Atlas Rehabilitation and Healthcare at Maywood

In the surveyor’s words

From the most serious findings on record at Atlas Rehabilitation and Healthcare at Maywood, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Aug 11, 2025

  Based on observation, interview, and review of other facility documentation, it was determined that the facility failed to handle potentially hazardous foods and maintain kitchen sanitation practices as well as store, and label in a manner intended to prevent the spread of food borne illness. This deficient practice was evidenced by the following:On 8/5/25 at 9:29 AM, the surveyor in the presence of the Food Service Director (FSD) observed the following during the initial kitchen tour:1. Two rectangular pans wet nesting on the racks. The surveyor asked when the pans were washed and the Main [NAME] (MC) responded, They were washed last night. The FSD confirmed the wet nesting on the pans and stated, I'm obviously upset right now and will talk to pot washer.2. […]

• No harm, potential for more than minimal, patternF585Aug 11, 2025

  Based on interview and review of facility documentation, it was determined that the facility failed to; a.) follow the facility's policy and procedure with regard to overseeing the grievance process, receiving, and tracking grievances through their conclusions; leading any investigations by the facility, b.) issue a written grievance decisions to the resident, and c.) ensure that all written grievance decisions include the date the grievance was received, a summary statement of the resident's grievance, the steps taken to investigate the grievance, a summary of the pertinent findings or conclusions regarding the resident's concerns(s), a statement as to whether the grievance was confirmed or not confirmed, any corrective action taken or to be taken by the facility as a result of the… […]

• No harm, potential for more than minimal, patternF636Aug 11, 2025

  Based on the interview and record review, it was determined that the facility failed to complete the comprehensive Minimum Data Set (MDS) assessment in accordance with the Resident Assessment Instrument (RAI) manual and facility policy for 6 of 6 (Residents #15, #17, #61, #74, #92, and #105) residents reviewed for comprehensive resident assessments. This deficient practice was evidenced by the following:Reference: Centers For Medicare and Medicaid Services (CMS), RAI manual, Version 3.0, last revised in October 2024 indicated in Chapter 2, pages 2-8 to 2-9 revealed: .admission refers to the date a person enters the facility and is admitted as a resident. A day begins at 12:00 AM (12 AM) and ends at 11:59 PM. […]

• No harm, potential for more than minimal, patternF761Nov 24, 2021

  Based on observation, interview, and record review, it was determined that the facility failed to properly label, store and dispose of medications in 4 of 5 medication carts and 2 of 2 medication refrigerators that were inspected. This deficient practice was evidenced by the following: On 11/23/21 at 10:35 AM, the surveyor, in the presence of Registered Nurse#1 (RN#1), inspected the 3-South medication cart. The surveyor observed an opened bottle of Glucose test strips (used with glucose meter to monitor the levels of glucose in human body) that were not dated, an opened [MEDICATION(S)] insulin vial that was not dated with a pharmacy date of 6/25/21, an opened [MEDICATION(S)] insulin vial that was not dated with a pharmacy label date of 3/31/21, an opened [MEDICATION(S)] insulin vial with… […]

• No harm, potential for more than minimal, isolatedF628Aug 11, 2025

  Based on interview, record review and review of other pertinent facility documents, it was determined that the facility failed to provide a copy of the resident and the resident's representative's written notification of the reason for transfer to the hospital to a representative of the Office of the State Long-Term Care Ombudsman (LTCO) for 1 of 2 resident's (Resident #130) reviewed for hospitalization. This deficient practice was evidenced by the following:A review of Resident #130's closed electronic medical record included the following:Resident #130's discharge return anticipated Minimum Data Set's (DRAMDS), an assessment tool used to facilitate the management of care, reflected that the resident was transferred to the hospital. […]