included in this meeting.2.QAPI committee meeting of 06/27/25 attendance list did not demonstrate participation of the Administrator. There is no evidence that feedback and data system monitoring performed by the Administrator is included in this meeting.3. During interview on 05/21/26 at 11:55 am QAPI officer (employee #2) stated that if the Administrator or Director of Nursing did not participate in each committee meeting an alternate designated member could present a report with this person feedback and data system monitoring performed related with QAPI activities. QAPI officer (employee #2) stated that this is not established in that specific way in the QAPI rules and regulations, but it can be established in this way to ensure that those persons feedback and data system monitoring performed related with QAPI activities is included without fail.

Based on review of Quality Assessment Performance Improvement-QAPI and interview with facility QAPI officer (employee #2) on 05/21/26 at 11:55 am, it was determined that the facility failed to maintain a QAPI committee with participation of the required members established in 483.75 (g)(1):Findings include:Review of trimestral QAPI committee meeting 2025 and 2026 on 05/21/26 at 11:55 am, the following was identified: QAPI committee meeting performed on 09/25/25 did not evidence the participation of the Director of Nursing.QAPI committee meeting of 06/27/25 attendance list did not demonstrate participation of the Administrator.Review of QAPI rules and regulation last updated on January 2026 with QAPI officer (employee #2) on 05/21/26 at 11:50 am evidence that Administrator, Director of Nursing, Infection Control Officer and Medical Director must be part of the required QAPI committee members.During interview on 05/21/26 at 11:55 am QAPI officer (employee #2) stated that Administrator, Director of Nursing, Infection Control Officer and Medical Director must participate in each committee meeting. She also stated that if the required member is not available must designate an alternate person who participates in representing that person.

Based on observations and staff interviews, it was determined that the facility failed to ensure medications and supplements from unauthorized access.Findings include: 1.On 05/21/2026 at 8:40 AM, during medication administration observations, Registered Nurse (employee #5), were observed leaving the medication cart unlocked and unattended while administering medications to residents. Further observation revealed a four unsecured basket attached to the medication cart containing supplements, syringes, needles and saline flush syringes that were readily accessible to unauthorized individuals. During an interview with the Head Nurse (employee #4) on 05/21/2026 at 8:55 AM, she states that the drawers have locks, so they must remain closed.

Based on observation, it was determined that the facility failed to maintain the kitchen freezer in proper condition.Findings include:During the observation on 05/20/2026 at 9:00 a.m., the freezer was observed to be condensing, at risk of affecting the integrity and safety of the food.

Based on observation and staff interview, it was determined that the facility failed to implement and maintain an effective infection prevention and control program by failing to ensure proper hand hygiene practices during medication administration. These deficient practices had the potential to increase the risk of cross-contamination and transmission of infectious organisms among residents.Findings include:1.On 05/21/2026 from 8:52 AM, through 9:40 AM, during the observation of the medication administration, a Registered Nurse (employee #5) was observed to entering residents' room [ROOM NUMBER], #704, #706 and #708, the nurse touched the door handle to open the resident room door, curtains, table and subsequently donned gloves and administered medications to residents without performing hand hygiene after contact with the door handle, curtains and table.According to CDC guidelines of hand hygiene to accept infection prevention practices, hand hygiene should be performed after touching the patient's surroundings, before donning gloves and before resident contact.

Based on observations and staff interviews, the facility failed to maintain the confidentiality of residents' clinical information by leaving identifiable resident documents exposed and unattended on the top of cart for 5 of 5 residents observed during medication administration pass. (Resident #17, # 20, #25, #26 and new resident admitted on [DATE], late in the afternoon at 5:05 PM on room [ROOM NUMBER]B).Findings include:1. During the medication administration pass on 05/20/2026 from 8:05 AM until 8:45 AM Registered Nurse (employee #5), left medication cart and entered residents' rooms to administer medications. While away from cart, resident vital signs sheets and medication Kardex records containing residents' information remained on top of the medication cart and were visible in the hallway.During the interview with the nurse (employee #5), on 05/20/2023 at 9:00 AM, she stated that she used those documents while performing the medication pass to confirm the vital signs of the residents, and that she left them on top of the cart while she gave the medications to the residents.This practice had the potential to allow unauthorized individuals to view residents' personal health information.

