Paradigm at Sweeny

In the surveyor’s words

From the most serious findings on record at Paradigm at Sweeny, in the surveyor’s own words.

• Immediate jeopardy, patternF600Jul 4, 2025

  Based on observation, interview, and record review the facility failed to ensure two residents (Resident #59 and Resident #60) of five residents reviewed for abuse and neglect were free from abuse.The facility failed to address inappropriate sexual behavior between Resident #59 and Resident #60. Resident #59 had a diagnosis which included Dementia and Resident #60 had a diagnosis which included Alzheimers.The facility failed to immediately implement the Psychology NP's recommendation to move Resident #60 off of the unit. An Immediate Jeopardy (IJ) was identified on 6/14/2025. The IJ template was provided to the facility on 6/14/2025 at 3:35 p.m. […]

• Immediate jeopardy, patternF656Jul 4, 2025

  Based on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care that included measurable objectives and timeframes to meet the residents' medical, nursing, and mental and psychological needs that are identified in the comprehensive assessment for 3 residents (Resident #31, Resident #59, and Resident #60) of 8 residents reviewed for care plans. -Resident #31's Care Plan did not include interventions and services to appropriately address the resident's behavior of placing inedible objects in her mouth.-Resident #59's Care Plan was not updated to include interventions and services to appropriately address inappropriate sexual behavior.-Resident #59 had delusional thoughts that Resident #60 was her husband.-Resident #60's… […]

• Immediate jeopardy, isolatedF686Jul 1, 2026

  Based on interviews and record review the facility failed to ensure a resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 (CR#1) of 7 residents reviewed. The facility failed to initiate wound preventative measures on [DATE] when CR#1 readmitted to the facility leading to infection and hospitalization. The facility failed to assess and recognize a change in condition and initiate wound preventative measures of [DATE] when the facility became aware that CR#1 had redness on her sacrum area during weekly skin observation leading to infection and hospitalization. An Immediate Jeopardy (IJ) was identified on [DATE]. […]

• Immediate jeopardy, isolatedF689Jul 4, 2025

  Based on observation, interview, and record review the facility failed to ensure each resident's environment remained free of accident hazards for 1 of 6 residents (Resident #31) reviewed for accident hazards.The facility failed to adequately supervise Resident #31 when she ingested plastic wrap from a container while being monitored by CMA H during dining.An IJ was identified on 07/03/35 at 1:22 PM. The IJ template was provided to the facility on [DATE] at 1:22 PM. While the IJ was removed on 07/04/25, the facility remained out of compliance at a scope of isolated and a severity of no actual harm with potential for more than minimal harm because all staff had not been trained on accidents and supervision.This failure could place residents at risk for injury, harm, and impairment. […]

• Actual harm, isolatedF580Dec 14, 2023

  Based on interviews and record review, the facility failed to immediately consult with the resident's physician of a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications) for 1 (Resident #1) of 5 residents reviewed for resident rights. -The facility failed to immediately notify Resident #1's physician when Resident #1 had an unwitnessed fall related to a syncopal episode due to pulse in the 40's . This failure placed residents at risk of not receiving appropriate care and/or interventions. […]