Maple Valley Nursing Home

In the surveyor’s words

From the most serious findings on record at Maple Valley Nursing Home, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Apr 25, 2024

  This Deficient Practice Statement (DPS) has two parts: A and B. DPS A: Based on observation, interview, and record review, the facility failed to prevent the unauthorized removal of a resident from the facility for approximately 16 hours resulting in the likelihood for serious injury, serious psychosocial harm, or death for one Resident #9 (R9) of one resident reviewed for abuse. Findings Include: The Immediate Jeopardy began on 9/18/23 at 6:07 PM when the facility failed to prevent R9's unauthorized leave from the facility by two former terminated Certified Nurse Aides (CNAs). […]

• Immediate jeopardy, isolatedF805Feb 17, 2023

  This deficient practice pertains to intake MI#00130116: Based on observation, interview, and record review, the facility failed to provide fluids in the prescribed texture/consistency for one Resident (#9) of two residents reviewed for food/beverages served in proper form. This deficient practice resulted in the delivery of fluid of inappropriate consistency which resulted in episodes of choking and aspiration (accidental breathing of food/fluid into the lungs, which can cause pneumonia), and the likelihood of aspiration pneumonia and potential for death. Findings include: Review of Resident #9's Electronic Medical Record (EMR) revealed admission to the facility on [DATE] with diagnoses including Huntington's Disease, aphasia, dysphagia, abnormal weight loss, and esophageal obstruction. […]

• Actual harm, isolatedF689Aug 20, 2024

  This deficiency pertains to Facility Reported Incident (FRI) MI00145634. Based on observation, interview, and record review, the facility failed to prevent a serious burn injury for one Resident of 3 residents reviewed for accidents and hazards. This deficient practice resulted in a second-degree burn sustained to the upper torso of Resident #1. Findings include: Resident #1 (R1): Review of R1's electronic medical record (EMR) revealed initial admission to the facility on [DATE] with diagnoses including dementia and fibromyalgia (a syndrome causing chronic widespread pain). Review of R1's most recent Brief Interview for Mental Status (BIMS) assessment, dated 5/26/24, revealed a score of 9, indicative of moderate cognitive impairment. […]

• Actual harm, isolatedF689Apr 25, 2024

  DPS A: Based on interview and record review, the facility failed to implement appropriate interventions to prevent a fall for one Resident (R24) of one resident reviewed for falls. This deficient practice resulting in R24 sustaining a fall with subsequent injuries requiring staples. Findings include: R24 A review of R24's electronic medical record (EMR) revealed admission to the facility on [DATE] with diagnoses including dementia, history of Urinary Tract Infections (UTI), and osteoarthritis. R24 scored an ,d+[DATE] on the [DATE] Brief Interview for Mental Status (BIMS) score indicative of moderate cognitive impairment. R24 did not have a completed Fall Risk Assessment during her stay at the facility. […]

• Actual harm, isolatedF600Mar 13, 2024

  Intake # M100143193 Based on interview and record review, the facility failed to protect one Resident (#1) of three residents reviewed for the right to be free from mental and/or potential sexual exploitation resulting in the potential for mental anguish and pain. Findings include: Resident #1(R1) Review of the quarterly MDS for R1 dated 2/28/24 revealed a Brief Interview for Mental Status (BIMS) score of 15, indicative of intact cognition. Diagnoses included quadriplegia, bipolar depression and traumatic brain injury. On 3/13/24 at 9:10 AM, a phone interview was conducted with the Guardian (A) for R1, who indicated there was concern for possible sexual exploitation. […]