Lawrenceville Health & Rehabilitation

In the surveyor’s words

From the most serious findings on record at Lawrenceville Health & Rehabilitation, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF814Mar 19, 2025

  Based on observations, staff interview, and facility document review, it was determined that the facility staff failed to dispose of refuse properly. The facility staff failed to maintain clean dumpster area during the facility task- kitchen observation 3/17/25 at 10:30 AM. The findings include: On 3/17/25 at 10:30 AM, an observation was conducted in the dumpster area outside of the main kitchen, with OSM (other staff member) #1, the dietary manager. Dumpster #1 had an open seam on the front bottom of the dumpster. Tin foil with food debris and a white paper/trash bag were hanging out of the seam. In front of the dumpster was a half sandwich and citrus peel. Dumpster #2 had a bifold lid. The right side of the bifold lid was open all the way back. […]

• No harm, potential for more than minimal, patternF657Mar 19, 2025

  3. For Resident #13 (R13) the facility staff failed to review and revise the care plan with a specialized diet order. On 3/17/25 at 12:55 p.m., R13 was observed sitting up in bed eating lunch. The resident's lunch tray contained regular consistency potato salad and peach cobbler (peach slices and cobbler crust). A review of R13's meal ticket revealed, in part: Dysphagia advanced .peaches and cream cake. On 3/17/24 at 5:55 p.m., R13 was observed sitting up in bed eating dinner. The dinner tray contained cubed chicken (approximately 1.5 centimeters cubed). […]

• No harm, potential for more than minimal, patternF712Mar 19, 2025

  Based on resident / staff interview, clinical record review and facility document review, it was determined the facility staff failed to provide evidence of the frequency of physician visits at least every 60 days for five of 29 residents in the survey sample, R48, R9, R59, R28 and R56. The findings include: 1. R48 was admitted to the facility on [DATE] with diagnosis that included but were not limited to acute respiratory failure, COPD (chronic obstructive pulmonary disease) and CHF (congestive heart failure). The most recent MDS (minimum data set) assessment, a quarterly assessment, with an ARD (assessment reference date) of 12/19/24, coded the resident as scoring a 15 out of 15 on the BIMS (brief interview for mental status) score, indicating the resident was not cognitively impaired. […]

• No harm, potential for more than minimal, patternF805Mar 19, 2025

  Based on observation, resident interview, facility staff interview, facility document review, and clinical record review, the facility staff failed to serve food in a form to meet resident needs for five of 29 residents in the survey sample, Residents #17, #19, #13, #1, and #20. The findings include: 1. For Resident #17 (R17), the facility staff failed to serve a mechanical soft diet on 3/17/25 at both the lunch and dinner meals. On 3/17/25 at 12:48 p.m., R17 was observed sitting up in bed eating lunch. The resident's lunch tray contained one regular roll and peach cobbler (peach slices and cobbler crust). The resident's tray also contained an empty Mountain Dew can with a straw. […]

• No harm, potential for more than minimal, patternF812Mar 19, 2025

  Based on observations, staff interview, and facility document review, it was determined that the facility staff failed to maintain the kitchen in a sanitary manner. The findings include: On 3/17/25 at 10:20 AM, an observation was conducted in the main kitchen. In the refrigerator, there was found one large five-pound bag of shredded sharp cheese that was opened and not dated. OSM (other staff member) #1, the dietary manager was observed with the back of her hair without a hair net covering. An interview was conducted on 3/17/24 at 10:40 AM with OSM (other staff member) #1, the dietary manager. When asked to review the five-pound bag of shredded sharp cheese, OSM #1 stated, that should be dated, we just opened it for breakfast. […]