Every finding on record at Osprey Point Nursing Center

Based on observation, interview, and record review the facility failed to ensure smoking paraphernalia (lighter) was secured to prevent possible accidents for 1 of 3 residents, Resident #34, sampled residents who smoke. Findings include: During an observation on 7/13/2026 at 9:55 AM, an unsecured yellow lighter was observed on Resident #34's bedside table. Resident #34 was not in the room, the lighter was not secured and was accessible to others. During an interview on 7/13/2026 at 9:57 AM, the Administrator stated, I'm not even sure where she [Resident #34] got that from. Lighters are supposed to be kept in the smoking box because they [facility residents] go out [to smoke] at specific times. During an interview on 7/15/2026 at 9:00 AM, Staff E, Licensed Practical Nurse/Unit Manager, stated she did not know where it [the lighter in Resident #34's room] came from and added somebody might have brought it [the lighter] in. Review of the facility smoking log, reviewed and updated 7/3/2026, revealed Resident #34 was classified by the facility as a supervised' smoker. Review of the policy and procedure titled, Resident Smoking Supervised and Unsupervised - Use of Electronic Smoking/Vaping Devices, last reviewed 1/15/2026, read, Standard: The facility shall establish and maintain safe resident smoking practices, and/or use of electronic smoking/vaping devices. 11. Residents who have independent smoking privileges are NOT permitted to keep cigarettes, e-cigarettes, pipes, tobacco, nicotine, and other smoking/vaping articles in their possession including all forms of lighters, matches, and electronic smoking/vaping device paraphernalia. 12. Residents who have independent smoking privileges may request smoking/vaping materials from nursing personnel when desired, thus alerting nursing personnel of their intention to smoke at that time. Following use, lighters/matches, unused cigarettes, electronic cigarettes, vaping materials, etc. [etcetera] shall be returned to nursing personnel for safe storage. 14. Residents without independent smoking privileges may not have or keep any smoking/vaping materials, including cigarettes, e-cigarettes, tobacco, nicotine, etc., except when they are under supervision.

Based on record review, observation, and interview, the facility failed to ensure physician ordered oxygen administration was followed for 1 of 3 residents, Resident #22, sampled for oxygen administration. Findings include: During an observation on 07/13/2026 at 9:22 AM, Resident #22 was administered oxygen via nasal cannula by an oxygen concentrator at 2 liters per minute. (Photographic evidence obtained) During an observation on 7/14/2026 at 8:18 AM, Resident #22 was administered oxygen via nasal cannula by an oxygen concentrator at 2 liters per minute. (Photographic evidence obtained)During an interview on 07/14/2026 at 8:19 AM, Resident #22 stated she does not adjust the oxygen settings and reported that the nurse or certified nursing assistant changes the oxygen flow rate.During an interview on 07/14/2026 at 8:34 AM, Staff B, Licensed Practical Nurse reviewed the resident's physician orders and confirmed the resident was prescribed continuous oxygen at 4 liters per minute via nasal cannula and stated only nurses are authorized to adjust the oxygen settings.Review of Resident #22's physician orders dated 03/26/2026 documented oxygen at 4 liters per minute via nasal cannula continuously for hypoxemia (a low level of oxygen in the blood). Review of Resident #22's care plan documented under interventions dated 03/17/2026, staff to administer oxygen per physician orders.Review of the policy and procedure title, Oxygen Administration last reviewed on 01/26/2026 read, Standard: The purpose of this procedure is to provide guidelines for oxygen administration. Procedure: 1. Review the physician's order for oxygen administration. General Guidelines: 1. Oxygen therapy is administered by way of an oxygen mask, nasal cannula, and/or other device per physicians' orders. 3. Adjust the oxygen delivery device so that it is comfortable for the resident and the appropriate flow of oxygen is being administered according to the resident's needs.

