Countryside Manor Health & Living Community

In the surveyor’s words

From the most serious findings on record at Countryside Manor Health & Living Community, in the surveyor’s own words.

• Immediate jeopardy, isolatedF760Aug 13, 2021

  Based on record review and interview, the facility failed to transcribe an order for [MEDICAL RECORD OR PHYSICIAN ORDER] . The medication was given at an incorrect dose, which resulted in a critically elevated PT (prothrombin time) and INR (international normalized ratio) level, which resulted in hospitalization for rectal bleeding due to a critically elevated PT/INR level of 9.9 for 1 of 3 residents reviewed for medication errors. (Resident B) The Immediate Jeopardy began on 7/12/21 when the facility failed to correctly enter a physician order, and Resident B received the wrong dose of medication and was transferred to the emergency room and required hospitalization for stabilization and treatment of [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• No harm, potential for more than minimal, widespreadF725Jul 16, 2021

  Based on interview, observation and record review, the facility failed to maintain sufficient numbers of staff to complete the activities of daily living (ADL) in the facility for 12 of 12 residents reviewed for ADL care. (Residents 3, 4, 5, 7, 15, 16, 18, 22, 33, 39, B, C) Findings include: 1. During an observation on 7/13/21 at 9:54 a.m., Resident 16 indicated she had her call light on a few minutes ago, and a male CNA came in and turned her call light off. He indicated he would be right back. She proceeded to turn her call light back on for assistance to go to the bathroom. At 9:57 a.m., the Administrator entered the resident room for approximately two minutes and turned the call light off. During continuous observation, at 10:36 a.m., the resident's call light came back on. […]

• No harm, potential for more than minimal, patternF565Dec 4, 2023

  Based on interview and record review, the facility failed to resolve resident council concerns related to call lights being turned off prior to assistance and long call light wait times. (Residents 2, 9, 10, 16, 20, 38, 49, 54 and 73) Findings include: During the Resident Council meeting on 11/29/23 at 2:35 p.m., Residents 2, 9, 10, 16, 20, 38, 49, 54 and 73 indicated the wait for call lights to be answered was long, and staff would turn off the call light without completing care. During an interview on 11/27/23 at 10:58 a.m., Resident 67 indicated the call light wait time ranged from 1 to 2 hours, with the average being around an hour. […]

• No harm, potential for more than minimal, patternF582Dec 4, 2023

  Based on interview and record review, the facility failed to provide notification of Medicare non-coverage for 3 of 3 residents reviewed for beneficiary protection notifications. (Resident 68, 185, and 71) Findings include: On 11/28/23 at 2:25 p.m., the SNF (Skilled Nursing Facility) Beneficiary Protection Notification Review Forms were reviewed, and indicated the following: 1. Resident 68 had admitted to the facility on [DATE] under Medicare Part A Skilled Services. The last covered day of Part A Services was 8/5/23. The resident remained in the facility. The clinical record lacked both Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) and the Notice of Medicare Non-coverage (NOMNC) notices. 2. […]

• No harm, potential for more than minimal, patternF585Dec 4, 2023

  Based on record review and interview, the facility failed to educate resident council members on the facility grievance process. (Residents 9, 16, 20, 38, 54, and 73) Findings include: During the Resident Council meeting on 11/29/23 at 2:30 p.m., residents 9, 16, 20, 38, 54, and 73 indicated they did not know the grievance process or how to file a grievance. During a record review on 11/28/23 at 9:57 a.m., the resident council binder lacked a record of grievances filed. During an interview on 11/30/23 at 9:25 a.m., the Administrator indicated there were no grievances from the resident council meetings and the Social Services Director (SSD) was the facility's grievance designee. […]