Autumn Lake Healthcare at Glade Valley

In the surveyor’s words

From the most serious findings on record at Autumn Lake Healthcare at Glade Valley, in the surveyor’s own words.

• Actual harm, isolatedF689Nov 15, 2023

  Based on medical record review and interview, it was determined that the facility failed to ensure that residents were safe from accidents during mechanical lift transfers which resulted in harm to resident #16. This was evident for 1 (#16) of 1 resident reviewed for accidents. The findings include: A care plan is a guide that addresses the unique needs of each resident. It is used to plan, assess, and evaluate the effectiveness of the resident's care. The MDS (Minimum Data Set) is a complete assessment of the resident which provides the facility information necessary to develop a plan of care, provide the appropriate care and services to the resident, and modify the care plan based on the resident's status. […]

• No harm, potential for more than minimal, widespreadF812Jun 1, 2026

  Based on observation, interview and review of pertinent documentation it was determined that the facility failed to prepare, distribute and serve food in accordance with professional standards for food service safety. This deficient practice has the potential to affect all residents. The findings include: 1)The initial tour of the kitchen began on 5/26/26 at 8:15 AM. During this tour of the kitchen surveyor observed, with the Food Service Director (FSD) #6, in the walk-in refrigerator a metal container with meat in it with plastic wrap covering the container. Written in marker on the plastic wrap was an expiration date of 4/25. FSD #6 reported this was a pork loin they had just recently cooked and then would cut off pieces to make pork chops. […]

• No harm, potential for more than minimal, widespreadF880Jun 1, 2026

  Based on observations and interviews, it was determined that the facility failed to ensure linens were processed in a manner that prevents cross contamination. This deficient practice had the potential to affect all residents of the facility. The findings include:On 5/28/26 at 12:20 PM, Laundry aide (Staff #27) explained her process as she demonstrated processing soiled linens. Staff #27 donned appropriate PPE while sorting and loading the washer with soiled linens. However, after doffing the washable gown and hanging it on the hook beside the sink, she proceeded to the clean side of the laundry room and started to fold clean linens.On 5/28/26 at 12:40 PM, Staff #27 was invited back to the soiled area of the laundry room. […]

• No harm, potential for more than minimal, widespreadF730Oct 15, 2021

  Based on record review and staff interview, it was determined that the facility failed to have a process in place to ensure that nurse aides were receiving performance evaluations annually and that in-services training was provided to the nurse aide based on the outcome of the performance evaluation. This was evident for 2 of 2 staff reviewed for annual performance evaluations. The findings include: On 10/7/21 at 8:34 AM, a review of Geriatric Nursing Assistant (GNA) #62's employee file revealed that GNA #62 had been employed for 4 years and there was no evidence found of performance evaluations. On 10/7/21 at 8:44 AM, a review of GNA #63's employee file revealed that GNA #63 had been employed for [AGE] years and no evidence was found that performance evaluations were completed. […]

• No harm, potential for more than minimal, widespreadF741Oct 15, 2021

  Based on record review and staff interview, it was determined that the facility failed to provide training to staff related to mental and psychosocial disorders that affected residents with trauma and a history of post-traumatic stress disorders as evidenced by those residents being identified in Facility Assessment Tool, however, there was no documentation that such training was provided to staff. This was evident for 4 (#60, #61, #62, and #63) of 4 facility staff reviewed. The findings included: On 10/7/21 at 8:34 AM, a review of the employee file for Geriatric Nursing Assistant (GNA) #60 failed to reveal that GNA #60 had received training about how to care for residents with mental and psychosocial disorders that included residents with trauma and post-traumatic stress disorder. […]