Every finding on record at Norway Center for Health & Rehabilitation, LLC

Based on observations and interviews, the facility failed to adequately provide housekeeping and maintenance services necessary to maintain the building in a sanitary, orderly, and comfortable environment on 2 of 2 wings (A wing and C wing) and the laundry room for 2 of 2 Environmental tours.(7/20/26 and 7/22/26) Findings:1. On 7/20/26 at 10:12 a.m., a surveyor and a Licensed Practical Nurse (LPN) observed in resident room [ROOM NUMBER] bathroom that the ceiling light had debris in it, the caulking around the base of the toilet was partially missing and dirty, and that there were two wash basins on the floor next to the toilet. At this time, the LPN confirmed the findings. 2. On 7/22/26 from 8:30 a.m. to 9:00 a.m., a surveyor conducted an Environmental Tour with the Maintenance Director, the Housekeeping Manager, the District Manager, the Administrator, and the Regional Director of Operations in which the following findings were discussed and/or observed: A Wing- Resident room [ROOM NUMBER]- Resident #3's wheelchair had rips/tears that were taped with black electrical tape on both the left and right armrests creating uncleanable surfaces.- Resident room [ROOM NUMBER]- The bathroom had a ceiling light which had debris in it. The caulking around the base of the toilet was partially missing and dirty. There were two wash basins on the floor next to the toilet. - Resident room [ROOM NUMBER] - The bathroom toilet had partially missing caulking and was dirty around the base. The ceiling light had debris in it. C Wing- Resident room [ROOM NUMBER] - The bathroom exhaust fan was making an extremely loud noise when turned on. - Resident room [ROOM NUMBER] - The bathroom toilet grab rails were extremely loose. - Resident room [ROOM NUMBER] - The cove base was coming off the wall by the corner near the bathroom. The two wall mounted circular fans were dusty/dirty. - Shower room- The floor had blackish colored buildup around the door frame and the shower edges. The wall grout, around the entire shower, had reddish and blackish colored buildup from the floor going up approximately 3 feet up. Laundry:- The molding behind the dryers was falling off the wall. The wall had chipped/peeling paint around a vent which was under the window. The floor was heavily soiled and dirty. There were multiple missing and broken floor tiles around the entire room. On 7/22/26 at 9:00 a.m., in an interview with a surveyor, the Maintenance Director, the Housekeeping Manager, the District Manager, the Administrator, and the Regional Director of Operations confirmed the discussed and observed findings.

Based on record review, observation, interviews, and the facility's Storage of Medications policy, the facility failed to ensure medications were stored properly in a medication storage refrigerator for 1 of 1 medication refrigerator observed. Additionally, the facility failed to monitor temperature controls for 1 of 1 medication refrigerator observed for 4 of 4 months reviewed. Findings:Facility policy titled Storage of Medications states, Medications requiring refrigeration or temperatures between [36 degrees farenheight] and [46 degrees frenheight] are kept in a refrigerator with a thermometer to allow temperature monitoring . A temperature log or tracking mechanism is maintained to verify temperatures has remained withing acceptable limits. The temperature of any refrigerator that stores vaccines should be monitored and recorded twice daily.1. On 7/20/26 at 9:30 a.m., observation of ice buildup in the medication refrigerator. The refrigerator contained medications Insulin, Ativan, Covid Vaccinations, and tuberculin purified protein (PPD).2. Review of the medication refrigerator temperature logs from April 1,2026 through April 30, 2026 showed missing temperatures for 11 out of the 30 days and temperatures being out of range for 5 out of 30 days. Review of the temperature logs from May 1, 2026 through May 31, 2026 showed missing temperatures for 1 out of the 31 days and temperatures being out of range for 2 of 31 days. Review of temperature logs from June 1, 2026 through June 30, 2026 showed out of range temperatures for 1 of 30 days. Review of temperature logs from July 1, 2026 through July 20, 2026 showed out of range temperatures for 3 of 20 days. On 7/20/26 at 9:30 a.m., the above findings were confirmed and reviewed with the Director of Nursing.

