Colonial Vista Post-Acute & Rehab Center

In the surveyor’s words

From the most serious findings on record at Colonial Vista Post-Acute & Rehab Center, in the surveyor’s own words.

• Actual harm, isolatedF550May 26, 2022

  Based on observation, interview, and record review, the facility failed to ensure two of two residents (37,5) were treated with dignity and respect when the facility delayed resolution and notification to Residents 37 and 5, the outcome of an investigation that revealed an unfounded allegation of sexual abuse. This failure placed both residents at risk for prolonged psychological distress and caused psychosocial harm to Resident 37 who experienced frustration, anger, increased sadness, and a diminished quality of life. Findings included . Resident 37. Review of the medical record showed the resident admitted in April of 2020. […]

• Actual harm, isolatedF689Mar 11, 2022

  Based on interview and record review, the facility failed to ensure adequate supervision was provided for one of one resident (1) reviewed for accident prevention. Failure to implement interventions including adequate supervision with the use of a mechanical lifting device (hoyer lift) consistent with the resident's care plan, resulted in a significant head injury to the resident, requiring hospital intervention. Findings included . Resident 1. Per the medical record, the resident was admitted to the facility on [DATE] with diagnoses including [CONDITION(S)], kidney disease, diabetes and dementia. […]

• Actual harm, isolatedF684Mar 3, 2021

  Based on interview and record review the facility failed to assess and implement interventions in accordance with professional standards of practice for one of four residents (#1) reviewed for diabetic management. Failure to monitor the resident's blood glucose (sugar) levels following notification of high blood glucose lab values, and discontinuance of a diabetic medication resulted in deterioration of the resident's medical condition, requiring hospitalization for emergency blood glucose management and related complications. Findings included . Resident #1. Per the medical record, the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. […]

• No harm, potential for more than minimal, widespreadF804Sep 27, 2024

  Based on observation, interview, and record review, the facility failed to maintain safe food holding temperatures for 1 of 2 meal preparations (lunch meal on 9/26/2024) reviewed for safe and sanitary kitchen. This failed practice placed all residents at risk for Food borne illness (caused by consuming foods that are contaminated with harmful pathogens [bacteria that reproduce rapidly once entered in the body and can damage tissues and cause illness]). Findings included . Review of a policy titled Food Preparation and Service dated 11/2022, showed the danger zone for food holding temperatures is below 135 Farenheit (F, a unit of temperature measurement) and the longer food sits below 135 F the higher the risk for the growth of harmful pathogens. […]

• No harm, potential for more than minimal, widespreadF812Sep 27, 2024

  Based on observation, interview, and record review, the facility failed to discard expired foods in 1 of 1 dry storage and 1 of 1 walk in refrigerator reviewed for safe and sanitary kitchen. This failed practice placed all residents at risk for Food borne illness (caused by consuming foods that are contaminated with harmful pathogens [bacteria that reproduce rapidly once entered in the body and can damage tissues and cause illness]). Findings included . During the general tour of the kitchen on [DATE] at 10:31 AM, showed expired foods in the dry storage room of the kitchen as follows; 1) three 46-ounce (oz, a unit of measure) containers of orange juice concentrate that expired on [DATE], 2) four 46 oz containers of thickened cranberry cocktail that expired on [DATE], 3) two packages of… […]