Based on observation, interview, and record review, the facility failed to ensure medications were properly stored when unattended for residents located on 2 of 3 halls, Residents #17, #26, #49, and #50. Findings included:1) During an observation on 7/13/2026 at 09:02 AM of Resident #17's room, one Fluticasone-Salmeterol 250-50 mcg/act (micrograms per inhalation) aerosol powder, breath activated inhaler was observed lying on the bedside table unsecured.During an observation on 7/14/2026 at 9:10 AM of Resident #17's room, one Fluticasone-Salmeterol 250-50 mcg/act aerosol powder, breath activated inhaler was observed lying on the bedside table unsecured.During an interview on 7/14/2026 at 09:30 AM Staff A, License Practical Nurse (LPN) stated, That inhaler must have been left by the night shift it is given in the morning. I did not administer it, but It cannot be left in the room.2) During an observation on 7/13/2026 at 09:23 AM of Resident #26's room one bottle of Fluticasone Propionate Nasal Spray 50 mcg (per spray of glucocorticoid) and one bottle of Deep Sea nasal moisturizing spray was observed lying on the bedside table unsecured.During an observation on 7/14/2026 at 09:10 AM of Resident #26's room one bottle of Fluticasone Propionate Nasal Spray 50 mcg, and one bottle of Deep Sea nasal moisturizing spray was observed lying on the bedside table unsecured.During an interview on 7/14/2026 at 9:30 AM the Director of Nursing stated No medications are to be left unsecured at the bedside, if they are allowed to self- administer the medications the medication still has to be secured.3) Review of the medical record for Resident #49 documented the resident was admitted on [DATE] with medical diagnosis to include atrial fibrillation (afib - irregular heartbeat) and hypertension (high blood pressure).Review of physician orders for Resident #49 documented, Apixaban [blood thinner] 2.5 mg [milligrams] - give 1 tablet by mouth two times a day for afib, Empagliflozin [used to treat heart failure (HF)] 10 mg - give 1 tablet by mouth one time a day for HF, Metoprolol Succinate ER [extended release - used to treat high blood pressure (htn)] 25 mg - give 1 tablet by mouth one time a day for HTN, Sacubitril-Valsartan [used to treat chronic heart failure] 49-51 mg - give 1 tablet by mouth every 12 hours atrial fibrillation, and Tramadol [a narcotic used to treat moderate to moderately severe pain] 50 mg - give one tablet by mouth every 4 hours as needed for nonacute pain level 4-10. Hold for lethargy or falls. 4) Review of medical record for Resident #50 documented the resident was admitted on [DATE] with medical diagnosis to include anxiety, malignant neoplasm of lung, atrial fibrillation heart failure (failure of the heart to pump), and hypertension.Review of physician orders for Resident #50 documented, Apixaban 2.5 mg - give 1 tablet by mouth two times a day related to atrial fibrillation, Furosemide [used to treat water retention] - 20 mg - give 2 tablet by mouth two times a day for SOB [shortness of breath], edema in the evening, Lubiprostone - give 1 capsule by mouth one time a day for constipation, Magnesium 400 mg - give 1 tablet by mouth one time a day related to hypomagnesemia [low magnesium level], Metoprolol Succinate ER 25 mg - give 1 tablet by mouth one time a day related to essential hypertension, Ondansetron 4 mg - give 1 tablet by mouth every 6 hours as needed for nausea and vomiting, oxycodone-acetaminophen 10-325 mg - give 1 tablet by mouth every 4 hours as needed for severe pain, Potassium Citrate ER 15 meq [milliequivalent] - give 2 tablet by mouth one time a day for concomitant and Senna 8.6 mg - give 2 tablet by mouth every 24 hours as needed for constipation.During an observation on 7/13/2026 at 9:48 AM, Staff A, Licensed Practical Nurse (LPN) prepared the medications for Resident #49 and delivered the medications to Resident #49's room. Staff A left the medications with Resident #49. Staff A, LPN returned to the medication cart to retrieve ordered pain medication for Resident #49. Staff A began to prepare medications for administration for Resident #50 while simultaneously preparing the pain medication for Resident #49. Staff A entered Resident #49's room, administered Resident #49's pain medication, and exited the room. Staff A entered Resident #50's room, and delivered Resident #50's medications to the resident. Staff A left the medications with Resident #50, exited the room to return to the medication cart to retrieve the ordered Zofran per Resident #50's request. Retrieved the Zofran, returned to Resident #50's room, and administered the Zofran to Resident #50. Staff A exited Resident #50's room and returned to the medication cart.During an interview on 7/13/2026 AT 10:00 AM, Staff A, LPN stated, I should have administered medications to only one resident at a time. I am supposed to stay with the resident until the medications are consumed. I should never have left the medications with the Residents to retrieve the additional medication.During an interview on 7/14/2026 at 9:30 AM, the Director of Nursing stated, Medications are not to be left unsecured at the bedside. The nurse is required to administer medications, remain with the resident until the medications are swallowed, and administer medications to only one resident at a time before proceeding to the next resident.Review of the policy and procedure titled, Medication Administration last reviewed on 1/15/2026 read, Standard: Medications are ordered and administered safely and as prescribed. Guideline: Medications will be administered safely and as prescribed by only licensed personnel.Review of the policy and procedure titled, Medication Storage and Labeling last reviewed on 1/15/2026 read, Guideline: The facility stores all drugs and biologicals in a safe, secure, and orderly manner. 1. Drugs and biologicals used in the facility are stored in locked compartments under proper temperature, light, and humidity controls. Only persons authorized to prepare and administer medications have access to locked medications.

