English Valley Nursing Care Center

In the surveyor’s words

From the most serious findings on record at English Valley Nursing Care Center, in the surveyor’s own words.

• Actual harm, isolatedF689Oct 19, 2023

  Based on observation, clinical record review, staff interviews, and facility policy review, the facility failed to prevent falls causing major injuries for 3 out of 5 residents reviewed with falls and a history of major injury (Residents #16, #21 and #36). The facility reported a census of 35 residents. Findings Include: 1. The Minimum Data Set (MDS) dated [DATE] identified Resident #36 as severely cognitively impaired with a Brief Interview for Mental Status (BIMS) score of 7 out of 15 and had the following diagnoses: Chronic Systolic Congestive Heart Failure, Debility, Cardiorespiratory Conditions and Alzheimer's. […]

• No harm, potential for more than minimal, patternF689Mar 3, 2021

  Based on observation, record review, and interview, the facility failed to maintain minimum safe water temperatures in resident rooms and the shower room. The facility reported a census of 40 residents. Findings: During a tour of the facility on 02/22/21 at 3:19 p.m., the survey team requested the Maintenance Supervisor to obtain and provide water temperatures and he provided the following(all temperatures in degrees Fahrenheit): room [ROOM NUMBER] 126.1 room [ROOM NUMBER] 126.5 room [ROOM NUMBER] 126.8 room [ROOM NUMBER] 126.3 room [ROOM NUMBER] 124.7 room [ROOM NUMBER] 125.6 During the tour, the Maintenance Supervisor stated he was newer in the position and the water was way worse when he first arrived. When asked to clarify, he stated the water was hotter when he first arrived. […]

• No harm, potential for more than minimal, isolatedF606Mar 3, 2021

  Based on record review and interview, the facility failed to ensure the completion of a criminal background checks for 1 of 4 newly hired employees(Staff B). The facility reported a census of 40 residents. Findings: Record review of facility New Hire list, Staff B had a hire date of 06/25/20. Review of a Single Contact License and Background Check(SING), dated 06/22/20, stated further research required and directed staff to await the DCI's(Division of Criminal Investigation) final response. […]

• No harm, potential for more than minimal, isolatedF609Mar 3, 2021

  Based on observation, clinical record review, policy review, and staff interview, the facility failed to report an injury of unknown origin(an arm fracture) to the State Agency for 1 of 1 residents reviewed with an injury of unknown origin(Resident #22). The facility reported a census of 40 residents. Findings: 1. The MDS(Minimum Data Set) assessment tool, dated 01/11/21, listed [DIAGNOSES REDACTED]. The MDS documented resident completely depended on 1 staff for dressing, eating, and personal hygiene, and completely depended on 2 staff for bed mobility, transfers, and bathing. The MDS also documented the resident's cognition was severely impaired. An observation on 02/25/21 at 8:59 a.m. […]

• No harm, potential for more than minimal, isolatedF658Mar 3, 2021

  Based on observation, record review, and staff interviews, the facility failed to prime (remove air bubbles from the needle) the needle tip of an insulin pen before injecting insulin in 1 of 1 residents observed receiving insulin (Resident #19) and failed to recognize a non-crushable medication when giving pills to 1 of 3 residents receiving crushed pills (Resident #35). The facility reported a census of 40 residents. Findings include: 1. The Medication Administration Record [REDACTED]. During an observation of insulin administration on 02/24/21 at 8:00 a.m., Staff A, Licensed Practical Nurse(LPN), disinfected the top of the insulin pen with an alcohol wipe. […]