Grantsbrook Nursing and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Grantsbrook Nursing and Rehabilitation Center, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF812Apr 4, 2024

  Based on observation and staff interviews, the facility failed to remove an expired food item stored for use in 1 of 1 refrigerated walk-in storage cooler. This practice had the potential to affect food served to residents. Findings included: During the initial tour of the kitchen on [DATE] at 9:59 am through 10:35 am, the Dietary Manager was present during the inspection the walk-in cooler was observed with a 1-gallon container of salad dressing that was ,d+[DATE] full dated as opened [DATE]. The Dietary Manager was interviewed during the initial tour on [DATE] at 9:59 am through 10:35 am. She stated that staff were trained on food storage to include dating, labeling, and discarding outdated foods. […]

• No harm, potential for more than minimal, isolatedF583Jul 2, 2026

  Based on observations, record review, and staff interviews, the facility failed to provide personal privacy during activities of daily living (ADL) care when Geriatric Care Aide (GCA) #1 video recorded Resident #81 with her cellphone while in the room during care without resident representative consent. This deficient practice affected 1 of 1 resident reviewed for privacy (Resident # 81).The findings included: Resident #81 was originally admitted on [DATE] and readmitted to the facility on [DATE]. Resident #81 expired at the facility on [DATE]. […]

• No harm, potential for more than minimal, isolatedF656May 12, 2025

  Based on record review and staff, Resident, and Resident Representative interviews, the facility failed to develop and implement a comprehensive care plan for a resident with a shellfish allergy. This was for 1 of 3 residents reviewed for dietary allergies (Resident #63). The findings included: Resident #63 was admitted to the facility on [DATE]. Resident #63's quarterly Minimum Data Set (MDS) dated [DATE] indicated the resident was cognitively intact. A review of Resident #63's care plan dated 1/3/25 and last revised on 3/4/25 did not include a focus area, goal or intervention for shellfish allergies. An interview with Resident #63 was conducted on 5/4/25 at 11:45 AM. Resident #63 stated he was served shrimp shortly after he moved into the facility. […]

• No harm, potential for more than minimal, isolatedF806May 12, 2025

  Based on record reviews, and interviews with the Resident, Resident Representative, and staff, the facility failed to obtain a resident's dietary allergies prior to serving food to a resident that would create an allergic reaction. This was for 1 of 3 residents (Resident #63) reviewed for food allergies and preferences. Findings included: Resident #63 was admitted to the facility on [DATE]. There were no allergies listed on the discharge paperwork from the hospital. Resident #63's quarterly Minimum Data Set (MDS) dated [DATE] indicated the resident was cognitively intact. An interview with Resident #63 was conducted on 5/4/25 at 11:45 AM. Resident #63 stated he was served shrimp shortly after he moved into the facility. […]

• No harm, potential for more than minimal, isolatedF880May 12, 2025

  Based on observations, record review, and staff interviews, the facility failed to implement their policy for enhanced barrier precautions (EPB) when Nurse Aide #1 and Nurse Aide #2 failed to wear a gown when providing incontinence care for Resident #14. This was for 2 of 9 staff members observed for infection control practices. Findings included: A review of the facility's policy titled Enhanced Barrier Precautions dated last revised on 4/1/24 revealed in part the following: Enhanced Barrier Precautions (EBP) are used in conjunction with Standard Precautions to reduce the risk of MDRO [Multidrug-resistant bacteria] transmission during high-contact resident care activities. […]