Based on record reviews, interviews, observations and facility policy the facility failed to implement care plan interventions for 1 of 3 residents reviewed for oral hygiene (Resident #7) Findings: Observations of Resident #7 by 2 surveyors on 7/20/26 at 9:20 a.m., and 1:21 p.m., on 7/21/26 at 10:35 a.m., and 1:25 p.m., and 7/22/26 at 10:31 a.m., and 11:44 a.m., and 12:45 p.m., there was obvious white caked on, build-up on bottom teeth.Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #7 had a Brief Interview for Mental Status (BIMS) of 3 of 15 indicating severe cognitive impairment. Review of Resident #7's care plan updated 6/24/26 states Oral hygiene: Partial/moderate assistance, helper provides less than half the effort; 1 staff.Review of Resident #7's ADL task: Oral Hygiene states he/she received oral care on 7/20/26 at 10:25 am, 19:24 p.m., on 7/21/26 at 9:48 a.m., and 7:10 p.m., and 7/22/26 at 10:15 a.m. There is no evidence that Resident #7 refused oral hygiene.During an interview on 7/21/26 at 1:21 p.m., Certified Nursing Assistant (CNA)2 stated teeth/dentures should be brushed twice a day in the am and before bed, and it should be documented in the resident task. If a resident refuses it should be documented as well.During an interview on 7/22/26 at 12:24 p.m., CNA3 stated teeth are typically brushed after breakfast. States she did brush Resident #7's the top dentures, but not the bottom teeth, so she documented for the dentures.During an interview on 7/22/26 at approximately 1:20 p.m. the above was discussed with Director of Nursing.

Based on observations and interviews, the facility failed to ensure that the resident's environment was free of accident hazards by ensuring that an electric baseboard heater cover was in place to cover sharp and potentially extremely hot metal on 1 of 2 wings (A wing) for 1 of 1 environmental tour (7/20/26).Findings:On 7/20/26 at 9:53 a.m., a surveyor and a Licensed Practical Nurse(LPN) observed in resident room [ROOM NUMBER] that the electric baseboard heating unit was missing the front cover exposing sharp metal fins and potentially extremely hot metal creating an accident hazard. At this time, the LPN confirmed that the sharp metal fins and the potential for residents to be seriously injured presented an accident hazard. On 7/20/26 at 9:58 a.m., a surveyor and the Maintenance Director observed in resident room [ROOM NUMBER] that the electric baseboard heating unit was missing the front cover exposing sharp metal fins and potentially extremely hot metal. At this time, the Maintenance Director stated that he was unaware that the cover was missing and confirmed that the sharp metal fins and the potential for residents to be seriously injured presented an accident hazard.

Based on record reviews, interviews, and the Payroll Based Journal Report (PPJ), the facility failed to ensure sufficient direct care staff were scheduled and on duty to meet the needs of residents for 1 of 4 quarters reviewed for weekend staffing (9/1/24 through 12/31/24). Findings: Review of Center for Medicare & Medicaid (CMS) PPJ Report revealed the facility triggered for low weekend staffing during the first quarter (10/1/24 through 12/31/24). During a review of first quarter weekend staffing with scheduler on 4/24/25 at 12:05 p.m., the scheduler confirmed the facility was not adequately staffed for 7 of 39 days reviewed. During a review of the daily staffing sheets with the Director of Nursing (DON) on 4/24/25 at 1:05 p.m., the above was confirmed. At this time DON stated she would have daily punches obtained for the days in question. The daily punches were not obtained by the end of survey.

Based on observation, interview, and review of the Culinary Services: Storage of Food & Supplies Policy and Procedure, revised 2/2022, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner for a hood, ceiling lights, a ceiling vent, and the walk-in refrigerator door; and failed to ensure foods were labeled and dated in a walk-in freezer for 1 of 1 kitchen tour for 1 of 1 day of survey (4/22/25). Findings: The facility's Culinary Services: Storage of Food & Supplies Policy and Procedure, revised 2/2022, noted: 2. Labeling and rotating food supply: a. Food products that are opened and not completely used or transferred from its original package to another storage container or prepared at the facility and stored should be labeled as to its contents and used by dates. 4. Food removed from its original container must be labeled with the common name of the food. On 4/22/25 from 9:00 a.m. to 9:30 a.m., an initial kitchen tour was conducted with the Food Service Director in which the following findings were observed: > The hood over the dish washing machine had rust build-up on the inside of it. > There were 3 ceiling lights, over a food preparation area, that had cracked/broken lenses. > There was a ceiling vent, over a food preparation area, that was heavily soiled with dust and had worn/missing paint. > The walk-in refrigerator door had rust build-up on the bottom inside of the door and up about halfway of the door. > The walk-in freezer had 8 bags of what appeared to be cauliflower that was not labeled and dated. On 4/22/25 at 9:30 a.m., in an interview, the Food Service Director confirmed the findings.

