Harmony Utica Ridge

In the surveyor’s words

From the most serious findings on record at Harmony Utica Ridge, in the surveyor’s own words.

• Immediate jeopardy, isolatedF686Jun 13, 2024

  Based on observation, clinical record review, resident, family and staff interviews, the facility failed to provide a wound assessment and intervention for 1 of 3 residents reviewed (Resident #16). A bandage over a wound to the right buttocks on Resident #16 was identified by nursing staff on [DATE] without prior documentation and without provider notification for a treatment order. Resident #16 required hospitalization on [DATE] for sepsis, an infected wound, Methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli (E.coli) and a Urinary Tract Infection (UTI). Resident #16 expired on [DATE]. This deficient practice resulted in an Immediate Jeopardy to the health and safety of residents who resided at the facility. […]

• Immediate jeopardy, isolatedF689Mar 5, 2024

  Based on medical record review, family and staff interview and facility failed to supervise and ensure a compromised resident (left sided weakness/paralysis) was safe from accidents when turned in bed, and the result was the subdural hematoma and death. (Resident #14). The facility reported a census of 99 residents. The State Agency informed the facility of the Immediate Jeopardy (IJ) on 2/22/24 at 1:50 PM. The IJ began on 2/20/24. Facility staff removed the Immediate Jeopardy on 2/22/24 at 4:34 PM by completing the following; a. At the direction of the center Quality Assessment and Assurance (QA&A) Committee, an investigation was initiated which included interviewing employees and interviewing like residents residing in the center beginning 2/20/24. b. […]

• Actual harm, isolatedF689Mar 25, 2021

  Based on record review, family and staff interviews the facility failed to safely transfer a resident with a mechanical lift for 1 of 3 residents reviewed (Resident #1) resulting in an injury to the resident. The facility identified a census of 77 residents. Findings include: 1. Resident #1's Minimum Data Set (MDS) assessment dated [DATE] showed the required extensive to total assistance of two staff for all cares, bed mobility, transfers and toileting. The resident did not ambulate. The assessment showed the resident had a Brief Interview for Mental Status (BIMS) of 12 indicating the resident had mildly impaired cognitive skills. […]

• Actual harm, isolatedF692Feb 2, 2021

  Based on record review and interview, the facility failed to assess and evaluate a resident's significant weight loss and implement interventions to prevent further loss for 1 of 3 residents reviewed with a weight loss (Resident #2). The facility reported a census of 85 residents. Findings Include: 1. The Minimum Data Set (MDS) Assessment Tool, dated [DATE], listed [DIAGNOSES REDACTED]. The MDS stated the resident required extensive assistance of 1 staff for personal hygiene, walking, and bathing, and extensive assistance of 2 staff for bed mobility, transfers, dressing, and toilet use. The MDS listed the resident's Brief Interview for Mental Status (BIMS) score as 15 out of 15, indicating intact cognition. […]

• No harm, potential for more than minimal, widespreadF851Apr 21, 2025

  Based on Payroll Based Journal (PBJ) review and staff interview, the facility failed to ensure accurate reporting of weekend staffing hours, resulting in a excessively low weekend staffing trigger for Quarter 1 2025 (October 1-December 31). The facility reported a census of 88 residents. Findings include: Review of the facility's PBJ report for Quarter 1 2025 (reported data from October 1-December 31 2024) revealed the facility triggered for excessively low weekend staffing for the time period. During an interview on 4/17/25 at 2:13 PM, the Administrator acknowledged they had not put agency hours in correctly. A facility policy to related to PBJ reporting requested. The facility reported they do not have such a policy.