Blue Palms Health and Rehabilitation Center of Day

In the surveyor’s words

From the most serious findings on record at Blue Palms Health and Rehabilitation Center of Day, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Apr 23, 2026

  Based on observations, interviews and record review, the facility failed to follow proper sanitation and food handling practices by failing to ensure the kitchen's ice machine was clean and free of black biofilm. This had the potential to negatively affect all 94 residents currently residing in the facility. The findings include:On 04/19/26 at 9:20 AM, an observation was made of the kitchen's ice machine air filters, which were covered with dust and spider webs. The air filter instructions read: Clean air filter twice a month. (photographic evidence obtained)On 04/20/26 at10:48 AM, another observation was made of the kitchen's ice machine air filters covered with dust and spider webs. […]

• No harm, potential for more than minimal, patternF582Aug 1, 2024

  Based on interviews and record review, the facility failed to provide documented evidence of having informed each resident before, or at the time of admission, and periodically during the resident's stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare/Medicaid or by the facility's per diem rate. This could have a potentially negative affect on 65 of the 82 residents currently in the facility who actively receive Medicare/Medicaid. […]

• No harm, potential for more than minimal, isolatedF656Apr 23, 2026

  Based on observation, record review and interviews, the facility failed to implement a care plan for one (Resident #5) of 38 residents in the total survey sample for administration of medications as ordered by the physician. The nursing staff did not adhere to the parameters set by the resident's physician, which could lead to a dangerous cardiovascular event such as severe hypotension (low blood pressure). The findings include:A review Resident #5's active physician's orders and Medication Administration Record (MAR) revealed parameters for Bumetanide (diuretic) 0.5 milligrams (mg) twice a day. The parameters were: Hold if systolic blood pressure is less than 115. […]

• No harm, potential for more than minimal, isolatedF609Aug 1, 2024

  Based on observations, interviews, record review, and a review of facility policy, the facility failed to report to the State Agency, injuries of unknown origin for one (Resident #43) of 31 residents in the total survey sample. The findings include: A review of Resident #43's medical record revealed an admitted [DATE] with diagnoses including atherosclerotic heart disease, protein-calorie malnutrition, dementia without behavioral disturbance, psychotic disturbance, mood disturbance, anxiety, and adult failure to thrive. Further review of the record revealed a progress note dated 7/18/24 at 5:25 a.m., which documented that facility staff observed a left elbow hematoma and left lower leg hematomas with dried blood. […]

• No harm, potential for more than minimal, isolatedF677Aug 1, 2024

  Based on observations, staff and resident interviews, and medical record review, the facility failed to ensure that three residents who were unable to carry out activities of daily living (Residents #34, #43, and #66) from a total survey sample of 31 residents, received necessary care and services to maintain grooming and personal hygiene. The findings include: 1. On 7/29/24 at 1:00 p.m., Resident #34 was observed lying in bed, awake. His feet were uncovered. His toenails were elongated on both feet with his right great toenail observed to be curled around his toe. The resident was asked if he had toenail care or had been seen by podiatry since arriving at the facility. He replied no. (Photographic evidence obtained) On 7/31/24 at 8:21 a.m., Resident #34 was observed lying in bed, awake. […]