Based on interviews and record reviews, the facility failed to implement and maintain an effective training program for nursing staff contracted through the Clipboard Application (App), and NURSA App in the areas of dementia care, resident rights, neglect training by failing to ensure contracted Clipboard/NURSA Professionals (Users) completed training prior to independently providing services to residents for 3 of 3 contracted staff reviewed during a complaint investigation.( Staff #1,# 2, & # 4). Findings: Review of the Clipboard app Terms of Service Agreement last updated 10/9/23 states, Clipboard operates an online, marketplace, accessed through the Site, that allows third-party clients (each, a Client) to post open shifts at facilities (each, a Facility), and allows independent contractor professionals (each, a Professional) to view and sign up to work such shifts if they so choose. Under the subheading 2.1 CLIPBOARD'S ROLE AS A MARKETPLACE states, Clipboard merely makes the Site and Services available to enable Professionals and Clients to find and transact directly with each other . Users alone are responsible for evaluating and determining the suitability of any shift, Client or Professional. Review of the NURSA app Terms of Service Agreement dated 3/26/25 states, The NURSA Platform is a software platform whereby Facilities and Clinicians may connect for posting, viewing, requesting, and acceptance of Shifts. Subsection 7. ADDITIONAL TERMS APPLICABLE TO CLINITIANS: 7.2 Independent contractor status: .Clinicians utilizing the Nursa Platform do so only as independent contractors . Review of National Health Care Agency Orientation Packet undated lacked evidence of Neglect, Resident Rights, and dementia training for agency/contracted staff. Review of facility provided Contracted Staff List revealed the following: Staff#1 first shift on 12/12/24 through staffing app (Clipboard) and has worked a total of 2 shifts. Review of Staff #3's education file lacked evidence she received education in the areas of dementia care, resident rights, neglect training. Staff #2's first shift was on 10/28/24 through the staffing app (Clipboard) and has worked 11 shifts. Review of Staff#2's education file lacked evidence she received education in the areas of dementia care, resident rights, neglect training. Staff #3 first shift was on 11/14/24 through the staffing app (NURSA) and has worked 2 shifts. Review of Staff #3's education file lacked evidence she received education in the areas of dementia care, resident rights, neglect training. During an interview on 4/23/25 at 12:05 p.m., the Scheduler stated that if there is a call out or no show for a shift the Scheduler or the Director of Nursing (DON) will be notified. The shift will be posted on the Clipboard App with a fee rate. A Clipboard User will accept the shift and an email from Clipboard will be sent to the Scheduler and the DON notifying them the shift has been filled. If the User cancels the shift, the shift will automatically repost. Users who don't show up for their shift are automatically blocked. At this time scheduler stated that they currently do have access/use of the Clipboard app but have not used it since 12/25/24 because there were too many weekend no call, no shows. During a follow up interview on 4/23/25 at 12:14 p.m., the Scheduler stated the facility also uses the NURSA app for staffing needs but has not used them since 4/13/25. At this time the Scheduler and a surveyor reviewed Agency Report 01/01/2025-04/22/2025. The Scheduler confirmed NURSA staff normally only work in Residential Care, but they did use them in Long Term Care on 12/26/24 for an 8 hour shift. During an interview on 4/24/25 at 8:50 a.m., with 2 surveyors, the Director of Nursing stated agency and contracted staff from Clipboard and NURSA apps have to complete an online orientation packet prior to the first shift worked, which includes abuse, neglect and misappropriation, and the charge nurse does an agency walk around for emergency exits, and there is a sign off sheet that is completed. DON further stated the staff hired through Clipboard and NURSA apps receive dementia training through their app and the facility does not track it. At this time a surveyor asked for evidence of sign off sheets. For Clipboard and NURSA staff. These were not provided by the end of survey.

Based on observations and interviews, the facility failed to provide personal hygiene for 1 of 1 resident reviewed for Activities of Daily Living (ADL) (Resident #26). Findings: On 4/22/25 at 9:32 a.m., 4/23/25 at 12:09 p.m., and 4/23/25 at 2:20 p.m., Resident #26 was observed to have notable buildup on his/her bottom teeth. During an interview with Resident #26 representative stated [Resident #26] bottom teeth have build up on them, and resident can't brush them independently and further stated [Resident #26] used to insist on brushing their teeth when they were young, and it would bother resident to not have them clean. Review of Resident 26's care plan, updated 3/16/25 states: Personal Hygiene: partial/moderate assistance, helper provides less than half the effort. Oral Hygiene: set up/clean up assistance, helper provides set up/clean up assistance, . Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #26 had a Brief Interview for Mental Status (BIMS) score of 3 of 15 indicating he/she is not cognitively intact. Review of Resident #26's Activities of Daily Living (ADL) Oral Hygiene from 4/1/25 through 4/23/25 lacked evidence that he/she refused any oral hygiene care. During an interview on 4/24/25 at 2:00 p.m., Certified Nursing Assistance (CNA) stated residents should be offered oral hygiene when getting ready in the morning and before bed. CNA further stated that if a resident refuses it should be documented in the chart as a refusal. At this time a surveyor asked about Resident #26's teeth. CNA stated Resident #26 is not too big on brushing. This surveyor and CNA went into Resident # 26's room and Resident #26 was asked if he/she would like to have his/her teeth brushed and he/she stated that would be very nice. On 4/23/25 at 2:20 p.m., Registered Nurse (RN) observed Resident #26's mouth and confirmed obvious build up . On 4/23/25 at approximately 2:30 p.m., the above was discussed with Director of Nursing and Assistant Director of Nursing.

