Chapel Hill Community

In the surveyor’s words

From the most serious findings on record at Chapel Hill Community, in the surveyor’s own words.

• Actual harm, isolatedF689Aug 26, 2021

  Based on Self-Reported Incident review, record review, personnel file review and staff interview, the facility failed to ensure residents were provided transfer assistance by properly trained staff members. Actual Harm occurred on 08/05/21 when Resident #58 was transferred from her wheelchair to bed by an untrained staff member, resulting in a fall with fracture to the left femoral neck which required surgical repair This affected one (Resident #58) of three residents reviewed for accidents. The facility census was 75. Findings include: Review of Self-Reported Incident (SRI) # 1 revealed on 08/05/21 Resident #58 was assisted by Maintenance Assistant #88 to transfer from the wheelchair to her bed and suffered a fall with fracture. […]

• No harm, potential for more than minimal, widespreadF804Jun 6, 2023

  Based on observations, interviews, facility food temperature logs review, and facility policy, the facility failed to ensure food items were served at palatable temperature which had the potential to affect all 67 residents who received food from the kitchen. The facility identified Resident #67 as receiving nothing by mouth. The facility census was 68. Findings include: Interview on 06/05/23 at 10:34 A.M. revealed Resident #61 felt the food was cold sometimes. Observation was conducted on 06/05/23 from 5:00 P.M. to 5:40 P.M. of dietary staff plating the lunch meal from a steam table in the second-floor unit dining room. As the tray line neared an end, the surveyor requested a test tray be prepared and placed on the second-floor room tray food cart. […]

• No harm, potential for more than minimal, widespreadF812Jun 6, 2023

  Based on observation, record review and interview, the facility did not ensure food was stored, prepared and served under sanitary conditions. This had the potential to affect 67 residents who received food from the kitchen. The facility identified one resident (#67) as receiving nothing by mouth. The facility census was 68. Findings include: 1. Observation of the facility kitchen on 06/05/23 from 2:25 P.M. to 3:20 P.M. with the Director of Dietary (DD) #701 revealed the following concerns verified at the time of observation by DD# 701: The microwave in the kitchen area had an accumulation of spattered debris on the walls, inside of the door, and the inside top of unit; In the walk-in cooler, there was one five-pound container of sour cream with an open date of 5/18/23 and best if used by… […]

• No harm, potential for more than minimal, widespreadF812Nov 7, 2022

  Based on observation, facility policy and procedure review and interview the facility failed to ensure staff washed their hands during the passing of the meal trays, failed to ensure the cleanliness of kitchen areas and timely and proper disposal of outdated/expired foods and failed to ensure dish machine temperatures were monitored to prevent contamination and/or food borne illness. This had the potential to affect 71 of 71 residents who received meal trays from the kitchen. The facility census was 72. Findings include: 1. On [DATE] at 8:32 A.M. observation during the initial kitchen tour revealed the following: a. […]

• No harm, potential for more than minimal, patternF550Jun 6, 2023

  Based on record review, observation and interview, the facility failed to ensure Residents # 6, #35, #42, and #45 were fed in a respectful and dignified manner. This affected four (#6, #35, #42, and #45) out of six residents reviewed for dining services. The facility census was 68. 1. Record review for Resident # 6 revealed an admitted [DATE]. Diagnoses included dementia, muscle weakness, need for assistance with personal care, cognitive communication deficit, anxiety disorder, schizophrenia, and age-related physical debility. Review of physician orders for Resident #6 revealed an order dated 03/09/23 for a no added salt, regular texture, regular/thin liquids diet. […]