Capri Gardens

In the surveyor’s words

From the most serious findings on record at Capri Gardens, in the surveyor’s own words.

• Immediate jeopardy, isolatedF684Nov 19, 2024

  Based on closed medical record review, review of the hospital records, staff and physician interviews, review of facility letters, and review of the facility policy, the facility failed to ensure Resident #80's continuity of care from the hospital to the facility was thoroughly reviewed and implemented. This resulted in Immediate Jeopardy and the potential for serious life-threatening injuries, negative health outcomes and/or death on [DATE] when Resident #80 received Coumadin (anticoagulation medication) despite hospital orders and recommendations to stop anticoagulation therapy until seen by the neurosurgeon. […]

• Immediate jeopardy, isolatedF695Jun 16, 2021

  THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on observations, review of an employee file, review of a Self-Reported Incident (SRI), review of the facility's investigation and witness statements, review of medical records, review of the State of Ohio Board of Nursing's Complaint Form, review of the coroner's report, review of the facility's policy on Respiratory: [CONDITION(S)] Care, staff interviews, interview with the Medical Director and interview with the local police detective, the facility failed to ensure necessary life-sustaining respiratory services were provided for one (#78) resident. […]

• Actual harm, isolatedF760Mar 1, 2021

  Based on medical record review, hospital record review, staff and family interviews, review of the medication error report, employee education, and review of facility guidelines, the facility failed to ensure residents were free from significant medication errors when one Resident (#07) had not received the appropriate dose of [MEDICATION(S)] (an anticonvulsant medication) upon admission. This resulted in actual harm for Resident #07 when the resident had not received the correct dose of the [CONDITION(S)] medication and had six seizures requiring hospitalization for four days. This affected one Resident (#07) of three reviewed for [CONDITION(S)] medications. The facility census was 75. Findings include: Medical record review revealed Resident #07 was admitted to the facility on [DATE]. […]

• No harm, potential for more than minimal, widespreadF812Jul 28, 2022

  Based on observation, record review, staff interview, and facility policy review, the facility failed to appropriately store, date, and maintain food safety in the kitchen. This affected 74 of 76 residents who receive food from the kitchen (Residents #3 and #34 do not receive food from the kitchen). The facility census was 76. Findings include: Observations on 07/25/22 from 7:35 A.M. to 8:00 A.M. of the kitchen revealed a plastic bag of chicken strips in the walk-in refrigerator that was not dated to when it was opened or when the chicken strips should be used by. Also in the walk in refrigerator, there was an opened bag of lettuce/salad with the perceived date of 06/25/22. The date on the lettuce was fading and very difficult to read. […]

• No harm, potential for more than minimal, patternF761Jul 28, 2022

  Based on review of the facility's policy, review of the Bristol [NAME] Squibb Prescribing Information document, observations, staff and staff interviews, and record review, the facility failed to properly store medications in a safe manner. This affected three of four medication carts and two of four medication rooms observed for medication storage. This affected one resident (#18) who was allowed to self-administer some of her medications. This had the potential to affect five residents who were identified by the facility as being cognitively impaired and at risk for wandering. […]