Emerald Care Center Southwest LLC

In the surveyor’s words

From the most serious findings on record at Emerald Care Center Southwest LLC, in the surveyor’s own words.

• Actual harm, patternF686Apr 16, 2021

  Based on observation, interview and record review, it was determined the facility failed to ~ perform weekly skin assessments for three (#2, #4 and #5); ~ obtain a physician's orders [REDACTED]. ~ complete wound treatments according to the physician's orders [REDACTED].#2) of five sampled residents who were reviewed for pressure ulcers. Resident #2 was readmitted to the facility on [DATE] with one stage II pressure ulcer. On 04/07/21 she had developed an unstageable deep tissue pressure injury wound on her sacrum. On 04/15/21 the pressure wound on the sacrum had deteriorated and was observed to be open during observation of wound care provided by the staff. […]

• Actual harm, patternF684Feb 22, 2021

  Based on observation, record review and interview, it was determined the facility failed to assess, monitor, and intervene for a resident with surgical wounds for one (#1) of three residents reviewed for surgical wounds. Resident #1 became septic seven days after admission post aortobifemoral bypass surgery. The facility identified seven residents with surgical wounds. Findings: Resident #1 was admitted on [DATE]. His admission [DIAGNOSES REDACTED]. The resident was admitted with three surgical incisions with staples. One incision was on the abdomen and two were in the groin areas. A physician's orders [REDACTED]. The resident's care plan was reviewed and there was no plan for surgical incision care. Medication administration records and treatment administration records were reviewed. […]

• Actual harm, isolatedF684Apr 9, 2025

  Based on record review and interview, the facility failed to ensure a urinalysis order was completed and an antibiotic was transcribed as ordered for 1 (#5) of 3 sampled residents reviewed for care and treatment. The administrator identified 63 residents resided in the facility. Findings: An undated facility policy titled Medication orders, read in part, Written transfer orders (sent with a resident by a hospital or other health care facility): Implement a transfer order without further validation if it is signed and dated by the resident's current attending physician. […]

• No harm, potential for more than minimal, patternF694Apr 9, 2025

  Based on observation, record review, and interview, the facility failed to provide care consistent with professional standards of practice and in accordance with physician orders for: a. a PICC line for 1 (#1) of 3 sampled residents reviewed for infection control; and b. the administration of IV fluids for 1 (#12) of 3 sampled residents reviewed for medications as ordered. The DON identified six residents with IV lines resided in the facility. Findings: 1. On 04/02/25 at 2:21 p.m., Resident #1's PICC line dressing was dated 03/20/25. […]

• No harm, potential for more than minimal, patternF803Apr 9, 2025

  Based on observation, record review, and interview, the facility failed to follow the menu for one of one meal service observed. The DON identified 63 residents who received their meals from the kitchen. Findings: On 04/03/25 at 12:39 p.m., cook #1 was observed to plate four regular plates with each containing three chicken tenders, one scoop of coleslaw, one scoop of mashed potatoes, and one scoop of gravy. On 04/03/25 at 12:44 p.m., cook #1 was observed to plate a mechanical soft diet plate with one scoop grounded chicken tenders, one scoop of mashed potatoes, one scoop of gravy, and one scoop of cooked cabbage. […]