Based on observation, record review, and interview, the facility failed to prevent the possible spread of infection for medication-related equipment maintenance, medication administration, wound care, and respiratory equipment maintenance. Findings included:1) Review of the medical record for Resident #49 documented the resident was admitted on [DATE] with medical diagnosis to include atrial fibrillation (afib - irregular heartbeat) and hypertension (high blood pressure).Review of physician orders for Resident #49 documented, Apixaban [blood thinner] 2.5 mg [milligrams] - give 1 tablet by mouth two times a day for afib, Empagliflozin [used to treat heart failure (HF)] 10 mg - give 1 tablet by mouth one time a day for HF, Metoprolol Succinate ER [extended release - used to treat high blood pressure (htn)] 25 mg - give 1 tablet by mouth one time a day for HTN, Sacubitril-Valsartan [used to treat chronic heart failure] 49-51 mg - give 1 tablet by mouth every 12 hours atrial fibrillation, and Tramadol [a narcotic used to treat moderate to moderately severe pain] 50 mg - give one tablet by mouth every 4 hours as needed for nonacute pain level 4-10. Hold for lethargy or falls. 2) Review of medical record for Resident #50 documented the resident was admitted on [DATE] with medical diagnosis to include anxiety, malignant neoplasm of lung, atrial fibrillation heart failure (failure of the heart to pump), and hypertension.Review of physician orders for Resident #50 documented, Apixaban 2.5 mg - give 1 tablet by mouth two times a day related to atrial fibrillation, Furosemide [used to treat water retention] - 20 mg - give 2 tablet by mouth two times a day for SOB [shortness of breath], edema in the evening, Lubiprostone - give 1 capsule by mouth one time a day for constipation, Magnesium 400 mg - give 1 tablet by mouth one time a day related to hypomagnesemia [low magnesium level], Metoprolol Succinate ER 25 mg - give 1 tablet by mouth one time a day related to essential hypertension, Ondansetron 4 mg - give 1 tablet by mouth every 6 hours as needed for nausea and vomiting, oxycodone-acetaminophen 10-325 mg - give 1 tablet by mouth every 4 hours as needed for severe pain, Potassium Citrate ER 15 meq [milliequivalent] - give 2 tablet by mouth one time a day for concomitant and Senna 8.6 mg - give 2 tablet by mouth every 24 hours as needed for constipation.During an observation on 7/13/2026 at 9:48 AM, Staff A, Licensed Practical Nurse (LPN) did not perform hand hygiene, prepared the medications for Resident #49 and entered Resident #49's room, did not perform hand hygiene, delivered the medications to Resident #49. Staff A did not perform hand hygiene and exited the room. Staff A, LPN returned to the medication cart to retrieve ordered pain medication for Resident #49. Staff A did not perform hand hygiene and began to prepare medications for administration for Resident #50 while simultaneously preparing the pain medication for Resident #49. Staff A entered Resident #49's room, did not perform hand hygiene, administered Resident #49's pain medication, did not perform hand hygiene and exited the room. Staff A entered Resident #50's room, did not perform hand hygiene, and delivered Resident #50's medications to the resident. Staff A exited Resident #50's room, did not perform hand hygiene, returned to the medication cart to retrieve the ordered Zofran per Resident #50's request. Staff A did not perform hand hygiene, retrieved the Zofran, returned to Resident #50's room, did not perform hand hygiene, and administered the Zofran to Resident #50. Staff A exited Resident #50's room, did not perform hygiene, and returned to the medication cart.During an interview on 7/13/2026 AT 10:00 AM, Staff A, LPN stated, I should have performed hand hygiene before and after medication.3) Review of Resident #9's clinical record documented the resident was admitted on [DATE] with diagnosis that include but not limited to diabetes, overactive bladder, and protein calorie malnutrition.Review of Resident #9's physician order dated 7/13/2026 read, Sacral to right buttock- cleanse with wound cleanser, pat dry, apply Triad Hydrophilic paste, leave open to air at brief changes, stooling episodes, daily, and as needed. During an observation on 7/13/2026 at 09:26 AM Staff D, Advance Registered Nurse Practitioner (ARNP) and Staff C, Registered Nurse (RN) entered Resident #9's room after donning gloves and gowns. Resident #9 was rotated to the left side by Staff D, ARNP and Staff C, RN. Staff C, RN sprayed wound cleanser on Resident #9's buttock and Staff D, ARNP used her gloved right hand to clean the resident's buttock with a 4 x 4 gauze. Staff D, ARNP did not remove her gloves or perform hand hygiene. Staff D, ARNP obtained the tiriad hydrophilic paste from the medication cup using her right gloved hand that was contaminated while cleansing Resident #9's buttock. Staff D, ARNP administered the medication to Resident #9's sacral region. During an interview on 7/13/2026 at 09:35 AM Staff D, ARNP stated, I should have conducted hand hygiene and changed my gloves prior to applying the medications.During an interview on 7/14/2026 at 10:10 AM the Director of Nursing (DON) stated, Hand hygiene must be conducted before wound care, after cleaning the site wound, and prior to administering medication to the wound.Review of policy and procedure titled, Hand Hygiene Infection Control with a last review date of 1/15/2026 read, Hand hygiene is the single most important measure for preventing the spread of infection. This facility shall require facility personnel to use accepted hand hygiene after each direct resident contact for which hand hygiene is indicated. 'Hand hygiene' is a general term that applies to washing hands with water and either plain soap or thoroughly applying an alcohol-based hand rub (ABHR). Situations that require hand hygiene include but are not limited to: When hands are visibly soiled, before and after direct resident contact (for which hand hygiene is indicated by acceptable professional practice). Before and after changing the dressing. After handling soiled or used linens, dressings, bedpans, catheters and urinals.4) During an observation on 7/15/2026 at 10:00 AM of Mediation Cart #1 the blue multi use pill cutter was observed to have a layer of a white powdered substance inside the pill cutter.During an observation on 7/15/2026 at 10:00 AM Medication Cart #2 the blude multi use pill cutter was observed to have a layer of a white powdered substance inside the pill cutter. During an interview on 7/15/2026 at 10:00 AM Staff G, License Practical Nurse (LPN) stated, I have not used the pill cutter, and I do not know how often it should be cleaned but I would clean it after it was use. During an interview on 7/15/2026 at 10:10 AM the DON stated, If it [the pill cutter] is used it should be cleaned between resident use.Review of the policy and procedure titled, Maintenance of Resident-Care Items and Equipment with a last review date of 1/15/2026 read. Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC [Center for Disease Control and Prevention] recommendations for disinfection and the OSHA [Occupational Safety and Health Administration] bloodborne pathogens standard. 5. Durable medical equipment (DME) is cleaned and disinfected before re-use by another resident.Review of Resident #40's clinical record documented the resident was admitted on [DATE] with diagnosis including but not limited to pneumonia, COVID-19 [coronavirus disease 2019], shortness of breath and acute respiratory failure with hypoxia.5) During an observation on 7/14/2026 at 10:20 AM Resident #40's Nebulizer mask and tubing attached to nebulizer machine were lying uncovered and exposed to room air on the bedside table.During an observation on 7/15/2026 at 9:20 AM Resident #40's Nebulizer mask and tubing attached to nebulizer machine were lying uncovered and exposed to room air on the bedside table.During an observation on 7/15/2026 at 10:25 AM Resident #40's Nebulizer mask and tubing attached to nebulizer machine were lying uncovered and exposed to room air on the bedside table. (Photograph evidence obtained). Review of Resident #40's physician orders dated 7/1/2026 read, Sodium chloride inhalation nebulization solution 3% inhale orally two times a day.Review of Resident #40's physician orders dated 7/2/2026 read, Ipratropium bromide inhalation solution .02% 1 vial inhale orally four times a day for pneumonia - inhale one vial via nebulizer.Review of Resident #40's physician orders dated 7/13/2026 read, Budesonide inhalation suspension 5mg/2ml - 2ml [5 milligrams to 2 milliliters] inhale orally two times a day for COPD [Chronic Obstruction Pulmonary Disease] rinse mouth and expectorate after use.Review of Resident #40's physician orders dated 7/13/2026 read, Formoterol Fumarate inhalation nebulization solution 20 mcg/2ml - 2 ml [20 micrograms] inhale orally two times a day for COPD.Review of Resident #40's medication administration record documented the resident was last administered a nebulizer treatment on 7/15/2026 at 06:00 AM. During an interview on 7/15/2026 at 10:25 AM, Resident #40 stated, I use the nebulizer several times a day. The last time I used it was early this morning. The mask is never placed in a bag.During an interview on 7/15/2026 at 10:30 AM Staff H, LPN stated, The nebulizer was given earlier, and I never thought to put it up in the bag.During an interview on 7/15/2026 at 1:50 PM the Director of Nursing stated, Nebulizer masks are to be placed in a bag for infection control when not in use.Review of the policy and procedure titled, Medication Administration last reviewed on 1/15/2026 read, Standard: Medications are ordered and administered safely and as prescribed. Guideline: Medications will be administered safely and as prescribed by only licensed personnel. 19. Staff follow established facility infection control procedures (e.g., handwashing, antiseptic technique gloves, isolation precautions, etc.) for the administration of medications, as applicable.Review of the policy and procedure titled, Oxygen Administration last reviewed on 1/15/2026 read, 4. Store oxygen tubing in a hygienic manner (i.e. labeling bag with date tubing was changed).