Based on record review and interviews, the facility failed to obtain provider orders for the maintenance and monitoring of a pacemaker. In addition, the facility failed to initiate goals and interventions necessary for the presence of a pacemaker for 1 of 13 care plans (Resident #34). Findings: Resident #34 was admitted in 2/25 and has a diagnoses to include chronic heart failure, ischemic cardiomyopathy, hypertensive heart disease, and type II diabetes mellitus. Review of Resident #35's clinical record revealed appointment CM Heart 4/10/25 at 1:00 p.m. Review of Resident #34's clinical record NSG Admission/readmission Evaluation originally dated 2/20/25 section: Devices and treatments (care profile) is blank in subsection: pacemaker . Review of clinical record [[Hospital] Consultation Note] dated 2/14/25 revealed Resident #35 had a past medical history of presence of combination internal cardiac defibrillator (ICD) and pacemaker. Review of Resident #34's signed provider orders for April 2025 lacked evidence that orders regarding maintenance/monitoring of Resident #34's pacemaker. Review of Resident #34's care plan initiated 2/21/25 lacked evidence of goals and interventions for the presence of a pacemaker. During an interview on 4/23/25 at 12:04 p.m., Registered Nurse (RN) stated Resident #34 did not go to his/her appointment scheduled for 4/11/25 at CM Heart as resident had a meeting with the care team, and they believed it was something Resident #34 could do once he/she was discharged . At this time RN stated the appointment was for a device check, but she was unsure if Resident #34 had a pacemaker or not and didn't know what kind of device resident has. Review of facility appointment calendar April 2025 revealed crossed out appointment on 4/11 states [Resident #35] CM Heart, 300 Main St, Lew [[NAME]] @ 13:00. Further review of residents clinical record lacked evidence Resident #35 went to this appointment. During an interview in presence of RN on 4/23/25 at 12:25 p.m., Resident #34 used his/her right hand and patted his/her upper left chest and confirmed he/she does have a pacemaker/defibrillator and hasn't gone to the cardiologist for a really long time and doesn't know why. States he/she does have a pacemaker monitor at home. Review of admission Minimum Data Set (MDS) dated [DATE] revealed Resident #34 had a Brief Interview for Mental Status (BIMS) of 13 of 15 indicating he/she is cognitively intact. On 4/23/24 at approximately 3:15 p.m., the above was discussed with Director of Nursing and Assistant Director of Nursing.

Based on observations, record reviews, interviews, the facility failed to provide a sanitary environment to help prevent the development and transmission of disease and infection related to respiratory care for 1of 1 resident reviewed for respiratory care (Resident #34). Findings: On 4/22/25 at 10:24 a.m., and 4/23/35 at 7:35 a.m., observations of Resident #34's nebulizer machine was observed on top of dresser with tubing and mask attached and resting on top of the nebulizer and not in a bag. Review of Resident #34's orders active for April 2025 revealed order for Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML3 ml inhale orally every 4 hours as needed for Wheezing or dyspnea; flu Lung sounds pre and post nebulizer treatment: C=Clear, D=Diminished W=Wheeze, bCR=Crackles R=Rhonchib Report abnormal lung sounds to RN for assessment. Document total min spent for nebulizer TX. Document Respiratory Rate before and after TX. Review of Resident #34's TAR dated April 2025 revealed nebulizer was last used 4/9/25. On 4/23/25 at 12:25 p.m., during an observation of Resident #34, Registered Nurse (RN) confirmed the nebulizer tubing was unbagged and stated Resident #34 has not used the nebulizer in a few weeks and it should not still be in there. On 4/23/25 at approximately 4:15 p.m., the above was discussed with Director of Nursing and Assistant Director of Nursing.

