Arcadia Retirement Residence

In the surveyor’s words

From the most serious findings on record at Arcadia Retirement Residence, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Dec 22, 2022

  Based on observations, record review, and interviews with staff members, the facility failed to 1) Ensure appropriate alert mechanisms on exit doors were functional on the nursing units after one resident (R)52, was able to elope from the facility. This deficient practice could have potentially placed any residents who wander in immediate danger and 2) Failed to implement interventions, including adequate supervision to prevent an avoidable fall for 1 out of 2 residents Resident (R)47 sampled for falls. As a result, R47 sustained a fracture to left ribs. Findings Include: 1) On 12/19/22 at 10:33 AM, observed R52 walking out of his room. […]

• Actual harm, isolatedF697Nov 3, 2023

  Based on observation, interviews, and record review, the facility failed to ensure pain management was provided to the resident according to the resident's goals and preferences. R7 reported lumbar pain which impeded the resident from using the Hoyer lift to get out of bed for showers and/or socializing with staff and/or other residents. R7 reported receiving Lidocaine patches and Tylenol as the current plan for pain management, however, the medications are ineffective. R7 reported increased feeling of depression and being worn down by constant, unrelieved pain, and the inability to get out of bed. R7 goal and preferences for pain management is to be able to use the Hoyer lift, increased sleep, and minimal severe pain. […]

• Actual harm, isolatedF689Feb 2, 2021

  Based on observations, record review, and interviews with staff member, the facility failed to implement interventions, including adequate supervision consistent with the resident's needs, goals, and care plan to prevent an avoidable fall for 1 out of 4 residents (Resident (R) 17) that resulted in sustaining a fracture to right arm and significant weight loss. Findings Include: Review of R17's Investigate Report Following Adverse Event regarding an incident on 12/18/20, R17 had a witnessed fall and sustained fracture to right acute great tuberosity (prominent area of bone at the top of the humerus and is the attachment for the two large, powerful rotator cuff muscles, injured by landing directly onto the side of the shoulder or landing with arm outstretched) and humeral neck (bone in… […]

• No harm, potential for more than minimal, widespreadF812Oct 4, 2024

  Based on observations and staff interview, the facility did not follow proper sanitation practices in the kitchen. As a result of this deficiency, there was an increase risk for foodborne illness and an increase risk for hazards such as a fire. Findings include: 1)During observation of the kitchen on 10/01/24 at 08:00 AM, the area between the stoves appeared dirty and not cleaned. The area had crumpled paper, dirty plastic bags, dirty napkins, and dirty paper bowls. Staff interview, on 10/01/24 at 08:05 AM, Kitchen Supervisor (KSupvr) acknowledged that the area previously mentioned was dirty and not cleaned. KSupvr said they will have the area cleaned and addressed for future cleaning services. 48351 2)Observation was conducted on 10/03/24 at 07:52 AM in one of the unit kitchens. […]

• No harm, potential for more than minimal, widespreadF812Dec 22, 2022

  Based on observations, review of the facility's policy and procedures, and interview with staff member, the facility failed to ensure that all foods were procured, stored, prepared, distributed, and served under sanitary conditions. Observations of a refrigerator found temperatures greater than 41 degrees Fahrenheit (F); and stored food items were not covered. Findings Include: During the initial kitchen tour observation with Head Cook on 12/19/22 at 08:15 AM, observed trays of raw chicken located in the walk in refrigerator on a tray cart uncovered. The plastic that was on top of the tray cart was not completely over the cart. Head Cook acknowledged it should be covered. […]