Based on observation, interview, and record review, the facility failed to ensure food was safely stored, labeled, or discarded in the areas of the kitchen and walk-in cooler. Findings include: During an observation while conducting an initial tour of the kitchen on [DATE] at 10:05 AM with the Certified Dietary Manager (CDM), there were one large container of sour cream on a shelf with an expiration date of [DATE] and three rolls of a meat product on another shelf without an identifying label in the walk-in cooler. In the walk-in freezer, there was one bag of tots that had a hole exposing the food product to the elements that could result in freezer burn. On the bread rack, there were two partial loaves of bread that did not have an expiration date on the package and were not labeled with the open date. During an interview on [DATE] at 10:10 AM, the CDM confirmed the products identified as expired and/or not labeled. The CDM stated that the container of sour cream should have been discarded on [DATE] and the rolls of meat were turkey and should have had an identifying label as the product was out of the original container and the bread should have had an open date on each package. During an interview on [DATE] at 8:17 AM, when requested for the policy and procedures related to food storage, the Registered Dietician (RD) stated the facility goes by the Food Code and not a particular policy. Review of the U.S. Food and Drug Administration' s (FDA) Food Code and the Centers for Disease Control and Prevention's (CDC) food safety guidance as national standards to procure, store, prepare, distribute, and serve food in long term care facilities in a safe and sanitary manner showed it read, Food Receiving and Storage - When food, food products or beverages are delivered to the nursing home, facility staff must inspect these items for safe transport and quality upon receipt and ensure their proper storage, keeping track of when to discard perishable foods and covering, labeling, and dating all PHF/TCS foods stored in the refrigerator or freezer as indicated.

Based on observation, interview, and record review, the facility failed to ensure a safe and sanitary environment while assisting residents with meals for 1 of 3 residents reviewed, Resident #42. Findings include: During an observation on 3/10/25 at 12:22 PM in the dining room, Staff A, Certified Nursing Assistant (CNA), was assisting Resident #42 with a partially eaten tuna fish sandwich during lunch. Staff A had the partially eaten sandwich in her bare hands encouraging Resident #42 to take another bite. During an interview on 3/10/25 at 12:23 PM, Staff A, CNA, confirmed she had the sandwich in her bare hands. Staff A stated she was trying to get the resident to take the sandwich, and acknowledged she was handling it with her bare hands and should have used a utensil or gloved hand. During an interview on 3/10/25 at 12:30 PM, the Director of Nursing (DON) stated that good hand hygiene was mandatory for any staff assisting residents with their meals. During an interview on 3/12/25 at 12:05 PM, the Infection Preventionist (IP) stated, For a staff member to handle a resident's food with bare hands, that would be considered an infection control issue as standard precautions were not followed for safe food handling.

Based on observation, interview, and record review the facility failed to provide treatment and care in accordance with professional standards of practice for 2 of 3 residents reviewed for intravenous infusion and wound care (Resident #48 and #35). Findings include: 1. During an observation on 11/28/23 at 7:45 AM of Resident #48's peripherally inserted central catheter (PICC) line dressing revealed was not dated, there was no gauze or bio-patch, and the stabilizer is observed outside of the transparent dressing. The PICC line had residue, there was a kink in the catheter and the insertion site had bloody leakage (photographic evidence). During an interview on 11/28/23 at 7:45 AM, Resident #48 stated My PICC line has been in since October 21st; I finished my antibiotics yesterday. Yesterday, the nurse taped the bandage because she told me it was probably coming out soon. No one has said anything to me about removing it before I go home. Review of the electronic medical record for Resident #48 documented an admitted [DATE], with a pertinent diagnosis of chronic osteomyelitis of left ankle and foot, chronic ulcer of left foot, and diabetes. The PICC line was placed on 10/21/23 during the hospitalization prior to being admitted to facility. Review of the prescription from the hospital dated 10/23/23 reads Vancomycin HCI (Hydrochloride) 1 g (gram) Intravenous Solution Reconstituted. Inject 1 (one) g into the vein every 12 hours for 35 days. End date of [DATE]. Review of the Medical Certification For Medicaid Long-Term Care Services and Patient Transfer Form [commonly known as the 3008], Resident #48 arrived at the facility with PICC line noted in the left arm and the date inserted was 10/21/23. Review of the physician's order dated 10/31/23 for Resident #48 reads IV's (Intravenous): Evaluate site for leakage/bleeding/signs of infection every shift. Review of Treatment Administration Record (TAR) for the period of 11/1/23 through 11/30/23 read, IV's: Evaluate site for leakage/bleeding/signs of infection every shift. There was no documentation on November 1, November 16, and November 17 by the nurse indicating the evaluation was completed. Review of the physician's order dated 11/1/23 for Resident #48 read, Change PICC line dressing every week on Wednesday night shift. Review of the physician's order dated 10/31/23 for Resident #48 read, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN (as needed). Review of the physician's order dated 11/1/23 for Resident #48 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. Review of Medication Administration Record (MAR) for the period of 11/1/23 through 11/30/23 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. There was no circumference and length documented on November 8 and November 21 and on November 15, there was no documentation of circumference, length or dressing change documented by the nurse to indicate if the measurements were completed. During an interview on 11/28/23 at 9:00 AM Staff A, Licensed Practical Nurse (LPN) stated, The dressing should be dated and initialed. I did look at it, but I didn't look at it closely. I looked at the dressing through the mesh. During an interview on 11/28/23 at 9:10 AM the Director of Nursing (DON) stated, This is not acceptable. It should have been a full dressing change regardless of whether the PICC line was supposed to be removed or not. My expectation is for the nurses to change the dressing weekly or when soiled or dislodged completely. During an interview on 11/29/23 at 11:18 AM the Medical Director observed the photographic evidence and stated, I see the kink and the site looks like it has some irritation. The Medical Director stated that he expected the PICC line to be better dressed and this was an opportunity to do better. Review of the policy titled Central Vascular Access Device (CVAD) Dressing Change, revision date 6/1/21 reads Application. Licensed Nurses Providing Infusion Therapy in the Post-Acute Care Facility. Considerations: 2. The catheter insertion site is potentially entry site for bacteria that may cause a catheter related infection. Procedure.16. Apply transparent dressing, covering catheter insertion site and securement device, if applicable, according to manufacturer's instructions. Smooth around the catheter starting at the insertion site and moving periphery. 23. Label dressing with: 23.1 Date end time. 23.2 Nurse's initials. 24. Document in the medical record includes, but is not limited to: 24.1 Date and time. 24.2 Site assessment. 24.3 Length of external catheter. 24.4 Arm circumference. 24.5 Reason for dressing change. 24.6 Patient response to procedure. 24.7 Patients/significant other teaching. 2. On 11/29/23 at 1:45 PM, an observation of wound care for Resident #35, with Staff B Registered Nurse (RN) was completed. Staff B, RN was observed to start wound care without washing her hands and donned clean gloves. Staff B, RN was observed to remove the old dressing from the resident wound and proceed to clean the wound without removing the soiled gloves. Staff B, RN was observed to clean the wound perimeter and move towards the center of wound wiping the area several times folding over the gauze repeating the move. Staff B, RN was observed to continue to scrub wound in the same direction towards the center using a new gauze several times rather than discarding after each pass. Staff B, RN was observed to remove the soiled gloves and don clean gloves without performing hand hygiene. Staff B, RN was observed to apply med honey and calcium alginate and cover with a foam bordered dressing, remove gloves, discard unused supplies, and leave the room without performing hand hygiene. During an interview on 11/29/23 at 1:55 PM Staff B, RN stated The way I scrubbed the wound repeatedly was not good and I did not perform hand hygiene. During an interview on 11/29/23 at 02:04 PM, the Director of Nursing (DON) stated, That is something every nurse should know. The wound should be cleaned from the center out. My expectation is for all the nurses that do wound care, change gloves and wash/sanitize their hands. Review of the policy and procedure titled Dressing, Dry/Clean, revised September 2013 read, Level III. Purpose. The purpose of this procedure is to provide guidelines for the application of dry, clean dressings. Steps in the Procedure. 15. Cleanse the wound with ordered cleanser. If using gauze, use clean gauze for each cleansing stroke. Clean from the least contaminated area to the most contaminated area (usually, from the center outward).