Based on record review and interview the facility failed to provide respiratory services as directed by physician orders related to nebulizer administration with monitoring for 1 of 3 residents reviewed who received nebulizer medications (Resident #27). Findings: On 2/13/22 at 12:57 p.m., observation of Resident #27 to have a nebulizer machine with tubing and face mask on the bed next to the pillow. Review of the medical record stated Resident #27 was admitted with acute and chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, respiratory bronchiolitis interstitial lung disease, panlobular emphysema and dependence on supplemental oxygen. Physician orders dated, 2/2/23 for Ipratropium-Albuterol Solution 0.5-2.5 MG (milligram)/3ML (milliliter), 3 ml inhale orally four times a day for SOB (shortness of breath) or Wheezing with instructions for nursing to monitor Lung sounds pre and post nebulizer treatment: C=Clear, D=Diminished W=Wheeze, CR=Crackles R=Rhonchi. Report abnormal lung sounds to RN for assessment. Document total min spent for nebulizer TX (treatment). Document Respiratory Rate before and after. Review of the medication administration record from 2/2/23 through 2/12/23 indicated the medication Ipratropium-Albuterol Solution was administered a total of 41 doses where nursing did not monitor lung sounds pre and post nebulizer treatment, did not document the total minutes spent for the nebulizer TX and did not document Respiratory Rate before and after. On 2/14/23 at 9:55 a.m., during an interview, the Director of Nursing confirmed the lack of monitoring the pre and post lung sounds, minutes of treatment and respiratory rate pre and post treatment from 2/2/23 through 2/12/23.

Based on observations and interview, the facility failed to adequately provide housekeeping and maintenance services necessary to maintain the building in good repair and sanitary conditions on 1 of 2 wings ( C wing), the laundry room, the handicap bathroom, and the employee/public bathroom for 1 of 1 Environmental tours (6/10/2021). Findings: On 6/10/2021 from 8:50 a.m. to 9:15 a.m., a surveyor and the Maintenance Director conducted an tour of the facility in which the following findings were observed: C Wing: > Six(6) hallway ceiling vents were visibly dusty/dirty. > Resident Room 7- The floor was dirty around the base of the toilet. > Resident Room 14- The floor was dirty around the base of the toilet and along the edge of the walls. > Resident Room 17- The floor was dirty around the base of the toilet. > Resident Room 18- The floor was dirty around the base of the toilet. The privacy curtain, closest to the window, was in disrepair. > Resident Room 19- The floor was dirty around the base of the toilet. Laundry Room: > There was a missing floor tile by the floor drain exposing untreated cement. > There were multiple missing and broken floor tiles between and behind the washing machines exposing untreated cement. > The floor had dirt/debris build-up throughout the room, around the edges and behind the washers/dryers. > The wall heater is broken and in disrepair. > The wall, beside the wall heater, is broken open exposing sheetrock. > Two(2) of three(3) dryers had duct tape on the top control door panels creating uncleanable surfaces. > The three(3) ceiling lights, above the dryers, had dust/debris in the lenses. Handicap Bathroom: > The floor was dirty around the base of the toilet. The floor had dirt/debris build-up in the corners of the room. The caulking was visibly soiled on the back of the sink. Employee Bathroom: > The floor was dirty around the base of the toilet. The caulking was visibly soiled on the back of the sink. The floor had dirt/debris build-up in the corners of the room. On 6/10/2021 at 9:15 a.m., a surveyor confirmed the above findings with the Maintenance Director.

Based on observations and interview, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner for the food disposal, the wall air conditioner, the wall exhaust fan, the floors, and failed to label and date foods in the walk-in freezer for 1 of 1 kitchen tours on 1 of 3 days of survey. (6/7/2021) Findings: On 06/07/2021 between 6:20 p.m. and 6:55 p.m., during the kitchen tour, a surveyor and the Food Service Director observed the following: > The food disposal unit had dried liquid splatter on it. > The wall air conditioning unit was dusty/dirty. > The wall exhaust fan was dirty/dusty. > The dry goods storage room floor had dirt/debris and trash on it and under the shelving. > The walk-in freezer had an open unlabeled and undated bag of chicken strips, an unlabeled and undated bag of meat patties, and the floor had dirt/debris and trash on it under the shelving. On 06/07/2021 at 6:55 p.m., the Food Service Director confirmed the findings.

Based on observations and interviews, the facility failed to maintain the garbage storage area in a condition to prevent the harborage and feeding of pests on 2 of 4 days of survey. (6/7/2021 and 6/10/2021) Findings: 1. On 6/7/2021 at 6:20 pm, a surveyor and the Food Service Director observed the trash dumpster to have the left side door and the right side door open, exposing garbage bags. Additionally, there were used nursing gloves, papers, cigarette butts, old packing tape, and plastic cup lids on the ground around the dumpster. On 6/7/2021 at 6:30 pm, the Food Service Director confirmed the findings. 2. On 6/10/2021 at 8:30 a.m., a surveyor and the Food Service Director observed the trash dumpster to have the left side door open, exposing garbage bags. On 6/10/2021 at 8:30 a.m., the Food Service Director confirmed the findings.