Based on records reviewed and observation, it was determined that the facility failed to meet professional quality standards to 1 out 1 resident. (RR#25) Findings include:1. RR#25 observation on May 21, 2026, at 9:55 AM: the resident had a wound on the left foot.2. RR#25 on May 21, 2026, at 10:52 AM: the doctor changed the prescription on May 17, 2026, from 1 tablet to 2 tablets of Ultracet, but did not provide justification for this change in the assessment.On the visitor's pass for May 17, 2026, the resident asked the doctor and the nursing supervisor if they could increase the medication. The doctor agreed and ordered the change but did not write a progress note for it.3. The institution's established protocol, titled Pain Management, specifies the importance of accurate documentation, including the justification for medical prescriptions.

Based on records review (RR) and staff interview, the facility failed to ensure documentation of education regarding the risk and benefits of antipsychotic medication and documentation of informed consent for its use for 1 out 1 resident reviewed for psychotropic medications (RR #28).Findings include:1.R.R #28 is a 61 years-old female who was admitted to the facility on [DATE] with a diagnosis of Right Total Knee Replacement, Major Depression, Schizophrenia, and Bipolar Disorder. During the (RR) performed on 05/21/2026 at 10:51 AM it was observed that the pharmacist completed the medication regimen review on 05/14/2026. A medical order dated 05/14/2026 at 4:20 PM was observed for Abilify 10mg orally daily, Trazodone 100mg orally at bedtime, Cymbalta 60mg orally daily, and Vistaryl 25mg orally every 12 hours if necessary for anxiety. However, there was no note or statement indicating that the risks and benefits of high-risk medications, such as psychotropic drugs, were discussed with the patient and/or family member, and that the patient consent on the use of antipsychotic medications.During an interview with the pharmacist (employee #1), on 05/21/2026 at 12:45 PM, he stated that for this specific resident, when the medication regimen review was conducted, the patient told him that she used Abilify for depression, and he affirms that the medication orders were placed after the review; however, the recommendations, risks, and benefits were not documented upon identifying that this resident was using psychotropic medication.

Based on interview and review of documents during initial pool on 5/20/26 at 9:10 am and further investigation on 5/21/26 at 8:55 am, it was identified facility failed to document a smoking plan of care for a resident who was receiving services and smokes in 1 out of 1 resident. (RR#19)Findings include:1.Resident #19 is an [AGE] year-old male resident admitted on [DATE] with a diagnosis of ulcer on right foot. He said he was admitted to receiving local care and intravenous antibiotic therapy for an ulcer that he develops in right foot.Resident stated in an interview on 5/20/2026 at 9:10 am that he is a smoker and smokes cigar every day during afternoon. He stated that he notified that he is a smoker during admission to the facility.Nursing Supervisor (employee # 4) stated during interview on 5/20/26 at 10:30 am that she explains to him during admission that smoking is prohibited in the building. Nursing supervisor explained to him that if he wants to smoke, there are designated areas for these purposes, and they need to establish a schedule because they need to accompany him while he is smoking to prevent accidents.Resident # 19 stated that nursing supervisor explain to him that there are options with nicotine replacement therapy if he wishes to quit smoking, but they are not forcing him to quit. Resident #19 stated that after nursing supervisor explanation, he stated he can adjust to the schedule that facility prepares. He also stated he plans to quit after being discharged home from facility, but he is not prepared to quit yet. 2.Review of medical record progress notes on 5/21/26 at 9:35 am with Director of Nursing (employee # 4) evidence that in the progress notes it was documented on daily basis that resident went to the designated area to smoke with the recreational therapist at 1:00 pm every day. Director of Nursing (employee # 4) provides evidence of a schedule form with the responsible personnel to accompany the resident who is the recreative personnel and the hour.Resident #19 stated in an interview on 5/21/26 at 10:00 am that he went to smoke at 1:00 pm because facility let him select the time to smoke. He stated facility Nursing Supervisor (employee # 3) explain to him the risk and the danger of smokes at his room and he agreed not smoke at his roomDuring interview Director of Nursing (employee #4) stated on 5/21/26 at 10;30 am that safety measures were explained to the residents and smoking habits were considered when the schedule for smoking was prepared. However, a comprehensive plan of care with smoking habits and safety measures to be maintained is not developed or implemented.No evidence was provided that Interdisciplinary team discussed that resident wish to smokes while admitted receiving services and that an schedule for this purpose was developed and implemented.

