Edgewater Skilled Nursing Center

In the surveyor’s words

From the most serious findings on record at Edgewater Skilled Nursing Center, in the surveyor’s own words.

• Immediate jeopardy, patternF755Aug 21, 2023

  Based on interview, and record review, the facility failed to ensure the residents' ordered medications were available for administration and were administered to residents as prescribed by the physician for four out of five sampled residents (Residents 1, 2, 3, and 4). The facility failed to: 1. Ensure Resident 1 received Seroquel [Quetiapine] a medication used to treat psychotic disorders [a mental disorder characterized by a disconnection from reality]), 150 milligrams [(mg) unit of measurement] twice a day (BID) as ordered for behavioral management. 2. Ensure Resident 2 received Prednisone (a medication used to decrease inflammation [body's response to injury marked by redness, heat, swelling and pain]) 10 mg three-times a day (TID) as ordered for knee inflammation. 3. […]

• Actual harm, isolatedF689May 2, 2024

  Based on interview and record review, the facility failed to ensure, the resident who was assessed as a high risk for falls and was totally dependent on staff for activities of daily living (ADL), did not fall out of bed and sustained injuries for one of three sampled residents (Resident 1). The facility failed to: 1. Ensure Resident 1 had more than one staff present to provide incontinence care when the resident was found being soiled while in bed. 2. Ensure Resident 1's bed was maintained in a lowest position as care planned to prevent the resident from fall. 3. […]

• Actual harm, isolatedF689Sep 14, 2022

  Based on observation, interview, and record review, the facility failed to ensure one of one sampled resident (Resident 1) was free of accidents and hazards. Certified Nursing Assistant (CNA) 1 assisted Resident 1 to the toilet without help of other staff and Resident 1 fell and hit his head on the wall. Resident 1, who was at high risk for fall was not assisted by two or more staff during toilet use as indicated in Resident 1's Minimum Data Set ([MDS], a standardized assessment and care planning tool) and per the Physical Therapy Evaluation and Plan of Treatment. […]

• No harm, potential for more than minimal, widespreadF867Dec 4, 2024

  Based on interview, and record review the facility's Quality Assessment and Assurance ([QAA] develop and implement appropriate plans of action to correct identified quality deficiencies) and Quality Assurance Performance Improvement ([QAPI] a systematic, interdisciplinary, comprehensive, and data-driven approach to maintaining and improving safety and quality in nursing homes while involving residents and families, and all nursing home caregivers in practical and creative problem solving) committee failed to develop and implement appropriate methods to measure the success of actions implemented addressing the continued concerns from the Resident Council pertaining to a delay in call light response during the hours of 11 p.m. […]

• No harm, potential for more than minimal, patternF565Feb 7, 2025

  Based on observation, interview and record review, the facility failed to ensure prompt attempts were made to resolve the resident council meeting complaints of call lights not being answered, staff being rude, and not receiving care timely or at all for 5 of 11 sampled residents (Resident 1, Resident 2, Resident 4, Resident 7, and Resident 9). This deficient practice had the potential to violate the residents' right to have their concerns addressed. Findings: a. During a review of Resident 1 ' s Admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including cerebral infarction (also known as a stroke, where blood flow to the brain is interrupted causing brain tissue to die) and congested heart failure (CHF - a heart… […]