Brunswick Cove Nursing Center

In the surveyor’s words

From the most serious findings on record at Brunswick Cove Nursing Center, in the surveyor’s own words.

• Actual harm, isolatedF600May 12, 2021

  Based on record review, staff and resident interviews, the facility failed to protect a resident ' s right to be free from mistreatment after notifying the Ombudsman of not getting showers for 1 of 1 residents (Resident #1) reviewed for abuse. Findings included: Resident #1 was admitted to the facility on [DATE]. diagnosis [MEDICAL RECORD OR PHYSICIAN ORDER] . The Minimum Data Set annual assessment dated [DATE] revealed the resident was cognitively aware, demonstrated no moods or behaviors, and required total dependence with two staff physical assistance with bed mobility, transfers, and bathing. Resident #1 had an impairment to one side to the upper and lower extremities and used a wheelchair. […]

• No harm, potential for more than minimal, widespreadF812Feb 10, 2022

  Based on observation, record review, and staff interviews, the facility failed to have system to ensure the water temperature of the low temp dish machine reached the minimum 120 degrees Fahrenheit for washing and sanitizing dishware as specified in the manufacturer's recommendations, failed to remove outdated food intended for use in the walk-in refrigerator, and failed to label foods in nourishment food refrigerators (100 hall, 300 hall, 400 hall). These practices had the potential to effect food served and distributed to all residents. Findings included: 1. Review of the low temp dish machine's manufacturer's specification sheet indicated a minimum required temperature of 120 degrees Fahrenheit (F). […]

• No harm, potential for more than minimal, patternF641Jul 25, 2024

  Based on record review and staff interviews, the facility failed to code the Minimum Data Set (MDS) assessments accurately in the areas of medication, dental and continence for 4 of 30 residents whose MDS assessments were reviewed (Resident # 283, Resident #99, Resident #76 and Resident #115). Findings included: 1. Resident # 283 was admitted on [DATE] with diagnosis which included major depressive disorder. Review of Resident #283's physician orders revealed an order dated 12/19/23 for Aripiprazole 5 milligrams (mg). Give 1 tablet by mouth every 12 hours related to major depressive disorder. Review of Resident #283's December 2023 electronic Medication Administration Record revealed resident received Aripiprazole 5 mg 1 tablet every 12 hours related to major depressive disorder. […]

• No harm, potential for more than minimal, patternF685Jul 25, 2024

  Based on record review, staff, Nurse Practitioner and Physician interviews, the facility failed to ensure a resident had an ophthalmology appointment scheduled as ordered on 1/11/24, 2/13/24 and 3/26/24 resulting in the resident not seen until 4/19/24 and failed to obtain the retinol specialist appointment recommended by the ophthalmologist for 1 of 1 resident (Resident #101) reviewed for vision. Findings included: Resident #101 was admitted on [DATE] with diagnoses which included post traumatic brain injury and Parkinson's Disease. Resident #101's electronic health record revealed a Nurse Practitioner progress note dated 1/11/24 which indicated resident had a visual disturbance and the note indicated the resident needed to see an ophthalmologist. […]

• No harm, potential for more than minimal, patternF756Jul 25, 2024

  Based on record review, staff interviews and Consultant Pharmacist interview the facility failed to ensure the facility staff reviewed pharmacy recommendations and documented any action taken or a rationale for no action taken on the pharmacy request for 1 of 5 residents reviewed for drug regimen review (Resident #115). The findings included: Resident #115 was admitted to the facility on [DATE] with diagnoses that included depression, dementia and agitation. A review of the physician's orders revealed Resident #115 received olanzapine (antipsychotic medication) 10 milligrams (mg) at bedtime since 3/11/24 for psychotic disturbance with mood disturbance and anxiety. A review of the electronic medical record revealed there was no AIMS (Abnormal Involuntary Movement Scale) completed. […]