Based on dining observations, review of policies procedures and facility staff interview performed on 12/02/2024 through 12/03/2024 to from 8:30 AM through 4:30 PM, it was determined that the facility failed to ensure that each resident receives, and the facility provides food and drinks that are palatable, attractive, and at a safe and appetizing temperature. This deficiency affects 1 out of 5 cases admitted receiving services (Resident #4). Findings include: During the initial pool process on survey on 12/02/2024 from 8:34 AM through 3:30 PM to screen residents the following findings were identified: 1. Facility failed to ensure that food and drink provided to residents maintain an appetizing temperature. a. Resident #4 is a [AGE] year-old female admitted to the facility on [DATE] with a diagnosis of Right Hip Replacement. On 12/02/2024 at 8:40 AM during resident interview she state that that the food came on disposable Styrofoam every time and that when she eats it was cold. b. Test tray was performed on 12/03/2024 at 11:28 AM. This test tray was performed to determine if food delivered to residents maintain appetizing temperature after surveyors noticed that food is brought by the diet department in Styrofoam disposable trays due to lack of sufficient kitchen personnel to sanitize and process trays. c. During the test tray on 12/02/2024 at 11:55 AM these were the findings: [NAME] rice temperature is- 158.6 degrees(º) Fahrenheit (F), beef stew-159.3ºF, canned mandarin orange -56.5ºF, beets -52.5ºF and milk-56.8ºF. For the cold items the acceptable delivery temperature (milk and mandarin orange) must be 40-55ºF. d. In addition to not complying with temperature, the Styrofoam trays are full; all food items containers (cold and hot), all of which contribute to a poorly presented that is not appetizing. 2. Lack of support personnel in the kitchen has its effect on the provision of meals trays and dinner in a way that maintains cold or hot when provided to the resident.

Findings include: The following was identified during the dining services evaluation process: 1. Breakfast and lunch are served in Styrofoam disposable trays. The trays are assembled in a way that hot food items and cold items are in contact and cold food items change the temperature of the hot food items and vice versa. 2. During the interview with the kitchen manager (employee #6) on 12/03/2024 at 11:30 AM she stated that the facility is serving food in disposable trays due to lack of available kitchen personnel to process and disinfect dinner trays. 3. Kitchen staffing pattern was requested to the kitchen manager (employee #6) by the surveyor on 12/03/24 at 11:30 AM. In this pattern it was identified that the facility lacks half of the personnel (50%). Since the month of September there have been resignations, which limits the service they offer even more. 4. The efforts made by the facility for recruitment of kitchen personnel are requested by the surveyor to the kitchen manager (employee #6) on 12/03/2024 at 11:35 AM which is presented, and five positions are observed. It was asked the reason why there are only 5 positions approved. She responds that she needs 8 employees but only 5 are authorized by the facility administration. Based on dining observations, review of staffing pattern and facility staff interview performed on 12/02/2024 through 12/03/2024 to from 8:30 AM through 4:30 PM, it was determined that the facility failed to ensure that facility failed to have sufficient staff to carry out the functions of the food and nutrition services. This deficiency affects 5 out of 5 cases admitted receiving services.

Based on observations of the physical environment and facility staff interview performed on 12/02/2024 through 12/03/2024 from 8:00 AM through 4:00 PM, it was determined that the facility failed to ensure to provide the residents a safe, funtional, sanitary and comfortable environment. Findings include: 1. During the tour of the rooms, the following was observed: a. On 12/02/2024 at 9:10 AM, observed commode toilet seat with dark stains, exhaust duct with lack of cleanliness and humidity on the wall in the sink in room [ROOM NUMBER]. b. On 12/02/2024 at 9:00 AM, stained acoustics were observed in room [ROOM NUMBER]. c. On 12/02/2024 at 9:24 AM, the washbasin was observed to be detached from the wall in room [ROOM NUMBER].

Based on announces recertification survey, during the observation procedure by the staff on 12/02/2024, it was determined that the facility failed to ensure follow accepted standards of practice to prevent the transmission of infections and communicable disease for 2 out of 5 Resident. (Resident #4 and #111) Findings include: 1. During the observations made to the nursing staff on 12/02/2024, the following was observed: a. Resident #111-B is an [AGE] year-old female admitted on [DATE] for Lower left leg extremities ulcer. On 12/02/2024 at 10:37 AM, registered nurse (employee #3) was observed donning gloves to check residents' IV without first washing her hands or using hand sanitizer and registered nursing (employee # 4) was observed at the time of donning her gown, the gown touched the contaminated waste container twice. b. Resident #4 -B is a [AGE] year-old female admitted on Right total hip replacement. On 12/02/2024 at 9:24 AM, physical therapy staff (employee #7) was observed on two occasions putting on gloves without washing their hands or using hand sanitizer before and after giving therapies. The facility failed to ensure maintain an infection prevention to provide a safe and sanitary.

