Fir Lane Care

In the surveyor’s words

From the most serious findings on record at Fir Lane Care, in the surveyor’s own words.

• Immediate jeopardy, widespreadF880Jan 7, 2022

  Based on observation, interview, and record review, the facility failed to operationalize all components of an effective infection control program to prevent and limit the spread of COVID-19 (an infectious virus causing respiratory illness with symptoms including cough, fever, nausea, loss of taste or smell and difficulty breathing that can result in severe impairment or death) throughout the facility for all residents at a widespread status, residing at the facility including cohorting and surveillance for nine of 21 sampled residents (9, 22, 11, 15, 17, 16, 20, 26 & 25) reviewed for infection control prevention and control. This failure placed all residents and staff at risk for exposure to COVID-19, related to serious medical complications, and diminished quality of life and death. […]

• Immediate jeopardy, isolatedF689Dec 17, 2024

  Based on observation, interview and record review the facility failed to ensure the resident environment was safe and free from hazards for 17 of 17 sampled residents (1 ,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17) residing in the facility's locked dementia unit. Resident 1 experienced harm when they sustained a significant second degree burn (burn that affects the epidermis [outer layer of skin] and the dermis [middle layer of skin] to the left hip when they were found unsupervised seated on a baseboard heater. […]

• Actual harm, isolatedF760Mar 27, 2025

  Based on interview and record review, the facility failed to ensure medications to prevent seizures were administered per physician orders for 1 of 3 residents (Resident 6) reviewed for quality care. Resident 6 experienced harm when they were found unresponsive, required Cardio-Pulmonary Resuscitation (CPR/an emergency procedure consisting of chest compressions combined with giving breaths of air) and was hospitalized when their medication for seizures were not administered for multiple doses due to the unavailability of the medications, resident refusals, and failure to notify the physician of the omissions. This failure placed all residents at risk for medical complications and a diminished quality of life. […]

• Actual harm, isolatedF686Feb 21, 2025

  Based on interview and record review, the facility failed to accurately assess and take timely action to prevent the development of pressure ulcers (injury to skin and underlying tissue resulting from prolonged pressure) experienced by 1 of 1 closed record Resident reviewed for wound care. Resident 1 experienced actual harm when they developed pressure ulcers to both heels which required hospitalization for surgical intervention, intravenous (administered through the vein) antibiotics and below the knee amputation (BKA) of their right lower extremity (RLE). […]

• Actual harm, isolatedF689Jun 8, 2023

  Based on observation, interview and record review, the facility failed to ensure the resident environment was safe and free from hazards when a resident received a significant burn from hot coffee for 1 of 1 sampled residents, and failed to supervise resident interactions and implement interventions to prevent a resident-to-resident altercation for 2 of 2 sampled residents (1 & 2) reviewed for accident hazards and supervision. This caused harm to Resident 1 when hot coffee spilled on the resident causing blisters and redness. These failures placed residents at risk for burns, unwanted touching and a diminished quality of life. […]