Based on record review and interview the facility failed to ensure resident assessments accurately reflected the resident's status for 2 residents, (Resident #17 and Resident #19), of 5 residents reviewed for restraints and unnecessary medications. Findings include: 1. Review of Resident #17's minimum data set assessment, dated 10/11/2023, documented under Section P titled Restraints and Alarms physical restraints in the form of bed rails were used daily. Review of Resident #17's care plan, revised on 11/19/2020, documented BED MOBILITY: The resident uses bilateral 1/4 side rails to maximize independence with turning and repositioning in bed. Review of Resident #17's physician's order dated 2/13/2023 documented Bilateral 1/4 side rails as enablers, and order dated 5/14/2022 documented 1/4 side rails x 2 while in bed for positioning, mobility and sense of security. Both physician's orders appeared on the Order Summary Report dated Active Orders As Of: 11/29/2023. 2. Review of Resident #19's minimum data set assessment, dated 10/13/2023, documented under Section P titled Restraints and Alarms physical restraints in the form of bed rails were used daily. Review of Resident #19's care plan, revision on 1/24/2022, SIDE RAILS: 1/4 SR [side rail] when in bed as enablers for increased independence with bed mobility. Review Resident #19's physician's order dated 2/13/2023 documented Bilateral 1/4 side rails as enablers. During an interview on 11/29/2023 at 7:59 AM, Staff B (Registered Nurse) stated [Resident #17's Name and Resident #19's Name] bed rails were used as enablers during turning. They [Resident #17 and Resident #19] could not get out of bed without assistance and the bed rails help them with mobility. They were not restrained in any way by the bed rails. During an interview on 11/29/2023 at 8:06 AM, the Minimum Data Set Coordinator agreed the bedrails were not used to restrain [Resident #17's Name and Resident #19's Name]. He stated [Resident #17's Name and Resident #19's Name] minimum data set assessments had been coded incorrectly.

Based on interview and record review, the facility failed to ensure residents with newly evident or possible serious mental disorder, intellectual disability, or a related condition were reviewed for level II pre-admission screening and resident review (PASARR) for 1 of 3 residents. (Resident #19) Findings include: Review of Resident #19's most recent PASARR Level l, dated 9/6/2021, documented Resident #19 as having no diagnosis or suspicion of serious mental illness or intellectual disability. Review of Resident #19's admission record documented Resident #19 was later diagnosed with unspecified psychosis not due to a substance or known physiological condition, onset date: 1/20/22. Review of Resident #19's psychiatry subsequent note, date of service 11/17/2023, documented chief psychiatric complaints included Parkinson's psychosis. Review of Resident #19's clinical records failed to reveal documentation that the resident was referred to the appropriate state designated authority for a Level II evaluation and determination following the identification of a newly evident or possible serious mental disorder. During an interview on 11/28/2023 beginning at 1:50 PM, the Director of Nursing stated the facility did not have documentation Resident #19's Level I PASARR had been revised to show the new diagnosis of unspecified psychosis and to initiate a Level II PASARR screening.

Based on interview and record review the facility failed to maintain resident medical records that were accurately documented and complete for 1 of 3 residents reviewed for intravenous infusion and wound care (Resident #48). Findings include: Review of the physician's order dated 10/31/23 for Resident #48 reads IV's (Intravenous): Evaluate site for leakage/bleeding/signs of infection every shift. Review of Treatment Administration Record (TAR) for the period of 11/1/23 through 11/30/23 read, IV's: Evaluate site for leakage/bleeding/signs of infection every shift. There was no documentation on November 1, November 16, and November 17 by the nurse indicating the evaluation was completed. Review of the physician's order dated 11/1/23 for Resident #48 read, Change PICC line dressing every week on Wednesday night shift. Review of the physician's order dated 10/31/23 for Resident #48 read, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN (as needed). Review of the physician's order dated 11/1/23 for Resident #48 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. Review of Medication Administration Record (MAR) for the period of 11/1/23 through 11/30/23 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. There was no circumference and length documented on November 8 and November 21 and on November 15, there was no documentation of circumference, length or dressing change documented by the nurse to indicate if the measurements were completed. During an interview on 11/28/23 at 12:00 PM, the Director of Nursing (DON) stated, I don't see where the documentation was done on the circumference and length of catheter on November 8th and November 21st. I see on the 15th [of November] they missed all the circumference, length of catheter and dressing change. My expectation is for nurses to follow the doctor's orders. Review of the policy titled Central Vascular Access Device (CVAD) Dressing Change, revision date 6/1/21 reads Application. Licensed Nurses Providing Infusion Therapy in the Post-Acute Care Facility. Procedure. 24. Documentation in the medical record includes, but is not limited to: 24.1 Date and time. 24.2 Site assessment. 24.3 Length of external catheter. 24.4 Arm circumference. 24.5 Reason for dressing change. 24.6 Patient response to procedure. 24.7 Patients/significant other teaching.

