Crestwood Manor

In the surveyor’s words

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

• No harm, potential for more than minimal, widespreadF812Sep 6, 2024

  Based on observation, interviews, and review of facility documentation it was determined that the facility failed to a.) properly label, date and store potentially hazardous foods in a manner that is intended to prevent the development of food borne illnesses, b.) maintain equipment and kitchen areas in a manner to prevent microbial growth and cross contamination. This deficient practice was evidenced by the following: On 09/03/24 at 08:30 AM, the surveyor conducted a kitchen tour with the Food Service Director (FSD) and the facility Executive Chef (EC). The surveyor observed the following: The Preparation Box refrigerator contained a 1 (one) gallon container of thousand island dressing and a 1-gallon container of tartar sauce with no opening date or use by date. […]

• No harm, potential for more than minimal, widespreadF812Jun 21, 2023

  Based on observation, interview and record review, it was determined that the facility failed to handle potentially hazardous food and maintain sanitation in a safe and consistent manner in order to prevent food borne illness. This deficient practice was evidenced by the following: On 06/12/2023 at 9:25 AM, the surveyor accompanied by the Food service Director (FSD) observed the following in the kitchen: The surveyor observed a number of unlabeled food items throughout the kitchen such as potatoes, a crate of milk, sugar, bagel, and cheese. The FSD observed at the time of the tour that these items were not labeled and confirmed the items should have been labeled appropriately. […]

• No harm, potential for more than minimal, patternF678Mar 12, 2026

  Based on record review, interviews, and policy review, the facility failed to ensure documentation of cardiopulmonary resuscitation (CPR) status for five out of 14 residents reviewed for advance directives (Resident (R) 16, R34, R56, R6, and R41) out of a total sample of 21 residents. This failure created a risk that residents would receive CPR or other life-sustaining interventions that were inconsistent with their expressed wishes, potentially resulting in unwanted treatment, emotional distress, and compromised quality of care.Findings include:1. […]

• No harm, potential for more than minimal, patternF656Apr 14, 2021

  Based on interviews, observation, record review, and review of pertinent facility documentation, it was determined that the facility failed to initiate a care plan for residents receiving anticoagulant medications (blood thinners). This deficient practice was identified for 5 of 17 residents (Resident #6, #7, #12, #26, and #37) reviewed for comprehensive care plans, and was evidenced by the following: 1. On 4/8/21 at 12:33 PM, the surveyor, observed Resident #12 sitting in their room eating lunch. […]

• No harm, potential for more than minimal, isolatedF880Mar 12, 2026

  Based on observations, interviews, record review, and facility policy review, the facility failed to implement Enhanced Barrier Precautions (EBP) and failed to handle soiled linen in a manner to prevent cross contamination for one of 21 sampled residents (Resident (R) 10) reviewed for infection control. These failures placed all residents of the facility at risk for the transmission and spread of infections. Findings include: Review of the facility provided Face Sheet indicated the R10 was re-admitted to the facility on [DATE] with a diagnosis of multiple myeloma and stress fracture. […]