Based on observations and interviews, the facility failed to follow Centers for Disease Control (CDC) recommendations for infection control practices regarding a dedicated space to monitor and care for residents with COVID-19. In addition, the facility failed to follow personal protective equipment (PPE) practices with COVID-19 exposure. This has the potential to affect all residents at the facility. (34 residents) Findings: 1. A review of Center for Disease Control (CDC) guidance Preparing for COVID-19 in Nursing homes, updated November 20, 2020, Core Practices: Identify Space in the facility that could be dedicated to care for residents with confirmed COVID-19. This could be a dedicated floor, wing, or wing in the facility or a group of rooms at the end of the unit that will be used to cohort residents with COVID-19. On 3/31/2021 at approximately 8:45 a.m., during initial tour of the facility with the Director of Nursing (DON), the following was observed: - Wing C: in the beginning of the C wing was a strip of blue tape on the floor, the first 3 rooms (10C, 11C and 12C) had a posted Droplet and Contact Precautions for Confirmed COVID-19 sign. The remaining rooms down the hallway were COVID-19 negative rooms - Wing A: in the beginning of the A Wing, the first room (1A), had a sign posted stating, Droplet and Contact Precautions for COVID-19 exposure. The remaining rooms down the hallway were COVID-19 negative rooms At this time, in an interview with the DON, she stated the above rooms on both A and C wings were COVID-19 exposed or confirmed cases and the rest of the rooms down the hallway were negative rooms. Surveyor questioned the placement of the COVID-19 rooms in the beginning of the hallway, thus making all staff and/or residents past the COVID positive rooms to get to the negative rooms. The DON confirmed she was unaware of the CDC recommendations for providing a dedicated space for COVID-19 residents at the end of the hallway, stating she was directed by the Director of Clinical Operations and the Regional Director of Operations to place tape on the floor to indicate COVID area. 2. A review of Center for Disease Control and Prevention (CDC) guidance, Cleaning your facility, updated January 5 2021, Cleaning and disinfecting your building or facility when someone is sick or has a COVID-19 diagnosis. When cleaning: wear disposable gloves and gowns for all tasks in the cleaning process, including handling trash. On 4/1/2021 at approximately 11:35 a.m., two housekeeping staff were observed terminally cleaning room [ROOM NUMBER]A, a 14- day quarantine room for COVID-19 exposure. Both housekeeping staff were wearing N95 respirators and face shields, they were not wearing gloves or gowns. At this time in an interview with the Administrator, she stated the sign which was posted indicating Droplet and Contact Precautions for COVID-19 Exposure was taken down when they moved the resident to another room. In an interview with housekeeping staff, they both confirmed they were unaware that the room they were cleaning was a COVID-19 exposure room.

Based on interviews, the facility failed to designate a qualified staff member to function as the Infection Preventionist, who is responsible for the facility's Infection Control Program since 10/2020, which has the potential to affect all residents in the facility. Finding: On 3/31/2021 at approximately 11:19 a.m., during an interview with the Director of Nursing (DON), the Assistant Director of Nursing (ADON), and Infection Control Nurse, the surveyor inquired who was responsible for the facilities infection control program. The ADON stated she was the facilities Infection Preventionist since December 2020 however; she has not completed a specialized infection control training for the Infection Preventionist role. At this time the DON confirmed the facilities previous Infection Preventionist left in October 2020.