Based on observation, interview, and record review the facility failed to ensure staff performed hand hygiene during wound care to prevent the possible development and transmission of infections for 1 of 3 resident (Resident #35). Findings include: On 11/29/23 at 1:45 PM, an observation of wound care for Resident #35, with Staff B Registered Nurse (RN) was completed. Staff B, RN was observed to start wound care without washing her hands and donned clean gloves. Staff B, RN was observed to remove the old dressing from the resident wound and proceed to clean the wound without removing the soiled gloves. Staff B, RN was observed to clean the wound perimeter and move towards the center of wound wiping the area several times folding over the gauze repeating the move. Staff B, RN was observed to continue to scrub wound in the same direction towards the center using a new gauze several times rather than discarding after each pass. Staff B, RN was observed to remove the soiled gloves and don clean gloves without performing hand hygiene. Staff B, RN was observed to apply med honey and calcium alginate and cover with a foam bordered dressing, remove gloves, discard unused supplies, and leave the room without performing hand hygiene. During an interview on 11/29/23 at 1:55 PM, Staff B, RN, stated, I should have changed my gloves, and I did not even have hand sanitizer in there. During an interview on 11/29/23 at 2:04 PM, the Director of Nursing (DON) stated, My expectation is for all the nurses that do wound care, change gloves, and wash/sanitize their hands. Review of the policy and procedure titled Dressing, Dry/Clean, revised September 2013 read, Level III. Purpose. The purpose of this procedure is to provide guidelines for the application of dry, clean dressings. Steps in the Procedure. 5. Wash and dry your hands thoroughly. 6. Put on clean gloves. Loosen tape and remove soil dressing. 7. Pull glove over dressing and discard into plastic or biohazard bag. 8. Wash and dry your hands thoroughly. 13. Put on clean gloves. 15. Cleanse the wound with ordered cleanser. If using gauze, use clean gauze for each cleansing stroke. Clean from the least contaminated area to the most contaminated area (usually, from the center outward). 19. Remove disposable gloves and discard into designated container. Wash your and dry your hands thoroughly.

Based on observation, interview and record review the facility failed to ensure nurse staffing information was posted on a daily basis for 1 of 4 days. Findings include: On Monday, 11/27/2023 at 9:05 AM, observation of the posted nurse staffing information revealed the daily nurse staffing information had not been posted since Tuesday, 11/21/2023. During an interview on 11/27/2023 at 9:25 AM, the Director of Nursing stated the Staffing Coordinator was responsible for updating the nurse staffing information. During an interview on 11/28/2023 at 7:51 AM, the Administrator reported the Staffing Coordinator had completed the nurse staffing information, but the staff assigned to post the nurse staffing information had forgotten to post the staffing information sheets. During an interview on 11/28/2023 at 11:43 AM, the Administrator reported the facility did not have a policy related to posting nurse staffing information but was aware the nurse staffing information should have been posted.

Based on interview and record review the facility failed to ensure records were complete and accurate for 1 of 3 residents, Resident #1. Findings include: Review of the medical record for Resident #1 documented diagnosis to include osteomyelitis of vertebra thoracic region, gastroesophageal reflux disease without esophagitis, chronic atrial fibrillation unspecified, essential primary hypertension, other abnormalities of gait and mobility, major depressive disorder, recurrent unspecified opioid abuse disorder, atherosclerotic heart disease of native coronary artery without angina pectoris, opioid use disorder, non-Hodgkin's lymphoma, post-traumatic stress disorder chronic, old myocardial infarction, anxiety disorder, low back pain, presence of coronary angioplasty implant and graft, presence of cardiac pacemaker, and insomnia. Review of the 3008 [medical certification for Medicaid long-term care services and patient transfer form] completed by the hospital documented Resident #1 has a right subclavian [NAME] catheter [a central line catheter that is placed on the right side of the chest wall]. Review of Resident #1's admission assessment dated [DATE] did not provide documentation of the resident having a right subclavian [NAME] catheter. Review of the Medication Administration Record for the period of 08/22/2023 through 09/30/2023 documented Vancomycin and Cefepime was administered to Resident #1 through a PICC [peripherally inserted central catheter line] per the physician's orders. Review of the physician orders dated 09/22/2022 read, DC [discontinue] PICC IV [intravenous] Vancomycin completed. Review of nursing progress note dated 9/30/2022 at 1506 [3:06 PM] reads, Spoke with [Doctor's name] ID MD [infectious disease medical doctor]. Update him with resident's recent Vanco [Vancomycin] trough of 25.09 and need to hold final dose of ABT [antibiotic] MD stated to D/C Vanco and PICC line. ABT therapy is complete at this time. Review of Resident #1 medical record did not provide documentation of the PICC line having been discontinued. Review of the physician orders dated 10/15/2022 read, Cover [NAME] Port with sterile border dressing until it is removed. Review of the transportation record for Resident #1 dated 12/28/2022 read, Transportation to have [NAME] catheter removed. Review of Resident #1's medical record does not provide for documentation of the [NAME] catheter having been discontinued. During an interview on 4/27/2023 at 9:55 AM the Director of Nursing (DON) stated, A nurse did attempt to remove his [Resident #1's] [NAME] catheter, her name was [Staff C's name], it is not professional standard of practice to do this, this is a tunneled catheter and needs to be removed by the physician. I was not the DON when this happened. Review of Resident #1's medical record did not provide for documentation of Staff C, RN's (Registered Nurse) attempt to remove the [NAME] catheter. During an interview on 4/27/2023 at 12:25 PM via telephone Staff C, RN stated, I did attempt to remove the [NAME] catheter and he needed to go out and have radiology do it. I did remove the stitches and I did attempt to remove it. I now know that it is not within my scope of practice to remove those. We were not using his [NAME] he had a PICC line and got antibiotics. He was sent out to get his [NAME] removed. I did not document anything in the chart about attempting to remove the [NAME] catheter. Review of the physician's progress notes did not provide documentation of the [NAME] catheter or the removal of the [NAME] catheter.

