Minneola District Hospital Ltcu

In the surveyor’s words

From the most serious findings on record at Minneola District Hospital Ltcu, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Mar 4, 2025

  The facility reported a census of 19 residents, with eleven residents sampled, including five residents reviewed for accidents. Based on observation, interview, record review, the facility failed to ensure that dependent resident (R)2 remained free from accident hazards/harm related to staff feeding R2 pureed foods, without ensuring the pureed foods were at a safe temperature to eat. The staff attempted to give R2 bites of pureed food which included: hot pureed soup, which had been heated 196 degrees Fahrenheit (F) and placed in an insulated container on the steam table; and a pureed grilled sandwich, which had been heated to 150 degrees F, without obtaining the temperature prior to serving the dependent resident. This failure placed R2 in immediate jeopardy. […]

• Actual harm, isolatedF692Mar 4, 2025

  The facility identified a census of 19 residents, with 11 sampled, including one reviewed for hydration. Based on observation, interview, and record review, the facility failed to offer sufficient fluid intake to maintain proper hydration and health for Resident (R)6. This deficient practice resulted the hospitalization admission of R6 for dehydration. Findings included: - Review of R6's diagnoses from the Electronic Health Record (EHR) included dementia (progressive mental disorder characterized by failing memory, confusion) and amnesia (loss of memory caused by brain damage or severe emotional trauma). The Annual Minimum Data Set (MDS) dated [DATE], documented R6 had a Brief Interview of Mental Status (BIMS) score of four, which indicated severely impaired cognition. […]

• No harm, potential for more than minimal, widespreadF761Mar 4, 2025

  The facility census totaled 19 residents and one medication carts. Based on observation, interview, and record review, the facility failed to ensure the staff had secured storage of resident medications when observation onsite revealed an unlocked and unattended medication cart, not in the line of vision of the attending staff, and contained oral, topical and inhaled medications. This deficient practice placed nine cognitively impaired, independently mobile residents at risk. Findings included: - On 02/25/25 at 08:36 AM, observation revealed an unlocked and unattended medication cart which contained oral, topical, and inhaled medications in the hall between the dining area and the commons area. […]

• No harm, potential for more than minimal, widespreadF812Mar 4, 2025

  The facility reported 19 residents with 11 residents sampled. Based on observation, interview and record review the facility failed to store, prepare and serve food in a sanitary manner. This placed all residents at risk for food bourne illness. Findings included: - An observation on 02/25/25 at 10:40 AM, revealed a trash can at the hand washing sink. The trash can failed to have a foot operated lid. The lid had a flip top and closed by swinging next to the food preparation area. An observation on 02/25/25 at 11:45 AM, Dietary Aide M pushed down trash into the trash can with a gloved hand then resumed preparation of food with the same gloved hand. The facilities Food Preparation and Service Policy revised 5/21/2024 under 5. […]

• No harm, potential for more than minimal, widespreadF880Mar 4, 2025

  The facility reported a census of 19 residents with 11 residents reviewed. Based on observation, interview and record review, the facility failed to maintain a comprehensive infection control program related to laundry delivery. This failure had the potential to lead to contamination of clean linens during delivery which had the potential to negatively affect all the residents in the facility. Findings included: - On 02/25/25 at 03:30 PM, observation revealed laundry personnel transported clean resident laundry in the laundry cart through the facility halls with one of the side covers draped over the top of the cart exposing the clean laundry. […]