Holiday Manor Care Center

In the surveyor’s words

From the most serious findings on record at Holiday Manor Care Center, in the surveyor’s own words.

• Immediate jeopardy, widespreadF812May 21, 2021

  Based on observation, interview, and record review, the facility failed to maintain the kitchen in a clean, safe and sanitary condition when did not ensure food was stored, prepared and served in accordance with professional standards of food service safety by: 1. Having cockroaches (small insects that carry and spread infectious diseases) in the kitchen and harborage conditions (locations and conditions where pests can live, thrive, reproduce, and feed). 2. Having one of one ice maker machine, located in the kitchen, with buildup matter inside the ice collection bin and throughout the areas in contact with water and ice. […]

• Immediate jeopardy, widespreadF880May 21, 2021

  Based on observation, interview, and record review, the facility failed to ensure an effective infection prevention and control program, led by the Infection Preventionist [IP] Nurse, to provide a safe and sanitary environment by: 1. Having cockroaches (small insects that carry and spread infectious diseases) in the kitchen and harborage conditions (locations and conditions where pests can live, thrive, reproduce, and feed). 2. Having one of one ice maker machine, located in the kitchen, with buildup matter inside the ice collection bin and throughout the areas in contact with water and ice. […]

• Immediate jeopardy, widespreadF925May 21, 2021

  Based on observation, interview, and record review, the facility failed to conduct an ongoing monitoring of the kitchen environment and effectiveness of the pest control service to prevent and eradicate (destroy/kill) cockroach infestation (presence of an unusually large number of cockroaches [small insects that carry and spread infectious diseases]) and eliminate harborage conditions in the kitchen for 75 of 75 residents residing in the facility and who ate food prepared in the kitchen. The kitchen had live cockroaches on the floor, between the dishwasher counter and a wall, in the dishwashing area between the counter and the wall, and live nymph (baby) cockroaches behind the stove. […]

• Immediate jeopardy, isolatedF600Sep 25, 2024

  Based on interview and record review, the facility (Skilled Nursing Facility 1 [SNF 1]) failed to protect the resident ' s right to be free from neglect (the failure to provide goods and services necessary to avoid physical harm, pain, mental anguish, or emotional distress) for one of three sampled residents (Resident 1), when the facility discharged Resident 1, who exhibited behaviors that made Resident 1 a danger to himself (Resident 1) and others, and who was admitted to SNF 1, a locked facility (facility that cares for residents that utilize secured perimeter fences or locked exit doors) to SNF 2, a non-locked facility (a facility that does not have secured or locked units) on [DATE] without providing safe and orderly discharge services by: 1. […]

• Immediate jeopardy, isolatedF624Sep 25, 2024

  Based on interview and record review, the facility (Skilled Nursing Facility 1 [SNF 1]) failed to ensure a safe and orderly discharge was provided to one of three sampled residents (Resident 1), who exhibited behaviors that made Resident 1 a danger to himself (Resident 1) and others, and who was admitted to SNF 1, a locked facility (facility that cares for residents that utilize secured perimeter fences or locked exit doors) to Skilled Nursing Facility 2 (SNF 2), a non-locked facility (a facility that does not have secured or locked units) on [DATE] by: 1. Failing to ensure Registered Nurse 2 (RN 2) obtained a physician order from Medical Doctor 1 (MD 1- Resident 1 ' s attending physician) to discharge Resident 1 to SNF 2 on [DATE]. 2. […]