Our Lady Of The Valley

In the surveyor’s words

From the most serious findings on record at Our Lady Of The Valley, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Apr 15, 2021

  Based on observation, staff interview and facility document review the facility staff failed to store, prepare and serve food in a safe and sanitary manner. The findings included: The facility staff failed to ensure serving pans in the facility were dry and clean and failed to date an opened package of dried pasta. During initial tour of the facility kitchen, conducted on 04/13/21 at approximately 1:45 pm, surveyor observed an opened package of macaroni noodles located on a shelf in the dry storage area. Surveyor could not locate an opened on date on the package. […]

• No harm, potential for more than minimal, isolatedF657Aug 25, 2023

  Based on staff interview, clinical record review and facility document review the facility staff failed to ensure care plan meetings were held in a timely manner for one of 21 residents, Resident #221. The findings included: For Resident #221 the facility staff failed to hold care plan meetings after each minimum data set (MDS) assessment. Resident #221's face sheet listed diagnoses which included but not limited to dementia, anxiety, depression, psychotic disturbance, hypertension, arteriosclerotic heart disease and hypothyroidism. Resident #221's most recent MDS with an assessment reference date (ARD) of 09/26/22 assigned the resident a brief interview for mental status score of 8 out of 15 in section C, cognitive patterns. […]

• No harm, potential for more than minimal, isolatedF684Aug 25, 2023

  Based on staff interview and clinical record review the facility staff failed to follow physician's orders for one of 21 residents, Resident #221. The findings included: For Resident #221, the facility staff failed to change the administration times for the medication Voltaren gel per the physician's order. Resident #221's face sheet listed diagnoses which included but not limited to dementia, anxiety, depression, psychotic disturbance, hypertension, arteriosclerotic heart disease and hypothyroidism. Resident #221's most recent MDS with an assessment reference date (ARD) of 09/26/22 assigned the resident a brief interview for mental status score of 8 out of 15 in section C, cognitive patterns. […]

• No harm, potential for more than minimal, isolatedF689Aug 25, 2023

  Based on staff interview, clinical record review and facility document review, facility staff failed to ensure the resident received adequate supervision and assistance devices to prevent accidents for one of 21 residents in the survey sample, Resident # 222. The findings: For Resident #222, one facility staff member transferred the resident from the bed to a chair instead of utilizing a mechanical lift with two+ staff members as required per the resident's care plan. During the transfer, the resident sat on her right lower leg which caused discomfort. An X-ray two days after the incident was negative for fracture. A subsequent X-ray three days after the incident indicated the resident had a tibial fracture. […]

• No harm, potential for more than minimal, isolatedF692Aug 25, 2023

  Based on resident and staff interview, resident observation and clinical record review, the facility staff failed to ensure that residents maintain acceptable parameters of nutrition for one of 23 residents in the survey sample, resident # 46. For resident # 46, the facility staff failed to follow the recommendations of the Registered Dietician (RD) to obtain another weight, and then do weekly weights if an actual weight loss is confirmed Additionally, the facility staff failed to ensure that resident # 46's weight loss was addressed by the physician. […]