Based on observation, interview, and record review, the facility failed to ensure a resident who is unable to carry out activities of daily living received the necessary services to maintain good personal hygiene for 1 of 3 sampled residents, Resident #6, in a total sample of 31 residents. Findings include: During an observation on 6/1/2022 at 9:18 AM, Resident #6 was in bed eating breakfast. Resident #6's fingernails were untrimmed, jagged and dirty (Photographic evidence obtained). During an interview on 6/1/20 22 at 9:20 AM, Resident #6 stated, I would like my fingernail trimmed. During an observation on 6/2/2022 at 1:44 PM, Resident #6 was had fingernails untrimmed, jagged and dirty. During an interview on 6/2/2022 at 2:01 PM, Staff A, Licensed Practical Nurse (LPN), confirmed that Resident #6's fingernails were untrimmed, jagged and dirty. During an interview on 6/2/2022 at 2:11 PM, the Director of Nursing confirmed that Resident #6's fingernails were untrimmed, jagged and dirty. Review of Resident #6's admission records revealed the resident was initially admitted on [DATE] and readmitted on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of Resident #6's Minimum Data Set (MDS) dated [DATE], reads, Section G- Functional Status. G0110. Activities of Daily Living (ADL) Assistance. J. Personal Hygiene: 1. Self-performance: 3. Extensive Assistance. Support: 3. Two + persons physical assist. Review of Resident #6's care plan dated 3/17/2022 reads, [Resident #6's name] has an ADL self-care performance deficit r/t [related to] impaired mobility, weakness, self limiting behavior . Interventions: . Bathing/Showering: Check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. Record of CNA (Certified Nursing Assistant) Bath Sheets dated 4/14/2022, 4/21/2022, 5/14/2022, 5/18/2022, and 5/28/2022 for Resident #6 showed the resident did not receive nail care. Bath sheets dated 5/2/2022, 5/8/2022, and 5/16/2022 showed no record documented for nail care. Review of the facility policy and procedures titled Care of Nails revised in on 9/1/2017 reads, Procedure: Perform hand hygiene. Explain procedure to resident and bring the following equipment to resident's bedside: Basin, optional; towel; emery board; orange stick; nail clippers.

Based on observation, interview and record review, the facility failed to ensure a resident who needs respiratory care was provided such care consistent with professional standards of practice for 1 of 3 residents, Resident #6, in a total sample of 31 residents Findings include: During an observation on 5/31/2022 at 9:18 AM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. During an observation on 6/1/2022 a 9:29 AM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. During an observation on 6/2/2022 at 8:50 AM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. During an observation on 6/2/2022 at 2:00 PM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. Review of Resident #6's admission records revealed the resident was initially admitted on [DATE] and readmitted on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of the physician order dated 2/15/2021 for Resident #6 reads, Oxygen 2 L/min [liter/minute] via NC [Nasal Cannula] PRN [as needed] as needed related to [CONDITION(S)]. Review of Resident #6's care plan dated 3/17/2022, reads, Focus: The resident has [CONDITION(S)] . Interventions: . Oxygen setting: O2 [Oxygen] via nasal prongs @ [at] 2 L PRN. During an interview on 6/2/2022 at 2:01 PM, Staff A, Licensed Practical Nurse (LPN), confirmed that Resident #6 oxygen was at 2.5 liter per minute. During an interview on 6/2/2022 at 2:11 PM, the Director of Nursing (DON) confirmed that Resident #6 oxygen was at 2.5 liter per minute. Review of the facility policy and procedures titled Oxygen Therapy revised on 8/28/2017 reads, Procedure: Physician's order for oxygen therapy shall include: Administration modality; FiO2 [Fraction of Inspired Oxygen] or liter flow; Continuous or PRN; PRN orders must include specific guidelines as to when the resident is to use oxygen.

Based on record review and interview, the facility failed to ensure the physician acknowledged and responded to the pharmacist's recommendations for 1 of 5 residents reviewed for unnecessary medications, Resident #10. Findings include: Review of Resident #10's pharmacy consultation report dated 4/14/2022 reads, 1. [MEDICATION(S)] Tablet 5 mg [milligrams], Give 1 tablet by mouth one time a day for inflammation. Recommendation: Please reevaluate continued [MEDICATION(S)] use. Rationale for Recommendation: Long term oral corticosteroid use has been associated with adverse effects (e.g. [CONDITION(S)], [CONDITION(S)], GI [gastrointestinal] disorders, hypertension, [CONDITION(S)]). The pharmacy consultation report documented the physician/designee had not acknowledged the recommendation from the pharmacist until 6/1/2022. During an interview on 6/2/2022 at 1:02 PM, the Director of Nursing verified the physician/designee had not acknowledged the recommendation made by the pharmacist on 4/14/2022 until 6/1/2022 (48 days after the recommendation). She confirmed the expectation the physician should respond to non-urgent recommendations from the pharmacist within 21 days and should respond to urgent recommendations from the pharmacist immediately. Review of the facility policy and procedures titled Monthly Drug Regimen Review, last reviewed on 1/13/2022, reads, Procedure: . Non-Urgent: Report provided to the attending physician for timely response: Day 1-14 provide recommendation(s) to physician(s) for review and response; Day 15-21 the DON [Director of Nursing]/designee will contact the physician(s) with any outstanding recommendations; if no response from physician notify the Medical Director for further assistance. Urgent recommendation(s) communicated to the physician/center at the time of the consultant pharmacist visit for timely response.