Based on record review and interviews, the facility failed to follow the Centers for Disease Control and Prevention (CDC) guidelines and the Center for Medicare and Medicaid Services (CMS) August 26, 2020 Quality, Survey and Certification Group (QSO)-20-38-Nursing Home (NH) for testing of staff with symptoms consistent with COVID-19. This has the potential to affect all residents at the facility. (34 residents) Findings: A review of the CDC Interim Guidance on Testing Healthcare Personnel (HCP) for [DIAGNOSES REDACTED]-CoV-2, updated 2/16/2021, stated under the section, Testing HCP with signs or symptoms consistent with COVID-19, recommends the following: HCP with signs or symptoms of COVID-19 should be prioritized for [DIAGNOSES REDACTED]-CoV-2 testing. Because HCP often have extensive and close contact to vulnerable populations, even mild signs or symptoms (e.g., sore throat) of possible COVID-19 should prompt consideration for testing. A review of The Center for Medicare and Medicaid Services (CMS), Center for Clinical Standards and Quality/Survey and Recertification Group memo, Interim Final Rule, CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long Term care facility testing requirements and Revised COVID-19 Focused Survey Tool, revised 8/26/2020, stated, Testing of Staff and Residents with COVID-19 Symptoms or Signs: Staff with symptoms or signs of COVID-19 must be tested and are expected to be restricted from the facility pending the results of COVID-19 testing. A Review of the facility's Healthcare Personnel (HCP) Screening Log contained instructions: Have you had any of the following symptoms since your last day at work or the last time you were here? Fever, or feeling feverish, cough, shortness of breath, sore throat, muscle aches, new loss of taste or smell, congestion or runny nose, nausea or vomiting or diarrhea. The facility will restrict entry for those who answer Yes to any of the following screening questionnaire. Please answer the question Y/N. On 3/31/2021 at approximately 11:19 a.m., in an interview with the Assistant Director of Nursing, Infection Control Nurse. She confirmed the facility has the ability to preform a Point of care (POC) rapid test for COVID-19 [MEDICATION NAME], on staff or residents who present with symptoms consistent with COVID-19. On 3/31/2021 and 4/1/2021 review of the daily screening logs stated the following: 1. The daily screening log dated 3/19/2021, stated Employee #4 answered the questions, Do you have, or had any medical symptoms listed above since your last entry into the facility and was the person denied entrance with a ?. Review of employee #4's timecard indicated she was not restricted from working and worked on 3/19/2021 from 2:24 p.m. to 11:00 p.m. The facility could not provide further evidence of a POC negative test to follow-up on the failed screening on 3/1920/21. 2. The daily screening log dated 3/22/2021, stated Employee #2 answered y the question, Do you have, or had any medical symptoms listed above since your last entry into the facility. Review of Employee #2's timecard indicated she was not restricted from working and worked on 3/22/2021 from 6:34 a.m. to 2:38 p.m. The facility could not provide further evidence of a POC negative test to follow-up on the failed screening on 3/22/2021. 3. The daily screening log dated 3/23/2021, stated Employee #3 answered y the question, Do you have, or had any medical symptoms listed above since your last entry into the facility. Review of Employee #2's timecard indicated she was not restricted from working and worked on 3/23/2021 from 6:29 a.m. to 2:53 p.m. The facility could not provide further evidence of a POC negative test to follow-up on the failed screening on 3/23/2021. 4. The daily screening log dated 3/24/2021, stated Employee #5 answered y the question, Do you have, or had any medical symptoms listed above since your last entry into the facility. Review of Employee #5's timecard indicated she was not restricted from working and worked on 3/24/2021 from 5:56 a.m. to 2:36 p.m. The facility could not provide further evidence of a POC negative test to follow-up on the failed screening on 3/24/2021. On 4/1/2021 at approximately 3:15 p.m., surveyor discussed the above findings with the Director of Nursing.

Based on observations and interview, the facility failed to adequately provide housekeeping and maintenance services, necessary to maintain the facility in good repair and sanitary condition, for 1 of 3 days of survey. Findings: On 5/15/19 from 9:00 a.m. to 9:25 a.m., a surveyor completed an environmental tour with the Regional Director of Engineering and Environmental Services for National Healthcare, the Maintenance Supervisor, and the Administrator in which the following were observed: - In Resident room [ROOM NUMBER] - There was dirt/debris build up around the edges of the room, there was missing cove base under the right-side of the vanity cabinet, the base of the toilet had missing/cracked caulking and the room entrance door bottom corner was gouged/chipped creating an uncleanable surface; - In Resident room [ROOM NUMBER] - The cove base was missing, along base of the vanity cabinet, creating uncleanable surfaces; - In Resident room [ROOM NUMBER] - The cove base was pulling away from the wall near the bathroom door; - In Resident room [ROOM NUMBER] - The caulking, behind the bathroom sink faucet, was stained and cracked; - In Resident room [ROOM NUMBER] - The entrance door was chipped/gouged creating an uncleanable surface, the ceiling had a large brownish stain around the curtain rail over Bed-1 and the base of the toilet had missing/cracked caulking; - In Resident room [ROOM NUMBER] - The vanity counter top edging was chipped and missing an area about 3 inches in diameter creating an uncleanable surface; - In Resident room [ROOM NUMBER] - The bottom of the vanity cabinet was chipped/gouged and missing the cove and the floor had dirt/debris build up in this area; - In Resident room [ROOM NUMBER] - The sink hot water handle was broken, the electric heater was broken at the head of Bed-2 and the floor had a buildup of dirt/debris around the edges and in the corners; - In Resident room [ROOM NUMBER] - The baseboard electric heater had chipped/missing paint and was rusty creating an uncleanable surface and the bathroom floor had missing floor tiles; - In Resident room [ROOM NUMBER] - The bathroom exhaust fan was very loud and the light cover had folded multifold towels wedged between it and the ceiling, the bathroom floor had dirt/debris build up in the corners and the room entrance door was chipped/gouged creating an uncleanable surface; - In Resident room [ROOM NUMBER] - The floor was dirty around the base of the toilet, the floor tiles had large gaps behind the toilet exposing the untreated cement floor, there was dirt/debris in the bathroom light and the room baseboard electric heater had chipped/missing paint and was rusty creating an uncleanable surface; - In Resident room [ROOM NUMBER] - The bathroom floor had broken/gapped floor tiles around/behind the toilet and the room baseboard electric heater had chipped/missing paint and was rusty creating an uncleanable surface; - Public Bathroom - The wall behind the sink was dirty and had missing caulking; - The Invacare Sit-to-Stand lift, #193, had a buildup of dirt/debris in the foot area; - The Invacare, Reliant 600 patient lift, #319, had dirt/debris on base and chipped/missing paint on base creating uncleanable surfaces; - The Acme resident scale chair, #299, was dirty/dusty on the base; - Ultra Lift 3510 patient lift had chipped/missing paint on the legs and base and the base plastic shroud was cracked/broken; and - The carpet in the C-Wing hall, by Resident room [ROOM NUMBER] had a large brownish stain. On 5/15/19 at 9:25 a.m., a surveyor confirmed the findings in an interview with the Regional Director of Engineering and Environmental Services for National Healthcare, the Maintenance Supervisor and the Administrator.

