Anchor Lodge Nursing Home Inc

In the surveyor’s words

From the most serious findings on record at Anchor Lodge Nursing Home Inc, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Mar 19, 2024

  Based on observations, medical record review, review of the incident log, review of facility in-services records, review of a personnel file, review of the safety inspection bus checklist, review of witness statements and the facility ' s internal investigation, review of policies, review of the emergency medical transportation report, review of hospital records, review of the monthly maintenance logs, interview with the medical director, and resident and staff interviews, the facility failed to ensure a resident dependent on staff, was safely secured in the wheelchair with a seat belt during transportation in a facility bus when coming back from a physician visit. […]

• Actual harm, isolatedF760May 26, 2023

  Based on medical record review, staff and resident interview, review of the hospital documentation, review of a facility medication incident report, review of an employee performance conference, review of the medication error log, and policy review, the facility failed to ensure physician orders were clarified and the correct dosage of chemotherapy medication was administered to Resident #10 to prevent a significant medication error. The facility also failed to ensure medications were administered as ordered to prevent significant medication errors for residents when medications were not administered as ordered on 05/14/23. […]

• Actual harm, isolatedF692Nov 7, 2022

  Based on medical record review, resident and staff interview, and review of facility policies, the facility failed to ensure weights were obtained per physician order, and ongoing monitoring was provided for residents identified at nutritional risk and sustaining weight loss. This resulted in Actual Harm when Resident #66 experienced a severe weight loss of 10.8 % from 07/26/22 to 10/17/22. There was no evidence weekly weights were obtained per physician order [MEDICAL RECORD OR PHYSICIAN ORDER] . Additionally, the facility failed to ensure Resident #51's weekly weights were obtained per physician orders, which placed the resident at risk for more than minimal harm that did not result in actual harm to the resident. This affected two (#66 and #51) of three residents reviewed for nutrition. […]

• No harm, potential for more than minimal, widespreadF804Sep 19, 2023

  Based on observation, resident interview, staff interview, medical record review, resident council minutes review, and review of policy, the facility failed to ensure food was palatable related to temperature and taste. This had the potential to affect 86 of 86 residents residing in the facility. The facility census was 86. Findings include: 1. Review of Resident #16's medical record revealed an admitted [DATE] and diagnoses included type two diabetes mellitus and Alzheimer's Disease with early onset. Review of Resident #16's physician orders dated 06/30/23 revealed liberalized consistent carbohydrate diet, regular texture. 2. […]

• No harm, potential for more than minimal, widespreadF727Sep 17, 2022

  Based on review of the staffing schedules and review of the Benefits Improvement and Protection Act (BIPA) daily staff postings, staff interview, and policy review, the facility failed to maintain the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week as required. This had the potential to affect all 80 residents currently residing in the facility. Findings include: Review of facility staffing schedules and the daily BIPA staffing postings dated between 08/14/22 and 09/15/22 revealed no RN were present working in the facility on 08/15/22, 08/16/22, 08/19/22, 08/20/22, 08/21/22, 08/24/22, 08/25/22, 08/26/22, 08/27/22, 08/28/22, 08/29/22, 08/30/22, 08/31/22, 09/01/22, 09/02/22, 09/03/22, 09/04/22, 09/05/22, 09/06/22, 09/07/22, 09/08/22,… […]