Colonial Pines Healthcare Center

In the surveyor’s words

From the most serious findings on record at Colonial Pines Healthcare Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jun 3, 2023

  Based on observation, interview and record review the facility failed to ensure the residents environment remained free from accident hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents for 2 of 5 residents (Resident #1 and Resident #2) reviewed for accidents, hazards, and supervision. 1.The facility failed to adequately supervise Resident #1 when being transferred. Resident #1 sustained a fracture of the distal femur (broken bone above the knee) when the Hoyer Lift Sling broke while being transferred with a Hoyer lift device on 1/31/2023. 2. The facility failed to adequately supervise Resident #2 while in a shower chair on 2/28/23. […]

• No harm, potential for more than minimal, widespreadF925Oct 29, 2024

  Based on observation, interview, and record review the facility failed to maintain an effective pest control program to ensure the facility was free of pests for 2 of 4 hallways, (hallway 200 and 400), 2 resident rooms (Resident #33 and Resident #15 rooms) and two of two dining areas (main and locked unit dining areas) reviewed for pest control. The facility failed to ensure hallways, resident rooms and dining rooms were free of flies. This failure could place residents at risk of a diminished quality of life due to an unsanitary environment. […]

• No harm, potential for more than minimal, widespreadF812Sep 7, 2023

  Based on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen in that: The facility failed to ensure opened items in the dry storage were labeled and dated correctly. The facility failed to ensure all food items were discarded by the expiration date. The facility failed to ensure there was soap at the handwashing sink. This deficient practice could place residents who ate food from the kitchen at risk for foodborne illness. Findings include: During an observation and interview on [DATE] beginning at 10:48 am it was observed that there was no soap at the handwashing sink. […]

• No harm, potential for more than minimal, widespreadF944Sep 7, 2023

  Based on interviews and record reviews, the facility failed to ensure Quality Assurance and Performance Improvement (QAPI) training that outlines and informs staff of the elements and goals of the facility's QAPI program for 14 of 14 employees (Administrator, DON, ADON, DM, AD, LVN A, LVN B, LVN C, Rehab Director, CNA D, CNA E, MA F, CNA G, AND CNA H) reviewed for training, in that: The facility failed to ensure that quality assurance and performance improvement training was provided to the Administrator, DON, ADON, DM, AD, LVN A, LVN B, LVN C, Rehab Director, CNA D, CNA E, MA F, CNA G, and CNA H. This failure could place staff and residents at risk for not being aware of facility programs, implementation and monitoring. […]

• No harm, potential for more than minimal, widespreadF812Apr 14, 2021

  Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards in 1 of 1 kitchen reviewed for food service. The facility did not label and date all food items stored in the freezer. The facility did not close the plastic container of food stored in the freezer. The facility did not close all the bags of food stored in the freezer. The facility did not have thermometers in 3 of 4 freezers. The facility failed to keep freezers free of pests. The facility did not label and date foods in dry pantry. The facility did not clean the floor under the shelf in the pantry. The facility did not remove expired foods from the dry pantry. The facility failed to ensure food was not stored on the floor. […]