Based on observation, record review, and interview, the facility failed to ensure wound treatment and care was provided per professional standards for 2 of 6 residents, Residents #4, sampled for wound care. Findings: During an observation on 1/25/2021 at 11:15AM of Resident #4 it showed the resident had a midback wound dressing dated 1/21/2021 and a sacrum wound dressing dated 1/21/2021. During an interview on 1/25/2021 at 11:15AM, Staff D, LPN (Licensed Practical Nurse) confirmed the dressing dates to be 1/21/2021. Review of the physician's orders [REDACTED].#4 revealed an order to cleanse midback every day with Normal Saline (NS), pat dry apply Silver Sulfadene and cover with dry clean dressing (DCD) until healed. Cleanse sacrum ulcer every day with NS, pat dry apply Silver Sulfadene padded dressing and DCD until healed. Review of Resident #4s care plan revealed resident has potential for pressure injury development related to impaired mobility, fragile skin. Interventions include administer treatments as ordered and monitor for effectiveness. During an observation on 1/25/2021 at 11:45 AM of Resident #5 it showed the resident had a wound dressing on his back dated 1/20/2021. During an interview on 1/25/2021 at 11:45AM Staff E, LPN confirmed the dressing date to be 1/20/2021. Review of the physician's orders [REDACTED]. Review of the policy and procedure titled, Dressing Policy, Revised September 2013 reads: #17 Apply the ordered dressing and secure with tape or bordered dressing per order. Label with date and initials to top of dressing.

Based on observation, interview, and policy and procedure review, the facility failed to maintain food preparation equipment in a clean and sanitary manner. Findings include: Review of the facility policy and procedure titled Equipment revised 9/2017, annually reviewed on 2/13/20, reads: Policy Statement. All food service equipment will be clean, sanitary, and in proper working order. 3. All food contact equipment will be cleaned and sanitized after every use. 4. All non-food contact equipment will be clean and free of debris. The initial tour of the kitchen was completed on 12/21/20 beginning at 8:55 AM with the Certified Dietary Manager (CDM) and showed: 1. On the bottom shelf to the right of the oven was an open area containing a hotel pan which contained the grill brick. The hotel pan was discolored with black and white debris. The shelf was unclean, full of crumbs/particles and other black and brown colored debris. 2. The outside of the grill have a build-up of grease and dark colored debris from front to back on the side of the grill. Hard black drips along the side edges were observed. The corners of the flat top grip have a build-up of grease and was discolored dark brown. 3. The doors of the convection oven were covered in a black substance. 4. The table-top under the microwave had dark colored particles on it. 5. The heavy-duty blender had brown and white particles/debris at the base. 6. The salad bar had food particles on the outside of the lids. An interview was conducted with the CDM following the initial tour on 12/21/20 at 9:15 AM. She confirmed the above food preparation equipment was not clean.

Based on interview, record review, and policy and procedure review the facility failed to ensure the development of a baseline care plan within 48 hours of admission and failed to provide a written summary to 1 of 5, Resident #100, sampled for baseline care plans in a total sample of 17 residents. Findings include: A review of the facility policy titled Plans of Care, revised 9/25/17, annually reviewed on 2/13/20 reads Policy: An individual person-centered plan of care will be established by the interdisciplinary team (IDT) with the resident and/or resident representative(s) to the extent practicable and updated in accordance with state and federal regulatory requirements. Procedure: Develop and implement an Individualized Person-Centered baseline plan of care within 48 hours of admission that induces, but not limited to, initial goals based on the admission orders [REDACTED]. Review of Resident #100's facility medical record revealed the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Brief Interview of Mental Status (BIMS) completed on 12/17/20 revealed the resident was cognitively intact with a score of 15. Review of the baseline care plan for Resident #100 revealed Page 1 containing the Baseline Plan of Care and Summary section was not completed, it was blank. The orders and services section were not completed, and equipment needed was not completed, they were blank. The Care Plan Areas on pages 2 - 7 were blank. Page 8, the signature page, was signed by the nurse and resident. An interview was conducted with Staff G, Medical Records Clerk on 12/22/20 at 8:43 AM. She confirmed the Baseline Care Plan was blank. An interview was conducted with Resident #100 on 12/22/20 at 9:55 AM. She stated she signed the Baseline Plan of Care, the nurse told her that she would fill it in later. An interview was conducted with the Regional Clinical Services Director on 12/22/20 at 10:10 AM. She confirmed the Baseline Plan of Care for Resident #100 was not completed. She stated, I know it is blank.

Based on observation, interview and record review, the facility failed to implement the written plan of care for Activities of Daily Living (ADL) to provide the necessary services to maintain good grooming and hygiene for 1 of 5, Resident #35 sampled for ADL care plans in a total sample of 17 residents. Findings Include: On 12/21/20 at 9:30 AM, Resident #35 was observed with long nails, debris under the nail beds of both hands. On 12/22/20 at 9:00 AM, Resident #35 was observed sitting up in bed eating breakfast. His fingernails were observed to have dark debris under the nail beds. On 12/22/20 at 11:15 AM, an observation of Resident #35 revealed he was laying on his back in bed, receiving oxygen via nasal cannula. The resident's fingernails were long, with debris under the nail beds of both hands. The resident was also observed to have dried egg on his face from his lower lip to his chin. Review of Resident #35's facility medical record revealed the resident was admitted on [DATE] with [DIAGNOSES REDACTED]. Review of the Minimum Data Set (MDS) Quarterly Comprehensive assessment dated [DATE] revealed Resident #35 requires limited assistance with one-person physical assistance for personal hygiene and requires physical help in part of bathing activity with one-person physical assistance for bathing. An interview was conducted with Staff E, Certified Nursing Assistance (CNA) on 12/22/20 at 11:15 AM. She confirmed that Resident #35's nails on both hands needed to be cleaned and cut and that there was dark debris under the nail beds of both hands. She stated she did not have any clippers. She also confirmed that the resident's face was dirty, and she had not provided his Activities of Daily Living (ADL) care today. An interview was conducted with the Regional Director of Clinical Services on 12/22/20 at 11:20 AM. She confirmed that Resident #35's nails had dark debris under the nail beds on both hands, and Resident #35 should have been offered assistance with washing his face following breakfast. It is the expectation to provide nail care, cleaning and trimming when bathing the resident. Residents that have visible soiled fingernail beds should be assisted in cleaning up.