Cloverleaf of Knightsville

In the surveyor’s words

From the most serious findings on record at Cloverleaf of Knightsville, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF880Nov 3, 2023

  A. Based on observation, interview, and record review, the facility failed to ensure an adequate infection control program was implemented to track the COVID-19 positive and potentially exposed residents which had the potential to effect 68 of 68 residents that reside in the facility. B. Based on observation, interview, and record review, the facility failed to follow infection control precautions, COVID-19 testing protocols, and ensure tracking for a COVID-19 outbreak for 68 of 68 residents reviewed for infection control. Findings include: A. On 11/2/23 at 9:01 a.m., the Infection Prevention Nurse (IP) indicated she was tracking for end dates to remove COVID-19 positive residents from the droplet isolation rooms. Residents would be in isolation for 10 days. […]

• No harm, potential for more than minimal, patternF812Nov 3, 2023

  Based on observation, interview, and record review, the facility failed to ensure food was covered when delivered to the units and the facility failed to ensure hand hygiene was completed when assisting residents to eat for 1 of 2 dining observations. Findings include: 1. On 10/30/23 at 11:59 a.m., dietary staff delivered an uncovered meal cart with Residents' trays to the A hall, with uncovered brownies on disposable plates on all of the uncovered meal trays. On 10/30/23 at 12:09 p.m., dietary staff delivered an uncovered meal cart with Residents' trays to the B hall, with uncovered brownies on disposable plates on all of the uncovered meal trays. […]

• No harm, potential for more than minimal, patternF812Aug 4, 2022

  Based on observation, interview, and record review, the facility failed to ensure staff wore a beard or hair restraints when in the kitchen for 2 of 2 days of observations in the kitchen, failed to ensure hand hygiene was completed prior to assisting a resident with their lunch meal for 1 of 1 resident observed for dining (Resident 28), and failed to ensure hand hygiene was completed prior to pureeing residents' food for 1 of 1 observation of pureed food. Findings include: 1. During an observation in the facility kitchen, on 7/28/22 at 10:07 a.m., Dietary Aide 5 was observed to wear a hairnet and a medical face mask. […]

• No harm, potential for more than minimal, patternF657Aug 13, 2021

  Based on interview and record review, the facility failed to ensure care plan meetings were provided and care plans were developed or revised in a timely manner for 7 of 21 residents reviewed for care plan meetings and updated care plans (Residents 39, 21, 32, 13, 5, 53, and 56). Findings include: 1. On 8/8/21 at 11:33 a.m., Resident 39 indicated she had not been invited to a care plan meeting. Resident 39's record was reviewed on 8/10/21 at 9:24 a.m. A quarterly Minimum Data Set (MDS) assessment, dated 6/28/21, indicated the resident had a moderate cognitive impairment. Census information indicated the resident was admitted to the facility on [DATE]. Progress notes, dated 2/1/21 to 8/8/21, lacked documentation a care plan meeting was offered, conducted, or refused. […]

• No harm, potential for more than minimal, isolatedF698Feb 13, 2026

  Based on interview and record review, the facility failed to ensure safe administration of peritoneal dialysis (a home-based treatment for kidney failure that uses the lining of the abdomen to filter waste and extra fluid from the blood) by staff trained and qualified to administer peritoneal dialysis for 1 of 1 resident reviewed for peritoneal dialysis (Resident 2). Findings include:During an interview, on 2/10/26 at 10:41 a.m., Resident 2 indicated he was on peritoneal dialysis and staff would place him on the dialysis in the evening and would remove it around 8 to 8:30 a.m. the next morning. Resident 2's record was reviewed on 2/12/26 at 3:09 p.m. […]