Based on observations and interview, the facility failed to ensure resident walls, ceilings, a cove base, furniture, bathroom floor tiles, seams around toilets used by residents, a radiator end cap in a hallway, and wheelchair arm rests were maintained in a clean and sanitary manner on 1 of 1 environmental tour. Findings: On 4/4/18 between 12:15 p.m. and 12:40 p.m., during the environmental tour with the Director of Maintenance, a surveyor and the Maintenance Director observed the following: 1. In room [ROOM NUMBER], the bedroom wall on the left side of the room was patched but not painted, the ceiling near the window was peeling with flecks of paint, and to the left of the entrance of the bathroom there was a cove base pulled away from the wall. 2. In room [ROOM NUMBER], the furniture drawers had a plastic covering on the edges that were chipped and cracked exposing unfinished marred wood, there was a clock on the wall that was cracked, and in the bathroom, the seams around the toilet base were soiled and stained. 3. In room [ROOM NUMBER], the ceiling was peeling with flecks of paint. 4. In room [ROOM NUMBER], in the bathroom, the seams around the toilet base were soiled and stained, the bathroom floor tiles behind the toilet had gaps creating an uncleanable surface, and there was dirt and debris in the corner of the bathroom floor. 5. In room [ROOM NUMBER], in the bathroom, there was one tile on the floor that had gaps and was raised higher that the rest of the tiles, creating an uncleanable surface. 6. In room [ROOM NUMBER], in the bathroom, the seams around the toilet base were soiled and stained. The inside of the bathroom door was gouged/scraped. 7. Resident in room [ROOM NUMBER]A, bed B, has a wheelchair with the right arm rest torn/cracked with clear tape covering the area, creating an uncleanable surface. 8. Resident in room [ROOM NUMBER]A, bed A, has a wheelchair with the right arm rest cracked/torn exposing material, creating an uncleanable surface. 9. Resident in room [ROOM NUMBER], bed A, has a wheelchair with the right and left arm rests cracked/torn exposing material, creating an uncleanable surface. 10. In the hallway, across from the linen closet, on C Wing was a baseboard with the end cap pulling away from the baseboard creating a catch point. The surveyor confirmed the above findings with the Maintenance Director at the time of the observations.

Based on observations and interviews, the facility failed to maintain essential kitchen equipment in a sanitary manner during 3 of 3 days of survey. Findings: 1. On 4/2/18 at approximately 9:34 a.m., during the initial tour of the kitchen, a surveyor observed the walk-in cooler to have hanging dust/debris along the ceiling and walls, and built up dust/debris on the cooler fan. 2. On 4/3/18 at 7:15 a.m., a surveyor observed the walk-in cooler to have hanging dust/debris along the ceiling and walls, and built up dust/debris on the cooler fan. 3. On 4/4/18 at 8:16 a.m., two surveyors observed the walk-in cooler to have hanging dust/debris along the ceiling and walls, and built up dust/debris on the cooler fan. A surveyor confirmed the above findings on 4/4/18 at 12:10 p.m. with the Administrator and Food Service Director.