Carlyle Senior Care of Fork

In the surveyor’s words

From the most serious findings on record at Carlyle Senior Care of Fork, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Aug 23, 2023

  Based on observation, interview and review of facility policy, the facility failed to ensure foods that are stored in the walk-in refrigerator and freezer, and unit refrigerators were labeled and discarded after manufacturer's expiration date. These deficiencies had the potential to affect all the residents who reside in the facility. Findings include: Review of the facility policy titled, Dietary-Food Safety Requirements-Policy with an approval date of 05/21/19 revealed under policy explanation and compliance guidelines, (1) b. Storage of food in a manner that helps prevent deterioration or contamination of the food, including from growth of microorganisms; (3)c iv. […]

• No harm, potential for more than minimal, isolatedF880Apr 18, 2025

  Based on observation and interview, the facility failed to ensure staff served resident meals in a clean and safe manner and utilized proper hand hygiene during meal service in one (1) of two (2) dining rooms and for one (1) of one (1)1 resident observed during tray set up. (Resident (R)15) Findings include: During midday meal service on 4/15/25 from 12:10 p.m. to 12:55 p.m., Certified Nursing Assistant (CNA) HH was observed assisting multiple unidentified residents throughout the dining room with tray set up, getting additional drinks, getting and opening a resident's sandwich, clearing tables and removing trays. Additionally, CNA HH touched multiple residents on the arm, shoulder or back to prompt or encourage them to finish the meal. […]

• No harm, potential for more than minimal, isolatedF550Aug 23, 2023

  Based on review of facility policy, observations, record reviews and interviews, the facility failed to ensure the dignity was maintained for 3 of 16 residents. Specifically, Resident (R)3, (R33) and R84 were observed in bed and wearing hospital gowns for multiple days. Findings include: Review of the undated facility policy titled, Dignity - Promoting ad Maintaining, states under Policy, It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, the maintains or enhances resident's quality of life by recognizing each resident's individuality. Under the section titled Compliance Guidelines states, 1. […]

• No harm, potential for more than minimal, isolatedF584Aug 23, 2023

  Based on observations, interviews, and facility policy review, the facility failed to ensure 2 rooms (room [ROOM NUMBER], room [ROOM NUMBER]) on 2 of 4 units were in good repair. Findings include: A review of an undated facility policy titled, Maintenance Request Form revealed, Policy Statement: The Maintenance Director and maintenance staff shall respond to all maintenance requests in a prompt and efficient manner and keep a record of all work performed. The policy included, Policy Interpretation and Implementation: 1. […]

• No harm, potential for more than minimal, isolatedF636Aug 23, 2023

  Based on review of facility policy, record review, and interviews the facility failed to accurately assess Resident (R)45 after a fall for 1 out of 3 residents reviewed for falls. Findings include: Review of facility policy titled, MDS-conducting an accurate resident assessment with an approval date of 09/25/19 revealed, the purpose of this policy is to assure that all resident's receive an accurate assessment, reflective of the resident's status at the time of the assessment, by staff qualified to assess relevant care areas. Review of the section titled policy explanation and compliance guidelines revealed, Qualified staff who are knowledgeable about the resident will conduct an accurate assessment addressing each resident's status, needs, strengths and areas of decline. […]