Based on flash tour and kitchen observations, performed on 12/02/2024 through 12/03/2024 from 8:30 AM through 4:30 PM, it was determined that the facility failed to ensure that facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety. This deficiency affects 5 out of 5 cases admitted receiving services Findings include: 1.During a visual tour of the kitchen area with the Dietary Service Manager (employee #6) on 12/02/2024 at approximately 8:19 AM the following was observed: a. A package of ham was observed open and not dated on the refrigerator. b. Cabbages (repollo) were observed in fridge with rotten leafs. c. Dietary Department Coordinator did not have hair net while working the food line. d. Ceiling near the food line was observed with perforations due to water damage.

Based on Physical enviroment observations, performed on 12/02/2024 through 12/03/2024 to from 8:30 AM through 3:30 PM, it was determined that the facility failed to ensure a safe, clean, comfortable and homelike environment for 3 out of 3 rooms observed. Findings include: The following was identified durin visual inspection of the facility from 12/02/2024 through 12/03/2024 : 1. Nigth stand on room [ROOM NUMBER] was observed with peeling vinyl cover 2. Gypsum board behind washbasin on room [ROOM NUMBER] was observed with peeled parts. 3. Loose grab bars on bath room of room [ROOM NUMBER] 4. Lamp cords on bed head boards on rooms #702 and #705 5. Broken soap dispenser in the washbasin area on room [ROOM NUMBER] 6. Water stain was observed on wall behind room entrance door

d. The Diet department was visited on 12/02/2024 at 10:20 AM. Kitchen the manager (employee #6) was asked by the surveyor in relation to the availability of yogurt, bananas and prune juice. Kitchen the manager (employee #6) stated in interview on 12/02/2024 at 10:35 AM that when they purchase the food only apples are available as fresh fruit. She stated that they substitute the fresh fruit for canned fruit without sugar and that also prune juice is not available. In relation to the yogurt she stated that the document submitted to the diet department stated that resident request yogurt as a snack and not as a food to be included at least two or three times a day, she does not have information in relation to prune juice preference. e. Kitchen manager (employee #6) stated 12/02/2024 at 10:45 AM, that when residents request food different from the menu cycle and existing food in the storage she proceeds to buy with the available petty cash. f. Kitchen manager (employee #6) stated in interview on 12/02/2024 at 10:50 AM that there is no problem in buying the bananas and prune juice to please the resident preferences. In relation to yogurt preferences to grant resident preferences to be included at least two or three times a day on food trays there is no problem to comply with this preference. Based on dining observations, review of policies procedures and facility staff interview performed on 12/02/2024 through 12/03/2024 to from 8:30 AM through 4:30 PM, it was determined that the facility failed to ensure that each resident receives, and the facility provides food and drink that is palatable, attractive, and at a safe and appetizing temperature. This deficiency affects 1 out of 5 cases admitted receiving services (Resident #4). Findings include: 1. Facility failed to promote residents' food preferences. a. Resident located in room [ROOM NUMBER]-B this resident stated that she likes to have the same types of food, because she experiences swallowing difficulties since several years ago when she had surgery for a brain tumor. She reports preferences for fresh fruit such as banana and yogurt, to be included at least two or three times a day. Resident also, stated she drinks prune juice twice a week to regulate her gastrointestinal system. Resident stated that those food preferences were not addressed by facility. b. Resident who was admitted on [DATE] with an order of Regular low salt diet; stated that she reports food preferences to the dietitian when she came to perform the initial evaluation on 11/17/2024. c. A document received by the diet department dated 12/01/2024 stated that this resident wants yogurt as a snack. The document does not specify that the resident wants yogurt as food to be included at least two or three times a day on the food trays.

Based on records reviewed (RR) and observations on 12/02/2024, it was determined that the facility failed to ensure that education was provided to residents on the benefits and side effects of Covid-19, influenza and pneumococcal vaccines. Findings include: During the evaluation of the files, it was observed that in the resident and/or family education sheet in the immunization area, the nursing personnel were not marking the orientations given to residents and/or family members on Covid-19, Influenza or pneumococcal.

Based on unannounced recertification survey, during the observation conducted at the nursing desk on 12/02/2024, it was determined that the facility failed did not ensure that the following information was provided daily postings. Findings include: 1. During arrival at the facility on 12/02/2024 at 8:00 AM, the following was observed: a. On 12/2/2024 at 8:00AM, it was noted that the facility's post was not up to date. The staff post was dated 11/29/2024 and had a census of 4 residents when there were 5 residents. b. On 12/2/2024 at 11:14 AM, we interviewed Supervisor (employee #8) and Nursing Director (employee #1), who stated that the person in charge of entering the personnel postings is the secretary at 7:00 AM from Monday to Friday, and on Saturdays and Sundays it is done by the nursing shift leader. The facility failed to have the updated postdate and resident census information accessible to residents and visitors.