Margaret E. Moul Home

In the surveyor’s words

From the most serious findings on record at Margaret E. Moul Home, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF552Aug 13, 2026

  Based on facility policy, staff interview, and clinical record reviews, it was determined that the facility failed to provide an explanation of the risks and benefits of psychotropic medication use and obtain consent prior to administering psychotropic medications for four of five residents reviewed for psychotropic medication use (Residents 1, 2, 7, and 43).Findings included: Review of facility provided policy, titled Psychoactive Drug Protocol, without implementation date, failed to reveal any expectation for providing an explanation of the risks and benefits of psychotropic medication use and obtain consent prior to administering psychotropic medications. […]

• No harm, potential for more than minimal, patternF582Sep 4, 2025

  Based on review of clinical records and staff interviews, it was determined that the facility failed to provide the required Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) appropriately, in advance of changes for Medicare covered services, to three of three residents reviewed whose Medicare coverage was discontinued (Residents 6, 9, and 66).Findings include: Review of Resident 6 clinical record documented last covered day for Medicare A services was April 10, 2025. Review of progress note dated April 8th, 2025, read, in part, a message was left for Resident 6's parents stating the Medicare services will end on April 10th, 2025, and on April 11th, 2025, she will evert back to Medicaid. […]

• No harm, potential for more than minimal, patternF812Sep 4, 2025

  Based on facility policy reviews, observations, and staff interviews, it was determined that the facility failed to store food and utilize equipment in accordance with professional standards for food service safety in the main kitchen.Findings include:Review of facility policy, titled Labeling and Dating last reviewed September 2, 2025, read, in part, All food items must be labeled and dated. All food items must be labeled with either a manufacturer label or handwritten label.Review of facility policy titled Purchasing Policy- Storage last reviewed September 2, 2025, read, in part, all items in refrigerators and freezers must be properly wrapped, labeled, and dated.Observation in the dry storage area on September 2, 2025, at 9:57 AM, revealed one open bag of macaroni pasta without an open… […]

• No harm, potential for more than minimal, patternF880Sep 4, 2025

  Based on an observations, facility policy review, record review, and staff interviews, the facility failed to implement infection control policies regarding Enhanced Barrier Precautions for eight of 19 Residents reviewed (Residents 1, 2, 6, 7, 10, 11, 12, and 13). Findings include: Review of facility policy, Enhanced Barrier Precautions, dated July 22, 2025, read, in part, indications for use include chronic wounds and/or indwelling medical devices such as central lines regardless of MDRO (multidrug-resistant organism) status.Review of Resident 1's clinical record revealed diagnoses that included gastrostomy status (a surgical procedure that involves creating an opening in the stomach through the abdominal wall, with the placement of a feeding tube) and cerebral palsy (a neurological… […]

• No harm, potential for more than minimal, patternF730Aug 28, 2024

  Based on document review and staff interview, it was determined that the facility failed to complete a performance review of every nurse aide once every 12 months for five of five nurse aide employee files reviewed (Employees 1-5). Findings Include: A performance evaluation or appraisal is defined as a tool to document an employee's performance over time. A review of Employee 1's information revealed a hire date of May 22, 2023. A review of Employee 1's training information revealed no annual performance evaluation. A review of Employee 2's information revealed a hire date of January 18, 2021. A review of Employee 2's training information revealed no annual performance evaluation. A review of Employee 3's information revealed a hire date of April 17, 2017. […]