Chippewa Manor Nursing and Rehabilitation

In the surveyor’s words

From the most serious findings on record at Chippewa Manor Nursing and Rehabilitation, in the surveyor’s own words.

• Immediate jeopardy, isolatedF678Jul 26, 2021

  Based on interview and record review, the facility failed to have a system in place to verify code status desires of Resident (R) and ensure Resident wishes were accurately identified in the medical record for a Resident wishing to receive emergency care for 1 of 13 sampled Residents, R36. R36's CPR consent form, dated and signed by her on [DATE], indicates R36 as a full code. The information in the consent form was not transcribed into the medical record. When R36 was found pulseless and nonbreathing, staff did not have accurate information to know to begin CPR. Facility failure to follow the wishes identified in the consent form and begin cardiopulmonary resuscitation created a finding of immediate jeopardy that began on [DATE]. […]

• Actual harm, isolatedF686Mar 24, 2026

  Based on observation, interview and record review, the facility did not ensure that 3 of 4 residents (R) reviewed for pressure injuries (PI) (R48, R47, and R51) received care consistently with professional standards of practice to prevent further deterioration and promote healing of an existing PI. R48 and R47 are being cited at (actual harm/isolated). R51 is being cited at (potential for minimal harm/isolated).R48 and R47 were at risk for PI development. The facility failed to provide adequate interventions to prevent PI development, and did not complete comprehensive weekly assessment with staging of the PI. […]

• No harm, potential for more than minimal, patternF880Jan 29, 2025

  Based on observation and interview, the facility did not maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections. This affected 5 out of 5 residents (R). (R29, R10, R24, R37, and R7) Laundry aide (LA) D did not sanitize hands in between delivering clean linens to R29, R10, R24, R37, and R7. Findings include: The facility policy, titled Laundry and Bedding, Soiled, revised September 2022, states: .Transport: #6. Clean linen is protected from dust and soiling during transport and storage to ensure cleanliness . On 01/27/25 at 10:17 AM, Surveyor observed LA D carry residents' clothes up the stairs to the 1st floor to clean linen cart. […]

• No harm, potential for more than minimal, isolatedF640Mar 24, 2026

  Based on interview and record review, the facility failed to ensure the Minimum Data Set (MDS) assessment was transmitted within 14 days of completion to the Centers for Medicare and Medicaid Services (CMS) for one of five residents (R7) reviewed for MDS.R7 expired in the facility on [DATE] with hospice services. R7's Minimum Data Set (MDS) assessment for a death in the facility was not submitted to the CMS System. On [DATE], Surveyor requested the facility's policy related to MDS assessments; the facility did not provide Surveyor with this policy. Per CMS requirements, within 14 days after a facility completes a resident's assessment, the facility must electronically transmit encoded, accurate, and complete MDS data to the CMS System, including a resident's death. […]

• No harm, potential for more than minimal, isolatedF698Mar 24, 2026

  Based on interview and record review, the facility did not ensure that a resident who requires dialysis receives such service, consistent with professional standards of practice for 1 of 1 residents (R51) reviewed for dialysis.The facility failed to provide ongoing assessment of R51's condition and monitoring for complications before and after dialysis treatments.On 03/23/26 at 3:30 PM, Director of Nursing (DON) B reported the facility did not have a policy. On 03/24/26, DON B provided Surveyor with a policy titled Hemodialysis Policy and Procedure. DON B stated the policy was created on 03/24/26. […]