Pine Valley Community Village

In the surveyor’s words

From the most serious findings on record at Pine Valley Community Village, in the surveyor’s own words.

• Immediate jeopardy, isolatedF678Jul 22, 2025

  Based on interview and record review, the facility failed to provide basic life support, including CPR (Cardiopulmonary Resuscitation), to a resident requiring emergency care and failed to immediately notify emergency medical personnel for 1 of 4 total sampled residents (R1). R1 was found pulseless and not breathing on [DATE]. R1's Physician Orders, Care Plan, CNA (Certified Nursing Assistant) Kardex, EHR (Electronic Health Record) banner, and MAR (Medication Administration Record) indicated R1 was a full code. Staff failed to immediately initiate CPR and immediately contact emergency medical personnel. Facility failure to immediately begin cardiopulmonary resuscitation and immediately summon emergency medical personnel created a finding of immediate jeopardy that began on [DATE]. […]

• Immediate jeopardy, isolatedF684Mar 31, 2025

  Based on interview and record review, the facility failed to ensure that each resident receives treatment and care in accordance with professional standards of practice for 2 out of 8 total sampled Residents (R4 and R5). Staff failed to recognize a change of condition in R5 until the Nurse Practitioner (NP) assessed the patient. Facility staff did not assess and monitor R5's condition as ordered by the physician. R5 was not sent to the emergency room (ER) per the NP's directive until 22 hours later, by which time R5's condition had worsened, resulting in R5 being admitted to Hospital where R5 was diagnosed with Sepsis, Pneumonia, and Acute Respiratory Failure with Hypoxia. R5 passed away two days later at the hospital. […]

• Actual harm, isolatedF760Jun 30, 2025

  Based on interview and record review, the facility did not ensure that residents are free of any significant medication errors for 1 of 3 residents (R1) reviewed for medication errors.R1 was given medications for R4 which made her blood pressure low. R1 required intravenous fluids and calcium gluconate intervention in the ER (Emergency Room).This is evidenced by:The facility's policy, Medication Administration, reviewed 6/2/25, documents, in part, as follows: . The nurse will confirm resident using photo identification located in Electronic Medical record (EMAR), as needed. Medication Administration Safety: Preparing and administering medications requires accuracy and the full attention of the nurse. The five rights, is a traditional checklist to promote accuracy in drug administration. […]

• No harm, potential for more than minimal, widespreadF801Jul 1, 2026

  Based on interview and record review, the facility failed to employ a full-time Director of Food and Nutrition Services with the appropriate certifications. This has the potential to affect all 64 residents in the facility.The facility's Dietary Manager (DM C) is not a Certified Dietary Manager or a Certified Food Service Manager and has no food service or hospitality specific education. Findings include:Surveyor reviewed DM C's information provided by the facility. DM C is not a Certified Dietary Manager or a Certified Food Service Manager and has no food service or hospitality specific education. […]

• No harm, potential for more than minimal, widespreadF812Jul 1, 2026

  Based on observation, interview, and record review, the facility did not maintain a safe and sanitary environment in which food is prepared, stored and distributed. This has the potential to affect all 64 residents who reside in the facility.Food items were observed to have incorrect or no dating.The facility was not manually checking the internal temperature of their dishwasher.Food items were observed to be improperly stored.Findings includeExample 1According to the FDA Food Code: After opening canned goods, store the food in the refrigerator. High-acid canned goods such as tomato products, juice, fruit, pickles, sauerkraut and foods in vinegar-based sauces can be stored five to seven days. […]