Deupree Cottages

In the surveyor’s words

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

• No harm, potential for more than minimal, widespreadF812Jul 17, 2025

  Based on observation, staff interview, review of facility documents, and review of the facility policy, the facility failed to store and prepare food in a sanitary manner and the facility failed to ensure the facility dishwashers maintained a proper temperature to ensure sanitization. This had the potential to affect all of the residents residing in the facility. The facility census was 22 residents.Findings include: 1.Observation on 07/15/25 at 9:20 A.M. with Household Coordinator (HHC) #103 of kitchen #1 revealed the refrigerator contained the following unlabeled and undated items: a container of mashed potatoes, an bag containing an uncooked hamburger patty, a container of chicken salad, a half of a lemon pie, a large open container of ham lunch meat, a purple onion that had been cut… […]

• No harm, potential for more than minimal, isolatedF644Jul 17, 2025

  Based on medical record review, staff interview, and review of the facility policy, the facility failed to complete an updated Preadmission Screening and Resident Reviews (PASARRs) for residents experiencing significant changes and new diagnoses. This affected three (Residents #3, #14, #16 of four residents sampled. The facility census was 22 residents. Findings include: 1. Review of the medical record for Resident #3 revealed an admission date of 04/06/21 with diagnosis including cerebral atherosclerosis, dementia with mood disturbance, and depression. Review of the progress note for Resident #3 dated 03/18/25 revealed the resident was admitted to hospice services. […]

• No harm, potential for more than minimal, isolatedF880Jul 17, 2025

  Based on medical record review, observation, staff interview, review of online guidelines for enhanced barrier precautions (EBP) per the Centers for Disease Control (CDC), and review of the facility policy, the facility failed to display proper signage on the door for residents in EBP and failed to provide a proper receptacle located inside the door of the room for staff to doff personal protective equipment (PPE). This affected one Resident (#6) of one resident reviewed for EBP. The facility census was 22 residents. Findings include: Review of the medical record for Resident #6 revealed an admission date of 02/29/24 with diagnoses including dementia, hypertension, and myalgia. […]