Countryside Estates

In the surveyor’s words

From the most serious findings on record at Countryside Estates, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF882Jul 28, 2026

  Based on record review and interview, the facility failed to ensure a qualified employee was assigned to perform the duties of infection preventionist in the facility.The DON identified 76 residents resided in the facility. Findings:A policy titled Infection Preventionist, dated 07/2016, read in part, The Infection Preventionist is responsible for coordinating the implementation and updating of our established infection prevention and control policies and procedures.A facility employment record, dated 07/22/26, showed the infection preventionist had been terminated on 07/22/26 and their last day worked was 07/20/26.On 07/22/26 at 5:20 p.m., the administrator stated their infection preventionist had resigned that morning (07/22/26) via an email. […]

• No harm, potential for more than minimal, widespreadF812Oct 27, 2023

  Based on observation and interview the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. The DON documented 40 residents received meals from the kitchen. Findings: 1. On 10/19/23 at 9:21 a.m., an initial tour of the kitchen was conducted. A cut tomato in a sealed bad, dated 10/17/23, a cut up onion in a sealed bad, dated 10/13/23, and vegetable soup in a sealed container, dated 10/09/23 were observed in the refrigerator. On 10/19/23 at 9:30 a.m., Cook #1 entered the kitchen with a sack containing salad and other items. Cook #1 was not observed to wash their hands when they entered the kitchen. Cook #1 was observed to start dating the bags of salad and placing them in the refrigerator. […]

• No harm, potential for more than minimal, patternF578Jan 9, 2025

  Based on record review and interview, the facility failed to ensure residents were offered the right to formulate an advanced directive for five (#6, 12, 14, 31, and #35) of eight sampled residents reviewed for advanced directives. DON #1 identified 70 residents resided in the facility. Findings: 1. Res #6 admitted to the facility on [DATE]. Res #6's medical record did not contain an advanced directive acknowledgement form. 2. Res #14 admitted to the facility on [DATE]. Res #14's medical record did not contain an advanced directive acknowledgement form. 3. Res #31 admitted to the facility on [DATE]. Res #31's medical record did not contain an advanced directive acknowledgement form. 46582 4. […]

• No harm, potential for more than minimal, patternF604Jan 9, 2025

  Based on observation, record review, and interview, the facility failed to ensure a resident was assessed, a care plan was completed, and a physician order was obtained for the use of a physical restraint for one (#25) of one sampled resident reviewed for physical restraints. The ADON identified one resident who utilized a wheelchair lap seat belt. Findings: An undated Use of Restraints policy, read in parts, All restraints must have a physician's order and an order for evaluation by designee for the least restrictive device that is appropriate for the resident .Restraints shall be used only for safety or postural support of a resident to prevent injury to self or others .An assessment regarding the need of restraint for the resident will be completed and documented .The physician's… […]

• No harm, potential for more than minimal, patternF688Oct 27, 2023

  Based on observation, record review, and interview the facility failed to ensure residents with limited ROM received the appropriate treatment and services to increase ROM and/or to prevent further decrease in ROM for four (#12, 23, 53, and #69) of six residents reviewed for position/mobility. The DON documented 41 resident with contractures resided in the facility. Findings: 1. Res #23 had diabetes mellitus, cerebral palsy, CVA, and TIA. A quarterly assessment, dated 08/09/23, documented the resident was intact in cognition and required extensive assistance with ADLs. The assessment documented the resident had limited ROM of the upper and lower extremity on one side. A care plan, updated 09/18/23, documented the resident had limited mobility due to left side hemiparesis related to CVA. […]