Kruse Village Senior Living Community

In the surveyor’s words

From the most serious findings on record at Kruse Village Senior Living Community, in the surveyor’s own words.

• Actual harm, isolatedF692May 20, 2021

  Based on interview, record review and policy review, the facility failed to ensure one of three residents reviewed for hydration/nutrition (Resident (R)12) received adequate fluids. R12 experienced a change in condition which included a refusal to eat and drink. The resident was not assessed for dehydration and fluid intake was not monitored even though R12 refused most meals for a period of approximately two weeks resulting in harm with an elevated sodium level on 09/25/20. R12 was sent to the hospital emergency room (ER) on 10/06/20 and was diagnosed with dehydration and a critically elevated sodium level; intravenous (IV) fluids were administered. Findings include: R12 was admitted to the facility on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• No harm, potential for more than minimal, widespreadF908Dec 1, 2022

  Based on observation, interview, and record review, the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition, for 1 of 2 Automated External Defibrillators (long-term care hall- AED) reviewed for safe operating status, in that: The facility failed to replace the long-term care hall's AED CPR-D Padz (electro sticky pads) before they expired, as evidenced by the expiration date of [DATE]. This deficient practice placed residents at risk for not receiving the lifesaving benefits of an AED during an emergency Cardiopulmonary Resuscitation (CPR) emergency. […]

• No harm, potential for more than minimal, widespreadF801May 20, 2021

  Based on observation, interview, record review and policy review, the facility failed to ensure the dietary department was managed by a qualified individual. The dietary department had been without a Dietary Manager for three months; the Consultant Dietitian was in the facility two days per month. Findings include: 1. Review of a typed letter to the previous Dietary Manager revealed her last day of employment was 02/02/21 due to a workforce reduction. 2. During the initial tour of the kitchen on 05/17/21 at 10:20 AM the Dietary Supervisor stated she was acting in a supervisory role the kitchen but was not the Dietary Manager. She indicated there was no Dietary Manager. 3. Associated Dietary Related Citations a. F803 - During the survey, menus were not followed. […]

• No harm, potential for more than minimal, widespreadF838May 20, 2021

  Based on record review and staff interview, the facility failed to conduct and document a comprehensive facility-wide assessment to determine what resources were necessary to care for its residents competently during day-to-day operations. The lack of an adequate facility assessment had the potential for resident's needs to go unmet and/or result in a lack of services provided by the facility to competently care for 50 residents who resided in the facility at the time of the survey. Findings include: A review of the comprehensive Facility Assessment, dated 02/21, was conducted. The comprehensive Facility Assessment failed to include: 1. […]

• No harm, potential for more than minimal, widespreadF880May 20, 2021

  Based on observation, interview, record review and policy review, the facility failed to ensure the ice supply was sanitary. This created the risk for spread of infections to all residents. Findings include: On 05/18/21 at 11:20 AM the ice machine located near the entrance into the kitchen was observed. The vertical stainless-steel panel on the front of the machine was fastened along the bottom, with the top and sides protruding (stainless panel no longer affixed to the sides or top). This created a gap of approximately two inches where the plastic lid met the horizontal stainless-steel surface. Due to the panel sticking out, the lid of the ice machine did not seal, or close properly. This allowed room temperature air access into the ice bin. […]