Calhoun Crossing of Journey LLC

In the surveyor’s words

From the most serious findings on record at Calhoun Crossing of Journey LLC, in the surveyor’s own words.

• Actual harm, isolatedF656Aug 28, 2024

  Based on observation, record review, interview, and review of the facility policy, the facility failed to implement a person-centered comprehensive plan of care with measurable goals and plans related to fall prevention for three of 22 sampled residents (R31, R47, and R10). Harm was identified to have occurred on 07/18/24 when the facility failed to develop and implement a care plan for R31 that addressed his desire for more independence with ambulation and his desire for bilateral prostheses. (Cross reference F657, F689 and F688) Findings included: Review of facility policy titled Comprehensive Care Plans undated indicated . […]

• Actual harm, isolatedF684Aug 28, 2024

  Based on record review, staff interviews, and facility policy review, the facility failed to provide appropriate adaptive equipment as directed by Physical Therapy recommendation for one of 22 sampled residents (R) (R31) related to a bi-lateral prosthesis to prevent further potential decline in muscle strength, joint mobility, and an ability to ambulate independently. Psychosocial harm was determined to exist on 7/18/24 due to R31's emotional state when he repeatedly expressed his need for the prosthesis to promote his independence. (Cross Reference F656) Findings included: A review of a facility's policy titled Reporting of Therapy Services dated 02/12/22 indicated . […]

• Actual harm, isolatedF689Aug 28, 2024

  Based on observations, interviews, record review, and facility policy review, the facility failed to prevent a fall for two of three residents (R) (R10 and R47) reviewed for falls. This failure resulted in harm to R10 when the nursing assistant failed to provide incontinence care with the assistance of another staff member per the care plan; R10 fell off the bed and suffered a closed head injury, laceration to the forehead, and fracture of the fifth finger on the right hand. Findings included: 1. […]

• Actual harm, isolatedF600Mar 16, 2023

  Based on interview, record review, and policy review, the facility failed to ensure one (Resident (R) 87) of two residents reviewed for abuse was free from physical abuse. Actual harm occurred on 2/4/2023 when R87 sustained a contusion to the scalp, left shoulder, and left knee after R300 attacked him in the common area. Findings include: Review of the facility-provided policy titled Abuse, Neglect and Exploitation, dated 2/1/2022, revealed, It is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property . Definitions: . […]

• No harm, potential for more than minimal, widespreadF865Aug 28, 2024

  Based on interviews and review of facility documentation, the facility failed to ensure a Quality Assurance Performance Improvement (QAPI) plan was developed to drive quality assurance (QA) measures that addressed resident care and safety, quality of life, and resident choice. This failure had the potential to affect all 91 residents who currently lived in the facility. Findings included: A review of a document provided by the facility titled Quality Assurance Performance Improvement (QAPI) Plan, dated 2022 prepared by Compliance Store, indicated . Introduction . The QAPI Plan of [Facility Name] is designed to establish and maintain an organized facility-wide program that is data-driven and utilizes a proactive approach to improving the quality of care and services throughout the facility. […]